Training and service in public health, Nigeria Field Epidemiology and Laboratory Training, 2008 - 2014.

The health workforce is one of the key building blocks for strengthening health systems. There is an alarming shortage of curative and preventive health care workers in developing countries many of which are in Africa. Africa resultantly records appalling health indices as a consequence of endemic and emerging health issues that are exacerbated by a lack of a public health workforce. In low-income countries, efforts to build public health surveillance and response systems have stalled, due in part, to the lack of epidemiologists and well-trained laboratorians. To strengthen public health systems in Africa, especially for disease surveillance and response, a number of countries have adopted a competency-based approach of training - Field Epidemiology and Laboratory Training Program (FELTP). The Nigeria FELTP was established in October 2008 as an inservice training program in field epidemiology, veterinary epidemiology and public health laboratory epidemiology and management. The first cohort of NFELTP residents began their training on 20th October 2008 and completed their training in December 2010. The program was scaled up in 2011 and it admitted 39 residents in its third cohort. The program has admitted residents in six annual cohorts since its inception admitting a total of 207 residents as of 2014 covering all the States. In addition the program has trained 595 health care workers in short courses. Since its inception, the program has responded to 133 suspected outbreaks ranging from environmental related outbreaks, vaccine preventable diseases, water and food borne, zoonoses, (including suspected viral hemorrhagic fevers) as well as neglected tropical diseases. With its emphasis on one health approach of solving public health issues the program has recruited physicians, veterinarians and laboratorians to work jointly on human, animal and environmental health issues. Residents have worked to identify risk factors of disease at the human animal interface for influenza, brucellosis, tick-borne relapsing fever, rabies, leptospirosis and zoonotic helminthic infections. The program has been involved in polio eradication efforts through its National Stop Transmission of Polio (NSTOP). The commencement of NFELTP was a novel approach to building sustainable epidemiological capacity to strengthen public health systems especially surveillance and response systems in Nigeria. Training and capacity building efforts should be tied to specific system strengthening and not viewed as an end to them. The approach of linking training and service provision may be an innovative approach towards addressing the numerous health challenges.

Situation-based survey of avian influenza viruses in possible "bridge" species of wild and domestic birds in Nigeria.

The highly pathogenic avian influenza (H5N1 subtype) recurred in Nigeria after 9 months period of no reported case. A critical look at possible sources of the re-occurrence was desirable. The objective of this study was to determine whether avian influenza viruses were present at reasonably detectable levels (0.5%) in possible "bridge" species of wild and domestic birds. The study was conducted in 8 Nigerian states. A total of 403 birds from 40 species were sampled. Virus isolation was done in embryonated chicken eggs according to standard protocols. The test results were all negative for avian influenza viruses. The overall confidence interval (CI) calculated in R using the exact binomial confidence interval function was 0-0.007406. Tawny Eagle (Aquila rapax) was the lowest sampled 0.3% (1/403) and Red-billed Firefinch (Lagonosticta senegala) the highest 11.7% (47/403). The limitations of the sample size and possibly designing effects on the study, as to make concrete conclusions were acknowledged. Species of wild birds, so identified in the study could be useful in future surveys. Furthermore, multidisciplinary and community oriented approach, blending targeted and passive surveillances was suggested. This approach was envisaged to bring about wider coverage of "bridge" species and clearer insight of their possible roles in avian influenza re-occurrences and spread in Nigeria.