|Year : 2010 | Volume
| Issue : 1 | Page : 21-27
Emergency preparedness and the capability to identify outbreaks: A case study of Sabon Gari Local Government Area, Kaduna state
AA Abubakar, SH Idris, K Sabitu, AU Shehu, MN Sambo
Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
|Date of Web Publication||17-Dec-2010|
A A Abubakar
Department of Community Medicine, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background : Widespread outbreaks, particularly of communicable diseases and weak surveillance systems, across the African sub-region led to the adoption of Integrated Disease Surveillance and Response (IDSR) as a regional strategy for strengthening national surveillance systems and effective response to priority communicable diseases. One of the goals of IDSR is to improve the ability of Local Government Areas (LGAs) to detect and respond to diseases and conditions that lead to high morbidity and mortality. The aim of the study was to assess the emergency preparedness and capability to identify outbreaks in Sabon Gari LGA.
Methodology : A cross-sectional descriptive study was carried out in Sabon Gari LGA in October 2007. Key informant interviews of the key personnel conducted using structured interviewer administered questionnaires were used to obtain information about the emergency preparedness and the capability of the LGA to identify outbreaks. The results obtained were compared to the recommendations of the National Technical Guidelines for IDSR 2002.
Results : There were no prepositioned stock of drugs and vaccines available; 8% of staff was trained in disease surveillance. There is a budget line available for emergency response. The LGA relies on reports from health facilities and communities to identify outbreaks; no threshold or markers are used. No form of analysis is carried out on data collected at the LGA level. Timeliness of monthly reporting for May and June 2007 was 26.5 and 22.5% respectively; completeness of monthly reporting was 32.7%.
Conclusion: The emergency preparedness and capability to identify outbreaks in Sabon Gari LGA is poor based on the selected criteria from the National Technical Guidelines for IDSR; less than 50% of the criteria are met. There is a need for Sabon Gari LGA to fully adopt the National Technical Guidelines on IDSR to be better positioned to prepare for and identify outbreaks.
Keywords: Emergency, Integrated Disease Surveillance and Response, outbreaks, preparedness, surveillance
|How to cite this article:|
Abubakar A A, Idris S H, Sabitu K, Shehu A U, Sambo M N. Emergency preparedness and the capability to identify outbreaks: A case study of Sabon Gari Local Government Area, Kaduna state. Ann Nigerian Med 2010;4:21-7
|How to cite this URL:|
Abubakar A A, Idris S H, Sabitu K, Shehu A U, Sambo M N. Emergency preparedness and the capability to identify outbreaks: A case study of Sabon Gari Local Government Area, Kaduna state. Ann Nigerian Med [serial online] 2010 [cited 2019 Jul 16];4:21-7. Available from: http://www.anmjournal.com/text.asp?2010/4/1/21/73877
| Introduction|| |
Emergency preparedness programs enable organizations and communities to deal with emergencies effectively and appropriately. The main objective of emergency preparedness is the protection of lives and reduction of vulnerability.  Ultimately, being prepared for an emergency situation can save lives when an outbreak occurs because where emergency preparedness plans have been put in place, timely detection of outbreaks is followed by prompt and appropriate response.  In 1999, the World Health Organization (WHO) Regional Director for Africa, Dr. E.M. Samba declared that the first major component of epidemic preparedness and response was detailed epidemiological surveillance. 
The prevailing poor surveillance system in the African sub-region led to the adoption of the Integrated Disease Surveillance and Response (IDSR) as a regional strategy for strengthening the weak national surveillance system and effective response to priority communicable diseases for the African region, by member states in September 1998 at the 48 th WHO/AFRO regional committee meeting. Implementation of IDSR in Nigeria started with orientation on the IDSR strategy of national program managers of the different disease control programs in June 2000.
The IDSR strategy calls for a coordinated approach to data collection, analysis, interpretation and use and dissemination of surveillance information designed for decision making and public health action.  The WHO promotes a two-pronged strategy which involves epidemic preparedness and epidemic response.  This is encapsulated in the IDSR which also makes clear essential tasks and activities required for strengthening or expanding existing surveillance systems. 
The National Technical Guidelines for IDSR was adapted by the Epidemiology Division, Federal Ministry of Health, in May 2002 from the Technical Guidelines for IDSR prepared by the WHO office for Africa and the Centers for Disease Control and Prevention, USA.
One of the goals of IDSR is to improve the ability of Local Government Areas (LGAs) to detect and respond to diseases and conditions that lead to a high rate of death, illness and disability. 
IDSR contributes to epidemic preparedness by providing skills and information for early detection of outbreaks, leading to enhanced preparedness for emergency situations. 
The preparation and response to outbreaks is an important part of the LGA health care delivery services. This means that it is necessary for the LGAs to be ready for outbreaks and have the ability to identify outbreaks for timely action to reduce morbidity and mortality in the event of an outbreak.
Since Nigeria adopted the IDSR strategy in 2000, only one assessment was carried out in 2009 to determine the level of implementation of IDSR across the country. In the northwest region, Kaduna state was not amongst the two states selected. The assessment found LGAs to have varying preparedness levels of response to outbreaks. There was generally poor preparedness to respond to outbreaks typified by non-functional emergency preparedness committees and epidemic rapid response teams, lack of trained staff as well as lack of prepositioned drugs and vaccines. ,
The aim of the study was to assess the preparedness to respond to outbreaks and the capability to identify outbreaks in Sabon Gari LGA of Kaduna state, based on the National Technical Guidelines for IDSR.
| Materials and Methods|| |
Sabon Gari LGA is one of the 23 LGAs of Kaduna state. It occupies an area of about 600 km 2 . It has a land area of about 600 km.  The population is a mixture of Hausa/Fulani, Bajju, Yoruba, Igbo and other tribes. It has an estimated population of 239,340.
The LGA owns a total of 22 primary health care facilities consisting of eight family health units, nine health clinics and five health posts. There are two secondary health facilities in the LGA. There are a total of twenty registered private clinics and hospitals and three institutional clinics. The Ahmadu Bello University Teaching Hospital, although located in a nearby LGA, serves as the main referral center for these health facilities.
This was a cross-sectional descriptive study.
Key informant interviews of the Disease Control Officer and the LGA Disease Surveillance and Notification/Monitoring and Evaluation Officer were conducted.
Qualitative data were collected by a trained interviewer using two structured interviewer administered questionnaires. Records were obtained and reviewed for the monthly reporting from the Health Department of Sabon Gari LGA. The questionnaires were pretested in Zaria LGA.
Data were entered into a spreadsheet in Microsoft Excel 3.0 and percentages were calculated where applicable.
The results obtained were compared to the national guidelines as outlined in the National Technical Guidelines for IDSR, May 2002. The core surveillance functions of confirmation, reporting, epidemic preparedness and analysis as well as support activities of training and resource provision were assessed.
Permission was obtained from the health department of Sabon Gari LGA and clearance was obtained from the scientific and ethical committee of the Ahmadu Bello University Teaching Hospital Zaria. Informed consent was obtained from the respondents.
| Results|| |
Emergency preparedness to outbreaks
There is an LGA Epidemic Management Committee (EMC) in Sabon Gari LGA. The members of the committee include the Chairman of the LGA, the Supervisory Councilor for Health, the Primary Health Care Coordinator, the Disease Control Officer, the Monitoring and Evaluation/Disease Surveillance and Notification officer (M and E/DSNO), National Programme on Immunization (NPI) Officer, District Head of Bomo, Women Leader and Youth Leader of Sabon Gari LGA. The committee meets two to three times in a year and it last met in February 2007; there were no minutes of the previous meeting available.
The LGA has an epidemic rapid response team which includes M and E/DSNO and unit heads of seven primary health care units who are all community health officers. The LGA does not have an epidemic response plan [Table 1].
Training on epidemic response/IDSR was last conducted in February 2007. Ten health care providers out of the 131 (8%) employed by the LGA were trained. The training was organized by the Kaduna State Ministry of Health.
Presently, there are no emergency stocks of drugs and supplies or supplies for collecting and transporting laboratory specimen in the event of epidemics. The standard procedure for procuring stocks of vaccines, where indicated, in the event of an epidemic, is an application sent to the Epidemiology Unit of the Kaduna State Ministry of Health (SMOH). It takes about 12 hours to obtain vaccines. The resources available for transportation are funds that are disbursed for logistics in the quote for emergency funds for outbreaks. The communication methods available that are used in the event of an outbreak include radio, local announcers and mobile telephones.
There are funds available for emergency response to outbreaks in the LGA, which are accessed by the Disease Control Officer writing to the Chairman of the LGA through the Head of Health. The Chairman then directs the accounts department to release the funds.
There is no laboratory support for confirmation of pathogens responsible for outbreaks in the LGA but there is a reference laboratory, the Barau Dikko Specialist Hospital Laboratory in Kaduna, to which the specimens are sent [Table 1].
|Table 1 :Criteria for assessing emergency preparedness to outbreaks in Sabon Gari Local Government Areas|
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Capability to identify outbreaks
Disease outbreaks are identified in Sabon Gari LGA from community reports and reports from health facilities.
A disease outbreak of a diarrheal disease occurred last year. It was identified through community reports from the village heads to the LGA health department.
Case definitions used for surveillance in Sabon Gari LGA list were reported to be available but none was seen. Case definitions specified by National Technical Guidelines for IDSR have been communicated to health facilities in the LGA but simplified case definitions have not been distributed to the communities in the LGA. There is a list of health facilities required to report surveillance data to the LGA.
There is no contact persons listed at the health facility. The LGA is divided into seven focal sites with seven focal persons for these sites. There are no contact addresses of the focal persons but the respondents listed the focal persons and their work addresses off head.
Surveillance data for the LGA are not analyzed at the LGA but collated and sent to the Epidemiology Unit of the SMOH. Threshold or markers are not used in the LGA to determine the action for diseases [Table 2]. A list of health facilities required to report surveillance data to the LGA is available, with 49 health facilities listed.
|Table 2 :Capability to identify outbreaks in Sabon Gari Local Government Areas|
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The public health facilities in Sabon Gari LGA constitute 59% of the health facilities, while the private health facilities constitute 41% [Table 3].
|Table 3 :Types of health facilities in Sabon Gari LGA as on October 2007|
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The records for October 2006-April 2007 were reported to be lost in the arson that occurred at the LGA headquarters in April 2007.
Out of the 49 health facilities in the LGA, only 21 health facilities (42.9%) sent reports to the LGA in the records available for May and June 2007 [Table 4].
|Table 4 :Distribution of health facilities by type for which records were available for the months of May and June 2007|
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Timeliness of monthly reporting for May and June 2007 was 26.5 and 22.5%, respectively, while completeness of monthly reporting from the health facility to the LGA was 32.7%.
| Discussion|| |
Although Sabon Gari LGA has an LGA EMC, the members of the committee are only from the public sector and the community. Although private hospitals/clinics in Sabon Gari account for 41% of the health facilities in the LGA, there are no representatives from the private sector and from non-governmental organizations with health care activities in the LGA, as is recommended by the National IDSR Technical Guidelines. A peer review of surveillance in Kaduna state in 2009 also showed a weak involvement of private health facilities in surveillance activities. 
The LGA EMC meets two to three times in a year, although the guidelines recommend monthly meetings whether or not there is an outbreak. A similar study in Uganda showed that 88% of districts had functional EMC,  while in the assessment of IDSR in Nigeria, out of the 41% LGAs with existing EMC, only one was functional. 
The LGA has an LGA epidemic rapid response team which includes the M and E/DSNO, nurses and community health officers but there is no laboratory technician or technologist and environmental health officer, as is recommended.
There is no epidemic response plan in the LGA. Other studies on IDSR in Uganda, Tanzania and Nigeria showed that less than half of LGAs had a written plan for epidemic response. ,, It is recommended that all LGAs assess the current situation in their areas and prepare a plan based on the assessment results. The plan is meant to review the existing resources and determine additional requirements in terms of human resources, funds, emergency stocks of drugs and supplies, laboratory support and logistics.
Although training an epidemic response/IDSR was last conducted in February 2007, only 8% of health care providers from the public sector were trained, no health care provider from the private sector was trained. In Tanzania, 81% of staff had been trained in surveillance,  while in the peer review of surveillance in Kaduna state, one of the problems cited was a lack of regular training for staff. The guidelines recommend that LGAs collaborate with the state health management team to train or retrain the LGA epidemic rapid response team members, LGA health staff and health facility to enhance the response during an epidemic. In Ethiopia, it was shown that training improved the awareness and use of IDSR indicators including timeliness and completeness of reporting. 
There were no emergency stocks and supplies of drugs and materials for collecting laboratory specimens in the event of an epidemic. IDSR assessment in Nigeria showed that only a third of LGAs had emergency stocks of drugs and supplies.  There is a need for the LGA rapid response team to compile a list and obtain the supplies to be set aside for use when the need arises.
There is a standard procedure for procuring stocks of vaccines for emergency immunization, if indicated. This is in conformation with the guidelines which stipulate that a plan should be established for acquiring an emergency stock of vaccines before an epidemic occurs.
The communication methods available at the LGA, which are used in event of an epidemic, include radio, local announcers, and mobile telephones. This is important because communication activities are important to inform and educate the community.
There is a procedure set up by the LGA for obtaining funds for emergency response, and there is a quota for outbreaks at the LGA level even before more support is requested from the state and federal government. This is very important as resources are crucial for rapid response in the advent of outbreaks. IDSR assessment in Nigeria showed that only 21% of LGAs had a budget line for epidemic response.  A study on the cost of IDSR in Eritrea, Burkina Faso and Mali showed that the cost was dependent on the health structure level, with districts having lower costs than provincial and national levels.  This is important as the LGAs are the lowest administrative levels and the relatively lower costs can encourage LGAs to participate actively in disease surveillance with a view to reduce morbidity and mortality due to priority diseases.
The LGA has no laboratory support for the confirmation of pathogens responsible for epidemics but has a reference laboratory in Kaduna to which specimens are sent. This is in conformation with the guidelines which recommend that if there is no laboratory support at the LGA there should be a reference laboratory.
In Sabon Gari LGA, standard case definitions are used for surveillance at the health facilities. This is similar to findings in Tanzania where all districts had standard case definitions in 2007,  but in 2004 there were no standard case definitions for most diseases.  The use of standard case definitions is important because if different case definitions are used, tracking the trend of infectious disease would be impossible across several LGAs.
However, simplified case definitions have not been distributed to communities in the LGA. It is recommended that the communities should be involved in surveillance and response activities. Selected community members should be taught how to recognize and report selected priority diseases to the health facility. This is important as the outbreak reported last year was from community reports; if the communities are trained to use simplified case definition, it may improve reporting which would lead to prompt identification of outbreaks and subsequent early response.
There is no contact person listed from health facilities. This does not meet the guidelines which recommend the list of focal persons and their contact addresses including their telephone numbers to be written down and placed clearly for everyone to see.
The guidelines recommend that there should be some data analysis at the LGA level at least by time, place and person; there was no data analysis carried out in Sabon Gari LGA. Several studies have shown that data analysis is very weak at district or LGA level. ,,,, Data analysis is important because scrutiny of data may reveal a change from the usual trend that may herald an outbreak.
No thresholds or markers are used in the LGA to determine action for priority diseases in the LGA, which is contrary to the guidelines. The assessment of IDSR in Nigeria showed that 74% of LGAs had action thresholds for priority diseases. 
For the monthly reporting records, less than half of health facilities sent monthly reports to the LGA; none of the private health facilities sent reports. Incomplete and late reporting has been reported in Tanzania. , Timeliness of monthly reporting for May and June 2007 was 26.5 and 22.5%, respectively, while completeness of monthly reporting was 32.7%, which was lower than that reported in Ghana in 2005  and Mozambique.  In Ghana, completeness and timeliness of reporting was shown to increase from 80 and 30% in 2004 to 98 and 78%, respectively, after training of the staff. 
When the surveillance system is good, the rates for timeliness and completeness should approach 100%. The timeliness and completeness of monthly reporting can allow for monitoring of progress so that action can be taken to improve timeliness of reporting. The national assessment of the national surveillance system found degree of completeness of reporting to be only 57%. 
| Conclusion|| |
The emergency preparedness to outbreaks and the capability to identify outbreaks in Sabon Gari LGA is found to be poor, based on the selected criteria from the recommendations of the National Technical Guidelines for IDSR. Less than 50% of the selected criteria from the National Technical Guidelines are met, and even where some of the criteria are available, they are inadequate. For instance, some of the structures have been put in place like the presence of the LGA EMC and the LGA epidemic rapid response team; the composition of the teams needs to include the private health facilities as well as the environmental health officer and a laboratory technician.
There is absence of an epidemic response plan, lack of emergency stocks of drugs and supplies for case management of outbreaks in Sabon Gari LGA.
From the study, it was found that the LGA relies on community reports and reports from health facilities to identify outbreaks. Neither the thresholds are used nor there is any analysis of data from the health facilities to monitor trends of the epidemic prone diseases. Also, timeliness and completeness of monthly reporting from the health facilities to the LGA is poor, as seen from the records available.
There is a need for the LGA to fully adopt the National Technical Guidelines for IDSR to be better positioned to prepare for and identify outbreaks.
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[Table 1], [Table 2], [Table 3], [Table 4]
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