1. Liberia Field Epidemiology Training Programme (LFETP)Liberia Field Epidemiology Training Programme LFETP) FIELD WORK 2 -Expanded Surveillance Report- -Data Quality Problem Analysis- Samuel Jlomu Jee County Surveillance Officer Grand Kru County Health Team 1

2. Liberia Field Epidemiology Training Programme (LFETP) Acknowledgement Ministry of Health, Liberia Field Epidemiology Training Programme, Liberia Emory University Centers for Disease Control and Prevention African Field Epidemiology Network My Mentor – Justin and Joseph WHO County Staff 2

3. Liberia Field Epidemiology Training Programme (LFETP) 3 Expanded Surveillance Report

4. Liberia Field Epidemiology Training Programme (LFETP) Introduction Grand Kru County is located in the south- eastern part of Liberia It has five health districts comprising 18 political districts It has 18 health facilities Population of 66,981 inhabitant This report focuses on key surveillance indicators and required targets

5. Liberia Field Epidemiology Training Programme (LFETP) A total of 306 cases and 16 deaths were reported in EPID WK31-42. – One cluster of AWD cases in week 38 (14 cases) Two water sources had E.coli – All EVD specimens tested for the period were negative – The zero reporting requirements were met by all districts. Summary: (WK 31-42): AWD 24(S), 0(C); EVD 279(S), 0(C) BD 1(S), 0(C); MEA 2(S), 0(C) Disease Summary C = Confirmed; S = Suspected

6. Liberia Field Epidemiology Training Programme (LFETP) Timeliness and Completeness of Reporting by Districts, Grand Kru County, 2015 DISTRICTBEFORE FETPDURING FETP % TIMELINESS WK1-30 % COMPLETENESS WK1-30 % TIMELINESS WK31-42 % COMPLETENESS WK31- 42 BARCLAYVILLE 90100 BUAH 7076.691.6100 DORBOR 56.670.07591.6 JRAOH 90 91.6100 TREHN 83.393.391.6100 COUNTY 77.985.990.098.3 Legend % Cumulative >=80% on time/Complete>=50-79.9% on time/Complete<50% on time/Complete

7. Liberia Field Epidemiology Training Programme (LFETP) Timeliness and Completeness of Reporting by Districts, Grand Kru County, EPI- WK 31-42, 2015

8. Liberia Field Epidemiology Training Programme (LFETP) C=Cases; D=Deaths; CFR=Case Fatality Rate Reported Key Notifiable Diseases, Grand Kru County, 2015 Diseases/Events Cumulative WK31-42Cumulative YTD (WK1-42) CDCFRCD Acute Watery Diarrhea (AWD)24006100 Cholera000000 Bloody Diarrhea (shigella)100200 Measles200500 AFP Suspected000000 Meningitis000000 Susp. Rabies (dog bite)000000 Yellow Fever000000 Lassa Fever000000 Suspected EVD279166781527 Neonatal Tetanus000000 Neonatal Death000000 Maternal Death000000 Total306165.20849526.12

9. Liberia Field Epidemiology Training Programme (LFETP) Trend of Suspected Ebola Virus Disease cases and Deaths in Grand Kru County, EPID WK31-42, 2015.

10. Liberia Field Epidemiology Training Programme (LFETP) Trend of Suspected Acute Watery Diarrhea cases in Grand Kru for EPID WK31-42, 2015

11. Liberia Field Epidemiology Training Programme (LFETP) Recommendation Disease Prevention and Control Department – Regular provision and maintenance of logistics to enhance surveillance – Establish district surveillance teams – Bi-yearly refresher training of surveillance officers at all levels to ensure standard surveillance protocols are used DSO/CSO/DPC – Provide regular feedback – Conduct regular supervision

12. Liberia Field Epidemiology Training Programme (LFETP) Public Health Action Regular feedback at all levels Facilities staff are utilizing available data collection tools to their advantage Improved reporting and documentation of cases at facility and district level Weekly meetings to review surveillance data

13. Liberia Field Epidemiology Training Programme (LFETP) 13 Data Quality Problem Analysis

14. Liberia Field Epidemiology Training Programme (LFETP) Quality surveillance data is key for decision making in public health Periodic data quality audit will improve the quality of data collection and analysis A SWOT analysis was conducted to identify gaps/weakness in the surveillance system Among other problems, data inconsistency was selected for further analysis Introduction

15. Liberia Field Epidemiology Training Programme (LFETP) NO.NAMEPOSITION 1Dr. Augustus G. QuiahCounty Health Officer GKCHT 2Dr. Victor TugumizemuWHO County Coordinator 3Mr. Naod BirhanuWHO Expect Field Epidemiologist 4Mr. Daniel Othiero WereWHO Expect IPC Consultant 5Mr. Saye GbanlekpehWHO National Field Epidemiologist 6Mr. Kay Sieh Smith County Health Services Administrator GKCHT 7Mr. J. Kollie NupoluCounty Clinic Supervisor GKCHT 8Mr. Andrew A. SaahCounty Environment Supervisor GKCHT 9Robertson N. OdarbehNeglected Tropical Diseases Sup. GKCHT 10John K. DoeDistrict Health Officer GKCHT 11Mr. Gebah MannahLab. Technician GKCHT 12.Mr. Kokulo TopahOfficer in Charge B/Ville HC 13.Mr. Samuel J. JeeCounty Surveillance Officer GKCHT Problem Analysis Team Members

16. Liberia Field Epidemiology Training Programme (LFETP) Results – Fishbone Analysis Inadequate supervision

17. Liberia Field Epidemiology Training Programme (LFETP) Monitoring and Supervision was identified as the critical cause Key areas lacking monitoring and supervision include: – Data entry – Data verification – Logistic management – Feedback Factors contributing to limited monitoring and supervision include: Limited bikes, Lack of vehicles, Lack of DSA, regular fuel shortage, limited forms supply, complacency, etc. Critical Cause

18. Liberia Field Epidemiology Training Programme (LFETP) Recommendations Biannual training of surveillance staff on data collection and reporting tools (T) MOH to establish a logistic management plan to ensure adequate supply of logistics at all level (N) Conduct biannual data quality audit (T) Develop appraisal for workers (T) 18

19. Liberia Field Epidemiology Training Programme (LFETP) Public Health Action Taken Scheduled biannual refresher training for surveillance staff DHOs carrying out weekly data verification Regular feedback share through email District surveillance officers (DSOs) have being recruited and listing submitted to national Screeners/registrars are now recording all patient diagnosis