Lessons learned from Nigeria's public health responses to infectious disease outbreaks: A systematic review

Abstract

Introduction: Nigeria has experienced repeated outbreaks of infectious diseases, such as Lassa fever, cholera, Ebola, and COVID-19, which have consistently challenged its public health response capabilities. This systematic review sought to consolidate evidence regarding the successes, challenges, and insights derived from Nigeria’s outbreak responses from 2010 to 2023 to enhance future preparedness. Methods: We conducted a systematic review following the PRISMA 2020 guidelines. A thorough search of five databases (PubMed Central, Web of Science, Google Scholar, Africa Journals Online, and NIH Library) was conducted for peer-reviewed English articles published between 2010 and 2023. Studies were included if they focused on Nigeria’s outbreak response strategies. The methodological quality of the included studies was evaluated utilizing the Mixed Methods Appraisal Tool (MMAT 2018). Results: Out of 52 identified records, 12 studies met the inclusion criteria. The findings were synthesized around four core objectives. Identified key strengths encompassed the efficient implementation of rapid case detection, contact tracing, and the coordinating function of national and state-level Emergency Operations Centers (EOCs). However, significant challenges persist, including critical subnational coordination delays averaging 5-7 days, fragile community trust leading to high refusal rates (15-20%) for contact tracing and vaccination, and a heavy reliance on multisectoral partners to fill systemic gaps in funding and logistics. Conclusion: Although Nigeria has established a comprehensive array of response strategies and coordination mechanisms at the national level, the efficacy of its outbreak response is persistently compromised by subnational operational impediments and diminished community trust. To build a resilient health security architecture, Nigeria must prioritise decentralising response capacity, institutionalising sustainable trust-building community engagement, and securing predictable domestic financing for preparedness.