On 28 February, 2020, barely 24 hours after Nigeria recorded its first coronavirus case, the Kaduna state government activated its Emergency Operations Committee (EOC) to prepare its public health response against the COVID-19 pandemic.
The public health system in Kaduna like in many other states in northern Nigeria was not fully prepared to handle an outbreak like the COVID-19 pandemic, so the government took steps to ensure that when COVID-19 cases hit the state, they would be low. According to a 2018 census by the Kaduna State Bureau of Statistics, there are 5,263 health facilities with a staff strength of 30,172 workers in Kaduna State, which has an estimated population of nine million. Understanding the potential risk to its population, Kaduna begun to put measures in place to prevent the spread of the novel coronavirus.
The EOC is a multi-sectoral body consisting of experts and public health practitioners from various Ministries, Departments, and Agencies (MDAs) of Kaduna, including officials of the Nigeria Centre for Disease Control (NCDC), World Health Organisation (WHO), and the United Nations Children`s Fund (UNICEF). Since the first index case in Kaduna State, which was recorded on 28 March, 2020, the NCDC has provided technical guidance to the EOC in terms of comprehensive analysis of COVID-19 data in the state to inform decision making, and using the information to formulate strategies and address challenges in the state.
“We [NCDC] support Kaduna State to detect, identify, and investigate COVID-19 cases. We also maintain COVID-19 records and databases, and perform epidemiological and statistical analysis as well as interpret the result of the findings for review at the EOC,” said Mrs. Amina Mohammed, an epidemiologist and data analyst, who works under the NCDC’s Disease Surveillance Department in Kaduna.
The EOC is chaired by the Kaduna State Commissioner of Health Dr. Amina Mohammed Baloni, and convened to provide technical support in response to the COVID-19 pandemic in the state. It also has members from the Kaduna State Primary Healthcare Development Agency (KDSPHA), local governments, universities and research institutions, and traditional and religious leaders., among others.
“What we tried to do in Kaduna was to quickly set up the EOC and have a multi-sectoral and multi-stakeholder response following the NCDC guidelines, which provides a framework for how states could approach the COVID-19 outbreak, to plan our activities both for prevention and readiness in case we started recording COVID-19 cases,” said Dr. Baloni. She is a public health expert with experience in controlling infectious diseases following her work against Lassa fever in the state. She noted that the state government`s response consists of a number of pillars, including Coordination, Epidemiology and Surveillance, Case Management, Laboratory Testing, Infection Prevention and Control, Risks Communication, Research, and Logistics and Supply.
On 22 March, 2020, Kaduna announced a state-wide lockdown for 30 days – five days before Nigeria`s federally-imposed lockdown and three days before the state`s index case was recorded. The lockdown effectively prevented those returning from Lagos and Abuja from entering the state. According to the state government, the goal was to delay the landfall of the coronavirus in Kaduna, as well as curb its transmission in the state. The initial lockdown was further extended to June 9.
Expanding treatment and testing capacity through collaboration
At the onset of the COVID-19 outbreak, the state had only one testing centre, which was set up in partnership with DNA Labs, a privately owned laboratory in Kaduna. However, since March 2020, Kaduna State has been working to expand its treatment and testing capacity, including the upgrading of the Infectious Disease Control Centre (IDCC) in Kakuri, Kaduna.
The state government also collaborated with the African Centre of Excellence for Neglected Tropical Diseases and Forensic Biotechnology (ACENTDFB) at Ahmadu Bello University (ABU), Zaria, to set up two new testing centres in Yusuf Dantsoho memorial hospital, Tudun Wada, with two polymerase chain reaction and GeneXpert machines. Kaduna also partnered with the KNCV TB Foundation to expand testing capacity in the state. And on 19 June, KNCV TB donated a mobile truck with GeneXpert machines, which travels around different communities in the state to carry out COVID-19 testing.
Currently, Kaduna has the capacity to conduct 400 tests daily and has five isolation centres, two in Zaria, two in Kaduna and one in Kafanchan. It has acquired about 10,000 testing kits and more than 16,000 tests have been conducted in the state, according to Dr. Baloni. “We are almost completing our 136-bed purpose-built infectious disease hospital in Mando, Kaduna. We hope that when it is finished, we can have more bed capacity. Currently, we have 236 beds, and with the new 136 beds we should be approaching 400 beds in the future,” Dr. Baloni said.
‘A CI GABA’: A campaign to address poor adherence to public health guidelines
Lack of adherence to public health guidelines, including handwashing, wearing of masks, and physical distancing remains a major challenge to the state`s COVID-19 response. Many residents do not adhere to the state government`s preventive measures against the spread of the COVID-19 pandemic in compliance with the NCDC. The state government, however, is working to provide handwashing facilities in public places including government offices, motor parks, train stations, and airports.
On 12 June, 2020, the state government launched a strategic risk communications campaign tagged, “Forward Campaign,” or “A CI GABA” in Hausa, focused on raising awareness about the coronavirus and encouraging Kaduna state citizens to take responsibility.
“The [FORWARD] campaign teaches the public to wear face masks always; observe social distancing; practice respiratory hygiene; wash hands with soap and water; avoid large gatherings; remain indoors; and stay on healthy diets to prevent diseases,” explains Dr. Baloni. She added that about 17,000 people have been mobilized and trained under the campaign to raise awareness about COVID-19 preventive measures and change public perceptions of the disease using tailor-specific messages in languages indigenous to the state.
Dr. Baloni said the state government had since observed that some people don`t believe that the coronavirus disease exists, hence, the need to shift people`s perceptions toward taking responsibility in fighting the COVID-19 pandemic in the state. “The risk communications team is constantly having interactions with the communities and listening to what they are saying and their perceptions about the disease. We then use that as a template to develop strategic engagements with the communities, specifically targeting those issues raised,” she said.
As at 29 September, 2020, Kaduna has 2,402 confirmed cases, and 39 deaths, according to the NCDC.
Thus far, the state government`s proactive measures, preparedness and response mechanisms have proved effective in Kaduna, especially in preventing extensive community transmission of COVID-19 in the state. The initial measures put in place, particularly the 11-week-lockdown, delayed the spread of the coronavirus and when the virus arrived, it was in small numbers that the state`s public health system could handle. The use of local languages to raise awareness about the COVID-19 pandemic in the state plays a key role in enhancing public understanding of the disease and improving adherence to COVID-19 preventive measures.
This narrative is part of the #COVID19NigeriaStories documentation project on state level responses to COVID-19, powered by Nigeria Health Watch with support from the Ford Foundation.