Northeast Nigeria Response: Health Sector Bulletin #32, 30 September 2017

Situation Report
Originally published



  • As for the month of September, the cumulative number of suspected and confirmed cholera cases was 4,356 and 59 deaths, with a 1.3% Case Fatality Rate.

  • For the first time in Nigeria, an Oral Cholera Vaccination (OCV) campaign in Borno state concluded last week, and vaccinated 844,000 people in cholera affected LGAs. In addition, the Borno State Ministry of Health confirmed that it would vaccinate with the support of the Health Sector partners the “hotspots” of Ngala, Rann, Banki, Bama and Pulka.

  • The 3rd round of the Seasonal Malaria Chemoprevention (SMC) campaign for children aged 03-59 months in Borno state has been scheduled to take place in Jere, Maiduguri Metropolitan Council, Konduga, Monguno and Mafa LGAs from 14 to 17 October 2017.

  • According to the UN Global Multi-Dimensional Poverty Index 46% of Nigerians lived below the national poverty line and the NE Region is one of the worst with 76.8% under the poverty line. The poverty indexes for the main affected states are Adamawa 59%, Borno 70.1% and Yobe 90.2%.

  • Preliminary figures shows close to 11 million conflictaffected people are in need of primary and secondary health interventions across the six states in the NE Region, of which an estimated 8.3 million people are in three priority states; Adamawa, Borno and Yobe.

Situation Update

The first Cholera case was confirmed on 23 August 2017 and the outbreak has, as of end of September 2017, claimed the lives of at least 59 individuals in the State. with a CFR 1.3%. As the cases continue to decrease in the five affected LGAs namely Maiduguri, Jere, Konduga, Dikwa and Monguno, simultaneously and for the first time in Nigeria, an Oral Cholera Vaccination (OCV) campaign in Borno state concluded last week (18-22 September).

An estimated 844,000 people were vaccinated (and ongoing) against cholera in the cholera-affected areas. The campaign occurred mainly in targeted internally displaced persons (IDPs) camps including Muna Garage, Farm Centre and Custom House in Jere LGA as well as the high-risk communities hosting the affected population. The campaign targeted everyone in these host communities over the age of one. The vaccination campaign adds to the preventive and ongoing water, sanitation and risk communication interventions.

The number of cases stands at close to 4,400 and are concentrated in the “Muna Corridor” in Maiduguri and Jere LGAs, which includes 15 different sites for displaced people, including Muna Garage, Customs House and Farm Centre. Following an initial rapid risk assessment, the State MoH and Health Sector graded the risk of spread in the Borno capital as “high,” given the congestion, poor infrastructure and water/sanitation conditions in the area. In addition, risk assessments took place in the high priority LGAs, strengthening surveillance and case detection, establishment of Cholera Treatment Centres (CTC) and Oral Rehydration Points (ORPs) in MMC, Jere, Dikwa and Monguno, along with social mobilization. As reactive cholera vaccination was considered key to control further spread of the disease, the high risks LGAs of Ngala, Kala Balge, Bama and Gwoza will be targeted in a future OCV campaign.

Besides cholera, the need for addressing essential primary care service delivery in IDP camps and host communities, hard to reach areas with limited or no access to health care services continue to be critical. Further deployment of mobile health teams as part of the health Rapid Response Mechanism (RRM) and support to secondary health care facilities/general hospitals in terms of deployment of medical specialists, supplies, medicines, ambulances, etc., are still required. The high risk LGAs identified in the preparedness plan for different outbreaks in Borno continue to be Maiduguri, Jere, Mobbar, Ngala, Kala Balge, Bama, Monguno, Dikwa; and Michika in Adamawa state and are under close surveillance by all the health sector partners.

The risk of other epidemic prone diseases like measles, meningitis, malaria, viral haemorrhagic fevers (VHF) etc. will continue to be threat to the lives of people in NE Nigeria. Endemic malaria in the region accounts with 50% of the total consultations reported by the early warning and alert disease response and surveillance system (EWARS) sentinel sites. Malaria, acute respiratory infections and watery diarrhoea are the top three leading causes of illness among IDPs along with foci of high levels of severe acute malnutrition.

Revitalization and strengthening of the health system is vital. Re-establishing functional, staffed and equipped health facilities to deliver health services to vulnerable populations including host communities is a key transitional strategy goal for 2018. Secondary health care and although improving, referral services is a big challenge facing the healthcare workers and affected population in remote areas due to lack of ambulance services and specialized health care providers. According to health sector 5Ws analysis, only 29% health facilities have a working referral mechanism to a higher level of care.

Over 50% of the formal/informal camps are with no health partner. In Borno state only 228 health facilities are functional (out of the total 755 health facilities assessed through HeRAMS conducted in September, 2017) with the support of health sector partners. 376 health facilities are non-functional while 151 are partially functional across Borno state. HIV/AIDs, mental health and reproductive health services are very limited in the health facilities across Borno state.