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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)
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)
• 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)
18
LiberiaFieldEpidemiology TrainingProgramme(LFETP)
PublicHealthActionTaken
• Scheduledbiannualrefreshertrainingforsurveillancestaff
• DHOscarryingoutweeklydataverification
• Regularfeedbacksharethroughemail
• Districtsurveillanceofficers(DSOs)havebeingrecruitedandlistingsubmittedtonational
• Screeners/registrarsarenowrecordingallpatientdiagnosis