CHOLERA EPIDEMIC PREPAREDNESS BY LOCAL HEALTH AUTHORITIES IN OYO STATE, NIGERIA

Abstract

Cholera outbreaks require an effective preparedness and a well-coordinated timely response to prevent associated fatalities. The recurrent cholera outbreaks in Nigeria and especially in Oyo State suggest a weak preparedness. An evaluation of the state of preparedness is required to determine gaps and proffer solutions to strengthening epidemic response in the State. This study was therefore aimed at assessing the level of preparedness to respond to cholera epidemic by Local Health Authorities (LHA) in Oyo State. The study was descriptive cross-sectional in design. All the Disease Surveillance and Notification Officers (DSNOs) (34), Monitoring and Evaluating officers (M/Es) (32), Primary Health Care Coordinators (PHCCs)(33) and the epidemiologist (1) from Oyo State participated in the study. A self-administered questionnaire was used to collect data on socio-demographic characteristics, previous training received and availability of surveillance logistics and supplies. A seven-point scale in which knowledge was categorised as adequate (>-4) and inadequate (<4) was used to assess knowledge of cholera case definition. A nineteen-point scale which included a checklist on surveillance practices and outbreak response strategies was used to assess the level of preparedness in the LHA. Preparedness score was classified into adequate (>-10) and inadequate (<10). Descriptive statistics and log rank test were used to analyse data The mean age of respondents and their mean service years were 44.4(± 6.6) years and 7.3(±5.1) years respectively and 54% were males. Less than half (49.0%) knew the number of cases that constitute an epidemic, although 83.0% knew the symptoms of cholera. Sixty-eight percent of the respondents had previous training. While the adequacy of the LHA in areas of surveillance logistics and supplies were 66.7% and 42.4% respectively, none was adequately prepared in areas of supplies and strategies against outbreak. A little above half(53.0%) of the respondents had adequate knowledge of cholera case definition. More OSNOs (70.6%) had adequate knowledge of cholera case definition compared with the PHCCs (64.7%) and M/Es (21.9%) (p<0.05). A higher proportion (64.7%) of those with previous training compared to those without (28.1 %) had adequate knowledge of cholera case definition (p<0.05). Only one (3.0%) LHA had supplies reserved for outbreak response. Though 78.8% of the LHA had the capacity to transport specimen to laboratory for confirmation, only 36.4% had specimen bottles. The logistic support available included a designated office for surveillance activities (81.8%), transport support (90.9%), assistant (33.3%), allocated funds (imprest) (33.3%), while all had survey forms. About 12.1 % had an Epidemic Preparedness and Response (EPR) team that meets regularly. A greater number (81. 8%) of the LHA had an inadequate level of preparedness. Level of preparedness for cholera epidemic was inadequate among local health authorities. There is therefore the need to still improve knowledge concerning cholera case definition especially among monitoring and evaluating officers through regular trainings and to also strengthen epidemic preparedness in the state in areas of logistics, supplies and funds.