liberia field epidemiology training programme (lfetp)liberia field epidemiology training programme...

Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP)

FIELD WORK 2 -Expanded Surveillance Report-

-Case Investigation Report-

FIELD WORK 2 -Expanded Surveillance Report-

-Case Investigation Report-

Moses B. FombaCounty Surveillance Officer

Bomi County

Liberia Field Epidemiology Training Programme (LFETP) 2

Expanded Surveillance Report

Expanded Surveillance Report

Liberia Field Epidemiology Training Programme (LFETP)

• Bomi County is located in western Liberia• Population: 97, 291 residents• Has four health districts

– Senjeh, – Klay, – Dewoin – Suehn Mecca

• Health facilities: 23 (one referral hospital)

Introduction Introduction

3


Communication FlowCommunication Flow

Community

Health Facility

District Surveillance Office

NATIONAL SURVEILLANCE OFFICE

County Surveillance Office

4


Disease Summary 1/2Disease Summary 1/2Summary of reported key notifiable diseases, Bomi County, 2015

C = Cases; D = Deaths; CFR = Case Fatality Rate

Diseases week 31-42 YTD Cumulative C D CFR C D CFR

Acute Flaccid Paralysis 0 0 0 2 0 0Acute Watery diarrhea 23 0 0 81 0 0Cholera 0 0 0 0 0 0Diarrhea with blood (Shigella) 0 0 0 0 0 0Lassa Fever 0 0 0 0 0 0Measles 6 1 17% 17 1 6%Meningitis 0 0 0 0 0 0Yellow Fever 0 0 0 1 0 0Human Rabies (susp) 0 0 0 0 0 0Guinea Worms 0 0 0 0 0 0Suspected VHF (incl. Ebola) 371 38 10% 813 178 22%Neonatal Death Neonatal 2 2 Maternal Death 3 6


Disease Summary 2/2Disease Summary 2/2• Week 31-42 had 405 suspected cases with 44

deaths– All suspected EVD cases were negative and reclassified

as non-cases– Zero reporting requirement was met by all reporting

districts.– Measles cases were investigated and control measures

implemented.


Timeliness and completeness of reporting by district, Bomi County-Liberia, 2015.

Timeliness and completeness of reporting by district, Bomi County-Liberia, 2015.

Legend

District BEFORE FETP (Week 19 – 30) DURING FETP (Week 31-42)% Timeliness % Completeness % Timeliness % Completeness

Senjeh 58% 100% 100% 100%

Klay 50% 91% 91% 97%

Dewoin 50% 91% 91% 95%

Suehn/Mecca 50% 91% 75% 92%

Timeliness and completeness of reporting has increased during the FETP

% Cumulative

>=80% on time/Complete >=50-79.9% on time/Complete <50% on time/Complete

7


WK31

WK32

WK33

WK34

WK35

WK36

WK37

WK38

WK39

WK40

WK41

WK42

0

1

2

3

4

5

Suspected Cases Deaths

Epi- Weeks

# o

f Cas

es

Trend of suspected Measles cases and death, Bomi County-Liberia, Epi WK31-42, 2015

Trend of suspected Measles cases and death, Bomi County-Liberia, Epi WK31-42, 2015

8


Trend of AWD cases, Bomi County-Liberia, 2015Trend of AWD cases, Bomi County-Liberia, 2015

WK30

WK31

WK32

WK33

WK34

WK35

WK36

WK37

WK38

WK39

WK40

WK41

WK42

0

1

2

3

4

5

6

Epi-Weeks

# of

Cas

es

9


• Maternal case investigation in Dewoin and Senjeh Districts

• Roll out of IDSR training for health workers in the county

• Roll out of SQS training for health worker in the county

• Review meeting for re-establishment of HERC in the county

• Performance feedback to districts and health facilities

Activities carried out between week 31-42

Activities carried out between week 31-42

10


Challenges Challenges

• Lack of network coverage at some facilities• High Staff attrition • Bad road condition

11


Case Investigation Report

Maternal DeathCase Investigation Report

Maternal Death


IntroductionIntroduction• Globally, approximately 800 women die daily from

preventable causes related to pregnancy and childbirth

• Maternal death is one of the leading causes• Maternal death:

– Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causesRef: Maternal death, WHO Fact sheet N°348, May, 2014


IntroductionIntroduction• In 2008,millennium Development goal aimed to reduce

maternal mortality rate by 75% in 2015.

• Maternal death is one of the immediately reportable diseases in Liberia due to increased reported cases

• A case of maternal death of a 43 year old from Dagweh’s Town occurred in Liberia government hospital on October 09, 2015

Ref: Maternal death, WHO Fact sheet N°348, May, 2014


IntroductionIntroduction• Investigation conducted on October 10, 2015

– County Surveillance Officer (CSO), – District Health Officer (DHO) – County diagnostic officer (CDO)

• Objectives:– Assess the cause of death – institute public health action based on findings.


MethodsMethods• Review of medical records • Interviewed family members, medical staff and

referral hospital staff (Trained traditional midwife(TTM) inclusive)

• Assess the health delivery system in the facilities.• Recommendation public health actions based on

findings


Results 1/2Results 1/2

Home

- Complained of stomach ache

- Midwife: Impressed false labour.

- Patient allowed to go home.

1st visit to clinic LGH2nd visit to clinic Death

45 mins walk

- Home delivery assisted by TTM

- Excessive bleeding with retained placenta

8:30 am

Sent to clinic

4: 45 pm

- Examined by midwife and referred to LGH

- No response by ambulance.

- Private vehicle utilized

No resuscitation

Certified midwife and the nurses couldn’t access the IV line because all veins had collapsed

55 mins Delay

5: 45 pm

- Patient expired

1 hour

Series of events:


Results 2/2Results 2/2• Patient was a high risk G12 P11: Poor assessment

done by certified Midwife (CM)• No response from ambulance due to fuel shortage• Delay in transporting patient with no professional

escort• No resuscitation: certified midwife and nurses

couldn’t access the IV line because all veins had collapsed.


DiscussionDiscussion• Probable causes of death: Hypovolemic Shock and

Postpartum hemorrhage • Contributing factors:

– negligence of certified midwife– lack of skills and required resources to manage such

complications at home by a TTM.– negligence of ambulance team in responding to the call– delay in transporting patient to referral hospital


RecommendationsRecommendations• That moderate to severe high risk pregnant women visiting the

health facility should stay around the facilities toward their delivery period.

• Refresher training for health workers on management of high risk pregnancies.

• Need for clear guideline on ambulance deployment and assess to logistics.

• That MOH through the government of Liberia should build maternal waiting homes at facilities more than 10 to 20 km from county referral hospitals.


Public Health ActionPublic Health Action• Following our recommendation, residents of the

community decided to build maternal waiting homes at every health facility in the districts with local materials to prevent home delivery


AcknowledgementAcknowledgement• Field Epidemiology Training Programme, Liberia

• Ministry of Health, Liberia

• Emory University

• AFENET

• Centers for Disease Control and Prevention

• World Health Organization

• My Mentors – Stephen and Joseph

liberia field epidemiology training programme (lfetp)liberia field epidemiology training programme...

Documents

field work

completeness of reporting

bomi countyliberia

suspected cases

measles cases

cases d

reporting districts

deathsall suspected