Nigeria’s public health response to the COVID-19 pandemic: January to May 2020

Dan-Nwafor, Chioma; Ochu, Chinwe Lucia; Elimian, Kelly Osezele; Oladejo, John; Ilori, Elsie; Umeokonkwo, Chukwuma David; Steinhardt, Laura C.; Igumbor, Ehimario; Wagai, John; Okwor, Tochi; Aderinola, Olaolu; Nwando,; Hassan, Assad; Dalhat, Mahmood; Jinadu, Kola; Badaru, Sikiru; Arinze, Chinedu; Jafiya, Abubakar; Disu, Yahya; Saleh, Fatima; Abubakar, Anwar; Obiekea, Celestina; Yinka-Ogunleye, Adesola; Naidoo, Dhamari; Namara, Geoffrey; Muhammad, Saleh; Ipadeola, Oladipupo; Ofoegbunam, Chinenye; Ogunbode, Oladipo; Akatobi, Charles; Alagi, Matthias; Yashe, Rimamdeyati; Crawford, Emily; Okunromade, Oyeladun; Aniaku, Everistus; Sandra,; Agogo, Emmanuel; Olugbile, Michael; Eneh, Chibuzo; Ahumibe, Anthony; Nwachukwu, William; Ibekwe, Priscilla; Adejoro, Ope-Oluwa; Ukponu, Winifred; Olayinka, Adebola; Okudo, Ifeanyi; Aruna, Olusola; Yusuf, F. S. G.; Alex-Okoh, Morenike; Fawole, Temidayo; Alaka, Akeem; Muntari, Hassan; Yennan, Sebastian; Atteh, Rhoda; Balogun, Muhammad Shakir; Waziri, Ndadilnasiya Endie; Ogunniyi, Abiodun; Ebhodaghe, Blessing Itohan; Lokossou, Virgile; Abudulaziz, Mohammed; Adebiyi, Bimpe; Abayomi, Akin; Abudus-Salam, Ismail; Omilabu, Sunday; Lawal, Lukman Ademola; Kawu, M.U.; Muhammad, Basheer; Tsanyawa, Aminu; Soyinka, Festus Olukayode; Coker, Tomi; Alabi, Olaniran; Joannis, Tony M.; Dalhatu, Ibrahim; Swaminathan, Mahesh; Salako, Babatunde Lawal; Abubakar, Ibrahim; Braka, Fiona; Nguku, Patrick; Aliyu, Sani H; Ihekweazu, Chikwe

doi:10.7189/jogh.10.020399

Cited by 91 publications

(95 citation statements)

References 7 publications

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“…Following the first reports of the SARS-CoV-2 outbreak in Wuhan, China, the Nigeria CDC (NCDC) established a multi-sectoral National Coronavirus Preparedness Group (NCPG) to ensure cohesive and effective coordination of the country’s response. 9 As of December 30, 2020, the NCDC reported a cumulative 85,560 COVID-19 cases (4.0 per 10,000 population) with 1,267 deaths (1.5% CFR). 10 Figure 1 s hows the epidemic curve as of December 30, 2020.…”

Section: Best Practices Key Challenges and Lessons Learnedmentioning

confidence: 99%

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

Nachega

Atteh

Ihekweazu

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

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Section: Best Practices Key Challenges and Lessons Learnedmentioning

confidence: 99%

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

Nachega

Atteh

Ihekweazu

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…Nevertheless, Nigeria's aggressive early response to COVID-19, leveraging existing preparedness and learning from countries where transmission began earlier, and coordinated by the highlevel leadership of the PTF, likely slowed virus transmission. 3 Many countries in sub-Saharan Africa have faced outbreaks in recent years, with lessons learnt, however, subsequent preparedness has been variable. At the end of 2019, Nigeria and almost all African countries had undertaken a Joint External Evaluation of the International Health Regulations, which showed gaps in several key technical areas needed for countries to address outbreaks in a coordinated manner, but also highlighted improving competencies in real-time surveillance and immunisation.…”

Section: Impact Of the Response And Government Interventionmentioning

confidence: 99%

“…8 In Nigeria, before the country's first reported case, NCDC introduced a COVID-19 module in its Surveillance, Outbreak Response Management and Analysis System, obtained PCR testing ability and set up the national response system with multiple workstreams. 3 Importantly, although the spread and severity of the disease appears to have been limited by policy, these decisions had trade-offs, especially in terms of the socioeconomic well-being of the poorest segments of the population. Lockdowns, compounded by self-imposed distancing, the closing of markets and businesses and travel restrictions led to skyrocketing food and transport prices, hoarding and post-harvest food loss at both farm and market levels, resulting in a 'hidden' food security crisis among the country's most vulnerable populations.…”

Section: Impact Of the Response And Government Interventionmentioning

confidence: 99%

Lessons from co-production of evidence and policy in Nigeria’s COVID-19 response

et al. 2021

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In February 2020, Nigeria faced a potentially catastrophic COVID-19 outbreak due to multiple introductions, high population density in urban slums, prevalence of other infectious diseases and poor health infrastructure. As in other countries, Nigerian policymakers had to make rapid and consequential decisions with limited understanding of transmission dynamics and the efficacy of available control measures. We present an account of the Nigerian COVID-19 response based on co-production of evidence between political decision-makers, health policymakers and academics from Nigerian and foreign institutions, an approach that allowed a multidisciplinary group to collaborate on issues arising in real time. Key aspects of the process were the central role of policymakers in determining priority areas and the coordination of multiple, sometime conflicting inputs from stakeholders to write briefing papers and inform effective national decision making. However, the co-production approach met with some challenges, including limited transparency, bureaucratic obstacles and an overly epidemiological focus on numbers of cases and deaths, arguably to the detriment of addressing social and economic effects of response measures. Larger systemic obstacles included a complex multitiered health system, fragmented decision-making structures and limited funding for implementation. Going forward, Nigeria should strengthen the integration of the national response within existing health decision bodies and implement strategies to mitigate the social and economic impact, particularly on the poorest Nigerians. The co-production of evidence examining the broader public health impact, with synthesis by multidisciplinary teams, is essential to meeting the social and public health challenges posed by the COVID-19 pandemic in Nigeria and other countries.

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“…In many settings – including low- and middle-income countries (LMICs) as well as high-income countries with large outbreaks – efforts to diagnose COVID-19 using nucleic acid amplification tests (NAATs) frequently exceed capacity. 1–3…”

Section: Introductionmentioning

confidence: 99%

Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis

Kendall

Arinaminpathy

Sacks³

et al. 2020

Preprint

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BackgroundSARS-CoV-2 antigen-detection rapid diagnostic tests (Ag-RDT) offer the ability to diagnose COVID-19 rapidly and at low cost; however, lower sensitivity than nucleic acid amplification tests (NAAT) has limited adoption of Ag-RDT in clinical settings.MethodsWe compared Ag-RDT, NAAT, and clinical judgment alone for diagnosing COVID-19 among symptomatic patients. We considered two scenarios: a high-prevalence hospital setting with 24-hour NAAT turnaround, and a lower-prevalence outpatient setting with 3-day NAAT turnaround. We simulated transmission from cases and contacts and relationships between time, viral burden, transmission, and case detection. We used decision curve analysis to compare the net benefit of diagnostic approaches relying on Ag-RDT versus NAAT.ResultsGreater net benefit was achieved with Ag-RDT than NAAT in the outpatient setting, as long as NAAT turnaround time was longer than one day. NAAT was predicted to offer greater net benefit than Ag-RDT in the hospital setting, unless NAAT turnaround times exceeded 2 days. Findings were robust to data-consistent variation in Ag-RDT performance, empiric isolation practices, duration of symptoms, and other model parameters. Both tests provided greater benefit than management based on clinical judgment alone, unless the available interventions carried minimal harm and could be provided at full intensity to all patients in whom COVID-19 diagnosis was considered.ConclusionsAg-RDT may provide greater net benefit than NAAT for diagnosis of symptomatic COVID-19 in outpatient settings when NAAT turnaround times are longer than one day. NAAT is likely the optimal testing strategy for hospitalized patients, especially those with prolonged symptoms prior to admission.

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Nigeria’s public health response to the COVID-19 pandemic: January to May 2020

Cited by 91 publications

References 7 publications

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

Lessons from co-production of evidence and policy in Nigeria’s COVID-19 response

Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis

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