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Measles is a highly infectious disease with great burden and implication on a displaced population with low immunity status. The disease can cause up to 140,000 deaths annually. Internal displacement during supplemental immunization activities often affects optimal reach and coverage of the campaign as people move and implementation and logistic plans are usually disrupted with attendant missed children. This study documented the process of extension of the measles vaccination campaign (MVC) 2018 for five internally displaced persons (IDPs) camps in Benue state, not previously in the microplan, to increase population herd immunity. We obtained population figures and disease surveillance data for five IDPs camps and used it to conduct detailed microplanning to determine the requirement for the conduct of additional days of measles vaccination. Vaccination teams used fixed posts in the camps and temporary posts strategy in designated locations in the host communities. The estimated total population of the IDPs was 170,000 with MVC target population of 9374 which was not earlier planned for. There was reported measles outbreaks in IDP camps in both Guma and Makurdi Local Government areas (LGAs) during period of displacement. Microplans requirement determined 10,421 bundled measles vaccine, 30 health workers, 5 vehicles and 15 motorcycles. A total of 7679 out of 9374 (81.9%) of the eligible children aged 9–59 months were vaccinated during the 3 days of the campaign. Non-inclusion of plans on internally displaced population in supplemental immunization activities (SIAs) microplans have a potential risk of vaccine preventable diseases (VPDs) outbreak. Future Measles Vaccination campaigns should take cognizance of internal displacement due to insecurity and other humanitarian emergencies.

Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0-23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. 984 caregivers with children aged 0-23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers' engagement and screening of vaccination documentation by health workers during every health service encounter.

Between June and September 2022, an outbreak of acute kidney injury (AKI) occurred in The Gambia among children, with 82 cases and 66 deaths recorded. Medicines taken by children with AKI were found to contain unacceptable amounts of diethylene glycol (DEG) and ethylene glycol (EG). The objective of the study was to establish the likely cause of the AKI outbreak and associated risk factors. A case-cohort study was conducted in six of the seven regions of The Gambia. Cases were children eight years or younger, residing within the six regions in the study period and diagnosed with AKI within that period. Controls were children in the same age range as cases and residing within the same neighborhood as cases but without a diagnosis of AKI. Three hundred twenty-one children were recruited for the sub-cohort from which controls were selected. Data were analyzed using Marginal Structural Models for a point treatment with the inverse probability of treatment weights estimator. Multivariable logistic regression was used to identify risk factors for AKI using a 5% level of significance in the final model. Sixty-three cases and 258 controls were enrolled into the study. Of the 63 cases, 58 were confirmed and five were suspected cases. AKI among the children was causally associated with ingestion of adulterated medicine(s) (OR = 1.76 (1.60-1.92); p < 0.0001). Risk factors of AKI were the ingestion of adulterated medicine(s), concomitant medicines, and being of a younger age. The acute kidney injury outbreak that occurred among children in The Gambia in the period June through September 2022 was causally associated with the ingestion of adulterated medicines. The risk was increased by consumption of concomitant medicines and being of a younger age. DEG adulteration of paediatric medicines has been an all-too -common event in multiple countries.

\"If research is to have impact and improve outcomes, it must be locally relevant and the findings actionable to shape policy and/or practice [...].\"If research is to have impact and improve outcomes, it must be locally relevant and the findings actionable to shape policy and/or practice [...].

The novel coronavirus disease 2019, COVID-19, which is caused by severe acute respiratory syndrome virus 2 (SARS-CoV-2) [1] was first reported in December 2019 by Chinese Health Authorities following an outbreak of pneumonia of unknown origin in Wuhan, Hubei Province [2,3]. SARS-CoV-2 is likely of zoonotic origin, similar to SARS and Middle East Respiratory Syndrome (MERS), and transmitted between humans through respiratory droplets and fomites. Since its emergence, it has rapidly spread globally [4]. Mandatory institutional quarantine and testing for international returnees Measures instituted by the NCPG included strengthening in-country diagnostic capacity for the testing of COVID-19 by leveraging and optimising three existing laboratories within the NCDC molecular laboratory network and assessing existing infectious disease treatment centres with a focus on identifying gaps and developing plans for case management. [...]an in-country risk assessment was conducted to assess border screening at the country’s international airports, and surveillance efforts were enhanced at the four international airports across the country to include temperature checks for all passengers and screening questionnaires for passengers arriving from countries with community transmission of COVID-19.

Background Yellow Fever is an acute viral hemorrhagic disease endemic in tropical Africa and Latin America and is transmitted through infected mosquitoes. The earliest outbreak of yellow fever in Nigeria was reported in Lagos in 1864 with subsequent regular outbreaks reported until 1996. A large epidemic of yellow fever occurred in Oyo State in April and May 1987 following an epidemic of sylvatic yellow fever in Eastern Nigeria the previous year. For 21 years, no further confirmed cases were reported until September 2017 following which Nigeria has been responding to successive outbreaks. The renewed onset of yellow fever outbreaks in Nigeria followed a global trend of reports and from other African countries. Yellow Fever disease has no cure, but control is through vaccination and vector control. Eliminating Yellow fever Epidemic (EYE) strategy to improve high-risk countries’ prevention, preparedness, detection, management, and response to yellow fever outbreaks was developed by the WHO in 2017 and launched in Nigeria in April 2018. Yet, poor vaccination coverage continues to be a cause for concern. Materials and methods We conducted a retrospective cross-sectional study that examines the resurgence of Yellow fever cases and outbreaks from 2013 to 2020 in Oyo State, Nigeria. The Yellow Fever data for both surveillance and routine Expanded Programme on Immunization (EPI) were the focus of the review. Surveillance data were retrieved from the State’s database reported by all 33 LGAs, maintained by the State and supported by the World Health Organization at the Zonal and State levels. The routine EPI data were retrieved from District Health Information Software (DHIS_2). The proportion of LGAs reporting at least one case of suspected yellow fever with a blood specimen and the number of suspected cases reported for each year within the period under review was measured. We also assessed the trend of confirmed cases and the incidence per 100,000 persons. Also, suspected cases of yellow fever were categorized into four age groups and their vaccination status was assessed. The State’s annual administrative routine vaccination coverage for yellow fever vaccine was compared with the number of confirmed cases for each year. Results The proportion of LGAs reporting at least a case of suspected yellow fever, with blood samples collected, ranged from 6.1 to 84.9% between 2014 and 2020 while a total of 9 confirmed (8 cases) and probable (1 case) cases of yellow fever were recorded. However, there were no confirmed cases from the year 2013 to 2016, including 2018 but an upward trend of incidence of the disease per 100,000 persons from 0% to 2013 through 2018, to 3.5% in 2019, and then to 5.6% in 2020 was observed. 93 of 240 (39%) suspected yellow fever cases reported during the given period were observed to have received yellow fever vaccine. Conclusions In conclusion, the increase in the circulation of the yellow fever virus in the state reiterates the state is at a high risk of yellow fever transmission and underlines the need for viable interventions such as environmental hygiene to rid the environment of the disease vector’s ecological niche and improving routine EPI coverage to provide population immunity.

Background The declaration of SARS-CoV-2 as a public health emergency of international concern in January 2020 prompted the need to strengthen infection prevention and control (IPC) capacities within health care facilities (HCF). IPC guidelines, with standard and transmission-based precautions to be put in place to prevent the spread of SARS-CoV-2 at these HCFs were developed. Based on these IPC guidelines, a rapid assessment scorecard tool, with 14 components, to enhance assessment and improvement of IPC measures at HCFs was developed. This study assessed the level of implementation of the IPC measures in HCFs across the African Region during the COVID-19 pandemic. Method An observational study was conducted from April 2020 to November 2022 in 17 countries in the African Region to monitor the progress made in implementing IPC standard and transmission-based precautions in primary-, secondary- and tertiary-level HCFs. A total of 5168 primary, secondary and tertiary HCFs were assessed. The HCFs were assessed and scored each component of the tool. Statistical analyses were done using R (version 4.2.0). Results A total of 11 564 assessments were conducted in 5153 HCFs, giving an average of 2.2 assessments per HCF. The baseline median score for the facility assessments was 60.2%. Tertiary HCFs and those dedicated to COVID-19 patients had the highest IPC scores. Tertiary-level HCFs had a median score of 70%, secondary-level HCFs 62.3% and primary-level HCFs 56.8%. HCFs dedicated to COVID-19 patients had the highest scores, with a median of 68.2%, followed by the mixed facilities that attended to both COVID-19 and non-COVID-19 patients, with 64.84%. On the components, there was a strong correlation between high IPC assessment scores and the presence of IPC focal points in HCFs, the availability of IPC guidelines in HCFs and HCFs that had all their health workers trained in basic IPC. Conclusion In conclusion, a functional IPC programme with a dedicated focal person is a prerequisite for implementing improved IPC measures at the HCF level. In the absence of an epidemic, the general IPC standards in HCFs are low, as evidenced by the low scores in the non-COVID-19 treatment centres.

Background From January to May 2019, large measles outbreaks affected Nigeria. Borno state was the most affected, recording 15,237 suspected cases with the state capital of Maiduguri having 1125 cases investigated and line-listed by March 2019. In Borno state, 22 of the 27 Local Government Areas (LGAs or Districts), including 37 internally displaced persons (IDPs) camps were affected . In response to the situation, an outbreak response immunization (ORI) campaign was conducted in the 13 most affected LGAs. In addition to conventional vaccination teams, special teams were deployed in security compromised areas, areas with migrants, and for nomadic and IDPs. Here we describe the outbreak and the ORI campaign. We also assess the measles-containing vaccine (MCV) coverage and vaccine effectiveness (VE) in order to quantify the population-level impact. Methods We reviewed the ORI activities, and conducted an analysis of the surveillance and the outbreak investigation reports. We assessed VE of MCV by applying the screening-method. Sensitivity analyses were also conducted to assess the effect of final classification of cases on the VE of MCV. The MCV coverage was assessed by a post-campaign coverage survey after completion of the ORI through a quantitative survey in the 12 LGAs that were accessible. Results Of the total 15,237 reported measles cases, 2002 cases were line-listed and investigated, and 737 were confirmed for measles by week 9 of 2019. Of the investigated cases 67.3% ( n  = 1348) were between 9 and 59 months of age. Among the 737 confirmed cases, only 9% ( n  = 64) stated being vaccinated with at least 1 dose of MCV. The overall VE for MCV was 98.4% (95%CI: 97.8–98.8). No significant differences were observed in the VE estimates of lab-confirmed and epi-linked cases when compared to the original estimates. The aggregated weighted vaccination coverage was 85.7% (95% CI: 79.6–90.1). Conclusion The experience in Borno demonstrates that adequate VE can be obtained in conflict-affected areas. In complex emergencies affected by measles outbreaks, health authorities may consider integration with other health strategies and the engagement of security personnel as part of the ORI activities.

Background Research evidence is needed to strengthen capacities in emergency preparedness and response (EPR). However, the absence of a clear research agenda limits the optimal use of research evidence. This paper reports on the prioritization of research questions and topics that could contribute to evidence-informed strengthening of EPR capacities in the African region. Methods The priority-setting consisted of desk review and stakeholder consultation workshop. Twenty-nine people participated in the workshop, including representatives from WHO regional office and EPR focal points in Africa, representatives of research institutions, and partners from Science for Africa Foundation, United Nations Children's Fund and Africa Center for Disease Control. Modified Delphi technique was used to systematically arrive at specific and cross-cutting research priorities in the three broad areas of the EPR, which are program Implementation, Clinical and Epidemiology. The research questions/topics were ranked on five-point Likert scale (1 = very low to 5 = very high) based on seven agreed-on criteria. Research priority score was calculated for each question as the mean of the criteria scores. Results A total of 123 research questions comprising, 29 on Epidemiology, 22 on Clinical, 23 on program Implementation, and 49 on cross-cutting issues were ranked. The top ten research priorities were: knowledge and skills of healthcare workers in detecting and responding effectively to disease outbreaks; quality of data (accuracy, timeliness, completeness) for epidemic prone diseases; determinants of vaccine hesitancy; determinants of infection transmission among health care workers during PHE; effective measures for protecting health workers from highly infectious pathogens in PHE; strategies to improve the effectiveness of contact tracing for epidemic prone diseases; effectiveness of current case definitions as screening tools for epidemic and pandemic prone diseases; measures to strengthen national and sub-national laboratory capacity for timely disease confirmation within the Integrated Diseases Surveillance and Response framework; factors affecting prompt data sharing on epidemic-prone diseases; and effective strategies for appropriate community participation in EPR. Conclusions The collaborative multi-stakeholder workshop produced a starting list of priority research questions and topics for strengthening EPR capacities in Africa. Action needs to be taken to continuously update the research agenda and support member States to contextualize the research priorities and commission research for timely generation and uptake of evidence.

Background Nomadic populations have a considerably higher risk of contracting a number of diseases but, despite the magnitude of the public health risks involved, they are mostly underserved with few health policies or plans to target them. Nomadic population movements are shown to be a niche for the transmission of diseases, including poliomyelitis. The nomadic routes traverse the northern states of Nigeria to other countries in the Lake Chad subregion. As part of the February 2016 polio supplemental immunization activity (SIA) plans in Bauchi state, a review of nomadic routes and populations identified a nomadic population who originated from outside the international borders of Nigeria. This study describes the engagement process for a transboundary nomadic population and the interventions provided to improve population immunity among them while traversing through Nigeria. Methods This was an intervention study which involved a cross-sectional mixed-method (quantitative and qualitative) survey. Information was collected on the nomadic pastoralists entry and exit points, resting points, and health-seeking behavior using key informant interviews and semistructured questionnaire. Transit vaccination teams targeted the groups with oral polio vaccines (OPVs) and other routine antigens along identified routes during the months of February to April 2016. Mobile health teams provided immunization and other child and maternal health survival interventions. Results A total of 2015 children aged under 5 years were vaccinated with OPV, of which 264 (13.1%) were zero-dose during the February 2016 SIAs while, in the March immunization plus days (IPDs), 1864 were immunized of which 211 (11.0%) were zero-dose. A total of 296 children aged under 1 year old were given the first dose of pentavalent vaccine (penta 1), while 119 received the third dose (penta 3), giving a dropout rate of 59.8%. Conclusions Nomadic pastoralists move across international borders and there is a need for transboundary policies among the countries in the Lake Chad region to improve population immunity and disease surveillance through a holistic approach using the One-health concept.