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The COVID-19 pandemic has been persistent with a huge demand for human health resources which is a vital component of its preparedness and response. Globally, the public health workforce through field epidemiology and laboratory training programme (FELTP) has been instrumental to global health security. We determined the status of FELTP in the region and its contributions to the COVID-19 pandemic response in the ECOWAS region. We conducted a desk review, shared a questionnaire among member states and organized a two-day online regional consultative meeting on field epidemiology training on 30 th -31 st March 2022 during which there were presentations, group discussions and deliberations on the status and contribution of FETP during the COVID-19 pandemic. Data collected were analyzed in themes. All countries in the ECOWAS region had established at least one tier of FELTP, 11 (73.3%) had established two tiers of FELTP and only 3 (20.0%) had established all three tiers of the program. Despite the pandemic, the cumulative number of graduates increased from 2996 to 4271 frontline, 41 to 380 intermediate, and 409 to 802 for advanced FELTP between 2019 and 2022. However, the progress has been disproportionate across countries. The key activities supported through FELTP graduates included pandemic response coordination, surveillance, data collection/management, laboratory support, case management, risk communication, infection prevention and control, COVID-19 vaccination, and research. Despite improvements in the FELTP in the Economic Community of West African States (ECOWAS) region, there is a need for continuous stakeholder engagement for its implementation, resource mobilization for sustainability, and leveraging critical partnerships., Competing Interests: The authors declare no competing interests., (Copyright: Virgil Kuassi Lokossou et al.)

Background: Vaccination is one of the most cost-effective public health interventions used to prevent diseases in susceptible populations. Despite the established efficacy of vaccines, there are many reasons people are hesitant about vaccination, and these reasons could be complex. This rapid survey estimated the prevalence of COVID-19 vaccine hesitancy and potentially contributing factors in Montserrado and Nimba counties in Liberia., Methods: A cross-sectional study was conducted among adults living in Liberia. The relationship between vaccine non-acceptance and sociodemographic characteristics was examined using chi-square statistics. The variables with a p-value less than 0.2 at the bivariate analysis were modelled in a binary logistic regression at a 5% level of significance. The adjusted odds ratio and 95% confidence interval are reported., Results: There were 877 participants in the study. Majority were 25-34 years of age (30.4%, 272/877), females (54.05%, 474/877), and Christians (85.2%, 747/877). Most of the participants were aware of the COVID-19 vaccine (75%, 656/877), single (41.4%, 363/877), self-employed (37.51%, 329/877), and live-in rural communities (56.1%, 492/877). Vaccine hesitancy was (29.1%, 255/877; 95% CI:26.2-32.2). Vaccine hesitancy was greater among adults living in urban areas (41%) compared to persons living in rural communities (59%) (aOR; 1.5, 95% CI: 1.1-2.1) and respondents aged 45-54 years (aOR:0.5; 95% CI: 0.2-0.9; p = 0.043) were 50% less likely to be hesitant to COVID-19 vaccination compared to those more than 55 years. The most common source of information was the media (53%, 492/877) and the main reason for being hesitant was a need for more information about the vaccine and its safety (84%, 215/255)., Conclusions: The majority of study participants were aware of the COVID-19 vaccines and their most common source of information was the media (television, radio). Vaccine hesitancy was moderate. This could pose a challenge to efforts to control the spread of the COVID-19 pandemic. Therefore, the health authorities should provide more health education on the importance of vaccines and their safety to the populace., Competing Interests: The authors have declared that no competing interests exists., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Introduction: The COVID-19 pandemic caused massive disruption to medical education in Nigeria, necessitating the call for online medical education in the country. This study assessed the readiness, barriers, and attitude of medical students of Ebonyi State University Abakaliki, Nigeria, to online medical education., Methods: A cross-sectional study design was employed. All matriculated medical students of the university participated in the study. Information was obtained using a pre-tested, semi-structured questionnaire which was self-administered. Good attitude towards information and communication technology (ICT) based medical education was determined by the proportion of respondents correctly answering 60% of nine variables. Readiness for online classes was determined by the proportion of students who preferred either a combination of physical and online lectures or only online medical education amidst the COVID-19 pandemic. Chi-square test and multivariate analysis using binary logistic regression analysis were used in the study. A p-value of <0.05 determined the level of statistical significance., Results: Four hundred and forty-three students participated in the study (response rate; 73.3%). The mean age of the students was 23.0±3.2 years. The majority of the respondents, 52.4%, were males. The students' most preferred sources for studying before the COVID-19 pandemic included textbooks, 55.1% and lecture notes, 19.0%. The commonly visited websites included Google, 75.2%, WhatsApp, 70.0% and YouTube, 59.1%. Less than half, 41.1%, have a functional laptop. The majority, 96.4%, have a functioning email address, while 33.2% participated in a webinar during the COVID-19 pandemic. Though 59.2% had a good attitude towards online medical education, only 56.0% expressed readiness for online medical education. The major barriers to online medical education included poor internet connectivity, 27.1%, poor e-learning infrastructure, 12.9% and students not having laptops, 8.6%. Predictors of readiness for online medical education included previous participation in a webinar, AOR = 2.1, (95%CI: 1.3-3.2) and having a good attitude towards IT-based medical education, AOR = 3.5, (95%CI: 2.3-5.2)., Conclusions: The majority of the students showed readiness for online medical education. Lessons from COVID-19 pandemic necessitate the initiation of online medical education. University authorities should ensure that every enrolled medical student owns or have access to a dedicated laptop through a university-mediated arrangement. Adequate attention should be given to the development of e-learning infrastructure, including steady internet services within the confines of the university., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ossai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This paper describes the process for developing, validating and disseminating through a train-the-trainer (TOT) event a standardised curriculum for public health capacity building for points of entry (POE) staff across the 15-member state Economic Community of West African States (ECOWAS) that reflects both international standards and national guidelines.A five-phase process was used in developing the curriculum: phase (1) assessment of existing materials developed by the US Centers for Disease Control and Prevention (CDC), Africa CDC and the West African Economic and Monetary Union, (2) design of retained and new, harmonised content, (3) validation by the national leadership to produce final content, (4) implementation of the harmonised curriculum during a regional TOT, and (5) evaluation of the curriculum.Of the nine modules assessed in English and French, the technical team agreed to retain six harmonised modules providing materials for 10 days of intensive training. Following the TOT, most participants (n=28/30, 93.3%) indicated that the International Health Regulations and emergency management modules were relevant to their work and 96.7% (n=29/30) reported that the training should be cascaded to POE staff in their countries.The ECOWAS harmonised POE curriculum provides a set of training materials and expectations for national port health and POE staff to use across the region. This initiative contributes to reducing the effort required by countries to identify emergency preparedness and response capacity-building tools for border health systems in the Member States in a highly connected region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The COVID-19 pandemic left countries to rapidly implement diverse and stringent public health measures without recourse to mitigate its effect on the sustenance of routine healthcare services. This study described routine health service disruption and restoration strategies at 6 months into the epidemic in Liberia., Methods: Liberia, with 15 counties, has 839 health facilities, with one-third in Montserrado County. A cross-sectional study using a mixed approach - quantitative and qualitative research with concurrent triangulation was conducted using a structured guide for group discussions among key health workers at 42 secondary and most patronized health facilities in 14 counties and 7 Montserrado districts. Additionally, routine health data between January and June 2019 and 2020 were extracted from the source documents to the electronic checklist. We performed a descriptive analysis of quantitative data and plotted the line graph of the relative percentage change. Transcribed audio recording notes were synthesized using ATLAS ti for content analysis to identify the themes and subthemes in line with the study objectives and excerpts presented in the results., Results: Liberia declared COVID-19 outbreak on March 16, 2020. From conducted interviews at 41 health facilities, 80% reported disruption in routine health services. From January to June 2020, scheduled routine immunization outreaches conducted decreased by 47%. Using a relative percentage change, outpatient attendance decreased by 32% in May, inpatient admission by 30% in April, malaria diagnosis and treatment by 40% in April, and routine antenatal obstetric care by 28% in April. The fear of contacting COVID-19 infection, redeployment of healthcare workers to COVID-19 response, restriction of movement due to lockdown, inadequate or lack of PPE for healthcare workers, lack of drugs and vaccine supplies for clients, and partial closure of routine healthcare services were common perceived reasons for disruptions. Massive community health education and strict compliance with COVID-19 nonpharmacological measures were some of the health facility recovery strategies., Conclusions: The COVID-19 outbreak in Liberia caused a disruption in routine healthcare services, and strategies to redirect the restoration of routine healthcare services were implemented. During epidemics or global health emergencies, countries should sustain routine health services and plan for them., (© 2022. The Author(s).)

COVID-19 remains a serious disruption to human health, social, and economic existence. Reinfection with the virus intensifies fears and raises more questions among countries, with few documented reports. This study investigated cases of COVID-19 reinfection using patients' laboratory test results between March 2020 and July 2021 in Liberia. Data obtained from Liberia's Ministry of Health COVID-19 surveillance was analyzed in Excel 365 and ArcGIS Pro 2.8.2. Results showed that with a median interval of 200 days (Range: 99-415), 13 out of 5,459 cases were identified and characterized as reinfection in three counties during the country's third wave of the outbreak. Eighty-six percent of the COVID-19 reinfection cases occurred in Montserrado County within high clusters, which accounted for over 80% of the randomly distributed cases in Liberia. More cases of reinfection occurred among international travelers within populations with high community transmissions. This study suggests the need for continued public education and surveillance to encourage longer-term COVID-19 preventive practices even after recovery., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite efforts to control COVID-19 pandemic, the outbreak has continued to ravage the world with high morbidity, mortality and economic hardship. The World Health Organisation reported that people are becoming complacent and their risk perceptions are lowering. Commercial drivers play significant role in outbreak control because of their regular mix with commuters from various sources., Objectives: We investigated risk perception and factors associated with compliance to COVID-19 preventive measures among commercial drivers., Methods: This study involved 502 commercial drivers in Abakaliki Nigeria using cross-sectional analytic design. Data was collected with interviewer-administered questionnaire and analyzed with IBM-SPSS version 23. Inferential statistics were done using Chi-square and binary logistic regression tests with significance set at p-value of 0.05., Results: The response rate was 502(98.4%) and mean age was 35.5±10.8 years. Majority of them were married 368(73.3%), had secondary education 279(55.6%) and operated commercial driving for 1-5 years 297(59.2%). There was high awareness, high-risk perception and good compliance with COVID-19 preventive measures in 99.8%, 69.1% and 54.4% of respondents respectively. Attaining tertiary education (aOR=6.5, 95% CI=1.5-28.1, p=0.012) and good knowledge of COVID-19 (aOR=4.3, 95% CI=2.7-6.8, p<0.001) significantly predicted high-risk perception while good knowledge of the disease alone predicted good compliance (aOR=5.5, 95% CI=3.6-8.3; p<0.001)., Conclusion: The awareness of COVID-19 is high but there is relatively lower risk perception and compliance with the preventive measures. We recommend improved public education, sensitization and risk communication as well as review of policies and adoption of new approaches about COVID-19 outbreak control., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2021 by West African Journal of Medicine.)

The ECOWAS Region and the world have learnt a lot in the last year and a half concerning the pandemic. As the pandemic continues to evolve, the region needs to put together all these lessons in other to better protect its people, rebuild its economy and strengthen the regional health security for better regional prosperity. We reviewed the response mounted by the region from January 2020 to July 2021 and the existing body of knowledge. We recommend that the region quickly increase the COVID-19 immunization coverage, sustain the enhance genomic surveillance, improve testing and the strengthen point of entry surveillance., (Copyright: Virgil Kuassi Lokossou et al.)

Introduction: The COVID-19 pandemic has had a great toll on global health. Frontline healthcare workers (FHCW) directly involved in the treatment of COVID-19 patients have faced some physical and psychological challenges. This study explored the stigma and traumatic experiences of the FHCW during the COVID-19 pandemic in Nigeria., Methods: We recruited twenty FHCW directly involved in the treatment of COVID-19 patients through purposive and snowball sampling techniques. Face-to-face in-depth interviews were conducted for all participants, and qualitative analysis of data was done using Colaizzi's phenomenological method., Results: Five themes identified were: Early stage of the pandemic (fear, anxiety, public fright, other countries repatriating their citizens, the socio-economic impact of the pandemic and a call to duty for the FHCW); working with COVID-19 patients (excitement on patients recovery and duty stress); psychological, mental and emotional trauma; stigmatization (stigmatized by colleagues, family, friends or their residential communities, reasons for stigmatization which were fear of infection, limited knowledge of the virus and working at the isolation centre and the effect of stigma); and recommendations (education and awareness creation, government showing more care towards the FHCW and provision of health insurance for FHCW to take care of those that get infected in the line of duty)., Conclusion: Stigmatization has proven to be a major challenge for FHCW in conducting their duties. The psychological impact experienced by FHCW may affect the quality of the services rendered by these workers. The study reveals the need of education and awareness creation in the ongoing pandemic. There is a need for the government and society to acknowledge and appreciate the efforts of FHCW., (© 2021. The Author(s).)

Free movement between countries without a visa is allowed within the 15-country Economic Community of West African States (ECOWAS) region. However, little information is available across the region on the International Health Regulation (IHR 2005) capacities at points of entry (PoE) to detect and respond appropriately to public health emergencies such as Coronavirus Disease 2019 (COVID-19). ECOWAS and the member states can better tailor border health measures across the region by understanding public health strengths and priorities for improvement at PoEs. A comprehensive literature review was combined with a self-assessment of capacities at PoEs across the fifteen member states from February to July 2020. For the assessment, the member states completed an adapted World Health Organization (WHO) self-assessment checklist by classifying capacity for seven domains as fully, partially, or not implemented. The team implemented three focus group discussion (FGD) sessions and 13 key informant interviews (KII) with national-level border health stakeholders. Univariate analysis was used to summarize the assessment data and detailed content analysis was applied to evaluate FGD and KII results. Of the 15 member states, 3 (20%) are landlocked; 3 (20%) have more than one seaport. Eleven (73%) countries have 1 designated airport, 3 (20%) have two airports, and only one country (6.7%) has three airports. Two hundred and seventy-eight designated ground crossings were identified in 12 countries (80%). Strengths across the PoE were existence of decrees and ministerial acts in some ECOWAS countries and establishment of national taskforces for the COVID-19 response at PoE in ECOWAS. Major challenges were porous borders, poor intersectoral coordination, lack of harmonized traveler screening measures, shortage of staff, and inadequate financial resources. Despite all these challenges, there are opportunities such as leveraging the regional cross-border poliomyelitis coordination and control mechanism, and existence of networks of infection prevention and control specialists and field epidemiologists. However, political instabilities in some countries pose a threat to government commitments to PoE activities. The capacity to respond to public health emergencies at PoE in the ECOWAS region is still below IHR standard. Public health capacities at a majority of IHR-designated PoE in the 15-country region do not meet required core capacities standards., Competing Interests: The authors declare no competing interests., (Copyright: Virgil Kuassi Lokossou et al.)

Introduction: the coronavirus disease COVID-19 pandemic has affected the way we live. The use of non-pharmaceutical interventions (NPI) has been reported to be effective in controlling similar respiratory diseases outbreak in the past and is being used as one of the mainstays of control of the pandemic. We therefore assessed the knowledge and practice of preventive measures against COVID-19 among adults in Enugu metropolis during the outbreak in the State., Methods: we conducted a descriptive cross-sectional study among 320 adults who were recruited through a multistage sampling technique. We used semi-structured interviewer-administered questionnaire to collect information on the knowledge and preventive practices against COVID-19. The data were analyzed using the IBM-SPSS version 25., Results: the mean age of the participants was 41.6±12.5 years. There were 168 (52.5%) male, 69.7% had attained tertiary education and 57.8% were self-employed. Overall, 256 (80.0%) of the respondents had good knowledge about COVID-19. Only 133 (41.6%) had good practice of preventive measures among respondents. The more commonly practiced NPIs among the respondents were use of alcohol hand sanitizer (86.6%), physical distancing (85.6%), washing of hands with soap and water (81.6%) and disinfecting frequently touched surfaces (80.9%). The NPIs the respondents practiced poorly were use of face mask (33.8%) and avoidance of crowded areas (47.2%). Having good knowledge (aOR: 3.2; 95% CI: 1.65 - 6.05) and attaining secondary education or less (aOR: 2; 95%CI: 10-3.13) were the only predictors of good practice of preventive measures., Conclusion: the highly educated segment of the population needs to be targeted with appropriate messages to improve their adoption of the right preventive measures against COVID-19., Competing Interests: The authors declare no competing interests., (Copyright: Elizabeth Uzoamaka Nwonwu et al.)