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