Challenges in Adhering to Infection Prevention and Control Guidelines and Controlling the Spread of COVID-19 in Lagos State

Lagos, Nigeria’s former capital and commercial nerve centre of the country is a city with an estimated population of over 15 million. There is a constant hum of activity, which is the reason it has earned the reputation of a city that never sleeps. In response to the COVID-19 pandemic, the Lagos State Government came up with various non-pharmaceutical measures and protocols to control the spread of COVID-19 such as different stages of lockdown, which included partial or almost complete restriction of movement, except for essential workers for months, a complete ban on large gatherings etc. 

The lockdown has had an adverse socio-economical effect on Lagos hence, the development of various IPC protocols for the opening of businesses, schools, and other public places. The protocols cover mechanisms on COVID-19 infection prevention and control which include physical distancing, frequent washing of hands with soap under running water, and proper wearing of face masks. The guidelines were developed and adjusted based on data gathered from the spread of the virus in the State.
According to WHO, Infection Prevention and Control (IPC) is a practical, evidence-based approach that prevents patients and health workers from being harmed by avoidable infection.


Lagos has a massive population, with young people making up a large percentage of the population. This factor has affected the implementation of Infection and Prevention Control protocols in the city. One of the partners supporting the COVID-19 response in Nigeria, the Africa Centre for Disease Control and Surveillance, designated an IPC expert, Mrs. Margaret Ayorinde to support the Infection Prevention and Control interventions in Lagos State and the Lagos State Public Health Emergency Operations Centre (PHEOC) led by Dr Folarin Opawoye. Mrs. Ayorinde was initially engaged by the Nigeria Centre for Disease Control to ensure that Personal Protective Equipment (PPEs) were always available, train and re-train healthcare workers, organise IPC drills, assess workflow in IPC which included ensuring proper decontamination of waste before disposal and ensuring the welfare of healthcare workers. 

According to Mrs Ayorinde, the IPC team encountered some resistance at the start of the response. “We had to push back from the healthcare workers including behavioural change challenges. Some health workers had a know-it-all attitude and refused to follow the guidelines and protocols. They realised the gravity of the situation when some of them contracted the disease.  I discovered through a mini- survey that some were not willing to wash their hands because they put on gloves. The most important thing for them was to cover their faces and nostrils and not touch their faces while on duty.” Mrs Ayorinde recounts.


“People feared the virus, hence felt there was a need to wear bogus facemasks to be more protected. As a personal decision, it is difficult to change someone’s opinions even with the knowledge that their opinion is wrong. However, Mrs Ayorinde reached a consensus to let them wear facemasks they were comfortable with. “We provided the two types of facemasks, those that insisted on N95 got infected while the healthcare workers who wore it well and obeyed the instructions did not get infected. However, things are different now.  “They know they have to adhere to the protocols; they know they have to wash their hands with soap and water after any procedure and keep themselves safe. They know that the moment a patient is brought in and confirmed positive for COVID-19, they must wear their facemasks and PPEs at all times.” Mrs Ayorinde explains

“We ensure that there is 100% compliance and printed protocol/guideline for every team member. If we do not accredit a facility, it cannot operate. We also have a director assigned to every team on the field to assess compliance. At the entrance of any public facility, there must be provisions for handwashing including adherence to other public health and safety measures. If it is a laboratory, there must be provisions for PPEs. In addition, religious centres must have an isolation area.” Mrs Ayorinde said.

The IPC pillar comprises 36 members in different subdivisions; site assessment, monitoring and evaluation, surveillance, and contact tracing. The IPC team also accredits laboratories, hospitals, worship centres, hospitality businesses, etc.  Lagos State also has IPC guidelines for people self-isolating at home, although she observed that the guidelines might not be applicable to people living in one room apartments. The Africa CDC has been supporting the COVID-19 Lagos state response with training and provision of consumables like PPE through the NCDC, masks, and sanitisers.


This narrative was done in February 2021 as part of the #COVID19NigeriaStories documentation project on state-level responses to COVID-19, implemented by the Nigeria Centre for Disease Control and Nigeria Health Watch with support from the Ford Foundation.

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