South Sudan implemented Ebola virus disease preparedness interventions aiming at preventing and rapidly containing any importation of the virus from the Democratic Republic of Congo starting from ...August 2018. One of these interventions was a surveillance system which included an Ebola alert management system. This study analyzed the performance of this system. A descriptive cross-sectional study of the Ebola virus disease alerts which were reported in South Sudan from August 2018 to November 2019 was conducted using both quantitative and qualitative methods. As of 30 November 2019, a total of 107 alerts had been detected in the country out of which 51 (47.7%) met the case definition and were investigated with blood samples collected for laboratory confirmation. Most (81%) of the investigated alerts were South Sudanese nationals. The alerts were identified by health workers (53.1%) at health facilities, at the community (20.4%) and by screeners at the points of entry (12.2%). Most of the investigated alerts were detected from the high-risk states of Gbudwe (46.9%), Jubek (16.3%) and Torit (10.2%). The investigated alerts commonly presented with fever, bleeding, headache and vomiting. The median timeliness for deployment of Rapid Response Team was less than one day and significantly different between the 6-month time periods (K-W = 7.7567; df = 2; p = 0.0024) from 2018 to 2019. Strengths of the alert management system included existence of a dedicated national alert hotline, case definition for alerts and rapid response teams while the weaknesses were occasional inability to access the alert toll-free hotline and lack of transport for deployment of the rapid response teams which often constrain quick response. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provides evidence to further improve Ebola preparedness in the country.
This study describes the coordination mechanisms that have been used for management of the COVID 19 pandemic in the WHO AFRO region; relate the patterns of the disease (length of time between onset ...of coordination and first case; length of the wave of the disease and peak attack rate) to coordination mechanisms established at the national level, and document best practices and lessons learned.
We did a retrospective policy tracing of the COVID-19 coordination mechanisms from March 2020 (when first cases of COVID-19 in the AFRO region were reported) to the end of the third wave in September 2021. Data sources were from document and Literature review of COVID-19 response strategies, plans, regulations, press releases, government websites, grey and peer-reviewed literature. The data was extracted to Excel file database and coded then analysed using Stata (version 15). Analysis was done through descriptive statistical analysis (using measures of central tendencies (mean, SD, and median) and measures of central dispersion (range)), multiple linear regression, and thematic analysis of qualitative data.
There are three distinct layered coordination mechanisms (strategic, operational, and tactical) that were either implemented singularly or in tandem with another coordination mechanism. 87.23% (n = 41) of the countries initiated strategic coordination, and 59.57% (n = 28) initiated some form of operational coordination. Some of countries (n = 26,55.32%) provided operational coordination using functional Public Health Emergency Operation Centres (PHEOCs) which were activated for the response. 31.91% (n = 15) of the countries initiated some form of tactical coordination which involved the decentralisation of the operations at the local/grassroot level/district/ county levels. Decentralisation strategies played a key role in coordination, as was the innovative strategies by the countries; some coordination mechanisms built on already existing coordination systems and the heads of states were effective in the success of the coordination process. Financing posed challenge to majority of the countries in initiating coordination.
Coordinating an emergency is a multidimensional process that includes having decision-makers and institutional agents define and prioritise policies and norms that contain the spread of the disease, regulate activities and behaviour and citizens, and respond to personnel who coordinate prevention.
The Corona Virus Disease 2019 (COVID-19) pandemic has rapidly spread in Africa, with a total of 474,592 confirmed cases by 11
July 2020. Consequently, all policy makers and health workers urgently ...need to be trained and to access the most credible information to contain and mitigate its impact. While the need for rapid training and information dissemination has increased, most of Africa is implementing public health social and physical distancing measures. Responding to this context requires broad partnerships and innovative virtual approaches to disseminate new insights, share best practices, and create networked communities of practice for all teach, and all learn. The World Health Organization (WHO)-Africa region, in collaboration with the Extension for Community Health Outcome (ECHO) Institute at the University of New Mexico Health Sciences Center (UNM HSC), the West Africa college of nurses and the East Central and Southern Africa college of physicians, private professional associations, academia and other partners has embarked on a virtual training programme to support the containment of COVID-19. Between 1
April 2020 and 10
July 2020, about 7,500 diverse health professionals from 172 locations in 58 countries were trained in 15 sessions. Participants were from diverse institutions including: central ministries of health, WHO country offices, provincial and district hospitals and private medical practitioners. A range of critical COVID-19 preparedness and response interventions have been reviewed and discussed. There is a high demand for credible information from credible sources about COVID-19. To mitigate the "epidemic of misinformation" partnerships for virtual trainings and information dissemination leveraging existing learning platforms and networks across Africa will augment preparedness and response to COVID-19.
Background and objective: Children in the developing world are vulnerable to iron deficiency (ID) and iron deficiency anemia (IDA) because they grow fast and consume diets low in iron. Thus, this ...study assessed anemia in children aged 6 - 12 years in rural Nigeria, using hematological indices and serum ferritin as diagnostic tools.
Materials and methods: This cross-sectional study was carried out in two primary schools in Kumin Masara Kataf village in Kaduna state, Nigeria. School children aged 6 - 12 years were enrolled. Personal information and laboratory data were collected. Hemoglobin and serum ferritin concentration was estimated to determine anemia and iron status. Data analysis was done using IBM-SPSS Inc., Chicago, IL, USA, version-25.0.
Results: A total of 191 school-age children aged 6 - 12 years were enrolled in the study. The overall serum ferritin was 16.51±5.20 mg/L, but the children aged 6 - 9 years had significantly (p<0.05) higher serum ferritin (17.23±5.57 mg/L), compared to children aged 10-12 years (15.62±4.62). The mean hemoglobin concentration and serum ferritin were significantly (p<0.05) more elevated among males (11.17±2.53g/dl and 19.01±5.06 mg/L, respectively) than females (10.18±2.46 g/dl and 14.03±4.02 mg/L respectively).The overall rate of anemia was 51.3%, while IDA was 70.4% (69/98). Iron deficiency was present in 47.3% (44/93) children. Also, anemia was significantly (p<0.001) more prevalent among females (66.7%), than males (35.8%), and a higher proportion of females (87.5%) than males (26.2%) were iron deficient (p<0.05), but more males (44.1%) had IDA, p<0.05.
Conclusion: This study found a high prevalence of IDA and ID among rural school children in Nigeria. It is recommended that healthcare providers focus more on preventing IDA right before childhood.
IMC J Med Sci. 2023. 17(1): 006. DOI: https://doi.org/10.55010/imcjms.17.006
*Correspondence: Andrew Nuhu Yashim, Haematology and Blood Transfusion Department, National Hospital, Abuja, Nigeria. Email: yashimnuhuandrew@gmail.com
Background and objectives: Rotavirus is a significant cause of nonbacterial diarrhea, especially in infants and young children worldwide. This study evaluated the pattern of rotavirus infection in ...children under five years presenting with acute diarrhea in Abuja Teaching Hospital, Gwagwalada, Nigeria. Methodology: It was a cross-sectional descriptive study to describe the prevalence of rotavirus infection among children. The study enrolled children 1 to 59 months old with acute diarrhea attending General Paediatric Outpatient clinic and hospitalized in the Emergency Paediatric Unit of University of Abuja Teaching Hospital (UATH), Gwagwalada, Nigeria. Rotavirus antigen was detected in the stool by qualitative enzyme-linked immunosorbent assay (ELISA). Data were analyzed using IBM-SPSS version 25.0. Results: The study comprised of 414 diarrhoeal children aged 1–59 months, of which 226 (54.6%) were male and the mean age was 12.1 months. The overall rate of rotavirus infection was 43.0% (178/ 414). The rotavirus infection was slightly higher among females than in males (46.8% vs 39.8%; p=0.153). Children from upper and middle social classes were at 1.95 CI=1.17–3.26 and 3.08CI=1.77–5.34 times higher risks of rotavirus induced diarrhea than the children from the lower social class (p<0.005). Children whose mothers had post-secondary education were three times more at risk of rotavirus diarrhea OR=3.70; CI=1.46–9.36 than those with primary or no formal education (p<0.05). Children who had never been vaccinated against rotavirus were four times more likely to suffer rotavirus infection than those who had been vaccinated OR=3.96; 95%CI=1.13–13.89, p=0.032. Conclusion: This study found that rotavirus was an important causative agent of diarrhea in children in Gwagwalada, Abuja. Due to low rotavirus vaccination status in children, rotavirus screening tests are necessary for children with acute diarrheal disease. J Med Sci. 2022; 16(2): 010. DOI: https://doi.org/10.55010/imcjms.16.020 *Correspondence: Felix Olaniyi Sanni, Department of Public Health, Fescosof Data Solutions, Ogun, Nigeria. Email: fescosofanalysis@gmail.com
ObjectiveTo assess implementation status of public health emergency operations centres (PHEOCs) in all countries in Africa.DesignCross-sectional.SettingFifty-four national PHEOC focal points in ...Africa responded to an online survey between May and November 2021. Included variables aimed to assess capacities for each of the four PHEOC core components. To assess the PHEOCs’ functionality, criteria were defined from among the collected variables by expert consensus based on PHEOC operations’ prioritisation. We report results of the descriptive analysis, including frequencies of proportions.ResultsA total of 51 (93%) African countries responded to the survey. Among these, 41 (80%) have established a PHEOC. Twelve (29%) of these met 80% or more of the minimum requirements and were classified as fully functional. Twelve (29%) and 17 (41%) PHEOCs that met 60%–79% and below 60% the minimum requirements were classified as functional and partially functional, respectively.ConclusionsCountries in Africa made considerable progress in setting up and improving functioning of PHEOCs. One-third of the responding countries with a PHEOC have one fulfilling at least 80% of the minimum requirements to operate the critical emergency functions. There are still several African countries that either do not have a PHEOC or whose PHEOCs only partially meet these minimal requirements. This calls for significant collaboration across all stakeholders to establish functional PHEOCs in Africa.
ObjectivesWe conducted a review of intra-action review (IAR) reports of the national response to the COVID-19 pandemic in Africa. We highlight best practices and challenges and offer perspectives for ...the future.DesignA thematic analysis across 10 preparedness and response domains, namely, governance, leadership, and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response, and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic.SettingAll countries in the WHO African Region were eligible for inclusion in the study. National IAR reports submitted by March 2021 were analysed.ResultsWe retrieved IAR reports from 18 African countries. The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and subnational levels.ConclusionThese findings suggest that African countries’ response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared with countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks.
Acute respiratory infections remain a leading cause of morbidity and mortality in Sierra Leone; however, similar to other African countries, little is known regarding the contribution of influenza. ...Routine influenza surveillance is thus a key element to improve understanding of the burden of acute respiratory infections in Africa. In 2011, the World Health Organization (WHO) funded the Strengthening Influenza Sentinel Surveillance in Africa (SISA) project with the goal of developing and strengthening influenza surveillance in eight countries in sub-Saharan Africa, including Sierra Leone. This paper describes the process of establishing a functional Influenza Sentinel Surveillance (ISS) system in Sierra Leone, a post-conflict resource-poor country previously lacking an influenza monitoring system.
Sierra Leone utilized a systematic approach, including situational assessment, selection of sentinel sites, preparation of implementation plan, adaptation of the standard operating procedures, supervision and training of staff, and monitoring of influenza surveillance activities. The methods used in Sierra Leone were adapted to its specific context, using the Integrated Disease Surveillance and Response (IDSR) strategy as a platform for establishing ISS.
The ISS system started functioning in August 2011 with subsequent capacity to contribute surveillance activity data to global influenza databases, FluID and FluNet, demonstrating a functional influenza surveillance system in Sierra Leone within the period of the WHO SISA project support. Several factors were necessary for successful implementation, including a systematic approach, national ownership, appropriate timing and external support.
The WHO SISA project demonstrated the feasibility of building a functional influenza surveillance system in Sierra Leone, integrated into existing national IDSR system. The ISS system, if sustained long-term, would provide valuable data to determine epidemiological and virological patterns and seasonal trends to assess the influenza disease burden that will ultimately guide national control strategies.
With the evolving epidemiological parameters of COVID-19 in Africa, the response actions and lessons learnt during the pandemic's past two years, SARS-COV 2 will certainly continue to circulate in ...African countries in 2022 and beyond. As countries in the African continent need to be more prepared and plan to 'live with the virus' for the upcoming two years and after and at the same time mitigate risks by protecting the future most vulnerable and those responsible for maintaining essential services, WHO AFRO is anticipating four interim scenarios of the evolution of the pandemic in 2022 and beyond in the region.
In preparation for the rollout of response actions given the predicted scenarios, WHO AFRO has identified ten strategic orientations and areas of focus for supporting member states and partners in responding to the COVID-19 pandemic in Africa in 2022 and beyond.
WHO analysed trends of the transmissions since the first case in the African continent and reviewed lessons learnt over the past months.
Establishing a core and agile team solely dedicated to the COVID-19 response at the WHO AFRO, the emergency hubs, and WCOs will improve the effectiveness of the response and address identified challenges. The team will collaborate with the various clusters of the regional office, and other units and subunits in the WCOs supported with good epidemics intelligence. COVID-19 pandemic has afflicted global humanity at unprecedented levels.
Two years later and while starting the third year of the COVID-19 response, we now need to change and adapt our strategies, tools and approaches in responding timely and effectively to the pandemic in Africa and save more lives.
Response to the 2014-2015 Ebola virus disease (EVD) outbreak in Sierra Leone overwhelmed the national capacity to contain it and necessitated a massive international response and strong coordination ...platform. Consequently, the Sierra Leone Government, with support of the international humanitarian community, established and implemented various models for national coordination of the outbreak. In this article, we review the strengths and limitations of the EVD outbreak response coordination systems in Sierra Leone and propose recommendations for improving coordination of similar outbreaks in the future.
There were two main frameworks used for the coordination of the outbreak; the Emergency Operation Center (EOC) and the National Ebola Response Center (NERC). We observed an improvement in outbreak coordination as the management mechanism evolved from the EOC to the NERC. Both coordination systems had their advantages and disadvantages; however, the NERC coordination mechanism appeared to be more robust. We identified challenges, such as competition and duplication of efforts between the numerous coordination groups, slow resource mobilization, inadequate capacity of NERC/EOC staff for health coordination, and an overtly centralized coordination and decision-making system as the main coordination challenges during the outbreak.
We recommend the establishment of EOCs with simple incident management system-based coordination prior to outbreaks, strong government leadership, decentralization of coordination systems, and functions to the epicenter of outbreaks, with clear demarcation of roles and responsibilities between different levels, regular training of key coordination leaders, and better community participation as methods to improve coordination of future disease outbreaks.
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