Building epidemiological capacity for health security in Liberia

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Descriptive characterization of suspected yellow fever cases in Kano state, Nigeria, 2015-2018

Introduction: Yellow fever remains a serious public health problem globally with an estimated 200, 000 cases annually despite the availability of an effective vaccine for more than 70 years. Nigeria had an outbreak of Yellow fever in 2017 after more than 2 decades of silence. We described the epidemiological characteristic of yellow fever in Kano State from 2015 to 2018. Methods: We conducted a retrospective review of suspected cases of yellow fever in Kano state from January 2015 to December 2018. A suspected yellow fever case was defined as any person residing in Kano state with sudden onset of fever, with jaundice appearing within two weeks of the onset of the first symptoms from the year 2015 to 2018. We calculated incidences, frequencies and proportions using Microsoft excel 2016 and health mapper version 4.3. Results: A total of 107 patients with suspected yellow fever were reported in the state between 2015 and 2018. The median age of the suspected cases was 13years (range 2-120years) and age group 15-44years had the highest number of cases. More males were affected 69 (64%) with rural local governments having the highest number of patients. Generally, the disease occurred all year round with peaks occurring the wet season mostly in June, July and August. The annual incidence increased from 1.7/1,000,000 populations in 2015 to 2.2/1,000,000 populations in 2016, remained at 2.2/1,000,000 populations in 2017 and slightly decreased to 2.1/1000,000 population in 2018. No mortality was recorded during the reporting period. Majority (99.1%) of the suspected patients had never received yellow fever vaccine. Conclusion: The study revealed no change in the incidence rate of suspected Yellow Fever cases in Kano State. Majority of the suspected cases are in the rural areas where immunization coverage was very low. Routine immunization has to be strengthened to address the problem. The findings were reported to the Kano state Ministry of Health for appropriate action

Setting the stage for Acute Febrile Illness Surveillance Network in West Africa: Report of a Regional Experts and Stakeholders Workshop in Accra, Ghana, April 2021

A three-day regional workshop of stakeholders, partners, and experts from the West African countries was held from April 14 -16, 2021 in Accra, Ghana to conduct a situational analysis on the existing knowledge, expertise, previous accomplishments, and current activities in laboratory and syndrome based Acute Febrile Illness (AFI) surveillance that will guide a regional strategy for AFI surveillance. Technical presentations were made by participants from ministries of health, national public health institutes, West African Health Organization, Food Agricultural Organization, and the United States Centers for Disease Control and Prevention (USCDC) on existing AFI surveillance activities and infrastructure. In groups, the participants conducted Strength, Weaknesses, Opportunities and Threat (SWOT) analysis on AFI surveillance followed by a prioritization of actionable steps. Thirty-eight participants from 9 West African countries attended the meeting. The strengths recognized from the SWOT analysis include the existence and implementation of Integrated Disease Surveillance and Response (IDSR) within the region for priority diseases and a regional collaborative platform. However, there was inadequate information and data sharing platforms, non-availability of accurate diagnostic tools, knowledge gap on AFI and lack of harmonized framework. The opportunities that can be tapped into include supporting partners and global bodies, existing laboratory networks in Africa and infrastructure built during the COVID-19 pandemic. The meeting unveiled opportunities and challenges associated with establishing a regional AFI surveillance framework. It provided opportunity for stakeholders and experts to discuss the way forward on laying a foundation for a regional AFI surveillance system in the region

Baseline epidemiology and associated dog ecology study towards stepwise elimination of rabies in Kwara state, Nigeria

Understanding domestic dog population dynamics and ecology is crucial to any effective rabies control program. This study was conducted as part of the baseline epidemiological studies necessary for the establishment of the Kwara Rabies Rapid Alert System "KRRAS". This study aimed to determine the dog population structure of Kwara State by assessing the dog ownership, vaccination status, and prevalence of dog bites. A total of 1460 questionnaires were administered to respondents in the three senatorial zones of the state using Open Data Kit (ODK) between June 2019 to January 2020. Of the 1460 households surveyed, 293 (20.1 %) owned at least one dog with an average of 2.25 dogs per household. The male to female ratio was 1.9:1 and 79.3 % (n = 523/659) of the owned dogs were local breeds. A total of 785 dogs was enumerated (659 dogs from 293 households and 126 free-roaming dogs) and 7811 persons which resulted in a dog-human ratio of 1:9.95. The estimated dog population is 376,789 (95 % CI: 343,700 - 379,878). Only 31 % (n = 204/659) of households vaccinated their dogs against rabies. The prevalence of dog-bite was 13 % (n = 193/1460) of which only 27 % of the victims (n = 61/225) received post-exposure prophylaxis (PEP). Dog ownership was significantly impacted by the ethnicity of respondents. Hausa (OR: 3.76; 95 % CI: 1.15-12.4; p &lt; 0.001) and Nupe (OR: 4.48; 95 % CI: 1.77-11.33; p &lt; 0.001) respondents owned dogs than Yoruba respondents. The rabies vaccination status of owned dogs was significantly impacted by the level of education (OR: 5.03; 95 % CI: 1.50-16.83; p &lt; 0.001); history of previous dog bite incidents (OR: 1.74; 95 % CI: 0.95-3.17; p &lt; 0.001); the breed of the dog with exotic dogs being more vaccinated (OR: 2.79: 95 % 0.64-12.05; p &lt; 0.001). Similarly, Male dogs (OR: 1.49, 95 % 1.03-2.86; p &lt; 0.001) and partially confined dogs (OR: 1.09, 95 % 0.45-2.11, p &lt; 0.001) were found to be vaccinated against rabies. The results of the study showed low dog vaccination coverage, and high number of free roaming dogs. Hence, a threat to public health. The low dog vaccination coverage is below the 70-80 % target recommended for herd immunity by the World Health Organization.</p

Descriptive characterization of the cerebrospinal meningitis outbreak in Zamfara State, 2017-18

Introduction: Cerebro-spinal meningitis (CSM) is an epidemic-prone disease characterized by inflammation of the meninges. From epidemiological week 36, 2017 through epidemiological week 21, 2018, Zamfara State reported an outbreak of CSM that affected all the 14 Local Government Areas (LGAs). Therefore, we conducted a descriptive analysis of the outbreak to determine its epidemiology. Methods: We line-listed all suspected cases during the outbreak between September 4th 2017, and May 22nd 2018. We described the outbreak in time, place and person and calculated the attack rates by LGA and the age- and sex-specific case fatality rates (CFR). Results: A total of 1125 cases were reported with an overall attack rate and CFR of 25.2 cases/100,000 population and 7.6%, respectively. The age-specific CFR was highest among individuals aged 5-9 years (9.7%), while the sex-specific CFR was almost equal in males and females. The epidemiologic curve showed an increasing number of weekly reported cases with several peaks, the highest in week 12, 2018. A clustering of cases was seen in 2 contiguous LGAs, Bungudu and Gusau; while the highest attack rate was recorded in Shinkafi LGA (51 cases/100,000 population). Only 24% of suspected cases had their cerebrospinal fluid collected, and Neisseria meningitidis C accounted for 77.1% of causative agents. Conclusion: Zamfara State has experienced an outbreak of CSM. Training health workers and improving their skills on sample collection and treatment protocol will improve profiling of causative agents and outcomes. The use of Vaccines containing serogroup C will help to prevent future outbreaks

Preparedness and perception of graduates and trainees of Nigeria Field Epidemiology and Laboratory Training Program towards participation in COVID-19 outbreak response

Introduction: Health workforce is one of the six building blocks of a resilient health system and is key to outbreak control. We assessed preparedness and perception of graduates and trainees of Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) towards participation in COVID-19 response. Methods: A cross-sectional study was carried out among 231 respondents. Respondents were graduates and trainees of NFELTP. Electronic self-administered questionnaire was used to collect information from the respondents. We described binary variables using frequencies and percentages; and normally distributed continuous variables using means and standard deviations. Responses to open-ended questions were analyzed in themes. Results: Many respondents (68.4%) had undergone at least one training on COVID-19 surveillance (72.2%), infection prevention and control (63.9%), risk communication (38.6%) and sample collection (31.7%). Respondents had previously participated in outbreaks of 27 health-related events especially Lassa fever, poliomyelitis, measles, cholera and yellow fever. Respondents were willing to be engaged in the response (86.6%), despite its novelty, although, 33.8% expressed apprehension for being infected in the course of response to COVID-19 outbreak, while 52.8% mentioned feeling safe in participating in the response. Conclusion: NFELTP trainees and graduates should be continuously engaged in outbreak response activities to enhance capacity of Nigerian health workforce

Knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria

Introduction:&nbsp;psychoactive substance use (PSU) is a patterned use of a drug in which the user consumes the substance in amounts or methods which are harmful to themselves or others. Psychoactive substance use takes a considerable toll on financial status, academic achievement and health status of addicts. In Nigeria, PSU is on the increase, one of the most disturbing health-related problems and a leading cause of premature death among school aged population worldwide. We therefore, determined the knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria. Methods:&nbsp;we conducted a cross-sectional study among 430 secondary school students that were selected using multistage sampling in Sokoto, Northwestern, Nigeria from April to May 2019. We collected data using a semi-structured, interviewer-administered questionnaire. We calculated proportions and adjusted odds ratios (OR) with 95% confidence intervals (CI) in a binary logistic regression model. Results:&nbsp;knowledge of health effects of PSU was good in 38.1% of the respondents with a mean score of 19.6 ± 10.0. The overall prevalence of PSU was high among current users (16.3%), male participants (78.6%) and those aged 17-years or more (68.6%). Independent predictors of current use of psychoactive substances were poor knowledge of health effects (aOR: 4.1, 95% CI: 1.7-10.0) and father´s use of psychoactive substances (aOR: 10.3, 95% CI= 1.9-57.1). Conclusion:&nbsp;knowledge of health effects of psychoactive substances was generally poor among the participants with an associated high prevalence among current users. Poor knowledge of its health effects determines the use of psychoactive substances. We conducted awareness campaigns and health talk on health effects of PSU to secondary school students in the state. The Federal Ministry of Education should ensure that PSU-related topics are incorporated in the secondary school curriculum

Descriptive epidemiology and mortality risk factors of COVID-19 outbreak in Delta State, Nigeria, March - August 2020

Introduction: The highly contagious Coronavirus Disease 2019 (COVID-19) was first confirmed in Nigeria on February 27, 2020. In Delta State, the first COVID-19 case was recorded on April 7, 2020, which spread across the state. We characterized the COVD-19 pandemic in Delta State in terms of person, place, and time, and determined the risk factors for COVID-19 mortality. Methods: We conducted a retrospective analysis of COVID-19 pandemic in Delta State between March 23 to August 17, 2020. We obtained line-lists of 5,917 COVID-19 patients, cleaned and analyzed sociodemographic, clinical characteristics and outcome variables using IBM SPSS Statistics 25. We calculated frequencies, proportions, mean and standard deviation (SD). Bivariate and multivariate logistics regression analysis were conducted to determine the risk factors of COVID-19 mortality, adjusted-odds-ratios were reported at 95% confidence interval and p-value set at 5% significance level. Results: From March-August 2020, 1,605 confirmed COVID-19 cases and 47 deaths (case-fatality-rate 2.9%) were recorded. Majority were aged 20-39 years 675 (42.1%) while 1,064 (66.3%) were males (mean age 39±15years). Persons aged ≥60years were more likely to die from COVID-19 than younger cases (aOR: 11.0; 95% CI: 4.9-24.4) while Symptomatic positive cases at time of test were more likely to die than those who were not (aOR: 3.2; 95% CI: 1.3-7.5). Conclusion: Males in the youthful age-group were mostly affected. Independent predictors of mortality were being elderly or symptomatic at time of testing. Strengthening case management to target symptomatic patients and intensifying sensitization activities targeting youthful males and elderly persons, are important to reduce mortality

Characteristics of COVID-19 cases and factors associated with their mortality in Katsina State, Nigeria, April-July 2020

Introduction: COVID-19 was first detected in Daura, Katsina State, Nigeria on 4 April 2020. We characterized the cases and outlined factors associated with mortality. Methods: We analysed the COVID-19 data downloaded from Surveillance Outbreak Response, Management and Analysis System between 4 April and 31 July 2020. We defined a case as any person with a positive SARS-CoV-2 test within that period. We described the cases in time, person, and place; calculated the crude and adjusted odds ratios and 95% confidence intervals for factors associated with mortality. Results: We analysed 744 confirmed cases (median age 35, range 1-90), 73% males and 24 deaths (Case fatality rate 3.2%, Attack rate 8.5/100,000). The outbreak affected 31 districts, started in week 14, peaked in week 26, and is ongoing. Highest proportion of cases in the age groups were 26.7% (184) in 30-39, 21.7% (153) in 20-29 years, and 18.3% (129) in 40-49 years. While the highest case fatality rates in the age groups were 35.7% in 70-79, 33.3% in 80-89 years, and 19.4% in 60-69 years. Factors associated with death were cough (AOR: 9.88, 95% CI: 1.29-75.79), age ≥60 years (AOR: 18.42, 95% CI: 7.48-45.38), and male sex (AOR: 4.4, 95% CI: 0.98-20.12). Conclusion: Male contacts below 40 years carried the burden of COVID-19. Also, persons 60 years and above, with cough have an increased risk of dying from COVID-19. Risk communication should advocate for use of preventive measures, protection of persons 60 years and above, and consideration of cough as a red-flag sign