Bassey Ebenso

Following confirmation of the first case of monkeypox in the UK by the UK Health Security Agency (UKHSA) on May 7, 2022, events have evolved with dizzying rapidity—as of May 21, 2022, 92 laboratory confirmed cases and 28 suspected cases of monkeypox have been reported in 12 non-endemic countries across three WHO regions.1WHOMulti-country monkeypox outbreak in non-endemic countries.https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385Date: May 21, 2022Date accessed: May 22, 2022Google Scholar Monkeypox is a rare viral illness that is seldom detected outside of Africa. WHO have projected that more cases of monkeypox will be identified as surveillance expands in non-endemic countries.1WHOMulti-country monkeypox outbreak in non-endemic countries.https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385Date: May 21, 2022Date accessed: May 22, 2022Google Scholar Although uncertain, some have expressed concerns that this outbreak of monkeypox could become the next global pandemic. Complicating the situation is the fact that most cases have occurred in men aged 20–50 years who identify as gay or bisexual or have sex with men and do not have recent travel history to monkeypox endemic countries.1WHOMulti-country monkeypox outbreak in non-endemic countries.https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385Date: May 21, 2022Date accessed: May 22, 2022Google Scholar Additionally, there does not appear to be links between these cases. So far, the number of infections detected outside of Africa since May 7, 2022, has already exceeded the number detected outside of the continent from 1970 to the current outbreak.2Kozlov M Monkeypox goes global: why scientists are on alert.https://www.nature.com/articles/d41586-022-01421-8Date: May 20, 2022Date accessed: May 22, 2022Google Scholar This unprecedented situation raises the possibility of community spread, with sexual contact being suspected as a factor contributing to transmission. Monkeypox is a re-emerging zoonotic disease caused by a DNA virus that belongs to the orthopoxvirus genus of the Poxviridae family. Since the first human case of monkeypox was diagnosed in the Democratic Republic of the Congo in 1970, the disease has become endemic in several African countries, including Nigeria, Benin, and Liberia.2Kozlov M Monkeypox goes global: why scientists are on alert.https://www.nature.com/articles/d41586-022-01421-8Date: May 20, 2022Date accessed: May 22, 2022Google Scholar Monkeypox is closely related to the variola virus (smallpox virus) and results in a smallpox-like disease.3Bunge EM Hoet B Chen L et al.The changing epidemiology of human monkeypox—a potential threat? A systematic review.PLoS Negl Trop Dis. 2022; 16e0010141Crossref PubMed Scopus (317) Google Scholar Two clades of the monkeypox virus exist: the Congo Basin (central African) clade and the west African clade. Mortality varies between clades, with estimated case fatality rates of 10·6% for the Congo Basin clade and 3·6% for the west African clade.2Kozlov M Monkeypox goes global: why scientists are on alert.https://www.nature.com/articles/d41586-022-01421-8Date: May 20, 2022Date accessed: May 22, 2022Google Scholar Monkeypox usually spreads among monkeys, Gambian pouched rats, and squirrels,4Ihekweazu C Yinka-Ogunleye A Lule S Ibrahim A Importance of epidemiological research of monkeypox: is incidence increasing?.Expert Rev Anti Infect Ther. 2020; 18: 389-392Crossref PubMed Scopus (17) Google Scholar but occasionally jumps to people, causing small outbreaks. In addition to fever, headache, muscle aches, and lymphadenopathy, infection triggers a distinctive rash that often begins on the face and spreads to other parts of the body, including the genitals.5Simpson K Heymann D Brown CS et al.Human monkeypox—after 40 years, an unintended consequence of smallpox eradication.Vaccine. 2020; 38: 5077-5081Crossref PubMed Scopus (93) Google Scholar Monkeypox is generally a mild, self-limiting illness and its established modes of transmission are close contact with infected individuals or contaminated clothes, towels, or furniture and respiratory droplets. The monkeypox virus does not transmit from person to person as readily as SARS-CoV-2 does. However, the current outbreak is exposing gaps in our knowledge of monkeypox. Promisingly, on May 19, 2022, scientists in Portugal reported the first draft genome sequence of monkeypox virus that had been recently detected in Portugal.6Isidro J Borges V Pinto M et al.First draft genome sequence of monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal).https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799Date: May 19, 2022Date accessed: May 21, 2022Google Scholar Preliminary genetic data suggest that the 2022 monkeypox virus belongs to the west African clade, and is most closely related to monkeypox viruses linked to disease spread from Nigeria to the UK, Israel, and Singapore in 2018 and 2019.5Simpson K Heymann D Brown CS et al.Human monkeypox—after 40 years, an unintended consequence of smallpox eradication.Vaccine. 2020; 38: 5077-5081Crossref PubMed Scopus (93) Google Scholar, 6Isidro J Borges V Pinto M et al.First draft genome sequence of monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal).https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799Date: May 19, 2022Date accessed: May 21, 2022Google Scholar, 7Mauldin MR McCollum AM Nakazawa YJ et al.Exportation of monkeypox virus from the African continent.J Infect Dis. 2022; 225: 1367-1376Crossref PubMed Scopus (82) Google Scholar A monkeypox vaccine (Imvamune or Imvanex) developed by a Danish biotechnology firm (Bavarian Nordic) has been approved by US regulators for both monkeypox and smallpox. Evidence from Africa indicates that smallpox vaccination provides 85% protection against monkeypox infection.8UK Health Security AgencyRecommendations for the use of pre and post exposure vaccination during a monkeypox incident. Updated May 2022 v6.6.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1077678/Recommendations-for-use-of-pre-and-post-exposure-vaccination-during-a-monkeypox-incident.pdfDate: May, 2022Date accessed: May 22, 2022Google Scholar The decline in population-level immunity since the cessation of smallpox vaccination in the 1980s contributed to the 2017–20 monkeypox outbreaks in Nigeria.4Ihekweazu C Yinka-Ogunleye A Lule S Ibrahim A Importance of epidemiological research of monkeypox: is incidence increasing?.Expert Rev Anti Infect Ther. 2020; 18: 389-392Crossref PubMed Scopus (17) Google Scholar On May 19, 2022, tecovirimat (Tpoxx) was approved in the USA, Canada, and Europe for the treatment of human smallpox disease.9Carlson R TPOXX smallpox treatment description for 2022.https://www.precisionvaccinations.com/vaccines/tpoxx-smallpox-treatment#:~:text=Then%20on%20May%2019%2C%202022,13%20kg%20in%20November%202021Date: May 19, 2022Date accessed: May 22, 2022Google Scholar The European Medicines Agency approval for tecovirimat also includes the treatment of monkeypox.10Huet N Monkeypox outbreak: drugmaker SIGA says EU authorities seeking to stockpile its smallpox antiviral.https://www.euronews.com/next/2022/05/20/monkeypox-outbreak-drugmaker-siga-says-eu-authorities-seeking-to-stockpile-its-smallpox-anDate: May 21, 2022Date accessed: May 22, 2022Google Scholar The unique variation in the epidemiology of human monkeypox during this current outbreak underlines several issues. For example, both the absence of prodromal symptoms, such as fever, malaise, and headache, and the presence of herald skin lesions at the point of sexual contact in some patients are strongly suggestive of sexual transmission. Nonetheless, there are concerns that the media's projection of men who have sex with men as the at-risk population for the outbreak might unduly stigmatise this group. Case definitions of monkeypox disease have been updated to account for possible cases that do not have a history of travel to endemic countries. Similarly, new clinical guidelines are being developed by the UKHSA to address important questions, including the use of appropriate personal protective equipment in sexual health clinics and the review of standard operating procedures in laboratories. With several cases of monkeypox now identified in 12 countries, the fear of cross-border transmission is real. Robust public health surveillance and control measures are crucial to address this threat. We declare no competing interests. AO and BE contributed equally to this Comment.

The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the 'urban advantage', the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.

BACKGROUND: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa. METHODS: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease. RESULTS: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola. CONCLUSIONS: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa.

June 24th, 2022, a day that will be etched in today and future generations' textbooks as a historic day, the United States of America revoked the constitutional right to seek safe abortion care. Overturning Roe v Wade allowed the divided individual states to independently decide the legal parameters regarding abortion care. A decision that disproportionately effects the reproductive lives of women residing on the land of America. Given the systemic impacts of racism, neoliberalism and white supremacy, it is the Black, racialized and poor women who suffer terrible repercussions. In this commentary the authors begin by discussing the historical biopolitical perspective, colonial systems and longstanding impacts on racialized women's bodies in America. The discussion transitions to the implications of geopolitics at play nationally and cascading impacts globally, focusing on humanitarian and emergency settings. Using a medical humanities perspective, authors highlight the collision between politics and reproductive health policy and its implications on social determinants of health, such as women's education, employment, housing, racial and gender equity and wellbeing. Long standing advocates, community leaders and healers, leading scientists, birth attendants, doctors, nurses, allied health professionals/providers and humanitarian workers - and many others - are reminded and live the weight of the continuous battle of population control, stemming from the oppressive history of control and exploitation.

News broke on Feb 27, 2020, that an Italian citizen was Nigeria's first case of coronavirus disease 2019 (COVID-19). The individual had landed at Lagos airport 2 days earlier on a flight from northern Italy, and had subsequently travelled from Lagos to Ogun State, western Nigeria, where he became ill and was promptly isolated. He is currently being treated for mild symptoms of COVID-19 in a hospital in Lagos. Upon identifying the index case, National Emergency Operations Centres were immediately activated to trace his contacts. By March 9, 2020, 27 suspected cases had been identified across five states (Edo, Lagos, Ogun, Federal Capital Territory, and Kano), of which two were confirmed to be positive (ie, the index case and a contact), with no deaths.1Nigeria Centre for Disease ControlCOVID-19 outbreak in Nigeria: situation report. March 9, 2020.https://ncdc.gov.ng/diseases/sitreps/?cat=14&name=An%20update%20of%20COVID-19%20outbreak%20in%20NigeriaGoogle Scholar 216 contacts were linked to the index case, 136 of whom are being followed up. Similar to COVID-19, the Ebola epidemic of 2014 was imported through Lagos airport. Within weeks, 19 people were diagnosed with Ebola across two states of Nigeria—Lagos and Rivers State—of whom eight died of Ebola.2Musa E Nasidi A Shuaib F Nguku PM Vaz RG Nigeria's Ebola outbreak response: lessons for future epidemic preparedness.Arch Med. 2016; 8: 6Crossref Google Scholar The dense population of Lagos, its overstrained infrastructure, and the fact that it is a major regional transit hub for air, land, and sea transport created the perfect conditions for the spread of Ebola. Nevertheless, Nigeria's aggressive and coordinated response successfully controlled the Ebola epidemic. Gilbert and colleagues' modelling study3Gilbert M Pullano G Pinotti F et al.Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study.Lancet. 2020; (published online Feb 20)https://doi.org/10.1016/S0140-6736(20)30411-6Summary Full Text Full Text PDF Scopus (697) Google Scholar of the risk of COVID-19 importation from China indicates that the ability of African countries to manage local transmission of COVID-19 after importation hinges on implementing stringent measures of detection, prevention, and control. Nigeria demonstrated its ability through intensifying its preparedness against COVID-19 importation, drawing on recent successes in controlling polio and Ebola epidemics.4Unah L 'Nigeria will deal with this': high alert after coronavirus case. March 1, 2020.https://www.aljazeera.com/news/2020/03/deal-high-alert-coronavirus-case-200301140838366.htmlGoogle Scholar These experiences strengthened the health system's capacity to rapidly deploy high-quality surveillance and temperature screening at airports using equipment acquired during the Ebola epidemic; collect passengers' contact details and interview those arriving from COVID-19 hotspots; and issue travel bans.1Nigeria Centre for Disease ControlCOVID-19 outbreak in Nigeria: situation report. March 9, 2020.https://ncdc.gov.ng/diseases/sitreps/?cat=14&name=An%20update%20of%20COVID-19%20outbreak%20in%20NigeriaGoogle Scholar However, unlike polio and Ebola, for which vaccines now exist,5Holmes C Boyce M Katz R Africa is not starting from scratch on COVID-19. Feb 27, 2020.https://www.thinkglobalhealth.org/article/africa-not-starting-scratch-covid-19Google Scholar COVID-19 has neither a vaccine nor an approved treatment. Moreover, Gilbert and colleagues' modelling rated Nigeria as vulnerable to exposing huge populations to COVID-19 (potentially 200 million citizens), with a moderate capacity to control the outbreak.3Gilbert M Pullano G Pinotti F et al.Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study.Lancet. 2020; (published online Feb 20)https://doi.org/10.1016/S0140-6736(20)30411-6Summary Full Text Full Text PDF Scopus (697) Google Scholar This assessment questions Nigeria's capacity to provide sufficient bed space and associated clinical care to support those who could need isolation and quarantine if local cycles of transmission of COVID-19 occur in the country. We declare no competing interests.