Pandemics are threats that still exist even with advances in medicine and technology. The closeness of the Ebola epicentre poses another risk. This country remembers too well the toll the last Ebola outbreak took on her people and health system. The relief of its successful control is tempered by the realization that it takes just an infected person and poor surveillance at ports of entry to be in the position we were in 2014.
On a wider scale, the current COVID19 outbreak has nations around the world grappling with overwhelmed health systems, a deluge of cases and deaths. It is a race against an ever-mutating virus to employ a variety of ways to protect citizens and prevent further spread of the SARSCov2 (the virus causing COVID19). This, unlike Lassa and Ebola, is transmitted via droplets and contaminated surfaces. The spread of all three can be curtailed by effective risk communication, early reporting, isolation and treatment of identified cases, personal protective measures like handwashing and debunking of dangerous myths.
There are many factors preventing the ordinary Nigerian from fully protecting himself from pandemics. Among these are widespread poverty, lack of education, poor awareness about the spread of infectious diseases, insecurity and poor health-seeking behaviour.
Perhaps the overarching challenge many Nigerian communities face is that of infrastructure. Irregular power supply often means lack of running water. This greatly reduces the number of times people practice handwashing. When members of a household have to go long distances in search of clean water, it is inevitable that they will minimize the use of this for hand hygiene. Many communities also lack a health centre with qualified health workers who disseminate information and conduct house-to-house checks to ensure hygiene is observed. In addition, many markets and slaughterhouses are poorly designed and so infectious waste is left lying around and may even contaminate fresh produce. Many do not have adequate bathroom facilities and thus hands used to handle faecal matter are also used to touch food for sale. Improved level of facilities will surely help in this area. However, community-owned interventions could be used temporarily to bridge this gap by alternate sources of power and clean water supply, provision of containers at strategic places with soap for regular handwashing.
Many areas are cut off from communication channels. They may thus rely only on radio services to keep abreast of information regarding a new epidemic. This gap unfortunately leaves room for fake news and rumours to spread. There may also be panic and prejudice which in turn help the epidemic to spread faster. Initiatives like call centres such as that used by EpidAlert during the 2014 outbreak have been shown to provide much-needed information for communities. This equips them to take appropriate measures to protect themselves and their families. It also debunks dangerous myths, quells rumours and reduces panic and stigma often found among the uneducated public.
Poverty is a major barrier to good health. The reduced spending power of individuals in a society without adequate welfare plans for its citizens puts them at a disadvantage. This is because, they have to prioritize their spending on perceived basic necessities like food and shelter. The global toll of the coronavirus on world economy is a further worsens the situation. This often leaves little or nothing to cover the cost of personal hygiene in soap, personal provision of water, face masks, accessing care and information, balanced diet and comfortable accommodation that is not overcrowded. This category of people are usually left on their own and this portends doom for us all. Thus, welfare packages should be considered to help them. They are also more likely to live in overcrowded slums which make it impossible for them to keep safe distance from one another. This borders on political will in providing adequate housing and jobs. But on the organizational level, packs containing hygiene products, free outreaches and community awareness programs are to be employed to include them in prevention efforts.
Another problem which exposes people to risk during pandemics is insecurity as seen in many communities during the lockdown. Entire lives are upturned, socio-economic strata are levelled and the priority is more on safety than healthcare. The insurgency in the northern part of the country has for years deterred efforts in healthcare provision. People fleeing conflict often leave property behind, are forced to stay in cramped displaced person camps where rates of infection are higher as a result of a strain on the few facilities available. Community-led vigilante efforts often employ methods like burning tires which pose grave risk to health manifesting down the line in respiratory disease and even death. Handwashing and other protective measures take low precedence in their daily lives with overcrowded quarters, loss of access to credible information and the general feeling of despondency further putting them at risk. Attacks on health workers, disruption of transportation and essential services keep the people affected away from accessing healthcare services. In this regard, the responsibility lies with the security agencies to intensify efforts at securing lives and property of citizens. Internally displaced persons camps must also be included in epidemic control strategy.
For many communities, harmful cultural practices and beliefs hold sway over proven medical information on disease spread. It is not uncommon to find handwashing and other forms of hygiene to be greeted with scorn, with the few who try to practice this being discouraged. In addition, women and children are often not included in health seeking decisions and are thus at the mercy of male and older relatives. Female children are not given an education making them less likely to practice safe health practices. In some cases, the male head of household has to grant permission before medical care can be sought. Where he is unwilling and unavailable, this leads to a huge gap in care. This causes a situation where some individuals know the right thing to do but are not able to practice it. Some cultural practices around gatherings, greetings of physical touch, handling babies and so on to be a source of infection spread. Community health workers need to be deployed to these areas with adequate sensitization and involvement of the decision makers to illustrate why it is important for these practices need to be changed.
These and other barriers must be taken care of to make pandemic control efforts become more effective. Thus collaboration is required across board to ensure that the country contains this virus.
- Parveen, S., Nasreen, S., Allen, J.V. et al. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health 18, 483 (2018). https://doi.org/10.1186/s12889-018-5365-1
Dr Mariam Toye