ABSTRACT
Introduction: following the spread of the COVID-19 pandemic to Nigeria, the Federal Government of Nigeria restricted human and vehicular movements to curb the spread of the disease. This action had a negative impact on Acute Flaccid Paralysis (AFP) surveillance, with a resultant reduction in the number of AFP cases reported. This paper describes the impact of the COVID-19 pandemic on poliovirus surveillance in Nigeria and the proactive interventions by Nigeria´s polio program to mitigate the impact of COVID-19 on polio surveillance. Methods: nine innovative strategies were implemented in all 774 Local Government Areas (LGA) of the 36 states and Federal Capital Territory (FCT) of the country. These strategies were developed by the national surveillance officers and operationalized by sub-national surveillance officers with different strategies starting at different epidemiological weeks from week 14 to 23, 2020. Many of the strategy innovations were technology-based and included: the use of mobile phones to send the AFP case definition and video by WhatsApp or by SMS, the use of state-specific toll-free numbers and Mobile Telephone Network (MTN) (mobile service provider) CallerfeelTM to community informants (CI) who were the main targets of the interventions to increase case detection and reporting. Others included the use of abridged e-surveillance integrated supportive supervision (ISS) checklists, virtual monthly DSNO meetings, and batched AFP stool specimen transportation network. Results: compared to the same period in 2019, the cumulative rate of AFP case detection and reporting had gradually declined from 39.1% in January to 16.7% before the commencement of the interventions in week 20, 2020. However, the detection and reporting increased by 57.% from week 20 to week 47 compared to the same period in 2019. This is because with COVID-19, hospital visitation dropped, and the sick remained in the communities, so the CI network was relied on to detect and report AFP cases. The cumulative proportion of AFP cases reported by community informants as of week 47 increased from 13% in 2018 to 21% in 2020. This indicates an increase of 38%. Thirty-five AFP cases were detected and reported using the MTN Caller Feel strategy, while 15 cases were reported through state-specific toll-free numbers. Conclusion: the implementation of the innovative strategies was able to mitigate the low AFP case detection and reporting observed at the initial stage of the COVID-19 pandemic. The use of technology facilitated reaching the CI network, which was more instrumental in detecting and reporting the cases.
Subject(s)
Poliomyelitis , COVID-19 , CreativityABSTRACT
Background: Acute flaccid paralysis (AFP) surveillance was adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. The main objective of AFP surveillance is to detect the presence of circulating wild-type poliovirus and other subtypes of polioviruses. Stool specimen collection kits for AFP surveillance and data tools, regrettably are not always available in health facilities, and thus cause gaps in specimen collection and proper documentation which could ultimately lead to under-reporting of cases. Methods: This survey was undertaken to determine the availability of stool collection kits and data capturing tools in health facilities in some randomly selected states in Nigeria. The main aim was to relate the findings with the quality of the surveillance system in the areas visited and an overall indication of the functionality of the process in the country. Results: The outcome of the study found only 32,598 (74.7%) health facilities out of the 43,644 health facilities who visited and had stool specimen collection kits, while of the 43,582 health facilities visited, only 38,029 (87.3%) health facilities had data tools. Conclusions: Gaps were noticed in the supply of key AFP surveillance components to the health facilities visited, which by extension could apply to those not visited. Countries that are still polio-endemic will have to regularly survey their facilities for the availability of these very important materials. The methodology can be adapted to other diseases to evaluate the strength of the surveillance system.
ABSTRACT
Ninety eight transvaginal hysterectomies were performed for non prolapse and enlarged myomatous uteri or adenomyosis , with the size equivalent to 6～18 gestational weeks or 138～741g . Bisection , enucleation, morcellation , coring and combination thereof were used to facilitate the operation by reducing the uterine volume. The results showed that, out of 98, 93 cases of vaginal hysterectomy were performed successfully . The average weight of the uterus for the 98 cases were 376g (ranging from 138 to 741g), the mean time for the operation was 99 minutes (ranging from 40 to 135 minutes), the average quantity of blood loss was 245 ml (range 50 to 600ml). The morbidity rate was as low as 3.1% and the average postoperative hospital stay was 5.4 days (range 4 to 9 days). These data suggest that non prolapse and enlarged uterus can be safely removed transvaginally through reduction of the uteriune volume . Not only the size , but also the shape and the mobility of the uterus should be considered when indication for transvaginal hysterectomy existed . The successful operation was closely related to the operator’s skill and experiences .