Search

The International Health Regulation (IHR) monitoring and evaluation framework includes voluntary instruments such as after-action reviews (AAR) as part of a five-year global strategic plan to improve public health preparedness and response. The Nigeria Centre for Disease Control conducted three AARs post-response to multi-city outbreaks of Monkeypox, Cerebrospinal Meningitis and Lassa Fever in 2018. All outbreaks were in urban local government areas (LGA)/cities across more than 20 states lending credence to the rise of city-states as a locus of risk for infectious disease re-emergence. Aspects of modern life in urban LGAs such as encroachment of humans into new environments and destruction of forests for agriculture puts residents in close contact with wildlife and at risk for infectious disease outbreaks. This chapter discusses the usefulness of AARs as a tool for evaluating responses to urban disease outbreaks and assess preparations for future ones using an approach that combines self-evaluation and peer review complying with the recommendations of the IHR for mandatory State Parties self-assessment annual reporting. This experience helped Nigeria identify how best practices can be maintained, improved, institutionalized and shared with relevant stakeholders. The AARs also determined how actions were implemented as opposed to how they were planned, identified processes that worked and those that didn’t, determined root causes for success and failure, and finally, provided SMART corrective recommendations to improve future performance actions and to strengthen cities pandemic readiness.

Introduction : lassa fever remains an important cause of morbidity and mortality in West Africa. In Nigeria, Lassa fever (LF) is endemic with an annual cycle of incident cases across the country. Despite seasonal epidemic preparedness and response efforts, there is still evidence of low clinical index of suspicion, poor sample management and delay in treatment resulting in nosocomial transmission, long turnaround time (TAT) for laboratory diagnosis and high case-fatality-rates (CFR). Methods : a structured questionnaire on sample and case management preparedness was developed by the multi-sectoral National Lassa Fever Working Group. The questionnaires were administered via telephone calls to all the 37 State epidemiologists. Variables of interest were summarized in frequencies, means and proportions using Epi-info Version 7. Results : most the states, 36 (97%) collect Lassa fever samples within 24 hours with 31 (83.7%) transporting samples immediately using personal delivery as mode of transportation. Majority (78%), of states routinely use standard triple packaging and 24 (64%) preserve samples in cold box prior to transportation. Two laboratories are designated for testing of viral hemorrhagic fevers in Nigeria (University of Lagos Teaching Hospital (LUTH) and Irrua Specialist Teaching Hospital (ISTH). The median laboratory TAT for LUTH is 48 hours (range 24 - 120) while for ISTH is 48 hours (range 24 - 48). Only sixteen states (43%) have designated Viral Hemorrhagic Fever (VHF) treatment centres with isolation units. Twenty-six states (70%) have trained personnel and a similar proportion (69%) commence presumptive treatment before receipt of laboratory result. Only 3(8%) States have ribavirin stock-out while 2(5%) States have short dated Ribavirin stock. Conclusion : there are nationwide gaps in sample and case management preparedness for Lassa fever outbreaks in Nigeria. Therefore the need for the establishment of designated functional VHF treatment centers in all states, active management of Ribavirin stocks and improvement in laboratory turn-around time.

Introduction : lassa fever is an endemic Viral Hemorrhagic Fever (VHF) in Nigeria. Improvements in case detection and treatment outcome could be achieved by understanding the transmission dynamics better and applying the lessons from previous outbreaks considering the resource constrained setting. This study assessed age-sex disparities in treatment outcome using data from 2016/2017 lassa fever outbreak surveillance in Nigeria. Methods : lassa fever surveillance and outcome data from December 2016 to May 2017 from 14 States was extracted from the VHF platform. Univariate and bivariate analysis were carried out using Epi info 7 for socio-demographics and treatment outcome. Possible association between treatment outcome and selected variables (age, sex) were analyzed using Chi square at 0.05 level of significance. Results : there were 168 confirmed cases of Lassa fever during the study period, data was complete for 139 (82.7%). More men were affected (56%), as 61 of the 139 patients (46%) were female. The median age for all the patients treated was 32 years (IQR 25 - 44). Symptoms at presentation prior to treatment included fever (67%), nausea and vomiting (34.5%), diarrhea (14.4%), and intense fatigue (39%) while only 10.8% experienced unexplained bleeding. A total of 75 (54%) patients were treated and discharged alive, while 64 (46%) died. No significant association was found between gender and treatment outcome (p value = 0.976). Although survival was higher among patients aged 15 to 24 years (72%) and lowest among patients who were 45 years and above (35%), age of the patient was not significantly associated with the adverse treatment outcome (p-value = 0.06). Conclusion : for the 2016/2017 lassa fever outbreak in Nigeria, age and sex did not influence the treatment outcome of the recorded cases. There is a need for further analysis and more large scale studies on Lassa fever treatment outcomes.