The Ebola outbreak in West Africa: a story of related public health challenges and a pointer to solutions to mitigate the inevitable next outbreak

Integrated disease surveillance and response implementation in Liberia, findings from a data quality audit, 2017

Introduction

in spite of the efforts and resources committed by the division of infectious disease and epidemiology (DIDE) of the national public health institute of Liberia (NPHIL)/Ministry of health to strengthening integrated disease surveillance and response (IDSR) across the country, quality data management system remains a challenge to the Liberia NPHIL/MoH (Ministry of health), with incomplete and inconsistent data constantly being reported at different levels of the surveillance system. As part of the monitoring and evaluation strategy for IDSR continuous improvement, data quality assessment (DQA) of the IDSR system to identify successes and gaps in the disease surveillance information system (DSIS) with the aim of ensuring data accuracy, reliability and credibility of generated data at all levels of the health system; and to inform an operational plan to address data quality needs for IDSR activities is required.

Methods

multi-stage cluster sampling that included stage 1: simple random sample (SRS) of five counties, stage 2: simple random sample of two districts and stage 3: simple random sample of three health facilities was employed during the study pilot assessment done in Montserrado County with Liberia institute of bio medical research (LIBR) inclusive. A total of thirty (30) facilities was targeted, twenty nine (29) of the facilities were successfully audited: one hospital, two health centers, twenty clinics and respondents included: health facility surveillance focal persons (HFSFP), zonal surveillance officers (ZSOs), district surveillance officers (DSOs) and County surveillance officers (CSOs).

Results

the assessment revealed that data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the subnational level. The findings indicated the following: 23% (7/29) of health facilities having dedicated phone for reporting, 20% (6/29) reported no cell phone network, 17% (5/29) reported daily access to internet, 56.6% (17/29) reported a consistent supply of electricity, and no facility reported access to functional laptop. It was also established that 40% of health facilities have experienced a stock out of laboratory specimens packaging supplies in the past year. About half of the surveyed health facilities delivered specimens through riders and were assisted by the DSOs. There was a large variety in the reported packaging process, with many staff unable to give clear processes. The findings during the exercise also indicated that 91% of health facility staff were mentored on data quality check and data management including the importance of the timeliness and completeness of reporting through supportive supervision and mentorship; 65% of the health facility assessed received supervision on IDSR core performance indicator; and 58% of the health facility officer in charge gave feedback to the community level.

Conclusion

public health is a data-intensive field which needs high-quality data and authoritative information to support public health assessment, decision-making and to assure the health of communities. Data quality assessment is important for public health. In this review completeness, accuracy, and timeliness were the three most-assessed attributes. Quantitative data quality assessment primarily used descriptive surveys and data audits, while qualitative data quality assessment methods include primarily interviews, questionnaires administration, documentation reviews and field observations. We found that data-use and data-process have not been given adequate attention, although they were equally important factors which determine the quality of data. Other limitations of the previous studies were inconsistency in the definition of the attributes of data quality, failure to address data users' concerns and a lack of triangulation of mixed methods for data quality assessment. The reliability and validity of the data quality assessment were rarely reported. These gaps suggest that in the future, data quality assessment for public health needs to consider equally the three dimensions of data quality, data use and data process. Measuring the perceptions of end users or consumers towards data quality will enrich our understanding of data quality issues. Data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the sub national level.

Role of contact tracing in containing the 2014 Ebola outbreak: a review

BACKGROUND

The 2014 outbreak of Ebola virus disease which emerged in the month of March in the year 2014 in Guinea has been declared as a public health emergency of international concern.

OBJECTIVES

The objectives of the review article are to assess the role of contact tracing in the Ebola outbreak and to identify the challenges faced by the health workers while performing contact tracing.

METHODS

An extensive search of all materials related to the Ebola outbreak and contact tracing was carried out in PubMed, Medline, World Health Organization website and Google Scholar search engines. Keywords used in the search included Ebola virus disease, West-Africa, contact tracing, World Health Organization. Overall 60 articles were selected and included in the discussion.

RESULTS

Contact tracing is an important strategy in epidemiology and refers to the identification and diagnosis of those individuals who have come in contact with an infected person. It ultimately aims to reduce the time span required to detect and treat a case of an infectious disease and hence significantly minimize the risk of transmission to the subsequent susceptible individuals. In-fact, contact tracing continues to remain an important measure, as it aids the epidemiologist in containing the infection.

CONCLUSION

The strategy of contact tracing has a great potential to significantly reduce the incidence of cases of Ebola virus disease. However, its success is eventually determined by the level of trust between the community and the public health system and the quality of the diagnostic & treatment services.

Training Ghanaian frontline healthcare workers in public health surveillance and disease outbreak investigation and response

Introduction

Beyond initial formal academic education, the need for continuous professional development through in-service workforce capacity improvement programs that are aimed at enhancing knowledge and skills of public healthcare workers has assumed immense priority worldwide. This has been heightened by the on-going Ebola Virus Disease outbreak, which is exposing the weak public health systems in West Africa. In response to this need, the Ghana Field Epidemiology and Laboratory Program organized a short-course for frontline health workers in the Greater Accra region of Ghana in order to augment their surveillance and outbreak response capacity.

Methods

Human and veterinary health workers were trained using Field Epidemiology and Laboratory Training Program short course model. A two-week didactic course was conducted with a 10-week field placement. Evaluation of the course was done by assessment of participants’ outputs during the training as well as pretest and posttest methods.

Results

A total of 32 frontline health workers from both the human and veterinary health services benefited from the two-week initial training of the 12-week course. There was a significant gain in knowledge by the participants after the training course. Participants developed concept papers and implemented their fieldwork projects. Overall assessment of the workshop by the participants was very good.

Conclusion

Capacity of the health workers has been improved in the area of public health surveillance, outbreak investigation and response. We recommend a scale-up of this training course to other regions.

West African Ebola epidemic: lessons and a call to action

The current Ebola epidemic in West Africa is unprecedented in terms of magnitude and spread. A year after the index case had been identified in a remote village in Guinea, over 17,000 cases and 6,000 deaths were reported in Africa and beyond. Many interventions have been implemented but the outbreak rages on. This paper examines key gaps in the interventions and calls for evidence-based actions to reverse the trend and prevent future epidemics of this proportion.