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Competing Interests: Disclosure of interest: The authors completed the ICJME Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

The COVID-19 pandemic has been persistent with a huge demand for human health resources which is a vital component of its preparedness and response. Globally, the public health workforce through field epidemiology and laboratory training programme (FELTP) has been instrumental to global health security. We determined the status of FELTP in the region and its contributions to the COVID-19 pandemic response in the ECOWAS region. We conducted a desk review, shared a questionnaire among member states and organized a two-day online regional consultative meeting on field epidemiology training on 30 th -31 st March 2022 during which there were presentations, group discussions and deliberations on the status and contribution of FETP during the COVID-19 pandemic. Data collected were analyzed in themes. All countries in the ECOWAS region had established at least one tier of FELTP, 11 (73.3%) had established two tiers of FELTP and only 3 (20.0%) had established all three tiers of the program. Despite the pandemic, the cumulative number of graduates increased from 2996 to 4271 frontline, 41 to 380 intermediate, and 409 to 802 for advanced FELTP between 2019 and 2022. However, the progress has been disproportionate across countries. The key activities supported through FELTP graduates included pandemic response coordination, surveillance, data collection/management, laboratory support, case management, risk communication, infection prevention and control, COVID-19 vaccination, and research. Despite improvements in the FELTP in the Economic Community of West African States (ECOWAS) region, there is a need for continuous stakeholder engagement for its implementation, resource mobilization for sustainability, and leveraging critical partnerships., Competing Interests: The authors declare no competing interests., (Copyright: Virgil Kuassi Lokossou et al.)

This paper describes the process for developing, validating and disseminating through a train-the-trainer (TOT) event a standardised curriculum for public health capacity building for points of entry (POE) staff across the 15-member state Economic Community of West African States (ECOWAS) that reflects both international standards and national guidelines.A five-phase process was used in developing the curriculum: phase (1) assessment of existing materials developed by the US Centers for Disease Control and Prevention (CDC), Africa CDC and the West African Economic and Monetary Union, (2) design of retained and new, harmonised content, (3) validation by the national leadership to produce final content, (4) implementation of the harmonised curriculum during a regional TOT, and (5) evaluation of the curriculum.Of the nine modules assessed in English and French, the technical team agreed to retain six harmonised modules providing materials for 10 days of intensive training. Following the TOT, most participants (n=28/30, 93.3%) indicated that the International Health Regulations and emergency management modules were relevant to their work and 96.7% (n=29/30) reported that the training should be cascaded to POE staff in their countries.The ECOWAS harmonised POE curriculum provides a set of training materials and expectations for national port health and POE staff to use across the region. This initiative contributes to reducing the effort required by countries to identify emergency preparedness and response capacity-building tools for border health systems in the Member States in a highly connected region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution., Design: This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available., Settings: The 15 States members of the Economic Community of West African States (ECOWAS) were considered., Results: As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau., Conclusion: We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed., Funding: The study was funded by the International Development Research Centre (IDRC) under CATALYSE project., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

The ECOWAS Region and the world have learnt a lot in the last year and a half concerning the pandemic. As the pandemic continues to evolve, the region needs to put together all these lessons in other to better protect its people, rebuild its economy and strengthen the regional health security for better regional prosperity. We reviewed the response mounted by the region from January 2020 to July 2021 and the existing body of knowledge. We recommend that the region quickly increase the COVID-19 immunization coverage, sustain the enhance genomic surveillance, improve testing and the strengthen point of entry surveillance., (Copyright: Virgil Kuassi Lokossou et al.)

Background: Zoonotic diseases pose a significant threat to human, animal, and environmental health. The Economic Community of West African States (ECOWAS) has endured a significant burden of zoonotic disease impacts. To address zoonotic disease threats in ECOWAS, a One Health Zoonotic Disease Prioritization (OHZDP) was conducted over five days in December 2018 to prioritize zoonotic diseases of greatest regional concern and develop next steps for addressing these priority zoonoses through a regional, multisectoral, One Health approach., Methods: The OHZDP Process uses a mixed methods prioritization process developed by the United States Centers for Disease Control and Prevention. During the OHZDP workshop, representatives from human, animal, and environmental health ministries from all 15 ECOWAS Member States used a transparent and equal process to prioritize endemic and emerging zoonotic diseases of greatest regional concern that should be jointly addressed by One Health ministries and other partners. After the priority zoonotic diseases were identified, participants discussed recommendations and further regional actions to address the priority zoonoses and advance One Health in the region., Results: ECOWAS Member States agreed upon a list of seven priority zoonotic diseases for the region - Anthrax, Rabies, Ebola and other viral hemorrhagic fevers (for example, Marburg fever, Lassa fever, Rift Valley fever, Crimean-Congo Hemorrhagic fever), zoonotic influenzas, zoonotic tuberculosis, Trypanosomiasis, and Yellow fever. Participants developed recommendations and further regional actions that could be taken, using a One Health approach to address the priority zoonotic diseases in thematic areas including One Health collaboration and coordination, surveillance and laboratory, response and preparedness, prevention and control, workforce development, and research., Conclusions: ECOWAS was the first region to use the OHZDP Process to prioritize zoonotic disease of greatest concern. With identified priority zoonotic diseases for the region, ECOWAS Member States can collaborate more effectively to address zoonotic diseases threats across the region using a One Health approach. Strengthening national and regional level multisectoral, One Health Coordination Mechanisms will allow ECOWAS Member States to advance One Health and have the biggest impact on improving health outcomes for both people and animals living in a shared environment., (© 2021. The Author(s).)

Background: As the global strategies to fight the SARS-COV-2 infection (COVID-19) evolved, response strategies impacted the magnitude and distribution of health-related expenditures. Although the economic consequence of the COVID-19 pandemic has been dire, and its true scale is yet to be ascertained, one key component of the response is the management of infected persons which its cost has not been adequately examined, especially in Africa., Methods: To fill gaps in context-specific cost of treating COVID-19 patients, we adopted a health system's perspective and a bottom-up, point of care resource use data collection approach to estimate the cost of clinical management of COVID-19 infection in Ghana. The analysis was based on the national protocol for management of COVID-19 patients at the time, whether in public or private settings. No patients were enrolled into the study as it was entirely a protocol-based cost of illness analysis., Result: We found that resource use and average cost of treatment per COVID-19 case varied significantly by disease severity level and treatment setting. The average cost of treating COVID-19 patient in Ghana was estimated to be US$11,925 (GH¢68,929) from the perspective of the health system; ranging from US$282 (GH¢1629) for patients with mild/asymptomatic disease condition managed at home to about US$23,382 (GH¢135,149) for critically ill patients requiring sophisticated and specialised care in hospitals. The cost of treatment increased by some 20 folds once a patient moved from home management to the treatment centre. Overheard costs accounted for 63-71% of institutionalised care compared to only 6% for home-based care. The main cost drivers in overhead category in the institutionalised care were personal protective equipment (PPEs) and transportation, whilst investigations (COVID-19 testing) and staff time for follow-up were the main cost drivers for home-based care., Conclusion: Cost savings could be made by early detection and effective treatment of COVID-19 cases, preferably at home, before any chance of deterioration to the next worst form of the disease state, thereby freeing up more resources for other aspects of the fight against the pandemic. Policy makers in Ghana should thus make it a top priority to intensify the early detection and case management of COVID-19 infections., (© 2021. The Author(s).)

Based on recommendations from two consultative meetings held in Dakar, Senegal (2016) and Abuja, Nigeria (2017) the Economic Community of West African States (ECOWAS) implemented a Regional One Health Coordination Mechanism (R-OHCM). This study analyzed the process, challenges and gaps in operationalizing the R-OHCM in West Africa. We utilized a scoping review to assess five dimensions of the operation of an R-OHCM based on political commitment, institutional structure, management and coordination capacity, joint planning and implementation, as well as technical and financial resources. Information was gathered through a desk review, interview of key informants, and the viewpoints of relevant stakeholders from ECOWAS region during a regional One Health technical meeting in Lomé, Togo in October 2019. It was found that political commitment at regional meetings and the countries adoption of regional frameworks were key strengths of the R-OHCM, although there are continued challenges with commitment, sustainability, and variability of awareness about One Health approach. ECOWAS formulated regional strategic documents and operationalized the One Health secretariat for strengthening coordination. The R-OHCM has technical working groups however, there is need for engagement of more specialized workforce and a harmonized reporting structure. Furthermore, inadequate focus on operational research, and weak national OHCM are identified as main gaps. Finally, the support of technical and financial partners will help to address the lack of funding which limits the implementation of the R-OHCM. West Africa has demonstrated profound effort in adopting the One Health approach at regional level but is presently deterred by challenges such as limited skilled One Health workforce, especially in the animal and environmental health sectors, and access to quality of One Health surveillance., (© 2021 West African Health Organisation.)

Free movement between countries without a visa is allowed within the 15-country Economic Community of West African States (ECOWAS) region. However, little information is available across the region on the International Health Regulation (IHR 2005) capacities at points of entry (PoE) to detect and respond appropriately to public health emergencies such as Coronavirus Disease 2019 (COVID-19). ECOWAS and the member states can better tailor border health measures across the region by understanding public health strengths and priorities for improvement at PoEs. A comprehensive literature review was combined with a self-assessment of capacities at PoEs across the fifteen member states from February to July 2020. For the assessment, the member states completed an adapted World Health Organization (WHO) self-assessment checklist by classifying capacity for seven domains as fully, partially, or not implemented. The team implemented three focus group discussion (FGD) sessions and 13 key informant interviews (KII) with national-level border health stakeholders. Univariate analysis was used to summarize the assessment data and detailed content analysis was applied to evaluate FGD and KII results. Of the 15 member states, 3 (20%) are landlocked; 3 (20%) have more than one seaport. Eleven (73%) countries have 1 designated airport, 3 (20%) have two airports, and only one country (6.7%) has three airports. Two hundred and seventy-eight designated ground crossings were identified in 12 countries (80%). Strengths across the PoE were existence of decrees and ministerial acts in some ECOWAS countries and establishment of national taskforces for the COVID-19 response at PoE in ECOWAS. Major challenges were porous borders, poor intersectoral coordination, lack of harmonized traveler screening measures, shortage of staff, and inadequate financial resources. Despite all these challenges, there are opportunities such as leveraging the regional cross-border poliomyelitis coordination and control mechanism, and existence of networks of infection prevention and control specialists and field epidemiologists. However, political instabilities in some countries pose a threat to government commitments to PoE activities. The capacity to respond to public health emergencies at PoE in the ECOWAS region is still below IHR standard. Public health capacities at a majority of IHR-designated PoE in the 15-country region do not meet required core capacities standards., Competing Interests: The authors declare no competing interests., (Copyright: Virgil Kuassi Lokossou et al.)

Since the beginning of the COVID-19 pandemic in West Africa, the region has faced a coexistence of epidemics raising questions about the management of the coexistence between COVID-19 and other epidemic prone diseases. We undertook a cross-sectional study covering the period from February to August 2020 in which an extensive desk review was completed and questionnaire was submitted to National Public Health Institutes. In addition, we conducted online interviews with 10 West African countries to discuss in-depth the strategies and challenges in managing the coexistence of epidemics. Eight epidemics coexisted with COVID-19 in West Africa. These epidemics were yellow fever and measles in five countries; meningitis in 4 countries; vaccine derived poliomyelitis and dengue fever in two countries; Lassa fever, Crimean Congo Hemorrhagic fever and hepatitis E virus in one country. COVID-19 pandemic has brought both positive and negative effects to the management of other epidemics. The management of coexistence was similar in most ECOWAS countries with different incident management systems set up to manage separate outbreaks. The experience in managing the coexistence of epidemics led ECOWAS Regional Center for Surveillance and Disease Control to recommend to member states that they should reinforce regular disease surveillance for seasonal outbreaks and country specific epidemiological diseases profile while not forgetting other emerging and remerging infectious diseases., Competing Interests: The authors declare no competing interests., (Copyright: Virgil Kuassi Lokossou et al.)

The ability to prevent, promptly detect, and appropriately respond to a public health threat is essential for health security. Field epidemiology training has helped increase the quality and quantity of the public health workforce to strengthen disease surveillance, outbreak preparedness and response, and general public health capacity. We conducted a desk review on the status of the Field Epidemiology and Laboratory Training Program model in 16 countries in West Africa. We also developed a questionnaire and shared it with West African Health Organization (WAHO) member states to document their experiences and the status of training in their countries. WAHO organized a regional 3-day consultative meeting with major stakeholders in the region to examine progress, gaps, and challenges, and outline a roadmap to strengthen the Field Epidemiology and Laboratory Training Program. Stakeholders shared their experiences, engaged in discussions to identify strengths and gaps, and made plans on a way forward. Member states are at different levels of implementing field epidemiology and laboratory training programs in their countries, and, therefore, major gaps remain in the number and distribution of trained epidemiologists throughout West Africa. Member states implement different variants of the program and in some instances the same cadre of health workers are trained in different but comparable programs with different funding streams. Two member states had not begun implementing the training program. Developing regional centers of excellence was recommended in the long term while collaboration among member states to train the required number of epidemiologists to fill the acute needs could be helpful in the short and medium term. Curriculum harmonization and expansion, deployment and use of trained epidemiologists, accreditation of training institutions, and generation of indigenous funding streams are recommended to improve the Field Epidemiology and Laboratory Training Program in West Africa.

Recurring outbreaks of infectious diseases have characterized the West African region in the past 4 decades. There is a moderate to high risk of yellow fever in countries in the region, and the disease has reemerged in Nigeria after 21 years. A full-scale simulation exercise of the outbreak of yellow fever was conducted to assess preparedness and response in the event of a full-scale outbreak. The exercise was a multi-agency exercise conducted in Lagos, and it involved health facilities, points of entry, state and national public health emergency operation centers, and laboratories. An evaluation of the exercise assessed the capability of the system to identify, respond to, and recover from the emergency using adapted WHO tools. The majority of participants, observers, and evaluators agreed that the exercise was well-structured and organized. Participants also strongly agreed that the exercise helped them to identify strengths and gaps in their understanding of the emergency response systems and plans. Overall, the exercise identified existing gaps in the current capabilities of several thematic areas involved in a yellow fever response. The evaluation presented an opportunity to assess the response capabilities of multisectoral collaborations in the national public health system. It also demonstrated the usefulness of the exercise in understanding public health officials' roles and responsibilities; enabling knowledge transfer among these individuals and organizations; and identifying specific public health systems-level strengths, weaknesses, and challenges.

The textile industry sector occupies a prominent place in the economy of Benin. It exposes workers to several occupational risks, including exposure to cotton dust. To assess the effect of exposure to cotton dust on the health of workers, this study was initiated and conducted in a Beninese cotton industry company. The objective of the study was to evaluate the respiratory disorders among the textile workers exposed to cotton dust and the cross-sectional study involved 656 subjects exposed to cotton dust and 113 non-exposed subjects. The methods used are mainly based on a survey using a questionnaire of organic dust designed by the International Commission of Occupational Health (ICOH); and on the measures of lung function parameters (FEV₁ and FVC). The main results of the different analyzes revealed that subjects exposed to cotton dust have more respiratory symptoms than unexposed subjects (36.9% vs. 21.2%). The prevalence of chronic cough, expectorations, dyspnoea, asthma and chronic bronchitis are 16.8%, 9.8%, 17.3%, 2.6%, and 5.9% respectively among the exposed versus 2.6%, 0.8%, 16.8%, 0% and 0.8% among the unexposed subjects. The prevalence of byssinosis is 44.01%.The prevalence of symptoms is dependent on the sector of activity and the age of the subject. These results should encourage medical interventions and technical prevention especially since the textile industry occupies an important place in the Benin's economy., Competing Interests: None.