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Wednesday, October 22, 2014

How Nigeria Defeated the Ebola Scourge

How Nigeria tackled the Ebola virus outbreak
Photo-courtesy: Doctors Without Borders
The World Health Organization recently declared Nigeria an Ebola-free territory. In this report by Guardian, we will be looking at how the country was able to overcome the scourge.

We must commend the efforts of those medical personnel on ground, who showed high level of professionalism, and in the process endangered their lives, to avert what could have become a major national disaster.

I do not forgot in a hurry many prescriptions by those who became ‘doctors’ overnight such as bathing with water laden with salt and making a meal of kolanut. Thank God for the happy ending, but as the epidemic is still ravaging some neighbouring countries, we must not rest on our oars by maintaining a hygienic environment.

So let’s look at the report after the cut…

SO many questions have been asked since the country was last week declared Ebola Virus Disease (EVD)-free by the World Health Organisation (WHO) and the United States Centres for Disease Control and Prevention (CDC). 
    Some are saying, ‘it was an act of God.’ To others, the Federal Ministry of Health and the Lagos State Ministry of Health have excellent disease surveillance and monitoring systems. 
    What really happened? How was the country able to record far lower fatality ratio of 36.8 per cent with only seven deaths in 19 confirmed cases compared to the global average of 70 per cent set by the WHO?
   To the CDC, Nigeria’s success story was due to her strong emergency operations centres (EOC) and polio eradication experience. The EOC was established after the first case of EVD in the country on July 20, 2014, to contain the disease. Dr. Faisal Shuaib was immediately appointed the Incident Manager and Head of the EOC by the Health Minister, Prof. Onyebuchi Chukwu. 
    Shuaib was  highly recommended for the job. Shuaib, who hails from Nasarawa State, studied medicine at the Ahmadu Bello University Zaria and was further trained at the University of Alabama at Birmingham, United States where he obtained a doctorate in public health. He was also once surveillance officer and state coordinator with the WHO in Nigeria before his current job at the Federal Ministry of Health where he is the Technical Assistant to the Minister of State for Health on Immunisation and Polio Eradication and Deputy Incident Manager of the National Polio Emergency Centre.
  Shuaib graduated from the doctoral programme in the U.S. with distinction, going home with the outstanding doctoral student and the dean’s prize as well as the best international student recognition. 
   (Shuaib) said the team did not use experimental drugs in the treatment of EVD during this outbreak but was able to achieve a relatively high survival rate using accepted, high quality standards of care.
   Shuiab said the lessons learnt are that we can defeat EVD and indeed manage any disease outbreak with adequate preparedness, effective coordination, rapid action and cohesive teamwork.
   Besides, a professor of pharmacy and member of the National Expert Committee on Ebola, Prof. Maurice Iwu, yesterday told The Guardian that contrary to some reports that the committee was to meet yesterday, it would be meeting today in Abuja.
      Nigeria has been hailed by the WHO, the United States and indeed the whole world for its efforts in containing the dreaded EVD that has ravaged some parts of West Africa. Shuaib said Nigeria’s success stemmed from three important variables that may have been missing in other West African countries: Firstly, when the index (first) case was confirmed, there was rapid action on the part of the federal and Lagos State governments. There was an immediate declaration of the event as a public health emergency by President Goodluck Ebele Jonathan and mobilisation of human, financial and material resources to contain the outbreak. 
   Secondly, the leadership provided by the Minister of Health, the Governor of Lagos State, Mr. Babatunde Fashola and the Project Director, Nigeria Center for Disease Control (NCDC) Prof. Abdulsalami Nasidi, were very critical towards ensuring the  setting  up of the Ebola EOC by providing it with protected authority and operational space to implement strategies required to contain the spread of the virus. 
      Thirdly, the establishment of the EOC itself was a game changer; the EOC is an operational organ of the NCDC. It operates using a war-room approach with co-location of all actors within a designated facility. Under the leadership of government, international development agencies like the WHO, United Nations Children Fund (UNICEF), CDC, Medicine San Frontieres (MSF), and the Red Cross participate in joint strategising, agree on one plan and implement it in a way that accentuates efficiency and accountability.
    Shuaib further described the structure of the EOC, the component teams and their functions: “The Ebola EOC used a war-room approach to coordinate the outbreak response. The EOC is an assembly of public health experts working under the leadership of the Federal Government of Nigeria. So you have a situation whereby Government and staff of international development agencies are co-located in a designated facility, agree on the strategies, develop ONE plan and implement this plan together. Central to the success of the outbreak response is the harnessing of all available resources towards the implementation of this unified containment strategy.”
     According to him, the Ebola EOC’s architecture is made up of six important pillars: epidemiology/surveillance, case management, point of entry, communication and social mobilisation coordination, logistics and management/coordination.  
  He  said : “The first four are directly involved in the technical aspect of the outbreak control so I will describe their roles briefly.
   “Epidemiology/surveillance: This unit analyses and maps chains of transmission with the objective of stopping them, they conduct a tracing exercise of everyone who comes in contact with a suspected/confirmed case, they also  list all contacts as indicated. The contact tracers who are largely residents of the Nigeria Field Epidemiology and Laboratory training programme, conduct daily assessments of each contact’s symptoms including temperature monitoring. The latter group also coordinates the management of rumours and alerts through proper investigation and triaging.
   “Case management team: This team is responsible for the  strict implementation of standard operating procedures for assessing, treating and caring for suspected and confirmed cases of EVD; they ensure management of other illnesses that are  present with  during the time of EVD clinical management; conduct decontamination of homes and other facilities from where cases are evacuated; ensure the collection of clinical specimens from suspected and confirmed patients; conduct counseling of all EVD suspects and confirmed cases.
  “Point of entry team: This team ensures screening of all arrivals/departures in and out of the country by land, air and sea to prevent importation/exportation of EVD. Screening includes temperature monitoring and analysis of the entrant’s contact with cases of EVD. They also ensure that capacity is available at all border points to properly manage passengers presenting with   symptoms of EVD including ability to isolate them.
   “Communication and social mobilisation team: The communication approach targets risky behaviours to contracting EVD. The team conducts house-to-house interpersonal communication; it also enables the implementation of community mobilisation strategies that uses the leadership and influence of religious, traditional, informal and professional bodies towards preventing the spread of EVD. They also develop and disseminate information, education and communication (IEC) materials that build awareness and knowledge around EVD. The team developed the social media platforms e.g. Facebook, Twitter and EbolaAlert website that were an integral part of the outbreak response.” be continued tomorrow.

Source: The Guardian

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