Elimian Kelly, Musah Anwar, Dewa Ozius, King Carina, Crawford Katerina, Pembi Emmanuel, Ike Ifeanyi, Myles Puja, Pritchard Catherine, Forsberg Birger Carl, Alfven Tobias
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Exhale Health Foundation, Abuja, Nigeria.
BMC Glob Public Health. 2023 Aug 4;1(1):6. doi: 10.1186/s44263-023-00008-3.
Limited healthcare facility (HCF) resources and capacity to implement multi-stranded cholera interventions (water, sanitation, and hygiene (WASH), surveillance, case management, and community engagement) can hinder the actualisation of the global strategic roadmap goals for cholera control, especially in settings made fragile by armed conflicts, such as the north-east region of Nigeria. Therefore, we aimed to assess HCF resource availability and capacity to implement these cholera interventions in Adamawa and Bauchi States in Nigeria as well as assess their coordination in both states and Abuja where national coordination of cholera is based.
We conducted a cross-sectional survey using a face-to-face structured questionnaire to collect data on multi-stranded cholera interventions and their respective indicators in HCFs. We generated scores to describe the resource availability of each cholera intervention and categorised them as follows: 0-50 (low), 51-70 (moderate), 71-90 (high), and over 90 (excellent). Further, we defined an HCF with a high capacity to implement a cholera intervention as one with a score equal to or above the average intervention score.
One hundred and twenty HCFs (55 in Adamawa and 65 in Bauchi) were surveyed in March 2021, most of which were primary healthcare centres (83%; 99/120). In both states, resource availability for WASH indicators had high to excellent median scores; surveillance and community engagement indicators had low median scores. Median resource availability scores for case management indicators ranged from low to moderate. Coordination of cholera interventions in Adamawa State and Abuja was high but low in Bauchi State. Overall, HCF capacity to implement multi-stranded cholera interventions was high, though higher in Adamawa State than in Bauchi State.
The study found a marked variation in HCF resource availability and capacity within locations and by cholera interventions and identified cholera interventions that should be prioritised for strengthening as surveillance and laboratory, case management, and community engagement. The findings support adopting a differential approach to strengthening cholera interventions for better preparedness and response to cholera outbreaks.
医疗保健机构（HCF）资源有限，且实施多方面霍乱干预措施（水、环境卫生和个人卫生（WASH）、监测、病例管理以及社区参与）的能力不足，这可能会阻碍实现霍乱控制的全球战略路线图目标，尤其是在因武装冲突而变得脆弱的地区，如尼日利亚东北部地区。因此，我们旨在评估尼日利亚阿达马瓦州和包奇州医疗保健机构实施这些霍乱干预措施的资源可用性和能力，并评估这两个州以及作为霍乱国家协调中心的阿布贾的协调情况。
我们采用面对面结构化问卷进行横断面调查，以收集医疗保健机构中多方面霍乱干预措施及其各自指标的数据。我们生成分数来描述每项霍乱干预措施的资源可用性，并将其分类如下：0 - 50（低）、51 - 70（中等）、71 - 90（高）和90以上（优秀）。此外，我们将实施霍乱干预措施能力高的医疗保健机构定义为得分等于或高于平均干预得分的机构。
2021年3月对120家医疗保健机构（阿达马瓦州55家，包奇州65家）进行了调查，其中大部分是初级医疗保健中心（83%；99/120）。在这两个州，水、环境卫生和个人卫生指标的资源可用性中位数得分较高至优秀；监测和社区参与指标的中位数得分较低。病例管理指标的资源可用性中位数得分从低到中等不等。阿达马瓦州和阿布贾的霍乱干预措施协调情况良好，但包奇州较低。总体而言，医疗保健机构实施多方面霍乱干预措施的能力较高，不过阿达马瓦州高于包奇州。
该研究发现不同地点以及不同霍乱干预措施之间，医疗保健机构的资源可用性和能力存在显著差异，并确定了应优先加强的霍乱干预措施，如监测和实验室、病例管理以及社区参与。这些发现支持采用差异化方法来加强霍乱干预措施，以便更好地防范和应对霍乱疫情。
