Presentation on Projects 1 and 2 of Basic Field...
Transcript of Presentation on Projects 1 and 2 of Basic Field...
LiberiaFieldEpidemiology TrainingProgramme(LFETP)LiberiaFieldEpidemiology TrainingProgrammeLFETP)
Presentation on Projects 1 and 2 ofBasic Field Epidemiology Training
Program, LiberiaPrepared By:
Benjamin F. KarmoDisease's Surveillance Officer
Sinoe County Health Team
November 2, 2015
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Acknowledgement• SinoeCountyHealthTeam• MinistryofHealth,Liberia• EMORYUniversity• CenterforDiseaseControlandPrevention(CDC)• WorldHealthOrganization(WHO)• AFENET• MedicalTeamsInternational• EmergencyOperationCenter(EOC)/eHealth Sinoe• AllMentors
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AFPCaseInvestigationReport
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Introduction§ Sinoe county is located in the southeastern part of
Liberia, shares border with Grand Gedeh, Grand Kru, River Gee and River Cess Counties
§ Has population of 119,668 inhabitants§ Has 10 health districts with 34 health facilities (1
Hospital and 33 Clinics).§ About 90% of the facilities with single clinician§ Active Surveillance is one of the most successful
method for controlling and managing diseases of public health concern
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Methodology§ On June 20th 2015, County health team investigated a
suspected case of Acute Flaccid Paralysis reported by the district mobilization coordinator (DMC) the day before in Butaw
§ Materials for investigation:§ AFP case investigation forms, specimen collection
cups and specimen carrier with solid ice pads
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Methodology § Case Definition:
§ Any child < 15years from Butaw with a sudden onset of paralysis (AFP) either in the arms or legs, or a person of any age in whom the clinician suspected polio from June 19 to October 3, 2015
§ First visit was conducted on 20th June, 2015§ the child was examined and two (2) stool specimens were
collected within 24 hours§ Active case search was done
§ 60 day follow-up visit was conducted on 3rd October, 2015§ the child was examined and history taken from the grand
mother
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The Results
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ExaminationduringfirstvisitJune20,2015
• History of pulmonary tuberculosis with uncompleted treatment
• Poor general condition, alert, cooperative with normal speech
• Slightly pale conjunctivae• Lungs normal on auscultation• Severe deformity of the spine at the level T6-T7• Unable to stand by herself or with support• Muscle tone: Spasticity on lower extremities with deficit
sensation. Normal on upper extremities
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ExaminationduringthesecondvisitOctober3,2015
• Good general condition, alert, cooperative with normal speech
• Pink conjunctivae• Lungs normal on auscultation• Severe deformity of the spine at the level T6-T7 stay
present• Muscle tone: Spasticity on lower extremities with intact
sensation. Normal on upper extremities• Able to stand by support and take few steps
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Discussion/Conclusion
• Although the patient presented with – muscular deficits with deficit sensation during first visit, – however intact sensation during the second visit
suggested– the child was in the spinal shock during the first visit
and not in a true acute flaccid paralysis.• In conclusion, the cause of the paralysis was probably
acute spinal cord compression due to tuberculosis spondylitis – Other etiologies like, cancer, fungal infection and
osteomyelitis of the spine should also be considered as differential diagnosis
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PUBLICHEALTHACTION
• A wheel chair was provided to the child by the County Health Team
• Encouraged to go to F. J. Grante Memorial Hospital for further investigation and restart TB treatment
• Physiotherapy is also being performed at home
– INVESTIGATORS• John Doedeh, CHO; Benjamin F. Karmo, CSO;
Jeremiads Naiene, WHO; Jemal Hassan, WHO; George Sie Williams, WHO; Daddy Nyenswah, EOC/E-Health
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Expanded Surveillance Reports(Wk31—Wk42), 2015
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Summary
• Summary Reports on IMRD: 630 Suspected Cases• 382 suspected EVD cases reported• 220 suspected Acute watery diarrhea cases reported• 14 suspected Measles cases reported• 12 suspected Bloody diarrhea cases reported• 2 Maternal death cases reported
• All specimen transported to the Reference Lab. returned negative for EVD (382) and Measles (14)
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Fig 1: Reporting quality( Week 31-42),2015, Sinoe County
Districts WK-31
WK-32
WK-33
WK-34
WK-35
WK-36
WK-37
WK-38
WK-39
WK-40
WK-41
WK-42
%Cumulativewk31-42
GREENVILLE
T T T T T T T T T T T T100%
PYNETOWN
T T T T T T T T T T T T100%
TARJUOWON
T T T T T T T T T T T T100%
JEDEPO
T T T T T T T T T T T T100%
BUTAW
L T T T T T T T T T T T92%
DUGBE
L T T T T T T T T T T T92%
TARSUE
T T NR T T T T T T T T T92%
KPANYAN
T L NR T T T T T T T T T83%
JAEDAE
T L L T L T T T T T T T75%
GBLONEE
T L NR T L T T T T T T T75%
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Legend
ThisWeek ONTime
T
Late
L
NoReportreceivedNR
%Cumulative
>=80%
Ontime
>=50-79.9%
Ontime
<50%ontime
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Figure2:Summaryofkeyprioritydiseases(week31-42,2015),Sinoe County
Diseases CurrentWeek31—Week42Cases Deaths CasefatalityRate
Acute FlaccidParalysis(AFP) 0 0 0%
YellowFever(YF) 0 0 0%
Lassa Fever(LF) 0 0 0%
Neonatal Tetanus(NNT) 0 0 0%
Cholera (CHO) 0 0 0%
AcuteWateryDiarrhea(AWD) 220 0 0%
Meningitis (MEN) 0 0 0%
Measles (MEA) 14 0 0%
BloodyDiarrhea(BD) 12 0 0%
Human Rabies(HR) 0 0 0%
SuspectedEVD 382 42 10.9%
Neonatal Death(ND) 0 0 0%
Maternal Death(MD) 2
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TimelinessofreportinginSinoeCountyofHealthDistricts,Epiweeks31- 42,2015
0%
20%
40%
60%
80%
100%
120%
Percen
tageTim
eliness
HealthDistricts
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Figure 3: Trend of suspected cases of Acute watery diarrhea in Sinoe County from Epi- week 31-42, 2015
0
5
10
15
20
25
30
Wk31 Wk32 Wk33 Wk34 WK35 Wk36 Wk37 Wk38 Wk39 Wk40 Wk41 Wk42
#0fsu
spectedcaseso
fAWD
Epi-week31—week42
Cases
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Figure4:TrendofsuspectedcasesanddeathsofEVDinSinoeCountyfromEPIweek31--week42,2015
0
10
20
30
40
50
60
w31 w32 w33 w34 w35 w36 w37 w38 w39 w40 w41 w42
#ofsuspe
cted
casesofEVD
Epiweek31—week42
Cases
Deaths