Aisha Abubakar

Assessment of integrated disease surveillance and response strategy implementation in selected Local Government Areas of Kaduna state

Background: Widespread epidemics of yellow fever and cerebrospinal meningitis across the African sub region in the 1990s were largely attributed to poor surveillance systems which were neither able to detect communicable diseases on time nor mount an effective response. Effective communicable disease control relies on effective response systems which are dependent upon effective disease surveillance. Integrated Disease Surveillance and Response strategy (IDSR) was adopted by the AFRO members of the World Health Organization (WHO) to improve surveillance activities. Aim: This study was conducted to assess IDSR implementation in selected Local Government Areas (LGAs) of Kaduna state. Settings and Design: Kaduna state is located in Northern Nigeria. It shares borders with the states of Sokoto, Katsina, Niger, Kano, Bauchi and Plateau. Based on the 2006 census projections, it has a population of 6.63 million. The study was a cross-sectional descriptive study. Materials and Methods: An interviewer administered questionnaire of an adaptation of the World Health Organization Protocol for the Assessment of National Communicable Disease Surveillance and Response systems was used. Data analysis was carried out using Epi Info statistical package version 3.5.1. Results: About a third of the health facilities (38%) did not have any case definition for the priority diseases. About 76% of the health facilities had electricity available from the National Grid. Seventy one percent have standby generators, out of which 67% were functional. Sixty two percent of health facilities had calculators available for data management while 29% had computers and printers available. No form of data analysis was available in 81% of the health facilities, analysis of data were however available in all 3 LGAs studied. A reporting system was available in 57% of health facilities. Thirteen percent of the health facilities reported receiving feedback from the LGAs. There was no feedback from the state to the LGAs, nor was there feedback from the national to the state level. Conclusion: The implementation of IDSR in Kaduna state is poor. Resources are insufficient and although some structures are present on ground like the presence of reporting mechanism, feedback is poor from the higher to lower levels. Standard case definitions are not used in all health facilities for all priority diseases. Standard case definitions should be made available and used in all health facilities.

Knowledge, Sources of information, and Risk Factors for Sexually Transmitted Infections among Secondary School Youth in Zaria, Northern Nigeria

Background: Sexually transmitted infections (STIs) are responsible for a variety of health problems especially among the youth who engage in risky sexual behavior. There are few studies that describe STIs among the youths in Northern Nigeria. The objective of the study was to assess knowledge of STIs and risk factors among secondary school youth. Materials and Methods: This was a cross-sectional study in which structured, self-administered questionnaire was used to collect data on socio-demographics, knowledge on STIs, and risk factors. Three senior secondary schools were purposively selected for the study. Results: A total of 1765 youths aged 10-30 years with mean age of 16.9 ± 2.0 years participated in the study. 1371 (77.7%) and 394 (22.3%) were respectively Muslim and Christian. Mean age at first sexual intercourse was 16.7 ± 2.0 years. A majority (67.6%) of them heard about STIs; sources of information of STIs were school lessons 23.6%, mass media 23.3%, and health magazines 19.2%, respectively. Generally, knowledge on STIs was good as 75.4% of respondents knew how the disease is transmitted. This knowledge was significantly associated with class of student, place of treatment, and religious teaching (χ2 = 9.6, P = 0.047, χ2 = 22.1, P = 0.035 and 42.6, P = 0.001, respectively). Mean knowledge score was 0.698 ± 0.01. A majority of respondents were engaged in risky sexual behavior as only 16.2% use condom as a preventive measure. Eleven percent reported ever having an STI in the past and majority (52.8%) go to government hospital for treatment of acquired STI. 56% of the youth had two or more boy/girl friends and 30% had sexual relationships. Conclusion: It was concluded that secondary school youth had good knowledge about STIs; however, the opposite is true when it comes to preventive practice (use of condom). Interventions such as periodic publicity awareness and school seminars focusing on STI preventions are needed to control the disease among the youth.

Emergency preparedness and the capability to identify outbreaks: A case study of Sabon Gari Local Government Area, Kaduna state

Background : Widespread outbreaks, particularly of communicable diseases and weak surveillance systems, across the African sub-region led to the adoption of Integrated Disease Surveillance and Response (IDSR) as a regional strategy for strengthening national surveillance systems and effective response to priority communicable diseases. One of the goals of IDSR is to improve the ability of Local Government Areas (LGAs) to detect and respond to diseases and conditions that lead to high morbidity and mortality. The aim of the study was to assess the emergency preparedness and capability to identify outbreaks in Sabon Gari LGA. Methodology : A cross-sectional descriptive study was carried out in Sabon Gari LGA in October 2007. Key informant interviews of the key personnel conducted using structured interviewer administered questionnaires were used to obtain information about the emergency preparedness and the capability of the LGA to identify outbreaks. The results obtained were compared to the recommendations of the National Technical Guidelines for IDSR 2002. Results : There were no prepositioned stock of drugs and vaccines available; 8% of staff was trained in disease surveillance. There is a budget line available for emergency response. The LGA relies on reports from health facilities and communities to identify outbreaks; no threshold or markers are used. No form of analysis is carried out on data collected at the LGA level. Timeliness of monthly reporting for May and June 2007 was 26.5 and 22.5% respectively; completeness of monthly reporting was 32.7%. Conclusion: The emergency preparedness and capability to identify outbreaks in Sabon Gari LGA is poor based on the selected criteria from the National Technical Guidelines for IDSR; less than 50% of the criteria are met. There is a need for Sabon Gari LGA to fully adopt the National Technical Guidelines on IDSR to be better positioned to prepare for and identify outbreaks.

Training and Service in Public Health, Nigeria Field Epidemiology and Laboratory Training, 2008 – 2014

The health workforce is one of the key building blocks for strengthening health systems. There is an alarming shortage of curative and preventive health care workers in developing countries many of which are in Africa. Africa resultantly records appalling health indices as a consequence of endemic and emerging health issues that are exacerbated by a lack of a public health workforce. In low-income countries, efforts to build public health surveillance and response systems have stalled, due in part, to the lack of epidemiologists and well-trained laboratorians. To strengthen public health systems in Africa, especially for disease surveillance and response, a number of countries have adopted a competency-based approach of training - Field Epidemiology and Laboratory Training Program (FELTP). The Nigeria FELTP was established in October 2008 as an inservice training program in field epidemiology, veterinary epidemiology and public health laboratory epidemiology and management. The first cohort of NFELTP residents began their training on 20th October 2008 and completed their training in December 2010. The program was scaled up in 2011 and it admitted 39 residents in its third cohort. The program has admitted residents in six annual cohorts since its inception admitting a total of 207 residents as of 2014 covering all the States. In addition the program has trained 595 health care workers in short courses. Since its inception, the program has responded to 133 suspected outbreaks ranging from environmental related outbreaks, vaccine preventable diseases, water and food borne, zoonoses, (including suspected viral hemorrhagic fevers) as well as neglected tropical diseases. With its emphasis on one health approach of solving public health issues the program has recruited physicians, veterinarians and laboratorians to work jointly on human, animal and environmental health issues. Residents have worked to identify risk factors of disease at the human animal interface for influenza, brucellosis, tick-borne relapsing fever, rabies, leptospirosis and zoonotic helminthic infections. The program has been involved in polio eradication efforts through its National Stop Transmission of Polio (NSTOP). The commencement of NFELTP was a novel approach to building sustainable epidemiological capacity to strengthen public health systems especially surveillance and response systems in Nigeria. Training and capacity building efforts should be tied to specific system strengthening and not viewed as an end to them. The approach of linking training and service provision may be an innovative approach towards addressing the numerous health challenges.

Nutritional Status and Pattern of Infant Feeding Practices among Children under Five in a Rural Community of Northwestern Nigeria

The study assessed the factors influencing nutritional status of children less than five years in Biye village in rural Nigeria. The study was a cross sectional descriptive study: 119 caregivers and mothers were interviewed. A structured questionnaire was used to collect data using multi-stage sampling. Anthropometric measurements of children were also taken. Data analysis was done using SPSS version 17.0. Respondents age ranged from 11–50 years, mean age of 26 (± 11.7); 79.8% had Quranic education; and 50.4% were not gainfully employed. Two-thirds (68.9%) were polygamous, and 64.7% had 1–3 children. Less than 1% of children were exclusively breast fed. From anthropometric data obtained, 62.2% were stunted, 12.6% wasted, and 48.7% underweight. A statistically significant relationship exists between family size and childrens nutritional status. The prevalence of malnutrition was high with poor child feeding practices. Thus, healthcare providers should carry out community-wide health education on the need to promote appropriate infant feeding practices and nutritional status.

Knowledge and prevalence of Human African Trypanosomiasis among residents of Kachia grazing reserve, Kachia local government area, Kaduna state, Nigeria, 2012.

Introduction Human African Trypanosomiasis (HAT) is a vector borne parasitic disease transmitted to humans by infected tse-tse flies cause morbidity including delayed child mental development. Reports of nuisance and bites from tse-tse flies by residents of Kachia grazing led to the study to determine the knowledge, practices and prevalence of HAT among residents of the grazing reserve. Methods We conducted active case search in a cross-sectional study using multi-stage sampling with probability proportionate to size. We administered structured questionnaire on Knowledge, practices relating to HAT prevention and screened for HAT using card agglutination test for Trypanosomiasis (CATT). Knowledge of HAT was scored 0-5 and categorized good (3-5) and poor (0-2) based on score, predisposition to risk of HAT as exposure to ≥two risk factors and, a case of HAT as any respondent that tested positive on CATT. We analysed data using Epi-info and MS-excel. Results Of the 300 respondents, mean age 39(±17years) interviewed, 56.3% were males, 12.0% had good knowledge of HAT and 76.3% were exposed to HAT risk factors. Prevention practices included clearing of overgrown bushes around houses (99%), use of insecticidal treated nets (75.7%) and protective clothing (41.0%). Males {Odds Ratio [OR] 5.0; 95% Confidence Interval (CI) 1.8 - 13.6}, age above 40 years {OR 5.0; 95% CI 1.1 - 24.4} and family history of HAT {OR 8.7; 95% CI 2.4 - 32.1} were significantly associated with HAT knowledge. None tested positive on CATT. Conclusion Despite poor knowledge of HAT, residents practiced HAT preventive measures and zero HAT prevalence was recorded.

Factors associated with adverse pregnancy outcomes and perceptions of risk factors among reproductive age women in Soba LGA Kaduna State 2013.

Introduction Maternal mortality defined as deaths due to complications of pregnancy or childbirth remains a public health concern. Although statistics show a decline in maternal mortality ratio from 380 deaths to 210 deaths per 100,000 live births from1990 to 2013, in Sub-Saharan Africa, maternal mortality rates remain unacceptably high. Maternal mortality In Nigeria is currently 560/100,000 live births. This study was conducted to identify the associated risk factors and perceptions of adverse pregnancy outcomes among reproductive age women in Soba local government area (LGA). Methods A 1:1 unmatched case control study with 138 respondents was used. Cases were women aged 15-49 years with a history of adverse pregnancy outcome. Controls: 15-49 years without a history of adverse outcomes. Adverse outcomes were: pregnancy induced hypertension and spontaneous abortions. Anthropometric measurements and blood pressure were taken. Six focus group discussions (FGDs) with grandmothers, mothers and teenagers were used to explore perceptions. Quantitative data was analyzed using Epi-info version 3.5.3. Qualitative data analyzed by thematic approach. Results The median age of cases was: 25 years (Range: 16-44years), Median age of controls: 27 years (Range: 16-43years). Commencement of Antenatal care (ANC) attendance <4months (adjusted odds ratio (AOR): 0.32; 95% CI: 0.12-0.81) and Number of pregnancies ≥4 (AOR: 5.02; 95% CI: 1.97-12.82) were found to be associated with adverse outcomes. Conclusion Risk factors associated with outcomes are multiple pregnancies and delayed commencement of antenatal care. There was poor perception of adverse pregnancy outcomes. We recommended frequent community health talks, early commencement of antenatal and Utilization of Family planning services.

Outbreak investigation of measles in Kaduna State, Northwestern Nigeria, 2015

Sub-Saharan Africa reports repeated outbreaks of measles, a vaccine preventable disease, which is notifiable under the Integrated Disease Surveillance and Response strategy in Nigeria. Nigeria has reported several outbreaks of measles in the last three years. Poor immunization coverage and weak health systems have been related with measles. This case study is based on real events that occurred during the 2015 outbreak of measles in Kaduna state Northwestern Nigeria. This case study was based upon real events that occurred in community X in Igabi LGA of Kaduna state. However, some of the results were edited to allow the case study to be completed in a facilitated classroom session. Knowledge and practice of investigating outbreaks is a key public health function of public health workers. The purpose of this case study is to simulate outbreak investigation for teaching of postgraduate public health practitioners. The participants should have received lectures or other training on outbreak investigation without the practical experience of investigating an outbreak but are being prepared to investigate outbreaks in the field. This case study should be taken in a classroom setting and should take two hours to complete.

Burden and trend of measles in Nigeria: a five-year review of case-based surveillance data, 2012 - 2016

Introduction : measles is a vaccine preventable, highly transmissible viral infection that affects mostly under-five year children. The disease is caused by a Morbillivirus; member of the Paramyxovirus family. Measles surveillance in Nigeria is through the Integrated Disease Surveillance and Response (IDSR). We reviewed surveillance data on measles from Nigeria over a five-year period to highlights its burden, and make recommendations for improvements. Methods : we conducted a secondary data analysis of measles specific IDSR records of all States in Nigeria from January 2012 to September 2016. The record had reported measles cases with laboratory outcomes from all the States. IDSR weekly epidemiological data were obtained from Surveillance Unit, Nigerian Centre for Disease Control (NCDC). Results : a total of 131,732 cases were recorded within the period. Highest number of cases 57,892 (43.95%) were recorded in 2013 while the least number of cases 11,061 (8.4%) were recorded in 2012. A total of 817 deaths were recorded, given a case fatality rate (CFR) of 0.62%. The CFR showed a decreasing trend over the years with the highest CFR (1.43%) recorded in 2012 and the least CFR (0.44%) recorded in 2016. Only 8,916 (6.7%) cases were confirmed by laboratory investigation. The Northwest region recorded the highest attack rate (AR) of 149.7 cases per 100,000 population, followed by the Northeast region with 140.2 cases per 100,000 population, while the South-south region recorded the least AR of 15.8 cases per 100,000 population. Case Fatality Rate per region followed similar pattern, with the North central region having the highest CFR of 4.38%. The trend of measles cases followed the same pattern. Cases peaked at March, then gradually reduced to lowest level at June. Conclusion : measles infection remains a burden especially in the northern region of Nigeria. Though measles fatalities were on decline over the years, laboratory diagnosis of cases has been suboptimal. We recommended improvement on routine immunization and measles case management, and strengthening of regional laboratories capacity for measles diagnosis.

Outbreak of cholera at Dutsen-Abba Ward Zaria local government Area, Kaduna State Nigeria 2015: the importance of hygienic practices

Introduction : cholera is an infection caused by Vibrio cholerae, which may lead to severe dehydration and death if not treated. On August 31, 2015, the Kaduna Ministry of Health received a notification of increase cases of vomiting and diarrhoea at Dusten-Abba in Zaria. A response Team was sent to confirm the outbreak, describe the socio-demographic characteristics and identify possible risk factors for the outbreak. Methods : we defined cases according to the World Health Organization (WHO) criteria. We conducted an unmatched case-control study and descriptive study. We retrieved line-listed cases at the ward facility. We interviewed cases at the facility and recruited controls from the community, and administered questionnaires to both cases and controls. We analyzed data using Epi-Info7 and Microsoft Excel 2016. Results : a total of 50 cases were recorded, with a median age of 20yrs and age range of 1-50yrs. There were more females (68%) than males. Majority of cases (52%) were under 20yrs, while all cases are below 50yrs. Seven (7) deaths were recorded giving a Case Fatality Rate (CFR) of 14%. The CFR was higher in females (14.7%) than in males (12.5%). The index case was seen on August 29, 2015. The outbreak lasted five days. The last cases were seen on September 2, 2015. The highest number of cases seen in a day (23) was on third day of the outbreak. Only two cases (4%) had their samples tested using cholera RDT, and both tested positive. Drinking un-boiled water (OR: 12.67, 95%CI: 2.33 - 68.93), regular hand washing (OR: 0.22, 95%CI: 0.06-0.90) and proper waste disposal practices (OR: 0.07, 95%CI: 0.02-0.36) are factors we found to affect cholera infection during the outbreak. Conclusion : our investigation confirmed a cholera outbreak with a high CFR, especially among females. Poor hygienic practices such as, drinking of un-boiled well water, improper waste disposal, and not washing handsvregularly among the populace, were found to be factors that propagate the outbreak.