June 29 – Aug 2 (contact follow up stopped)

Kakata Town, CHT Conference Room

CHTSep 17, 2015

� Introduction

� General trend

� Responses

� Opportunities

� Challenges

� Good practices

� Way forewords

Needowein Response Review Sep 17, 2015 2

� Margibi county – is the 3rd hardly hit county in previous outbreaks

� Mamba Kaba district is located in the lower end and have close interaction with Monrovia

� Needowein town, Epi center of the outbreak is a main corridor b/n Monrovia/Airport & Grand Bassa

� Liberia was declared free of EVD for about 7 weeks

� June 29,15 several calls came to M&E from MoH (5 pm)

� Response start quick the same day (with a meeting)

Needowein Response Review Sep 17, 2015 3

Case Estimate date of onset

age Sex Location date tested

Lab-result ETU entry date/date of admission

Date of exit from ETU

Type of exit

On Contact

list?

KK 10-Jun-15 24 M Needowein 01-Jul-15 Positive 01-Jul-15 20-Jul-15 Survivor N

MD 10-Jun-15 9 M Needowein 01-Jul-15Indeterminat

e 01-Jul-15 13-Jul-15 Survivor N

OM 18-Jun-15 19 M Needowein 01-Jul-15Indeterminat

e 01-Jul-15 15-Jul-15 Survivor N

FN 20-Jun-15 27 M Needowein 01-Jul-15 Positive 01-Jul-15 20-Jul-15 Survivor N

AM 21-Jun-15 17 M Needowein 29-Jun-15 PositiveDeath, 28-

Jun-15 NA dead N

MA 06-Jul-15 40 M Needowein 07-Jul-15 Positive 08-Jul-15 ? Survivor Y

GD 06-Jul-15 13 F Needowein 07-Jul-15 Positive 07-Jul-15 ? Survivor Y

Montserrado case

KeK 01-Jul-15 28 FMontserrad

o 12-Jul-15 PositiveDeath, 12-

Jul-15 NA dead Y

• High survival rate (80% for Margibi C., 67% for Liberia)• More case in males than Females • Localized transmission Needowein Response Review Sep 17, 2015

4

Needowein Response Review Sep 17, 2015 5

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17-Jul-15

19-Jul-15

21-Jul-15

23-Jul-15

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Needow

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ep 17, 2015

6

� Investigate, Confirm

� Identify Causative agent (5 - 1st from Swab MRG-0276)

� Emergency & Planning meetings

� District command post

� Contact tracing, ACS, Line listing & Data presentation

� Cross county coordination

� Daily Taskforce & evening data verification meeting (30+ days)

� Early detection & Case Management ETU (CFR-20%)

� Coordination, WASH, IPC,PSS, EPI Surveillance, SM, FS & Log)

� Strengthen Surveillance facility & community

� Reporting & Documentation

Needowein Response Review Sep 17, 2015 7

Emergency Response Meetings

� 2 Emergency meetings held

� The same day 8:30, 29th June – UT Clinic

it was a join meeting (Central level & county team)

� On the 30th of June

Needowein Response Review Sep 17, 2015 8

� Plan meeting was held for 2 days

� Formation/reestablish of clusters (WASH /IPC-RITE & FS /Log, EPI-Sur, PSS, SM

� Each pillar were requested to have their own plan

� Key decisions were passed

Needowein Response Review Sep 17, 2015 9

� Re-initiate the response team

� Quick meeting

� Planning meeting

� Shift command post to District

� Daily coordination meetings

� Command post management

� Documentation and reporting of events

Needowein Response Review Sep 17, 2015 10

� Reactivate Contact tracers, Active case searcher

� gCHVs (ACS/CT) refreshment taring

� Recruited gCHVs from Motorbike riders

� Follow up & trace contacts twice daily

� Set up data flow

Needowein Response Review Sep 17, 2015 11

� Set daily evening Data verification meeting

� Daily field Report from gCHVs

� Early detection of cases (2 cases turn (+) in ETU

� Safe & dignified burial continue

� Swab collection continue Funeral Home

� Extended to HCF

Needowein Response Review Sep 17, 2015 12

� 9 Trucks (648 bags of rice were distributed for HH

� 278 sack of Water supplied

� Adequate transport for all the responses were secured

� Store management

� Flit Management

Needowein Response Review Sep 17, 2015 13

� Ring approach assessment done to 16 HF

� Specific regular risk assessment to the 3 HF

� Strengthen the IPC practice & protocol

� Harmonize RITE & CI Team

� RITE –Training

� IPC –SQS Training Pilot

Needowein Response Review Sep 17, 2015 14

� Distribute Hygiene kits–County

� Water & swage system in the command centers

� Construction of triage at Gates

� Water tankers and maintenance

� Construct temp Latrine for community under close observation

� Swab Collection training for HCW-66

� Swab collection scale up to HCF

� Dislodging of temp. latrine, disinfection of cars & 3 HCFs

Needowein Response Review Sep 17, 2015 15

� 40 SS volunteers were taring

� Team council family resistance to any investigation

� Team carried out counseling for family refuse investigation, hide family member

� Counseling of people under close observation sites

� Supportive in all mater related to care and support

Needowein Response Review Sep 17, 2015 16

� Engage community at all level

� Engage leaders thorough meetings

� Work with Community, youth, women & religious leaders & Traditional healers)

� Train all the volunteer from 6 zone

� Inter personal communication House to House

� Use local radio station

Needowein Response Review Sep 17, 2015 17

� Chief, religious leaders, formal leaders - were committed on assisting the process

� Motorbike riders association leaders support

� Liberian Police

� 500 (+) volunteers were participated

� Companies - Firestone

Needowein Response Review Sep 17, 2015 18

� Easy accessible area

� Only One Community (Localized Outbreak)

� Partners willing to support

� Near Monsorado (Coordination between counties)

� Community cooperative and involved

� Good communication

� Motor Bock association with good record system

Needowein Response Review Sep 17, 2015 19

� Individual denial

� Data flow first few days

� Change of pyt rate

� Rain

� Getting the source of Infection

Needowein Response Review Sep 17, 2015 20

� Decision to bring Command post to District

� Decision not use force for resistance

� Data Quality (at all level, suspected case report, & surveillance)

� Community involvement at all level

(quarter leaders, workshop for 220 leaders)

� Support from and coordination with Monsorado team (more & more investigation in the field)

� Higher level commitment –MoH, WHO & Partners

� Pool of resources for achieving common Goal

� Motorbike riders – is about best example for decision-making / leadership (CSO have great role on this)

Needowein Response Review Sep 17, 2015 21

� Main lesson learned is the confidence “we can interrupt virus circulation”

In Addition

� Cohesiveness b/n partners & county

� Better planning

� Improve surveillance (both blood and swab)

�Capacity building of Health facilities (both health provider & the institute)

� Vigilant for 42 days plus the 90 days

� Proper Introduction of IDSR (initial phase)

� Close coordination with survivorsNeedowein Response Review Sep 17,

2015 22