fetp project presentation leela k. zaizay public health training lead november 2, 2015
DESCRIPTION
Cumulative timeliness and completeness of Counties in Liberia, Epi Week 31 to 42, 2015TRANSCRIPT
FETP PROJECT PRESENTATION
Leela K. ZaizayPublic Health Training Lead
November 2, 2015
Introduction• Liberia: – Located in West Africa– 15 counties– 91 districts– 718 health facilities
• Surveillance indicators from epi-week 31– 42• Problem analysis: why counties do not get
feedback from the lab regarding priority diseases
Cumulative timeliness and completeness of Counties in Liberia, Epi Week 31 to 42, 2015
BongBomi
Gbarpolu
Grand Bassa
G. Cape M
ount
Grand Gedeh
Grand KruLofa
Margibi
Maryland
Montserra
doNim
ba
Riverce
ss
RiverG
eeSinoe
88%
90%
92%
94%
96%
98%
100%
102%
Cumulative timeliness Cumulative completeness
County
Perc
enta
ge
Summary of Notifiable Diseases, EPI wks 31 -42, 2015 Liberia
Disease Cumulative: Week 31 – 42, 2015Cases Deaths Case Fatality Rate
Acute Flaccid Paralysis (AFP) 10 0 0%Yellow Fever 1 0 0%Lassa Fever 3 0 0%Neonatal Tetanus 1 1 100%Cholera 0 0 0%Acute Watery Diarrhea 2,345 0 0%
Meningitis 3 0 0%Measles 392 2 0.5%Bloody Diarrhea 50 0 0%Human Rabies 27 0 0%Suspected VHF/EVD 5,893(S) 0 0%
Neonatal Death 6
Maternal Death 23
Trend for suspected EVD Epi Wks 31 to 42, 2015 in Liberia
• Increase due to the recent changes in the standard case definitions of EVD.
wk31 wk32 wk33 wk34 wk35 wk36 wk37 wk 38 wk39 wk40 wk 41 wk 420
100
200
300
400
500
600
700
800
Suspected EVD cases EVD Death
num
ber o
f cas
es
Distribution of suspected EVD cases and unexplained death per county
County EVD suspected cases Unexplained death
Gbarpolu 306 11
Montserrado 342 85Bomi 442 38
Bong 657 69
Nimba 1,351 116Maryland 100 25
G. Bassa 1,015 59River- cess 251 13
Grand Kru 279 16
Grand Gedeh 1,676 5
Sinoe 382 42
Margibi 1,073 121
Lofa 419 130Grand Cape Mount 870 56
River- Gee 206 31
Trend for suspected MeaslesEpi Wks 31 to 42, 2015 Liberia
wk31 wk32 wk33 wk34 wk35 wk36 wk37 wk 38 wk39 wk40 wk 41 wk 420
10
20
30
40
50
60
70
80
90
Trend for suspected Measles from Epi Week 31 to 42, 2015 Liberia
cases of measles death of measles
Num
ber o
f cas
es
Discussion
• A total of 8,754 immediately notifiable diseases/events were identified with 3 deaths (0.05%).
• Suspected cases of Ebola Virus Disease (EVD) were the highest (5,893 ) recorded
• However, there was no confirmed case of EVD/ VHF during this period.
• Followed by cases of Acute Watery Diarrhea (2,345)• And Measles (392)• Timeliness of reporting from counties was 93% with
100% completeness of reporting
Intervention
• Roll out of IDSR training for health workers in the county
• Polio immunization and deworming campaign in the 15 counties
• Suspected measles outbreak investigation in counties with cases
IDSR county TOT Training
Poor feedback of lab confirmation of priority diseases
Poor laboratory services:• Laboratory service is a critical component of Liberia’
health system
• It is central in disease diagnosis, prevention, surveillance, treatment, and outbreak investigations
• However, Liberia laboratory service is poor and needs to be strengthened
• All the counties complained of not getting feedback about priority disease from the labs
Problem Analysis: Fish Bone
Critical Cause: • Poor sample collection and filling of case-based
forms
• Labs unable to work on poor samples/trace origin of the sample for feedback
Poor feedback
of lab confirmati
on of priority diseases
AdministrationStaff
LogisticsEnvironment
Limited number of trained staff (P) Inadequate sample collection materials
(P)Delay in picking samples (P)
Unknown pick up sites (P)No focal person at some pickup sites (P)
Most clinicians who collect samples have not been trained (P)
Inadequate knowledge on use of case base form (P)
Poor coordination between riders of health and County health team (P)Delay in hazard payment of lab technicians (N)
Inadequate training for lab staff (P)
Inadequate laboratory supplies (N)
Limited lab for priority diseases (N)
Bad road conditions (N)
Poor network coverage (N)Un sensitized communities about disease control and prevention (P)
Hard to reach counties and districts (N)
Poor coordination between communities and HF (P) Limited case-based forms at the district and county
levels (T)
Inadequate sample collection materials (p)
Inadequate laboratory supplies (N)
Inadequate reagent (P)
Expired reagent (P)
Poor sample collection
and filling of case-based
forms
Recommendation
• IDSR training should be conducted• Strengthen supervision at all levels• Adequate provision of case base forms• Provision of special training for laboratory
technicians• Continuous refresher training of lab
technicians• Adequate supplies of laboratory materials• Riders of health to provide TOR to county
health teams
Acknowledgement• I wish to acknowledge the invaluable guidance
and counsel accorded to me by Dr. Maame
• Also special thanks to Emory and AFENET, for all the support given during this period
• Finally, special gratitude to MoH in partnership with CDC for this great opportunity awarded me
• May God reward you all
Thank You for Listening