Infectious Diseases Prevention: The Power of a Community-Led Initiative in Lagos State
Blessing Oladunjoye (Guest Writer)
In May 2024, Gbenga Ogundimu (not real name), a resident of Ajeromi-Ifelodun, Lagos State, appeared pale and emaciated. He had been coughing for several weeks, and his condition worsened to the point where he was coughing up blood. Ogundimu believed it was a spiritual attack, and he intensified efforts to seek spiritual cleansing, hoping for healing.
Meanwhile, Kehinde Omolade, a Traditional Birth Attendant (TBA) and a local herb seller popularly referred to as ‘elewe omo’, knew that Ogundimu was not suffering from a spiritual attack, but her advice for Ogundimu to seek proper medical attention fell on deaf ears.
When Omolade realised that Ogundimu would not visit the hospital as recommended, she called the hotline at Tolu Primary Healthcare Centre (PHC), one of the health facilities offering free Tuberculosis (TB) treatment in Ajeromi-Ifelodun.
“I made sure I described the man appropriately while reporting the case to Tolu PHC. They went to his house with their ambulance to take him to the hospital. Ogundimu’s mother who was embarrassed that an ambulance was in front of their house, initially denied that there was no sick person in the house,” Omolade narrated.
Ogundimu tested positive for TB and was prescribed medication, which facilitated his recovery.
In Nigeria, infectious diseases remain a significant public health concern, accounting for 68% of deaths in children under five, according to the World Health Organization (WHO). Lagos State, with its population of over 16 million, frequently grapples with infectious diseases such as Tuberculosis, Cholera outbreaks, Measles, and Mpox.
In Lagos, two municipal Local Government Areas (LGAs), Ajeromi-Ifelodun and Somolu, stand out for their unique challenges. With dense populations, poor sanitation systems, and limited access to clean water, these LGAs have long been vulnerable to infectious disease outbreaks.
However, an intervention by the Dr. Ameyo Stella Adadevoh (DRASA) Health Trust, is changing this narrative . Through the Strengthening Community Knowledge and Response on Infectious Disease Prevention (SCKaR-IDP) project , a community-based surveillance and behaviour change initiative, DRASA is equipping the residents with the knowledge and tools to fight against the threat of infectious diseases.
The project, which equips key groups at the grassroots with the skills to detect and prevent and control infectious diseases, represents a bold step toward securing our health security through grassroots participation.
Equipping health champions: A grassroots solution
To ensure that the SCKaR-IDP project reaches the community members, most effectively, community influencers were recruited by engaging with key groups and leaders within the community. These influencers, identified through a consultative process, act as ambassadors for the project, disseminating information and promoting positive health behaviors within their respective communities.
Between March and April 2024, DRASA Health Trust equipped 2,089 Health Champions from Ajeromi-Ifelodun and Somolu LGAs. These individuals, comprising market women, hairdressers, butchers, TBAs, artisans, transport workers, and religious leaders, received training on identifying symptoms of infectious diseases, reporting cases, and promoting preventive measures.
“We wanted people who were already central to community life. These groups interact with hundreds daily, making them ideal for spreading awareness and driving change,” Christopher Aliu, Health Security Program Manager at DRASA, explained.
The SCKaR-IDP project aimed to build the capacity of community members to detect and prevent infectious diseases through informative sessions and materials. It also conducted comprehensive KAP (Knowledge, Attitude, and Practices) assessments, at both the baseline and endline stages. These assessments were designed to identify existing knowledge gaps and behavioural patterns within the target groups, and later measure changes in their KAP levels due to the project’s interventions. This multi-faceted approach provides a comprehensive understanding of infectious disease knowledge among the target groups, enabling the organisation to tailor its strategies for maximum impact.
Despite being volunteers, the community influencers, receive modest reimbursement for their logistical expenses, such as transport. The organisation also provided them with contact information for the LGA’s Disease Surveillance and Notification Officer (DSNO) and created a WhatsApp group for continuous information sharing and learning.
As a result of these efforts, Aliu said the post-intervention assessments revealed a 43.2% increase in the residents’ understanding of infectious diseases, with significant improvements in knowledge about causes, symptoms, and prevention strategies.
Voices of transformation
For many Health Champions, the training was a transformative experience that reshaped their personal habits and empowered them to become agents of change.
Kehinde Omolade, the Traditional Birth Attendant (TBA) whose insistence helped to save Ogundimu’s life is one of the DRASA Health Champions. Since the training, Omolade who lives in a shared apartment with a shared toilet and bathroom, understands the importance of personal hygiene and environmental sanitation.
“I now understand the health implications of abandoning faeces in potties within the compound after my neighbour’s children might have defecated, and I take it upon myself to sensitise my neighbours to maintain a high level of hygiene,” she said.
For artisans like Salam Wasiu, the engagement with DRASA prompted practical changes. Wasiu, who is the Secretary of the Motor Mechanics and Technicians Association of Nigeria in Somolu LGA said, “before, we usually defecate wherever and whenever we have the urge. But after this engagement, we made contributions among ourselves and built a toilet where none existed before. We now penalise members who don’t maintain cleanliness.”
Health Champions in action
The intervention has spurred visible improvements in hygiene and public health. In Achakpo Market in Ajeromi-Ifelodun, butchers now wear white uniforms and adhere to strict cleanliness protocols. “We have enacted laws to ensure meat handling meets hygiene standards,” said Akinleye Wasiu, the Secretary of the Butchers Association.
Corroborating the evidence of impact, Aliu said the intervention proved invaluable during the recent cholera outbreak in the state. Health Champions, he said, promptly reported suspected cases to their local health authorities, enabling faster responses. “We are seeing an increase in early reporting, which is crucial for containment,” he buttressed.
Commending the initiative, Mrs Adebukola Adeniji, the DSNO at Somolu LGA, said that DRASA’s intervention has been useful in curbing the spread of infectious diseases in select LGAs in Lagos State. She also noted that the intervention has made it easier for grassroots community members to report suspected cases that could lead to outbreaks, stressing that DRASA Health Trust’s efforts are contributing to improved public health and disease prevention.
Challenges and constraints
Notwithstanding its success, the project faced significant hurdles, including managing community expectations. Aliu said people expected financial incentives, which DRASA Health Trust does not provide and “this, sometimes, affected participation,” he said
Similarly, he explained that the limited capacity of PHCs in these areas affected the intervention. For instance, he said that during the Cholera outbreak in July 2024, free treatment ended when the outbreak was declared over, leaving patients unable to afford care.
“It’s heartbreaking when people [are] turned back because they can’t pay,” Aliu stated, adding that strengthening PHCs was essential for sustaining the progress.
On the part of the Health Champions, misinformation, ignorance and resistance to change were also barriers. “Some people dismissed hygiene campaigns, saying hunger was a bigger problem,” Temidayo, a community member, said. However, he noted that practical examples, like seeing a family affected by cholera, helped change minds.
Strengthening Nigeria’s health security and governance requires sustained investment in community-led initiatives. By equipping local health champions and fostering accountability at the grassroots level, the project aligns with the Federal Ministry of Health and Social Welfare’s pillars of the health sector reform, ensuring that communities are not just beneficiaries, but active participants in achieving National Health Security.
To scale and sustain these efforts, there must be increased funding for primary healthcare centres (PHCs), and continuous training for community health workers, enabling us to strengthen our defence against infectious disease outbreaks.
