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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 42-49

Social characteristics and risk factors for diseases among internally displaced persons: A study of stefano's foundation camp in Jos, Nigeria


1 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
2 Centre for Disaster Risk Management and Development Studies, Ahmadu Bello University, Zaria, Nigeria
3 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
4 Department of Epidemiology and Community Health, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria
5 Department of Surgery, Kaduna State University, Kaduna, Nigeria
6 Department of Microbiology, Kaduna State University, Kaduna, Nigeria
7 Monitoring, Evaluation and Learning, Maternal and Child Survival Program, John Snow Inc, Abuja, Nigeria
8 Maternity Unit, General Hospital Jahun, Jigawa State, Nigeria

Date of Web Publication20-Apr-2017

Correspondence Address:
Istifanus A Joshua
Department of Community Medicine, Kaduna State University, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/archms.archms_17_17

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  Abstract 

Background: Nigeria like the rest of the world is exposed to a wide range of natural and human-induced disasters such as flood, plane crash, communal clashes, and postelection violence and recently, insurgency from Boko Haram. Most of these disasters have led to population displacement and its consequences. This study assessed the social characteristics and risk factors for diseases among the internally displaced persons (IDPs) at Stefano's foundation camp in Jos, Nigeria. Methodology: The study was a cross-sectional descriptive in nature carried out on March 1–30, 2015. The data were collected using 312 interviewer-administered questionnaire, key informant interview, and participant's observation and analysis was performed using SPSS version 20.0. Results: Majority (85%) of the respondents were within the age bracket of 18–49 years, 61% of females, 39% had no formal education, 53% of farmers by profession among others, 96% and 4% of them were displaced as a result of the insurgency in Borno and Adamawa States, respectively and had stayed in the camp for 3 months (43.8%). There was report of several morbidities and one case of mortality from malaria, diarrhea, and cholera due to inadequate water supply, poor refuse, and fecal disposal and the presence of disease vectors in the camp and a case of death of a 6-year-old child from malaria. Majority (83%) of the IDPs obtained medical treatment at the ill-equipped camp clinic. Conclusion: This study showed that the IDPs were faced with so many challenges and the nongovernmental organization has been rendering assistance. There is a need for all relevant stakeholders to key in to make life meaningful to this vulnerable group.

Keywords: Disaster, health care, internally displaced persons, Jos, social characteristics, Stefano's camp


How to cite this article:
Joshua IA, Biji BD, Gobir AA, Aliyu AA, Onyemocho A, Nmadu AG, Makama JG, Bobai M, Olayemi AG, Andrew K. Social characteristics and risk factors for diseases among internally displaced persons: A study of stefano's foundation camp in Jos, Nigeria. Arch Med Surg 2016;1:42-9

How to cite this URL:
Joshua IA, Biji BD, Gobir AA, Aliyu AA, Onyemocho A, Nmadu AG, Makama JG, Bobai M, Olayemi AG, Andrew K. Social characteristics and risk factors for diseases among internally displaced persons: A study of stefano's foundation camp in Jos, Nigeria. Arch Med Surg [serial online] 2016 [cited 2019 Jun 19];1:42-9. Available from: http://www.archms.org/text.asp?2016/1/2/42/204798


  Introduction Top


Disaster is defined as the “serious disruption of the functioning of a community or a society causing widespread human, material, economic, or environmental losses, which exceed the ability of the affected community or society to cope using its own resources.”[1] They are the results of a combination of risk factors that can be summarized as the exposure of people and assets to hazards, and their preexisting vulnerability to them. No country in the world is immune from disasters (Nigeria inclusive). It could be classified into natural and human-made, slow or rapid onset.

Displacement is the forced or obliged movement, evacuation or relocation of individuals or groups of people from their homes or places of habitual residence to avoid the threat or impact of a disaster.[2] Most disasters often result in the displacement of some persons which could be described as internally displaced persons (IDPs) or refugee. IDPs are the individuals who are forced to flee their residences but remain within their nation's borders as a result of armed conflict, militancy, or natural disaster.[1] Global estimates show that displacement associated with disasters is widely distributed across the world, including both the richest and poorest countries. Protracted displacement is often assumed to be an issue for developing and fragile states only, which have less capacity and resources to facilitate durable solutions.[1] People who were internally displaced globally as result of conflict and violence as at December 2015 amount to 40.8 million and now internal displacement is a growing global crisis.[3]

Displacement in Africa was three times lower than average in developed countries in the year 2014. This was in absolute terms, but many African countries in the recent past experienced frequent and high levels of physical violence relative to their population size, and nearly half of the world's conflict-induced IDPs are currently in Africa (e.g., Sudan, DRC, and Somalia). The global focus on IDPs is the assurance of their protection, rights, and privileges.

The guiding principles on Internal Displacement are the standard manual for IDPs' rights and practices. The Guiding Principles on Internal Displacement was documented in 1998 and was recognized as an important international framework for the protection of IDPs in 2005 World Summit. The principles were later on translated into more than forty languages. The provision of basic needs to the IDPs is the duty of government under which the region falls. Therefore, the government is autonomous in her responsibilities and actions. Based on the guiding principles, it is not only the international community but also national authorities that have the primary duty and responsibility to provide protection and humanitarian assistance to IDPs within their jurisdiction (Principle 3[1]).[4]

Nigeria in the recent years has witnessed a sudden upsurge of a population of people forced to move into temporary settlements or camps due to protracted internal conflicts. These IDPs are usually faced with increased risk of infectious diseases, severe disruption of basic infrastructures resulting in overcrowding, increased exposure to disease vectors, food insecurity, malnutrition, lack of access to safe water, sanitation, and basic health services, sexual assault among others.

There are about 1.5 million IDPs in Nigeria widely spread across the country. A good number of these persons usually take refuge with relatives and friends or are integrated into more peaceful host communities, which is why it is very difficult to ascertain the actual number of IDPs in the country.[5],[6]

The protracted insurgency in northeastern states of Adamawa, Borno, and Yobe in the past 5 years has now affected over 20 million people in the region.[6] However, a significant number are left with no other options than to stay in designated IDPs camps such as classes of schools, churches, mosques, tents set up by Emergency Management Agencies such as National Emergency Management Agency (NEMA) and nongovernmental organizations (NGOs) among others in Nigeria.

In addition to the human-made disasters, natural disasters such as flooding, drought, pandemics, and soil erosion are also known to be precursors of displacement in the country.[5] However, the majority of IDPs in Nigeria today are due to internal conflicts and not natural disasters.

This study assessed the social characteristics and risk factors for infectious diseases among the IDPs at Stefano's Foundation camp in Jos, Nigeria.


  Methodology Top


Study area

Stefano's Foundation Camp is located in Plateau State, Nigeria. Based on the history of the State, it was created in 1976 out of the northern half of former Benue-Plateau State. It is bounded by Kaduna and Bauchi to the North, Taraba to the East and Nasarawa to the South and West.

Stefano's Foundation Camp was opened in October 2014 and is being managed by an International Faith Based, NGO in Jos, Plateau State, Nigeria. The camp is located in the female hostel of Zang Commercial Secondary School, Bukuru, Jos. It has a population of 935. The camp has previously been used as National Youth Service Corps temporary orientation camp. The camp has a clinic, and there is one health personal (a Nurse) that runs clinic twice in a week - Tuesdays and Thursdays [Picture 1].



Study design

The study was a cross-sectional descriptive in nature carried out on March 1–30, 2015.

Study population

These included all the persons staying at the camp during the study (but not <18 years) and they have consented to participate.

Sampling and sample sized estimation

The sample size was calculated using Yamani formula;[7]n = N/1 + Ne 2

Where n = sample size, N = sampling population (935), e = marginal error (5% was used here).

Therefore, n = 935/1 + 935 (0.05)2n = 284, with 10% attrition = 28, giving total estimated sample size of 284 + 28 = 312.

Data collection tools

Semi-structured interviewer administered questionnaire covering sociodemographic characteristics, medical history, risk factors for diseases, and assessment for basic facilities among others.

Participant observation by the principal researcher and use of checklist.

Key informant interview.

These tools were pretested in an IDP camp in Nasarawa State.

Data analysis

The data analysis was performed using SPSS version 20,0 (IBM, SPSS Inc., Chicago, USA) and results are presented in the form of frequency tables and charts. The results from the qualitative method were transcribed.

Ethical considerations

Ethical clearance was obtained from the camp manager, and the IDPs gave verbal consent to participate in the study. The participants anonymously responded to the questionnaires.


  Results Top


A total of 312 questionnaires were administered at the camp, of which, 284 responses were received giving a response rate of 91.0%.

Over 90% of the respondents are aged between 18 and 49 years with the mean age of 36 ± 4.5 years, and there were more females (60.9%) than males (39.1%) in the camp.

Findings also revealed that the largest percentage of the respondents (39.1%) had no formal education and only 7.8% have a tertiary education.

The respondents are of the different profession, but majority (52.8%) are farmers. It can, therefore, be deduced that 76.8% of the respondents were income earners before their displacement.

In addition, 96.1% were displaced form Borno State and 3.9% from Adamawa both in the North-Eastern part of Nigeria. All respondents also attested to the fact that it was the Boko Haram insurgency in the North-Eastern part of the country that displaced them. About 44% of the respondents had stayed in the camp for 4 months as of the time of the study, and 96.1% have been staying at the camp permanently [Table 1].
Table 1: Sociodemographic characteristics of the internally displaced persons, March 2015

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About 78% of respondents said that they have fallen sick since they started staying at the camp. Of this, 39.7% have fallen sick once and 26.1% twice. Malaria was the most common sickness suffered by them accounting for 78.9%. Other diseases included typhoid fever, diarrheal disease among others [Table 2].
Table 2: Medical history of the internally displaced persons, March 2015

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Some of the respondents (42.9%) were aware of outbreaks of diseases such as malaria (66%), typhoid (24.3%), and hepatitis (9.7%) in the camp and their possible reasons were the presence of high level of disease vectors (mosquitoes in particular) (78.9%), poor quality of drinking water (46.5%), overcrowding (33.9%), and poor hygiene and sanitation measures (29.3%) (Some identified more than one factor). There was one mortality from malaria in an approximately 6-year-old child [Table 2].

The majority of the respondents said refuse disposal is either by open dumping (66.8%), burning (32.8%), or burying (0.4%) [Figure 1].
Figure 1: Methods of refuse disposal at the internally displaced person camp, March 2015.

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Most of the respondents said 5–10 person sleep per room in the camp (85.8%).

The majority of the respondents (55.6%) were using insecticide treated nets (ITN). Majority of those that said they do not use mosquito nets, however, stated that they have it but lack where to hang it (65.2%), only a few (16.2%) stated that they dislike using nets, whereas 18.8% said that they do not have the ITNs at all.

The identified major sources of water in the camp according to respondents are the well (79.7%) and the borehole (78.1%). Here, the percentages do not add up to 100% because most respondents indicated that they get their drinking water from more than one sources. Only 23% admitted that they treat their drinking water before use. Out of those that indicated how they treat their drinking water, 60% confirmed they use some form of tablets they do not know their names); 20% admitted they treat it by boiling, and 20% said that they treat it using alum. It is only pit toilets that are available in the camp and about 42% confess of not washing their hands with soap or ashes after using the toilets [Table 3].
Table 3: Risk factors for infectious diseases in the internally displaced person camp, March 2015

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The majority of the respondents (83.3%) identified the ill-equipped camp clinic as their only source of medical assistance; only 6.9% said that they get their medical assistance off camp, and a further 9.8% said that they get assistance both from the camp clinic and other health-care facilities off camp [Figure 2].
Figure 2: Sources of medical assistance for the internally displaced persons, March 2015.

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The immunizations respondents said have been given since the setting up of the camp are the ones for hepatitis (80.3%) and polio (19.7%) [Figure 3]. No immunization was given against measles, cerebrospinal meningitis.
Figure 3: Vaccines given to the internally displaced persons at the camp, March 2015.

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Where are the results of observations made by researchers? Bad toilets, out of stock of drugs in the clinic, the absence of disinfectants, lack of cleaning, and the checklist?


  Discussion Top


Over 80% of the respondents are youths aged between 18 and 49 years which could be rightly described as the most productive age group of the population. A possible explanation to their dominance could be that this was the group that was strong enough to escape the terrorists' attacks. It should also be noted that the research only considered adults and teenagers. It can also be deduced that most of the men decided to stay back and guard their property at home or are out there trying to fend for the family that is why they are fewer (39.1%) than the female folks (60.9%).

Findings also revealed that the largest percentage of the respondents lack formal education and only 7.8% have a tertiary education. Illiteracy or the lack of knowledge could greatly increase the risk of infection and also its spread. If more camp inhabitants are aware of how diseases spread and what they can do to prevent and protect themselves and their families, it will probably, lower their risk of being infected.

Majority of the respondents were farmers, therefore the lack of the land to cultivate while in the camp may likely add to their worries in the camp if they do not have alternative means of livelihood. The same applies to the traders (15.7%) who may not have the capital to start a business, the civil servants (6.5%) whose jobs are no longer there and the artisans (1.9%) who cannot practice their trades for lack of tools; students (11.7%) cannot go school and jobs not forth-coming for the applicants.

In addition, that all of the respondents are either displaced from Borno State or Adamawa State, is a testimony of the severity of the effects of the insurgence in both States and the whole North-Eastern part of Nigeria because all respondents also attested to the fact that it is the Boko Haram insurgency that displaced them.

The camp was opened in October 2014 and majority of the respondents have spent at least 2 months in the camp as at the time of administering the questionnaire. Almost all respondents (96%) said that they live and sleep in the camp. The few that do not sleep in camp, however, said they do every other thing in the camp; they only have a better sleeping place off camp. The longer the duration of stay in the camp the more the chances of being exposed to the risk factors for infection.

The common assumption that displacement following disasters is short term and temporary does not hold true in many cases; there have been reports or instances where people have lived in a protracted displacement for up to 26 years.[1]

The majority of the respondents (78%) said that they fell sick at least once and about 19.1% of respondents said that they were down with an illness at least 5 times within the little time they have stayed in the camp. Many people who were interviewed said that they were sick even at that moment. If so many people could be sick this much within just about 4 months of setting up the camp it implies that the risk factors are very high and could get even worse [Picture 2].



Malaria is a protozoan disease caused by a parasite that is transmitted through a mosquito bite. In addition to the fact that malaria is endemic Nigeria, the high incidence of malaria infection in the camp could furthermore, be attributed to overcrowding of infected and susceptible hosts, increased exposure to mosquitoes while sleeping outside, movement from nonendemic to endemic areas, a pause in disease control activities, the lack of or inability to use ITNs, etc. This is in-line with other studies that showed diarrheal diseases, measles, malaria (in endemic areas), and acute respiratory infections are the major causes of morbidity and mortality in displaced populations, particularly in the presence of high rates of malnutrition.[8],[9] Studies by other researchers also show that malaria is endemic in over 80% of areas affected by humanitarian emergencies.[10],[11]

Typhoid fever is a bacterial disease cause by  Salmonella More Details typhi. Poor quality of drinking water and inadequate hygiene and sanitation such as regular hand washing could be the best explanation to the high incidence of typhoid in the affected population. Typhoid, like most communicable diseases, can spread very quickly in the crowded setting because of the increased contact with infected people.

A small percent of the respondents said they have fallen ill to cholera. Cholera transmission has also been associated with mass population displacement, crowding, poor access to safe water, inadequate hygiene and toilet facilities, and unsafe practices in handling and preparing food [Picture 3]. All of these risk factors have been identified in the camp. If an outbreak were to occur, it could spread quickly in the camp.



Another big health concern identified in the camp is tuberculosis. Pulmonary tuberculosis is caused by a bacterium that targets the lungs. It is a droplet infection and contracted if a person with the bacteria in their lungs breaths it out and an uninfected person breaths it in. Although the incidence of tuberculosis among the IDPs is very low (0.4%), tuberculosis can be fatal, especially in conjunction with other diseases such as HIV.[11],[12] Some of the above-discussed diseases are perceived as outbreaks by more than 40% of the respondents and reasons for the outbreaks included poor water supply, overcrowding, dirty environment and high presence of vectors (e.g., mosquitoes) in the camp. These could have played an important role in the death of an approximately 6-year-old child in the camp from suspected malaria.

The identified major methods of refuse disposal which were open dumping, burning, and burying were associated with problems such as indiscriminate dumping and burning in the camp during participant observation. These could serve as source of environmental pollution, fire outbreak and transmission of diseases.

Most of the rooms (of the average size of 12 m × 12 m square) in the camp have 5–10 occupants per room indicating overcrowding which is a risk factor that easily facilitates the spread of infectious diseases in the camp. This could be by bringing infected persons into proximity with the uninfected persons. The researcher was made to understand that the rooms were shared by families, it does not matter whatever the size of one's family. This has made some people be too crowded together, whereas others have a little more space; but overall, nobody has the minimum comfort of a typical home.

Majority of respondents said that they use ITNs, whether they use it correctly is another issue. Some of the people who were not using ITN was because they do not have the nets but others lack where to hang it because of the crowded nature of their rooms among others. Sleeping under ITN greatly reduces the risk of malaria,[13] but this is rare in camp for some reasons.

The identified major sources of water in the camp according to respondents were the well and the borehole; although, the majority of the respondents said that they obtain their drinking water from more than one source. As at the time of this research the borehole was not optimally functional, so most of the IDPs were depending more on the water from the well which is less clean. Only 23% said that they treat their drinking water before use, 60% said that they use some form of tablets (these are mainly those that get their medical assistance in facilities outside the camp); nearly 20% said they boil their drinking water; and 20% said that they use sedimentation (alum). The importance of potable water in any community cannot be overemphasized. Water shortage is responsible for about 80% of all communicable diseases especially in the developing countries (Nigeria inclusive).[14] The basic physiological requirement for drinking water is about 2 L/day and a daily supply of 150–200 L needed per capita per day.

It is only pit toilets that were available in the camp and their sanitary condition was a problem, and about 42% confess of not washing their hands with soap or ashes after using the latrines. These may be a contributory factor to some food or water-borne diseases in the camp.

About 4/5 of the IDPs seek medical care at the camp clinic, and only small percent of them use hospitals within the community or both. That means a bulk of the respondents (83.3%) solely depend on the ill-equipped camp clinic for medical assistance. The camp clinic lacks basic drugs such as anti-malaria drugs and antibiotic. It also lacks a functional medical diagnostic laboratory. In fact, the researcher was informed by the head of the camp clinic himself that he comes only twice a week (Tuesdays and Thursdays) and he is the only one taking care of all the IDPs.

In general, immunization activities in the camp have been very poor; according to respondents, only polio and hepatitis vaccines were administered in the camp. Sixty-nine percent of respondents said they had been immunized at least once since they arrived the camp. Only about 30% said that they have never received any form of immunization.However, some of those that said they had been immunized said they did not know what they were immunized against. Nearly 80.3% of respondents who know what they were immunized against said that they only received hepatitis immunization. Some parents said their children had been immunized against polio (19.7%). These findings imply that a lot has to be done about the other major vaccine-preventable killer infections such as measles, tuberculosis, meningitis, and pneumonia.

No single rape case was recorded in the camp. This is probably because it is a faith-based organization that is managing the camp. Another possible factor could be the level of orderliness and coordination the researcher observed in the camp.


  Conclusion Top


There were numerous risk factors for infectious diseases in Stefano's IDP camp in Jos. Hence, it was not surprising that diseases were prevalent with their attendant consequences including significant mortality. This predicament was essentially due to the lack of basic facilities such as adequate potable water, good shelter, sanitary methods of sewage and refuse disposal, schools, equipped medical facility and coverage, provision of farm lands, credit facilities, and security at the camp among others.

Recommendations

These include:

  • Proper collaboration between NGOs, NEMA, and other relevant stakeholders in disasters management
  • Provision of suitable accommodation to meet the physiological and psychosocial needs of the IDPs and also prevent the spread of diseases. NEMA, State Emergency Management Agency, Local Emergency Management Authority and Ministry of Housing are very relevant in this regard
  • The Medical Officer of Health at the Local Government need to be proactive by engaging with the State and Federal Ministries of Health for medical supplies such as drugs, vaccines among others
  • Provision of adequate medical facility at the camp to meet the health needs of the IDPs in terms of coverage, availability of essential drugs, facilities for diagnosis, treatment, and psychotherapy. The Medical Office of Health at the Local Government, State and Federal Ministries of Health can be more proactive here
  • Heath education of the IDPs by the health personnel from the relevant stake ministries should be carried out on hand hygiene, provision and use of ITN, environmental sanitation, proper disposal of refuse and sewage, avoiding indiscriminate burning of refuse among others
  • Provision of temporary farm lands to farmers and credit facility and provision of employment to those that are skilled by the three-tier of government to relieve the sufferings of the IDPs
  • Relevant stakeholders in disaster management should screen donated relief materials to avoid donation of expired items such as drugs and other food items. And donations should be based on genuine need
  • The three tier of government should embark on the national orientation of the citizens on peace education and the use of alternative methods of conflict resolution such as inquiry, collective bargaining, mediation, arbitration, and adjudication among others to reduce human-made disasters such as insurgency and other armed conflicts.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Global Estimates 2015. People Displaced by Disasters. Internal Displacement Monitoring Centre. Available from: http://www.internaldisplacement.org/idp. [Last accessed on 2015 Jun 20].  Back to cited text no. 1
    
2.
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Internal Displacement Monitoring Centre Report; 2016. Available from: http://www.internal-displacement.org/globalreport2016/. [Last accessed on 2016 Dec 30].  Back to cited text no. 3
    
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Kalin W. Guiding Principles on Internal Displacement Annotations.2nd ed. Washington, USA: The AmericanSociety of International Law and the Brookings Institution; 2008.  Back to cited text no. 4
    
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Joshua IA, Makama JG, Joshua WI, Audu O, Nmadu AG. Disasters in Nigeria: A public health perspective. J Community Med Prim Health Care 2014;26:59-75.  Back to cited text no. 5
    
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Daily Trust (Editorial). Addressing Health Concerns in IDP Camps; 2014. Available from: http://www.dailytrust.com.ng/daily/editorial/36467-addressing-health-concerns-in-idp-camps. [Last accessed on 2015 Jan 12].  Back to cited text no. 6
    
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Israel GD. Sampling the Evidence of Extension Program Impact. Program Evaluation and Organizational Development, IFAS, PEOD5, University of Florida USA; 1992. Avilable from: http://edis.ifas.ufl.edu/pd005. [Last accessed on 2016 Jan 11].  Back to cited text no. 7
    
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Connolly MA, Heymann DL. Deadly comrades: War and infectious Diseases. Lancet 2002;360:S23-4.  Back to cited text no. 8
    
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Noji E. Public Health Consequence of Disasters. New York: Oxford Press; 1997.  Back to cited text no. 9
    
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World Health Organization. Malaria Control in Complex Emergencies: An Interagency Field Handbook. Geneva: World Health Organization; 2005. Available from: http://www.who.int/malaria/publications/atoz/924159389x/en/. [Last accessed on 2015 Aug 24].  Back to cited text no. 10
    
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World Health Organization. Communicable Diseases Following Natural Disasters: Risk Assessment and Priority Interventions. Programme on Disease Control in Humanitarian Emergencies Communicable Diseases Cluster. Geneva: WHO; 2006. Available from: http://www.who.int/diseasecontrol_emergencies/guidelines/CD_Disasters_26_06.pdf. [Last accessed on 2015 Jan 24].  Back to cited text no. 11
    
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The Johns Hopkins and International Federation of Red Cross and Red Crescent Societies. Public health guide in emergencies 2008. Available from: www.bvsde.paho.org/texcom/desastres/ficrphge. [Last accessed on 2016 Jan 11].  Back to cited text no. 12
    
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Malaria Consortium. Malaria Prevention through ITN. Brief Advocacy Brief; April, 2016. Malaria Consortium, Disease Control, Better Health. Available from: http://www.malariaconsortium.org/media-downloads/802. [Last accessed on 2016 Dec 30].  Back to cited text no. 13
    
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Lemonick DM. Epidemics after natural disasters. Am J Clin Med 2011;8:144.  Back to cited text no. 14
    


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