In 2021, the Nigerian Red Cross Society (NRCS), in collaboration with the Norwegian Red Cross, initiated a Community Health Program aimed at enhancing healthcare access in conflict-affected regions such as Adamawa and Borno States. As part of this program, Community-Based Surveillance (CBS) using the digital solution Nyss was deployed to provide early warning of potential disease outbreaks.
Volunteers have been conducting CBS activities since the beginning of the programme in the Local Government Area (LGA) of Dikwa, Borno State, encompassing 10 settlements including rural communities and IDP camps. Twenty dedicated volunteers (predominantly female) received comprehensive training in integrated CBS closely aligned with the government system. Each settlement is overseen by a pair of trained volunteers.
In 2023, Nigeria faced one of the most severe diphtheria outbreaks in recent years, exacerbated by alarmingly low vaccination rates. The highest burden of cases was recorded in the Northeast of the country. For efficient preparedness, the NRCS took measures by incorporating the community case definition for diphtheria – fever and painful throat – into their CBS efforts in their catchment areas. Volunteers were equipped with training on how to use the simplified community case definition for prevention activities (such as risk communication and support to vaccination campaigns), early detection, and response activities.
On November 14th, 2023, NRCS volunteers in Dikwa sent three signals on fever and painful throat via SMS to the Nyss platform. Subsequent signals shared by additional volunteers followed in the coming days. The designated NRCS supervisor cross-checked the signals to ensure it matched the community case definition before escalating the alert to district and state health authorities for a swift investigation and response. A total of 24 suspected cases of diphtheria were identified and reported during this period. Volunteers conducted risk communication and community engagement measures and ensured prompt referral of affected individuals to nearby health facilities.
Samples were collected from individuals exhibiting typical signs and symptoms of the diseases for laboratory analysis and appropriate treatment. Health facility staff in operational LGAs were advised to initiate treatment based on clinical diagnosis to prevent fatalities and complications while awaiting laboratory results. In the end, the first cases of diphtheria were detected in that district through CBS by NRCS.
The Ministry of Health commended NRCS for its pivotal role in enhancing the surveillance system and facilitating early detection and response to outbreaks, curbing community transmission. Partner meetings convened by the Ministry aim to strategize further responses. NRCS contributed significantly through awareness campaigns on recognizing signs and symptoms, promoting hygiene practices, advocating routine diphtheria vaccination, and fostering improved healthcare-seeking behaviour.
NRCS volunteers remain vigilant in identifying potential health risks within communities through CBS and the Nyss platform, integrated seamlessly into their routine health awareness initiatives. Plans are underway between NRCS and the Ministry of Health to integrate CBS data directly into the national surveillance system, further bolstering disease monitoring and response efforts.
Photo credits: Nigeria Red Cross volunteers supporting the investigation of suspected diphtheria cases with MoH