University of Nigeria Virtual Library

Serial No.

Author 1

NWAKOBY, B.A.N

Author 2

Author 3

Title

Operational Research Project on Communicable Diseases Surveillance in the Republic of Nigeria.

Keywords

Description Operational Research Project on Communicable Diseases

Surveillance in the Republic of Nigeria

Category

Medical Sciences

Publisher .

Publication Date

August, 1989

Signature

OI3ERAT IONAL RESEARCH PROJECT ON CCMMUN ICABLE

D ISEASES SURVE ILLANCE I N THE FEDERAL REPUBLIC

OF N I G E R I A

A REPORT ON Tt lE A C T I V I T I E S OF THE OPERATIONAL SUSPPORT TEAM ON CCMlvlUNICABLE D ISEASES CONTROL

I N N I G E R I A

S tl B r e w - G r a v e s

M P M a n d a r a

0 Tornor i

G M R Munube

B A N N w d k o b y

2 C A M v a n Vliet

S 0 O k o k w ~ i

V I E z i k e

J A A d e n i j i

LAGOS, AUGUST, 1989

LIST OF CONTENTS

PAGE

'. I. IMTI~OUUCTION

1 . 1 R A C K G R G i J N U II\II'OI?MATION

- ilislorical Background I

- Recent Epidemics Since 1986

2.c TERMS OF R E F E R E N C E A N D OBJECTIVES

3 .O STRA'TEG IES FOR IMPLEMENTAT ION OF TilE PROJECT

3 . ' Concept of Emergency Zanc I

3.2 Gcogrxpl~ic;ll Rcconnaissdnce 5 .

4.0 OPERRT IOI\IAL RESEARCi l D O C U W I T

- Actjv:ities a t thc Stdte Level

- Activities d t the Local Government Area Level \ '

- Activities a t t h e Peripheral ilealth Unit Level

- F u l l ow-up Visits

5.0 FINDINGS A N D RESULTS

5. 1 Initial Asscssmcnt dnd Training Visits

- Bcnue Sta-Le

- Crxss River State

- Bauclli S t i l k I

I - Niger and Kaduna Stata

6.C: FOLLOI'I-UP V IS ITS

- Bcnue Stat(?

- Crxss River stat^!

Page

93

65

68

72

7.0 EVALUATION OF TiIE PROCEDURE FOR EMERGENCY NOTIFICATION OF D I S E A S E WTBREAKS USING WTOREAKS I N CRDSS R I V E R , BENUE AND OYO STATES

- Suspec1:cd ou!hrheak o f YF i n Cross Rivc!r' Sta te 82

- Suspected outbrezk o f Lassa Fcver i n tlenue S t a t e 83

- Susp~ctecl case nf YF i n Qbomosho, Oyo State 84

- Outbredk cr-F Typhcid Fever i n Qbomosho, Gya S t a t e 86

- Cibscrviltion i lnd ConcI us i ons - 8 6

8. C RECOMMENDAT IONS ON D ISEASE SU RVE ILLANCE 87

9 . C ACKN OblLEDGEMENTS \ 9 0

ANNEXES

ANNEX 1 - Routine (mon th l y ) N o t i f i c a t i o n Form

ANNEX I I - Emergency ( immediate) N o t i f i u a t i o n Forms Forms END0 1 & 2

ANNEX 111 - Case D e f i n i t i o n s .

I N ~ . R O O U C T I O N

1 . UI~CIGRWND INFORMATION ADCUT E P I D E M I C S I N N I G E R I A

1 . 1 i-1ist;oricill Backgr-ounci ---------

I\l:igc.r:i~l t ins over t he Iilsl: century b w n plagued with cpidernics o f

' .various coi~lmunic~ble discases which unti 1 the causative agents were

isolated had often times been regarded as the wrdth o f the gods. Of the

comniunicabIe diseases, f 3ve are of very important pub1 ic health attention

due t o the frequency of occurence and high fa ta l i ty rate associated w i t h

their outbreaks. These diseases are ye1 low fever ( Y F ) , cet'ebrospina1

meningitis (CSM), cholera, typhoid fever dnd lassa fever.

Niger-id l i e s within the Yellow Fever endemic zone i n Africa

(bct.wccn p d r d 1 1 el s of 1 ti tude 1 5 ' ~ a n d 1 0 ~ 5 ) . Urbm outbredks occurr-ed

i n Ldqos dtid Accrd as fdr b d c k as in 1925-26. There was d long quiescent

pcriod u n t i l 19CO when mother. outbredk in Nigeria resulted in an \

es t i rn~ ted 100 ,000 cases w i t h u p t o 40% fatal i ty rate.

Recur5rcni; epidemics of cholcra have occurred in Nigeria sfnce 1970

d n d t h d t o f ccrebrospina1 mcningi t i s i s now d n a n n u d l phencmenom. Typhoid

i s cansidcred unnecessary by some h e a l t h warkers.

1 .2 Rcccn L Ep:idem:ics S:ince 19 86

Mass imnun i z d l j o n progr;lmmes embarked upon by various governments

a a a l n s t clllldl~o~d and othcr communicable diseases in the wake of t he .

g l o b d l s!:r.al:egy of universal immunization created a fa1 se sense o f

"cradicat;iori" o r most: disc(~scs until 1986 wt1c.n Nigeria wds s t ruck by an

u ~ w x p c c t c d cu-!:br.edk of ye1 low fever. The outbreaks occurred almast

s i m u l taneausly .in O j u LGA in Benue Stale dnd Dgoja LGA in Cross River

S t i l k . These twa l o c a l government: areds border each other and i t is

difficult: ;lt: t11e moment t o identify the actudl epicentre.

S i x months l d t e r , ie 1987, Oybornostio LGA in Gyo State, Mariga in Niger

S-1:at:e d n d Kacli:ia in Kaduna Stdte a1 1 over 500 kilometres from O j u had also

been hit: l?v !;Iw epidemic. By 1980, Fika and Fune LGAs in Borno State as well

a s Misau , ~ n d Stlira LGAs in B a u c l i i , had been affected. Ch the whole,

o v e r 25 LGAs in 10-1.2 States were dffected by the epidemic. The exact

prevalence mi incidence are u n k n o w n since a large percentage of cases are

e i ther n o t recognized or9 even when recognized are n o t reported. I t was

discuvercd during t h e v i s i t s of the operational support team t h a t morbidity

and mortilIity during epidemics dr'e under estimated by a f a c t o r sometimes

as h i g h as 1000. Tllis was the case in 1969 when 208 cases with 60 deaths

vrcre o f - F : i c i d I l y notified as against 100,000 cases w i t h 40% f a t a l i t y ra te

detcrr-nined by epidemic1 ngicaI investigdtion. Conclusive figures fo r the number

o f cdscs and deaths r e c ~ r d e d during the 1986-88 yelIcw fever Ppidemics have not

bccn ~ b l : i ~ : i r ~ r d s i r i cc o F f l c i a I f igurcs released irr-e d fdr c r y f rom the estimates \

caIcu1ai:ed during the control ac t iv i t i es . To complete t he yearly scorge, i n

March and Apr.il lgm, there were outbreaks of Lassa fever in Ekpoma i n BendeI,

Aboll-l4bdise a i d A h in Irno and Oju in Benue States. Not less t h a n 23 people

c1ic.d jnclucliny 5 rr~edicaI doctors, some of wtiorn were involved i n the management

o f the cases . It; !:aok a teIepl ione c a l l from the Centre fo r Disease Contrlol .

( C D C ) , At;lan!:il in USA, t c a Nigcridn friend t o investigate the poss ibi l i ty of

L ~ S S J ~ E J V P T ' in Nigeria. This was necessitated by t he sudden death of a middle-

aged PJiger'.'lan who rci.urwd t o the United S t a t ~ s of Pmerica a f t e r spending his

vdca t i~n in Nigericl. Investigations df ter this phone c d l l reveilled tha t some

r e l ~ t i v e s o f [:Ire .indc.x case lwre in Nigeria had already died w i t h features

suggcstivc o f lass^ fever.

The f ~ l : d l i?:y rilte clssocidt:etl itt ti epidemics i n Nigeria is usually high

Ixcause of I a t c I-ccogrii1:ion of tllc di,scase concerned. Thcre i s thus an .

unw;lr.rilni:cd l o n g interval (3-5 months in the case o f Oju/Ogoja yeIlow fever

epidcm:ic ) I~et:wcc.ri the outbreak tlnd the inst i tut ion of c o n t r o l measures.

2. TERMS OF REFERENCE AND OBJECTIVES

2.1 The dim of the @er5at:ionill Resedrctl Project on Communicable

Oisedses Surveil Imce i s t o develop d system whlch should have

sufficicnl: sensitive indicdtors t o detect a n impending epidemic

wr31y c.nouyli 1:o avoid unnecessary dedth and d i s d b i l i t y . I t

should h a v e inbuil t pr~ldictive indicators which wiII serve as

an "Early warning systcm" well before an epidemic occurs.

Epidcrnics usual l y s t d r t in remote, peri pheraI communities

~ 5 t h t h e nearest health u n i t being e j ther a dispensary or a heal th

post. This medns t h d t for the surveiI Iance system t o be suff ic ient ly

sensitive d n d r-el iable, hedl th d a t a must regularly be collected

di: tile peripheral health units , colliited and p a r t i a l l y analysud

by the I-oral Government ileddquarters s ta f f before submission t o

tlir:! S t ~ t : c Epider~liologio~ll Unit. . \

The current situation i n the health informaticn dissemination

shows I;liill: lwaI Lh \ilor*kc.rls a t these pcriptiera 1 levels from which the

d a t a i s generated do n o t have the motivation nor the sk i l l s t o

cuIIc.ci: and p;lrti;lI Iy process epidem:ioIogicaI d a t a .

TIic! objectives of the project are:

2.2. I 10 acquaint PcrTiptieral Hedl t t i Workers (PiiWs) w i t h

t h e c d s e defini t ion of selccted diseases and t o develop their s k i l l s in the presumptive c l in ical

diagnosis of t hese disedscs based on t he cl in ical case Iiist,orics provided for them. The selected diseases include Yel lcw Fever ( Y F ) , Cerebrospinal Meningitis(CSM),

Cliolcr*a and Typhoid Fever fo r which immediate notif icat ion

i s manddtory when d single cdse occurs o r is suspected.

2.2.2 To 1:r-ain the Pi-INS, in the process of proper recording

u f disease inFormt:ion on d modificdtian o f the exist ing

n d t i o r l d l Iy appr-oved disedse reporting form.

2.2 .3 To make t h e PilWs ciware of the need for urgent

noliFic~tion and dispatch of such information 1.0 LIw next Iliglier level .

2.2.4 To develop the sk i l l s of the Pi-IWs' for d a t a

ccllot9on ilnd simple drlalysis, includirig t h e

'grilpliic plotting of disease incidence, entornologIca1

and rnetearolagical d a t a , the use of such analysis

t o determine e a r l y warning signs of occurence

[ I F epidemics.

2 . 2 . 5 To test-run a new form for disease surveiIIance

designed by ?Ae Ndtiondl Ta,sk Force on Epidemic

Diseases ( N T F E D ) d n d t a obtain comments of the PiWs on improving the new forms.

2.2.6 Tu identify trainer's/facilital:ors among the PAWS

wllo \.rill participa-t:c in training other PilWs on d d t d coI 1 ec t im, co l ldtion, analysis and notif icition.

2.2.7 To w r k wi,Lli tlic sc lected trilinerslf dci : i tators \

i n developing training rnoduIes for training other

Pi-ILIs . 2.2.8 To cval uiltc ( d n d provide where necessary faciI i t i e s

required t o make) the Iledlth units of t h e trainers/

fdci 1 itdtors suitdble as :

( ) Training centres for other PYWs

( b ) Sentinel centres for monitoring

cornrnunicablc diseases.

3. STRATEGIES FOR IMPLEMENTATION OF TtlE PROJECT

3.1 Cnncept o f Emergency Zone ---- - 3 .1 .1 Nigeria as a whole I ies within the yellow fever endemic zone.

However', the central t h i r d o f the country consisting o f about

j O S!,;lt:~c d n d having a population a f near ly 50 mill ion peaple is

prone t:o r-ecur'rent outbredks of yellow fever. The l a s t lmajor

oui,break which occurred in 1986 had Oju dfld/or Ogaja a s i ts

cp icent t ' c . Ldter outbreaks in Ogba~noslro LGA i n Oya Std t e and

Mdr'iga L G A in Niger Stcltx were t h o u g h t t o have spread from the

Oju cpidcniic. By ldte 1907 and ea;.ly 1908, nearly 12 States had

been affcct;cd. The States regdrded d s being in ttle Emergence I

Zune ilr'c Uyo, Kwril, Niger', K d d u n d , PIdLeau, Uduclli, Gongold,

Oorno, Oenue and Cross River.

3 . 1 . 2 7'1ic eleven ( 1 1 ) Sht:c.s iri tlie Nortliern part of Nigeria \

i n c l udiny A b u j ~ dre considered 1 ocdted within the "Meningitis I

bell:". Tlwsc States are Kwara, Niger', Sokoto, Kaduna, Kano,

P l c t t e a u , C~ucli:i, Gongold, Borno, Benue and Abuja.

3.2. 1 Seven Stlatcs were selected fo r tile exercise based on t h e i r

expcr'ience o f one epidemic or dnother. Five of these (Benue,

Cross River, K a d u n a , Niger and Gya) 1 i e within the Emergency Zone I

f a r YF. 1wo Operationdl Suppart Teams, each comprising an

Epjdeni'lologisi:, a n Entornolog i s t d n d a Virologist were farmed for

Lht. exercise. 7hc cauntr'y w ~ s d i a n ~ t r i c d l l y d ivided i n t o Edst

i ~ n d Plcs!:, eilcli p a r t was covered by a team. The "Eastern Team" . .

covcrw Cross River., Bcnuc., Bauchi and Dorno States. Bo th teams

wrl:cd tcge ther i n Gyo S!,;lte in order t o harrnoni se thei r a c t i v i t i e s

Ixforc. tlic "IksLer'n Team" covered Niger m d Kaduna States.

3.2'. 2 An i n i t i a l assessment and training v i s i t was made Lo

edch O F t l l c selected Stdtcs. The v is i t s afforded t h e

terns 1:lie opportunity t o evdl udl:e the d i s e d s ~ reporting situation I

incl ud ing t h e qua1 i t y and frequency o f flea1 t h d a t a reporting.

. . llie teams a l s o looked into t h e a v a i l ablc mdnpowcr, mater ia ls

and other' flcccssilr'y requ j rwnents.

3.2.3 A t t t i u S t a t e Ministry ievel , the teams f i r s t pald courtesy

c a l I s on the Cummissioner o f ilealth and the Director-General.

Next , the team held meetings with the tectinica1 s t d f f

i n v o l vccl with disedse prevention d n d control -Directors of Disease

Curl t.rx 1 drid their. s t a f f , stdff' of the S t d t e EpidemiologicaI Units,

dnd occdsionally staff involved in particular disease control

programmes. ~ 3.2.4 /\I: t:hc LGA lcvel , ?:tic terns again f i r s t paid courtesy cal ls

i \

on the L G A Cllilirrnen d n d their secretaries. Such meetings provided

the opportunity LO bri'ef t i i c s ~ pol i t icaI leaders and t o so l i c i t

thci r. conin~itmen l; and support.

3.2.5 M e x l , the tems held mcetings w i t h the staff o f the LGA

i-lca1 t t i Dcpilrtmcnt. Pt'cvious health returns were evaluated and

3.2.6 Four poripherdI Iiedltti units, evenly spread within the LGA

wrv sc.lccl.ed by thc klcdd o f the LGA %dlth Depdrtrnent. The

four' sc1cct:cd Iwaltli uhits )!ere of different grddes and different

saur'ccr; u F funding (onb State-supported, one LGA-supported, one

v n l untary agency-suppokted and my ~ t h c r faci 1 i ty ) . The staff I

o f t h e chosen health f dci 1 i t i e s were trained on the exercise.

4 . OPERAT IONI\L RESEAIICki DOCUIIENT

The opcrdtiondl Resellrch Document was drawn u p by a group o f experts

corllprising a n Epidcmiolagist, d Virologist. d n Entomalogist and a Public

fIt.c111.11 Pllysii: i d [ , . Tti i s Rc~seclrcll Documcnt prav ides g u i d c l i nes on I

communicable diseases survei 1 I m c e and control i n t h e Federdl Republ i c I

of lligcrid. The guidelines gave psopasdls f o r tl?c surveillance and

cantrcl a f the f au r ( 4 ) most rdcent epidemic d i seases namely - Yellow I

Fever, Ccrebrospindl Meningitis, Cholera and Typhoid Fever. Cri teria

f a r q u i c k cl inical diagnosis m d for s u s ~ i c i o n o f an impending epidemic I

were included. Strategies fo r inter-epidemic control of these diseases

( in order t o void future ~ ~ i d e b i c s ) were also suggested f o r yellow f eve r

m d ccrebrvspincll meningitis, bhscd on dvaildble infermatian. Areas of

further rcscarcli La support the preposed control strategies were proposed

fo r t h e two ciisedses. In preparing t l i c . protocol, the group made liberat \

use 2F a l l dvailable p u b l i s h e d d a t a including the working papers,

delibcri-lticns arid recommendations of the Ndtiandl Task Force on Epidemic

Discascs Ccntrnl .

4.1 M d t : ~ l ' i i l I s and I.tel:liodnlcgj -----------

Two Gpc.rdtiona1 Support Teams were formed f'or the exercise. I

The teams visited seven ( 7 ) States - Benue, Cross River , Oyo, Bauchi,

Niger-, B ~ r n o d n d K d d ~ n d . In each S t a k , meetings and interviews . i i

' 1

kieiTe u a n d u c t ~ d a t 3 levels vi ti1 the appropridte health personnel.

Tliese w r e the S t a t e level, Local Government Area ( L G A ) level , and /

! 1:llc Per41)l i~r~~l ikdl t t l U n i i t ( P i l U ) level . I

4 . 1 . 1 flc1:iv:i'iies at; 1:lw S t d k L ' C V C ~ -- I

Tlw rir-st: dctivity a t ~ ~ 1 ~ 1 1 S t d t e wds pdyiny courtesy ca l l s

on the S t d k Coni~nissioner- for ilealth, ttie Director-General, the .

Chief il~i31t;h Officer and the Director of Disease Control.

This i s follaw~d by a mr:etin$ with the relevant teclinical s t a f f - Director

a ' D:ismr;c Cuni . r 'o l , State P r j r n a r y i-lealth Care Coot-diniltor and staff of the

( i ) DcI!:~ CUI I~c1:ion Activil~ies

( d ) The d a t a received :frc!r peripheral health u n i t s and LGAs .

( b ) T t w f o r m being used to c ~ l l cc t di l ta .

( c ) The dates and reguIdrity of rec~iving such d a t a .

( ( 1 ) T l ie compIeLeness of the returns.

( c ) The dni~lysis carried o u t if any .

( f ) 11Jhcw arid t o whom notification i s made i n

tImes o f disease outbreaks.

( i i ) Vcci;c!t- Co~itrol Rctivi !lies ----.---. ---

( 3 ) / k v : i e ~ t h e vector control act ivi t ies a t the

S'tilte level.

( b ) Review of aum:~n and material resources for vector

corltral, Chly 1-2 Stdtcs o u t o f the 7 States visited

l ~ d d an Entomologist on tier staff l i s t . Most of them

t~owvc.r, tlitve mosquito scouts.

( c ) Nc! coordinated vcctor control activity was f o u n d in

my a f the States visited.

( i l i ) Mc.!:caralnqlcal Date1 Col lcction - . - . -- - -. -2 -- - _- -_ .- -- Nunc o f the S?;ales visited had a meteorological unit.

i l o w c v ~ r , t h e 0perilt.ional Support Team i s ioaking into the

possibillly of using the ~neteoralogicdl d d t d ~f the Geography

( i ~ ) S t a f F u f the Statc Epid~rniologic~l Unit i n each State visited

wcrc trained on d d t a collection, collation, analysis and

dlssemindtion including fccdbdck t o the LGA i iea l th departments/

. ( 1 1 ) Some staff were a l s o trained on col lection and

iden-t:ificat:lon o f mosquitoes. They were also t a u g h t

haw t o r-ecord the monthly collections as well as

plot!:ing the figurcs into graphs. '

4 .,I .2 Loccil Gov~!r~nrr~err l: /Irked ( !LGA) ~ c v e 1 ' --------

At the LGA level , the f i r s t act ivi ty was paying courtesy

cell 1s uti tlie Cliilir~ndti and Secretary of the LGA. This was

usually .Followed by d rnecting with s ta f f o f the LGA Health

The f-ol1ow:ing c l a r ; s ~ s of iieal t l i information were reviewed

in each of the 7 LG05 vjs i ted:

( i ) h t a Collec t ion Activities --------..------

( i l ) 'i'lir !:~il~iis w n l , LhrY~ugl i the reporting forms previously :in use.

( b ) k n t : .tiiruugli t h e records f o r the number of Ileal th

f d c i l i t i e s in t l ~ e LGA !:hat sent in returns fo r the f i r s t

clusrtcr- of 1983.

( c ) Assessed the cnmpldteness of d a t a sent in from the

( i l ) Mosquito scouts wer'e trained by the EntornoIogist on how t o

C J toti and identify masquitoes. The essential materials

rXequi red for coil ecltion of a d u l t rnosquitces and recording

such as flash 1 iglit, bat teries, test-tubes, c o t t o n wool and

( b ) llie mosquito scouts' so trdined were tt iougllt how t o record

t;liei r moritlil y mosqulit:o col lections on graph paper.

( c ) The significance of a rising mosquito (Aedes) p o p u l a t i o n and

?;lie n c m l t o rcport such a finding t o the appropriate authority

blitli the as,cist:mce of the ilead o f L G A Yealth Depdrtment,

f ~ u r ' (4) Ilcilltli f a c i l i t i e s evenly spread within the L G A were

sc. lec1:c.d Tor- 1:lic. c x c r c isc.

(;1) SI:c~F-F o f tlic LGA k a l t l i O f f ice were trained on ccl lat ion

of I w a l t l i returns from i t s peripheraI health units.

(I?) SOW sLd fT wr'e trained on how t o coIlect dnd identify

mosquitoes.

( c ) Staff of the LGA ijealth Department were trained on how

t o p l o t reported cases of the four diseases under study -

Y F , CSM, Cliolcra and Typhoid into graph paper. They were

a 1 cu tduglit I I O W t o recor-d weekIy mosquito coI Iections and

(IC tlic end of each month p19-t the figures into graphs.

4. 1 . 3 Pcr*i~Pter.dl ilcalth Unit (Pi.IU) Level

In e;icli O F the LGAs vis i ted , four ( 4 ) Iledlth faoil i t i e s were

se1eci:ed for the study. Ckle State-run, one LGA-run and one or two

NGO-run I i ~ a l t h units evenly spread within the L G A were selected and

visited.

The following activitSer; were carried o u t in each periplwral

u n i t v is i ted:

( i ) Da!:a Col I et:t;:ior~ Activities -------a -- ( a ) Go:iny 1;Iir'ougIi ttle ouf:patient/treatnient, registers t o

( b 1 Going t t i r ~ o u g l ~ the previous rcporting forms and assessing

thc nmnpr- o f comuletion. The team dIso looked into

prXnblcn,s being encountered in cornplcting the forms.

( c ) Guing I:hr'ougl~ t h e case definitions developed t o

lwl 11 pcr'ipl~crdl Ileal th workers ( P i lWs ) i n reaching

quick clinical diagnosis of the four diseases under

s,Ludy.

( d ) Training thc clinical stdff on how t o use the newly

jntroduced notification forms, and how t o p l o t cases seen

or suspected nf the four diseases into graphs.

(c .) Stressing the need for prompt notification even with

d mere suspicion o f any o f the diseases being studied.

j i i ) Vector Control Activjties

liiformdtion on vector (mosquito) co l lection tectmiques and

idcntif icdtjun o f Aedes were given t o 2 health attendants in each of

t h e Iiedl-!:I1 units. The following ski1 1s were incul cdted into these

s?:3 Ff : \

( 2 ) Mosquito collection techniques between 4 and 8 pm.

( b ) Mctliods O F counLing a n d identification of Aedes type

o f mosquitoes.

( c ) Tile rationale nf weekly mosquito collections.

( d ) Keeping proper record of collections and also storing

the i ~ d u l t mosquitoes for col lection and verification by

more experienced c o l l c a g u e s from the Arbovirus Research

Depil r-?:~n~ni:.

( e ) Plot?:ing of weekly Aedes mosquito counts on a graph paper

d n d dppr'cciating the significance of upward fluctuations.

) The importclnce a f discussing the upward f 1 uctuations w i t h

the o l i n l c ~ l colleagues t o ascertdin if there is a simultaneous ir~creclsc i n ?:lie nunib~r o f cases suggestive of yellow

fever disease.

4.1.4 Follow-Up Visits --------

Monthly f o l l a w - u p visits are p l a n n e d to e v a l u a t e t h e

e x e r c i s e and r c t r d i n s t a f f where necessary. T h r e e States have

been re-visited after t h e initial con tac t . The team found

~ i r l ~ n c o u r a g i n g impravement i n the disease r e p o r t i n g w i t h

prompt n o t i f i c a t i o n o f suspected disease outbreaks.

5. FINDINGS A M l RESULTS

5.1 1n:il:idl Assessment; clnd P r 8 d i n J n g Visits -- Initid1 assessment and training vi'sits were pa id t a t h e

. selected Statss b e t w ~ e n Apr i l and June 1989. The f i n d i n g s during

t hese visits were a s follows:

DENUE STATE: 10-14 A P R I L 1983 - 5.1 . I Oju Locdl Government Arm was chosen f a r the exercise i n this S ta te .

5 . 1 . 2 -/-I)(-? f o u r - ( 4 ) IiedIth units selected for t h e exerc ise were as

f o l lows:

* O j u L G A klealtl~ Clinic d t [gede Centre (LGA-suppor-ted)

* Obusa iledl t h C l inic (LGA-supported ) * ILo Bdsic i-ledlttl Clinic (State-supported)

* Bethesdil i lospj t a l , Ikacli i (Bethesdd Miss ion tiospiTa1)

5. 'i - 3 StclFf 1:r.ctinc.d on d iscclsc d n d vector survei 11 mce.

Miss Ab:igcl.il Q b a d a

Fir. I s d i ~ l ) Udenyi

P4r L Egbc

Mr Jackson Ajigcl

Mr Jmes m u m MI. Jnlm Olrrugo

M r A Oltupd

Plr J Obdndr.

Mr. E Qnenkd

\ Designation Training Given

Senior Midwife Disease Surveil lance Comni . ileal t:h I t 11

Ext. Worker

Cornrn. Heal tti Officer I1 11

Midwife II I I

Snr. Camrn. iiealth I I I I

Supervisor

Snr. Corm. i-kalth [ I In

Assistant

Cornrn klealtli Asst. I I II

ileal t h Attenddnt Vector Surveillance

FREQUENCY OF ifEALTii U N I T S I N 13 L K A L GOVERNMENT AREAS ---- - - SUDM TTT I N G RETUI?NS TO T i iE STATE EP IDEMIOLOGY U N I T AS OF ----- --

JAPIUARY W M -- --

TOTAL RECE I V E D

-- .

6

6

1

7

6

12

2

6

3

18

0

0

0

6 7 ---

NO. EXPECTED N.8.U NRR TNRE -

X SUBMITTED

Ni lU = I\lumbc.r. of F le ;~ l t l i U n i t s i n LGA

MRR = Number of Reports Reccivcd a t S t a t e Level

TNRE = T a t d l Number o f Rcports Expcctcd a t S t d t e Level

As shown in tllc t a b l e , ttie submission of weekly and monthly returns

by H ~ l t l i Un i t s t o Sta t e level ranged from 0%-8%, giving an overal l

ilver'i-igc af I . I % . Ttre Stiltc Epidemialogical Unit cannot therefore be

expected t o submit t o {:lie Federdl level a meaningfuI mani;lily or even

quarter ly repart.

Thesc findings were corif i rmed by tile Chief ilealtti Officer who

attributed this Lo Iack of political comitm~nt and the a v a i l a b i l i t y

~f Funds t a support and motivate the s taff f i l l i ng i n the numerous forms.

This has in the p a s t years Icd t o the unsavoury situation in which

epidemic diseases reports dre received thrqougli the Governor's Off ice

or* f i r s t learn-1: by the Chief ilealttl Officer from the news media.

Tlie Cliief iledl t ' l Officcr cornpl imented t h e group for having picked

fa r study ttic four most important epidemic diseases in Benue State

p ~ ~ t i ~ u I a r l y iltld Nig~ria as a whale, She furtlwr pointed o u t t h a t t h e

s t r d x g y o f v d c c indling school children against cerebrospinal meningitis

(CSM) whic-ti :is part; o f tile Guidelines an Epidemic Disease Control had

reduced CSM from an cpidemic t o a sporadic disease in the state .

/\I; t l i e time of this visit:, there were ,reports of Typhoid epidemic

( ~ ~ n c o r i f.l r-riled ) , ;7nd sporddic cascs of CSM.

Returns from I ) ~ r i p i ~ ~ t . a I ikrlltil Units t o t h e LGA ilealth Office -... .- - ( l i l y LGA-supported Iledlth units send their reports t o the LGA

i-leadqui~r'!;ers. T l w Mission and State supported ifealth Institutions repart

Very 1 it:l;lc if any col lation i s done a t the LGA deddquarters.

Returns frcin t . 1~ L G A i-lealtli O f f ice t o the State Epidemiological Unit ------- A t O j u LGA ileadquarters, i;her;e are three ( 3 ) possible officers who

c o u l d d o tile handling of the reports from the peripheral health

instiI;u!:iuns. Tlicse are the i le~d of tlie i l c a l t h Department, the LGA

P X CoordindI:or and t h e Assistant L G A Pi-IC Coordinator, There seemed t o

be some confusion as t o who wds responsible for d a t a handl ing a t the

ilcaIth OFficc. This c o u l d explain in part,, the absence of O j u returns

for Jdnudr'y, Februilry and Mtlr-ch, 1989 a t the State level.

3. i -5 iabur'atory -.-- Fdc.il ii.ics

T l w S t ~ k tlds fdc i l i t ies a t the General ilospital i n Makurdi t o

di~gnose cerebrospinal meningi!:is and typhoid fever.. The General Hospital

is hcswcvcr r ~ l uc. h n l : t o process 1 drge number of Pub1 ic iffaIt1.r Specimens

ior lilck of reagents. A P u b l i c i - leal th Laboratory attached t o the Sta te I

I

Ep: ' rc lemiologic~l Unit canno't: be p u t t o use because of l a c k of water I s u p p l y , essential equipment and suppl ies. I

5. i .G Vectur Surve:il l a n c e Activities ------ i I i

The S t a t e h a s n o Entomologist on i t s staff 1 is+,. I t has however !

;I r~urnbr-\r' o f nlosqu:ib,o scout:s ut;titclled t o the S h t 6 Epid~rniological Unit \ I

a t Makurdi, who d t the time o f the v is i t were on a simul ium searching I !

5.1 .? Contribution -- f ram the Nnn-Governmental Organization I

(Bcthcsda Missian ilospila 1, Ikxhi )

This unit i s supported by the Netherland 'Reform Church. I t has been I I

f i l I i n g i n t h e weekly dnd month ly returns which are sent directly t o t he 1 I 1

S t a t % Epldcmlological Uni t ; . The importance of routing their returns . I

1:I~rougl~ the L G A was stressed t o the Medical Superintendent (Dr A h i t s ) .

The Ycl law Feverq Epidemic in Oju LGA in 1986 was f irbst suspected

and reported by t h i s Iiospital. The report however was n o t routed through

the LGA H~ildqudt-ters. This unit i s a f u l l -fledged hospital, run by

Dr. Smi l:s, w i L h d bclsic 1 dbcrdtory cdpilble of diagnosing cerebrospinal

metiingi!;is. I t has very good co ld chain f ac i l i t i e s capable of hand l ing

r e q u i s i t ; ~ number o f ye1 l o w feve r d n d cerebrospindl meningitis vaccines.

5 . 2 C R O S S R I V E R STATE: 24-73 A P R I L 1989 ----

5 .2 . I UClr;ed an i t s experi~nce of an epidemic ( Y F epidemic in 1986), Ogoja

L G A was chosen for this exerlcise in Cross River State.

3.2.2 -Thc F u l l crw.irig Lllr-ce (3 ) i-ledltll Units were selected :

* Lu-t;fic.ran Basic i k a l th Centre, A1 ifckpa

* Roman Cdttlolic Mission i-lospitdl, Moniaya, Q o j a

* L u t k r ' i l r i Haspital , Yahe.

The missionary nrganizatians constitute an important provider o f

l~ealtti services t o the pcapl& of this LGA. The Lutheran Haspital a t Yahe

played a significant role in the diagnosis and t rea tment of the 1986

ycl low f e ve r cases. I t a1 so participated ac t ive ly i n the vaccination

i.xer.c.ise. I t has 105 beds and a care of sedsaned and dedicated staf f .

I t a I s u supcr'viscs a Rural ifcalth Programme using 10 clirl:ics which have

a combined bed occupmcy O F 23. These clinics are as fol lows: \

Wanlkande Clinic (10 Beds)

bhniliem C I inic (10 beds)

Ekpari C l inic ( 3 beds)

Igedde Clinic

Btlwop C I :iriic

Erruen C l in ic

Izzi Clinic

Wanckpe kiealth Past

Eb i a ku I 1 I1

Nwmg I I 1 1

Attactled i.o t f le Lutheran ilospital i tself is a 36-bed unit for

tuberculosis p~ticnts.

5.2.3 - Disei~se Reporting --- Pdttern Within the Mission ilospitals

LUTi-IERAbl M ISS ION ---

I4eclcIy reports of infectious diseases dre sent directly by the main

h o s p i t a l (Lu1:herilri ifospii;al, Y a k ) t o the L G A ileadquarters. Since 1982,

n o repor-t:s arc prcpar'cd a t the peripheral clinics under t he Yahe

I~aspi-Ldl. ilowcver, each clinic is visited a t lease once a m o n t h by a team

from the milin IiaspitaI i n Ydhe and comprising o f :

1 k d i c i l i Officer

1 Medical Reoards Officer

1 Sen;lor Coniniunity ilealtli Officer

2 I I INIUII j z i l t l a n s t d F F .

A 1 1 the i-leclltll clinics are connected by a radio network such t h a t

each c l i n i c i s within 112-1 hour walking distance of a transmitting r a d i o

station. Many vil lagers can dlso receive information on the i r regular

bd-t:i:er3y-operdted r ad io receivers. Radio transmission is twice a day

a t 7.30 am and 5.00 pm.

ble fourid the Lutheran ilospital a t Y a k and i t s sate1 l i t e c l inics

ldeill for our study. The Medical Officer currently i n charge of the

Rur-dl tledlth Programmc agreed t o inc 1 ude d l 1 the peripheral cl inics and

t l w ~~lilit~ 1 m j ) : i t a l a t Y a k i n t h e study. Thus, we would be g e t t i n g d a t a

From 1 1 r'epor'tirrg stations instedd of' one. The Lutheran Basic iiealth

ccntr 'e, Al i fokpi l is one o f t h e hedlth f a c i l i t i ~ s chosen for t h e exercise.

711:is cumrnunity w d s chosen because i t was the epicentre of ye1 low fever ?

o u l : b r w l : :in 1986. I t was estimated t h a t 2,0150 cases of YF were recorded , . '

'

i n th is drea w i t h 205 deaths. '. fi ', 1::

I . . . a

5.2.4 RQW\i CATi IOL ZC M ISS ION I .! I --.----------- . l a , .? ,

This miss ion runs the RCM i l ~ s p i t a i in Msniaya, Cgoja. This u n i t , . .

i s a fu l l -FLe t lged l i o sp i t a l with a rehbbilitdtion centre f o r the handicapped:: .

(usucll l y 001 iclmyel i i i s - d f f e c t c d cll i ldrcn ) , a tuberculos is centre and a . : .by> . , . ' ) I (

l-l~:is u r i l l : is being earmarked ds trdin'ing and/or sentinel centre for

d i ~ e i l ~ ~ ~ survei 1 1 ~ C C . Ttie I~ospitdl ' s weekly and monthly reports are

farwilr-ded di rec l : ly t o the stat:^ Epidemiologicdl Unit in Calabar.

5.2.5 STATE A N D LGA-SUPP ORTED HEALTi U N I T S - Tllc Si:dt:e-supported I w a l t l i institutions bypass the LGA ilealth

O f f ice drld forward their returns d i rectly ,to the S t a t e Epidemiological

Tllc L G b f unded t1ea1th inst itutians send i n their returns, though

Infrcqucntly, t o Lhc LGA Heal t l i Off ice.

5.2.6 DISEASE ANU VECTOR SURVE ILLANCE TRAIN I N G

The f o l lowing s h f f were trained for disease and vector surveil lance

S-Ld-Le Euid Unit 1 . Cl~ ie f J B Edem Princ. Rural HeaIth Superintendent

i /c Stdte Epid Unit

TRAIN I N G GIVEN iiIPF NAME OF FACILITY STAFF

Disease Survei 11 ance

DESIGNATION

2. MI. E E Edu Asst Mcd Records I I

,Officer

1 . lilrs T Ayim District Health Disease Surveil lance Supt . ilead gf klealth Office

2 . rilr J u ~ d u liigher Rural I I

ikalth Supt. -------.

I 1 2. Mr T A g b o r . ( iiigher ilealth Supt I " I I

I $a ja LGR 1 ileadqu;lrter's

I 5. MrD Ogar I iligher i l ~ a I t l l ~ u p t

, I . M r % 1.1 Egozi

3. Mr U mini 4 . P1r3 D Akwagiabe

Higher Health Sup t

pub1 ic ilealth S u p t

Sn r Env i rmrnenta I aealth Officer

-1 6 . Mr7 Fl O F i

-

I 1 .--- -- Lutlicr'iln Bds i c 1 1. M r J Obri Clerk ( Vector Surve i 1 1 ance

Vector Survu i 1 1 ance

Snr Environmental ilealth Officer

Lutherm Basic ;ledICh Ccntre, A1 i f okpa

i h l Lh Ccntre, A1 i Fokpa

Dispenser

1. Mr M &ley

2. Pliss E bmosike

Comm %calth Asst

Nurse

Disease Survei 11 ance I I I I

NAt'IE OF F P C IL ITY NAME OF STAFF DES IGNAT I ON TRAINING G I V E N -----.--+ ----

I 1 . Dr C Rourdil l n n ( Medical , S u p t

2 . Mrs P Agddd Med Records W f icer

Briefing on the study

Dfseasc Surveillance

RCM ilr~spil;dl 1 . Miss V Agba Oko Mcdlcdl Record Moniaya, Q o j d Attendant Vector Surve i 1 1 ance

2. Miss J Orji ~edica1 Record I I #I

Attendant --

L u t k rdn ~ I P S p itd 1 Ydhe

----.

1. D r M a r t h i n Kok

2. Mr' Simeon Ojiji

Lut :k r-dn \lo s p itc] 1 Ydtx

- -

3 . b l r L A g i Princ. Vospital S~cretary

4. Flr C Alego Medical Records Assistdnt

I -- -

Medicdl Officer

Snr Camm Hea 1 t h Officer

II II !I It

I I II lI I I

1. Clr T Idu

2. Mr S Ajogi ~ 3. Miss P ~ d a ~ k r

4. Miss E Agbe I

5. Miss E Obdgu

G . Miss bl Achong

7. Mr. A Gleje

8. M r P Ebu

9 . T4r C Aleje

Briefing on the study

I I 11 II !I

Clinic Assistant

Revenue Col lector Ward Orderly

I I I I

I I I I

I1 I I

Typist

Revenue Col lector

Ned. Record Ass i stani:

Vector Survei 11 ance I1 I I

It I I

I I I 1

I I I 1

I I I I

I I I 1

I I I 1

II I I

5.2 .7 FREQUENCY OF LGAs SUBWTT ING WEEKLY JP!ONTHLY REPORTS T O T i lE STATE EP TI IEMIOLOGICAL U N I T IN CROSS R I V E R STATE (TABLE 2 ) - -

I

NAME OF LGA TOTAL NO. OF JANUARY I iEALTi l U N I T S W M

- - . .

AKAMP A 2 3 0 0

OBU DU 13 1 1 1

ODU K P N I I 2 3 0 0

OG OJ A 2 0 4 0

1

% SUB- M ITTED

\ I4 = WEEKLY REPORT

F1 = M0Nl-il~Y REPORT

A!: the t.iine o f our vis i t (Apri 1 25 , 19 &3 ) the State had received only

20 or 19% o f t h e 105 weekly and monthly returns expected from the 7 LGAs far

1:tw mont:lis of Jdr-luary, February and March; 1989 ( fable 2). Four L G A s (Akampa,

b l a b a r , Obubr'a and W u k p d n i ) had n o t submitted any returns for t h a t period.

I k o r n LGA wds 1;he rnudel in the S ta t e , hdving submitted 80% of the expected '

r5el:urms by Apr:il 25, 1983. I t i s obvious that: with such poor returns, the

State is not in a pasi t ion t o feed the Federal Ministry of Health w i t h

ncccssilry it1 for.n~ctCic~n dboul: .the disease incidence and survei 11 ance i n

the S t a t e .

5.2.8 - Reasons Given for the Poor Performmce

The reilsons advanced for th is poor performance i n disease

reporting incl uded :

( i ) -- S t a f f Shortage - - In some instances, when the officer in charge

uf collation gaps on leave, no replacement i s provided and work

En L l w forms i s suspended u n t i l his return.

( i i ) InsufFicicncy of I\loi:ifical;iwn Farms - Often, peripheral heal th

units hdve t o wait u n t i l they have f u n d s f a r stenciIs and

d u p l icating papers before forms are produced.

( i i i ) Despatching of forms through the regul d r postdl system results

in undue delays, and funds are n o t available for more rapld

modes of despatch e.g. EMS, Courier service, etc.

( i v ) Pour/lack of mobil ity a t every stage of information collection

ilrid clc.spil.l:cli. \

( v ) No a n a l y s i s of d d t a on returns from the LGAs was carried o u t

d f - 1 : ~ ~ 1984 w l m the last malysis was done.

( I ) There i s Iiowever, some sort of feedback from the State Epid

Unit t o the LGAs. Phis is in the form of le t te rs pointing

o u t dr -cas of t h e form t h a t are not properly completely.

( v l : i ) Tile SI:dtc lids n o t received any feedback from the Federal

Epidcmiulagical Division on the forms forwarded.

5.2.9 Vec.I:c!rl Con t:rol Activities -

T l w Sta t e t u s na Entomologist on i t s s taff l i s t . However, about

10 nmsclu.i,Lo scout:s are dttaclled t o the Malaria Control Unit which is

responsible for vector control act ivi t ies in the State. Vector c o n t r d

activit ies ilrc 1 irnited t o occasional spraying with insecticides.

5.2.10 Mct;enr.olooic;ll Activities

The S1:;lte hils no official meteorology unit. The Department of

Ge~gr~~pl~y , University of Gal d b a r 118s f ac i l i t i e s for meteorological

rccordirlgs. ilowever, there i s no 1 i n k between the department and the Minjstrt,y .

5.2.11 Labord tnry Services ---- No l d m r l ~ t o r y f a c i 1 i t y exis ts in any S t a t e Government health

ins t i tu t iun for the diagnosis o f Yellow fever, CSM, Typhoid fever and

Cllu1er.d. 'I lic S t d k School o f ilcill Lli Technology dnd the Infectious

Diseases i lospiLaI (IDi-I) I ldve facilities f o r microscopy. On a person

t o person drrmgcment, the University of Calabar Teaching i-lospital can

ilssist: with t h e diagnos i s of typhoid disease. A few p r i v a t e medical

ldmrdtories i n t h e S t a t e also cdrry out some labora to ry tests, b u t they

are nut; supervised by the State Ministry of dea1t.h.

5.3 OY 0 STATE ( I 5- 19 MAY 19 89 ) ' C

-- 5.3.1 1-he e x e r c i s e i n t t i c S t a t ~ sta,rted with a meeting with the of f ic ia ls

o-F the State Ministry o f 9ealtli. The Off kers present were:

M r s r o l d z l ~ ~ d ~ Q u n l d

Dr (Mr-s ) A 0 A Iyun

Dr' (Mr's) E N (Xlafowa

D r E O B a b a j ide

,The Uir'ector-Generdl, SM0i-I

Director of Disease Control

Deputy Director, Disease Control

Assf stant Director, Disease Control,

A F I x r b r i e f i n g t hese ortlcers, a second meeting was held w i t h

the officials o f t h e S t a t e Epidemiological Unit. The team also went

t h r o u g h a 1 1 t h e reports received from t h e LGAs during the f i r s t quarter

uf 1983. (See h b l e 3 ) . The Disease Control Unit was undergoing some

farm o f rc-organization a t the time OF t h e visit with a new team t a k i n g

over the un i L. There was t h u s no coord ina led activity go-lng on a t the

u n i t wi Lllin t ; l ld t pcriod. I

\

. 5.3'.;1 FREQUE!,ITY OF LGAS 5.UDMITTING WEEKLY AND MONTiiLY REPORTS TO TilE STATE EP IDEMIOLOGICAL U N I T , OYO STATE (TABLE 3 ) ---

NEEKLY AND MONTkILY RETURNS - 19 89

No returns f o r Oybomosho were found a t / t h e State. Epid Unit, but a t the LGA, we

faund c v i d ~ f l c c oi. c.onsisLcnt subn~issior(. Ogbomasl~o has 71% submission rate.

. --

L G A - --

I . Ircm . .

i . Oyu

. I < ; ~ j a l d

!. 1 1 ~ s ~

O1ujrcie . Alcinycle

. Orwniyan

. E j i g b o

. I b a r a p a

0. Atakumasa

----a

TNIIE

21

2 1

2 1

2 1

2 1

2 1

21

2 1 .

2 1

21

lb l i IUs*"

43

------L-

---

N = GIcekIy Report; TNRE - M = Mc~ntl i ly Report TNRR -

**TNWs -

-- JANUARY 14

~ -- 0 1

2 1

il 0

4. 0

4 0

4 1

3 0

2 I

0 0

0 0 0 0

0 1

0 1

4 0

0 0

4 1

4 1

Cl 1

3 0

4 1

3 01

4 0 1 o 0 1 - J 0 ,

1

5 2 10 /

1 . I f c d a p o / 21

T o t a l Number o f Reports Expected Ta ta l Number o f Reports Received T o t a l Number o f Hcdlth Units per LGA.

2. I re pad u r ~ 3. IhIG

4. IMI

5. Cgbonnsllo*

6 . I l a -Oragun

7. lrewrrle

3. Obaklin

I . If-eladun

I . Iseyln

. Ede

'. Oscogbo

. ~ilgcl ~r

. Wo-OLln ---

TOTAL

-7

FEBRUARY MARCH A P R I L

' 21

2 1

2 1

21

21

2 1

2 1

2 1

2 1

2 1

2 1

2 1

2 I

504

M W

0 0

4 1

3 0

4 0

3 1

0 0

4 0

4 1

4 1

3 0

0 0

4 1

1 0

4 0

0 0

4 I

4 1

0 1

4 1

4 1

3 0

2 0

o o 0 0

59 10

M ' N M

0 0

5 1 0 0

4 0

4 0

4 1

3 0

5 1

0 0

3 0

3 0

4 1

1 0

4 0

0 0

5 0

5 1

0 1

2 , O 0 0

4 1

4 0

0 0

0 0

GO 7

W M

0 0

1 0

0 0

4 0

4 1

4 1

4 0

4 1

4 1

4 0

3 0

0 0

0 0

4 0

0 0

1 0

4 1

0 1

0 0

4 1

4 1

0 0

0 0

0 0

49 8

1

15

7

16

17

15

14

19

10

10 6

11

3

16

0

16

2 1

4

10

15

16

10

o 3

255

4.8

71.4

33.3

76.2

8 1 71.4

6 7 90.5

47.6

47.6

28.6

52.4

14.3

76.2

0

76.2

100

19

47.6

71 - 4

76.2

47.6

o 14.3

50.6

The tea l found t h a t the State o f reporting i n Oya Sta t e was better

and mure rqguldr t h a n in t h e two States ear l ie r visited (Benue and

Cross River 5tdtc.s). A t tllc t i m e o f the y i s i t on 15 May 1983, t he

SIx tc El) idenl'inlogicdl Unit l i ~ d rewived lid1 f a f t he expected 504

weekly dnd rn~nthly returns from the then 24 LGAs for the period January

t o A 1 I . Irewole and E j i gbo LGAs had submitted 100% and 90%

respectiv~ly o f t l l c r expected returns; and aver 10 LGAs had submitted

70% o r rnure of the expected t'elurms. No returns were found for

Ckjbornnsllu LGA a t the State level b u t we la ter discovered t h a t these

returns were d l 1 lcs t in t ransi t between t h e LGA Health Office and

the S!;~tc Ministry of ilcalth. We found t h a t @~bomosl~a had in f a c t

subrnitt~d aver 70% o f her expected returns.

llic t cdm d l s a found t h d t d l t t m u g h u p t o 50% of weekly dnd monthly

r\c_.par\Ls h d beer1 submitted t o the State Epid Unit by peripheral h e d l t h \

units, the types af reports submitted were f o u n d t o be wanting. The

t~por '1 .s cnr~Cd.iruxl on; y the t o t d l number4 o f male and female attendance

for' the weck or month . kcasiondl l y , +he d a t a further s p l i t the

al:tcnddnces into "adults" and "children". Individual diseases were n o t

mentimed and in many cases, the cyclostyled forms were n o t ava i l ab l e .

As a result, tl,e reports were submitted on a 6 cm x 15 cm s l ip of

paper. No analysis o f d a t a an the returns from the LGA was ever

carried aut.

5.3.4 Dascd on i t s experience of the Ydllaw Fever epidemic i n 1987, Ogbomosho

LGI\ wils selected for the exercise in Oyo Stdte. . . ' 5.3.5 The f o l l o w i n g 4 health f a c j 1 i t i e s evenly spread within Ogbomosha LGA

(j) B a p t i z l : Medicdl Centre, ~bbrnostio ( i i ) A j a - a w a Dispcnsary and Maternity Centre

( i i i ) Gbede Dispensary ( i v ) Ire-sadu Cispcnsary md Maternity.

Qie a f ttis medical officers o f t h e General ilospital i n Ogbomosho

wds bricf-etl with d view o f incorporating the 6~neral ilospital into the

cxerc i se. There are 4 1 LGA-supported and 2 State-supported health

f d c i l il.:ics i n 1 : k LGA. . .

5.3.6 The Role o f Dilptist Mission in H e a l t h Care Provision i n Ogbwosho LGA

The Baptist Medicdl Centre, Cgbomasha i s the highest provider of

IienlCIi services 1:a most p a r t s ~f the LGA. I t runs a Rural Health

Pr-ogr~mme whicli involves the use of Vi-lWs i n 9 communities, with a

coverage o f an estimated 8 ,000 population. This hospital has an

cquipped 13bordt0r-y c a p a b l e o f confirming diagnosis of CSM, Cholera

and Typhoid Fever. I t also has very good c o l d chain f a c i l i t y capable

a f h a n d l i n g requisite number of ye1 low fever and CSM vaccines.

Ttw h o s p i t a l has a properly orgdnised Medical Records Department

w n by i;r-;iincd personnel . 1

5.3.7 DISEASE A N D VECTOR S U R V E I L L A N C E T R A I N I N G IN OYO STATE

NAME OF FACILITY

S t d t e Ministry o f ,..i-kg 1 t l 1

S t a t e Epidcrria Logic, Un i-t

~ b o n k l l n L G A Epiderniolpgical U n :

B a p t i s t MedicaI Centre Og bomosllu

Medicdl Records Dept, G a p t i s t Medical Centre Qbumosho

NAME OF STAFF

1 . Dr ( M r s ) A 0 R Iyun

1. M r P .4 Odewole

2. Mr F I so la

3. Mrs M B Buari

4. Plr A A Adelcke

5. blr. E 0 Olaogun

1. M r 0 Oke

2 . Mr. W 0 OgundcIe

1, Mr A A Oladipo

2. Plr D Osunbede

3. Plr7 0 Ohlolabi

4. Mr. B Oyewa

5. Mr A Alade G. Mr 0 Cl amiran

7 . Mrs L 0 Alabi

/ DESIGNATION ! ' ~ i r e c t o r , Disease

Coritr-a I

Deputy Director, Diesease' Control

A s s t Director, Disease Control

Princ. Rural seal th Supt I I

Snr Environmental deal t h Officer

Comm Health OFf icer

I I I1

S n r Vdccinator

Princ. Health S p p t I 1 deal t h S u p t

Medical S u p t

Director, Comrn. %ill t l i Programme

part II,,GP Residency Programme

Snr Medical Records Officer

Asst. Ned ical Records Officer

Asst. Medicdl Records Officer

Clerk

Clerical Asst.

Clerk

Med Records Clerk

Briefing on t he Exercise

Briefing on the Exercise

Briefing on the Exercise

Disease Surveil 1 ance

Disease Surveil 1 ance

I1 I I

-

Briefing on the Exercise

Briefing on t he Excrc i se

Briefing on the Exerc ise

Disease Survei 11 ance

NAME 01- STAFF

1 . Mr S A Akinrinmadc

1. Mr S r", Iso la

2. Mr L Lawuyi

3. Plr B Adisa

/ 2. Mrs E Y Akintayo

5.3.8 V~c1:or' Cont:r,ol Activities

DES IGNAT I ON T R A I N ING GIVEN

Higlie? Pharmacy Disease Surveillance OFficcr i / c of Dispensdry

Midwife Sister I I I I

i /c of Maternity bddrd h i d Vector Surveil 1 ance

Dispensary IN II

Orderly

Surveil lance i /c Dispensary

Dispensary ileal th Attendant Vector Surveillance

iiunter and Guard I1 I I

Comrn. ilealth Disease and Vector Assistant Survei 11 ance i /c Dispensary \

deal t h Assistant Disease and Vector i /c Mdternity Survei 1 1 ance .

The S.t:ate h a s na Entom~lagist b u t has a ,few mosquito scouts at tached

t u t h e Mal i l r ia Control Unit, The Disease Control Unit has embarked on

tlie p l m t o I;rc?in a iledlth Superintendent as a Vector Control Officer

pending i;lw recruitment of a n Entomologist as soon as one is available.

She post o f a S t n t c Entomologist has been approved b u t no funds have .

been reIeased t u dppoint one.

5.3.9 Pieteorologicdl Unit --- Oya S t a t e has no' official meteorological unit a t present. Professor

Tomori has p l e d g e d t o involve the Geogrpahy Depdrtment of the University

o f Ibsdari .in provid'iny d a t a from their meteorological recordings.

5.4 BORN0 STATE: 22-25 MAY 1983 ---- 5. f l . I Tllc exercise i n Borno S ta t e started with a courtesy c a l l on

. ~ r S L Wakdwil , t l ~ c Directar-Gcneral o f the Ministry of i l e a k h . Next,

t h e twm held il rneeting with the o f f i c e r s involved w i t h Disease

Prcvcntion and Control. Present d t t h a t meeting were :

Or M A Mongunc Director o f I l is~ase Control

A1 hilj i Plustdpha Bulama Chief Community Health OFf i cer i /c State Epidemiological U n i t

Ma1 1 i lm Kyari K Muhammed Assistant Chief Community ilealth Officer i /c Malaria Control Unit.

5.C.2 The .tcarrl Lhcn visited the State S t ; a t i s t i c s / E p i d ~ m i o i r s g i c d l U n i t and

Iwld d rnccting w i t h t h e s t a f f . The unit has a staff strength o f three ( 3 )

Assistant: S.ta1:istical Officers, seven ( 7 ) Assistant Medical Medical Records

OTficers and d typist;. The staff were briefed on the exercise.

5 . f i . 3 --.-.--. Fr~equcr~cy o r LGhs Submitting Rcturns, t o the State Epidemiological U n i t

Ad:. the time of the visit; (22 May, 1989 ), .none o f the 18 LGAs had

s u b m i t t c d m y report f a r the period January t o April, l 9 a . There are a

?:o'i;aI of 407 peripherdl henlth units distributed in the 18 LGAs as i n

TABLE 4 belaw.

TABLE 4 : ---- D ISTR IBUT ION OF PER IPi lERAL i lEALTH U N ITS BY LGAs

I_ LGA

1 . F i k i l

2 . Gcidaril

3. Nguru

4. K a g i ~

5. O ~ L I

No. OF i-lEALTH UNITS

28

13

24

18

P

N O . OF i lEALTH UNITS

TIICI'F clre 8 cornpreticnsive Ilea 1 th centres and 13 General ifaspitals

TOTAL

i n 1;Iw S1:L~!2. These IledlC11 faci 1 i t i e s are supposed t o send reports

dircrlLly tc l Lhe St;(lt;e Epidemiologicdl Unit. OF these, only 3 o u t o f tlic O ccmprahcnsiv~ h e d l t l i centres ,and seven o u t of the 13 General

i-lospitdls I ud ~ ~ ~ b n ~ : i t t ~ d reports t~ the State Epidemiological U n i t fur t i i J ~ r y to A i l , 1 . (See tclbles 5 & 6 ) .

40 7

OF ?Arc four goverrlrneni:-owned special i s t hospitals - General

iIosjii1:iil fk~lili, Psychiatric iiospital, University of Maiduguri Teaching

i-bsp:'t t c i l d n d t l l v Infect ious Oiscdses ifuspitdl , o n l y Generdl h s p i t a l

Flulai lldd submi-!:!;eel ii:s repart f o r 1989 (See table 7 ) .

-------

TABLE 5 : CIP1IJREi-IENS I V E ;IEALTH CENTRE R E T U R N S 19 83

G u j ba 1 0 0 1 0 0 10 0 1 0 0

W = W e ~ k l y Rqmrts received

M = Monthly Reports received

TNRE = T o t a l Nu. of Reports Expected

TNRII = T o t a l No. o f Reports Received

TNRE 1 1

Thc :xturris from clinics dnd compretiensive health centres are not farwarded t o the FMOi. Chly returns from General Hospitals are supposed t o be submitted.

5 .4 .5 ' ' S ~ l e ~ t : i t l ~ ~ o f L G A f'or t l i~ ~xcrc i se ----

1'. J d s t J - .,( on tlie experience of an epidemic, (YF epidemic i n 1987/88),

IFika L G A ? i d s selected for the study.

1-tlc % n n c l l ileil1t;tl Officer in charge of Fika and Fune LGAs - A1 h a j i

,ilusscir~.i i'4 1 ' : in jd 3rllo~ed nlucll enthusiasm a b o u t the exercise and mobilised

most or LIE Ilcillth s t d f f for training.

I . Selection olr ------- Pcrip'fizrill tledltli Units -

The f'ol l u w i r q 3 health units were selected for the exercise i n

t h e L G A :

( i ) F: ika ile,~l.tll Centre, Potiskurn

( : i i ) Kukc i r G d d , ~ Dispensary (Mission Dispenstlry )

( i i i ) I;liikr.ildl mcl Child ilealth C l inic, Nangere

( i ) Pot:.iskum Cerltrdl Dispensary.

A:jdr'l: f r o m the 4 selected units, 4 staff each (2 for Disease

S u r v c i 1 l a n c c i r ~ d 2 ./'or kc-Lor ' Survei 1 l'mcc ) were niobi 1 ised f rom seven other \

t i ~ d l t l l units Tor t l w trdining. A1 h a j i Tin jc., pr-ornised t o coordinate the

(iui;iv.i::ics C I ~ 0 1 1 tlic e l c v ~ n ( 1 1 ) reporting Iiedltll units in the LGA.

Tlrc t ~ d l l i also :.ncluded the General ilospital in Potiskum where 33 s t a f f

5.4.7 : DISEASE AN11 VECTOR SURVEILLANCE TRAIN ING

NAME OF STAFF

1 . D r M I\ Flonguno

2. A l l ) . M Bulama

3. Mill 1 am K K Muhdnimed

2 . L) Guda

3. J, Zorndai

4 . C Goni

5. I Usmari

G. I Adarnu

7 . 11 Tur*dl,:i

0. U Mdl 1 am Bukar 9 . U G Mulmrned

10. K Kyilri --------

1. A l l ~ ilusseini M Tinj;

DES IGNhT I ON

Director o f Disease Cantrol

Chief Comm ilealtli Officer .

A s s t Chief Comm d e a l t h Officer

A s s t Med. Records Officer

I I I I I I

Assl : StclLisl:icill \ Officer

I I I I

I t II

Asst Ned Rec OFficer

Zonal ilealtli Officer

Area dealth Officer

Comrn ilealth Asst

Rural He~tltti Asst

dealth Assistant

Asst Dresser

dedl t h Assistant

Cornin ileal 1:h Sup. Con~in ile~11:li A s s t . Attendant Attend d n t

TRA I N I N G G I V E N -

Briefing on the Study

Briefing on t h e Study

Briefing on the Study

Disease Survei 11 ance II II

I I II

BFief ing on the Study

Briefing on t h e Study

Disease Surveil lance I I I 1

Vector Survei.1 lance I I I1

I I I I

Disease Survei 11 ance II II

Vector Surveillance I I I I

. . 5 . 7 DISEASE AND VECTOR SURVE I L L A M C E T R A I N I N G

NAP1E OF STAFF

1. Ad;lrnu Kariya

2 . i labu Shdyibo

3. Pldlcil i Addmu

4. il Dan Borna

1 . Mal~amnied Aba

2. M Danchuwa ----

I . iY1 Abil

2 . PI A P I q i l l a

3. A l t l M B a ' a b a

4 . i-lajiya K Dauda

5. Idi Abubakar 6. N Gar'ba

7 . Abdulhmid YusuFu

0 . Addmu U thmm

9 Acldmu Ycr'irna

10. Musa Dumbulwd

11. Aya Mclinamili

12. Acld~riu Mdi Ldbuga

'13. U ilussilini

1 4 . T ~ n n i l M~stdphd

15. k r k a Shork

16. Lawal Ta lba

17. FdLi Abba

18. i-lanna Abdul Kadir

1 . Admu S Ddwi

2 . I j d T u Bukar 3. .5in1on D Dilniski

4. Plrs J D Gisliu~a

5. Nrs K I C h m a

Snr Cornm i - lea l th Ass1

Comm iiedltl, Aide

Dresser'

Dresser -

Cornnl ileal th Asst; i/c

Dresser

Comm h l t h Sup II I1

I1 I I

I I I1

II I I

I I I I

\ 11 I1

I I I I

Dresser I I

I I

I I

11

Attendant I I

I1

I I

I1

I I

Ass t I I

II

I t

I 1

I I

Prirlc iledlth S u p t I1 I I I I

I1 I I I I

Princ Nursing Sister I I I I I I

TRA IN ING GIVEN - - - - - - - -

Disease Surveillance 11 11

I1 II

I I I I

Disease Surveil 1 ance

Vector Surveillance

Disease Survei 1 lance II I I

I1 I1

I I I I

I I I I

I I I I

I1 I I

II I1

Vector Surveillance Il II

I I II

I I II

Disease Surveil lance I I I I

II I I

5.:; . 7 : D I S C A S E AND V E C T O R S U R V E I L L A N C E TRAINING

1 3 . Audu M a i d a l a

1 4 . A l l i a j i Ali

15. Plusd Adilrnu

15. O U Sarnbo

1 7 . Plul,mnetl Ny ;lko

18. i l u s s d j n i Ad~tmu

1q . Sclr'dl~ J o h n s o n

2C). '{clllcli B ~ ~ k d r

2 1 . Abdu Mudu

22. Junlrlldi J o s e p h

2 3 . E l i z i l b e t h I b r d l i m

24. Cdbcl M Y u s u f ~ ~

25. DaOclwd B i y a b r a

26. L A i h d j i Addrnu

27. Yusufu U ~ b a n i

28. Eh1 I a n I Molidmmed

23. Plohdrnrned Mustdpha

DESIGNATION

P r i n c Nursing Sister

Snr. Nursing Sister I I I 1 I I

I I I 1 ( 1

I 1 I1 I 1

S n r N u r s i n g O f f i c e r

F i e l d O p e r a t i o n O f f i c e r

N u r s i n g S u p t

Snr Comm ilealth Asst I 1 I I I I I I

F i e l d O p e r a t i o n O f f i c e r

Cornrri i l e d l t l l S u p t

Comni i l e d l t l l Asst 11 I I I I

1 I I I I 1

i l e a l t h A s s i s t a n t I 1 I I

Comm i l e a l t l i Officer

S n r Comm H e a l t h Ass t

+ d l t h A s s i s t a n t I I II

TRA I N I N G GIVEN - -

Disease Surveillance

Vector Survei I 1 ance I 1 I I

I 1 I1

5.4.8 Vcctnr Surveillance ---- Activjties,

-!lie S1;i~'tc lids na Enturrmlogist b u t i t has a Malaria C o n t r ~ l U n i t

which i s lieaded by a n Assistant Chief Community Health Officer. A

Senior ileilll:ll 5uperinter1dent; - NgilCiya ;lend is i n chdrge of vector

surveil lance i n the State. i-k I iowwer, cannot identify mosquitoes t o

spccies level. The State hils spraymen in the Local Government Areas.

5.4.9 Ldboratory Facilities --- Tlie St:atc has 1aboral;o.r.y f ac i l i t i e s for diagnosis of cholera, CSM

and typhoid .fever. These fac i l i t i e s exist a t Nguru, P o t i s k u m and Biu

General klospitals. No laboratory in the State can diagnose yellow fever.

5.4. i O Discasc Outbreaks

' ll~~r'e WJS an outbreak a f yellow fever in Fika LGA between &tuber

1988 a n d Jdnuary 1 9 B . Ttie index case was from Fune LGA, which is

cantiguous w i t l i F i k a LGA. In the f q i l y of the index case, 4 children

died before the f a t t i e r sought help from the LGA. The remaining 2

childrcn wcre brought down t o Potiskum &nerdi Hospital and admitted.

The 5 t h ul i ' i ld d'ied while in tlie hospital and when the condition of the

l a s t dei:crior3dted, the father dbsconded w i t h .h im t o an unknown destination.

On the ~ . r l~o lc . , 30 deai.hs (23 in Fune LGA and one i n Fika) were recorded.

For CSM, 25 cdscs were reported from the General h o s p i t a l s i n F ika ,

F u n c a n d the neighbo~tring Bauclii State. There were 3 cases of t ypho id

fever w i t h 2 deatlls in Potiskum General dospital. ,

It: ~ o u l c l be necessary t o high1 ight the high enthusiasm showed by

the Ilecll t:l, iluf;lioritics in Borrio State. The dynamic posture o f Alhaji

Tinjd, the Zonal i-lcaltli Officer for Potiskum manifested in his mobilization . '

~f the en't:.'lre LGA which resulted i n qur training of over 70 health workers

i n 1 1 heali.I~ uni-tr;. Potiskum would provide an ideal training centre with

Allidj i T i n j d d~ a resource person.

5 . 5, UAUCiI I STATE: - 26-3 1 MAY 19 El -

5.5.1 T i w CXFI-cise in Orluchi Stdte caninienccd with a courtesy cal l on

tlie Director-General o f the State Ministry of Health. He was briefed

on tile exc.r3c:isc. ~ n d pledged the support of his Ministry.

5.5.2 TIE tear11 n e x t held a meeting w i t h the o f f i c i a l s of the Ministry

o f iledlth. Present a t t h a t meeting were:

Dr. M A i-lussein Chief Medical Officer

Dr h i s d l Oycscmyd i-lead o f Preventive iiealth Serv ices and i / c State Epidemiological U n i t

5.5.3 Tlic. team then visited the State Epidemiolbgical U n i t and had

discussions wit11 the s t a f f . The off icers present a t the meeting were:

Dr Faisal Oyesanya Head, Preventive Health Services

Mr. Ibrilhim Uitraya iiigher Health Supt (S t a t i s t i c s )

Mr Jubril M Garnoma Snr Medical Records/Statistics Assistant.

Phcrc were no weekly or monthly reports from the LGAs seen a t t h e \

S1:ate Epidmiological Unit.

5.5.4 Selection o f tlie LGP, ---------

Witli -I:k dssistance of the Chief Medical Officer, Tor0 LGA was

clmscri for [:tie exercise in the State.

5.5.5 ileilltll UdI;il R e p o r t i n g --.- - - The LGAs hdve dispensaries and cl inics which are manned by CHAs,

D:ispcnsilry attendants, and occasional l y Nurses and Midwives. In the -

pas t , cases o f disease outbreaks were reported t o the General Hospitals

whicli instedd o f reporting t o the State Ministry of Health, often

. rc.porl;cd direct ly t o the Govcrnor ' s Off ice.

Hi tli the curvmt re-organization in t h e Ministry of Health, the

Epid U~li-t which was formerly under the State itqilth Services Management

Bodrd i s now directl;, under t h e Ministry of Health.

Secondly, reports o f disease outbreaks from peripheral heal th

units arc now t o be forwarded u p the hierarchical ladder of peripheral

Iiedlth unit t o Area ilcalttl Wfice located. in General Hospital, then t o

the Pub1 f r : i-lealth Officer in tile Zonal OFf ice who can take appropriate

measures dnd then r?porl t o t h e State.

5.5.6 --- Frequency n f Repor t ing

TIE LGfl-run health units (Dispensaries, cl inics and maternities)

d o n o t send rel:ur.ns regularly t o their LGAs. The Private and Mission

i-lcal-th f ac i l i t i e s account for 5-10 per cent of health f a c i l i t i e s i n

the State and d o n o t submit any report.

The co t t age and General Hospitals however, send the i r monthly

rc tu rns dlr.ect;ly t o the State ilealtli Mandgement Board. Occasionally,

t f i c se rvturns are sent t o the Federal Epidemiological Division, Lagos

d ir7ect.ly f r'om I:lw Genera 1 ilospi t d l s ,without my copy t o t he State. This

credtes il fdlse picture of t h e health situation i n the S t a t e since d a t a ,

submi t ted cone orily from t l ~ 13 General ibspitclls and 13-14 Cottage

43.

TXNE 8 : I1ISI"ENSARY REPORTS OF 1'ORO LGR - JANUARY-APRIL 1969

GI diseases are reported on a Standard form ... showing c~ttenddnccs by sex - male, female, t o t a l ; / g ~ , itddress and didgnosis n o t i n c l u d e d .

No reports from General i-fospitdl

No reports from ECWA Dispensary

ECWR C l i n i c , R i n j i n G d i n i

I\lilb~.r'do D:i s~cr1sar.y

Guntdu O ' I S ~ C I ~ S J . ~ ~

Rish:i C o t t a g s i l o s p i t d l .

5.5.8 U J SEA% AND VECTOR SURVE I L L A N C E TRA I N ING ----.--

DES IGNAT ION T R A I N ING G I V E N

Briefing on the exer-c ise

Briefing Qn the exercise

Chief Medicdl O f f iccr

ilead, Preventive ilealth Services

1 . Mr I Uaraya

2. Mr J M Barnonla

Higher. ilC!dlLh Sup t (Stdtist ics) Snr Med Records AssL

D i s e a s e Survei 11 ance

I I I I

Chairwan, Toro LGA Supervisory C a u n c i l lor for H e a l t h He.ad, Med icdl /ileal t l i De pt Supcrvisar, Nedical Services Npt

Briefing

Disease Surveil lance

Disease ~urve i 11 ance

Vector I I

I I I 1

1. P a u I k j i James P r i n c Camm i -kal th Officer Clinic Assistdnt Qfiesser

;?. Uukdr Lere 3. P l n d d r Raboga

~ -

Gurnau Dispensary 1. 5 n k ~ R i b i r a 2 . Ad m u Mrrliilmmrld 3. Ctl i r~do Ibrilhirn 4 . t\luliu Y~r lga 5. M r s Mairo Yol iannd

C . A . S . i / c Dispensary i j ~ i l l t t l Inspector Leprosy Attendant Dispensary Cleaner Dresser

Disease Survei 1 lance I 1 - 1 1

Vector I I Surveil lance I I

I I 1 1 '

1 . Alh A A Mcsau 2. MdI 1 an1 A Slieliu 3. Mallam L c ~ d m Umdr 4. F4,~ll dm S Motl~mmed 5. Mdl l a rn S A b d u l l a h i G . Mr. M Oywucl~e 7. M ; l l l ~ m I Ibrdhim

.-.---.- - 1 . Scl~r~dila Yusuf

2. Rlfkatu Anyazi

3 . Slidk~rd Jaura

Snr C il 0 c i l s C i t S C il S C. ilealth Aide C ii Attendant C a Attendant

Disease S u r v e i 11 ance I I I I

I I I t

I1 11

I I I I

Vector Survei 1 lance I I I 1

-

D l sease Survei 1 lance

Vector Survei 1 lance I I I I

Dispensary Attendant

Cleaner

cxe~xise. 'Illis I i u 5 p i t i l l will be xlequill;e ils a training centre.

Mr. Mdtliins Qwuche, a CtlAide p~rt iculi lr ly requested t o be included i n

tlw t r ' i t i n ing tcdrn.

Errie~'ye~icy r'epartlng of diseise outbreaks was already going on i n

tliis i~c!sl)ii.~il bcroi-e tile v is i t . Only CSM outbreaks were being reported.

an Mar'cli 2 1'303 (20 cases with 7 deaths) and on A p r l l 2 1989

(8 cclses witti I death). . TIie hospital ~ l s o sends monthly reports t o the State. The r e p o r t s

sl~owecl t.he different discdses seen for t h e month for adult male, adult

fmalc , pd~did'tr'ic nmlc ilnd f~mdle. The record a l s o showed the number

Thc i~lorr thly reports were ds f 0 1 lows :

Jcll'l uii~-.y 32 discilses reported

Febr'ua ry 40 d iswscs reported

[lip Stcltc lids 2 EnZ:orr~nloy.ists on i t s s t a f f l i s t h e i s a t t ached

to I:llr? M o l d r i a Cutitrol U n i t d n d other t o t h e School of Heal th

T~cl inc l loyy . Tlie dctivities of the Mdl aria Contra1 Unit include mainly

sptxy ing oF t;lie cnvir'onnicnt b u t tliis is n o t extended t o cover the LGAs.

Tilt u n i t I ~ ~ i s no nlosquito scouts.

o f CSi-.I, 1'ypho:id d i d poss ib ly Clioleril. The General Hospita l in Gornbe

dlsc~ lids f . ~ c i l : i t : i ~ s for didgnosis of the three diseases. Yellow Fever

'IIw t x c ~ n i t l i ~ t covet7cd the Nestern half of tlie country vis i ted

Iiiijcr m d K ~ d u n d S t~ l t e s . 110th teams worked together in Oyo State.

( I ) N I G E R STATE -------

( i ) S u l ~ j t ~ L G A wos selected f a r the exercise

( i i ) lllc 4 Iicaltli units visited were:

- Generdl i-lospitill , Sulejd Town (State-owned)

- Uiko Bdsic ilealttl Clinic (State-owned )

- Ij<.-Gwari Bilsic i-lealth Clinic (LGA-owned)

- Maraba Haspitdl, Suleja (Privately-owned )

( i ) Z a r i d LGA w d s selected.

( i i ) lhe 4 Iiealtli units visited fo r the training - ~ x e r c i s e were:

\

- Zab i Primdry ilealth Clinic - (LGA-owned)

- Giwd Dispensdr'y ( LGA-owncd )

- Y d k d s a i ;-led1 tli Clinic (Stdte-owned )

- Z c l r i d c l i r l i ~ and Plediccll Centre (Private)

49.

5 . G . Z [1 ISEASE AND VEI:'TOR SURVE ILLAPICE TRAIN ING (N IGER STATE --+-.------

Sf.;lte Ministry o f i-Ips1 .tl~ . .

Su 1 e j a L G A i-1c.d l th O F f :i ce

IlAl4E OF STAFF UESIGNATION . -- - . ----

I . Dr Susan Saba O i rector-Gcneral 2. Dr il M Garribo CliieF Med. Officer 3. D r R C Ascuncion State Epiderniol

logisi: 4. blr* Gdrabc Mull~rn~ncd CDD/ ORT M ~ n ~ g e r ' 5. F1r Mdugu S Anta Stdtistjcian G. Mrs A Abdullahi I I

7. A111 Alimed Usman Plann ing Officer ----- --

'1 . Fir, S A Jatilu Counci 1 lor for idea1 th

2 . Mr il D A i-IdIilu P A S 3. Mr Abdullalii K Takwa digher tfealth

Sup t i /c 4 . Mr Ibrahirn M Izam PllC Coordinator

bkdd o f ilospital Services Pled. Records Asst.

I I I I 11

11 I 1 I t

\I ' I 1 11

Card Issuer -- 1 . M r S S Gdwa C i l S 2 . Mr-s Navrni Danl ~ c l i C il A 3. Mr A A I j t lkoro CtfAide 4. bliss Nl ry Clidwd

~ j d - ~ ~ ~ ~ t - i :led1 L I I 1 I. nr ~ o s c p i ~ ~ d k i d o Clinic 2. f . l r Ibr'dllim Gdrbd

3 . Miss Ruth Scriki

/ 4. Jum Yakubu

~ r i h c C tf S i /c C i l A

CilAide

Card Issuer

Bricf ing on exercise ' Il 11 II

Briefing an exercise

Disease Surveillance I 1 II

Disease Surveillance I I II

II I 1

I 1 II

I I II

Vector Surveil 1 ance

Disease Surveillance I I I I

Vector Surveillance II I I

Disease Survei 1 lance I I I I

Vector Surveillance. I 1 I I

Disease Surveil lance

5.1;. 2 I1 ISCASE Af\lU VECTOI? SURVE ILLAF1CE TRA I N I N G l KADUNA STATE )

---. --------- --

rdAl*lE 01' FAC IL I - I -Y

Zar i a LGA i i c a l t t i OFF i ce/ilca l1:h Dpp-l:

t~/Al.lE OF STAFF DES I G N A T I O N --.----

TRA I N ING G I V E N

1 . Mrs Sdrd t i i-ldssdn Hun, Comnissioner Briefing an exercise fo r ileal t i 1

2. Mr.s R L Lazzdr i D i rector-Genera 1 I I I1 I 1

3. U t \ 1) 'I Kdtung O i r c c t a r , P l dnnirlg I k s c a r c h & I I II 11

S t a t i s t i c s 4 . Dr Y F a y o m i S t a t e Ep idemioIog i s t " I1 I I

5. Mr J PI Udba Snr Med Rec O f f i ce r I I I I I 1

13. Ivlrs tl B Tukur EP I Manager I1 I I I I

--- I . A l l ~ B Shurail~u Ass t C h i e f Comm Disease Surveil 1 ance

k l e d l t t i Officer 2. A l t ~ 3 G Zaria + a d , i lealt t l Dept I t I1

3. A l l 1 Dhgdrd Kayd 2 e d l t h , Med Dept I I I 1

-- 1 . Zubdir,u Mdgdji C i l A Disease Survei 1 l ance 2. Msydji Musa Dresser Vector Surveil 1 ance 3. aajiyd Mdiro G d r h Attenddnt I1 I I

1 . Plrs T i t i M d g d J i 2. IJbd ilussaini 3. Mrs D A b u b d k a r 4 . Mr.5 L iidrund 5. Plrq l 4d r l i r Yusuf

" s t a f f NurseIMidwife Disease Survei 1 lance C i l A I t II

C il A II II

CiMide Vector Surveillance Dresser II

I I

5.E.3 Fr~qucncy o f Disease R e p o r t i n g ---.-.-

( i ) N I G E R STATE - - The figures obtained from the' S t a t e Epid Un i t Minna, showed

1:1151: 1 3 3 (133) o f the expected 200 returns f o r Jdnudry-April

1983 l~i ld been received at: the time of the visit an 19 May 1989

( T d b l e 9 ) .

TIE rcturns f o r i.he 4 hea l th u n i t s t o t h e LGA health

office were mom regu l~r t h a n i n t h e other States visited.

The -Tjgures showzd t h a t 97 (73%) of t t ~ c cxpected t o t a l of

105 r7cJxrns for January-April: 1989 had been received a t the

L G A i l c d l t l l O f f i c e a"Ltl1d-t; t ime , (Table 10).

TABLE 9 --- FREQUENCY OF REPORTING BY LGAs TO STATE EP IDEMIOLOGICAL U N I T (NIGER STATE)

19 83

-- JANUARY I4 1'1

----.--.

1 1

3 1

1 0

0 0

0 0

0 0

1 1

1 1

2 1

3 0

F E B R U A R Y I !ARC: W M

iJ = Ncekly Reports M = Nontl i ly Reports

I NKE I NRR I4 M

NRR = No. ofl' ReporLs Rcccived

NRE = No O F R e p o r t s Expected

IAOLE 10: I?KIIUI<l-II4G FI?EQUENCY BY SELECTED ilEALTkI UNITS I N SULEJA LGA ------.-.---A-

N I G E R STATE. 19 1B

% SUBMITTED NRE

'T OTA t

i l = Mcckly Reports

I.4 = Flontli l y ?c.ports

3 = I<epor'tiny f ron is exlidusted\dnd no furtiicr reports submitted.

Id[<[ = No. rsf R~por ts Expeci.ed

NRI< = No. o f Reports Received.

KADUb/A STATE --..-----

For Kildunil Stcite, t he disedse reportfng pattern was f a i r l y

r'egrrl ~ i r , w i l:h 6 2 h a F expcct:cd returns f r m the LGAs received

d t ttrc S t ~ t e E p l d e r n i o l o g i c ~ l Unit at the time of the visit .

( ' r d m ? I I ) .

TABLE 1 1 : REPORTING FREQUErJCY BY LGAs TO STATE EP lDEM IOLOG ICAL U N I T KAUUNA STATE 1903

P -- FEBRUARY W M

-.

0 0

4 1

0 1

4 1

8 1

0 0

- 4 1

- - - - -

% SUBMITTED NRE

- .

2 1

2 1

2 1

2 1

126

2 1

2 1

252

N . O Nmbcr o f R e p a r t i n g Cen t res p e r LGA e x c e p t Kaduna

Municipality n o t a v d i l a b l e .

I = \ 4 x k l y Reports

M = Monthly Repor ts

NRE = No. o f Repor t s Expected

NRK = Ra. o f Repor t s Received

NRR

- 0

15

2

2 1

36

5

15

9 4

The min objective $as t o cdrry o u t dn apprdisal of the Disease

r d c i l il.ics d r t e r - t . 1 ~ prelimindry v i s i t . In addition, staff were

Stcit:cs V i s :i !:ed - -.-- Five 5t:~l:es, Cruss River 19 -23 June, Benue 26-28 June, Oyo 28 June-3 July,

huc l r . i 16-22 August md ~brrw 22-25 August 1989 have had f o l l o w I

u p v i s i i :~ . I

i ione o t h e 2 natifiddtion forms h d d been received a t the State

E p i d c ~ n i o l o g i c d l U n i t a t the time af the vis i t . The reports expected. 4

wcr-c t:hc routine (n lon th ly ) ' report fob May 1983 from Oju LGA and any

anc2rgnncy iiotificdtion o f h is -E~SE outbreak.

Tlw S t ~ t c Epidcmiologist reported t h a t he had n o t had the 1

opport:unil;y o f visiting the LGA (Oju L G A ) . Copies of the report of the I/ i

pr.climindr\y v i s i t wr'c givdn t o the ilon. Commissioner of Health, the ;I Director-Generdl, t h e ~ t d t d PHC Coordinator dnd the State Epidemiologist. 1

Mr J A Ajinah, the ~ s s i s t a n t PilC Coordindtor, Oju LGA provided 1 1 ! 1

(Mr igbdyumc) during whicl~ h copy of tlre report was presented t o him.

Oj u LGA i-lr-ld 1 l:Il Off i cc I I ----- I

I us w i t 1 1 tllc r-cporting forms 1 which were f i 1 led dnd submitted by the

I ! I

4 selcctcd Iicil1l:ll units t o the LGA ilealtll Office (see Table 1 2 ) I

1

I

i I

TA3LE 12 : l901~lTilLl' REPORT FORPlS - --

Igedc Ccn t ra 1 ikc l l th C l inic

I t o Basic i l ~ d l th C l iriic

DATE D ISPATCYED

Not Ind i c d t e d

111/5/89

7/6/83

6 16 183

Not Ind icated

DATE R E C E I V E D DATE AT LGA COLLATED

P /5/m -

Hot: - Indicated

The tilble shows - t h a t the monthly return forms are f i l l e d by the peripheral

health units ilnd disp;ltched such thi t t they r e a c h the LGA Headquarters w i t h i n the . {

>

first: wcck as recommended. The Bet;ksdd i-lcalth Unit a t Ikachi d i d n o t indicate ~i I!

t l l c diltes of complet ing the form m d ' dispiitching i t while Obusa health u n i t d i d

no!. dispatch the form ~t d l 1 due t o Llie off icer in charge of the unit being on

1 w v e a t tlic 111dt;cri;ll tirne. Except for the Bcthesdd ilospital , Ikaclii, none of .

?l\e otl.?r Iicd11;11 unlts Carrie across, any suspect epidemic. Details o f the

Ikaclli suspect: epiclcmic are given on ) the sect ion on Evcl l uation of the procedure !

i\.s prLcviously mentioned, the mon th ly rcport form w d s f i l led in '

sirlylc copy m d ret:;lincd d t the health unit . ,This was caused by the , ' ! I i

filcl: bI1d.t: !:lie rniln in chdrge of ttic Ilcalth unit was on leave and did I

nul; ir~sf:ruct; his colledgue l e f t in charge as t o what t o do. The t I

situdtion w ~ s explained dgain t o the person acting md he promised h

Tlwr-e was no suspect epidemic recorded. They were instructed

t a plot the grdpll accordingly. I

I Nosquito Cd-lxtiing Ac1:ivitic.s - ---

A - L o t d l o f 105 mosqui!:?es were collected for the month o f May.

Total Number

1 I 115IN 2 1 7 pni - 8 pm 3 0

'Tllis was plo.tI;ed i n the! graph book correctly. The group

identified Mr' Augustine 0kuph - d i l e~ l t l i Attendant as a possible

l:rTdinc.r i n mosquito sur'vei 1 ldnce.

ti.3.4.2 IGEDE CENTRAL C L I N I C

Plu cincrlr*i]c.rlcy form wds f i l led i n d s t t l ~ r e was no suspect

epidcrnic. Mori Chly r e p o r t forms for A p r i l . dnd Mdy were c o r r e c t l y filled.

A t c j t a l of 28 niosquitoes were caught for 2 weeks i n A p r i l and

-t;ol:,~l OF' 105 were caught, f o r t l i e wl lo le riiontli o f Mdy. D e t a i l s

T ime - No of People 7 5 t X i n F Tota 1 s

5-6 pln 6-7 prn 7-8 ~ I T I

T o t a l for April ( 2 w e e k s ) = 28

5-6 pm 6.50-7 pin

7-8 pm

5-6 prn G.58-7 prri

7-8 pm

5-6 pm 6-7 prn 7-8 pm

Time No. o f People Tota 1 s C d t c h i n g

5-6 pm 1 9

l-ol:dl f o r Mdy (4 w c k s ) = 105

51.3.4.3 1 T O B A S I C i . I E A L T i l C L I N I C

'The nlonthly report form for May was properly f i l l e d in and

d:ispd:clwl .to Oju LGA kleiidc~uilrters. There was no suspect epidemic

S O n o w o f Z : k Emergency f o r m s were f i l l e d i n .

G . 4 . < CI?OSS R I V E R STATE M I N I S T R Y OF iiEALTd, CRLABAR ---.-----.- --- !

'I'llc f i r s t fol lo\+up e x e r c i s e commenced a t t h e S t a t e l e v e l w i t h i

a v i s i t t o t l ie S ta te M i n i s t r y o f dea l t l i . The team held a mee t ing w i t h I !

Dr' C B Edern, t h e D i r e c t o r , P u b l i c i l e a l t h Department. Dr Edern g a v e

o f t h e v i s i t !lad cldirned abou t I 3 1 i v e s . The v i c t i m s were a1 1

chilrlrc~n bc.l:wocn t he c~gcs o f 8 ~nont l i s and 3 yedr's. The team s tudied

t h e File on r e p a r t c d ep idemics which confirmed t h a t a copy of the

En~crgcncy Not ; i f i cz t ion forw was sen t from Roman C a t h o l i c Missfan

(RCM) i losp i t ; l l , Mon i d y a , CQoj a and t h e c o r r e s p o n d ~ n s e showing t h e

subsequent ~ c t i o n s t a k e n by t l ~ e State a f t e r n o t i f i c a t i o n . The

cincrgcncy n o t i f i c a t i o n form was completed on 2 0 t h May, -1989 and sent

P r m ~ I<CM i l ~ s y ~ i i ; d l , Mondiyd t o b o p t h e LGA i l e d l t h O f f i c e and t h e

S h t e Miriistr 'y 0 6 H e d l t h , Cdlabdr.

Ttw .form redched Calabdr t h e f o l l o w i n g day (21/5/89).

Or Eden1 dncl h i s i n v e s t i g a t i n g team went t o Q o j a on 22nd May, 1989

drld Llie I?xlerill Mir1i~t1.y O F i k i r l t h wcls c ~ l e r t e d on 23rd May, 1989.

Or Edcin came down t o Ldgos w i t h 4 b laod samples on 25th May,

I . The samples were tdken t o t l ic F ~ d e r a l Labora to ry , Yaba

(Dr I . las: idi ls Lilb) on t t w same day. Ch Monday, P t h May, 1989,

Pr'crfessor Fab iy i a r r i v e d Cdlabar t o begin the i n v e s t i g a t i o n of t h e

epidcrnic. i le had 10,000 d o s e s of YF vrlccinc. A second ba tch o f

40,OCO doses was l a t e r s u p p l i e d t o t h e S t a t e , out of which 15,000

~ C I W T w r e s e n t t o t h e L G A ( Q o j d L G A ) . A t t h e t i m e of our visi t ,

t l i e StoCe I I J ~ not: yet r e c e i v e d t h e r e s u ! t s of t h e l a b o r a t o r y tes ts

c 3 r r i e d o u t on t h e 4 b l o o d silrnples, a l t l iough P r o f e s s o r Tomori had

ir ifurmi~tiuri t l i d t a 1 1 ?:Iic sainplcs were ric-!gdtive f o r YF Igm and igG

~ t l l : i l a J i ~ s .

6.4.2 STATE EP IDEM I O L O G TCAL UCI IT

Tile tern Iielri it m ~ c t i n g with Ct~leF J I3 Edm, i-lead of

Epid~r~iiologicill Unit:. As a t the time o f the v i s i t , the monthly

rcl)ort; for May 1 9 8 tldd not been received f r o m the LGA. The weekly

report- for the wekk ending 26 May 1983 from Clgoja had been received

a n d sl~owecl 9 cases of YF with 9 dedths. I t was sent by telegram.

Ttic rc?rnc.r-yency notification from RCM i l o sp i t a l , Ogoja was sent directly

.to I ) r - Edcrr~, I:lle Djrc.cl:or. No copy wds t lwcfore , seen a t the

S t i l k Epid~rnirsIogical Unit:.

4 .3 \/:isit 1x1 OcJojd ------

6.4.3.1 LGA i-IEALQUARTERS I 1 i

The team paid courtesy cal ls an the following LGA off icials: i

I

Mr. Njil Nkang-Abang (Snr) - Secretary, t o LGA - ' i lWs Agnes Manjok - . Sup~rvisory Council lor for ilealth

\ \

Tlic Sccr-ct;ar7y exprcsed his gratitude for the choice o f Q a j a LGA for 1 t Iw s1:ucly dnd pledged his cooperation. ,

5.4.3.2 LGA kIEAl-7 i l OrF ICE ------ 1

Tlic. twrn Llicn met Mr-s T Ayirn, the District Hca l th Superintendent C

irl chargc, Maternal and C h i l d ilealth, a n d Pub l i c Health D iv ls fon . i i

P4r-s Ay.it11 expressed her dlssdt isfaction with the manner in which the . I 1

suspectd YF o u t b r m k was reported, s t ress ing t h a t the information

rcdclled C a l a h r b~f0r-e the LGA wds n o t i f i e d . She then went further

I ' 1

3 t o exp la in t h a t a t t h e instance o f Professor Fabiyi, YF vaccine had

i

!

been incorporated into E P I and a1 1 chi tdren 1-3 years were. vaccinated. . ' ,

The 10 children t h d t died a t the RCM Hospital, Moniaya had had

previous contact with t h a t h o s p i t d l 1-2 weeks before they were C .

re-cldmit'ied and la ter died. She a l s o stated t h a t a case each had

b w r l rvpur'tctl f rorn I t e k p ~ drid Ugdgd v i 1 1 ages b u t she W ~ S not sure they

were 1:ctk~ti t o Iiospitdl becduse of the d i f f i cu l t terrdin.

*

E d r l -ier on the d a y of our arrjval, slic had received an

enlergerlcy r1ot:ificaticn o f yet anather suspected YF case from t he RCM.

i l o s p i t d l , Moniaya. Investigation however showed that the child was

. . ;1 ktiowrl s i~k le r . who bus in cr is is . Tlierc wds no montliIy return from

;In)/ u f the reporting hedltli units in tllc LGA. The emergency

nol;ificai:iori o f suspect& YF outbreak i n RCM 8ospita1, Maniaya was

r e c ~ i v ~ d on the 22nd o f May 19 89 . G.4;rl Visit Lo Ind . iv idu i l l +tlli:lr Units --- 6.4.4.1 LUTkIERAN BASIC kfEALTi i CENTRE, AC IFOKPA

711e 1 ) ~ d l t l l nil: 1s one of 'the rural outposts of the Lutheran

s t : l I . The tiealtli unit d i d n o t complete the monthly return

furni for Mcly WtB, due t o a confusion a b o u t the irnplementhtion of -

the excrc.ise between the 2 medicdl of f icer's who run the Rural Health

Prograrm. The instruction passed\dbwn from the h o s p i t a l was t h a t

the coniplrtirly a i the reporting forms should commence June instead

o f Mily cls we irlstructcd. 'There was n o report d b o u t any suspected

epidemic. T h i s confusion was resolved when iJ1e team visited the

liospital :n Yalie.

6.4.4.2 LUTi-iE17AN i l O S P I T A L , YAi iE ------- This Ixspital has a Rural Hea

Itcaltli pazts . Tltcre wds n n return

p o s t s becduse of the confusion exp

1 t t i Programme and supervise 10 rural

for Mdy 1969 f rorn any o f the health

lained above. This confusion was

resolved and t l w Dir'cctur o f tlic Programme, Dr Bassey promised t o

collect a1 1 the monthly returns during the Monthly Review Meeting

o f d l l the per'iplierdl I~eilIt.t~ units sclieduled for July 6. The tedrn

promised [:a re-visit tlie hospital within t h i l t period t o .retrieve the

camplc.~I:ed I'nnns i ~ n d also use tlic opportunity of the meeting t o t rain

further. tllc Iictlltti workers on the exercise. Copies o f the amended

crwrgcncy drid rmutine (mcntl~ly ) forms were suppl ied t o the hospital

ilnd Dr. 13dssc.y clnd his cnl league, Dr. Udoumo promised t o retrieve the

o l d f o r m from the health units.

5 . 3 IICF-I i10SPITI1l-, M O N I I ~ Y A ---------

This wils the Ileal ti~ institution t h a t alerted the S ta te Ministry

O F i I r- . ,~l [:I1 CIT the s ~ ~ s p e c t e d YF epidemic. Rev. Sister D r Bourdil lon ,

the I\lcdical Superintendent informed the team t h a t she noticed a

suddcn inuredse in

8 months - 3 yedrs

S l w c\x,i~n ir~ccl 1:llei r i

presented wi th one

the number of declths drnongst children dged

in the hospital between April 28 and May 20, 1969.

cdsc hist:ories md discovered t l i d t a1 1 the children

or more of the f~lfowing complaints - diarrhoea,

vomiting , cough, we<ikncss c t c . t o the outpatient department, about

6-10 ddys pr3ior t o r-e-dmission with non-specific symptorns

progressing t o oliguria/anuria and death within a few days.

By the 20th of May, 1981 , when Dr Bourdi l lor1 informed the State

M i n i ~ l ~ r y of i-fealtli, ten children hat i died. An investigation team

led by Dr Edern, Stdte Director of Public k a l t l ~ arrived CQoja an the

22nd Mdy, 1983 and collected samples from the sick and contacts.

Ql -I:lle 23rd W l y , 1983 , Dr Edern sent ' d l e t t e r t o Epid. Division, Federal

Ministry of 1-l~dltli, I-dgos reporting ille epidemic and calling for

dssist:ance. 0-1 t h e 25th May 1989, Or Edem took the samples personally

t o Ldgos and Informed Professor Fdbiyi a b o u t the epidemic. 0-1 the

2 3 t h Mdy, n m , Professor' Fdbiyi drrived h l d b d r t o carry o u t further

invcsl:igdtions. After examining the available records, our team f e l t

c o n v i n c d tllcl.(; the epidemic W J S n o t due t o ye1 low fever virus. The

retisons for ttlis were :

1. ?tic "c.p:idcrnicl' was restricted t o children between

8 months and 3 ycdrc.

2. A 1 1 t l w children tldd 1 1 ~ d previous contdct w i t h the RCM

i l a ~ p i t ~ l , Marlidyd 6-8 ddys prior t o tile onset o f the

illrlcss now described ds yellow fever.

3 . Ttlc "epidemic" was arrested fmrncdiately t h e RCM H o s p i t a l

wi~s c l o s e d down an the 23rd Mdy 1989.

0 t : l l ~ r p o s s i b l e c a u s e s of ep idemic of dcaLhs were cons ide red .

The p o s s i b i l i t y o f deaths from d rug i n t o x i c a t i a n / p o i s o n i n g was

consider-cd. In t h e m e t i n g he ld with Dr Bourdi l l o n , she e x p r e s s e d

the f e a r she had t h a t t h e d e a t h s cou ld a1 1 have been due t o a d e f e c t

i n the compounding o f s y r u p s i n t'he h o s p i t a l pharmacy. The NYSC

Phamrac is t a t t a c h e d t o t h e h o s p i t a l compounds such s y r u p s a s

pdr.acc.tilmo1, c l l lo raq* .~ ine , cough m i x t u r e , mist bel ladonna t i n c t u r e ,

phenobarb i tone s y r u p , va l iurn e l i x i r , mist magnesium t r i s i l i c a t e and

mist k a o l i n . '

Thc team had d i s o u s s i a n s with M r Esike, the NYSC Pharmac i s t on

t h i s a s p e c t . i-k e x p l a i n e d t h a t he had since d e p l o y m e n t t o t h e h o s p i t a l

been cnmpounding t h e above d rugs . ile pr'ocured the i n g r e d i e n t s through \ ,\

a s u p p l i e r i n Enugu and prepares t h e d r u g s once or twice e v e r y month.

Tlie prepared samples drc usmi by bo th the main h o s p i t a l and i t s I . 8 .

s c l t e 1 l i . L ~ c l i n i c s . 7 ' 1 1 ~ most c a m o n l y used d r u g s were parace ta rnol , .

ch l or-oquine i~rrd be1 1 ildonncl. The paracctacno 1 sample whfcli was t h e

suspected drug was compounded i n March and was used up ti1 1 May when

d l 1 the hospi tdl-pr*ept l red d r u g s were withdrawn. Samples o f t h e

i n g r e d l c n t s f o r a l l the d r u g s a s well a s the prepared syrups have been

sent t o .Llle Federal Labora to ry , Lagos and a l s o abroad f o r a n a l y s i s .

6.4.4.4 1nve~t:ig~~ting the Epidemic -----.---- - llic t e m employed ,tlie f o l lowing strategies : .

1. Going t l i r ~ ~ u g h tlie case f i l e s of d l .the 85 children

in tlic dgc-group G moritlis - 3 years ddmitted i n t o the

Iiospitdl i n April dnd Mdy 1989. For the analysed data,

sce ttic sepclrdte rcport on the epidemic in Ogojd. ( 7 . 2 )

i i . Blood smplcs were collected from one survivor and also

frwm 2 children in tlie fdniily of one of the dead children.

Ldboratory tes t s are t o be carried o u t by Professor Tomori.

i i i . Samples of the ingredients for compounding the syrups as

well as the suspected syrups prepared in March were collected

for possible andlysis. (see ReportG.4.5).

iv. Tlier~ were 4 children who were admitted inta the ~eke ra l

ilospihl Ogoja when the RCM ilpspital was closed down. These

cases were fol lowed up and a l l the necessary information

collected from the case f i l e s . Three of the cases which were

referred t o University of Calabar Teaching Hospital were

d l so f o l lowed u p and tile relevant information col lected.

G.4.5 ---- Report on Analysis - of Samples of ~aracetamol - Components and Syrup

Brxug l i t : f rmn RCM ilospital Moniaya, Ogoja - -- - -- -

t h d t :

Tlie arialys i s report from the Federal Laboratory, Lagos revealed

i . The syrup complied with specification for paracetamol content. .'..<,.;,

i i . Tlie syrup was lieavi ly contdminatcd with bacteria and fungi; . :'. . . . ,

I . .

dnd W ~ S consequently unsdfe for human consumption.

l i i . Some o f the components analysed were a l s o contaminated with

bdcteria. , .

Tlie report did n o t however identify the specific bacteria and

fungi involved.

L. 5 0'1'0 STA.1-E: %U JUNE - 3 JULY 1989 -------

5.5.1 1 i IE 5 1'A.l E El' IIIEM IOLOG I C A L U N I T -.----------

T l w I:em nwt w i t h Dr. (Mr's) A 0 A Iyun, t l i c D i r e c t o r o f Disease

Con trxl wllo Look us t o t h e ;leal t l l P l a n n i n g , Research and Statistics

Un:i-l: wllct'e WP .found t h e Emergency & p o s t form sent from Qbornosho

LGA err, I W l June, 1939 I n t h e i r f i t ~ s and dated as rece ived on the

2 3 w u f June. D r Iyun \,as n o t informed m d no a c t i o n was tdken.

We c o u l d no[ ; trdce t h e Play 1983 Monthly Report forms sent from

Ojbunmslw LGA on 9 th June, 19 &J . Ef-Forts are currently being made

, to i;r',~cc. t he farms i n one o f t h e S t a t e i- lealt l i Off ices.

6.5.2 OGD Q4 OSFI 0 LGA

\Ie Found one emergency report form sent from Bdptist Medical

CeriLr,c, Cgbornosho r r y m r t i n g il c d w of suspected ye1 low fever . The \

form was filled on 16 June 1869 and the p a t i e n t ' s dddress was given

~s Iltoy i-Orire I-GA. The form bids d ~ s p ~ t c l l e d on the sdme day Lo the

S~J!:C l e v e l where i t was ill lcged to have arrived an 23 June 1989.

F o r 1:lw r'olrl:inc n lon t l~ l y r'ctur'ns, see tile dt tdc l ied t a b l e (Table 13).

TAOLE I3 PURL IC i l E A L T i l OFF I C E , OGBCTIDSHO --.---- MONTilLY RETURN FORFlS FOR MAY 1989

NED ICAL CENTRE

DATE TTISVATCflED T O STATE

9 /6/89 9 /wm 9 16/89

No cpidmic of d n y a f the 4 disedses wds reported. No Emergency

Forms wore tlicr'cfor'e f i 1 led in.

Tlie ~1unt:lily r?eportr, fo rm for May 1989 was f i l l ed on 31 May 1983,

despdk l l ed on ttie same day and received a t tlic LGA Headquarters on

1 June 19r0.

Mozrlui t o Col lcctions -- --------

Five mosquitoes were clollccted for the m o n t h of May 19B.

1clenL.i.rical:lon wds yet t o be cdrried out a t the time o f the vis i t .

I'rom the the t ab l e , i t is olcdr t h a t the flow of information

from the periplieral health uni ts t o t he LGA up t i l l tlie t ime of

dc.spdlcli t o ttie St:&? leveI fol lowed the laid down guidelines. There

was ~ i r r cr?pid~.rrric o f typlioid f e v e r ir;h t h e LGA. Tlierc were 9 cases o f

st~spr_.cl,ed typlioid fever' reported from Baptist Medical Centre,

Qjbornc?slio. Two O F them w r e conf irrned in Elie 1 aboratory. Unfortunately,

Cq~t;:isl: MctJic<ll Ccntrc liils been having many cdscs of typhoid and did

n o t deem i t Iieccssclry t o report the epidemic using tlie Emergency

Rcporl: Porn. In any case, t t i e 9 cases werc reported on the routine

(nmn Lhly ) report: Form.

6.5.3.2 f\lnsquii:o Ccrllecticrn

A toi:,il of G mosquitoes were cdught i n May 1989 around the

L G A i-leadqudrt~rs o u t of which o n l y one wds identified a s Aedes s y p t i .

A n Entcrgency Report form wds f i l led tror a case of wlioaping cough

u n 2 JUDC l9trl and despdl;clied on tlic same ddy t o the LGA. No action

LI~JS i:dk(-_'~i drld I I C ~ ~ I I C I ' do wc expec t any d c t i o n since whooping cough is

nnl: m e uf 1.11e 4 diseases ur,dcr stlxly. There as no epidemic Of any

o r t l w f o u r rliseclscs under. s!;udy.

Tlic monthly report f a n for May 1989 was f i l l ed on

1 June 1983 and despcltctied t o the LGA an 2 June 1989 . I t was

r.ccc ived on the sarlie day.

Three rnasquitaes were collected for the month o f May 1989, out . o f

which only one was Aedcs s y p t i .

5.5.3.4 GBEDE DISPENSARY ---- Na Emeryency Report f o r m wds received a t t h e LGA. The Rout ine

fo rm for Mdy 1983 w a s filled on 31 May 1CJ83, d e s p a t c h e d t h e following

day tlnd received a t the LGA iieiidquarters on 2 June 1989.

Ik~squi to Col l e c t i o n s - No i n f o r m d ? : i o n wns a v d i l d b l e d s t l ~ c o f f i ce r i n c h a r g e had

trdvelled,

6.6

G.G. 1

BAUCi.1 I STATE : 16-22 AUGUST I9 83 -------- State Lcvel ---

Nane o f the two Notification forms had been received a t the State

Epidcrniological Unit a t the time of the vlsit. The reports expected

were the routine ( r r a n t h l y ) reports for June and July 1989 and any

cmeryency n u tif icdtion of disease outbreak f rorn T Q ~ LGA.

The i-lmd o f Preventive ikalth Services reported t h a t he had not had

the opportunity o.f visiting the L G A (Tciro L G A ) . No reminder letters

tiad been s m t t o t t ~ LGA.

Copies o f the T-eport o f tile preliminary v is i t were given t o the

i-Ian. Comn~.'lssionw, the Director General, Chief Medical OFf icer and the

;lead u f ~rcveniive ilealtti Serariccs.

The tedm once again stressed the n ~ e d f o r feedback w i t h particular

cmphasis on us ing reminder letters t~ defaulting LGAs and health units.

The Preventive Health Services Department has finalised plans t o

or-ganisc t l i c State workshop on Oiscase Surveil lance and Notification

fo l l owing t h e completion of the Zonal worksliop in Kano. The tentative

timctilble :is -Tror~, 26-28 September 1983.

Taro LGA klcilclquarters

The Learn f i r s t paid courtesy c a l l s on the new LGA officials following

the dissolution of the fomcr Local Government Councils by the Federal

Governmcrl-L. The officers mct were : . .

M r . Silrnaila ifassan Sole ~dmin istrator Nh. i-luss~ini A1 iyu Giade Secretary A 1 h . Moh~rnmcd Jairo A1 iyu i-lead, Medical & Health Department.

/

6.6.3 L G A i-Icdlth OFfIce

Na emergency form hild been received from any of the f o u r health

units t a k i n g pdrt i n t h e exercise.

ilowcvcr, three o u t of the four Iiealth units had sent i n the

monthly reports for June 1959 while only one had sent i n for Ju ly 1989.

TABLE 14. PIONTiILY REPORTS JUNE AND JULY 1983 , TOR0 L G A , OAUCilI STATE

--

i lEALTi l U N I T MON 1 tl DATE DATE ' DATE DATE DESPATCHED F I L L E D DESPATCHED R E C E IVED TO STATE

AT LGA -- ECWA Clinic June 1983 3.7.89 4.7.89 Not f i 1 led Not despatched

Curndu Dispcnsdry June 1983 Not Not Not Ind icat.ed Indicated Indicated N o t despatched

N;lbot.do Dispcns2r.y June 19 83 30.6.83 3.7.89 Not Not despatched Indicated -

Ristii i l u s p i t r l l June 1983 No report -

ECNA C l i n i c July 1983 No report

Gurnau Dispcnsdr'y July 1983 No report

Rishi Ilospitttl July 1969 No report

3.8.m Not despdlched

Ch:y twu hcaltli units (Gurnau arid Nabordo Dispensaries) sent i n returns on

mosquitoes for the mon1:h of June 1983 . I

Gumau cul lected 5 nmsquit-ies while in Nabordo, 6 mosquitoes were col lected.

A1 1 tilc mosquitoes col lected were of C u l icine species.

\4lm the t w o hcal t h units were visited, i t was discovered t h a t the s taf f d i d

t i c s t ca r ry out: t l l c nmsquilo col lection ds d i r c c t ~ d . ilowever, they promised t o carry

o u t the cxercisc cis directed in future. Each staff involved in the mosquito co l l ec t i on

was g i v c n a p a i r of battery and some test-tubes.

The ather two h e l i l t h tunits (Rishi Cottage H o s p i t a l and ECWA CIin ic )

d i d not: submit: any collection f a r the months o f June and July 1989. It

was n o t possible t o v i s i t Rishi Cottage H o s p i t a l t o ascer ta in the

situation k c d u s k of heavy floods and bad bridges. The ECWA c l in ic

d i d n o k d o any catching for the two months b u t the s t a f f i n charge

has promised t a cnsuru tha t : the attenddnts do t h e collections in future.

Ttie mosquitoes from Nabordo and Gumau Dispensaries were collected .

For identjficalion by M r V I Ezike a t the Nd'Li~ndl Arbovirus and Vector

Laboratory a t Enugu.

Each o f the hcalth units wds suppl ied with several copies of the

drncndcd nutif i c a t i m forms.

6.6.4 Visit t o Individual ifcalth Units

6.6.4.1 ECI4A CI inic, Rinjin Gaini

This Ilcaltli fac i l i ty submitted t;t,\e monthly report for June 1989. The

form was pr'aperly f i l l ed and despatched as directed. The monthly report

for J u l y 1983 w s s a i d t o have bccn dispdtched but c o u l d n o t be traced

a t the L G A Office. A copy was however found a t the Clinic.

Thcre was no suspect epidemic recorded.

Pile morbidity pattern found in the cl inic was as f o l l o w s :

CASES SEEN ( 1989 ) DISEASES

JUNE JULY - .

Malarid 110 85

Diarrt10ed 5 5 4 0

Dy sentry 10 15

Gastroentritis 12 12

- Measles 6 0

I4lloopiny C o y h 0 1

6.6.6.2 - Naborda Dispensary

Tlmugli this k i l l t h unit lias sent in the monthly reports for June

and July 1983, no copies were retained a t the unit as directed. The

s t d F F wer*e once dg~in bricfcd a b o u t the need t o f i l l

f o rms ~ n d t o retain a copy a t the health unit.

The rnor%idity/mortality pdtter-n found was a s fol

3 copies of the

' .

Inws :

CASES SEEN ( 1989 ) D I S C A S E S

- JUNE JULY

CASES DEATaS CASES DEATHS ------

Mdlaria

Measles

Dy sentry

Diarrhoea

8 3 1

5 Nil

13 Nil

5 6 Nil

G. 6 . 4 . 3 Gurnar~ Uispens~ry -.------ - Nu emr'gcncy report form was completed in this health u n i t . because

t

. I .

ttier'e was no outbrei-lk of any disease. The routine (monthly) repart for . , .

Junc 1963 was fi l led and despatched t o the LGA as directed b u t the . ., . . ' .. . .

instructions an f i l l ing i n dates t o help trace the movement of the forms :,,.

3 5' were no!: dl~er.ed t o . The s t d f f were retrained on t h e proper filling .. I

* L +

a .

o f t l w fcrrrirs s ince diffcrcnt morbidity figures were found i n the copies ' : retained dl; the unit dnd t h e one sent t o the LGA Health Off ice. . ( I .c,:. .. '<

' : . The team could n o t ge t t o this unit because of heavy f laods and a . .

6 -. . / BORN0 STATE: 22-25 AUGUST 1989 -- -- 6.7.1 S t a t ~ Epidcrniological ------ Un i t , Maiduguri -

Tllc State Epidcmio 1 ogical Unlt had n o t received any report (emergency

or routine) from the 4 health units taking part in the exercise. I t had .

. .

however, received ernergcncy reports of outbreaks o f Typhoid, Cerebrospinal

Mcningitis, Cllolcra and Rabies which occurred in March 1989 a t Potiskum. ,

Thesc r.cpor*ts were sent i n on 3 August 19@ (5 months after the outbreaks)

.: , . . and Maternity, Potiskum which i s a privately-owned health facil i ty. ,. .,!? . . .,!, ,

' , The morbidity and mortality pattern a t t h d t time was as follows: . . ,

., ' .

* Typhoid 15 cases w i t h n i l death : : . ,-

+ Rabies with 4 deaths . . . 4 cases . . 1 . 1 . .. .-

1 < . . . . * CSM 23 cdses with 3 d e a t h s . . .. , * Cholera 2 cases wit11 n i 1 death. .

' .

The 1.-ederSrll Epidemiological DWision, Lagos was notified the same . . . <;,k ,.., ,* F: .'!.

4

dcly (3/8/@l ) disa for record purposes. The reporting officer, Mr Baba .. a

Gilnd Mollilnirnecl, a Statistical O f f j c e r stated t l i d t t h e LGA i-lealth Offices' . .

wcr-c being s1,irnulcltcd t o s u b m i t t t ~ c l r reports on schedule and also t o . a .

1 ' ' 1' . . ' ' 1 ,, tllc S t d t c Epid U n i t . A v i s i t t o the o f f i c e of Alhaji M Tukur, Assistant . .-

. ;: ' I ,.ill:

. .. Dircct;orT, Discasc Control and I n t . ~ r n a t i s n a l iicalth revealed t h a t t he . . . c d .

, . . %' .

monthly re!;urns fu r June and July 1989 f r o m F i k a LGA were f i led i n his' . .. "'

. . I .: .,

... I., - .- . , 3 . .

.' , -1,;

o f f ice. Tlicse reports were retrieved and sent t o the Epid U n i t for ' .':, ;, .'!cr ,. . . I '

'I J.;, '. . col latian and analysis. A lha j i Tukur was br ie fed on the exercise and . . .M ..- :,:c $,* .. ? I b * , , - w <,. ,

urged t o d i rec t a l l reports received i n his office t o appropriate . ."< ,. . .;. ::. ~%j;,i

- .., .{Z'f:',.r , . ) t , - , < . , . . ri;, . , ,.:+;; 1

depilr'tment wliicli is the Epid Uni t . ,..!, .l!,t , , ,;.,$,!j . P C ;

', . . . . ,LL . - ,. ....

Iri his response, A1 liilj i Tukur. reported t h a t the p l m s for the I . I ' , , "L:!)'

' . *;" t;: : I . , .? ,.' 3 . ..,+,t;fi-

S t a t e workshop on Disease Surveilldnce and Notification were i n the . .>I : . . <;;,c ' * i 3 ; .. .

.' ,,,. !*< .;!;+.L,

,..L? d I..:. , f i n i l l phase. ' . .

6.7.2 l ieports Found d t 1:h~ State Level

Flontlily rcports from a l l tlic 4 Iiealth units which were forwarded

by F i k a L G A Health Office were found a t the State level. Copies of

1:liclsc. r v p o r t s were forwarded t o t l w F~deral Ministry o f ilea1tI1, fo r the

i l t t c n t i o n o f tllc Director o f Diseases Control and International i-lealth.

In ~lcldi t ian t o tlie r o u t i n e reports, an emergency report af suspected '

i;yplioid outbreak i n Gadaka Gov~rnment Secondary School was found a t the

S t a t e Ministry o f Heal th . This report was received a t the Disease Control

Unit and filed. No action was taken and the Epid U n i t was not notified:

6.7.3 Mctsclu-ito Ciltching Activities he--- . .

I . ., . . Tl~cre was an encouraging response on mosquito surveillance i n t h i s . . . '

S h t c . TIE s h f f i n a1 1 the choscn lied1 t h units carried out the I

cxt.rcfse, t l lough nane of t t i m followed the instructions dn the time - . ,

o f the ddy t o carry o u t the catchiqg. ..

11 t o t a l of 181 mosquitoes were collected by the staff i n the

f o u r Iicaltli units. 'rllese rnosquitocs were taken down by Mr V 1 Ezike of . .I . .

the Ar-bovirus ilnd Vector Laboratory, Enugu and identified a s follows: . . : . . 1 . ,.

TABLE 15 TDEN T I F ICAT ION OF MOYJU ITOES COLLECTED I N F I K A LGA, -------- JUNE AND JULY 1983

. ' . I - No te - . .

. . \ ' ..,.I' The rnansonia i s il good v e c t o r o f Ye1 low Fever. . , 'Pi I . ., a

. -

-------.---we-

ilEALTi-l U N I T

. .

1 . F i k a i l ~ a l l:h Centre

2 . P o t i s k u m Gcneral i i o sp i t a l

3. ECWA GI i n i c Ihkar* G x l u

1 . ECWA C l i n i c Kukilr- G d d u

2. General aospital Potiskurn'

TOTAL --

Lui:cccepha 1 us dnd i legypti spf c ies a re a1 so vectors. -- The coqwil spp arc n o t known vec tors o f Yellow Fever. -- ---

.

NO. OF M O q U ITOES COLLECTED

, 34

19 19

16 2 8

- 1 1 18

17 23 --

181

,-..-----

MONTF1

- lJunc 1989

J u n e 1989

June 19 83

J u l y 1983

Ju ly 1989

SPEC IES

Mansonia a f r i cana

Coquil. a u r i t e s Coqui 1. metall ica

AE 1 u t~ocepha l US Ae i lcgypt i

- ,

Ae 1 uteocephal us Ae aegypt i

Coquil a u r i t e s . Coqui 1 metal 1 ica

4

'. : . . : . "

. I . . . .. , 4.

-, ,; .. .

r::' A:. . * . :

6.7.4 F i k d LGA kle~dquarters -- ----

Tllc team f i r s t pa id J courtesy c a l l on the new Sole Administrator

o f tlic LGfl - Mr Bukar K Diu. The SoIe Administrat'or was briefed on the

exercise and he pledged his commitment and cooperation towards i t s

successful implementation.

6.7.5 Zcl r i i l l ilealttl Office -- .-

The i-lealth Officers i n cl idrge of this o f f i c e during the

pt-clinlin~ry vis i t i n May 1983 lldd been trdnsferred t o other zonal

offices. i-lowever, the new tearn was properly briefed by the former

o f f icers before they left .

The new team comprises o f : .<. ., ,

' . .. 1. f+lallam Dalliru M Mdilafiyd Zonal lealth Officer I .

2. Mohammed Abba Deputy Zonal Yealth Officer

3 , Mahammed Sabo \ Head, Medical & Health Dept, F i k a LGA

TI115 t c d m t o o k over on the 7 t h of May 1989.

6 .7 .5 Emergency Reports ---+

A t o t a l ol: 4 cmergcncy reports wet? rmcivcd ~t the Zonal i-lealth

Off ice between 19 t l i June 1982 and 15th August 1989. Three of these

were u f suspcctcd typhoid outbreak while one was of CSM.

Tilblcs 16 8 17 sl~ows t h e sequential movement of the form i n the

, .

MONTilLY REPOR1-S RECE IVEO AT TilE ZONAL i lEALTH O F F l C E

AS AT 22 AUGUST l g D 3

--- - MONTH

-

TO LGA A T L G A

DATE F ILLEC)

DATE C O L L A T E D

DATE DESPATCHED TO STATE

I 11 ZALTi-I FAC IL ITY 1

June

June

--

June

June**

-.--

Ju ly

P1Ci.I , Sa bon Gar i Nimgcre

Id-

E W A C t i n i c

J u l y

J u l y

Ju ly

' * Delay - S t a f f went on leave. . Forms later despatched on resumption ** D f l a ~ - Zonal i-leallh O f f i c e came for the returns when the f i r s t one

was lost in transit.

-A- - D ISEASE DATE SII SPECTED FILLED AlJD LOCATION

* ,

Ge-iei~I Hospital 9.0.83 PoLiskurn

.-

DESPATCHED

19 .6.B

TIME 1 WTE 1 TIME IDATE AND TIM DESPATWED RECEIVED AT RECEIVED DESPATCHED

Z ONAL OFF I C E TO STATE --

, . It i s impa r tan t t o I~ ighl ight t h e promptness w i t h which reports dre sent up f r om . I

one level t e the next. 3 . - ',: r . . : -1

The zonill i l c a l t h Office i s l oca ted w i t h i n the General i-lospital i n Potiskum and I ' , '. i . . .. : . .

' . .: th i s f i l c i l i t a t e s t h e collaboratiun between this health u n i t and the LGA Health Office. i,s;!

No action was hkcn I J ~ thc Stcite Disease Contra1 U n i t on any o f these reported

o u t ~ r c d k s .

\I I S !'I 1'0 1 N L ) I V IINAI- i lEAL ' l - i l UNITS ---- 6 .7 .7 . 1 F i k d i lenl f:h Ccritr%e ----

No cnlcrgcricy r,cpor'l fo rm was filled by this unit because there

was no outbreak of any disease.

As shown on T,lble 1G, the routine (monthly) reports fa r June and

July 19 8J wkrer'e we1 l f i l led and despatched as directed.

Morbidi ty Pdt t~rn

7 '11~ mor'bidity pattern found in this health u n i t was a s follows:

1 CASES SEEN (1981 ) DISEASES

JUNE JULY

Chicken pox 9

. . . I . . :

Copies af the report o f the preliminary visit were given to ..;: . .:

. b ,

. , 8 . . ... the s t d f f . Several copies of the amended notification forms as well

;,> ,.: . .

. .

~1s grclpl l boaks, exercise bocks, 2 pairs of batteries, test-tubes etc, ,: ;;;;.:' : ". ;: . :';.

were supplied t o tlirc! staff. The staff had another t r a i n i n g on graphic . I -;. . I I ' , .I . , .; -*

mpr'cscntation o f d i s e ~ s c incidence and mosquitoes col lected. . ., .$/& " . % & :

- ...';, A>.' . .?p> 6.7.7.2 ECWA C l i r i ic , Kukdr Gadu .,t...fiij %.:?!

,.., . (. ..- - 8 .. . . . .. I . ,. :.\ .i..l ~. !C2#', No erncrgency report form was f i l led by this health unit because , .,.: . b .Fiiq, - :y$

The routine (month ly ) reports for June and July 1989 were properly . . q . .

f l l led ~ n d dcspatch~d as directed. The s t d f f were however retrained on

gr'dpli i u rcpr'cscn!;al:ion o f d i s ~ i l s e incidence and mosquito col lections.

Thcy wr'c cil sa suppl icd wit.h s t r l t i o n ~ r i ~ s ilnd Fornis.

Morb id itylklor-Ld I ity P J [:tern --- --.-

11-IP morbidi~l,y/111or~tol i t y pc l t t c rn found i n tilis health unit wds

CASES SEEN ( 1989 )

JUNE CASES DEATi lS

165 Ni 1

20 1

103 I

6 Ni 1

5 \ ' Nil

4 6 Ni 1

153 Ni 1

JULY CASES DEAT~IS

124 N i 1

2 7 3

9 2 3

10 N i 1

15 N i 1

5 1 Nil

110 N i 1

Illis u n i t : I I J ; no facility t o admit p t ients . S t d f f could t lwefore

nut: give il proper niortal ity picture.

Nn cnlcrgency report was fi l led by th i s h e d l t h u n i t because there

was 110 discdse outl)rc.ak. The routine (monthly! reports for June and

J u l y 1903 were properly f i l l ed dnd despatched as directed (see t a b l e 16). . . . ' The s t r l f f wcr'c! howev~r re t rd ined on g r a p h i c represcnt~tion of

d iseosc incidence t ~ n d mosquito col lections.

bltiaoping Cough

. CASES SEEN (1989 ) , JUNE JULY

CASES DEATi-lS CASES DEATHS P --

8 8 Nil I 139 N i 1

This I-ie;lli:h u n i t has no f a c i l i t y f o r admitting pat ien ts and s t a f f

c u u l d r ~ o t give 11 proper r n o r t d l i t y picture. \ \

Illis Iic~11tli T i l c i 1 illy is il f u l l -f l e d g ~ d h o s p i t a l w i t h f i lci l i t i e s

for ' smc Idbor-ilt;or.y i n v e s t i g a t i o n s . A t the moment, t h e hospital cannot

coril ' i r.~n cl idg~lc~sis nf i:,ypl,oid, CSM dnd clio1cr.a due t o l a c k o f reagents.

Crnergcncy r e p o r t s bosed on c l i n i c o l diagnosis o f CSM and typhoid

were sen t by t h i s Iwiriltli u n i t t o t l ic L G A i-fedlth Office (Zonal iiealth

Off l c c ) . Tliese reports were received, c o l 1 a te ' j and despatched to the

S h t e l c v e l . No a c t i o n wds however tdkcn and there was no feedback

DISEASES CASES SEEN (1989 )

JUNE CASES DEATidS

Nil 1

JULY CASES DEATilS

EVALUATION OF V I E PR'ICEDURE FOR EMERGENCY NOT I F I C A T ION OF DISEASE

7 1 ~ q)crillional S u p p o r t Team carried out cornmun icable disease

survci 1 l m c c asscssmrnt d n d training programme in seven States o f

NIgerid b~.!.wccn 1 0 t h April m d 31 s t May 1903. Follow-up v i s i t s were

lndde bc [ :pen l ~ t l , Maj 19 and 25th August 1983 . The objectives of the

] ) ~ ' c I ~ J ~ ~ ~ I I ~ I I I I ~ ~ iriclr~d(-ld m~orlgst al:licr's the develolnnerit o f sk i l l s I n the

correct pvesurnptive cl inicaI diagnosis, proper recording of disease

informcltinn, d a t a collating and prompt notification t o the next

hlglier level. '

In th i s report, we shall describe the notification of three

suspcctcd autbrcaks o f yel low f e v e r dnd lassa fever in the Cross River,

Benue drld Oyr3 S W C . \

SUSPECTED OUTOREAK OF YELL04 FEVER - CROSS R I V E R STATE t -. - --- -- - -

An out:br.eilk a f a diseasc. suspected t o be yellow fever was

'rhc index cdsc wcls cldi:iit:ted on 28 A p r i l 1983. T h r w other cases were 1 i

admi-tt~d in the week May 5 t o May 12 1983 , and another four cases from I

b1;l.y 16 -to Chy 20, 1 9 B . It w s c l t th is point t h a t an epidemic was i i i

' I suspect:cd. Soon a f t e r , immcdfdte action was taken. The Sta t e and I

1- 3 '

LGA duthoritjes were notified on 20th ,and 22nd May, 1989 respectively. I

Action wils initiated a t the S t a t e and LGA levels w i t h i n 24 hours o f . . . .

z

r'cceipt; Q T - ' the notification o f the disease outbreak. Federal

ilut;tiorli t ies were iriformed within 24 hours of the investigations

. , ,

.

c ; l r* l - id ou'l: by t l ~ e SLa t e , a1 t t ioug l l the notif icdtian l e t t e r d i d n o t . * j;

ilrrive t tw Fed~r~al Epi~~~miologicdl Division until 1 June 1989, ie , I

i I ~ i l I . l ; I l p~rsondlly too!; b l o o d smples collected during tlre investigation

LC] l:llr? Fcc!~r.~il L,lbord!,or.y in Lagos d n d contaci.cd a cansultdnt wlio came

t o -I;lie S h t e f m ~ r day; df ter Ile wds notified. In summary, t he interval - 9

I~cl:wec.ri t l w -!:imc af noti Ficdtinn by the IWJ dnd ini t iat ion of action

by t:Iw L G A ilnd S-Ldte clutl~or.ities wds 24 hours; and 4 days between the

Stcltc and Federdl ilutl~orities.

SUSPECPED OUTOREAK OF LRSSR FEVER: BENUE STATE - -.-

Four C ~ W S o f d d iswse suspected t o be Ldssa fever were admitted

into the CkLllesdd iAospila1, Ikdciii, Oju L G A , Benue Sta te between

22 A p r i l 1919 i~rid 23 A:~ri 1 1 9 B . Ch the 2 5 t h April 1983 , a notification

for111 was r'i 1 1 ed md d i jpdtclied by hand t o the LGA ifeadquarters a t Oj u.

Thc rncssqe kids received the sdme ddy and within three hours, ttie

Corn~nissinner' for k l w 1 th i n Ihkurd i wds contacted tlirougli a rad io

rncssqe. As dl; the timc o f our j~isit; , (2716169) no dction lidd been

t : d k ~ . n by tlic St:dte Governmuit. A t the peripheral Unit, the pdtients

w r ' ? 1:r~clt:~d ~yfHj>t~[~ ldf ; i~d) ly ilrid l l i r w of the four cases recovered and

i r ~ ~ r ' ~ d l s~l i i l rgd. , '

,,'

S!?r '~~rn sclirrpl~s were sent t o Ibddan fo r serology on 30 April 1989

and thrcc o f tlic scrmplcs were positive dt law t i t e r s ( 1 :8) for

ldssil ~ P V C I - I gM d n t i b o d i c s . A request wds sent back on 31 May 1989 ,

for cotivcll~.,sccrit serum "ram tlic recovered cases. The hospital has

n o t bccn clblc. t o contact !;lie p a t i e n t s who 1 i v e very f a r away from Ikachi. t

1 Agclin, t;lw i n t c r ' v ~ l be twcn notificdtion by the PifU and in i t ia t ion , .

1 I

c f dction by the LGA wds very short [3' flours). ilowever, the State I

ilu!:l~crri!:lcs f ' ~ i 1 c . d t o dci; daspitc contclcts nidde by ttie LGA s t a f f . I t

is I~owczver riot:ewartliy Wilt tlic PtlU continued t o take necessary action

by ~.mI:~~c!::irq !:lw 1 ~ b a r ' a t : n r ' y :I11 s p i k o'f tile dppilrent ; ~ p c l t l ~ y and

Iiappcncd at; t h e Sta t e Icvel, b u t we have contacted the State

Plinistry O F i-lealth on t h e mdtter. - / .4. SUSPECTED CASE OF YELLOW FEVER: OGBCMOSi-tP, -- O Y O STATE

01 t l w 13th Junz, 1903, il suspected uilse of yellow fever was

adrnii.ted i n t o t hc B a p t i s t Haspjtal, Ogbomosn. Information about the

cdse was rleldyed t o the LGA ifecldqudrters on the 15th June 1989 and

wtls r~ccived t h e f o l l o w i n g day 16 June 1989 ; The LGA dispatched a notifi-

cill:ior~ form Lo the Stilte Epidc~niologiccll Division on t h e 16 th June,

1 9 . TIE form w;ls brought by hand t o the i leal th Planning S t a t i s t i c s

and Rescilrcli Unit (H3SRU) o f the S t a t e Ministry o f Heal th , Ibadan on

Flonday tire 13th Junc 19m. iiowevcr, the form was not attended t o u n t i l

23r'd Jund, 1983 when i t was f i l ed and no a c t i o n taken. (X1 3rd Ju ly ,

1963 , the .tr!;lrn met with D r Iyun, tlic Director, Disease Co'ntrol , Oyo

SI:ili:e, who confirmed t h a t no informqtion reached her division. A

visit: t c the. o f f ices of the i-IPSRU confirmed t h a t the emergency form

wi~s t'cxc~ivctl clr~d 1;Ii~f: 110 a c t i o n 11dd been Ldken u p u n t i l 3rd July 1989,

t l i c d d y o r uuu' vis i t .

Tlic sequence o f events on Epidem'ic Disease notification and

control i n Cr*ar;s Rivcr, Benue dnd Oyo States' are shown i n the t a b l e

ai :Lxlied. ( h M e 18).

I;: ~ \ d a m

I . . s

7.5 OUTURCAK OF 'TYPiIOID FEVER --.-.-----

I!; ~ C I S rlntcd on the m o n t h l y returns from Ogbomoso L G A t h a t #I

pcr~:iljlicr~~l- Iieilltl~ u n i t reported 9 cases of, t y p h o i d fever of which two

c ~ s c s wr.c lclborator:v corlfir-~iied. The niedicdl o f f i c e r in chdrge did n o t

-fee 1 I:yl)ltc~ i d CilScS mf?r*it emergency reporting bccduse very many cases

are seer1 ewry m o n t h .

7 . r; OI:SERVA-I-ION A N D C O N C I - U S I O N --------.- -*---- -- --

7.L. I Excepi: for ' the Cross River State , no further action was taken

beyorid 1:tie LGA level on the emergency not i f icat ion form. In Benue

SI:rl.l.e, wc WPIY r ioL able t o f i n d the redson f o r lack of ac t ion a t the

S t c l l : ~ ~ C V U I . In Qrs State , we discovered t h d t the emergency !

noi;ific~l:iari form war; submitted t o the ilealth Planning S t a t i s t i c s

and Rescdrch Uni t where i t wds f i l ed dnd closed. No information was

pilssed t o t he Diseds~ Control Di vi $,ion charged with taking appropriate

d c t i u n .

7.L1.2 Corll:r%dry t;o widc>ly lwld b ~ l i c f s , disedse epidemics can be

quickly nuLlFicd by s tdff a t the PilU and LGA levels. As has always been

sucpcci;crl, tlre conFusion dr1iscs d t the Stdte level , and this is often

wspclr~s i ble fo r i:lw undue clel dy in ins t i tu t ing actions t o control

diserlzc outbr5eaks. l4e have made appropriate recommendations which we

tmpc i i : i l l c l c c ~ r thc confusion d t the Stdte Ministries of i-lealth.

8. RECCPIPIENIlA'r IONS ON I1 ISEASE S U R V E I L L A N C E

0 .1 Tlic. (!pcri~t;ionsl Support T c m studied the rccomrnenddtions of the

I\l~i;ion~~l 7-(1sk Furoe on Epidemic Diseases clo$ely. The recommendations

Ijclow arc I~,~sc:d o n t h e pr 'dc ticdl field ~xperience of 1.31~ tmrn i n the

following St:clt;es - Bcnrrc, Cross River, Oyo, Bauchi, Borno, Niger and

Kildui-id. :lwy sliould bc considered in conjunction w i t h those o f the

N a t i o r ~ ~ l l Task F o r w .

0.2 Number anti I'ldture of tlic Forms

3.2. i We I ~ v e noticed a number of forn~s s t i l l being f i l l ed by peripheral

lie31th uni t;s N I I : ' L C I I dr'e sonict;irnes sent t o the Stilte leveI clnd a t other

times t o l:lw Fedcrcil Ministry of Heal th. (Yellow Fever Surveillance Form

21: Ito Oclsic i-IeillLh Unit for FMOil). I t Is r~cornmended t h a t a l l other f oms

be wi?;lidrawn a n d only the t m nationally approved forms bc used. Any .other

form Filled s l ~ ~ u l d specificdl l y bc of + short duration and be designated

0.2.2 'Ihc pr~c"sr:!rit: situiltlon of tlic L G A sending monthly reports which

.r;ta?:e orily tllc nurnbcr of c a w s b u t n o t the number o f health units reporting

noti I.'icd-l;.'lurl. It Is recornmcnded cis a1 ready incl uded in the amended monthly

(rxul.inc) nut-ification form, t h a t the t o t a l number of hea l th units i n the

LGA iis well cls 't;lle total number t h d t reported for t h a t month be included

In s l l the reports.

0.2.3 At: I:Iw S'txte level, a simildr niodification should be made indicating

t h e totdl number of Ilcalth units in the Stdte and the number t h a t are

3cI:ual l y reporting. This would make i t easier t o send reminders t o defaulting '

LGAs a d Iwal1;h units.

8.2.4 h e of the hcal~th institutions t a k i n g part in this s tudy has

Rural i-led1 Lh r-'rograrnme supervising a number of Ilealth posts and is looking

i n t o the possibility o f %rdnsldting the Emergency Noti f ica t ion Form and the

guidcl incs for diagnosis o f +?he four diseases into vernacular. T h f s wi l l . .

enable t lw lesser-trained health workers i n these outposts (ViiWs & TBAs)

t o par-ticipdtc in 1:lie cxi?rcise. I t wuuld be of interest t o see the outcome

o f 1:hi.s exercise.

8.3 FLOH OF INFORMATION -----.------.--

8.3. I In most; of the Statcs vlsited, the State-funded health institutions

by-pass t h e LGA and send returns d i r e c t l y t a the Stale level. A directive

-Fryom the FMOi-1 {:ha-l;' heal tl~ d a t a from d l 1 heal t i 1 institutions, irrespective .

oF source u f Funding sl~oi~ld be routed tlirougli the LGA in which they are ' '

sitcd w i l l help t o pr'ovic'e a more complete picture of the health s i t ua t ion I

i n t h a t LGA. i

\ , \

8 .3 .2 Our\ exper-iencc i n tbree States showed t h a t information smoothly gets

from t h e periyli~r-a1 health unit thraugli the LGA t o the State level where no

action i s taken. In one o f the States, this state o f a f f a i r s did indeed

(J iscuur-dgc [:Iw per5.ij~lwrdl Iwd 1 L l i urlit: f VOIII rvyor-1:irig of- f u Lure outbreaks.

8.3.3 Based on t h e experience o f O j u LGA in reporting a suspected Lassa

f cvc r c?pidm:ic :in April, 19@, and since most LGA ileadquarters have radio

canimuniciition Fdcil i t ies , i t i s recommended t h a t other LGAs adopt the

sclme ~1:riltegy for rdpid eineryency disease reporting.

8.3.4 The Sl;cl!;c Epid. Unit in collclbordtion with the LGA, should tabulate

the number o t hcdl tli units t l ~ i l t are n o t reporting in the individual LGAs

and advise such LGAs t o follow u p the defaulting health units.

8.3.5 11.1 order. t o strcdrril irrc t lw f l o w of informtion, cledr instructions

sliould be giver) t o staff af t lw periplieral health units, the LGAs and the

Stake h e ~ l t h clul;l~orll:ies t.hilt d l 1 returns be sent t o the dppropriate

Epide~r~iologicdl Urlit;. A1 l otl~er drrns of the gover3nrnent requiring such

Sn.forn~d:iorl slicluld o b t ~ i n tliern f rum the appraprf ate Epidemiological Unit .

8.4 FERSONNEL AND T R A I N I N G ----

8.4.1 T t w L G A ileill tli OFficcs and Epidemiological Units should be strengthened

Ly dep1oyn;oril; oF trilinecl persoonel who w i l l be .capable af some basic d a t a

a r i ~ l y s i s . . .

0.4.2 The PFfisc o f tlie State EpidemioIogical Units should a l s o be '

s t rT~ny l - . l : ~ r l ed by dcvelaping proper s t a t i s t i c a l units which will be responsible

for' da-l:ii collation and feedback t o the L G A Headquarters. This will enable

t l ~ stclT-'f !:o furw d picture o f the perf~mdncc level of the LGA compared

t o t h e olliers i n matters of prompt submission o f disease reporting forms,

1:hc oonrp1cl;encss drld ilccurdcy in f i 1 1 ing thc forms dnd the dppropridteness

O F my obs~rlrvilClons rnilde o f likely epidemics in their LGAs or neighbouring

L G A .

8.5 - LABORATORY SUPPORT FOR D ISEASE SURVE ILLANCE

9 . 5 , 1 The process O F disease survcil lancy t h r o u g h mosquito co l lection

seems t o bc progressing well b u t for i t Lo serve as an early warning system. '

Fcir ~pr'cd:ic-t:iny ~.pidc~nics, i t sl~ould be complementcd with virus isolation

f r w m ttic col leu-Led mosquitoes using the EL ISA technique.

Our\ s iriccr'c dl~l)rcc idtian goes t o the f~l lowing people w i t h o u t whose

u c ol-.cr-dtiarl m l ~ b n Lri bu t ion, t h e irnpImcnLatiorl of l h i s exercf se would n o t I

hclvc been : ~ o s s i b l e . A t the WiiO Office, w dre grateful t o the WR,

D r 5 i l Brew-Graves for Ills approva l and total commitment t o the exercise,

d r ~ d PIr' S Anf:cy for his valudble support , A t the Icvcl af the States and

LGAs, we are indebtd t a the following people: 1

Chief Medical Officer

Hcdd, Preventive Hcdl t h Services

Cli~innan, T ~ r o LGA

Supervisor, Medical Services Department Toro LGA.

DENUE STATE

D r '1 I Our

Dr. Dclum--th 1 i

D r y (Mrs) R A Abdulldhi

Dr' J U A c l i q b u l u

Dr C T I t y ~ n z u g f i u l

Cliicf Pd t r9c l c lkwc

Mr I 0 Ikpa

Mr Jgbdyurnt.

Dr A Slni Ls

0 0RkI0 STATE

ilori. Cornml$s loner f o r ileal C h

Chief i-fedltll Off iccr

Principdl Health Officer

S h t e PAC Coor 'dbator Dc.puLy Clidinndn, O j u LGA

Supervisory Council 1,or f o r Yealth L G A Secr~tary , ZIj u LGA

Med ica 1 Superintendent, Bethesda ilospital , Ikd~hi , O j u LGA.

Director, Oisedsc Control and Chief Health Officer

Chief Community Health Officer

S ~ ~ r ~ h r y , F i k c l LGA

Z o n d l ;led1 tl, 'Off i cc r , Po t iskurn (now trdnsferrecl) Senior i i cd l t h Superintendcnt: :i/c F i k d Ared i k d l t l l Office.

NPW Z o n ~ l ilcaltll OFficcr, Potiskum Ass!:. D i r-ector, Disedse Control Unit

Sole AdministrVcltor-, Nmgcre LGA

CROSS R I V E R STATE ___r_---.-

D r Spcnwr Efcni

Dr P M O j u n

Dr C 13 Edcm

Cl i ic f J B tldcrn

Mrs J Asuquo

l\lr Godwin 0 Awe

l4rs Agnes blcnjok

Plrs T ,4y im

Mr. J U Udu

Mr M Egozi

Mr Isidore Anymgo J P

Dr C i3ourdillon

D r q E t t a

Dt* F,lart,in Kok

Mr i Agi

Mr. Sirncm O j i j i

Or Ui~ssey Dr' U ~ L I O ~ O

KAOUMA STATE --- Mr3s Sarah ililssiln

Mrs R L Ldzzarl

Dr P Y K ~ t u n y

Dr Ycrrii FdyQlni

A1 h ~ j i Bunyilminu Sllurilihu

Dr M Bclllo Abdullillli . . Dr' M S d i f u d d i n Nard

Mr Garba Sal ihu

N I G E R STATE

D r Susan Sdbd

D i-l M G m bo

Dr R C Ascuncion

Mr J A J c l l : ~ ~

MI.' Pi D A i l c l l i l u

, ,,,, . Cornniissioncr f o r i l ea l th

U i recl:or'-General

D i r e c t o r , Pub1 i c . i i e a l t h Department

ilcrld, StdCe Epid. U n i t

PHC Coord ina tor , Ca labar LGA

Vice-Chairman, Cgoja LGA

Supervisory Counci 1 lor for Heal th

D i s t r i c t Heal th Super in tendent i / c Publ ic i l e a l t h Div i s ion , Ogoja LGA

Ag. ilead, LGA Epid Un i t , Oge jd

Senior Environmental Heal th Officer, Ogoja

Community Leader, A1 i fokpa Community

Medical Super in tendent , RCM Hosp i t a l Moniaya, Ogoja

Medical Officer, General i - lospi ta l , Ogoja

Medical O f f i c e r , Lutheran i - iospi ta l , Yahe

Pr inc ipa l Hospital Secretary, L.H. Yahe Senior C i1, 0 L,% , Yahe

\

Fkdical Officer, L.i-l. Yahe

Mcdical O f f i c e r , L . H . Y ~ h c

iinn. Commissioner f o r i k a l t h

D i rector-General

D i r e c t o r , P ianning , ' Research &

S t d t e Epidemiologis t

Statistics

A s s i s t a n t Chief Community iieal t h Of f i ce r , i / c Government t lea l th Off ice , Zaria. Mcdiccll Director, Z a r i d C l i n i c and Medical Centre

I . .. k d i c a l Oircctor, Z d r i a C l i n i c and Medical Centre , . . L, Snr Nursing S u p t . Zaria C l i n i c and Medical centre .:.$:

.. .. t ,A.

D i rector-Genera 1 , SMW . , .

Chief Mcd ical O f f i c e r

S t a t e Epidemiologis t

Cauricil lor for i l c ~ l t h , S u l e j a L G A

PAS, Su le j a LGA

OYO STATE

Plrs Fol ilshilde Qun 1 dde

Dr (Mrqs) A O A Iyun

D r (Mrs) E N Q - l a f o ~ m k d n

Dt* E 0 B d b a j i d e

M r Lekdn Adeyboye

Mr G A Adenf ran Mrs A A Popoald

Mrs B o l d Qunjumo

Dr P 0 Elcmile

j , Gmeral klospital, Suleja icd1 Director, Milrdba ilospitill , Sule ja

Director-General , SMOH

!ctor, Disedse Control ICY Dlrector, Disease Control istanl Director, Disease Control .n O F f icer I , Ogbornoso LGA

. n Officer, Ogbornosho LGA

Icr Executive Officer, Ogbornosho LGA ...

t h Sister in LGA I I I 1

.cal Superintendent, Baptist Hospital . .

lmosa u~rector , Comm. Hedlth programme

Pari; I I GP Residency Programme.

Tllsnks are a l s o d u e t a M~ssrs Francis d i s i and Augustine h o g h i e ,

(FMCCI a d '!i10 Drivers respectively) who conveyed t h e terns t o the various

l o c a t i o n s . The sccrlctdrial support fo r production of t h e notification and other

forrns ds b i c l 1 as p~'cpi l r i l t ; j~r i o f the reports were provided by Miss Cllizoma alagr;la, +

Pliss JuI ie Ben-Emuzc, Mrs Shade Ajilore, Mr Fi Gpia and Mr Mustapha Olowu.

r 1 - 1 .

In - \- I -

n : . LLJ L 2 % -- 3.- - -J L< - 3 - -- t h r-

C Y , - I 17 -- i-t

I

7 -- Crl . Il t -2 > -. -- f3 r

............................... 2. LoraLiori: ......................... LGA " S t a t e

I

1 own . , . > . . I # . : , I

................................................ 3 , . I I J ~ o f D i ~ ~ i l ~ e suspected : . I :. .

.......................................................... 4. 'Syrnp!:~~!)~ ilnd Sigris : : e . .......

5. f h t u oi' inclcx case:. ........................................................ j ' . .

............................................................................. . .

7 . 1.h~ C ~ S P rcfwred f r o m anoti lcr5 heal th f d c i l i t y ? y e s ' / / . No . / / . . . 8 I ,::

'3. I f i i nswv . l c 7 i s yes , (live: , . ! , .

( i l ) I lme of' rrlt!rlic;ll pcrsar ir~cl r-cl'errlng : ..... .-. ..........................m !

( b ) nddrcss JIKI te lcplmnc nun~bcr- . i f d v a i l a b l e : ........................... . . . ...................................................................... 3 . Oatc m d p l ~ C I ? o f or1;c.t : ................................. ... .........ern.... 10. i l a v o s d ~ ~ ~ p l e s Irr:cn c a l l c c t e d Tor- Idborar8or.y s tudies? Yes / / NO / . /

... . . ....................................................................**....* -..a.- ~. . . . . . ... , ... , s. , . . . t h e .{sf pcrs,t-t~r' r e p o r t i n g : ........................ Signature: ........... .., . . . . i .

. , a

. . I . . 9 ' .... .. . , De:iiqr~rlLim~ : ,... ...................................... Ddte:. ..., ....,..- . . . . '.

. -. . ' . I;. . . . . * , . , ; ; I . ..................................... , . , . , Mdrcss: ...,.. ., '?'

. . * 1' . ...;*..,. . : 5, . Date Dcsp;lil;cl~cd': ............................................................ .:. ... . . . . r e , , . . . . . . . " I

. . ' . - l u.. . . I . ' 1 .,..:\,

5 . T i n ~ t " P r ;p ; l . t r : l i~x l : ......................... , ...'........ , ......... , ........... '

. . . . . . . . , - . . . . . :I/ "::?- , : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . ; ..,,,!?bi ,;; . ,. . -a '

- . a . . . . . .

. . . . . 1'

, . . I ~ V C ; I / \ [ ? G I I . RI:CEI ~ ~ ' L I I ! ; i / ~ ~ , ~ - ~ ~ l l v s a " . . - ( . . ,.. - 1

.,:I j . . . . . . . . [ . . . . : * ! . . .a 5 , !* , - + --., . -- -- --- ..--- .--. --- -

? . . 4

. . . . . . . . . . . . . . . .I! i . . . . .... . . . * . . . ' ;.: . . . . . I . C .......... ....... I . t i I ............ - '. ..................... .. ..........,.'

. q i . . . . . . . . _ . . . . . . . 2'. I I ... , ..............*....:...... , ,'. ............'.............. ;. ......' . . . , . . . . - . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - .

. . 3. Sigr~aLur 'c: .............................................................. ? . . . .,,. 1 ., ' . , . _ . .

I . " "" . , , . . . . I . . I . . . . . . . i , . . : ,..: 'a .............................. . ' 4 . I h t c k r ; c i vcd : ....................... ..., :. .-, :. ,,?. ,::, . I . . . . . . . . . . . , . . . . . ' - . il

c' . . ........... .I. Ti:iic Received: * . - . .. ................................ ....'...-... . I . . . . . . . . . . . . . . . . . . . . .

" . t , . . . . : .

4.: . D ~ t e . l kcu 4 vet1 : ........................... , ..... ,, ................ .,+ .. r) , . , ... I - . ..;:I d

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7. . T i m ~ l!ts~p~ltclwd : ........................................................... . I # . I . , . . . . . . . . . . . . . . . . . . . .

I E I C i l l W E STf\'TE LEVEL . . . . . . . . . - -....-.--- , , I ---, . . . . . . . .

1. I : . . . . . . I . . . . . . . . . . . l . . . . . . . . . . . . . . . . .~ . . . . . . . . . . . . . . . . . .~ . .e . . . . . . .~~ 0 .

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... ................. . . . . . . ! Tirne . . . C!?ceivecl: . . . . . . ....................*.............. '.:: . . - . . . . .

6 . L ~ J ~ c ? I ? ~ s p d t c I ~ ~ d : .................................... . ............... .. . .. . .. 7. T ~ I I ? ~ ! Ik:pil!;cl~i)tl! ;. ;:. .:. ................. 8 . . *. 1 *.. :. ...........

FORM END0/2

I IA 11-Y INC I l l E N C E - ,, ISEASE 5 INCE INDEX CASE

(I:o be submitted a t the end o f every month) --.---- -

.... z... ......... ............ L GA STATE

.................................................. 3. Name of Dlscdse suspected

ANNEX 111

CASE IIEF I N IT IONS

( 1 ) Yellc!w I1evcr

( 2 ) C ~ r v l ~ r ~ c l l S p i n ~ 1 Meningil- is

(4 ) TypIm:id

( I ) YELLON FEVEI? -.---

Any pcr jp l tc ra l h e d l t l l worker s h o u l d on n o t i c i n g - ONE Case wi th

clny - 0 4 E o f i:lw f a l l o w i n g combinil t ion o f c l i n i c d l f c d t u r e s a r r i v e a t

d pr'esurnpl:ive d i a g n o s i s o f Ye1 low Fever .

( i ) Fever f o l lowcd by Ye1 law Eyes w i t h i n a maximum

of f o u r d ~ y s .

( i i ) Fever. fo l lowed by d e a t h wi t t i in 4 t o 7 days .

( i l i ) Inorcas~ i n t h e number of unexp la ined d e a t h s i n . a1 1 age g r o u p s / a d u l t males.

( i v ) Ycl low Eycs w i t h a1 bumin iri\ u r i n e .

( v ) Ye1 low Eyes w i t t i any one o f t h e f a 1 lowing:

( a ) Bleeding from the nose ( E p i s t d x i s )

( b ) Uluod s t i l i ned n a s a l d i s c h d r g e or on blowing

dlw nose .

( c ) Ulceding f rom t h e guns o r mouth

( d ) Caugliing up blood

( e ) Vomiting blood

( f ) Blood i n stalls (Malaena)

(g ) & c u l t ( h i d d e n ) blood i n s t o o l s (conf i rmed by t e s t )

( 1 1 ) Excess ive or u n c o n t r o l l a b l e b l e e d i n g f rom any fresh p u n c t u r e wounds c . g . after c o l l e c t i n g blood u s i n g a r ~ e e d l e o r tclking blood # f o r - mdlclri J p d r c l s i t e s .

( v i ) Susp ic ion o f an Impending Ye1 low Fever o u t b r e a k w i l l be

sl:r~ct.r~gt:l~cnr.d by - incr'edse i t1 A F ~ P S m o s q u i t o p o p u l d t i o n r e p o r t s

frxam your Entomolvg i s l col l e d g u c .

P LA-TEAU

IKAUU NA

BAUCi l I

K A li1 0 0 DI?N O

KATS INA

may mike (I p r s u m p t i v ~ diilgnasis o f Ccrebral Meningitis (CSM), i f heJshe

sces W l C E d s many cases f o r t h e season presen'ting w i t h m y - ONE of the fallowing combination of clinical fea tures:

I' ( i ) Fcvar, i-lcadachc, Plmtopliobia (fear o f l i g h t ) and

s t i f f neck.

( i i ) Fcvcr leading t o death i n 4 t o 7 days (cases of

ntcningococcaemia

( i i i I~icr'eilse i n number or' dedths of s c l ~ ~ o l age children

( 5 t o 15 years).

( i v ) Iticreilse i n t o t a l aeattis from unexplained cause

( 4 ) An incrcdse i n the index o f suspicion w i l l be

crilidriced by my o f t h e ilbove occuring .du r ing t h e cold

d u s t y 1i;lrrnai;tiln period. A better indicator is being

( 3 ) Ci-IOLEIM -----

( d ) A ~.)er'iplieral ikdl th worker sllouid suspect dn epidemic

o r cliolcril i f slle/lw encounters ,

( 1 ) S F V E ~ Didrrhoea: ( 4 or more watery stools per

24 hdurs reported i n ;

( 2 ) --- A i lu l t s : Origindting from;

( 3 ) 1-1. Separatc lirjusetiolds and occurring;

( b ) At1 epidemic of ctlaIerd mcly bc diff icul t t o pick ou t a t the

periplwr.al Ileal t l i unit, therefore LGA and State d a t a col lators

s l lou ld bc. on thc look o u t for:

( i ) Iricreasc in didrrlma disedsf reporting dmbngst

aJult;s or- older children.

( i i ) A d ~ d t t i or d~dtlis from didrrfioea in a d u l t s / a d u l t

or olclcr* childr-cn.

( i i i ) Congestion o f sucli cdscs i n m d around a trouseholds

or. peoplc sllclriny d conirnon wcltcr saurcc.

( i v ) Diarrtioca reports i n older ch'iidren or adult or deaths

from didrrhoed by d d u l t s or older children from

conticontiguous d r e d s O f two neigl~bouring !+.GAS.

Suspicion of an epidemic should be enhanced if the above

4 hppenings arc accompmjcd by an obvious/reported or suspected

brcdkdown in water systcm i n w b a n or l o c d l government area.

Stool specimens must: ascotnpmy the emergency report

fo rm dt1nc.x IV.

An cplde~riic o f t y p h o i d fever a t t lw periphery can be suspected i f :

( i ) Tticrie is a ldrgc nurnbcr af fevers no t responding t o the

usual treatment of f e b r i l e illnesses for t h e area especially

anti-m~larials af ter a wried o f 7 days.

The suspicion f o r a typhoid epidmic i s strengthened i f :

( i ) dbove i s accompanied by:

( Bre~kdown of con~nunual w a t e r suppIy or

( b ) If t l ierqe is cvidencc of another epidemic disease

spread through thc filecar orcil route eg, a d u l t

dil~t*rlioca or' f r d n k cl~oIercl. 1

Slc io 1 spcc irnuns must dccornpmy the Energency Not i f ica t ion

.for.m Annex VI.