Assessing Capacity and Implementation Status of the Disaster Risk Management Strategy for Health and Community Disaster Resilience in Malawi

Resource availability and capacity to implement multi-stranded cholera interventions in the north-east region of Nigeria

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Healthcare workers knowledge of cholera multi-stranded interventions and its determining factors in North-East Nigeria: planning and policy implications

BACKGROUND

Healthcare workers' (HCWs) knowledge of multi-stranded cholera interventions (including case management, water, sanitation, and hygiene (WASH), surveillance/laboratory methods, coordination, and vaccination) is crucial to the implementation of these interventions in healthcare facilities, especially in conflict-affected settings where cholera burden is particularly high. We aimed to assess Nigerian HCWs' knowledge of cholera interventions and identify the associated factors.

METHODS

We conducted a cross-sectional study using a structured interviewer-administered questionnaire with HCWs from 120 healthcare facilities in Adamawa and Bauchi States, North-East Nigeria. A knowledge score was created by assigning a point for each correct response. HCWs' knowledge of cholera interventions, calculated as a score, was recoded for ease of interpretation as follows: 0-50 (low); 51-70 (moderate); ≥ 71 (high). Additionally, we defined the inadequacy of HCWs' knowledge of cholera interventions based on a policy-relevant threshold of equal or lesser than 75 scores for an intervention. Multivariable logistic regression was used to identify the factors associated with the adequacy of knowledge score.

RESULTS

Overall, 490 HCWs participated in the study (254 in Adamawa and 236 in Bauchi), with a mean age of 35.5 years. HCWs' knowledge score was high for surveillance/laboratory methods, moderate for case management, WASH, and vaccination, and low for coordination. HCWs' knowledge of coordination improved with higher cadre, working in urban- or peri-urban-based healthcare facilities, and secondary education; cholera case management and vaccination knowledge improved with post-secondary education, working in Bauchi State and urban areas, previous training in cholera case management and response to a cholera outbreak-working in peri-urban areas had a negative effect. HCWs' knowledge of surveillance/laboratory methods improved with a higher cadre, 1-year duration in current position, secondary or post-secondary education, previous training in cholera case management and response to a cholera outbreak. However, HCWs' current position had both positive and negative impacts on their WASH knowledge.

CONCLUSIONS

HCWs in both study locations recorded a considerable knowledge of multi-stranded cholera interventions. While HCWs' demographic characteristics appeared irrelevant in determining their knowledge of cholera interventions, geographic location and experiences from the current position, training and involvement in cholera outbreak response played a significant role.

A Deliberative Rural Community Consultation to Assess Support for Flood Risk Management Policies to Strengthen Resilience in Malawi

As disasters increase in frequency and magnitude with adverse effects on population health, governments will be forced to implement disaster risk management policies that may include forced relocation. Ineffective public consultation has been cited as one reason for failure of these policies. Using the deliberative polling method, this study assessed the capacity of rural communities to participate in flood risk management policy priority setting and the impact of providing accurate and balanced information on policies by comparing pre-and post -deliberation data. The study also assessed the level of trust on whether government and community would use the results of this study. Results indicated strong community support for policy options to reduce vulnerability in communities and strong resistance to relocation. As all the top five ranked policy options were concerned with population pressure, gender, and social service issues, which are all conceptually considered social determinants of a healthy community, this study concludes that public health considerations are central to flood risk policy development and implementation. The study revealed high levels of trust in government and the community relating to flood risk management, which policymakers in low-to-middle income countries can capitalise on for meaningful community consultation for effective disaster risk management.

Technology-Based Social Innovation: Smart City Inclusive System for Hearing Impairment and Visual Disability Citizens

The multilayer technology integration of hardware and software will reduce the social inclusion gap and increase the support in case of an emergency for people with special needs at hearing and visual levels. This research shows a development based on Internet of Things to support people with visual disabilities (PwVD) for indoor and outdoor activities. The decision-making process is made at the operational, tactical, and strategic level, providing a safe place so people with visual and hearing special needs can make decisions, their families can make decisions, and the government authorities can make decisions in case of an emergency or even on a day-by-day basis. In the case of the authorities, the smart visualization of the data according to the information provided facilitates Comprehensive Disaster Risk Management (CDRM) and Disaster Risk Reduction (DRR). The main findings are based on the need to develop mobile applications, dashboard and web applications that are responsive to people with visual or hearing disabilities, and the need to develop an infrastructure of communication systems assisted by batteries and clean energy, and independent of the current telecommunications system, to allow greater reliability.