Health & Nutrition Cluster, Institute of Development Studies, University of Sussex, Library Road, Falmer, Brighton, BN1 9RE, United Kingdom.
Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria.
Soc Sci Med. 2024 Oct;358:117246. doi: 10.1016/j.socscimed.2024.117246. Epub 2024 Aug 13.
Mpox (formerly known as monkeypox) was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization on 23rd July 2022, however cases of the disease have been detected in Nigeria since the 1970s and more recently since it began spreading in more urban areas of the country from 2017 onward. Nigeria has a strong track record of epidemic preparedness and response, spearheaded by the Nigeria Centre for Disease Control. Despite being somewhat separate architectures on paper, epidemic response (in particular, integrated disease surveillance and response) relies on a foundation of primary health care, which is inadequately funded not only in Nigeria, but globally. Situating mpox response within this wider landscape, we draw on ethnographic research from September 2022-March 2023 in southwestern Nigeria on lived experiences of mpox and mpox response, focusing on the perspectives of frontline health workers and community-based suspected or confirmed mpox cases. We aimed to understand how prioritization and resource constraints shape mpox response at a local level, including effects on the everyday work of frontline health workers in public health and clinical care who are left to "make do." We analyze their experiences interfacing with two intersecting infrastructures, community-based surveillance and primary health care. Health workers' improvisation and "repair work," which we detail, enables the surveillance system to function in some capacity. However, health workers must regularly contend with competing priorities and routine care that may be sidelined during an outbreak or epidemic. We argue that this reveals the limitations of a global health security agenda as it materializes at a local level and the need for strengthening primary health care for longer-term sustainability.
猴痘（以前称为猴痘）于 2022 年 7 月 23 日被世界卫生组织宣布为国际关注的突发公共卫生事件（PHEIC），然而，自 20 世纪 70 年代以来，尼日利亚已发现该疾病病例，最近自 2017 年以来，该疾病在该国更多城市地区开始传播。尼日利亚在疫情准备和应对方面有着良好的记录，由尼日利亚疾病控制中心牵头。尽管在理论上有不同的架构，但疫情应对（特别是综合疾病监测和应对）依赖于初级卫生保健的基础，而不仅仅是在尼日利亚，而且在全球范围内，初级卫生保健的资金都不足。我们将猴痘应对置于更广泛的背景下，利用 2022 年 9 月至 2023 年 3 月在尼日利亚西南部进行的关于猴痘和猴痘应对的实地研究，重点关注一线卫生工作者和社区内疑似或确诊猴痘病例的生活经历。我们旨在了解资源限制如何在地方一级影响猴痘应对，包括对公共卫生和临床护理前线卫生工作者日常工作的影响，这些工作者只能“凑合着做”。我们分析了他们与两个相交的基础设施（基于社区的监测和初级卫生保健）对接的经验。我们详细介绍了卫生工作者的即兴创作和“修复工作”，这使监测系统在某种程度上得以运作。然而，卫生工作者必须经常应对相互竞争的优先事项和常规护理，这些可能在疫情爆发或流行期间被搁置。我们认为，这揭示了全球卫生安全议程在地方一级的实施所存在的局限性，以及加强初级卫生保健以实现长期可持续性的必要性。
