ANNUAL REPORT 2014

NFELTPNigeria Field Epidemiology & Laboratory Training Program

ContentsIntroduction 3NFELTP goals 4NFELTP objectives 4Primary Objectives Secondary Objectives Program Activities 5Training and related activities 5Cohort VI Cluster 1 Training Cohort VI Cluster 1 Examinations Cohort IV Pre-internal Defence Census and Survey Processing System Training Anti-Retroviral Therapy (ART) Impact Evaluation Workshop Biosecurity Engagement Program (BEP) Training Field Activities 9Partnership on Protocol Development for Malaria Program evaluation KADAIS SOP Writing Workshop Involvement in HIV/ AIDS activities 9Kaduna Aids Indicator Survey (KadAIS) Protocol Development Kaduna Aids Indicator Survey (KADAIS) HIV/AIDS Surveillance Outbreak investigations 11Dengue Fever Outbreak Investigation, Abuja Cohort V residents investigate a suspected cholera outbreak in Mpape, Abuja Lassa Fever Outbreak, University of Ibadan NFELTP involvement in Ebola response in Nigeria Support of the West African Ebola Outbreak by NFELTP; acquiring necessary experience for Nigeria preparedness

Meetings and conferences 15Abstract accepted to EIS Conference Cohort IV resident presents at EIS Conference, Atlanta Fifth AFENET Scientific Conference- best overall and 2nd best oral-poster presenters AFENET Conference Ethiopia European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE) Polio workshop during the AFENET conference Other programme updates 17NFELTP Journal supplement in the Pan African Medical Journal Japanese International Cooperation Agency (JICA) Country Representative Visits NFELTP World Rabies DayAdvocacy visit to Taraba and Adamawa state Bill and Melinda Gates Foundation Grant National Stop Polio Transmission (NSTOP) Program Activities 21Integrated measles and oral polio vaccination campaign (IMC) N-STOP Local Government Officers (NSLO) 4th Routine Immunization Thematic Training Strengthening the Acute Flaccid Paralysis Surveillance Component of the Polio Eradication Initiative through SMS Reminders NSTOP - USAID Meeting in Sokoto Routine Immunization Thematic Training IPV acceptability study N-STOP Local Government EPI Team 7th USAID Do No Harm training

This publication was supported by a Cooperative Agreement Number (GH11-1181) U2GGHOOO431 from Centers for Disease Control and Prevention. Its contents are solely the responsibility of AFENET and do not necessarily represent the official views of the Centers for Disease Control and Prevention

Polio Eradication Initiative (PEI)/Routine Immunization (RI) Intensification in Adamawa and Taraba states Thematic Training of N-STOP Local Government Officers (NSLO) 6th RI Distribution of participants by state and designation during the 6th Routine Immunization thematic training on Data Management Strengthening Local Government Routine Immunization Data Management Routine Immunization (RI) Coverage survey Rapid assessment of readiness for implementation of NHMIS with enhanced RI-specific data module at LGA level, Nigeria Polio Emergency Operation Center Training for poor performing Local Government Areas January Immunization Plus Days (IPDs) debriefing and March IPDs planning meeting March Immunization Plus Days (IPDs) and Enumeration NSTOP Participation in the Nigeria Polio Summit 2014 April Immunization Plus Days (IPDs) Inactivated Polio Vaccine Acceptability Study

Follow-up Evaluation of the Routine Immunization System in LGAs at high risk for cVDPV Wild Polio Virus Outbreak in Kano state 7th Routine Immunization (RI) Training Recruitment of Phase 3 NSLOs Inactivate Polio Vaccine training in Kano N-STOP Local Government Thematic Training (EPI 9th Routine Immunization) June Immunization Plus Days (IPDs) National Polio Emergency Operations Center Meeting with Poor Performing LGAs Third Annual NSTOP Training on Polio Eradication Initiatives and Strengthening Routine Immunization NSTOP Routine Immunization Follow-up Assessment NSTOP Leadership and Management Workshop Annex 1 Presentations 21 Annex 2 Publications 37 NFELTP supplement papers published in the Pan African Medical Journal Cohort IV HIV theses NFELTP abstracts presented at the 5th AFENET

conference, Ethiopia

AcronymsABU Ahmadu Bello UniversityAFENET African Field Epidemiology NetworkCDC Centers for Disease Control and PreventionEIS Epidemic Intelligence ServiceFMARD Federal Ministry of Agriculture and Rural DevelopmentFMOH Federal Ministry of HealthNFELTP Nigeria Field Epidemiology and Laboratory Training ProgramPEPFAR President’s Emergency Plan for AIDS ReliefSMOH State Ministries of HealthSMOA State Ministry of Agriculture

Established in October 2008, the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) is a two year in-service training program in applied epidemiology, veterinary epidemiology and public health laboratory epidemiology and management. NFELTP was created to be a long-term ongoing program within the Federal Ministry of Health (FMOH) and Federal Ministry of Agriculture and Rural Development (FMARD). The program aims at training field epidemiology, veterinary epidemiology, and public health laboratory residents for leadership positions at various levels in both ministries mentioned above. During their training, residents provide epidemiological service as may be required to the FMOH, FMARD, and respective State Ministries of Health (SMOH) and State Ministries of Agriculture and Rural Development, through short and long-term field placements.

The field epidemiology component is similar to programs that have been established in more than 50 other countries and modeled after the United States Centers for Disease Control and Prevention’s (CDC) two-year Epidemic Intelligence Service (EIS) training program. The public health laboratory training component is based on CDC’s Emerging Infections Program which is a one-year applied laboratory training program. Nigeria is among the first countries to implement a veterinary track to address the ever-increasing threat of zoonotic infectious diseases and strengthen the collaboration between the human and animal health sectors; a concept popularly known as the One World, One Health concept.

Like other field and competency-based training programs, NFELTP is composed of a 25% didactic component and a 75% field based component. The course duration is 24 months. Two leading Nigerian universities- University of Ibadan (UI) in the

south west region and Ahmadu Bello University (ABU) in the north-west region provide teaching support and accreditation for the academic qualifications obtained by NFELTP graduates.

The first cohort of 13 NFELTP residents began their training on 20 October 2008 and completed in December 2010. The second cohort of 13 was admitted on 26 October 2009 and completed their training in August 2012. The third cohort marked the start of the scale up of the program and consisted of 38 residents. This cohort began their training on 21 February 2011 and completed their training in March 2014. The fourth cohort of 39 residents began their training on 30 April 2012 and is scheduled to complete their training in 2014. The fifth cohort of 47 residents began their training on 21 January 2013 and will complete their training in 2015. The sixth cohort of residents commenced training on 10 March 2014. In total 207 trainees have so far been admitted in six cohorts in the last 6 years for the two year training whose aim is to strengthen public health systems particularly surveillance and response.

In addition to the degree awarding two-year long course, NFELTP also offers a series of short courses meant to strengthen the epidemiological capacity of various public health implementers at the Federal, State and Local Government Areas (LGA) levels. In the last four years, the program has conducted a total of 13 short courses in Outbreak Investigation, HIV/TB collaboration and Zoonoses control. Overall, over 500 health officials have been trained in all 36 states of Nigeria and the Federal Capital Territory. These short courses have been funded by CDC, WHO, AFENET as well as the Government of Nigeria.

In September 2011, the African Field Epidemiology Network (AFENET) was awarded a 5-year cooperative agreement to strengthen NFELTP and promote its sustainability. This cooperative agreement seeks to improve the public health

INTRODUCTION

workforce as a means of strengthening, expanding, and sustaining Nigeria’s disease surveillance and response system. Funding to implement activities through this cooperative agreement is provided through the President’s Emergency Plan for AIDS Relief (PEPFAR). AFENET provides technical support, manages program funds, and links the Nigeria FELTP to the other FE(L)TPs in Africa.

This report highlights activities carried out from October 2013 – September 2014.

NFELTP goalsTo develop self-sustaining institutionalized capacity to train public health leaders in field epidemiology and field-oriented public health laboratory practice.

To provide epidemiological services to the public health system at Federal, State, and Local Government levels.

NFELTP objectives

Primary Objectives

Training leaders in applied epidemiology, veterinary epidemiology and public health laboratory practice; emphasis is on problem solving issues of public health concern

Provide epidemiologic services to federal, state, and local government health authorities in Nigeria

Secondary Objectives

• Strengthen capacity to respond to public health emergencies

such as outbreaks, epidemics, natural disasters, and emerging

infectious diseases

• Strengthen public health and veterinary surveillance systems

• Strengthen laboratory participation in surveillance and field

investigation

• Strengthen the linkage between public health and veterinary

epidemiology

• Conduct research activities on priority public health problems

• Improve communication and networking within the country

and throughout the region

• Strengthen affiliations with international organizations, such

as the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), the umbrella organization of applied epidemiology training programs, the African Field Epidemiology Network (AFENET), a networking organization for applied epidemiology training programs located in Africa.

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Cohort VI Cluster 1 TrainingClasses for Cohort VI commenced on 10 March 2014 covering 6 modules: Introduction to Epidemiology, Public Health Surveillance, Biostatistics, Computer use in Public health, zoonoses and one health and fundamentals of laboratory methods in epidemiology. Facilitators during the training were from the two collaborating Universities, NFELTP, FMOH, FMARD and other partners. The cluster I training ended on 4 April 2014. With this new cohort, the program has admitted 207 residents since its inception in 2008.

Distribution of NFELTP Cohort VI by track and university of admission

University Medical Laboratory Vet Total

Ahmadu Bello University

18 8 3 29

University of Ibadan

16 6 3 25

Total 34 14 6 54

The residents were a representative of all 36 states and the Federal Capital Territory (FCT) which had one resident admitted.

PROGRAM ACTIVITIESTraining and related activities

Analysis of residents by State of Origin

Analysis of residents by place of work

The highest number of residents admitted where 19 from Kano state as shown in the maps below.

6NFELTP has a target of training at least 5 epidemiologists per 1 million population. The table below shows the progress made so far in reaching this target.

Zone Number PER 1 MILLION POPULATION % COVERAGE***

North West 42 1.14 23%North Central 44 1.83 36%South West 40 1.21 24%North East 31 1.41 28%South East 32 1.78 36%South South 18 0.90 18%

Total 207 1.34 27%

The program has achieved 27% of its 10 year target. This varies by region from 36% in north central region to 18% in the south south region.

NFELTP Cohort VI group picture during the cluster 1 training, April 2014

Cross Section of Cohort VI residents during cluster 1 training

Cohort VI Cluster 1 ExaminationsCohort VI residents completed their cluster 1 examinations on 16 May 2014. The residents were assessed on topics such as: epidemiology, biostatistics, public health surveillance, computer use in public health, laboratory methods in epidemiology and introduction to zoonoses /one health.

Cohort IV Pre-internalDefenceCohort IV residents defended their thesis from 16 – 20 June 2014 at the NFELTP training facility. The pre- thesis defense was to ensure that the residents write their thesis in line with the university thesis structure before the external defense.

Eight residents presented their results of HIV/AIDS-related work during the defense. The topics presented include: ART adherence studies in Lagos and Zamfara, HIV co-infections with infectious diseases (Hepatitis B and malaria), delayed

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diagnosis of cancer in HIV patients, feeding options in HIV positive mothers, linkage between PMTCT and ART services, access to ANC and Prevention of Mother-to-Child Transmission (PMTCT) services in nomadic women.

Census and Survey Processing System TrainingThe Centers for Disease Control and Prevention (CDC) conducted a Census and Survey Processing System (CSPRO) training for NFELTP data management staff and a selected number of residents from 22 – 23 May 2014. CSPRO is a data management software distributed freely by the United States Census Bureau. The training was part of preparations to enter and analyze data from the routine immunization coverage survey conducted in May 2014

The workshop was facilitated by Alicia Ruiz from Centers of Diseases Control and Prevention (CDC), Atlanta assisted by Joel O. Adegoke, the NSTOP Data Manager.

Anti-Retroviral Therapy (ART) Impact Evaluation Workshop NFELTP hosted an Anti-Retroviral Therapy (ART) Impact Evaluation Workshop organized by CDC from 13 – 14 May 2014. According to the World Health Organization, ART programmes significantly enhance the survival of people with advanced HIV infection or AIDS.

Seven NFELTP residents and other PEPFAR Implementing partners participated in

the workshop. Participants gained skills in developing monitoring and evaluation systems and other strategic information efforts. They gained hands on experience on use of the Spectrum Software (AIDS Impact Model {AIM}). AIM projects the consequences of the HIV epidemic, including the number of people living with HIV, new infections, and AIDS deaths by age and sex as well as new cases of tuberculosis and AIDS orphans. AIM is used by UNAIDS to make the national and regional estimates that it releases every 2 years.

Biosecurity Engagement Program (BEP) TrainingNFELTP participated in a training on Strengthening Detection and Diagnostic Capacity for Dangerous Zoonotic Pathogens in Nigeria from 25 June – 2 July 2014 at the Nigeria Institute of Science Laboratory Technology, Samonda, Ibadan. The training was funded by the United States Department of State Bio-Security Engagement Programme with the support of CDC Atlanta.

Participants at the Census and Survey Processing System (CS PRO) Training, NFELTP

Alicia Ruiz from CDC, Atlanta facilitating the CS PRO training, NFELTP

8The training was a collaboration between CDC Atlanta, Federal Ministry of Health (FMOH), Federal Ministry of Agriculture and Rural Development (FMARD), Irrua Specialist Hospital, National Veterinary Research Institute (NVRI), Ahmadu Bello University and University of Ibadan. It aimed to ensure best practices on biological safety and security, build capacity to detect, diagnose and diseases and conduct outbreak investigations of highly infectious diseases, enhance laboratory networking and train participants on the importance of data analysis, reporting and feedback. A total of 101 participants from across 26 states of the country took part in the training.

Dr. Adebola Olayinka - Lab Resident Advisor, Dr. Funmi Fawole - Academic coordinator and residents: Ms Aman Oloniyo, Ms Adama Ahmad Abubakar, Dr Bamiselu Oluyomi , Dr Sambo Adamu and Mr Joshua Rikoto were part of the facilitators for the training.

Cohort VII AdvertisementNFELTP issued a call for applications for Cohort VII on 7 October 2014. Selection of the residents will take place in the last week of November. Cohort VII is expected to commence training in early 2015.

Cluster II Training for Cohort VIThe 2nd cluster training for Cohort VI was conducted from 15 September - 7 November 2014. Topics covered included: field presentation, basic epidemiology and data management review, advanced

epidemiology, research methods, scientific communication in public health and geographic information systems. Facilitators for the training were drawn from the two collaborating universities, CDC, NFELTP and other FELTP programs. Residents will thereafter proceed to their respective universities for examinations which begin on 24 November 2014.

Cluster III and IV Examinations for Cohort VCohort V residents undertook examinations in topics covered during cluster III and IV trainings. The examinations took place from 10 – 21 November 2014 at their respective collaborating universities. The examinations covered leadership and management, teaching and mentoring, special topics in public health, preventive effectiveness, veterinary epidemiology, laboratory methods, laboratory policy and management as well as quality management systems. After the examinations, residents will focus on thesis completion.

Malaria TrainingSeveral residents were involved in a three - day Training of Trainers and review of the data collection tool that was used for evaluation of Global Fund (GF)-supported training of health workers on malaria in 12 states. The meeting was organized by the National Malaria Elimination Programme (NMEP). Residents conducted state level training of trainers and supervised data

collection across 72 LGAs in 12 states namely Adamawa, Bayelsa, Delta, Ebonyi, Ekiti, Enugu, FCT, Katsina, Kogi, Osun, Taraba and Zamfara. The purpose of the study was to assess the effectiveness of GF-supported training of health workers on malaria case management, diagnosis, Malaria Commodity Logistics System (MCLS) and data capturing with the Health Management Information System (HMIS) tools in order to learn lessons, determine gaps between knowledge and practice and make recommendations to the NMEP for improvement of subsequent trainings.

The objectives of the training were to:

• To assess the knowledge of health care providers trained on malaria case

management, including diagnosis using malaria Rapid Diagnostic Tests

• To assess the practice of trained

health workers on malaria case management

• To evaluate the effectiveness training

on health workers on malaria commodity logistics system

• To assess the quality of data captured with the HMIS tools at the facility level post-training of health facility record officers on the harmonized HMIS data capturing tools

• To compare knowledge and

practices of health workers on malaria

diagnosis, case management, MCLS and HMIS in GF-supported health facilities to non-GF supported sites

NFELTP residents took part in a writing workshop from 15 - 16 July 2014 in preparation for the Kaduna Aids Indicator Survey (KADAIS). The aim of the workshop was to provide NFELTP residents with an educational experience in planning and developing standard operating procedures (SOPs) for a large-scale household survey, specifically AIDS Indicator Surveys.

The specific objectives of the workshop were to:

• To provide participants with a thorough understanding of the complex operational and managerial aspects of conducting a large-scale, household survey.

• To provide participants with a thorough understanding of the

purpose of standard operating procedures (SOPs).

• To provide participants with the skills

necessary to write SOPs for a

multitude of sections within the KADAIS protocol:

• Field methods

• Informed consent

• Laboratory

• Data collection, processing, management and analysis

• To use these skills to create and write

SOPs for KadAIS using similar SOPs from studies performed in Ethiopia, Kenya and Swaziland.

Residents who participated in the workshop include: Abiodun Ogunnyi, Fatima Cheshi, Jamiyu Ganiyu, Chioma Ukanwa, Chidinma Agbai and Olufunke Fagbemiro from Cohort IV and Joan Ejembi, and Damaris Osunkwo from Cohort VI.

Involvement in HIV/ AIDS activities

Kaduna Aids Indicator Survey (KADAIS)The US CDC supported the Kaduna State Ministry of health to conduct a state wide aids indicator survey to guide its HIV response strategy. NFELTP residents were part of training for a joint survey protocol development held from 1 – 4 June 2014. The Kaduna AIDs Indicator Survey (KADAIS) is the first HIV-focused population based survey strictly implemented in one state. With a high prevalence of HIV and relatively small (Antiretroviral Drug Treatment) ART scale up, there is the need for a more glandular understanding of the HIV epidemic in Kaduna State. The overall aim of this survey was to describe the HIV epidemic amongst adults and children, assess the

coverage and impact of HIV services on the population level, and measure HIV-related risk behaviors to provide useful, actionable data to guide the HIV response in Kaduna State, Nigeria.

As a prelude to the survey, the residents of the program in conjunction with CDC and other stakeholders attended a workshop session to develop the SOPs for various aspects of the survey. The residents and other NFELTP staff were involved in discussion on methodology, sampling strategy and various SOPs for implementation since June 2014.

HIV/AIDS SurveillanceCohort V and VI residents conducted a rapid survey on HIV/AIDS surveillance in 36 states including the Federal Capital Territory (FCT). The focus of the survey was on data flow, data validation (M&E, data review), analysis and feed-back mechanisms at community level, LGA level, state and federal level. By 1 July 2014 information collected from the survey was from 19 states. The survey aimed to provide HIV/AIDS program support.

Cohort IV Pre-internal Thesis Defense

A pre-internal thesis defense for Cohort IV residents was held from 16 – 20 June 2014 in preparation for finalization of their

FIELD ACTIVITIESKADAIS SOP Writing Workshop

10training in August 2014. A number of the theses were HIV related and in line with PEPFAR main goals. Cohort IV theses can be found in annex 2.

Other core HIV activities undertaken from April – August 2014:

• Secondary data analysis for HIV

programmatic data in CDC, CDC

implementing partners and FMOH:

A meeting was held to guide data analysis of various HIV programmatic data to aid. The results of the analysis

will inform program planning by the Government of Nigeria

• Re-analysis of Antenatal Care (ANC) sentinel surveillance data – manuscript

ready: This is an activity that focuses

on secondary analysis of the HIS

sentinel survey dataset for 2010 and previous years.

• Antiretroviral Therapy (ART) outcome assessment: This was a review analysis

of HIV /AIDS service data from 2007

to 2012. It involved analysis to determine quality of service and survival.

• Data and service quality assessments:

A structured checklist was used to determine quality and correctness

of data generated on HIV services in selected health facilities in Nigeria.

The quality of service delivery was assessed in the surveyed facilities.

• Initial discussion on how FELTP can

strengthen state level HIV data collection, collation and analysis.

• HIV/AIDS Surveillance: Cohort V and VI residents conducted a rapid survey

on HIV/AIDS surveillance in the 36

states including FCT. The focus of

this survey is on data flow, validation

(M&E, data review), analysis and feed-

back mechanisms at community level, LGA level, state and federal level. By the end of June 2014, information had been collected from 19 states.

Integrated Biological and Behavioral Surveillance Survey (IBBSS)

As part of support to HIV/AIDS activities, NFELTP faculty and residents participated in fieldwork for the Integrated Biological and Behavioral Surveillance Survey (IBBSS) from August - September 2014. The main goal of the study was to obtain serological and behavioral information on key and vulnerable populations with a view to developing HIV prevention and care programs suited to their context.

Residents were posted to each of the 14 states participating in the survey for 4 weeks. The first week was for state level training of all fieldwork staff for each target group, while the next 3 weeks were dedicated to data collection.

Residents participated as co-supervisors assisting, the central supervisors, field supervisors, interviewers, and counselors

as required. The team was supervised by: Prof. Kabir Sabitu and Dr. Ade Bashorun.

At the end of the survey residents were expected to understand the rudiments involved in the conduct of a national HIV survey.

National Health Management Information Systems

On 18 September 2014 Cohort V and VI residents attended a talk organized by the Centers for Disease Control and Prevention (CDC) on National Health Management Information Systems (NHMIS). A follow up discussion was held on how best residents could acquire competencies on NHMIS while supporting state based data collection and analysis. Residents will also contribute to the following:

• Evaluation of the HIV/AIDS surveillance

system at state level including:

• Evaluating the objectives of the

system and determining if it is meeting its objectives.

• Evaluating the baseline

surveillance system attributes, usefulness and resource needs.

• Periodic surveillance system

evaluation for changes in the system qualities referred to above

• Development of state newsletters

with basic HIV data analysis for dissemiation h with all stakeholders.

• Working with states to review data

and disseminate through scientific publications.

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Below are some examples of residents’ HIV specific publications

which can be found on:

www.panafrican-med-journal. com/content/series/18/1 :

• A description of HIV prevalence trends in Nigeria from 2001 to 2010:

what is the progress, where is the problem?

• HIV disclosure status and factors among adult HIV positive patients

in a secondary health facility in North-Eastern Nigeria, 2011

• Building a public health workforce

in Nigeria through experiential training

• Training and Service in Public Health, Nigeria Field Epidemiology and Laboratory Training,

2008 – 2014

Integrated Biological and Behavioral Surveillance Survey (IBBSS)

As part of support to HIV/AIDS activities, NFELTP faculty and residents participated in fieldwork for the Integrated Biological and Behavioral Surveillance Survey (IBBSS) from August - September 2014. The main goal of the study was to obtain serological and behavioral information on key and vulnerable populations with a view to developing HIV prevention and care programs suited to their context.

Residents were posted to each of the 14 states participating in the survey for 4 weeks. The first week was for state level

training of all fieldwork staff for each target group, while the next 3 weeks were dedicated to data collection.

Residents participated as co-supervisors assisting, the central supervisors, field supervisors, interviewers, and counselors as required. The team was supervised by: Prof. Kabir Sabitu and Dr. Ade Bashorun.

At the end of the survey residents were expected to understand the rudiments involved in the conduct of a national HIV survey.

Outbreak investigations

Cohort V cholera outbreak investigation in Mpape, AbujaSix Cohort V residents and the Resident Advisor- Prof. Gabriel Poggensee

conducted a cholera outbreak investigation in Abuja from 2 – 7 April 2014.

The investigation followed a report of a cholera outbreak in Mpape, Abuja on 2 April 2014. The team was mandated to investigate the outbreak with a view to controlling and preventing further spreading. They conducted an active case search, collected samples for rapid and water testing and conducted health education in the communities. The residents included: Aman-Oloniyo Abimbola, Dr.Samuel Sha’aibu, Dr.Egwuenu-Oladejo Abiodun, Zephaniah Zaiki Balogun, Dr.Lydia Taiwo, and Dr. Godwin Okezue. The outbreak was confirmed as cholera outbreak caused by water source contamination.

NFELTP residents during the cholera outbreak investigation in Mpape, Abuja

12Lassa Fever Outbreak, University of Ibadan

A suspected case of Lassa fever was presented to the University College Hospital, University of Ibadan on the 17 June 2014. The case of the 2 year old who presented with fever and convulsive episodes was prior to the case of a four year old child whose brother had died from unknown causes about two weeks prior to his presentation.

Residents were mobilized on 19 June 2014 to investigate the incident for a period of five days. The residents characterized the outbreak, took samples for laboratory confirmation, did contact tracing, assessed the knowledge gap of the affected community about lassa fever and sensitized the community about the disease. The residents who participated in the outbreak include: Drs. Aiyelotan Oluwatoyin, Ayenimelo Olujide, Victor Oyedele, (Cohort V), Akinyode Akinfemi and Omale Anthony (Cohort VI).

Lassa fever in Nasarawa, Taraba, Oyo and Ebonyi States

Two Cohort IV residents: Peter Attah and Musa Abdullahi and a staff of FMOH were deployed to Nasarawa State to investigate an outbreak of Lassa fever from 4 to 14 January 2014. Residents supported sensitization campaigns in wards with suspected cases. The community was educated on preventive measures to be taken at household level.

Residents also supported another outbreak investigation in Taraba State, northern Nigeria, were three Cohort V

residents: Taiwo Lydia, Samuel Shua’ibu and Tijo Kenneth were deployed to the state to investigate from 8 to 12 January 2014.

Cohort V residents: Titilope Olugbade, Oluwaseyi Israel, and Oluwapemi Fadahunsi, Cohort IV resident - Abiodun Ogunniyi, and Dr Nnalue and Mrs Funmi Badmos from Oyo State Ministry of Health and Federal Ministry of Health respectively were deployed to investigate an outbreak of Lassa fever in Oyo State, 6 – 10 February 2014. The team administered questionnaires to determine the level of knowledge of the disease, did contact tracing and sensitised health workers on Lassa fever.

In the same period, Cohort V residents: Chinyere Ezeudu and Elvina Orji were in Ebonyi State South East Nigeria to investigate a Lassa fever outbreak.

Lassa Fever at Abakaliki and Agbaja-unuhu Federal Teaching Hospital

In May 2014, MOH was notified about another outbreak of Lassa fever at Abakaliki and Agbaja-unuhu Federal Teaching Hospital in Ebonyi State. NFELTP resident - Mr Abiodun Ogunniyi worked with the Ebonyi State Ministry of Health to determine the magnitude of the outbreak, risk factors, strengthen infection control and assess knowledge, attitude and practice of health workers to aid sensitization at health facility and community levels.

Measles in Kebbi State

A suspected outbreak of measles in Kebbi State was investigated by three NFELTP residents: Yahaya Nura, Simeon Ajisegiri, and Emmanuel Eze. The residents were deployed from 10 -14 January 2014 to investigate the outbreak and support the State Ministry of Health to institute preventive and control measures. Residents took blood samples of five suspect cases, reviewed measles surveillance data and conducted active case searching.

Cholera outbreaks in Nasarawa and Bauchi statesCohort IV residents: Idowu Makinde, Peter Attah, Ismaila Habila were deployed to Nasarawa State while another two: Charles Akataobi, Dimas Janada and Chigbu Paulinus, (FMOH) were deployed to Bauchi states to support the state team to investigate and respond to cholera outbreaks. The outbreaks had been ongoing since mid-February 2014. In Bauchi, nearly 100 suspected cases were reported from a number of local government areas (LGAs) whereas in Nasarawa over 200 cases were reported in 3 LGAs. Residents designed a case control study to determine the mode of transmission and risk factors.

Scabies in Kano State

Three Cohort V residents: Abdullahi Musa, Saude Abdullahi Ibrahim and Jibrin Abdullahi investigated an outbreak of scabies in Kano State. The team, including staff of Kano State MOH, quantified the magnitude of the outbreak, identified

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the agent and source of infection and the gaps in disease surveillance.

NFELTP involvement in Ebola response in Nigeria NFELTP was involved in the response of the Ebola outbreak since 23 July 2014 when the outbreak was confirmed in Nigeria. Residents, faculty and graduates of the program were keenly involved in investigation and response of the outbreak coordinated through an emergency operation centre in Lagos. Residents were divided into 5 groups which included: co ordination, epidemiology and laboratory, social mobilization and communication, surveillance at ports of entry and case management.

A total of 100 residents and graduates participated in response hence supporting the government through the Ministry of Health to curb down the outbreak.

With support from the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), AFENET and other partners NFELTP participated in a number activities listed in the activity table in annex 1.

As a result of the support a number of manuscripts being developed based on the following topics:

• Description of Ebola response in Nigeria

• Epidemiological description of EVD outbreak

• Contact tracing, social mobilization effort, clinical profile of cases and use of technology in EVD response.

The activities undertaken by the NFELTP can be found in annex 1

NFELTP residents during the Ebola outbreak investigation

14Support of the West African Ebola Outbreak by NFELTP; acquiring necessary experience for Nigeria preparednessDr Adebobola Olayinka - Laboratory Resident Advisor NFELTP travelled to Sierra Leone in July to provide technical assistance in the management of and response to the Ebola Outbreak in Kenema district, the third largest city in Sierra Leone. Dr Olayinka participated in the outbreak as part of the Global Outbreak Alert Network (GOARN). Kenema district borders Bo District to the west, the Republic of Liberia to the south, Tonkolili and Kono Districts to the north, Kailahun District to the southwest, and Pujehun District to the southeast. The Ebola treatment centre was located at the Kenema General Hospital.

Support provided to Kenema Ebola Treatment centre included: case management, prevention of healthcare-associated infections, review of IPC measures implemented, review of training needs, guidance on immediate IPC policies, resources, and equipment and community awareness among others.

Detailed report of from the support at Kenema District, Sierra Leone can be found in annex 1

NFELTP cohort VI residents doing contact tracing during Ebola outbreak investigation in Lagos

Dr Patrick M. Nguku – NFELTP Resident Advisor giving an update during a meeting on Ebola at the Emergency Operation Centre

Dr. Endie Waziri (AFENET) and Dr Frank Mahoney (Centered) during the Ebola meeting at the EOC in Lagos

Cohort IV resident presents at EIS Conference, Atlanta

Dr Elizabeth Adedire, a Cohort IV resident presented at the 63rd Annual Epidemic Intelligence Service (EIS) Conference which took place from 28 April - 02 May 2014 in Atlanta, Georgia, USA. Her paper titled “An Outbreak of Cholera Associated Breakdown of Municipal Pipe Borne Water Supply – Egbeda, Oyo State, Nigeria, August 2013” was accepted for oral poster presentation. Dr. Adedire was accompanied NFELTP faculty and other residents. Dr Patrick Nguku - NFELTP Resident Advisor, also attended the Resident Advisor’s retreat which is a forum for sharing experiences and discussing strategic directions for FELTP and FETP programs. NFELTP has presented in each of the EIS presentations since its inception in 2008. In 2012, 61st EIS conference, Dr Luka Ibrahim from Cohort II became the first trainee from an African FELTP to win the prestigious William Foege Award for best oral presentation and abstract.

Fifth AFENET Scientific Conference- best overall and 2nd best oral-poster presenters Two NFELTP residents received awards at the 5th AFENET Scientific Conference

held in Addis Ababa, Ethiopia from 18 - 21 November 2013. Dr Isaac Akyala of Cohort V was awarded for the best oral-poster presenter and Dr Belinda Uba of Cohort II for the 2nd best oral poster presenter.

Out of 54 abstracts submitted to the conference, a total of 41 presentations, 30 oral-poster and 11 oral presentations were made by the program.

The conference was also attended by Prof. Abdulsalami Nasidi - Project Director Nigeria Centers for Disease Control, Dr. Okey Nwanyanwu – Director CDC Nigeria, and Dr Akin Oyemakinde - NFELTP Program Director.

Polio workshop at the AFENET conferenceThe NFELTP-NSTOP Program organized a polio workshop on 17 November 2013 during the 5th AFENET Scientific Conference in Addis Ababa, Ethiopia. The workshop discussed the ongoing polio eradication efforts in Africa. The NSTOP Program Coordinator and four Field Coordinators made presentations during the workshop. Other countries that made presentations were Cameroon and South Sudan. The team was later invited by the Ethiopia WHO country office to share experiences with the country on its strategies to reach the underserved populations.

MEETINGS AND CONFERENCES

16European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE)Dr Elizabeth Adedire made an oral presentation titled “Evaluation of Malaria surveillance system in Oyo State, South-western Nigeria January 2013” during the 2013 ESCAIDE conference, held from 5 – 7 November 2013 in Stockholm, Sweden.

Nigeria’s Certification as a Guinea worm Disease Free Country by the World Health Organization The Honorable Minister of Health- Professor C. O. Onyebuchi accompanied by the Permanent Secretary Health- Ambassador Sani Bala, Chairman, and National Certification Committee on Guinea worm Disease Eradication- Professor A. B. O. O. Oyediran and the Director/National Coordinator, Nigeria Guinea Worm Eradication Programme (NIGEP) - Mrs. Ifeoma N. Anagbogu a Cohort II graduate of Nigeria FELTP presented to President Goodluck Jonathan the formal notification about Nigeria’s certification as a Guinea worm disease-free country by the World Health Organization (WHO) signed by the Director General, WHO, Dr Margaret Chan.

While receiving the certificate on 15 January 2014, President Jonathan said the certification was a centenary gift. He stated that the development would strengthen the resolve of his administration in its war against other endemic diseases such as HIV/AIDs, malaria, tuberculosis and polio. He also added that before the end of the year, wild polio would have been checked drastically.

Nigeria’s certification is considered a

global achievement as Nigeria was the most endemic globally and therefore had the largest eradication campaign and programme, covered the largest areas and interrupted GWD transmission in 2008. For the post certification stage which commences this year, 2014, nationwide

GWD surveillance fully integrated in the national disease surveillance and publicity, also conducted during national immunization campaigns and through other disease control programme activities until global eradication of the disease is achieved will be maintained.

OTHER PROGRAMME UPDATES

The GWD eradication effort in Nigeria can be summarized as follows:

President Goodluck Jonathan receives the formal notification about Nigeria’s certification as a Guinea worm disease-free country by the World Health Organization (WHO) signed by the Director General, WHO, Dr Margaret Chan.

18Support to Namibia FELTPThe NFELTP Resident Advisor- Dr Patrick Nguku and the Program Director – Dr. Akin Oyemakinde travelled to Namibia in January 2014 to attend the inauguration and support training activities at the Namibia FELTP. Also in attendance was Dr Endie Waziri, a graduate of the NFELTP and staff of the Nigeria Stop Transmission of Polio (STOP) program. Other program staff visited the program to support the didactic training.

NFELTP Journal supplement in the Pan African Medical Journal

NFELTP published a supplement in the Pan African Medical Journal (PAMJ) on 21 July 2014. The papers published consisted mainly of thesis work from its first and second cohorts. Some of the papers published by FELTP faculty include: “Setting Research Priorities for HIV/AIDS-related research in a post-graduate training programme: lessons learnt from the Nigeria Field Epidemiology and Laboratory Training Programme scientific workshop” by Gabriele Poggensee, Ndadilnasiya Endie Waziri, Adebobola Bashorun, Patrick Mboya Nguku, Olufunmilayo Ibitola Fawole, Kabir Sabitu and “Setting research priorities to reduce malaria burden in a post graduate training programme: lessons learnt from the Nigeria field epidemiology and laboratory training programme scientific workshop” by Olufunmilayo I Fawole, Olufemi Ajumobi, Gabriele Poggensee, Patrick Nguku.

The papers published in PAMJ are available on:

www.panafrican-med-journal.com/content/series/18/1 and can be found in Annex 2.

Japanese International Cooperation Agency (JICA) Country Representative Visits NFELTP

The Country Representative of the Japanese International Cooperation Agency (JICA) - Mr. Tetsuo Seki visited the NFELTP/Nigeria CDC on 19 June 2014. - Mr. Tetsuo was given an overview of NFELTP, its activities and achievements and challenges. He expressed his impression on the role of NFELTP in the country. During his visit, he met Cohort IV residents and talked about JICA’s interest

in supporting capacity building especially in disease control. Mr. Tetsuo also shared his country’s strategy on global health diplomacy and why it matters. Details on this are published in the Lancet journal http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673613616396.pdf

World Rabies Day

Dr. Aboyowa Edukhugo, a Cohort III graduate was interviewed by the African Independent Television (AIT) during the World Rabies Day event. During the interview, he called for improved awareness of rabies and regular pet vaccination. World Rabies Day is celebrated annually on 28 September and is a day set aside by the World Health Organization to create awareness among the public on the dangers of rabies and the need to eliminate the disease.

Dr. Aboyowa Edukhugo, NFELTP graduate being interviewed by the African Independent Television (AIT) during the World Rabies Day celebration in Nigeria

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Advocacy visit to Taraba and Adamawa stateA team from the NFELTP faculty conducted an advocacy visit to Taraba and Adamawa state from 3 - 05 October 2013 for potential Cohort VI residents and field posting. The two states are considered not well covered in terms of recruitment and field posting. The team aimed to conduct sensitization on the activities of NFELTP, advocate for the need of states to encourage qualified staff to apply for both the short and long courses, improve collaboration between NFELTP and States on epidemiology and disease surveillance in man and animals and brief on the program structure.

The advocacy team comprised of: Dr. Chima Ohuabunwo (NSTOP Coordinator), Ms. Gana Chinyere (Senior. Administrator), Ms Gloria Okara (Administrator), Dr. Sundawa Aminu Usman (Cohort VI Resident and Dr. Atume Yakubu (NSTOP)

Bill and Melinda Gates Foundation Grant, Phase 2 Proposals NFELTP won a grant on the Bill Gates Grand Challenge which was applied for in November 2013 through the NSTOP Deputy Coordinator Dr. Ndadilnasiya Endie Waziri a Cohort I graduate of the program. The foundation convened

a grant proposal writing workshop for phase 1 awardees in Accra Ghana from 23 – 26 June 2014 to prepare for phase 2 applications. The program was represented by the Resident Advisor and the NSTOP deputy coordinator. Details on the grant can be found here: (http://www.grandchallenges.org/Pages/Default.aspx )

Resident receives travel award

Dr Paulinus Ossai an NFELTP graduate won an Emerging African Investigators Symposium and Travel Grant Awards to the 16th International Congress on Infectious Diseases which took place from 2 – 5 April 2014 in Cape Town South Africa.

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Integrated measles and oral polio vaccination campaign (IMC)

An integrated measles and oral polio vaccination campaign was held in the 19 northern states of Nigeria and the Federal Capital Territory (FCT) from 5 - 8 October 2013. The aim of the joint vaccination campaign was to ensure that all children 0 - 8 months of age immunized with two drops of potent Oral Polio Vaccine (OPV), while children 9-59 months of age are given 2 drops of OPV and a dose of measles vaccine in a bid to ensure polio eradication and measles elimination.

The NSTOP program deployed 41 officers to 41 Local Government Areas (LGAs) in addition to the 100 NSTOP Local Government officers (NSLOs) across the 19 states and the FCT to

NATIONAL STOP POLIO TRANSMISSION(NSTOP) PROGRAM ACTIVITIES

support the campaign. NSTOP officers provided technical and management support for the pre-campaign, intra-campaign and post-campaign activities from 2- 10 October 2013. Along with overall support and supervision for the exercise, NSTOP officers paid particular attention to ensuring inclusion of nomadic Fulani, migrant farming, border and other scattered or hard-to-reach (under-served) settlements/communities in the exercise. They supervised the campaign activities majorly in these areas according to the NSTOP mandate from the national and state polio eradication Emergency Operation Centers (EOCs). NSTOP national and state level officers also participated actively as members of the multi-agency national and state Integrated Measles-polio Campaign (IMC) teams led by the Primary Health Care Development Agency.

N-STOP Local Government Officers (NSLO) 4th Routine Immunization Thematic Training

N-STOP Local Government Officers (NSLOs) for Routine Immunization Service Delivery participated in the 4th thematic training from 22- 23 October 2013. In the same period a training entitled, ‘Reach Every Ward Micro-planning’ was held for phase 1 and phase 2 NSLOs. The trainings were held in five clusters with facilitators drawn from NSTOP and the National Primary Health Care Development Agency (NPHCDA). The main objective of the two trainings was to improve routine immunization planning and service delivery to ultimately improve coverage.

Table showing participants, facilitators and venue of training

Theme venue Participating states Designationof participants No. of participants No. of facilitators

REW micro-planning Kano Kano LIO, NSLO, SIO, DPHCDA 58 8

REW micro-planning Katsina Katsina LIO, NSLO, SIO, DPHCDA 51 6

REW micro-planning Sokoto Kebbi, Sokoto, Zamfara

LIO, NSLO, SIO, DPHCDA,WHO, TSHIP 90 7

RI service delivery Kaduna FCT, Jigawa, Kaduna LIO, HE, NSLO, PRINN, WHO 74 6

RI service delivery Bauchi Bauchi, Borno, Yobe LIO, HE, NSLO, TSHIP, WHO 69 7

Total 5 11 342 34

22surveillance and their consent obtained to receive SMS reminders on reporting of AFP cases. The SMS reminders were to be sent on a weekly basis over a period of 2-3 months. At the end of this period, a follow-up survey was to be conducted to determine any changes in the KAP of these health workers.

NSTOP - USAID Meeting in SokotoOn 28 October 2013, key management officers from the NSTOP program and the USAID-funded Targeted States High Impact Project (TSHIP) held a meeting in Sokoto. The objective of the meeting was to identify areas for combined Routine Immunization (RI) efforts in Sokoto state to further NSTOP program’s RI strengthening activities in polio high risk

states. The meeting was an important step in the preparation for scaling-up NSTOP LGA officers (NSLOs) deployment and support to the remaining 15 LGAs in the state. NSLOs are supporting RI activities and other Polio Eradication Initiatives (PEI) efforts in 8 of the 23 LGAs of Sokoto state.

LGA Expanded Program on Immunization (EPI) trainingNational Stop transmission of polio Local Officers Routine Immunization thematic training on campaign management and service delivery for phase 1 and 2 LGAs respectively was held in five different venues on 3 and 4 December 2013. The tab le below shows a summary of persons trained during the workshops held in various states.

Strengthening the Acute Flaccid Paralysis Surveillance Component of the Polio Eradication Initiative through SMS RemindersTwelve residents of NFELTP participated in an NSTOP study in collaboration with the World Health Organization to strengthen acute flaccid paralysis (AFP) surveillance in Sokoto State. The main objective of the study was to assess the effectiveness of training and sending SMS reminders in improving reporting of AFP cases. A baseline survey on the Knowledge, Attitude and Practices (KAP) of AFP surveillance focal persons and health workers in all 120 AFP focal sites in the State was carried out by NSTOP from 24 - 31 October 2013. After the baseline survey, the focal points were then trained on AFP

Theme of training Venue Participating states Designation of participants No. of participants

RI service delivery Kano Kano LIO, HE, NSLO, SIO, DPHCDA 142

RI service delivery Katsina Katsina LIO, HE, NSLO, SIO, DPHCDA 74

RI service delivery Sokoto Sokoto LIO, HE, NSLO, SIO, DPHCDA,WHO, TSHIP 120

RI campaign Management Kaduna FCT, Jigawa, Kaduna LIO, HE, NSLO, PRINN, WHO 96

RI campaign Management Bauchi Bauchi, Borno, Yobe LIO, HE, NSLO, TSHIP, WHO 55

Thematic Training of N-STOP Local Government Officers (NSLO) 6th RI The 6th Routine Immunization thematic training on Data Management for the N-STOP Local Government Officers (NSLOs), LIOs, M&Es, other government EPI officers and partners was held 17-18 February 2014. The trainings were held in Kano, Katsina, Kaduna, Bauchi and

Sokoto states with facilitators drawn from NSTOP, National Primary Health Care Development Agency (NPHCDA) and other partners. During the exercise, 553 persons were trained. The main objective of the training was to: impart skills in basic use of computers and data management, review use of routine immunization data and introduce participants to Microsoft Excel, Microsoft Word and Microsoft Power Point. Prior to the training, a

training of trainers (TOT) was held at the NFELTP training centre in Abuja on 7 February 2014.

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Theme of training Venue Participating states Designation of participants No. of participants

RI Data Management Kano Kano LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 155

RI Data Management Katsina Katsina, Yobe and Borno

LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 180

RI Data Management Kaduna Kaduna and FCT LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 73

RI Data Management Bauchi Bauchi and Jigawa LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 40

RI Data Management Sokoto Sokoto, Kebbi and Zamfara

LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 105

Strengthening Local Government Routine Immunization Data ManagementAs part of NSTOP commitment to strengthen management of data at the local government level, the program donated a total of 121 laptops to 121 Local Government Immunization offices. The recipient states were Kano (44), Katsina (20), Kaduna (10), Jigawa, Sokoto, Yobe, and Zamfara (8 each), Borno (7), Bauchi (4) Kebbi (3), and Federal Capital Territory (1).

Routine Immunization (RI) Coverage survey Some members of CDC Atlanta polio response team for Nigeria were in Abuja from 16 to 26 February 2014 to conclude plans on the proposed routine immunization coverage survey. The Atlanta team together with some NSTOP staff reviewed and pre-tested the data collection tool in some communities in Abuja. The coverage survey is scheduled to start in early March 2014.

Rapid assessment of readiness for implementation of NHMIS with enhanced RI-specific data module at LGA level, NigeriaThe NPHCDA developed a strategic plan for the rollout of the National Health Management Information System in some select states and LGAs in 2014. In order to inform proper planning, staff responsibilities, training requirements, and identify current infrastructure and immunization data practices, a rapid data needs assessment in 5 LGAs from each of 10 states was done from 10 - 15 February 2014. The states were Bauchi, Borno, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, Yobe, and Zamfara states. Three NSTOP data mangers, 10 NSTOP States Coordinators, 28 NSLOs and 4 NPHCD staff participated in the assessment.

Polio Emergency Operation Center Training for poor performing Local Government AreasThe national polio emergency operations center held a training for immunization officers from poorly performing LGAs and states. Participating states at the training were Jigawa, Kaduna Sokoto,

Zamfara, Borno, and Yobe. NSTOP State Field Coordinators from these states and NSLOs from the selected LGAS attended the training. The training was held in clusters in Katsina between 15 and 17 February 2014. The main focus of the training was to brainstorm on strategies to improve immunization coverage in these poor performing LGAs.

January Immunization Plus Days (IPDs) debriefing and March IPDs planning meeting The program conducted the post January Immunization Plus Days (IPDs) and enumeration debriefing and March IPDs and enumeration planning on Friday 21 February 2014. Findings and challenges from the January enumeration were discussed and the enumeration data collection tool was revised based on present findings. NSTOP adhoc officers, State Field Coordinators, Zonal Field coordinators, National Coordinator, members of CDC Polio response team and the NFELTP Resident Advisor attended the meeting.

24March Immunization Plus Days (IPDs) and EnumerationThe NSTOP program deployed 113 NSTOP officers to support the March IPDs as Management Support Teams in various northern Nigeria states from 23 February to 07 March 2014. In addition, 29 NSTOP officers were deployed to Adamawa, Bauchi, Borno, Kaduna, Katsina, Kebbi, Niger, and Yobe states to conduct enumeration and land escape analysis of nomadic and other underserved settlements. As part of the enumeration exercise, NSTOP officers are to ensure that all children missed by vaccination teams during the IPDs are vaccinated by the enumeration data collectors.

IPV acceptability studyNSTOP in partnership with UNICEF conducted an Inactivated Polio Vaccine (IPV) acceptability study in Sokoto, Kano, Borno and Cross Rivers States from 17 - 22 March 2014 to address the issue of acceptability.

The introduction of IPV into the routine vaccination schedule in Nigeria in combination with Oral polio vaccine (OPV) is expected to significantly reduce polio transmission by raising the level of immunity of the population. However, considering the level of resistance to vaccination, it is important to assess the acceptability of the new vaccine prior to its introduction in the four target states. Eleven NFELTP residents and six UNICEF staff were trained in qualitative data collection and deployed to the various states. Focus group discussions and key informant interviews were

conducted with community members, ward focal persons, leaders of community development committees, and traditional and religious leaders. After the study, participants were trained on analyzing qualitative research data. The training provided the residents an avenue to appropriately analyze qualitative data.

N-STOP Local Government EPI Team 7th Routine Immunization Thematic TrainingThe 7th Routine Immunization thematic training on Demand creation for the N-STOP Local Government Officers (NSLOs), LIOs, M&Es, other government EPI officers and partners was held from 25 - 26 March 2014. The trainings were held in Kano, Katsina, Kaduna, Bauchi and Sokoto states with facilitators drawn from NSTOP, National Primary Healthcare Development Agency (NPHCDA) and

other Partners. The main objectives of the training were to define demand in the context of routine immunization, describe the relationship between supply and demand, and to identify communication channels of creating demand for routine immunization by communities. Prior to the training a training of trainers (TOT) was held at Gracious Hotel, Abuja from 20 - 21 March 2014. During the TOT, the facilitators were given refresher training on effective facilitation.

NSTOP Coordinator confirming finger marking for polio vaccination in a converted non-compliance household Sardauda Lga Mambila Plateau, Taraba State

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Table showing Participants at the N-STOP Local Government EPI Team 7th Routine Immunization Thematic Training

S/No. Venue Participating states Designation of participants No. of participants

1 Kano Kano LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 160

2 Katsina Katsina LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 116

3 Kaduna Kaduna, Jigawa and FCT LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 104

4 Bauchi Bauchi, Yobe and Borno LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 62

5 Sokoto Sokoto, Kebbi and Zamfara LIO, NSLO, M&E, ZTO, SIO, DPHCDA, WHO & UNICEF officers 105

USAID Do No Harm training The NFELTP polio response program invited two state Field Coordinators of Borno and Yobe states and the Zonal Coordinator for the region to participate in the USAID Do No Harm training in Abuja. The trained aimed at quipping them with skills and to give them some security update as they are working in high security prone areas.

Polio Eradication Initiative (PEI)/Routine Immunization (RI) Intensification in Adamawa and Taraba statesNFELTP supported Adamawa and Taraba states to strengthen routine immunization following an outbreak of wild polio virus in Cameroon. The overall objective of the support was to boost immunity of children less than 5 years old to prevent WPV transmission and improve the sensitivity of AFP surveillance in 10 and 5 Local Government Areas (LGAs) of Adamawa and Taraba states respectively. These LGAs share borders with Cameroun and often experience large volume of human traffic across the borders. NSTOP

plans to hire local NSTOP officers that will be posted to the LGAs to serve as adhoc NSLOs to the LGAs. The support went on from March to June 2014.

NSTOP Participation in the Nigeria Polio Summit 2014The NFELTP NSTOP program participated in the Nigeria Polio Summit 2014 in Abuja organized by the Federal Ministry of Health

in collaboration with Rotary International District 9125 on Monday 28 April 2014. The summit was themed: Sustaining the End Game Strategy Tempo, “Polio End Game …Let’s End It Now.” Nigeria NSTOP National Coordinator - Dr Chima Ohuabunwo received an award for his efforts towards global polio eradication. The NSTOP coordinator also gave one of the key thematic presentations for the summit titled;’The Polio End Game

NSTOP Coordinator NSTOP National Coordinator - Dr Chima Ohuabunwo receiving an award at the Nigeria Polio Summit held at the Transcorp Hilton Hotel

26Strategy: Ensuring Adequate Technical Capacity at the Ward Level’

The summit was opened by His Excellency, President Goodluck Jonathan. Also present was the Hon. Minister of Health, Prof. Onyebuchi Chukwu and all Global Polio Eradication Initiative (GPEI) partner agencies such as: World Health Organization (WHO), The United Nations Children’s Fund (UNICEF), Centers for Disease Control and Prevention (CDC), United States Agency for International Development (USAID) and Department for International Development (DFID).

April Immunization Plus Days (IPDs)The NSTOP program deployed 132 officers to support the April IPDs as Management Support Team officers in various northern Nigeria states from 06 to 14 April 2014.

Inactivated Polio Vaccine Acceptability StudyThe introduction of Inactivated Polio Vaccine (IPV) into the routine vaccination schedule in Nigeria in combination with OPV is expected to significantly reduce polio transmission by raising the level of immunity of the population. To address the issue of acceptability, NSTOP in partnership with UNICEF, conducted an IPV acceptability study in Sokoto, Kano, Borno and Cross Rivers States in March, 2014. With request from the National Primary Health Care Development Agency, the study was done in Enugu Sate in April 2014. Four NFELTP residents participated in the study from 28 April - 3

May 2014. The study involved interviewing traditional and religious leaders, leaders of community development committees and ward focal persons for immunization as key informants and also conducting focused group discussions with community members. The data analysis of this study is ongoing.

Follow-up Evaluation of the Routine Immunization System in LGAs at high risk for cVDPV Sixteen NFELTP residents and Field Coordinators of Kano, Zamfara, Bauchi, Katsina, Jigawa, Sokoto, and Niger states carried out a follow up assessment from 4 - 12 May 2014 to determine if there are improvements in the routine immunization delivery system of eight Local Government Areas (LGAs). This followed a routine immunization delivery system assessment conducted a year ago on the eight LGAs. A year ago, the routine immunization delivery system of 8 Local Government Areas (LGAs).The data generated is now being collated for analysis.

Wild Polio Virus Outbreak in Kano stateFollowing the report of a confirmed wild polio virus case in Taurani LGA of Kano state, Dr Aboyowa Edukugho - NSTOP Field Coordinator, was deployed to join two other Field Coordinators for Kano state and other partners in the outbreak response. Activities carried out included: household surveys to assess immunization status of neighbouring children, micro

plan review, planning and implementation of immunization mop up, active search for Acute Flaccid Paralysis (AFP) cases and intense social mobilization. NSTOP also deployed a Field Coordinator, Dr Belinda Uba to Bayelsa state to join the response team following the report of a suspected wild polio virus (WPV) outbreak. The case later turned out to be negative for WPV.

7th Routine Immunization (RI) Training N-STOP Local Government Officers (NSLOs) conducted the 7th Routine Immunization (RI) Training in their respective LGAs in April 2014. The activity was supervised by the respective State Field coordinators.

Recruitment of Phase 3 NSLOs NSTOP recruited 72 additional Local Government Officers for Bauchi (16), Borno (20), Kano (21) and Sokoto (15) states. With this new recruitment, NSTOP has gone state wide in the four states. This brings the total number of NSTOP staff at the LGA level to 172.

Inactivate Polio Vaccine training in Kano The government plans to introduce the use of the Inactivated Polio Vaccine (IPV) during the June IPDs in Borno and Yobe states. In order to acquaint all immunization officers, training on IPV was organized for (Expanded Program of Immunization (EPI) staff of Yobe and Borno states in Kano. In attendance

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were the National coordinator, the zonal coordinator for North east Nigeria, the state field coordinators of Borno and Yobe states, and 27 and 5 NSLOs from Borno and Yobe states respectively.

N-STOP Local Government Thematic Training (EPI 9th Routine Immunization) The first thematic Routine Immunization (RI) training on Introduction to RI for the newly recruited NSLOs and LIOs, and the 9th thematic trainings for N-STOP Local Government Officers (NSLOs), LIOs, M&E officers, and other government EPI officers on Monitoring and Evaluation were held in June and July 2014. The trainings were held in different clusters with facilitators drawn from NSTOP, the National Primary Health Care Development Agency (NPHCDA), WHO and UNICEF. The main objective of the two trainings was to improve routine immunization planning and monitoring which will ultimately improve coverage. Specifically, the objectives of the Introduction to RI was to strengthen the capacity of participants on basic concepts of Routine Immunization and RI strategies used in Nigeria while that of the M&E was to acquaint participants on monitoring and evaluation techniques used in RI and how to analyze and use M&E data for improving RI. Prior to the training, a training of trainers (TOT) was held at Gracious Hotel from 2 - 3 June 2014, in Abuja. A breakdown of participants and

venue of training is given in the tables below.9th Routine Immunization Thematic Training on Monitoring and Immunization

Cluster States Date No of LGA No. of trainees

Kaduna Kaduna and Jigawa 9 – 10 June 2014 18 70

Bauchi 1 Bauchi and Yobe 12 – 13 June 2014 12 48

Bauchi 2 Borno 30 June – 1 July 2014 7 21

Kano Kano 9 – 10 June 2014 23 73

Katsina Katsina 9 – 10 June 2014 20 101

Sokoto Kebbi, Sokoto and Zamfara 8 – 9 June 2014 19 77

1st Routine Immunization Thematic Training on Introduction to Routine Immunization

Cluster States Date No of LGA No. of trainees

Bauchi 1 Bauchi 9 – 11 June 2014 16 42

Bauchi 2 Borno 2 – 4 July 2014 20 46

Kano Kano 30 June –1 July 2014 7 21

Sokoto Sokoto 5 – 7 June 2014 23 73

June Immunization Plus Days (IPDs) The NSTOP program deployed about 230 NSTOP officers including NSLOs to support the June supplemental immunization activities in polio high risk Local Government Areas of northern Nigeria. The NSTOP officers provided management support during pre-campaign, intra-campaign and post-campaign activities from 16 - 28 June 2014.

National Polio Emergency Operations Center Meeting with Poor Performing LGAs The polio Emergency Operations Center (EOC) organized a targeted meeting with PEI team members of poor performing LGAs to review their performances, challenges and chart a way forward to

improve quality of future supplemental immunization activities and immunization plus days in these LGAs. The meetings were held on 12 June 2014 and 19 July 2014. The meeting in June was held by State Field Coordinators of Jigawa, Katsina and Kano with their respective poor performing LGA NSLOs.

The July meeting was sponsored by NSTOP and attended by a total of 110 participants drawn from Kaduna, Katsina, Sokoto, Jigawa and the Federal Capital Territory were in attendance.

Third Annual NSTOP Training on Polio Eradication Initiatives and Strengthening Routine Immunization The 3rd annual NSTOP training on polio eradication initiatives and strengthening routine immunization was held from

287 – 11 July 2014. The training targeted Cohort VI residents of the Nigeria Field Epidemiology and Laboratory training Program (NFELTP). In attendance were Chairpersons of State Primary Healthcare Development Agencies, State Directors of Primary Health, State Immunization Officers, University of Maiduguri, Core Group and the National Primary Health Care Development Agency. The objectives of the training were to orient participants on:

• Basic epidemiology of poliomyelitis

and other vaccine preventable

diseases, and polio eradication strategies in Nigeria

• Planning, conducting and monitoring of polio immunization campaigns

• Developing effective supplemental

immunization and routine immunization micro-plans.

• Standard operating procedures for outreach to underserved populations, AFP surveillance, wild polio virus case investigation and outbreak response

• Accountability framework of the National Polio Eradication Emergency Plan (NPEEP)

Facilitators from were drawn from the United States Centers for Disease Control – Nigeria Country Office, NSTOP, WHO and UNICEF. The training was declared open by the NFELTP Program Director, Dr Akin Oyemakinde with the Acting CDC country Director, Ms Catherine Avery in attendance. Certificates were awarded to the participants by the Program Director and NFELTP Resident Advisor, Dr Patrick Nguku, assisted by the NSTOP National

Coordinator, Dr Chima Ohuabunwo.

NSTOP Routine Immunization Follow-up Assessment NSTOP conducted a routine immunization (RI) follow up assessment in NSTOP supported LGAs in Northern Nigeria as a follow up to the baseline RI assessment conducted by the NSLOs in their LGAs of posting a year ago. This assessment is done at the beginning of activities in the LGA to assess the RI system in the LGAs. Following one year of NSTOP support in strengthening RI in the LGAs in collaboration with other RI partners, the follow up assessment is conducted to assess the progress made in the LGAs. The assessment was being carried out primarily by NFELTP Cohort VI residents, and some ad-hoc NSTOP officers from National Primary Health Care Development Agency, Federal Ministry of Health, Federal Ministry of Agriculture and Rural Development. The assessment was conducted in two phases. The first phase of the assessment was held in 54 LGAs from 13 – 25 July 2014, while the second phase involving 40 LGAs was conducted from 30 July – 9 August 2014.

NSTOP Leadership and Management WorkshopThe program organized a leadership and management workshop for staff from 17 – 20 July 2014. The overall goal of the workshop was to improve program structure and management and accountability. The workshop was attended by the NFELTP Resident Advisor, NSTOP National Coordinator, Deputy

Coordinator, NFELTP Senior Administrator and Accountant, and all NSTOP Staff. Also in attendance were CDC NSTOP staff, CDC Atlanta and Nigeria Global Immunization Division staff.

Modern Research Ethics workshop

Residents and faculty of NFELTP and NSTOP personnel took part in a two - day workshop on Modern Research Ethics by the West African Bioethics Training Program (WAB), Ibadan in collaboration with Centers for Disease Control (CDC. The training took place from 4 – 5 August, 2014 at Gracious Hotel, Abuja. In attendance were 15 participants and 2 facilitators.

The aim of the workshop was to strengthen the skills of trainees and staff of NFELTP/NSTOP on research ethics and how to obtain ethical clearance/approval for research studies.

The training curriculum was accredited by the National Health Research Ethics Committee (NHREC/TR/31/07/2014). Some of the topics included: History of research ethics and research regulation; legal, moral and philosophical foundations of modern bioethics; elements of informed consent; The consent process-comprehension, voluntariness and risk; exploitation, benefits, inducements and compensation for research injuries and vulnerable populations; functions of the National Health Research Ethics Committee and composition, functions and management of Institutional Ethics Committees among others.

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Acute Flaccid Paralysis (AFP) Follow Up Surveillance

NSTOP program trained and deployed 15 NFELTP residents and 3 supervisors for the Acute Flaccid Paralysis (AFP) follow up surveillance activity in Sokoto state from 4 - 10 August 2014.

The residents visited AFP reporting sites across the 23 LGAs and interviewed all AFP Focal Points and clinicians in these sites. The aim of this activity was to assess improvement in knowledge of AFP definition, reporting requirements, attitude and practice in the intervention areas after conducting a short training for the Focal Points and healthcare workers. The team was also involved in sending weekly SMS to focal points over 7 months. The outcome is specifically measured by:

• Increased number of AFP reporting

(statistical analysis to be used

comparing data over a few years for

the same time period for any significant change)

• Number of cases reported through

SMS, and a comparison of this to the number reported by the DSNO (the case count should be the same as the SMS reminder pilot should not alter the AFP reporting network that exists in all of Nigeria)

• Changes in the key awareness indicators

(e.g., diagnosis, investigations, reporting) by conducting questionnaire on all focal points at end of study, as done initially at the start of the training session)

August Immunization Plus Days (IPDs) and Mop up

NSTOP deployed 235 NSTOP officers including N-STOP Local Government Officers (NSLOs) to support the August supplemental immunization activities in polio high risk Local Government Areas of northern Nigeria. The NSTOP officers provided management support during pre-campaign, intra-campaign and post-campaign activities June from 4 - 13 August 2014. The IPDs was followed by Mop up activity in Kano state from 24 - 30 August 2014.

DHIS2 Academy in Calabar

The NSTOP program sponsored 5 NSTOP staff, 6 NFELTP residents and 12 National Primary Health Care Development Agency (NPHCDA) staff for the District Health Information System 2 (DHIS2) academy training in Calabar from 21 - 31 August 2014. The objective of the training was to develop the capacity of officers on basic DHIS2. DHIS2 is a platform used in Nigeria to capture all routine and non routine primary health care data and disseminate across all health care strata through. The DHIS2 software is web based, real time, has adequate user level control and has mobile functionality. The academy is conducted and managed by Health Information Systems Program (HISP) global with various representatives across the world. The training was in preparation for the National Health Management Information System (NHMIS) scale up and Routine Immunization (RI) dashboard introduction in Nigeria.

N-STOP Local Government Thematic Training

NSTOP conducted trainings on Vaccine Preventable Diseases (VPD) surveillance in September 2014 for the newly recruited NSLOs, LIOs and DSNOs and enhanced Acute Flaccid Paralysis surveillance for phase 1, 2 and 3 LGAs for N-STOP Local Government Officers (NSLOs), DSNOs, and other government officers. The trainings were held in different clusters with facilitators drawn from NSTOP, the National Primary Health Care Development Agency (NPHCDA), WHO and UNICEF. The main goal of the two trainings was to strengthen surveillance for vaccine-preventable diseases and AFP surveillance enhancement.

The following were the specific objectives of the training:

• Take an active role in detection and

reporting of VPDs with special emphasis on AFP surveillance

• Identify and propose solutions to challenges of VPD surveillance

• Apply principles for investigation and control of VPD outbreaks

• Analyze and use disease surveillance data for action and decision making

30AFP enhancement surveillance training

Cluster States Date No of LGA No. of trainees

Kaduna Kaduna and FCT 12 September 2014 11 24

Bauchi 1 Bauchi 15 September 2014 20 58

Kebbi Kebbi 09 September 2014 3 8

Zamfara Zamfara 09 September 2014 8 18

Jigawa Jigawa 09 September 2014 8 18

Kano Kano 10 September 2014 44 109

Katsina Katsina 09 September 2014 20 62

Sokoto1 Sokoto 08 September 2014 23 50

Yobe Yobe 15 September 2014 8 17

Borno Borno 15 and 29 September 2014 26 83

VPD Surveillance Training

Cluster States Date No of LGAs No. of trainees

Bauchi 2 Bauchi 15 and 16 September 2014 16 50

Borno Borno 15,16, 29 and 30 September 2014 19 60

Kano Kano 10 and 11 September 2014 21 70

Sokoto Sokoto 08 and 09 September 2014 15 51

Adamawa Adamawa and Taraba 25 and 26 September 2014 15 50

September Immunization Plus Days (IPDs)

The NSTOP program deployed 225 NSTOP officers including NSLOs to support the September supplemental immunization activities in polio high risk Local Government Areas of northern Nigeria. The NSTOP officers provided management support during pre-campaign, intra-campaign and post-campaign activities from 17 - 24 September 2014. On the first 2 days, Direct Observed Polio Vaccination (DOPV) was conducted in the very high risk LGAs to maximize the number of immunized children and reduce the number of missed children.

DOPV is exclusive outside vaccinations in streets, transit points and social events such as naming and wedding ceremonies; religious events among others.

Criteria for DOPV implementation settlement prioritization includes:

• Densely populated Settlements with Non-compliance

• Settlements with suspicious coverage.

Settlements with reported concealments during of previous SIAs,

fraudulent finger marking etc

• Settlements with high number of

Pending CA or suspiciously too many N houses.

• Settlements with Motor parks, Markets,-Daily & Weekly, Busy Streets

• Settlements /Households with Social Events.

NFELTP Ebola response status table

DATES EVENT/ ACTIVITY

23 July 2014Hosted the first Ebola rapid response coordination meeting to develop jointly with Federal Ministry of Health, CDC and WHO terms of reference for the rapid response team (RRT), case definitions and plan of action (immediate and long term) for the outbreak.

25 July 2014 One graduate and four residents were deployed to Lagos to support case investigation, contact tracing, coordination and development of public health communication working with CDC and WHO team.

26 July 2014A Resident Advisor and two more graduates were deployed to support response efforts. The Resident Advisor was coordinating the Epi/lab team working with the Lagos state Ministry of Health, WHO and CDC. An additional Resident Advisor is helping to review SOPs remotely.

26 July – 4 August 2014

Three residents were deployed to the response team. NFELTP graduates and residents working with state surveillance officers have identified more than 70 primary and 20 secondary contacts who where then monitored on a daily basis. The team investigated all rumors and supported the Emergency Operations Center (EOC) with contacts detailed database for decision making. The team also helped with airport contact tracing and training of disease surveillance officers. The system has helped to identify all symptomatic contacts for timely case management. So far eight symptomatic contacts have been identified.

Developed Standard Operation Procedures (SOPs) for contact tracing, case investigation, contact Household care, surveillance guidelines and rumor logging and investigations

ANNEX 1Presentations

Support of the West African Ebola Outbreak by NFELTP; acquiring necessary experience for Nigeria preparedness by Dr Adebobola Olayinka

Dr Adebobola Olayinka - Laboratory Resident Advisor NFELTP travelled to Sierra Leone in July to provide technical assistance in the management of and response to the Ebola Outbreak in Kenema district. Dr Olayinka participated in the outbreak as part of the Global Outbreak Alert Network (GOARN).

Background on Kenema District, Sierra Leone

Kenema is the third largest city in Sierra Leone (after Freetown and Bo) and the

largest city in the Eastern Province with a population of more than half a million. Kenema borders Bo District to the west, the Republic of Liberia to the south, Tonkolili and Kono Districts to the north,

Kailahun District to the southwest, and Pujehun District to the southeast.

It has one main hospital, the Kenema General Hospital where the Ebola treatment centre is located.

Fig 1: Map of Sierra Leone Fig 2: Front of Kenema Ebola treatment Centre

32The support provided to Kenema Ebola Treatment centre included:

• Conducted case management to ensure Infection, Prevention and Control (IPC) priorities and activities are managed effectively

• Advised on prevention of healthcare- associated infections

• Reviewed of IPC measures implemented

• Advised on prevention of health care- associated infections

• Reviewed of training needs, based on this assessment, conduct training in IPC for staff based on the review of IPC measures

• Provided guidance on immediate IPC policies, resources, and equipment

• Improved community awareness

about prevention and control measures

Key Findings

• Absence of IPC structure and poor IPC

practices in place at the Ebola treatment Centre

• Poor and sometimes absent triaging: Only one shift covered (8am – 4pm), not a 24hr coverage and weekends and public holidays not covered

• Poor management of sharps and waste

• Poor use of PPEs: not putting

on complete PPE to engage in risky

procedures especially by the support staff, unsafe removal of PPEs to avoid contamination

• Inappropriate sample collection and transportation methods (Poor PPE usage, Poor sharps management, Samples not transported in covered containers etc)

• Overcrowding of wards and terrible hygienic state of wards

• Lack of organization and job description at the treatment centre

• Inadequate nursing care (poor staff strength) so patients most times left in their secretions etc

Outbreak response activities undertaken

• Participated in the Emergency Operations Center (EOC) meetings as part of the clinical case management

team

• Conducted a rapid assessment of the Ebola Treatment Centre IPC structure,

practices and equipments, in order to

assess level of IPC and identify the gaps

• Discussed gaps identified with team and hospital management and ways of addressing the identified gaps

• Implementation of IPC activities within the treatment centre

• Started on site/ hands on training and monitoring of day to day activities with regards to IPC

• Improvement of flow of staff movement from low risk to high risk and not the other way round.

• Instituted regular shift cleaning and disinfection of wards. (instead of once

a day to 3ce a day)

• Improvement in sharps disposal, using

safety boxes and not disposing in general waste

• Removed old mattresses, clutter lying around, extra beds etc from around and within wards

• Improved on waste management in terms of waste segregation (sharps

and others), provision of waste buckets at point of use, for used PPEs etc and safe measures for

disposal of all waste from the treatment centre. Encouraged daily burning instead of once or 2ce a week to reduce bulk.

• Worked with logistician on provision of modified drums for burning of PPEs

and suggestion on provision of a pit for the ashes.

• Provision of 100Litres water drums

with colour codes for the 2 concentrations of chlorine solution.

• Discussed with management on

provision of 2 sets of scrub suits for each staff (Can do colour codes for different categories) so they don’t work in their home clothes and also for identification of who is authorised to be at the centre

• Provided chart to help ensure adequate concentration and dilution of chlorine water strengths.

• Developed some pictorial charts as SOPs as majority of the support staff are unable to read

• Conducted training for newly

recruited burial team members on

33

putting on and removal of PPEs and

decontamination procedures and waste management

• 10 burial team members

• 11 Sprayers

• 9 Drivers

• 1 Nurse

• Conducted training for 2 new supervisors and 4 old members of

the support staff on IPC basic principles, appropriate use of PPEs and modes of transmission

• Conducted training on Transmission of Ebola, Standard precautions and

basic IPC principles to staff currently

working at the Ebola Treatment Centre.

• 19 porters and cleaners

• 4Sprayers

• 4 Gatemen

• 4 Trained nurses

• 3 Nurse assistants

• 2 Lab technicians

• Discussed with management on

providing 3 duty shifts for staff to avoid overwork and carelessness

in the process. Provided a list of minimum staffing requirements for the centre and ideal staffing list.

• Provided needed list of basic care items for the patients and equipment

for cleaning the wards and surroundings.

• Worked with the Deputy matron and liaised regularly with the DMO

to ensure that the changes are sustained. 2 supervisors were provided

for this for the support staff who were

also trained so they know what to do:

Supervision of putting on and removal

of PPEs, control of flow from high risk

areas, overseeing appropriate disinfection procedures etc.

• Instituted policy that all new staff sent to the centre must be trained and

undergo an orientation before starting to work at the centre

• Recommendation on provision of

storage/buffer tanks for sustained water flow to the centre

• Worked with MSF on design of new facility to identify various procedure areas and requests for where chlorine water taps need to be in and around the confirmed cases ward

• Made suggestions to them on maximum number of beds to be

within in each section to prevent

overcrowding and maintaining recommended distance

Conclusions

The absence of IPC structure and implementation of IPC guidelines had led to the sustained amplification of the outbreak among the staff. Another contributory point is the inadequate knowledge of the staff themselves on the facts surrounding Ebola transmission thereby engaging in risky practices and carelessness within the community, in private practices and within the facility.

Recommendations:

• Training, Monitoring and Supervision of the workers to ensure they comply with IPC guidelines and Procedures

• Strict demarcation of high risk and low risk areas and compliance to the same

• Improvement of triage so only those that fit into the case definition criteria are admitted

• Change of mattresses within the

suspect ward as most if not all are contaminated

• Movement of confirmed cases with

their mattresses from annexe to the confirmed ward whenever they are confirmed

• Improvement in staffing conditions

(adequate no for each category,

staff toilets and showers, scrub suits, incentives)

34Before intervention

After intervention

 

   

 

   

35

Training and other pictures

Training of Staff of Ebola Treatment Centre on IPC measures

About to enter the Isolation ward 3rd from left putting on PPE before morning ward round

 Training of Porters and Burial team members

36

 Discussing with other Aids workers during burial ceremony Walking around the hospital to ensure procedures are being done safely.

On way to Isolation center in scrub suit before morning duties Supervising team during burial of Dr. Humar Khan

NFELTP supplement papers published in the Pan African Medical JournalNo Supplement No Article Authors

1 Pan Afr Med J. 2014;18(Supp 1):1

Building a public health workforce in Nigeria through experiential training

Akin Oyemakinde, Patrick Nguku, Rebecca Babirye, Sheba Gitta, Peter Nsubuga, Joseph Nyager, Abdulsalami Nasidi

2 Pan Afr Med J. 2014;18(Supp 1):2

Training and service in Public Health, Nigeria Field Epidemiology and Laboratory Training, 2008 – 2014

Patrick Nguku, Akin Oyemakinde, Kabir Sabitu, Adebola Olayinka, Ikeoluwapo Ajayi, Olufunmilayo Fawole, Rebecca Babirye, Sheba Gitta, David Mukanga, Ndadilnasiya Waziri, Saheed Gidado, Oladayo Biya, Chinyere Gana, Olufemi Ajumobi, Aisha Abubakar, Nasir Sani-Gwarzo, Samuel Ngobua, Obinna Oleribe, Gabriele Poggensee, Peter Nsubuga, Joseph Nyager, Abdulsalami Nasidi

3 Pan Afr Med J. 2014;18(Supp 1):3

A description of HIV prevalence trends in Nigeria from 2001 to 2010: what is the progress, where is the problem?

Adebobola Bashorun, Patrick Nguku, Issa Kawu, Evelyn Ngige, Adeniyi Ogundiran, Kabir Sabitu, Abdulsalam Nasidi, Peter Nsubuga

4 Pan Afr Med J. 2014; 18(Suppl 1): 4

HIV Disclosure Status and Factors among Adult HIV Positive Patients in a Secondary Health Facility in North-Eastern Nigeria, 2011

Raymond Salanga Dankoli, Alhaji A Aliyu, Peter Nsubuga, Patrick Nguku, Okechukwu Ossai, Dahiru Tukur, Luka Ibrahim, James Madi, Mahmood Dalhat, Mohammed Abdullaziz

5 Pan Afr Med J. 2014; 18(Suppl 1): 5

Factors associated with tuberculosis among patients attending a treatment centre in Zaria, North-west Nigeria, 2010

Ndadilnasiya Endie Waziri, Simeon Cadmus, Patrick Nguku, Olufunmilayo Fawole, Olajide Adewale Owolodun, Hyelshilni Waziri, Luka Ibrahim, Oladayo Biya, Saheed Gidado, Samuel Badung, Peterside Kumbish, Peter Nsubuga

6 Pan Afr Med J. 2014; 18(Suppl 1): 6

Knowledge, care-seeking behavior, and factors associated with patient delay among newly-diagnosed pulmonary tuberculosis patients, Federal Capital Territory, Nigeria, 2010

Oladayo Biya, Saheed Gidado, Ajibola Abraham, Ndadilnasiya Waziri, Patrick Nguku, Peter Nsubuga, Idris Suleman, Akin Oyemakinde, Abdulsalami Nasidi, Kabir Sabitu

7 Pan Afr Med J. 2014; 18(Suppl 1): 7

Prevalence and risk factors of Mycobacterium tuberculosis complex infection in slaughtered cattle at Jos South Abattoir, Plateau State, Nigeria

Lilian Akudo Okeke, Maryam Muhammad, Ikenna Okeke, Simeon Cadmus, Oluchi Awoloh, Endie Waziri, Adebola Olayinka, Patrick Nguku, David Dairo, Olufunmilayo Fawole

8 Pan Afr Med J. 2014; 18(Suppl 1): 8

Health care workers’ knowledge and attitude towards TB patients under Direct Observation of Treatment in Plateau state Nigeria, 2011

Luka Mangveep Ibrahim, Idris Suleiman Hadjia, Patrick Nguku, Ndadilnasiya Endie Waziri, Moses Obiemen Akhimien, Phillip Patrobas, Peter Nsubuga

9 Pan Afr Med J. 2014; 18(Suppl 1): 9

Determinants of routine immunization coverage in Bungudu, Zamfara State, Northern Nigeria, May 2010

Saheed Gidado, Patrick Nguku, Oladayo Biya, Ndadilnasiya Endie Waziri, Abdulaziz Mohammed, Peter Nsubuga, Henry Akpan, Akin Oyemakinde, Abdulsalami Nasidi, Idris Suleman, Emmanuel Abanida, Yusuf Musa, Kabir Sabitu

10 Pan Afr Med J. 2014; 18(Suppl 1): 10

Characteristics of persons refusing oral polio vaccine during the immunization plus days – Sokoto, Nigeria 2011

Abdulaziz Mohammed, Kabir Sabitu, Patrick Nguku, Emmanuel Abanida, Sadik Sheidu, Mahmood Dalhat, Raymond Dankoli, Saheed Gidado, Idris Suleiman

11 Pan Afr Med J. 2014; 18(Suppl 1): 11

Evaluating a surveillance system: live-bird market surveillance for highly pathogenic avian influenza, a case study

Ndadilnasiya Endie Waziri, Patrick Nguku, Adebola Olayinka, Ike Ajayi, Junaidu Kabir, Emmanuel Okolocha, Tesfai Tseggai, Tony Joannis, Phillip Okewole, Peterside Kumbish, Mohammed Ahmed, Lami Lombin, Peter Nsubuga

12 Pan Afr Med J. 2014; 18(Suppl 1): 12

Profile of dog bite victims in Jos Plateau State, Nigeria: a review of dog bite records (2006-2008)

Olaniran Alabi, Patrick Nguku, Silvester Chukwukere, Ayika Gaddo, Peter Nsubuga, Joliath Umoh

13 Pan Afr Med J. 2014; 18(Suppl 1): 13

Prevalence and factors associated with hypertension and obesity among civil servants in Kaduna, Kaduna State, June 2012

Abisola Monisola Oladimeji, Olufunmilayo Fawole, Patrick Nguku, Peter Nsubuga

14 Pan Afr Med J. 2014; 18(Suppl 1): 14

High concentration of blood lead levels among young children in Bagega community, Zamfara – Nigeria and the potential risk factor

Olufemi Olamide Ajumobi, Ahmed Tsofo, Matthias Yango, Mabel Kamweli Aworh, Ifeoma Nkiruka Anagbogu, Abdulazeez Mohammed, Nasir Umar-Tsafe, Suleiman Mohammed, Muhammad Abdullahi, Lora Davis, Suleiman Idris, Gabriele Poggensee, Patrick Nguku, Sheba Gitta, Peter Nsubuga

15 Pan Afr Med J. 2014; 18(Suppl 1): 15

Bacteriuria and urinary schistosomiasis in primary school children in rural communities in Enugu State, Nigeria, 2012

Okechukwu Paulinus Ossai, Raymond Dankoli, Chimezie Nwodo, Dahiru Tukur, Peter Nsubuga, Daniel Ogbuabor, Osaeloka Ekwueme, Godwin Abonyi, Echezona Ezeanolue, Patrick Nguku, Douglas Nwagbo, Suleiman Idris, George Eze

ANNEX 2Publications

38Other publications

No Supplement no Article Authors

1 The Pan African Medical Journal. 2014;17:78

Factors associated with interruption of treatment among pulmonary tuberculosis patients in Plateau State, Nigeria, 2011.

Luka Mangveep Ibrahim, Idris Suleiman Hadejia, Patrick Nguku, Raymond Dankoli, Ndadilnasiya Endie Waziri, Moses Obiemen Akhimien, Samuel Ogiri, Akin Oyemakinde, Ibrahim Dalhatu, Okey Nwanyanwu, Peter Nsubuga

2 The Pan African Medical Journal. 2013; 16:144

Factors associated with probable cluster of Leptospirosis among kennel workers in Abuja, Nigeria. Factors associated with probable cluster of Leptospirosis among kennel workers in Abuja, Nigeria.

Emmanuel J Awosanya, Patrick Nguku, Akin Oyemakinde, Olutayo Omobowale.

3 The Pan African Medical Journal. 2014; 17:77

Evaluation of quality of TB control services by private health care providers in Plateau state, Nigeria; 2012.

Luka Mangveep Ibrahim, Obinna O Oleribe, Patrick Nguku, Gabriel Chukwak Tongwong, Lakda Gonen Mato, Musa Istifanus Longkyer, Samuel Ogiri, Peter Nsubuga.

4 MMWR / April 18, 2014 / Vol. 63 / No. 15

Assessment of Blood Lead Levels Among Children Aged ≤5 Years — Zamfara State, Nigeria, June–July 2012

Muhammed Bashir, Nasir Umar-Tsafe, Kabiru Getso, Ibrahim M. Kaita, Abdulsalami Nasidi, Nasir Sani-Gwarzo, Patrick Nguku, Lora Davis, Mary Jean Brown

5 MMWR / April 18, 2014 / Vol. 63 / No. 15

Assessment of Potential Zoonotic Disease Exposure and Illness Related to an Annual Bat Festival — Idanre, Nigeria.

Neil M. Vora, Modupe Osinubi, Ryan M. Wallace, Abimbola Aman-Oloniyo, Yemi H. Gbadegesin, Yennan Kerecvel Sebastian, Olugbon Abdullateef Saliman, Mike Niezgoda, Lora Davis, Sergio Recuenco

6Journal of Public Health and Epidemiology Vol. 6(1), pp. 1-7, January 2013

Implication of coliforms as a major public health problem in Nigeria. Akyala Ishaku A., Olufemi Ajumobi, Adebola Olayinka

7Public Health Research 2014, 4(1): 7-12 DOI: 10.5923/j.phr.20140401.02

Investigation of Cholera Outbreak in an Urban North Central Nigerian Community-The Akwanga Experience

Akyala Ishaku A., Bright Esyine Shadrack, Olufemi Ajumobi, Adebola Olayinka, Patrick Nguku

Cohort IV HIV theses NAME TOPIC

Dr. Usman Sunusi Usman Comparative Studies on Socio-Prevalence and Risk Factors of HIV/AIDS in between long distance and short distance Commercial drivers in Kano

Dr. Nurudden Aliyu Factors associated with adherence to antiretroviral therapy among People living with HIV/AIDS at FMC Gusau, Zamfara State

Mikhail A. Abubakar Factors affecting quality and accessibility to Laboratory investigation for HIV/AIDS Patients in Selected health facilities in Kano-Nigeria.

Olagunju O. Timothy Socio-Demographic Correlates of Nutritional Status of People Living with HIV/AIDS in Oyo State Nigeria

Isichei Mercy Wakili Factors associated with late Presentation of Symptomatic Cancer among HIV Positive Patients in Jos, Plateau State.

Fatima Cheshi Assessing the PMTCT-Adult ART Services in Nigerian Military Health Facilities

Agbai Chidinma Sero-prevalence of Hepatitis B virus among adult HIV Positive Patients attending the 44 Nigeria Army Reference Hospital Kaduna, Nigeria

Joshua A. Rikoto Pattern of anti-tuberculosis drug resistance and associated factors in patients attending National tuberculosis reference Hospital, Zaria

Dr. Chioma Ukamwa Risk Factors for drug Resistant Tuberculosis among the patients receiving treatment at the Multi-Drug Resistant TB (MDR-TB) treatment site in Oyo and Lagos State

Kayode Olawuyi Prevalence and determination of Malaria parasitaemia among under –five (U 5) children attending ART clinics in selected health facilities in Jos, Plateau State

Dr. Umakaltume Abubakar Factors Influencing Access to antenatal care and prevention of Mother-Child Transmission of HIV among nomads in Makarfi LGA, Kaduna State

Offor Mauren Adaora Factors associated with delayed access to prevention of mother-to-child services in Federal Capital territory, Abuja Nigeria

Dr. Ganiyu Jamiyu Factors Associated with Poor Adherence among HIV/AIDS Patients accessing care at Tertiary Health Facility in Lagos,Nigeria

Dr Bukola Aisha Factors influencing Infant feeding option among mother attending PMTCT clinics in Osun state

39

NFELTP abstracts presented at the 5th AFENET conference, Ethiopia

Author Title Result

Nuruddeen Aliyu Measles outbreak investigation in Sokoto State – Nigeria, February, 2013 OralFatima L. Cheshi An outbreak of measles in Kubau Local Government Area, Kaduna State, Northern Nigeria, February, 2013 Oral

Celestine A.Ameh Trend in the prevalence of Tuberculosis and HIV infection in suspected Tuberculosis cases at the Directly Observed Treatment Shortcourse (DOTS) clinic of Barau Dikko Specialist Hospital, Kaduna State, Nigeria – June, 2010 -July, 2012 Oral

A. Musa Prevalence and pattern of bacterial infection in febrile children with sickle cell anaemia Oral

Muhammad S. Balogun An outbreak of hepatitis B infection in Yarkasuwa and Bakula communities in Ikara Local Government Area of Kaduna State, Nigeria – March, 2013 Oral

Aboyowa A. Edukugho Knowledge, Attitude and Practice of Residents of Abuja Municipal Area Council of the Federal Capital Territory, Nigeria, towards Rabies – April 2013 Oral

Muhammad B. Abdullahi Predictors of Pulmonary Tuberculosis in Zamfara State-Nigeria, March 2013 OralChimezie C. Nwodo Outbreak of Food Poisoning in Ede-Oballa community, Enugu State, South-East Nigeria: October, 2012 Oral Abbott S L Analysis of stillbirths in Jibril Mai-Gwari I Memorial Hospital Birnin Gwari, Kaduna State Oral Olawunmi O. Adeoye Prevalence and risk factors of Precancerous Cervical Changes among Sexually Active Women in Lagos, Nigeria Oral Abbott L Samuel Measles outbreak in Birnin Gwari Local Government Area, Kaduna, Nigeria 2013 Oral Ishaku A. Aklaya Evaluation of a Malaria Rapid Diagnostic Test among Febrile Children in Nasarawa, North Central, Nigeria Poster Elizabeth B. Adedire Assessment of Malaria Control Interventions amongst high-risk groups attending health facilities - Oyo State, Nigeria, September 2011 Poster Nasir T. Umar-Tsafe An Epidemiologic Review on the Lead Poisoning Disaster in Zamfara, Nigeria, 2010 - 2013 Poster

Jamiyu Ganiyu Prevalence and Risk Factors associated with HIV Transmission among Clients Accessing HIV Counselling and Testing (HCT) service in a Tertiary Health Facility in Lagos, Nigeria Poster

Lilian A. Okeke Prevalence and risk factors for Mycobacterium tuberculosis complex among slaughtered cattle and cattle handlers at Jos south abattoir, Plateau state – Nigeria, 2012 Poster

Kabiru I. Getso Trend and Risk factors of Poliomyelitis Transmission in Zamfara State, Nigeria – 2009-2011 Poster Aishat B. Usman Willingness to Participate in Community-Based Health-Care Financing Scheme by Rural Households – Osun State – Nigeria, 2012 Poster Dairo M Factors affecting disease notification and reporting among health workers in selected local government areas in Oyo State, Nigeria Poster Dairo M Routine immunization coverage and associated factors among children aged 12 – 23 months in odeda local government area, Ogun state, Nigeria Poster Kabiru I. Getso Cholera Outbreak in Bungudu Local Government Area - Zamfara State, Nigeria; July, 2011 Poster Usaini Bala An unusual outbreak of Pharyngotonsillitis caused by Aeromonas hydrophila in Karaye, Kano State – Nigeria 2012 Poster Muhammad B. Abdullahi Epidemiological Characteristics of Patients with Obstetric Fistula in Zamfara State Poster Aishatu A. Sadiq Acceptability of new combined campaign for polio and meningitis: Kumbotso LGA, Kano State, Nigeria – September 2012 Poster Charles A. Michael Human Rabies Outbreak – Cross River State, Nigeria, September, 2012 – the role of canine vaccination and post exposure prophylaxis Poster Binta S.Bako Outbreak of Measles among Farmers Children, Gwadabawa Local government Area, Sokoto State, Nigeria - 2012 Poster Felix E. Mbodi Trend and characteristics of fatalities associated with road traffic crashes – Nigeria, 2001 - 2011 Poster Abimbola Aman-Oloniyo Progress towards Polio eradication: Lagos State, 2001-2012 Poster Mikhail A. Abubakar An outbreak of cerebrospinal meningitis (CSM) in Kebbi State, Nigeria – Febuary 2013 Poster Adewuyi Peter Sensitivity of Case-Based Measles Surveillance in Selected Local Government Areas Of Oyo State, Nigeria, January 2011- June 2012 Poster Adebobola T. Bashorun HIV prevalence and associated factors amongst prison inmates in Kuje federal prison, Federal Capital Territory, Abuja, Nigeria, 2013 Poster Lilian A. Okeke Lassa fever outbreak investigation, Plateau State – Nigeria, 2013 Poster

Jamiyu Ganiyu Characteristics of People Living with HIV (PLHIV) diagnosed for Tuberculosis a nd treatment outcomes among HIV/AIDS patients attending TB clinic in Nigeria Institute of Medical Research, Lagos State, Nigeria Poster

Belinda V. Uba Knowledge and Prevalence of Human African Trypanosomiasis among Residents Kachia Grazing Reserve – Nigeria, 2012. Poster Iman Bello Wada Gas inhalational injury near a smelting and pot-making industry, Kano state – Nigeria, 2013 Poster

Aishatu A. Sadiq Improving healthcare delivery to nomads: Enumeration of settlements and monitoring for polio vaccination campaigns August-September 2012, Maru LGA, Nigeria Poster

Abubakar A. Jafiya Lead residues in tissues of animals for human consumption at Gusau modern abattoir, Zamfara State, Nigeria Poster Shember A. Igbabul Polio Outbreak Investigation and Response in A Previously Polio Free State in North Central Nigeria – 2012 Poster

Ilechukwu Preparedness Against Cholera Epidemic Among Local Health Authorities In Oyo State, Nigeria Oral Poster

Adedire Elizabeth.B Evaluation of Malaria surveillance system in Oyo state, Southwestern Nigeria January 2013. Oral Poster

Joshua A. Rikoto Outbreak of Cerebrospinal Meningitis in Gwandu Local Government, Kebbi State – Nigeria, 2013 Poster