International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
World Health Organisation, Nigeria Country Office, Abuja, Nigeria.
BMJ Glob Health. 2020 Jan 28;5(1):e002000. doi: 10.1136/bmjgh-2019-002000. eCollection 2020.
In August 2017, a cholera outbreak started in Muna Garage Internally Displaced Persons camp, Borno state, Nigeria and >5000 cases occurred in six local government areas. This qualitative study evaluated perspectives about the emergency response to this outbreak.
We conducted 39 key informant interviews and focus group discussions, and reviewed 21 documents with participants involved with surveillance, water, sanitation, hygiene, case management, oral cholera vaccine (OCV), communications, logistics and coordination. Qualitative data analysis used thematic techniques comprising key words in context, word repetition and key sector terms.
Authorities were alerted quickly, but outbreak declaration took 12 days due to a 10-day delay waiting for culture confirmation. Outbreak investigation revealed several potential transmission channels, but a leaking latrine around the index cases' house was not repaired for more than 7 days. Chlorine was initially not accepted by the community due to rumours that it would sterilise women. Key messages were in Hausa, although Kanuri was the primary local language; later this was corrected. Planning would have benefited using exercise drills to identify weaknesses, and inventory sharing to avoid stock outs. The response by the Rural Water Supply and Sanitation Agency was perceived to be slow and an increased risk from a religious festival was not recognised. Case management was provided at treatment centres, but some partners were concerned that their work was not recognised asking, 'Who gets the glory and the data?' Nearly one million people received OCV and its distribution benefited from a robust infrastructure for polio vaccination. There was initial anxiety, rumour and reluctance about OCV, attributed by many to lack of formative research prior to vaccine implementation. Coordination was slow initially, but improved with activation of an emergency operations centre (EOC) that enabled implementation of incident management system to coordinate multisectoral activities and meetings held at 16:00 hours daily. The synergy between partners and government improved when each recognised the government's leadership role.
Despite a timely alert of the outbreak, delayed laboratory confirmation slowed initial response. Initial responses to the outbreak were not well coordinated but improved with the EOC. Understanding behaviours and community norms through rapid formative research should improve the effectiveness of the emergency response to a cholera outbreak. OCV distribution was efficient and benefited from the polio vaccine infrastructure.
2017 年 8 月，尼日利亚博尔诺州穆纳汽车修理厂境内流离失所者营地爆发霍乱疫情，6 个地方政府地区发生了 5000 多例病例。本项定性研究评估了对这起疫情的应急反应。
我们进行了 39 次关键知情人访谈和焦点小组讨论，并与参与监测、水、环境卫生、病例管理、口服霍乱疫苗（OCV）、通信、后勤和协调的 21 名参与者审查了 21 份文件。定性数据分析采用了主题技术，包括上下文中的关键词、单词重复和关键部门术语。
当局很快得到了警报，但由于等待培养物确认需要 10 天，因此宣布疫情爆发需要 12 天。疫情调查发现了几个潜在的传播渠道，但在指数病例家周围的一个渗漏厕所没有得到修复超过 7 天。由于有传言称氯会使女性绝育，社区最初不接受氯。主要信息是用豪萨语发布的，尽管主要当地语言是卡努里语，但后来这一点得到了纠正。规划将受益于使用演习来发现弱点，以及共享库存以避免库存不足。农村供水和环境卫生机构的反应被认为是缓慢的，而且一个宗教节日带来的风险没有得到认识。病例管理是在治疗中心提供的，但一些合作伙伴担心他们的工作没有得到承认，他们问：“谁得到荣誉和数据？”将近 100 万人接受了 OCV，其分发得益于用于脊髓灰质炎疫苗接种的强大基础设施。最初，人们对 OCV 感到焦虑、谣言和不情愿，许多人认为这是由于在疫苗实施前缺乏形成性研究。协调最初很慢，但随着应急行动中心（EOC）的激活而得到改善，该中心启用了事件管理系统，以协调多部门活动和每天 16 点举行的会议。当合作伙伴和政府都认识到政府的领导作用时，它们之间的协同作用得到了改善。
尽管疫情及时得到警报，但实验室确认的延迟减缓了最初的反应。对疫情的最初反应协调不力，但随着应急行动中心的启用而得到改善。通过快速形成性研究了解行为和社区规范应提高对霍乱疫情的应急反应效果。OCV 的分发是高效的，并受益于脊髓灰质炎疫苗基础设施。
