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COVID-19 response in southern Nigeria boosts surveillance of other diseases

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In many countries, tackling the COVID-19 pandemic has taken cues from other disease approaches, such as lessons from protecting communities against Ebola. But in Nigeria’s Niger Delta, health workers have found inspiration from guarding against the coronavirus.

They have exploited the rigorous surveillance standard set by the COVID-19 response to keep from losing sight of other priority diseases. Mostly what they have learned is how not to divide their attention.

The unifying surveillance strategy they have enveloped is quickly producing significant and – possibly oddly – uplifting results.

“I recorded my first acute flaccid paralysis case since last year while I was following up on the contact of a confirmed case of COVID-19,” says Sarah Oladimeji, a Diseases and Surveillance Notification Officer in charge of finding cases of preventable and infectious diseases in Oredo Local Government Area of Nigeria’s Edo State.

When COVID-19 crept into the southern Delta region in April, health workers had to learn to overcome their worries and hunkered down to the needed work. The odds seemed stacked against the six states that make up the South-South zone: Akwa Ibom, Bayelsa, Cross River, Delta, Edo and Rivers. COVID-19 cases increased daily while community attitudes towards the virus grew lax. Health workers scrambled to manage the time and resources available to respond to both COVID-19 and other endemic-prone diseases.

One solution government teams and health workers hit upon: bring the aggressive COVID-19 surveillance into the systems used to monitor priority diseases.

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Across the Niger Delta, the World Health Organization (WHO) and its partners retrained 3874 surveillance officers who had been mobilized to detect COVID-19 cases in hospitals and communities to also look for acute flaccid paralysis (AFP), polio, meningitis, cholera, neonatal tetanus, yellow fever, measles and more.

After the Government decentralized the COVID-19 response in April, some states began also training religious and community leaders – who are often important decision-makers, influencers and informants – to help find and report suspected COVID-19 and other priority diseases in their communities.

Now, four months into the region’s COVID-19 outbreak, health workers are seeing spectacular efficiency. Detected cases of AFP, for example, increased substantially (doubling and even tripling in one state) between the end of March and end of July as the harmonized surveillance ramped up.

Protecting immunization gains

Keeping eyes on both COVID-19 and other diseases, most of which are vaccine-preventable, is an important but challenging task in the Niger Delta where immunization coverage had been low for years. Located along the Niger River and the Gulf of Guinea, the Niger Delta, or South-South zone, comprises a system of coastal communities that rely on farming and fishing. Waterway systems here are often inadequate and moving around is difficult. In the past, residents in the deepest riverine communities, far from a mainland, had little luck accessing a health centre. Many were discouraged by the distance from taking their children for vaccinations, which led the region to its poor immunization coverage and thus heightened risk of disease outbreaks.

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Since 2016, community engagement, better access to health care and increased surveillance have led to rising numbers of vaccinated children. Health workers now attend patients in on-sea treatment centres or travel into the deep-river communities by canoe to provide services.

Navigating the creek communities may be hard but health workers accept that medical care has no boundaries, says Dr Edmund Ogbe, WHO Coordinator for Bayelsa State. Public health commitment and resourcefulness seem to be ingrained characteristics of this region.

Increased detection of measles and yellow fever

To protect their gains in immunization coverage and keep from neglecting other worrisome diseases in these times of COVID-19, the integrated surveillance is making a difference. In March, Bayelsa State recorded nine cases of AFP. But 16 new cases were investigated over the next four months – a 180% increase.

With COVID-19 case findings now meshed with the systems used to detect and report priority diseases, more cases of measles and yellow fever are emerging, too. The reported numbers of both diseases increased considerably between the end of March and the end of July. In a couple states, case detection nearly doubled.

The next step will be to accelerate case search throughout the region. State governments in the South-South zone, supported by WHO, continue to train more surveillance officers and community informants on combining COVID-19 and preventable-disease surveillance. Involving communities by educating them and appointing them as public health informants will help ensure that the combined surveillance continues to be a success, says Dr Olubowale Ekundare Famiyesin, WHO Zonal Coordinator of the Niger Delta.

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Early detection of any disease is the goal for health workers in the Delta. “All resources for surveillance at our disposal will be deployed to improve early infectious disease detection and reporting, including COVID-19,” Dr Famiyesin promises.

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Health

Every year, 1.9 million people die from tobacco-induced heart disease – Report

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tobacco responsible for 20% of deaths from coronary heart disease

 

Every year, 1.9 million people die from tobacco-induced heart disease, according to a new brief released on Tuesday by the World Health Organization, World Heart Federation and the University of Newcastle Australia ahead of World Heart Day, marked on 29 September.

This equates to one in five of all deaths from heart disease, warn the report’s authors, who urge all tobacco users to quit and avoid a heart attack, stressing that smokers are more likely to experience an acute cardiovascular event at a younger age than non-smokers.

Just a few cigarettes a day, occasional smoking, or exposure to second-hand smoke increase the risk of heart disease. But if tobacco users take immediate action and quit, then their risk of heart disease will decrease by 50% after one year of not smoking.

“Given the current level of evidence on tobacco and cardiovascular health and the health benefits of quitting smoking, failing to offer cessation services to patients with heart disease could be considered clinical malpractice or negligence. Cardiology societies should train their members in smoking cessation, as well as to promote and even drive tobacco control advocacy efforts,” said Dr Eduardo Bianco, Chair of the World Heart Federation Tobacco Expert Group.

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The brief also shows that smokeless tobacco is responsible for around 200 000 deaths from coronary heart disease per year. E-cigarettes also raise blood pressure increasing the risk of cardiovascular disease.

Moreover, high blood pressure and heart disease increase the risk of severe COVID-19. A recent WHO survey found that among people dying of COVID-19 in Italy, 67% had high blood pressure and in Spain, 43% of people who developed COVID-19 were living with heart disease.

Governments have a responsibility to protect the health of their people and help reverse the tobacco epidemic. Making our communities smoke-free reduces the number of tobacco-related hospital admissions, which is more important than ever in the context of the current pandemic,” said Dr Vinayak Prasad, Unit Lead of the WHO No Tobacco Unit.

Tobacco control is a key element for reducing heart disease. Governments can help tobacco users quit by increasing tax on tobacco products, enforcing bans on tobacco advertising and offering services to help people give up tobacco.

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COVID-19: Lagos health commissioner, Abayomi tests positive

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The Lagos State Commissioner for Health,  Prof. Akin Abayomi, has tested positive for the coronavirus disease (COVID-19).

Gbenga Omotoso, the state Commissioner for Information and Strategy, disclosed this in  a statement issued on Monday.

The statement also added that Abayomi had close contact with persons feeling unwell who tested positive for COVID-19.

“Subsequent to close contact with persons feeling unwell and testing positive for the COVID-19 infection, the Honorable Commissioner for Health, Prof. Akin Abayomi, has tested positive for the virus.

“Professor Abayomi became aware of his status following the required testing protocol of contact tracing procedures,” the statement partly read.

The commissioner who had no symptoms of the virus, is adhering to the protocol of home-based strategy in the state.

While embarking on self-isolation for the next 14 days, he will still continue to discharge his duties both as the Deputy Incident Commander of the Incident Command System for COVID-19 and as the Commissioner for Health.

Meanwhile, members of the State Executive Council wish him a speedy recovery during the period.

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COVID-19: Imo govt. launches innovative mobile health insurance with support from WHO

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The Governor of Imo State, Mr. Hope Uzodinma last Wednesday launched the innovative Mobile Health Insurance Programme in Owerri.

This mobile health insurance initiative has been designed with support from the World Health Organization (WHO) to achieve seamless coverage of the over 96% population in the informal sector of the State on health insurance while reducing the existing out-of-pocket expenditure of 92%. The mobile platforms in addition, provide automated opportunities for philanthropists to graciously adopt the poor and vulnerable on health insurance.

In his remarks, the  Governor appreciated the leadership role of WHO in the health sector of the state and globally especially in the ongoing fight against COVID-19. He added that the state government depends strongly on the genuine and constructive partnership of the World Health Organization towards achieving Universal Health Coverage (UHC).

Governor Uzodinma added that WHO supported the state, with the design and flag-off of the Health Insurance Scheme, which now culminates in the launch of the use of mobile phone technology to pay for and access Health Insurance, the first of its kind in Africa towards   ensuring that people can get quality health services, where and when they need them, without suffering financial hardship.

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He restated his commitment to repositioning the entire Health Sector in the State, while requesting WHOs renewed partnership in “PHC revitalization, full implementation of the State Health Insurance scheme to provide access to essential Healthcare to Imo citizens at primary, secondary and tertiary levels of care, revamping of our Health Security, Emergency preparedness and response, and overhaul of the drug revolving scheme to eliminate the issue of fake or substandard drugs in our hospitals.”

Speaking at the event, the WHO Nigeria Representative,  Dr Walter Kazadi Mulombo appreciated the government of Imo State for placing the health of her people high on overall agenda of government. While recognizing that the COVID-19 pandemic has further exposed the vulnerabilities of the global health systems, he pledged WHO’s continuous support within the 13 General Program of work and the State Health Strategic Development Plan.

Dr Mulmbo said that WHO recognizes the peculiar needs of each population from others and thus, makes deliberate efforts to fashion out the health system that works for them based on their needs.

He appreciated the level of political commitment to health in the State and expressed confidence that if sustained, the State and WHO will together promote health, keep the world safe, and serve the vulnerable.

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WHO already supported the State with core health financing analytics with development and printing of the State Health Financing Policy and Strategy, operational guidelines of the State Health Insurance Scheme key operational documents for the State Primary Healthcare Development Agency, as well as laptop computers, some of which were presented during the event.

The high point of the event was the conferment of the title of “Oche Ndu 1 (protector and preserver of life) of Imo State” on Dr. Kazadi on behalf of WHO, by the Chairman of Imo State Traditional Rulers, in recognition of all the lives that have been saved through the humanitarian work done by WHO in the State.

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