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

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

Acknowledgement• SinoeCountyHealthTeam• MinistryofHealth,Liberia• EMORYUniversity• CenterforDiseaseControlandPrevention(CDC)• WorldHealthOrganization(WHO)• AFENET• MedicalTeamsInternational• EmergencyOperationCenter(EOC)/eHealth Sinoe• AllMentors

LiberiaFieldEpidemiology TrainingProgramme(LFETP)LiberiaFieldEpidemiology TrainingProgrammeLFETP)

AFPCaseInvestigationReport

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LiberiaFieldEpidemiology TrainingProgramme(LFETP)

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

LiberiaFieldEpidemiology TrainingProgramme(LFETP)

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