An Evaluation of the Integrated Disease Surveillance and Response (IDSR) in Enugu State, Nigeria

Background: The Integrated Disease Surveillance and Response (IDSR), adopted in 1988 at the 48th World Health Organization Regional Committee for Africa meeting in Harare, Zimbabwe, is a regional strategy to strengthen the weak national surveillance systems in the region. In Nigeria, and prior 1988, there was no coordinated system of disease reporting and surveillance system in place until after a major yellow fever outbreak in 1986/87 that claimed many lives. The IDSR in Enugu state, as supported by the WHO, has 17 disease surveillance and notification officers across the 17 LGAs and 89 reporting sites covering the 3000 health facilities. Method: This study is a prospective cross-sectional study using WHO and CDC assessment protocols modified to reflect the local settings. The study samples were selected based on the IDSR performance indicators for AFP, measles core indicators, status of epidemic-prone diseases, and adequacy of feedback and feedforward of surveillance activities. Using desk review of the EPI/IDSR surveillance reports between 2012 and 2017, and also questionnaires between April and July 2017 to eligible participants, data were obtained, cleaned, and analysed using the SPSS version 24. Results: The Overall average score of IDSR performance indicator for Enugu state from the pooled data was 39% against the expected of >80%. These findings are in disagreement with the globally recommended standard IDSR practice and response. Conclusion: The outcome of this study highlights that Enugu state surveillance and IDSR practice are short of the standard practice as prescribed by WHO and CDC assessment protocols. Main reasons for this include poor disease reporting, poor documentation of conducted activities, and lack of adequate feedback system. Similarly, there is non-involvement of community and private health facilities that made up more than 95% of surveillance networks in the state. However, global polio eradication initiative and change management approaches identified remain a huge opportunity for the improvement of the system. Keywords: Enugu State, IDSR, AFP, Measles, Outbreaks, Yellow Fever, Nigeria, WHO, CDC.

Assessing the Knowledge, Practice and Attitudes (KPA) of Traditional Healers in Malaria Control Programme in Nsukka Zone of Enugu State Nigeria

Background: Malaria remains one of the major public health problems as well as the main cause of mortality among young children in sub Saharan Africa and Nigeria in particular. It is endemic throughout Nigeria with about 97% of the population at risk and an estimated 300,000 deaths annually. Malaria is responsible for 60% of outpatient visits and 30% of hospitalizations in children under five years old and contributes to about 11% of maternal mortality in Nigeria. Traditional Healers play an important role in providing health care in Nigeria with a significant proportion of the population patronizing them for treatment of most of their ailments. The aim of this study was to assess the Knowledge, Practice and Attitudes (KPA) of Traditional Healers in malaria control in Enugu state, Nigeria with a view to developing appropriate intervention strategies aimed at improving collaboration and malaria quality of care in rural community settings. Design: This is a qualitative study using ethnographic approach carried out in Nsukka district, a rural community in Enugu North senatorial districts in South-east Nigeria, The study involved in-depth interviews of fifty (50) traditional healers selected out of 68 registered traditional healers in the zone. This was complemented by observations of service delivery to determine the quality of care each traditional healer gave to their patients. The fifty (50) selected partici