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In September 2017, Nigeria experienced a large outbreak of human monkeypox (HMPX). In this study, we report the outbreak experience and response in the Niger Delta University Teaching Hospital (NDUTH), Bayelsa state, where the index case and majority of suspected cases were reported. In a cross-sectional study between September 25th and 31st December 2017, we reviewed the clinical and laboratory characteristics of all suspected and confirmed cases of HMPX seen at the NDUTH and appraised the plans, activities and challenges of the hospital in response to the outbreak based on documented observations of the hospital's infection control committee (IPC). Monkeypox cases were defined using the interim national guidelines as provided by the Nigerian Centre for Disease Control (NCDC). Of 38 suspected cases of HMPX, 18(47.4%) were laboratory confirmed, 3(7.9%) were probable, while 17 (18.4%) did not fit the case definition for HMPX. Majority of the confirmed/probable cases were adults (80.9%) and males (80.9%). There was concomitant chicken pox, syphilis and HIV-1 infections in two confirmed cases and a case of nosocomial infection in one healthcare worker (HCW). The hospital established a make-shift isolation ward for case management, constituted a HMPX response team and provided IPC resources. At the outset, some HCWs were reluctant to participate in the outbreak and others avoided suspected patients. Some patients and their family members experienced stigma and discrimination and there were cases of refusal of isolation. Repeated trainings and collaborative efforts by all stakeholders addressed some of these challenges and eventually led to successful containment of the outbreak. While the 2017 outbreak of human monkeypox in Nigeria was contained, our report reveals gaps in outbreak response that could serve as lessons to other hospitals to strengthen epidemic preparedness and response activities in the hospital setting.

Introduction Combating the several public health threats on the African continent requires trained and equipped workforce. The establishment of the 6-month Africa CDC Public Health Emergency Management (PHEM) fellowship provides a pathway for developing a cadre of workforce that is capable of initiating and leading emergency management programs in Africa. Objective We present the process undertaken to draw up a competency-based curriculum for the first continental advanced training program in PHEM.  Method A multi-step, mixed methodology was employed in this study. Systematic review process was triangulated with case reviews of similar training programs to provide the first draft of competencies. Through subsequent consultations with experts and technical iterations, the program’s competencies and curriculum were developed. Result Through four iterative revisions, the competencies framework evolved with input from each stage, resulting in a final structure of three competency domains and 10 sub-domains. These informed the development of an 11-course syllabus with corresponding learning objectives, outline and content. Conclusion A curriculum that reflects the foundational skills desirable of professionals engaged in the practice, education, and research in public health emergency management in Africa was developed utilizing mixed methods. Although this exercise was designed for the advanced PHEM Fellowship program at Africa CDC, the process, emerging competencies and curriculum could benchmark competency-based emergency management training across the African continent.

The West African Ebola virus disease (EVD) epidemic of 2013–2016 was the largest on record, severely affecting Guinea, Liberia, and Sierra Leone, and overwhelming public health systems. Following Nigeria’s successful containment of its domestic EVD outbreak in 2014, the African Union Support to Ebola Outbreak in West Africa (ASEOWA) mission deployed 196 Nigerian public health professionals, the largest single-nation contingent, to Liberia and Sierra Leone. This commentary reflects on that deployment, highlighting operational contributions, innovations, and the enduring impact of the mission on Africa’s public health security landscape. The Nigerian team strengthened Ebola Treatment Units (ETUs), surveillance, epidemiological investigations, laboratory testing, infection prevention and control (IPC), community mobilisation, and restoration of essential health services. Significantly, no responder infections occurred under Nigeria’s deployment. The mission reinforced African-led outbreak response and contributed to the evolution of regional security structures, including the Africa Centres for Disease Control and Prevention (Africa CDC) and the African Union Volunteer Health Corps (AVOHC). A decade later, the deployment remains instrumental in shaping sustained public health workforce investments and integrated emergency preparedness systems across Africa.

Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018. Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.

Road traffic accidents are leading cause of injuries and deaths globally. Low income economies are the most affected. Most causes of RTA are predictable and preventable. This study describes trends and causes of road traffic accidents in Anambra State, South Eastern Nigeria. We conducted a retrospective study of road traffic accidents from 2010 to 2014. Data were obtained from the Federal Road Safety Commission, Anambra State Command. Information extracted included sex, age, cause of accidents, number of people and type of vehicles involved. Cases were recorded as fatal if any victim died, serious if any victim was hospitalized for more than 24 hours and minor if any victim was hospitalized for less than 24 hours. Causes of accidents were classified into human, mechanical, and climatic factors. Univariate analysis to generate frequencies and proportions was conducted using Microsoft Office Excel 2007. A total of 1,141 road traffic accidents consisting 271 fatalities, 652 serious and 218 minor cases were recorded in Anambra State from 2010-2014. Seven thousand, four hundred and forty-four persons involving 1,816 vehicles were involved in RTA that resulted in 448 deaths and 2,785 injuries. More deaths 348 (77%) and injuries 2009 (72%) occurred more in males than females. Major causes of road traffic accidents were loss of vehicle control 256 (17%) and speed violation 207 (14%). There was an increased number of persons involved in RTA in 2014 (1,842) compared with 2010 (299). In all, 3,233 casualties (deaths and injuries) and crashes (fatal, serious and minor) were recorded out of which 900 (27.8%) casualties and 294 (9.1%) crashes occurred in 2013. Leading causes of road traffic accidents are human factors; speed violation, loss of vehicle control and dangerous driving which are sadly preventable. Sensitization and enforcement of safe road principles among commercial vehicles and car drivers will help curb this menace. Government at all levels should implement strong policies aimed at reducing the speed of vehicles on roads.

Despite the availability of vaccines, pertussis outbreaks still occur in developing countries. In December 2015 we investigated a pertussis outbreak in Kaltungo, Nigeria to identify determinants of infection and institute control measures. We enrolled 155 cases and 310 unmatched controls. We defined cases as residents of Kaltungo with paroxysmal or whooping cough lasting 2 weeks with or without vomiting and randomly selected neighborhood controls. Using structured questionnaire, we collected data on socio-demographics, clinical and risk factors. We collected twelve nasopharyngeal swabs for laboratory analysis using Polymerase Chain Reaction. Median age was 24 months (range 1-132 months) for cases and 27 months (range 1-189 months) for controls. Female cases and controls were 86 (55.5%) and 150 (48.4%) respectively. A total of 83 (56.6%) cases were in age group 12-59 months. Age-specific-attack-rate was 83/1,786 (4.7%); Age-specific-case-fatality-rate was 21/83 (25.3%); Age-specific-proportional-mortality-ratio was 21/24 (87.5%). A total of 61 (39.4%) zero doses and 30.1% Pentavalent dropouts were documented. Multivariate analysis revealed parental refusal (adjusted OR = 27.8; CI = 8.8-87.7), contact with a case (AOR = 7.9, CI = 4.3-14.7, P = 0.000), belonging to the Muslim faith (AOR = 2.0; CI = 1.1-3.5) and having mothers with informal education only (AOR = 4.7, CI-2.6-8.4) as independent predictors of pertussis infection. Sub-optimal vaccination due to parental refusal and informal education of mothers were major determinants of pertussis infection. We conducted awareness campaigns of key immunization messages targeted at the informal education sector. We ensured appropriate case management, contact vaccination and health education in public gatherings, worship places and schools.

vital events registration is not accurately done in Nigeria. Hence, mortality data is often not available. Health facility-based data can provide useful information on the trends in mortality of a population. This study describes the trend of deaths in a tertiary health facility. a retrospective review of the medical records of all patients that died in the Federal Medical Centre, Owo, Ondo State, Nigeria from 2006 to 2014 was conducted. Data extracted from the records included age, sex, primary cause of death and date of admission and death. Frequencies were done and the median age of male and female deaths were compared using Mann-Whitney U test. a total of 1,326 deaths occurred in the hospital. The median age at death was 46 years (range: 0-110), median age was 49 years in males and 43 years in females (p = 0.025). One fifth (20.9%) of deaths was in infants. The median length of hospital stay was 4 days (range: 0-277). The highest proportion of death (16.4%) was in 2009 and on Wednesdays (15.9%). More deaths occurred in January (11.5%) and (10.3%) in February than in other months. The leading cause of communicable disease death in age 1 and above were HIV (15.2%) and TB (2.5%). Birth asphyxia (39.3%) and low birth weight (46%) were the commonest cause of death in infants. over the years the leading causes of mortality were preventable. Infant mortality remains a public health problem. Hospital mortality data could guide health decision making and interventions in Nigeria. Interventions to reduce death from communicable diseases and in infants are urgently recommended.

On Sep 22, 2017, a suspected human case of monkeypox was reported to the Nigeria Centre for Disease Control (NCDC) from Bayelsa State in southern Nigeria. Because monkeypox had not been reported in Nigeria since 1978 (1), the case raised national and international concern. A multisectoral, international outbreak investigation was undertaken to identify sources and risk factors, establish surveillance, and enhance preparedness. A suspected case was defined as the sudden onset of fever, followed by a vesiculopustular rash primarily on the face, palms, and soles. A confirmed case was any suspected case with laboratory confirmation. Joint human and animal health teams conducted field investigations to study the human, animal, and environmental sources of infection, as well as risk factors and modes of transmission. Human-to-human transmission was presumed in a limited number of cases through investigation into clusters (within individual households) of confirmed cases.