mbds lab strategy activity - mbds secretariat · dengue fever, malaria, japanese encephalitis,...

MBDS Lab Strategy Activity

Laboratory Field Survey Narrative Report

1 Purpose

The mission of the Mekong Basin Disease Surveillance (MBDS) lab survey is to provide technical support

to the MBDS Executive Board Committee and Country Coordinator Committee, for better understanding

the status quo of laboratory capacity to address specified diseases in MBDS regional, especially in the

border areas and province, and to guide the MBDS lab strategy plan development to strengthen lab

capacity in this region.

2 Description

MBDS Yunnan helps establish the standards and procedures for lab assessment, prepares the

questionnaires (annex 1) with support from Pasteur Institute, Cambodia and GHSi, and in coordination

with MBDS Coordination Office and Country Lab Coordinators, we forms the schedule of lab survey.

(Annex 2) The questionnaires are designed to address the capacity of 7 core diseases (sever pneumonia,

dengue fever, malaria, Japanese Encephalitis, cholera, EV71 and typhoid) identified by country lab

coordinator in Phnom Penh MBDS regional forum 2008.

2.1 Method

Use questionnaires for national, provincial, district and cross border lab in each member country, also a

questionnaire to general information in the country; interview with key informant in each lab and lab

visiting.

There are 8 parts related to lab capacity asked in each questionnaire.

a) lab diagnosis, including sample transportation and MBDS core diseases diagnosis capacity

b) lab human resource

c) lab equipment

d) Biosafety

e) Technical training

f) support for surveillance and response

g) Quality assurance/Quality Control

h) Urgent need for training and research

2.2 Country Assessment Results

2.2.1 Cambodia lab assessment was carried out from 22-28 Mar., we covered 3 labs from national,

provincial and cross border levels. In national level, with support from Pasteur Institute of Cambodia, it is

capable to test 5 core diseases except sever pneumonia and EV 71, and lab supply is relatively sufficient.

And the national lab also involved with a lot international lab quality assurance program. As aspect of

provincial and cross border level, the capacity is lagged for the core diseases diagnosis, in the labs we

surveyed, the labs only diagnose malaria due to not sufficient supply and human resource. Moreover,

biosafety is also a big problem to them, there is not sufficient personal protection equipment and very low

rate of biosafety training to lab staffs cause the lab staff worked in exposure environment. Suggestion

solution: Provide basic lab apparatus (standard glasswares, basic equipment and reagents) and PPE to

cross border and provincial levels, training of biosafety and basic lab operation, support national level

research on food microbiology test and clinic virology/bacteriology.

2.2.2 China (Guangxi and Yunnan) lab assessment was carried out from 2-17 Feb., we covered 7 labs

from provincial and cross border levels. In our survey to the 5 cross border sites, 3 core diseases

diagnosis (malaria, cholera and typhoid) were carrying out, and to the other 4, samples will be sent to

prefecture or provincial level for testing. And the provincial level of Yunnan and Guangxi, they all have the

capacity to diagnose the 7 core disease with sufficient lab human resource and capacity. In the past 2

years, Chinese central government implement Central/Western China Province (including Yunnan and

Guangxi) lab capacity building program, and 360,000RMB (approximate 52,900 USD) was allocated to

each county (cross border site located) to procure basic lab equipment as needed. By this year, most

equipment is ready. Finding: The priority in next stage is to training on food poisoning and virology

diagnosis of the 7 core diseases in the provincial and cross border sites, and provide research support on

rapid test, respiratory virology separation and identification, molecular biological application and

molecular epidemiology.

2.2.3 Laos lab assessment was carried out from 15-22 Jan., we covered 9 labs from national, provincial

and cross border levels. In national level, it is capable to test 6 core diseases except EV 71, and lab

supply is relatively sufficient. However, the biosafety is a gap since there is no biosafety program even in

the national level and only some SOPs included the biosafety part, that leads the coverage of biosafety

trained rate relatively lower. As for provincial and cross border level, most labs there are based in hospital,

and capacity shows great diversity in different provinces. Generally, most province can diagnose 4-5 core

diseases, and 2-3 in the cross border district. Moreover, the QA/QC program is not carried out in the lab

system. Suggest solution: Provide basic lab equipment and PPE to cross border and provincial levels,

develop comprehensive biosafety program in the national level and provide training of biosafety and

QA/QC to lower level lab staffs. On the research aspect, provide molecular diagnosis support to national

level and the QA/QC training to lower lever as well as relevant virology and bacteriology diagnosis.

2.2.4 Myanmar lab assessment was carried out from 2-8 Mar., we covered 8 human diseases labs from

national, provincial and cross border levels, at the same time, 4 animal labs were also provided precious

information to the assessment group. That is great help for us to better understand the cooperation

between human and animal sector on zoonosis, that’s also one strategy of MBDS. For human diseases

lab, in national level, it is capable to test 6 core diseases except EV 71, and questionnaires reflect the lab

supply is insufficient, moreover, there is no biosafety program even in the national level and SOPs do not

included the biosafety part; that leads the coverage of biosafety trained rate quite low (2/164). In the

survey, we noticed most lab also emphasized on the HIV/AIDS diagnosis, although it is not in the core

disease list. As for animal labs, 4 zoonosis (High pathogenic avian influenza, rabies, tuberculosis and

brucellosis) is selected as core diseases in the questionnaires, unlike human disease system, the

biosafety in animal sector is much more developed, all level already set up manuals and/or SOPs,

however, the training seems not carrying out well. And reagent and equipment of AI and serology test is

urgent needed. Suggest solution: Provide basic lab equipment and PPE to human and animal labs,

develop comprehensive biosafety program in the national level of human diseases lab and provide

training of biosafety and QA/QC to lower level lab staffs. On the research aspect, provide dengue

serology research and HIV/AIDS and STDs transmission research.

2.2.5 Thailand lab assessment was carried out from 4-9 Apr., we covered 6 labs from national, provincial

and cross border levels. In national level, it has strong capacity to diagnose all 7 core diseases, and lab

supply and equipment are sufficient. Besides, the National Institute of Health (NIH) also passed the ISO

15189, now the whole national level lab running and management complies with this standard. And a

department is newly founded to coordinate and manage in the whole lab system. Other function of NIH is

also responsible for the quality control and quality assurance system in Thailand, in the survey, we

noticed a data management system running effectively from provincial level to the central level, all the

data sheet are stored in categories and monitoring and evaluation to lower level lab is carried regularly at

least once a year. Moreover, there are 14 Regional Medical Health Center (RMHC) spread in whole

country, covered all the area of the country. Using this network, the province could transfer the sample to

the nearest RMHC in shortest time. We also surveyed one RMHC (based in Chiang Rai Province) in

Thailand, the lab there can diagnose most bacteria test, and the virus related disease samples (EV71 and

JE) will transfer to NIH. The provincial and cross border lab mostly based in hospital, Compare to the NIH

and RMHC, the lab supplies and equipment is relatively insufficient, and biosafety is also a gap in those 2

levels, especially in the cross border labs. Suggest solution: Provide basic lab equipment, PPE and lab

technician training to cross border and provincial levels, provide molecular diagnosis support to regional

level and train cross border lever on virology and bacteriology diagnosis. Provide exchange program of

lab technician with neighboring countries to regional lab.

2.2.6 Vietnam lab assessment was carried out from 19-25 Feb., we covered 7 labs from national,

provincial levels. In national level (NIHE), it is capable to test all the 7 core diseases, and lab supply and

equipment is sufficient. Biosafety program is running well now and a department in the NIHE responsible

of it, and the program also implements in each province we assessed. On the other hand, the provincial

level lab can also diagnosis most of the core diseases (5-7), but reagent and basic equipment is

insufficient. Moreover, the QA/QC system doesn’t carry out in the provincial level. Suggest solution:

Provide basic lab equipment and PPE to provincial level, develop comprehensive QA/QC program in the

national level and provide training of it to lower level lab staffs, as what reflect in the survey results, most

province hope to receive training on microbiology, food safety and occupational health, and specimen

transportation is also a priority. On the research aspect, the priority is the zoonosis diseases such as

H5N1 and rabies.

3 Recommendations

3.1 An elaborated assessment report should be developed, after reviewed by all 6 countries’ lab

coordinators, the report will be disseminated to MBDS Country Coordinators, Executive board and

Coordination Office for technical support on the lab capacity strengthening, and share with development

partners and other network.

3.2 Conduct lab resource mapping in this region to determine reference lab on specific core disease(s).

3.3 Convene MBDS lab coordinator workshop in coming MBDS regional forum to prioritize countries

needs, revise the MBDS regional lab strengthening proposal and submit to development partner.

3.4 Using the assessment results to leverage fund for MBDS lab strategy.

Annex 1

MBDS Laboratory Core Capacity Questionnaire

(General Information, suggested completed by Lab CO)

Country/Provincial

Key informant:

Tel:

Email:

2007 2008

1 General information

1.1 No. of National level lab(s)

1.2 Total number of provinces in your country

1.2.1 No. of provincial lab(s)

1.3 No. of cross border sites

1.3.1 No. of lab(s) at cross border

1.4 National Reference Labs designated by national

authority

1.4.1 Activities covered by the National Reference

laboratories

1.4.2 No. and location of BSL-3 Laboratories

1.4.3 No. and location of BSL-2 Laboratories

1.4.4 No. and location of animal facilities and

insectariums

1.5 No. and location of WHO accredited lab. (Polio,

dengue, JEV, malaria, NIC, others)

1.6 Existing links with WHO Reference Labs for

specimen sharing (pathogens, name of the WHO

Reference lab)


(National level)

Country/Provincial/District: Key informant:

Tel: Fax:

Email:

2 National lab(s)

2.1 Lab Policy/guideline

2.1.1 Did MoH develop lab services policy/strategy?

2.1.2 Is there any unit/person in MoH responsible for

lab coordination?

2.1.3 Was lab inventory carried out?

2.2 Lab diagnosis

2.2.1 Are there SOPs for specimen collection, storage

and transport?

2.2.2 Are National labs participating to any

international quality assessment program? If

yes, specify

2.2.3 Are lab supplies sufficient?

2.2.4 Is there a guideline for supplies stock

management?

2.2.5 Specify the diagnostic methods used for the

following diseases or syndromes

2.2.5.1 Sever pneumonia

2.2.5.2 Dengue Fever

2.2.5.3 Malaria

2.2.5.4 Japanese Encephalitis

2.2.5.5 cholera

2.2.5.6 Enterovirus type 71

2.2.5.7 Typhoid

2.2.6 Are there any rapid tests adopted for the

diseases listed above?

Please specify.

2.3 Human resources

2.3.1 Total No. of lab staff

2.3.2 No. of Biologists/Pathologists

2.3.3 No. of Lab Assistants/Supervisors

2.3.4 No. of Lab. Technicians

2.3.5 Others

2.4 Lab Equipment (in good condition)

2.4.1 No. of biosafety cabinets (specify if there is a

maintenance contract to change filters and to

control the number of particles)

2.4.2 No. of deep freezers (-80°C)

2.4.3 No. of fridges and -20°C freezers

2.4.4 No. of microscopes (specify: standard, inverted

or fluorescence)

2.4.5 No. of centrifuges (specify : standard or

refrigerated)

2.4.6 No. of ELISA washer and reader

2.4.7 No. of incubtors (specify : standard and CO2)

2.4.8 No. of computers used for lab data management

2.4.9 Are equipments under maintenance contract

with the suppliers or controlled regularly by a

technician ?

2.5 Biosafety

2.5.1 Did MoH establish biosafety program? /was the

program implemented and reviewed regularly?

2.5.2 Were SOPs/manuals for biosaftety prepared?

2.5.3 How many lab staffs were trained on biosatety?

2.6 Technical training

2.6.1 No. of staff trained in 2007 & 2008

2.6.2 No. of training courses held (mention aims of

training courses)

2.7 Support of surveillance and response

2.7.1 No. of lab staff included in SRRT

2.7.2 In how many outbreaks lab investigations were

conducted?

2.7.3 Total No. of outbreaks (per disease or

syndrome)

2.8 Quality assurance/Quality control

2.8.1 Check list developed for quality assessment of

non-national labs ?

2.8.2 Quality assurance program carried out for

non-national labs ?

Others

Priority research needs

Priority training needs


(Provincial level)


Email: Mobile:

3 Regional/Provincial level labs

3.1 Lab diagnosis

3.1.1 Are there SOPs for specimen collection,

storage and transport?

3.1.2 Participating any internal/external quality

assessment program?

3.1.3 Are lab supplies (reagents, equipments, ..)

sufficient? If no, what are the needs

3.1.4 Is there guideline for supplies stock

management?





3.1.5.3 Malaria


3.1.5.5 Cholera


3.1.5.7 Typhoid

3.2 Human resources





3.2.5 Others

3.3 Lab Equipment







or fluorescence)


refrigerated)


3.3.7 No. of incubators (specify : standard and CO2)

3.3.8 No. of computers used for lab data

management



technician?

3.4 Biosafety


3.4.2 How many lab staffs were trained on biosafety?




training courses)




conducted?


syndrome)



lower level lab?

3.7.2 Quality assurance program carried out

internal/external?

Others


Is there any policy to refer systematically some specimens

to National Lab? If yes, please specify


(Cross border)


Tel: Fax:

Email:

4 Regional/Provincial level labs

4.1 Lab diagnosis

4.1.1 Are there SOPs for specimen collection,

storage and transport?

4.1.2 Participating any internal/external quality

assessment program?

4.1.3 Are lab supplies (reagents, equipments, ..)

sufficient? If no, what are the needs

4.1.4 Is there guideline for supplies stock

management?





4.1.5.3 Malaria


4.1.5.5 Cholera


4.1.5.7 Typhoid

4.2 Human resources





4.2.5 Others

4.3 Lab Equipment







or fluorescence)


refrigerated)


4.3.7 No. of incubtors (specify : standard and CO2)

4.3.8 No. of computers used for lab data

management



technician?

4.4 Biosafety


4.4.2 How many lab staffs were trained on biosatety?




training courses)




conducted?


syndrome)



lower level lab?

4.7.2 Quality assurance program carried out

internal/external?

Others


Is there any policy to refer systematically some specimens

to National Lab? If yes, please specify

Annex 2

MBDS Lab Survey Agenda

Country Lab Name Lab Type Date Key informant

Cambodia

General information 23, Mar,2009 Choup Sokheng

National Lab National 23, Mar,2009 Ly Sovann

Svay Reang Provincial 25, Mar,2009 Ke Rotha

Takeo Cross Border 27, Mar, 2009 Nuth Sinath

China (Guangxi)

General information 2,Feb, 2009 Liu Huiyang

Guangxi CDC Lab Provincial 2, Feb, 2009 Liu Huiyang

Lin Mei, Gong Jian

Dongxing City CDC

lab

District 3-4, Feb, 2009 Zhao Huaide, Pang

Guoqing

Pingxiang City CDC

Lab

District 5-6, Feb, 2009 Chen Chunmao

China (Yunnan)

General information 9, Feb, 2009 Duan Zhiquan,

Chang Litao

Mengla County

CDC Lab

District 11, Feb, 2009 Yang Shunyun

Luchun County

CDC Lab

District 13, Feb, 2009 Bai Hailin

Ximeng Country

CDC Lab

District 17, Feb, 2009 Cheng Xianjun

Laos

General information 15, Jan, 2009 Thongchanh SISOUK

NCLE National 15, Jan, 2009 Thongchanh SISOUK

Bokeo Province Provincial 16, Jan, 2009 Soupha PANYADA

Champasack

province

Provincial 17, Jan, 2009 Bountiem and

Nanthasan

Kong District Cross Border 18, Jan, 2009 Bountiem and

Nanthasan

Savannakhet

Provincial Hospital

Provincial 19, Jan, 2009 Vatsana

Sepone District Cross Border 20, Jan, 2009 Phanmkla BISY

Borikhamxay Provincial 21, Jan, 2009 Somphone and

Douangngong

Khamkeuth Cross Border 22, Jan, 2009 Somephone

Loungnamtha

province

Provincial 23, Jan, 2009 Sengvong and

Khammone

Myanmar

General information 2. Mar,2009 Maung Maung Kyin

National lab national 2. Mar,2009 Maung Maung Kyin

Mandalay provincial 3. Mar,2009 Khin Aye Win

Ayeyarwady, provincial 4. Mar,2009 Sum Dun

Country Lab Name Lab Type Date Key informant

Pathein

Shan (South),

Taungyi

provincial 5. Mar,2009 Aye Aye Than

Shan (North),

Lashio

Cross border 6. Mar,2009 Ma Mya Win

Shan (East), Muse Cross border 7. Mar,2009 Win Win Myint

Shan (East),

Kyaingtone

Cross border 7. Mar,2009 Kyaw Htun Khaing

Kachin, MyitKyiNa Cross border 8. Mar,2009 Khin Ma Ma

Thailand

Don Tan Hospital

Lab

Cross border 4, Apr, 2009

Mukdahan Hospital Provincial 4, Apr, 2009

NIH National 7, Apr, 2009 Rungreung

General Information 7, Apr, 2009 Rungreung, Sirivan

Chiang Rai Hospital

Lab

Provincial 8, Apr, 2009

Regional Medical

Center

provincial 8, Apr, 2009

Maesai Hospital Lab Cross Border 9, Apr, 2009

Vietnam

General Information 19. Feb, 2009 Tran Nhu Duong

NIHE National 19. Feb, 2009 Nguyen Thanh Thuy,

Tran Nhu Duong

Ha Tinh provincial 20. Feb, 2009 Bui Van Bon

An Giang provincial 21. Feb, 2009 Pham Van Be

Lai Chau provincial 22. Feb, 2009 Nguyen Van Doi

Lang Son provincial 23. Feb, 2009 Trieu Cao tan

Quang Ninh provincial 24. Feb, 2009 Nguyen Van Thich

Quang Tri provincial 25. Feb, 2009 Tran Kim Phung

Annex 3 Assessment Photos

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