Kaduna – When Dr Mark Anthony makes his weekly rounds in Kaduna state, from public hospitals to private facilities, he is encouraged to see health workers protecting themselves, attending to patients with the right protective gear and performing the necessary hand hygiene. It gives him hope that the battle against COVID-19 will be won in his country.

In late March, Dr Anthony, Kaduna State Health Ministry Infection Prevention and Control lead benefitted from a World Health Organization (WHO) supported training on infection prevention and control measures, which has since been held across all six geopolitical zones of Nigeria. He then came back to his home state, in the northwest of the country, equipped with the materials to pass on this knowledge to others.

“The training exposed us to many issues that were unclear to us before. It gave me the confidence to be able to come back to Kaduna and help nurture the right attitudes in our health workers,” Dr Anthony says.

Infection prevention and control is a key tenet of the response to COVID-19. So far Nigeria has recorded more than 52 000 infections, including in 2175 health workers. In April, just a month into the outbreak in Nigeria, Kaduna state recorded some of the highest levels of health worker infections, with 30 health care staff infected.

Dr Anthony has helped to train as many as 4000 health workers in Kaduna and across the northwest region on infection prevention and control, including the appropriate use of personal protective equipment, respiratory and hand hygiene. The state now has some of the highest numbers of health workers trained, and this also cascades down to the non-medical staff.

“Everyone benefited from the training, and we are really seeing the impact,” says Dr Isaac Nathaniel, a gynaecologist with the Kafanchan General Hospital in Kaduna. “In the new isolation centre located close to my hospital, none of my colleagues has been infected so far,” he adds. Like Dr Anthony, Dr Nathaniel has also helped to train others, including workers tasked with burying COVID-19 positive cases.

Limiting infections

In a bid to keep lowering infection rates, Nigeria’s Federal Capital Territory and all 36 state governments have invested in training their health workers with the support of WHO. The national and state governments have also strived to make personal protective equipment and other essential supplies more readily available to health workers. Nigeria has benefited from the United Nations Solidarity Flight campaign, which distributed essential medical supplies including personal protective equipment and ventilators.

Back in April, Kano state, which borders Kaduna to the north-east, was particularly badly hit by COVID-19 infections. Many of the first cases detected in the state were among health workers, prompting the deployment of a federal response team for support. WHO also helped in coordinating infection prevention and control training for health facility staff.

Some of the challenges identified were: inadequate knowledge regarding COVID-19 transmission, non-triage of patients, and incorrect use of PPE. Intensive three-week practical training promptly began for healthcare providers in public, private and primary health care facilities in the state.

“IPC (infection prevention and control) is critical because it protects both the health workers and the people who come to the facilities,” says Professor Bola Olayinka, a WHO leading expert in infection prevention and control who led the training team deployed to Kano and coordinated national training across Nigeria’s six geopolitical zones. “Whether it is COVID-19, Ebola, Lassa fever, meningitis or cholera, we don’t want patients to come in with one problem and leave with an additional one,” she adds.

Since February, Professor Olayinka has been to several states in the country, including Ogun and Lagos in the south-west, to train various groups, including rapid response teams, on IPC. COVID-19 regulations mean she can only train a few people at a time, so she has adopted a train-the-trainer model, requesting states to send health workers who can then teach others. Across the country, about 10,000 health workers have trained under Professor Olayinka. In turn, they have gone on to train tens of thousands of others.

“Fewer healthcare workers are getting infected compared to before in the nine states that have gone through the intensive training so far and there is a better knowledge of what to do to avoid infection,” Professor Olayinka says.

But she cautions that the situation remains volatile. In Kaduna, while 30 health workers were infected in April, that number has since increased to 285, despite the training in infection prevention and control. 

“IPC is not a once and for all thing and it’s not just a COVID-19 thing. It needs to be entrenched in the health care system and it should be part of the normal standard of care,” Professor Olayinka says. “People need to be aware, trained, retrained and reminded.”