LiberiaFieldEpidemiology TrainingProgramme(LFETP)LiberiaFieldEpidemiology TrainingProgrammeLFETP)

FIELDWORK2-ExpandedSurveillanceReport--DataQualityProblemAnalysis-

SamuelJlomuJeeCountySurveillanceOfficer

GrandKruCountyHealthTeam

1

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

Acknowledgement• MinistryofHealth,Liberia

• FieldEpidemiologyTrainingProgramme,Liberia

• EmoryUniversity

• CentersforDiseaseControlandPrevention

• AfricanFieldEpidemiologyNetwork

• MyMentor– JustinandJoseph

• WHOCountyStaff2

LiberiaFieldEpidemiology TrainingProgramme(LFETP) 3

ExpandedSurveillanceReport

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

Introduction• GrandKruCountyislocatedinthesouth- easternpartof

Liberia

• Ithasfivehealthdistrictscomprising18politicaldistricts

• Ithas18healthfacilities

• Populationof66,981inhabitant

• Thisreportfocusesonkeysurveillanceindicatorsandrequiredtargets

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

• A totalof306casesand16deathswerereportedinEPIDWK31-42.– OneclusterofAWDcasesinweek38(14cases)• TwowatersourceshadE.coli

– AllEVDspecimenstestedfortheperiodwerenegative– Thezeroreportingrequirementsweremetbyalldistricts.

Summary:(WK31-42):AWD24(S),0(C);EVD279(S),0(C)BD1(S),0(C);MEA2(S),0(C)

DiseaseSummary

C=Confirmed;S=Suspected

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

TimelinessandCompletenessofReportingbyDistricts,GrandKruCounty,2015

DISTRICT BEFOREFETP DURINGFETP%

TIMELINESSWK1-30

%COMPLETENESS

WK1-30

%TIMELINESSWK31-42

%COMPLETENESSWK31-

42BARCLAYVILLE 90 100 100 100

BUAH 70 76.6 91.6 100DORBOR 56.6 70.0 75 91.6JRAOH 90 90 91.6 100TREHN 83.3 93.3 91.6 100COUNTY 77.9 85.9 90.0 98.3

Legend

%Cumulative

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

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

TimelinessandCompletenessofReportingbyDistricts,GrandKruCounty,EPI- WK31-42,2015

0%

20%

40%

60%

80%

100%

120%

BARCLAYVILLE BUAH DORBOR JRAOH TREHN

PERC

ENTA

GEOFRE

PORT

ING

HEALTHDISTRICTS

TIMELINESS COMPLETENESS

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

C=Cases;D=Deaths;CFR=CaseFatalityRate

ReportedKeyNotifiableDiseases,GrandKruCounty,2015

Diseases/Events CumulativeWK31-42 CumulativeYTD(WK1-42)C D CFR C D CFR

AcuteWateryDiarrhea(AWD) 24 0 0 61 0 0Cholera 0 0 0 0 0 0BloodyDiarrhea(shigella) 1 0 0 2 0 0Measles 2 0 0 5 0 0AFPSuspected 0 0 0 0 0 0Meningitis 0 0 0 0 0 0Susp.Rabies(dogbite) 0 0 0 0 0 0YellowFever 0 0 0 0 0 0LassaFever 0 0 0 0 0 0SuspectedEVD 279 16 6 781 52 7NeonatalTetanus 0 0 0 0 0 0NeonatalDeath 0 0 0 0 0 0MaternalDeath 0 0 0 0 0 0Total 306 16 5.20 849 52 6.12

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

TrendofSuspectedEbolaVirusDiseasecasesandDeathsinGrandKruCounty,EPIDWK31-42,2015.

0

10

20

30

40

50

60

31 32 33 34 35 36 37 38 39 40 41 42

#OFC

ASES

EPIDWEEKS

EVDCases EVDDeath

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

TrendofSuspectedAcuteWateryDiarrheacasesinGrandKruforEPIDWK31-42,2015

0

2

4

6

8

10

12

31 32 33 34 35 36 37 38 39 40 41 42

#OFC

ASES

EPIDWEEKS

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

Recommendation• DiseasePreventionandControlDepartment– Regularprovisionandmaintenanceoflogisticstoenhancesurveillance

– Establishdistrictsurveillanceteams– Bi-yearlyrefreshertrainingofsurveillanceofficersatalllevelstoensurestandardsurveillanceprotocolsareused

• DSO/CSO/DPC– Provideregularfeedback– Conductregularsupervision

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

PublicHealthAction• Regularfeedbackatalllevels

• Facilitiesstaffareutilizingavailabledatacollectiontoolstotheiradvantage

• Improvedreportinganddocumentationofcasesatfacilityanddistrictlevel

• Weeklymeetingstoreviewsurveillancedata

LiberiaFieldEpidemiology TrainingProgramme(LFETP) 13

DataQualityProblemAnalysis

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

• Qualitysurveillancedataiskeyfordecisionmakinginpublichealth

• Periodicdataqualityauditwillimprovethequalityofdatacollectionandanalysis

• ASWOTanalysiswasconductedtoidentifygaps/weaknessinthesurveillancesystem

• Amongotherproblems,datainconsistencywasselectedforfurtheranalysis

Introduction

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

NO. NAME POSITION1 Dr.Augustus G.Quiah CountyHealthOfficerGKCHT2 Dr.VictorTugumizemu WHOCountyCoordinator3 Mr.NaodBirhanu WHOExpectFieldEpidemiologist4 Mr.DanielOthiero Were WHOExpectIPCConsultant5 Mr.SayeGbanlekpeh WHONationalFieldEpidemiologist6 Mr.KaySiehSmith CountyHealthServicesAdministrator

GKCHT7 Mr.J.KollieNupolu CountyClinicSupervisor GKCHT8 Mr.AndrewA.Saah CountyEnvironmentSupervisor GKCHT9 RobertsonN.Odarbeh NeglectedTropicalDiseasesSup. GKCHT10 JohnK.Doe DistrictHealthOfficerGKCHT11 Mr.GebahMannah Lab.TechnicianGKCHT12. Mr.KokuloTopah OfficerinChargeB/VilleHC13. Mr.SamuelJ.Jee CountySurveillanceOfficerGKCHT

ProblemAnalysisTeamMembers

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

Results– FishboneAnalysis

-Staffattrition(P)-Lackoftraining(P)-Limitedintegration(T)-Staffshortage(P) -Lowmotivation(P)-Workoverload(N)-Irregularmonitoring/supervision-Aidesasfocalpersons(P)-Lackofdisciplinaryaction(T)-Lackofcommitment(P) -Nobudget(N)-Screenernotrecordingalldx(T)-Registrarnotloggingalldx(T)-Under/overreporting(T) -LackofPrinter(N)-Delayedreporting(T) -Insufficientmotorcycle(N)-Nomobilephone(T) -Lackofvehicle(N)-Insufficientrechargecard(N) -LackofsurveillanceLogbook(T)-Poorfeedback(T) -Lackofstationery(P)-Poor/noGSMnetwork(N)-Regularlackofcartridge(P)-LimitedVHFradios(N)

DATAINCONSISTENCY

ADMINISTRATION

LOGISTIC

STAFF

COMMUNICATION

LEGEND

T=totallywithincontrol

P=partiallywithincontrol

N=Notwithincontrol

CriticalCau

se

Mon

itorin

g/Supe

rvision

Inadequate

supervision

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

• MonitoringandSupervisionwasidentifiedasthecriticalcause

• Keyareaslackingmonitoringandsupervisioninclude:– Dataentry– Dataverification– Logisticmanagement– Feedback

• Factorscontributingtolimitedmonitoringandsupervisioninclude:Limitedbikes,Lackofvehicles,LackofDSA,regularfuelshortage,limitedformssupply,complacency,etc.

CriticalCause

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

Recommendations• Biannualtrainingofsurveillancestaffondatacollectionandreportingtools(T)

• MOHtoestablishalogisticmanagementplantoensureadequatesupplyoflogisticsatalllevel(N)

• Conductbiannualdataqualityaudit(T)

• Developappraisalforworkers(T)

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LiberiaFieldEpidemiology TrainingProgramme(LFETP)

PublicHealthActionTaken

• Scheduledbiannualrefreshertrainingforsurveillancestaff

• DHOscarryingoutweeklydataverification

• Regularfeedbacksharethroughemail

• Districtsurveillanceofficers(DSOs)havebeingrecruitedandlistingsubmittedtonational

• Screeners/registrarsarenowrecordingallpatientdiagnosis