The focus of the meeting was an update on the centre’s Lassa Fever surveillance mechanism. The meeting highlighted some successes as much as the challenges in early detection and urgent responses to Lassa Fever outbreak. One of the successes is the drop in the index on suspicion. But the centre’s challenges revolve around its collaboration, prevention mechanism, surveillance and coordination of the available public health laboratory networks in Nigeria.
On January 24, 2020, Nigeria Centre for Disease Control had its management debriefing with its technical working committee to review its responses to the increasing threats of outbreaks of infectious diseases and other public health emergencies.
The focus of the meeting was an update on the centre’s Lassa Fever surveillance mechanism. The meeting highlighted some successes as much as the challenges in early detection and urgent responses to Lassa Fever outbreak. One of the successes is the drop in the index on suspicion. But the centre’s challenges revolve around its collaboration, prevention mechanism, surveillance and coordination of the available public health laboratory networks in Nigeria.
During its surveillance pillar update on Lassa Fever, some of the centre’s challenges highlighted in two different PowerPoint presentations by team members are: inadequate treatment centres, poor reporting lines with its state and LGA’s liaison officers, unprofessional conduct by some health workers, ineffective logistics and poor interaction with the media.
Even though the NCDC was established to strengthen its focus on prevention and preparedness for outbreaks across Nigeria, its coverage of the country’s landscape isn’t yet effective. In most states of the federation, its LGAs liaison officers are still not familiar with SORMAS – a real-time software for outbreak and epidemic surveillance.
The centre’s management meeting with its technical working committee highlighted the need to train its LGAs representatives on the use of the Surveillance Outbreak Response Management and Analysis System – SORMAS.
SORMAS is an open source mobile ehealth system that processes disease control and outbreak management procedures in addition to surveillance and early detection of outbreaks through real-time digital surveillance including peripheral health care facilities and laboratories.
Also, another challenge highlighted at the meeting was the unprofessional conduct by some health practitioners treating patients of Lassa Fever. It was reported during the meeting that a pregnant woman, a dentist in Ebonyi State, died of the disease because doctors, who were supposed to attend to her ran away because of the stigma that the disease was a highly contagious virus. Another challenge here is the lack of precautionary measures by physicians while treating patients. Some were reported to quarantine patients without gloves.
Overstretched health workers and limited treatment centres were also some of the centre’s challenges. With 36 states and a Federal Capital Territory, there are only 21 treatment centres across 17 states of the Federation. This is alarmingly ridiculous for a centre established to stockpile and preposition for outbreak response across the country.
NCDC might not be successful in its development of guidelines and checklists for emergency preparedness and increasing roles to the country if it is limited in emergency operations centre during outbreaks. From the presentations, it was clear that the centre’s restrained efforts occasioned by different factors might affect its capacity to coordinate and bring together the various pillars of outbreak response in a command and control structure.
Another impeding factor to the centre’s efforts, as highlighted in the course of the meeting is the refusal of airlines to convey samples. Ibom Airline was specifically reported to reject conveying samples from Uyo; hence, they were conveyed by road to Port Harcourt, Rivers State. With limited public health laboratories in the centre’s networks, logistics is a challenge as it battles threats of outbreaks of infectious diseases and other public health emergencies.
Weak reporting lines between laboratories and physicians and poor data management between public health practitioners and the Incident Coordination Centre tasked with daily intelligence gathering are other serious challenges the centre is facing. These challenges are without the centre’s poor interaction with the media in its operations and development.
On Monday, it was widely reported in the media that a corps member serving in Delta State died from Lassa Fever. But during the debriefing, the centre repudiated the report and stated that the corps member was transferred on Monday to Irrua Specialist Hospital in Edo State where he was tested and treated of Lassa Fever. He was since confirmed to be free of the virus and alive too. But the centre didn’t deem it necessary to brief the media in order to correct the misinformation. The lack in harmonious functioning of the centre with critical stakeholders, states and LGAs liaison officers and all public health institutes further compounds its readiness and efficiency in detecting and responding to infectious disease outbreaks in the country.
These are the major challenges of the centre given the size and complexity of Nigeria. Several large infectious disease outbreaks have been reported in Nigeria, including the yellow fever outbreak, the Ebola outbreaks, cholera outbreaks, Lassa Fever, and more recently, the meningitis outbreak.
Nigeria’s public health challenges continue to grow—rapid population growth, increasing movement of people and destruction of infrastructure in North-East of Nigeria following the ‘Boko Haram’ insurgency and outbreaks from new and re-emerging pathogens. The year 2017 saw an increase in the rate of infectious diseases like Lassa Fever, 11 Yellow Fever, Monkey Pox, Cholera and new strains/subtypes/serotypes of existing pathogens like Neisseria meningitis serogroup C in Nigeria.
If the Nigeria Centre for Disease Control, which was conceived to effectively mobilise its resources to respond to these outbreaks and other public health emergencies is limited in capacity and functions, addressing outbreaks will remain a huge task.
Nigeria and several other African countries have been battling with public health challenges for decades. These challenges came to fore during the Ebola virus disease crisis that affected many countries in the West African region including Nigeria.
As a result, many African countries have established their National Public Health Institutes as a focal point to prevent, detect and respond to diseases of public health importance but currently, only nine of the 15 countries in West Africa have a designated national public health institute.
Even at that, the nine West African countries with designated national public health institutes are still below expectation in addressing outbreaks of infectious diseases and other public health emergencies.