Public health response and challenges during COVID-19 in Nigeria: a systematic review.

Background: The COVID-19 pandemic brought unprecedented challenges to public health systems worldwide. Nigeria faced unique challenges due to its diverse cultural landscape and the influence this may have had on public health behaviour. This systematic review explored the effectiveness of the public health response and identifies the challenges encountered in Nigeria during the COVID-19 crisis by collating data from qualitative studies, especially focusing on the perceptions, experiences, and opinions of Nigerians towards COVID-19 management, including healthcare workers and internally displaced populations. Methods: A total of eight papers were selected for systematic review. This systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines to ensure transparency and reproducibility. Critical Appraisal Skills Programme (CASP) checklist for qualitative studies was used to evaluate the validity and applicability of the research findings. Qualitative studies were deliberately included to communicate deeper insights into the beliefs, values, and motivations driving public behaviour during the pandemic. Thematic analysis was then applied to identify and form themes within the data. Results: The thematic analysis revealed insights into Nigeria's public health response during the COVID-19 pandemic. Major themes included government response, public compliance, healthcare accessibility linked to socioeconomic status, community engagement, and health facility resources. Gaps were identified in support for vulnerable groups, efficient aid delivery, ensuring adherence to guidelines due to economic constraints and stigma, and addressing systemic issues like poverty, overcrowding, low literacy, and healthcare worker burnout. The importance of comprehensive, inclusive approaches tailored to cultural contexts and lived experiences was emphasised. Recommendations highlight strengthening community- healthcare partnerships, incorporating faith groups and local organisations, integrating technology, and tackling corruption. Conclusions: The themes identified through this systematic review illustrated the challenges and complexities faced by Nigeria during the COVID-19 pandemic. They highlighted the necessity for integrated, inclusive, and adaptable public health responses that address the multifaceted impacts of the pandemic. This research stressed the importance of considering cultural, economic, and social factors in crisis response planning and implementation. Ensuring that public health interventions are culturally appropriate, economically feasible, and socially acceptable are essential aspects of future pandemic management.