Battling outbreak of diseases in northeast’s ‘war zones’

Nine years ago, before the Boko Haram insurgency hit the northeast states of Adamawa, Borno and Yobe, life was normal for the millions of Nigerians now living in the Internally Displaced Persons (IDP) camps. As the war rages, they were forced to flee their homes leaving the dead behind and taking refuge in clusters of tents.

But the camps are still not safe havens as land mines and explosives buried by the insurgents in the ground in vast swaths of the territory once controlled by them are yet to be located, exhumed and deactivated.

Also, the presence of the explosive ordinances make accessibility to camps in such areas difficult and risky for humanitarian workers or even military personnel, making the IDPs in those camps hard to reach.

Some of the settlements now harbouring the IDPs are in difficult terrains with little or no access to water and medical facilities. Previously existing makeshift healthcare centres in the refuge areas had been torched by the insurgents, leaving the people vulnerable to disease outbreaks.

One of these vulnerable persons is Saratu Mohammed, whose greatest nightmare is how to save her one-month-old baby boy. She had lost the first child a year earlier at Barkam, a remote village in Bayo Local Government Area in the southern part of Borno. At first, she appeared unwilling to discuss her past but she said the presence of health workers encouraged her to speak.

“Three days after I was delivered at home in this village a year ago, I lost our first baby,” she began her story in a rather pensive mood. There was a big silence around the small home that housed
the family of three. “My husband and I were very curious about my pregnancy because of my previous experience,” she added.

Barkam is a small, rocky community tucked away from basic amenities and the savanna nature
of most communities in southern Borno. There is no clinic or any health facility. Indigenes and residents rely on bicycle or motorcycle for transportation. The only road to the area is a footpath carved out of rocks and stones, making the one-hour journey to the village by motorbike a tedious one.

As such, the complete and partial destruction of health facilities by Boko Haram insurgents in the North-East has denied about 77 per cent of children under-five years from being vaccinated against preventable diseases in the Internally Displaced Persons (IDP) camps and communities.

According to the World Health Organisation (WHO) mid-year 2018 report, “with 64 per cent of health facilities completely or partially destroyed and 32 per cent completely non-functional, over three quarters of children below the age of five were also never vaccinated against measles.

Conflict in affected states of Borno, Adamawa and Yobe running into a decade of attacks and massive displacement of people has dramatically dropped vaccination of children, leaving them at greater risk of preventable life-threatening diseases. The life-threatening diseases, according to the report include polio, malaria, meningitis and measles.

This informed WHO Community Health Champions (CHCs) to embark on real-time exchange of information to enable people at risk take informed decisions to mitigate effects of disease outbreaks that became critically imperative.

For Dr. Wondimagegnehu Alemu, the Country Representative of WHO, “early detection and rapid response to a reported cholera is vital to controlling it, especially in areas where access to safe water is limited and hygiene conditions are inadequate.”

He said WHO had to engage 1,120 health champions, including eight supervisors and two coordinators to detect, investigate and properly assess cases, guide rapid response appropriately in over 1,000 conflict-affected IDP camps and host communities.

Despite the liberation of communities by the troops for CHCs to access the vulnerable people, Chima E. Onuekwe, the Health Emergency Communication Officer for Northeast, noted that it is even more pertinent and urgent as the north-east Nigeria continues to report concurrent outbreaks of communicable diseases.

The diseases, according to him, include Acute Watery Diarrhea (AWD), meningitis, Lassa fever and Hepatitis B among others that had claimed dozens of lives between 2013 and 2017.

He said IDPs are at higher risks of contracting and transmitting disease infections due to the crowded, poor sanitary conditions and inadequate water supplies; which characterize their living environments.

He disclosed that the community health champions’ employ a mix of communication and engagement strategies to build capacities of targeted audience, so they could take informed decisions about how to protect people’s lives and live healthier.

“Our health champions therefore adopted a three-pronged risk communication strategy for implementation in Boko Haram insurgency affected states,” said Onuekwe in the recent released report in Maiduguri.

WHO’s CHCs adopted a radio health messaging; motorized health campaign and house-to-house health risk education in various IDP camps and host communities to save people’s lives.

“The house-to-house and motorized risk intervention was to empower targeted population with personalized health risks messages on how to protect themselves and families from preventable disease infections.”

It further disclosed that the most at risk population in insurgency-affected states include IDPs, women and children, who are being affected by the seasonal disease outbreaks in August to September every year.

The global health agency attributed outbreaks of polio, malaria, cholera, meningitis, measles, hepatitis E and Lassa fever to crowd and poor sanitary conditions and inadequate water supplies in camps and host communities.

“To save people’s lives against these diseases, CHCs had to first educate over 750,000 persons in 101 IDP camps in Maiduguri Metropolitan Council (MMC), Jere, Konduga, Bama, Monguno, Dikwa, Mafa and Damboa councils of Borno.”

In Adamawa State, the report added that 105 community health champions reached over a million houses with the ambulance free call numbers whenever, and wherever there is a patient.

While distributing the Aqua tabs tablets in affected communities, 60 suspected cases of cholera were found in Mubi North and Mubi South Local Government Areas.

The ambulances, according to report, rapidly intervene and locate where the patient is and he or she is taken immediately to the hospital for treatment.

On how health champions save lives, Dr. Collins Owili, WHO’s Health Emergency Programme manager, said: “Our house-to-house risk communication messaging by 142 health champions were adopted to save people’s lives in camps and host communities.

“The champions had been trained on IPC with household members using WHO certified IEC materials on diarrhea, meningitis, Lassa fever and exclusive breastfeeding by mothers,” Dr. Owili told The Guardian in Maiduguri.

Continuing, he added: “Each CHCs visited a minimum of 30 households a day in the selected camps over 15 days. At the end of 15 days, a total of 108,900 households would have been empowered with preventive messages on priority diseases.”

While in Borno State this year, he said about 101 IDP camps in eight councils were covered by the health champions. He added that 750,000 IDPs were educated on how to preventive priority diseases of public health importance.

Besides, he said leaflets on frequently asked questions on cholera, meningitis, Lassa and yellow fever, measles, polio and hepatitis in local languages were also distributed.

Also, the technical support and intervention of health champions, led to reported suspected cases of measles, polio, scabies, yellow fever, hepatitis E from Maiduguri Metropolitan Council (MMC), Jere, Bama and Monguno local government areas.

Maidugu Ahaji Bukar, a community leader in Jere local government area of Borno was excited on how the health champions averted many deaths from preventable diseases at the El-Miskin I and II IDP camps of Maiduguri.

He said the regular visits and education of IDPs by the health champions on personal hygiene, Water, Sanitation and Hygiene (WASH) and distribution of aqua tabs tablets have led to zero deaths in the two camps.

Fanna Bukar, a mother of five at El-Miskin I camp, corroborated Maidugu on the efficiency of the health champions to save people’s lives in camps and host communities of Jere and Maiduguri metropolis.

“These five children that surround you in this camp today were taken care of by community health champions. They taught mothers in camp on how to wash their children’s hands before and after eating and returning from toilets and games,” said Fanna, while thanking WHO for saving her children’s lives.

She said the education of health champions has protected her children and over 6,550 others from contracting any disease in camps. According to her, aqua tabs tables and malaria chemotherapy drugs were also distributed to each of the tents in camps.

The ex-Director, Emergency Medical Response and Humanitarian Services in Borno, Dr. Mohammed Ghuluze, described the health champions as “health vanguards in disseminations of health information in communities with capacity to deal with basic health issues.”

He said that during outbreaks of diseases like cholera, they are very important in providing information to responders. “The WHO community health champions are actually called the first responders in insurgency affected communities of Borno,” he said.

Ghuluze, the Chief Medical Director of State Hospital Management Board, disclosed that the enlightenment of communities on certain health habits, is the primary health functions of WHO’s health champions in insurgency affected states of Borno, Adamawa and Yobe.

Speaking on preventable diseases, he said: “The health champions must also identify facilities within the communities and link them up to the people. If there is any referral, they also arrange for referrals from primary to secondary healthcare centres in the Northeast.”

He told The Guardian that the intervention of CHCs has impacted positively on communities, as people are now aware of precautionary measures against preventable diseases of cholera, malaria, polio, measles and meningitis, adding that the sustained adoption of personal hygiene in communities reduces 90 per cent of problems associated with cholera that claimed the lives of 61 people last year.

“The adoption has to be enhanced and sustained with health seeking behaviours among members of communities, instead of ‘wait and see’ after a disease outbreak,” he warned.