Northeast Nigeria Response (Borno State): Health Sector Bulletin #20, 5 March 2017
Borno SMOH in northeast Nigeria has recorded its first Lassa fever outbreak in almost five decades. The last confirmed outbreak of the deadly disease was in 1969. On 22nd February, an alert was received at the WHO field office in Maiduguri about a suspected case of Viral Haemorrhagic Fever (VHF) detected at the Umaru Shehu Hospital. The laboratory confirmation for Lassa fever was reported on the 27th Feb 2017.
The Lassa fever response mechanism has been set up on March 1 st by the Honourable Health Commissioner, and a daily coordination meeting supported by WHO is taking place. It includes teams for case management, contact tracing, laboratory and infection control, environmental investigation, social mobilization and communication.
In 2017 so far, a total of 8,596 children (2.7 per cent of annual nutrition sector target of 314,557) with severe acute malnutrition have been admitted into therapeutic program in Borno and Yobe states. The quality of the program implementation is within the sphere standards.
The health sector strategy has been informed by and supports the MOH NE Health Sector Response Plan, the HRP 2017, State MOH Health Sector Operations Plans and health sector partner strategies.
The four countries in the Lake Chad Region have similar health priorities: rapidly expanding access to a package of essential health care services – including child and reproductive health; boosting immunization rates; preventing, detecting and responding to disease outbreaks; effectively treating malnutrition and its consequences.
The most urgent needs are in north-eastern Nigeria, particularly Borno State. This is the heart of the Lake Chad Region crisis, where at least 6.9 million people, including 1.8 million internally displaced persons, urgently need the expansion of life-saving health services.
High morbidity, excessive mortality and high rate of severe malnutrition cases have been a consistent feature. Over 2016 there were serious outbreaks of measles and polio – in fact, the eradication of polio in Africa, and globally, is threatened by the crisis in NE Nigeria. Besides the polio and measles outbreaks, malaria continues to be the major cause of morbidity and the main cause of mortality among children under 5 years of age. It is also expected that there will be an increase in respiratory infections and the potential for a cholera outbreak and/or meningitis in the coming months.
Although the disease surveillance, alert and outbreak response system have been seriously eroded at a time of high population vulnerability and increasing likelihood of outbreaks; the local health officials in Borno on 27th February 2017 confirmed a case of Lassa Fever from Zabarmari village, Jere LGA. The initial diagnosis was septicaemia, but the case was compatible with the viral haemorrhagic fever case definition (fever, bleeding from nose, vagina, and blood in vomiting). The patient had been hospitalized on 20th February. The patient was isolated in a single room; recommendation was made to the personnel to wear PPE until laboratory diagnosis was received. The patient is under isolation and receiving proper medical care.
WHO is supporting the government to contain the outbreak in an area of the country which is already coping with a humanitarian crisis resulting from years of conflict. In order to contain the outbreak, the WHO emergency humanitarian health team in the state has taken a number of actions. This includes rapid training on clinical case management, contact tracing, mobilizing a network of healthcare workers at the hospital, and building public awareness. Fiftyfour people who had contact with the index case have been identified and will be monitored for 21 days according to WHO protocols to ensure that any Lassa fever-related incidence is immediately contained.
The State Government and health partner’s capacity to respond has been overstretched with the continued increasing requirements. Revitalizing and strengthening of the health system is vital. Re-establishing functional, staffed and supplied health facilities to cover vulnerable populations and moving away from mobile services must be a priority for the health sector in 2017. The current picture is of protracted conflict and a continuing active insurgency. Many areas have now become more accessible, however insecurity remains and the pattern of safe accessibility on the ground remains liable to local changes and reversals not in control of the health sector.