1. FETP PROJECT PRESENTATION Leela K. Zaizay Public Health Training Lead November 2, 2015

2. Introduction Liberia: – Located in West Africa – 15 counties – 91 districts – 718 health facilities Surveillance indicators from epi-week 31– 42 Problem analysis: why counties do not get feedback from the lab regarding priority diseases

3. Cumulative timeliness and completeness of Counties in Liberia, Epi Week 31 to 42, 2015

4. Summary of Notifiable Diseases, EPI wks 31 -42, 2015 Liberia DiseaseCumulative: Week 31 – 42, 2015 CasesDeathsCase Fatality Rate Acute Flaccid Paralysis (AFP)1000% Yellow Fever100% Lassa Fever300% Neonatal Tetanus11100% Cholera000% Acute Watery Diarrhea2,34500% Meningitis300% Measles39220.5% Bloody Diarrhea500 0% Human Rabies2700% Suspected VHF/EVD5,893(S) 00% Neonatal Death6 Maternal Death23

5. Trend for suspected EVD Epi Wks 31 to 42, 2015 in Liberia Increase due to the recent changes in the standard case definitions of EVD.

6. Distribution of suspected EVD cases and unexplained death per county CountyEVD suspected casesUnexplained death Gbarpolu30611 Montserrado34285 Bomi44238 Bong65769 Nimba1,351116 Maryland10025 G. Bassa1,01559 River- cess25113 Grand Kru27916 Grand Gedeh1,6765 Sinoe38242 Margibi1,073121 Lofa419130 Grand Cape Mount87056 River- Gee20631

7. Trend for suspected Measles Epi Wks 31 to 42, 2015 Liberia

8. Discussion A total of 8,754 immediately notifiable diseases/events were identified with 3 deaths (0.05%). Suspected cases of Ebola Virus Disease (EVD) were the highest (5,893 ) recorded However, there was no confirmed case of EVD/ VHF during this period. Followed by cases of Acute Watery Diarrhea (2,345) And Measles (392) Timeliness of reporting from counties was 93% with 100% completeness of reporting

9. Intervention Roll out of IDSR training for health workers in the county Polio immunization and deworming campaign in the 15 counties Suspected measles outbreak investigation in counties with cases

10. IDSR county TOT Training

11. Poor feedback of lab confirmation of priority diseases Poor laboratory services: Laboratory service is a critical component of Liberia’ health system It is central in disease diagnosis, prevention, surveillance, treatment, and outbreak investigations However, Liberia laboratory service is poor and needs to be strengthened All the counties complained of not getting feedback about priority disease from the labs

12. Problem Analysis: Fish Bone Critical Cause: Poor sample collection and filling of case- based forms Labs unable to work on poor samples/trace origin of the sample for feedback

13. Poor feedback of lab confirmati on of priority diseases Administration Staff Logistics Environment Limited number of trained staff (P) Inadequate sample collection materials (P) Delay in picking samples (P) Unknown pick up sites (P) No focal person at some pickup sites (P) Most clinicians who collect samples have not been trained (P) Inadequate knowledge on use of case base form (P) Poor coordination between riders of health and County health team (P) Delay in hazard payment of lab technicians (N) Inadequate training for lab staff (P) Inadequate laboratory supplies (N) Limited lab for priority diseases (N) Bad road conditions (N) Poor network coverage (N) Un sensitized communities about disease control and prevention (P) Hard to reach counties and districts (N) Poor coordination between communities and HF (P) Limited case-based forms at the district and county levels (T) Inadequate sample collection materials (p) Inadequate laboratory supplies (N) Inadequate reagent (P) Expired reagent (P) Poor sample collection and filling of case-based forms

14. Recommendation IDSR training should be conducted Strengthen supervision at all levels Adequate provision of case base forms Provision of special training for laboratory technicians Continuous refresher training of lab technicians Adequate supplies of laboratory materials Riders of health to provide TOR to county health teams

15. Acknowledgement I wish to acknowledge the invaluable guidance and counsel accorded to me by Dr. Maame Also special thanks to Emory and AFENET, for all the support given during this period Finally, special gratitude to MoH in partnership with CDC for this great opportunity awarded me May God reward you all

16. Thank You for Listening