Surveillance and Readiness to Respond to Public Health Events of International Concern at Three Major Nigerian Points of Entry: Capacities, Gaps and Post-Ebola Improvements

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Abstract Background: Surveillance and response to Public Health Events of International Concern (PHEIC) are core capacities under the IHR (2005), requiring designated Points of Entry (POEs) to detect, report, and respond to disease events through standardized, coordinated systems. Objective: To assess disease surveillance, laboratory referral capacity, and PHEIC emergency preparedness at Nigeria’s busiest airport, seaport, and land border, and the influence of the 2014 Ebola outbreak on subsequent preparedness. Methods: A comparative cross-sectional mixed-methods study combined a structured questionnaire (n=122; 41 airport, 41 seaport, 40 land border) with key informant interviews and focus groups at Murtala Muhammed International Airport, Apapa Seaport, and the Seme land border, February-May 2017. Results: Disease and event surveillance was not coordinated through any standard. routine agreed upon across the POEs; only the land border reported surveillance guided by a drafted contingency plan with a standard operating format. No POE possessed a laboratory facility fit to handle critical emergency cases, and the unavailability of utility vehicles for transporting detected cases constrained surveillance. Simulation exercises had been conducted at air POEs, particularly post-Ebola. and quarterly at the land border, but without key equipment for proper case handling. Mostly, it was WHO or the Federal Government, rather than local surveillance, alerted port health services to emerging threats, e.g., displaced persons entering from Cameroon. Conclusion: Surveillance and PHEIC Response readiness at Nigeria's principal POEs remains below IHR (2005) requirements: non- standardized reporting, absent laboratory capacity, and equipment-poor simulations. The post-Ebola rise in simulation activity is a meaningful but incomplete step toward the required capacity

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