The Third Emmet Adolphus Dennis National Scientific Conference Proceedings

National Public Health Institute of Liberia¹, Liberia Field Epidemiology Training Program^2,&

 

¹National Public Health Institute of Liberia, Monrovia, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia

 

 

^&Corresponding author
Chukwuma Umeokonkwo, African Field Epidemiology Network, P. O. Box 12874, Kampala, Uganda. dchukwuma@afenet.net

 

 

 

 

 

 

Kemah Vivian Lymas-Tegli^1,&, John Doe¹, Lily Sanvee-Blebo¹, Peter Adewuyi¹, Himiede Sesay¹, Maame Amo-Addae¹, Obafemi Babalola¹

¹Liberia Field Epidemiology Training Program, Monrovia Liberia

^&Corresponding author: Kemah Vivian Lymas Tegli, Liberia Field Epidemiology Training Program, Monrovia, Liberia.

 

Email address: vivianlymas29@gmail.com

Background: During the second and third waves of COVID-19 in Liberia, the Government of Liberia made non-adherence to COVID-19 preventive measures a public health offense. Poor knowledge of these measures was posited as a contributor to low compliance. We estimated the level of knowledge of COVID-19 preventive measures among students of tertiary institutions in Liberia and assessed factors associated with good knowledge.

 

Methods: We applied an analytical cross-sectional design. We enrolled a representative sample of 818 students from the 53 tertiary institutions in Liberia using multi-stage sampling. Demographics and knowledge of COVID-19 prevention data were collected using a structured questionnaire. Participants who answered ?5 out of 8 questions correctly were categorized as having good knowledge of COVID-19 preventive practices. We estimated the proportion of respondents with good knowledge, the measures they were aware of, and factors associated with good knowledge of COVID-19 preventive measures in a multiple logistic regression at a 5% level of significance. Written informed consent was obtained from the participants.

 

Results: The mean age of respondents was 21.8+1.9 years. Overall, 36.4% (298/818) of the students had good knowledge of COVID-19 preventive measures. The commonest known measures were hand washing with soap and water 88.6% (725/818), wearing a face mask 87.7% (717/818), and social distancing 60.8% (497/818). The use of vaccines was the least measure known among the students, 41.9% (343/818). Students with good knowledge were more likely to practice handwashing frequently (aOR:4.3, 2.9-6.2, p <0.001), and avoid handshaking (aOR:3.5, 2.3-5.5, p<0.001). However, avoiding crowds (aOR:1.4, 0.9-2.0, p=0.1185) and use of nose masks (aOR:1.5, 0.9-2.2, p=0.0787) were not significantly associated with good knowledge

 

Conclusion: Knowledge of COVID-19 preventive measures did not translate into adherence to all COVID-19 protocols among tertiary students in Liberia. Based on our findings and recommendations to the Ministry of health, efforts were targeted at risk communication among this group.

 

Keywords: COVID-19, Prevention, Knowledge, Liberia

 

 

Dauda Kamara^1,2,&, Doris Bah², Momodu Sesay², Anna Maruta³Bockarie Pompey Sesay³Bobson Derrick Fofanah³Ibrahim Franklyn Kamara³, Joseph Sam Kanu^4,5, Sulaiman Lakoh^5,6,7, Bailah Molleh⁷Jamie Guth⁸, Karuna Sagili⁹, Simon Tavernor¹⁰, Ewan Wilkinson¹¹

¹Water, Sanitation, and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown, Sierra Leone, ²Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown, Sierra Leone, ³World Health Organization (WHO) Country Office, 21A/B Riverside Drive, Freetown, Sierra Leone, ⁴National Disease Surveillance Program, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Cockerill, Wilkinson Road, Freetown, Sierra Leone, ⁵Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone, ⁶Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone, ⁷Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown, Sierra Leone, ⁸Global Health Connections, Center Barnstead, New Hampshire 03225, United States of America (USA), ⁹International Union Against Tuberculosis and Lung Disease (The Union), India, ¹⁰School of Medicine, University of Liverpool, Liverpool, United Kingdom, ¹¹Institute of Medicine, University of Chester, Countess Way, Chester, CH2 1BR, England, United Kingdom

^&Corresponding author: Dauda Kamara, Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown, Sierra Leone.

 

Email address: dkamara@mohs.gov.sl

Introduction: Water quality surveillance can help to reduce water borne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources.

 

Methods: In this cross-sectional study, we collected water samples from 15 standpipes and five wells and measured the physicochemical and bacteriological water quality and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and the wet season 2021.

 

Results: All water sources had a low level of E.coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E.coli. There was no antimicrobial resistance detected in the E.coli tested. The nitrate level exceeded the WHO recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% v 7%). The level of water contamination is concerning.

 

Conclusion: We suggest options to reduce E.coli contamination, and further research is required to identify where contamination in standpipes is occurring.

 

Keywords: Clean water; standpipes; community wells; water contamination; nitrates; public water company; Structured Operational Research Training Initiative (SORT IT); operational research.

 

 

Karim Darboe^1,4,&, Momodou Lamin Waggeh^3,4, Abdoulie Taal^3,4, Baba Ceesay^3,4, Peter Adewuyi⁴

¹Regional Health Directorate, Western, Ministry of Health, Banjul, Gambia, ²Sheikh Zayed Regional Eye Care Hospital, Kanifing, Gambia, ³Epidemiology and Disease Control Unit, Ministry of Health, Banjul, Gambia, ⁴Gambia Field Epidemiology Training Program (GamFETP), Banjul, Gambia

^&Corresponding author: Karim Darboe, Regional Health Directorate, Western, Ministry of Health, Banjul Gambia

 

Email: kdarboe80@gmail.com

Background: IDSR strategy was adopted in The Gambia in 1998, yet gaps still remained in its proper functioning. Western 2 is one of the 7 health regions in The Gambia where IDSR is being practiced. The objectives of the evaluation are to assess whether the system is meeting its objectives and to assess some attributes such as usefulness, simplicity, flexibility, acceptability, data quality and timeliness of the surveillance system in WR 2 health region of the Gambia.

 

Method: A convenience sampling was done, and we interviewed 64 healthcare workers in 12 health facilities in all 8 districts of the region. Quantitative methods were used to assess the performance of each attribute.

 

Results: Fifty-five percent (35/64) of the respondents affirmed that the IDSR system is simple and 87% of respondents spent not more than an hour on IDSR activities. The system is flexible as Covid-19 has been introduced in routine reporting, and all suspected cases are reported through a regional WhatsApp platform. Less than 50% (30/64) had good knowledge of IDSR implementation. Awareness of IDSR strategy, PHOs had good knowledge (100%) compared to other cadres. In the last 3 months, all suspected cases detected were reported within 24 hours. The completeness of variables in the case-based form was 80%, and laboratory feedback and completeness were 35%. Though data reporting was acceptable, only 22.9% (11/48) of the facilities analyzed surveillance regularly.

 

Conclusion: The IDSR surveillance system is simple, flexible, and acceptable. Incomplete data recording and reporting and lack of analysis of surveillance data were the major challenges. We have provided mentorship at the health facilities to encourage data analysis.

 

Keywords: Integrated disease surveillance and response (IDSR), Western 2, Public Health Officers, Health Care Workers.

 

 

Josephine Amie Koroma^1,&, Adel Hussein Abdallah², Jean Leonard Hakizimana², Amara Alhaji Sheriff², Kassim Kamara², Isha Sesay², Gebrekrstos Negash Gebru³

¹National Tuberculosis Leprosy Program, Ministry of Health and Sanitation, Freetown, Sierra Leone

¹National Tuberculosis Leprosy Program, Ministry of Health and Sanitation, Freetown, Sierra Leone, ²Sierra Leone Field Epidemiology Training Programme, Freetown, Sierra Leone, ³African Field Epidemiology Network, Freetown, Sierra Leone (AFENET)

^&Corresponding author: Josephine Amie Koroma, National Tuberculosis Leprosy Program, Ministry of Health and Sanitation, Freetown, Sierra Leone

 

Email: josephineamie22599@gmail.com

 

Background: Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem globally. The tuberculosis rate in Sierra Leone is 298 per 100,000 population, and it is considered a high tuberculosis burden country. In Sierra Leone, there is limited information regarding MDR-TB treatment outcomes, especially those exacerbated by COVID-19. We identified factors associated with unfavorable treatment outcomes among MDR-TB patients in Sierra Leone.

 

Methods: We conducted a cross-sectional study to analyse hospital-based MDR-TB data for 2017 to 2021. Demographic, clinical, and treatment outcome data were abstracted from the main MDR-TB referral hospital database. We defined unfavorable outcomes as patients who died, were lost to follow-up, or defaulted. We calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify predictors of MDR-TB treatment outcomes.

 

Results: Between 2017 and 2021, 628 MDR-TB patients were reported at Lakka hospital; 441 (71%) were male, with a median age of 34 years (range: 1-70). Clinically, 21 % of the 628 MDR-TB patients were HIV-positive, and 413 were malnourished (66 %). Seventy per cent (440) of MDR-TB patients were receiving tuberculosis treatment. The majority of patients, 457 (73 %), were treated with the short treatment regimen, and 126 (20 %) experienced unfavourable outcomes. Age group less than 20 years (aOR=5.08; CI:1.87 – 13.82), tuberculosis retreatment (aOR=3.23; CI:1.82 – 5.73), age group 21- 45 years (aOR=2.22; CI:140 – 3.54), HIV (aOR=2.16; CI:1.33 – 3.53), malnourishment (aOR=1.79; CI:1.12 – 2.86).

 

Conclusion: This analysis found a high proportion of unfavorable treatment outcomes among MDR-TB patients in Sierra Leone. Malnourishment, TB retreatment, HIV co-infection, and young age were predictors of unfavorable MDR-TB treatment outcomes. Increasing patients' awareness, mainly among the youngest, heightens treatment adherence and HIV monitoring can reduce adverse treatment outcomes in Sierra Leone and other Sub-Saharan African countries.

 

Keywords: Multidrug-resistant tuberculosis, unfavorable treatment outcomes, Sierra Leone

 

 

Abass Kamara^1,2,&, Joel Mansaray^1,2, Philip Gevao^1,2, Binta Bah^1,2, Elduma Adel^1,3, Mohamed Vandi², Gebrekrstos Negash Gebru^1,3

¹Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone, ²Ministry of Health and Sanitation, Freetown, Sierra Leone, ³African Field Epidemiology Network, Freetown, Sierra Leone

^&Corresponding author: Abass Kamara, Ministry of Health and Sanitation, Freetown, Sierra Leone

 

Email: abassskamara1994@gmail.com

Background: Measles, a vaccine-preventable disease, is one of the fourth leading causes of death among children under five in Africa. Studies showed that COVID-19 has affected routine health services including essential immunization services in Sierra Leone. The measles coverage in 2019 was 95% and drops to 87% in 2020. On October 19, 2021, three children with possible measles were reported to the Kambia District Surveillance Unit. We investigated to confirm the diagnosis, identify the source, and mode of transmission, and instituted control and prevention measures.

 

Methods: We defined a case as any resident of Magbema chiefdom, Kambia district with fever and rash, cough, runny nose, or conjunctivitis from 1st October to 30th November 2021. We interviewed caregivers and community people to find the source of the infection. We checked vaccination and vitamin A status inpatient register, under-5 cards. Using the case investigation form, we collected patient demographic, clinical, travel, and contact data. We conducted active case searches in communities and health facilities. We collected blood samples to test for measles antibodies and isolated case patients to prevent further transmission.

 

Results: A total of 60 measles cases were reported. Five were laboratory confirmed and fifty-five by epidemiological link. The median age was 4 years (range: 4 months – 23 years). Females made up 67% of the cases. No travel history was reported. Bamoi Luma's Measles-Rubella vaccination coverage was 28%. In the past 6 months, only 20 patients (12%) received measles vaccination and vitamin A supplementation.

 

Conclusion: A measles outbreak was confirmed and more cases were found in the community, indicating that community transmission was ongoing. Factors contributing to this measles outbreak include low vaccination coverage, the implication of COVID-19 pandemic impact on routine health services, and home contact with measles cases. We recommend routine measles vaccination, delivering vitamin A supplementation, and intensifying community sensitization on measles prevention.

 

Keywords: Measles outbreak, COVID-19, Routine immunization, Kambia, Sierra Leone

 

 

Kokulo Franklin^1,&

¹Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia

^&Corresponding author: Kokulo Franklin, Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia.

 

Email: KFranklin@prevailcr.org

Background: The aim of nationalizing ethics and regulatory documents is to ensure that the internationally accepted benchmarks for research on humans are included in local guidelines, policies, and laws. However, assessing the success of this effort, i.e., the presence of acceptable benchmarks in national documents, can oftentimes be challenging because of the variety of benchmarks across the different documents. It was in this light that Emanuel et al proposed the eight (8) overarching principles and 31 different benchmarks by which clinical research, especially in resource-limited settings, can be acceptable. While these benchmarks have been used to evaluate different aspects of clinical research, including responses from ethics committees, there is a paucity of records linking them to the evaluation of national ethical-legal documents. This study sought to document the specific protective benchmarks that are enshrined in the documentary framework supposedly governing health research in post-Ebola Liberia.

 

Method: Using a modified version of the Emanual et al framework developed for this study, a total of 15 different national ethical-legal documents (guidelines, policies, procedures, and regulations) were analyzed to assess the presence or absence of 36 contextualized benchmarks.

 

Results: The documents were found to contain most of the benchmarks, a total of 29 out of the 36. Benchmarks centering on contextually relevant issues (post-trial access, ancillary care, and consent in local languages) were found to be evidently absent or only fleetingly mentioned.

 

Conclusion: Whereas the Liberian ethical-legal documents do contain a vast majority of the acceptable benchmarks for the governance of clinical research, there appears to be a need for depth – as some of these benchmarks are only fleetingly mentioned; and contextualization, with some key issues relevant to research in resource-limited settings being absent.

 

Keywords: Ethics, Research, Liberia, Benchmark

 

 

Kura Joof^1,3,&, Baba Ceesay^2,3, Peter Adewuyi³, Buba Manjang⁴, Abdoulie Jarju¹, Lamin Jobarteh¹

¹Regional Health Directorate, North Bank East, Ministry of Health, Banjul, Gambia, ²Epidemiology and Disease Control Unit, Ministry of Health, Banjul, Gambia, ³Gambia Field Epidemiology Training Program, Banjul, Gambia, ⁴Directorate of Public Health Services, Ministry of Health, Banjul, Gambia

^&Corresponding author: Kura Joof, Regional Health Directorate, North Bank East, Ministry of Health, Banjul, Gambia

 

Email: kurajoof@gmail.com

Introduction: Diarrhoea With Blood (DWB) is defined as diarrhoea with visible or microscopic blood in the stool. In the Gambia, diarrhoea with blood is one of the immediately reportable diseases that is reported weekly and it is diagnosed clinically. We conducted this study to determine the incidence of DWB among patients and missed outbreaks in the North Bank East Health Region from 2017 to 2021.

 

Methods: We reviewed outpatient, and inpatient registers in all 7 health facilities in the region. Descriptive data were summarized into frequencies and proportions and displayed in charts. We calculated the Cumulative Sum (CUSUM2) for missed outbreaks. Microsoft Excel was used for data entry and analysis.

 

Results: Of the 794 patients with Diarrhoea With Blood, the median age was 2.2 (0.1to 99) years. 379(52.3%) of patients were females and 786(98.9%) were Gambians nationals. Age group 1-4 years had 422(53.0%) cases, while Upper Badibou recorded 468(58.9%) cases. Most of the cases were registered in 2019, 235(33.6%). Peak periods for DWB were in July, August, and September. The regional incidence rate was 58 cases per 10,000 population while incidence rate among the Under 5year children was 251 per 10,000 population. Upper badibou the district has the higest incidence of 81 per 10,000 population. A total of 25 missed outbreaks during the period under reivew.

 

Conclusion: About half of the DWB was among children ≤2 years, incidence rate was highest among under 5 children, and there were 3 peak periods during the rainy season. Oubreaks were missed because there is no national thresholds for DWB. The ministry of health and partners have commenced calculating thresholds for DWB to include in IDSR Guidelines 3.0. We recommend further studies to determine causative organisms to enhance treatment of cases.

 

Keywords: Diarrhoea with Blood, surveillance data, Patient, Missed outbreaks, North Bank East

 

 

Bubacarr Jallow^1,2,&, Adebayo Peter Adewuyi¹, Amadou Woury Jallow³, Joseph Jatta⁴, Ebrima Jallow³, Basiru Drammeh⁵, Sulayman Keita⁶, Ebrima Colley⁷, Ivan Coker⁸, Burama Badjie⁹, Mustapha Bittaye¹⁰

¹Gambia Field Epidemiology Training Program, Banjul Gambia, ²3Epidemic and Disease Control Unit, Ministry of Health, Banjul Gambia, ⁴Directorate of Health Research, Ministry of Health, Banjul, Gambia, ⁵Farafenni General Hospital, Gambia, ⁶Galleh Manda Circuit, Central River Region, Gambia, ⁷North Bank region East, Regional Health Directorate, Gambia, ⁸Bundung Maternal and Child Health Hospital, Gambia, ⁹Bansang General Hospital, Gambia, ¹⁰Directorate of Health Services, Ministry of Health, Banjul Gambia

^&Corresponding author: Bubacarr Jallow, Primary Health Care Unit, Ministry of Health, Banjul Gambia.

 

E-mail: jallowbubacarrm@gmail.com

Background: Neonatal mortality surveillance has not been prioritized in The Gambia, despite the global target of the SDGs to reduce the Neonatal Mortality Rate to <12/1000 live birth by 2030. We conducted this study to describe the epidemiology of neonatal mortality in four public hospitals in the Gambia from 2017 to 2021.

 

Methods: We conducted a cross-sectional study in a teaching hospital and three other referral hospitals in the country among neonates who died within the period under study. We extracted data from various sources in the hospitals. We analyzed demographic variables, listed sources of data, and determined risk factors for death at a 95% confidence interval.

 

Results: Of the 663 neonatal deaths between 2017-2021, 362 (54.46%) were male, the median age is 2 (<1-11) days. Of the total deaths, the teaching hospital had 306 (46.15%), Bansang 201 (30.32%), Bundung 90 (13.57%), and Farafenni 66 (9.95%). The highest cause of death was sepsis among 132 (19.91%), while the highest non-infectious cause of death was respiratory distress syndrome accounting for 65 (9.80%) deaths. Male neonates and neonates born in Western regions (Western1 & 2) are more likely to die of infectious causes compared to those from other 5 regions [POR:1.36 (CI= 0.99-1.85)] and [POR 1.23 (CI= 0.90-1.68)] respectively. These possible risk factors are not statistically significant. Sources of data vary for each hospital: case folders, admission registers, hospital database and death certificates.

 

Conclusion: The majority of the deaths occurred among males, who are probably more likely to die of infectious causes than females. We recommend a policy to establish a civil registry at all hospitals and prioritization of neonatal mortality surveillance in The Gambia, so data can be collected uniformly for informed decisions on how to improve neonatal care.

 

Keywords: Neonate, Mortality, The Gambia, epidemiology

 

 

Saikou Maffuge Fatajo^1,&, Momodou Kalisa², Peter Adewuyi³, Chukwuma David Umeokonkwo⁴, Lily Marie Sanvee-Blebo⁴

¹Western I Health Region, Gambia, ²Epidemiology Disease Control Unit Ministry of Health, Banjul, Gambia, ³Africa Field Epidemiology Network, Banjul, Gambia, ⁴African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Saikou Maffuge Fatajo, Western I Health Region, Gambia

 

Email: saikoufatajo@gmail.com

Background: Globally, 536,000 women die of pregnancy-related complications annually. Of the 340 annual maternal deaths in the Gambia, hospital accounts for more than 30%. Therefore, this study aims to determine the distribution and factors associated with maternal death in Western I Health Region, The Gambia.

 

Method: Records of maternal death and delivery from 2017 to 2021 from 3 hospitals and 1 Minor Health Center (public health facilities) in the Western I Health Region (WIHR) were retrieved from DHIS2, Maternity registers and patient folders. Variables such as age, cause, place and date of death were analyzed using Microsoft Excel and Epi-Info.

 

Result: 186 maternal deaths were reported with a median age of 29 (13-45) years. The age group 15-29 accounts for 51.4% (93/186). Eclampsia, Septic shock and Respiratory failure accounted for 11.3% (21/186), 10.8% (20/186), and 10.2% (19/186). Maternal Mortality Ratio was 321.2 per 100,000 live births. EFSTH accounted for 52.2% (97/186) of the deaths. While health facilities in Kanifing Municipality and Kombo North District both accounted for 68.2% equally. Maternal death mostly peaked in September, October, and November. EFSTH was 11.1 (C. I 7.6-16.2) times more likely to register maternal death as compared to other facilities. EFSTH also had 0.8 (C.I 0.4-1.5) times the odds of death, due to infectious disease compared to other health facilities.

 

Conclusion: Maternal Mortality in WI was higher than the country average, and it occurred mostly among the young reproductive age group with eclampsia being a major cause of death. EFSTH being the only tertiary hospital in the country had the highest maternal death, though deaths were less likely to be due to infectious causes. More investment in improving IPC in WIHR health facilities is needed.

 

Keywords: Maternal Death, Western Health Region I, Edward Francis Teaching Hospital

 

 

Darius Dolopei^1,&

¹Lofa County Health Team, Liberia

^&Corresponding author: Darius Dolopei, Lofa County Health Team, Liberia

 

Email: dariusdolopei46@gmail.com

Background: Globally, an estimated 2.5 million newborns died in 2018, constituting about 7,000 newborn deaths every day. In Sub-Saharan Africa, 28 deaths per 1,000 live births, which contributes up to 41% of the total burden of neonatal deaths worldwide. In Liberia, the neonatal mortality rate ranges from 30 to 32 deaths per 1,000 live births in the last five years. We described neonatal deaths by person, place, Time (including early and late deaths) and causes of death to support evidence-based decision-making.

 

Methods: We conducted a retrospective data review with six years of neonatal data retrieved from the Lofa County Surveillance Unit. Data set was cleaned using Excel filters. We summarized data using counts, proportions, frequency tables and rates.

 

Results: Of the 245 neonatal deaths, the mortality rate was 14.8 per 1,000 live births among males. The early neonatal mortality rate among age group 0-7 days was 21.1 per 1,000 live births. Of the six health districts, Kolahun had 29% (70/245) deaths with 6.3 per 1,000 live births; Vahun had a death rate of 6.6 per 1,000 live births. Hospitals account for 81% (199/245) of deaths. Government facilities reported 66% (162/245) of deaths with a rate of 3.1 per 1,000 live births. Birth Asphyxia 58% (141/245) is the leading cause of death.

 

Conclusions: On overall, the neonatal mortality rate in Lofa County is 5 per 1,000 live births. Neonatal deaths were more common among males during the period under review. Government Health Care Facilities were the most affected areas. Neonatal deaths in early life were very common. Therefore, we recommend to the Ministry of Health of Liberia as well as to the Lofa County Health Team and Partners to strategies a plan that will help to mitigate gaps identified for the purpose of reducing neonatal mortality across the 15 counties in Liberia.

 

Keywords: Neonatal deaths, Causes of deaths, Liberia

 

 

Tete Kpoeh-Thomas^1,2,&, Chukwuma David Umeokonkwo3 Himiede Wede Sesay^1,3, Peter Adewuyi^1,3, Obafemi Joseph Babalola^1,3, Ian Wachekwa² Maame Pokuah Amo-Addae^1,3

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia, ²John F. Kennedy Medical Center, Monrovia Liberia, ³African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Tete Kpoeh-Thomas, John F. Kennedy Medical Center, Monrovia Liberia

 

Email: kpoehtetenyamah@gmail.com

Background: Maternal mortality is a global concern targeted for a reduction to 70 per 100,000 live birth by 2030 according to Sustainable Development Goal Three. Liberia has a high Maternal Mortality Ratio (MMR) of 725 deaths per 100,000 live births as of 2015. Anecdotal evidence showed increased maternal deaths at the major tertiary hospital over the past two years (2020-2021). The study sought to: describe the data, and identify causes of death, and some risk factors. Findings are shared with policymakers to help reduce maternal mortality and add to existing literature.

 

Methods: Conducted a secondary data review and analysis of maternal death at one of Liberia's tertiary referral hospitals located in Monrovia. Four years of data (2018-2021) were extracted from patient medical records. Variables; age, occupation, referral status, and cause of death, were cleaned and analyzed using Epi- info7 and Excel. Results are presented in frequencies and proportions. Also, the calculated prevalence odds ratio, 95% CI, and P-value were reported.

 

Results: A total of 15,112 deliveries were recorded with 233 deaths and 14,982 live births. Median age 29 (14-45) years and MMR 1,555/100,000 live births. About 40.3% (94/233) of cases died within < 1 day, referrals accounted for 59% (137/233). Direct causes of death accounted for 66% (147/233). Patients referred from other facilities were 7.9 times more likely to die as compared to non-referral (pOR:7.9, 95%CI: 5.9- 10.6, p<0.001).

 

Conclusion: The tertiary hospital MMR was higher than the national. While direct causes of death remain a concern, the study also found women dying from indirect causes of death. Cases referred were at a higher risk of dying as compared to non-referral. Equipping peripheral facilities in handling maternal emergencies, early referrals, and strategies to address direct and indirect causes of death is key to reducing maternal mortality.

 

Keywords: Maternal mortality Liberia, Direct cause of maternal death, Indirect cause, Non-referral, Referrals

 

 

Jimmy Lawubah^1,2,&, Chukwuma David Umeokonkwo³, Himiede Wede Sesay³, Babalola Joseph Obafemi³, Faith Tina Whesseh³, Leroy Maximore³, Francis Bobway^1,2, Boye Nuyelleh^1,2, Lily Marie Sanvee-Blebo³, Maame Amo-Addae³

¹Grand Kru County Health Team, Grand Kru, Liberia, ²Liberia Field Epidemiology Training Program, Congo Town, Liberia, ³African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Jimmy Lawubah, Grand Kru County Health Team, Grand Kru, Liberia

 

Email: lawubahjimmy87@gmail.com

Background: The average global neonatal mortality rate is 17 deaths per 1,000 live births, while in Liberia, the neonatal mortality rate is 30.6 deaths per 1,000 live births as of 2020. Liberia is among countries in the world with the highest neonatal mortality rate. In 2016, the former president of Liberia declared neonatal mortality as a public health emergency due to the high neonatal mortality rate which was recorded as 42 deaths per 1,000 live births. The aim of this study is to describe the burden of neonatal death in Grand Kru from 2017-2021 and identify direct causes and contributory factors.

 

Methods: A retrospective record review of neonatal death surveillance data from 2017 to 2021 was conducted. We reviewed neonatal death investigation forms, health management information system (HMIS) monthly reports, weekly surveillance reporting ledgers for neonatal deaths and labor and delivery ledgers for live births. Data was cleaned and analyzed in Excel, we calculated the proportion for each socio-demographic variable, direct causes of death and contributory factors.

 

Results: Of the 126 neonatal deaths and 3,714 live births reported from 2017-2021, sixty-seven (53.2%) were females, 82.5% (104/126) occurred in the health facilities, the median age was 3 days (range <1 – 25) days. Barclayville district accounted for 49.2% (62/126), followed by Jroah district 30.1% (38/126). The main direct causes of neonatal death were birth asphyxia 39.6% (50/126) and neonatal sepsis 25.3% (32/126), while contributing factors include: late community referral 48.7% (74/152), lack of functional incubators 23.7% (36/152) and delayed ambulance services for patient referral 13.8% (21/152). The average neonatal death rate in Grand Kru from 2017-2021 was 33.9 deaths per 1,000 live births.

 

Conclusion: Our result shows that the burden of neonatal death in Grand Kru from 2017-2021 was high. Birth asphyxia and neonatal sepsis were the primary causes of neonatal deaths, while late community referral, lack of functional incubators and delayed ambulance services for patients' referral were leading factors contributing to neonatal mortality in Grand Kru County.

 

Keywords: Liberia, neonatal, mortality, birth-asphyxia and morbidity

 

 

Emmanuel Dwalu^1,2,3,4,&, Patrick Kpanyen^1,2, Obafemi Joseph Babalola^4,5, Maame Amo-Addae^4,5, Peter Adewuyi^4,5, Chukwuma David Umeokonkwo^4,5, Eerementary Kpoeh Junior⁴

¹School of Graduate and Professional Studies, Cuttington University, Liberia, ²National Public Health Institute of Liberia, Monrovia, Liberia, ³President's Young Professionals Program, Monrovia, Liberia, ⁴Liberia Field Epidemiology Training Program, Monrovia Liberia, ⁵African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Emmanuel Dwalu, National Public Health Institute of Liberia, Monrovia, Liberia.

 

Email: dwaluemmanuelf@gmail.com

Introduction: Substance use disorder is a public health problem in Liberia. This study determined the prevalence of substance use disorder and identified factors associated with substance use among patients at E.S Grant's Mental Health Hospital, 2020.

 

Methods: We conducted an analytic cross-sectional study among 62 inpatients at the E. S. Grant's Mental Health Hospital. All mental health patients admitted from January-March, 2020 were included. We collected data on substance use and associated factors using a structured questionnaire. We used Epi Info 7 to calculate the proportions of participants who ever used substances and factors associated with substance use among the patients.

 

Results: The mean age of the patients was 31±9.6 years. There were 74% (46/62) males, 89% (55/62) single, unemployed 92% (57/62), and high school students 69% (43/62). The prevalence of substance use was 76% (47/62). Opium, alcohol, marijuana, weed, and cigarette accounted for 68 % (32/47), while cocaine, heroin, tide, and tramadol were the least, 32% (15/47). The mean age at the commencement of substance use was 20±6 years. Those less than 20 years accounted for 43% (20/47). They were introduced to substances by friends, 49% (23/47) and peer pressure as the reason for using a substance, 60% (28/47) were risk factors of substance use disorder identified. Being male (OR= 8.6, 95%CI: 2.3-31.7, p =0.001 and being single (OR = 5.3, 95%CI: 1.0 - 27.4, p=0.03 were associated with substance use disorder among mental health patients. However, being male (aOR=7.0, 95% CI:1.8-28.2, p=0.01) was the only significant risk factor associated with substance use disorder among mental health patients.

 

Conclusion: The burden of substance use disorder is high among mental health patients at the E.S Grant's Mental Health Hospital. Being male was the only significant risk factor associated with substance use disorder. Efforts to control and prevent substance use disorder among males is recommended.

 

Keywords: substance use disorder, schizophrenia, psychosis, bipolar, depression

 

 

Jonathan Kpaka^1,&, Anita Ghansah², Jeff Bailey³

¹Ministry of Health, Monrovia, Liberia, ²Noguchi Memorial Institute of Medical Research, Accra, Ghana, ³Brown University, Rhode Island, USA

^&Corresponding author: Jonathan N. Kpaka; Ministry of Health, Monrovia, Liberia

 

Email: jonathankpaka@gmail.com

Background: Implementation of RTS, S/AS01 vaccine is underway in three African countries, Ghana, Kenya, and Malawi. The vaccine targets the Plasmodium falciparum circumsporozoite protein (CSP) but provides partial protection against malaria infections. CSP and human leukocyte antigen (HLA) variations have been implicated. We defined the variants of CSP and determined its distribution between Begoro and Cape Coast in Ghana over three years. Further, the influence of HLA genotype in terms of parasite frequency and RTS,S/AS01 response was assessed.

 

Methods: Peripheral blood was collected from participants (aged 6 months to 14 years old) in 2014, 2015, and 2016, and DNA was extracted. The C-terminal of CSP and HLA class II gene in humans were deep sequenced. The translated amino acid haplotypes of the CSP were aligned to the reference 3D7 vaccine strain. The HLA class II haplotypes were grouped and their correlation with CSP variants was ascertained.

 

Results:There were 31 Th2R haplotypes in Begoro and 30 Th2R haplotypes in Cape Coast; 15 Th3R haplotypes in Begoro, 13 in Cape Coast. About 86.7% (26/30) of Th2R and 92.3% (12/13) of Th3R haplotypes in Cape Coast are shared with Begoro. There is a 53% and 60% reduction in 3D7 Th2R and 3D7 Th3R haplotypes, respectively, from 2014 to 2016. The 3D7 haplotype does not correlate with HLA-DRB1, but there is with HLA-DQA1 and HLA-DPB1.

 

Conclusion: The high Th2R polymorphism is driving a higher non-synonymous amino acid substitution which may have vaccine implications. A decline in the frequency of the 3D7 parasite population may also affect the performance of the vaccine in Begoro and Cape Coast. Initial correlations indicate that HLA-DPB1 (01:01/17:01) correlates with the 3D7 vaccine strain, but HLA-DPB1 (01:01/17:01) and other variants of HLA-DQA1 also correlate with other Th2R haplotypes and may compete with the vaccine haplotype for antigen presentation to CD+4 T cells.

 

Keywords: Malaria, Vaccine, Plasmodium falciparium, Parasite

 

 

James Sinnatwah Junior^1,&, Peter Humphrey¹, Laura Skrip¹

¹University of Liberia, Monrovia, Liberia

^&Corresponding author: James D Sinnatwah Jr, University of Liberia, Monrovia Liberia

 

Email: douglassinnatwah@gmail.com

Introduction: The COVID-19 pandemic has affected populations globally with an estimated 1,813,188 lives lost worldwide in December 2020 (WHO, 2020). To protect against severe COVID-19, vaccines are being distributed globally. However, Vaccine hesitancy has proven to be an obstacle to reaching coverage targets. The Africa CDC estimated that over 60% of Africa needs to be vaccinated to ensure herd immunity (Rutschman et al., 2020). The objectives of this research were to understand COVID-19 vaccine hesitancy among people in the Johnsonville Pepper Wulu Town community, and to solicit community feedbacks on what can be done to encourage the uptake of COVID-19 vaccines.

 

Method: A qualitative method was used to conduct the study to allow participants to express themselves fully. The Purposive sampling technique was used to identify 12 participants based on their knowledge and understanding about the COVID-19 pandemic, and they were aged 18 years or older for in-depth key informant interviews. Audio recordings were transcribed and manual coding and thematic analysis was undertaken.

 

Results: Out of the 12 participants interviewed, 10 said they have not gotten a shot of the COVID-19 vaccine and were not willing to take the vaccine due to reasons like; fear to die in two years after taking the vaccine, lack of trust in Government, and low knowledge about the vaccine. 8 said they are not prepared to recommend the vaccine to their child/children or relatives.

 

Conclusion: The results of the study indicate that COVID-19 vaccine hesitancy exists in the community and stems from issues such as misinformation, lack of information, and/or mistrust. Social mobilized Community engagements through local NGOs or Community based-Organizations holds potential to alleviate the myths of death, and liaising with authorities to address issues around trust could help build knowledge around the vaccine, hence promoting higher uptakes of the vaccine.

 

Keywords: Vaccine Hesitancy, COVID-19, Low- and middle income countries, Johnsonville Pepper Wulu Town community, Herd Immunity, coverage, Mistrust, Misinformation

 

 

Fallah Nyandemor¹, Charles Adams^1,&, Ophelia Nyandemor²

¹Regional Transport Research and Education Center Kumasi (TRECK), College of Engineering, Kwame Nkrumah University of Science and Technology, Kumasi (KNUST), Ghana, ²Lois B. Hemgren School of Nursing, Liberia Dujar University College, Monrovia, Liberia

^&Corresponding author: Charles A Adams, Center Director, Regional Transport Research and Education Center Kumasi (TRECK), College of Engineering, Kwame Nkrumah University of Science and Technology, Kumasi (KNUST), Ghana

 

Email: carladams1702@yahoo.com

Introduction: Corona Virus Disease (COVID–19) was discovered in Wuhan China on December 31, 2019, in the city of Wuhan. The disease swiftly became a global pandemic in 2020 and has claimed more than 6 million lives as of March 2022. With the availability of the COVID-19 vaccine across the world, hesitancy in taking the vaccine has become a health challenge. Liberia is facing the challenge of vaccinating its population to curtail the transmission of this deadly virus. The current body of knowledge fails to adequately represent Liberia and most especially Monrovia in the study of COVID–19 vaccine perceptions of people. This study is directed to determining the COVID-19 vaccine safety perception of people in Monrovia, Liberia, and the factors that are associated with vaccine safety perception.

 

Method: A cross-sectional survey was conducted in Monrovia, in December 2021 and 700 persons aged 18 and above responded to a questionnaire soliciting information relating to the safety of the COVID–19 vaccine. The data were analyzed using R version 4.0.2, and the vaccine safety perception was modelled using logistic regression.

 

Results: It was revealed from the study that, most people still consider the COVID–19 vaccine unsafe (67%) as compared to those who consider the vaccine safe (33%). The variables, gender, and awareness campaigns through social media were the most significant factors associated with the study.

 

Conclusion: Most people in Monrovia still consider the COVID–19 vaccine unsafe. The results of this study can be used by health workers, policymakers, and other researchers to carry out more awareness campaigns on the COVID–19 vaccines and thereby reduce the COVID–19 vaccine hesitancy rate among the population.

 

Keywords: SARS-CoV-2, Pandemics, Perception, Vaccines, Awareness

 

 

Lamin Sawo^1,&, Abdoulie Taal¹, Ebba Secka¹, Bubacarr Baldeh¹, Peter Adewuyi², Amadou Woury Jallow³, Mustapha Bittaye¹

¹Regional Health Directorate, Bansang, Gambia, ²Ministry of Health, Banjul, Gambia, ³Africa Field Epidemiology Network, Banjul, Gambia

^&Corresponding author: Lamin Sawo, Regional Health Directorate, Bansang, Gambia

 

E-mail: doctorsawo2013@gmail.com

Background: Schistosomiasis is a neglected tropical disease caused by parasitic blood flukes known as "bilharziasis". Recent estimates indicate that 779 million people are at risk of infection, and 85% of them are in Africa. Evidence from the NTD baseline assessment in 2016 revealed a prevalence of 14.2% representing the highest prevalence in the region. We conducted this study to determine the prevalence of schistosomiasis and assessed missed outbreaks in the Central River Region, The Gambia.

 

Method: We conducted a cross-sectional study and extracted data from outpatient and laboratory registers from all public health facilities in the Central River Region from 2017 to 2021. We line-listed cases using MS Excel and exported them into EpiInfo version 7 for analysis. We summarized quantitative variables into means and standard deviation and qualitative variables into proportions. We calculated monthly regional thresholds using the cusum method and compared them with actual cases to identify missed outbreaks.

 

Results: Of 679 suspected schistosomiasis cases, 89% (607/679) were positive out of which 93% (564/607) are male. Lower Fulladu District had 79% (478/607). The prevalence was 0.2%, while there was a yearly increase in the prevalence except in 2021 which had a prevalence of 0.08%. During the 5 years, a total of 10 outbreaks mostly occurring in September and October of each year were missed.

 

Conclusion: The prevalence of schistosomiasis was low but has been increasing over the years. Males and those living in Lower Fulladu District were mostly affected. Because there was no regional threshold for schistosomiasis, outbreaks of the disease were missed. The Ministry of Health is currently working on developing national thresholds for schistosomiasis.

 

Keywords: Schistosomiasis, Epidemiology, Surveillance, Data, Analysis

 

 

Janjay Glay^1,&, David Tokpah², Arku Sumo⁴, Alphonso Tohpah¹, Lawrence Jallah³

¹Grand Bassa County Health Team, Grand Bassa, Liberia, ²District 3 A&B Health Team, Grand Bassa, Liberia, ³District 4 Health Team, Grand Bassa, Liberia, ⁴Liberia Agriculture Company Hospital, Grand Bassa, Liberia

^&Corresponding author: Janjay H. Glay, Grand Bassa County Health Team, Ministry of Health, Republic of Liberia

 

Email: janjayglay@gmail.com

Introduction: Lassa fever is a zoonotic disease and potentially deadly hemorrhagic illness caused by Lassa Virus. The main animal reservoir for the Lassa virus is the rodent Mastomys natalensis. The incubation period ranges from 6 to 21 days. In Liberia, the magnitude of Lassa Fever mortality and morbidity is underreported. Although, the disease remains a major public health challenge and its endemicity had gained an expanded area in the country. On November 5, 2021, Grand Bassa County Health Team reported a confirmed Lassa fever, from the Liberia Agriculture Company hospital. The team commenced an investigation to confirm the outbreak, determine the magnitude of the outbreak and analyze it by Person, Place and Time.

 

Methods: We conducted a cross-sectional study. We interview suspected cases and contacts, conducted an active case search, and collected whole blood for laboratory confirmation. We reviewed medical records and established line-listed for all of the cases.

 

Results: We identified 17 suspected Lassa fever cases of which 8 were confirmed by the laboratory. More than half 6/8 (75%) of the confirmed cases were females with the majority 5/8 (62.5%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) was 1/8 (12.5%) among the laboratory-confirmed positive cases. Thirty-seven contacts of the confirmed cases were identified out of which 35/37 (94.6%) successfully completed the follow-up and 2/37 (5.4%) lost to follow-up. The overall incidence rate of Lassa fever in the county was 0.3/10,000 population. District No. 3A&B was the only affected district with an attack rate of 0.014%.

 

Conclusion: There was an outbreak of Lassa fever in Grand Bassa County. More than half of the cases survived. District No. 3A&B was the only affected district in the county.

 

Keywords: Lassa fever, Outbreak, Grand Bassa, Zoonotic

 

 

Titus Nimley^1,3,&, Himiede Wilson², Elijah Edu-Quansah², Maame Amo-Addae², Thomas Nagbe³

¹Rivergee County Health Office, Rivergee, Liberia, ²African Field Epidemiology Network, Monrovia, Liberia, ³National Public Health Institute of Liberia, Montserrado, Liberia

^&Corresponding author: Titus Nimley, Rivergee County Health Office, Liberia

 

Email: titusnimley@gmail.com

Introduction: Whooping cough is a highly contagious bacterial infection caused by Bordetella pertussis, Symptoms are usually similar to those of a common cold, fever and mild cough followed by weeks of severe coughing. The onset of symptoms is usually 7-10 days. The disease spreads easily from person to person, mainly through droplets produced by coughing or sneezing. An estimated 16.3 million people were infected in 2015 worldwide. There has been a severe outbreak of pertussis in Liberia. On Aug 9, 2019, we received a report of suspected pertussis cases from Korh town, Potupo District. Based on this report a team was set up and dispatched to the community with the following objectives; to confirm the existence of the outbreak, to determine the cause of the outbreak, to describe the outbreak by person, place and time, and to provide control measures to the outbreak.

 

Methods: We interviewed affected patients on their vaccination Status and reviewed clinical records at a health facility. We did a line listing of cases in Korh town and conducted an active case search in communities. Control measures are provided based on findings.

 

Results: Twenty-eight cases were identified and line-listed, the median age was 5 years, ranging from 2 months to 13 years. Males accounted for 61% of the cases, and 64% of cases identified were vaccinated. The index case was a 9 years old boy, who started showing signs on July 28, 2019, but did not visit the hospital.

 

Conclusion: A point source outbreak occurred in Fishtown. The cause was due to poor immunization practices. close personal contacts also contributed to the spread. The age group below five years were most affected. Community sensitization and health education were conducted.

 

Keywords: Pertussis, Korh Town, Vaccination

 

 

Jimmy Lawubah^1,2,&, Babalola Joseph Obafemi³, Himiede Wede Sesay³, Lily Marie Sanvee-Blebo³, Francis Bobway¹, Boye Nuyelleh¹, John Doe², Chukwuma David Umeokonkwo³, Peter Adewuyi³, Maame Amo-Addae³

¹Grand Kru County Health Team, Grand Kru, Liberia, ² Liberia Field Epidemiology Training Program, Congo Town, Liberia, ³African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Jimmy Lawubah, Grand Kru County Health Team Liberia

 

Email: lawubahjimmy87@gmail.com

Background: On March 16, 2020, Liberia recorded her first confirmed case of COVID-19. In order to guide response activities following this case, a study was conducted to assess the knowledge, risk perceptions, and preventive practices of adult Liberians one month into the COVID-19 outbreak and identify contributory factors.

 

Methods: A cross-sectional survey was conducted in 41 of the 93 health districts of Liberia among 1,025 respondents selected using a multi-stage sampling technique one month into the outbreak. Using a structured questionnaire, we obtained information on their knowledge, risk perception, and practice of preventive measures related to COVID-19 through an in-person face-to-face interview. A pre-determined set of criteria based on the literature review, was used to categorize the knowledge and preventive practice as good, fair, and poor, and risk perception as high and low. We reported the dependent variables in proportions and assessed the relationship between them and other sociodemographic characteristics using chi-square and multiple logistic regression.

 

Results: The median age of the respondents was 39 years (interquartile range: 43-67) with 40.4% (415/1,025) aged 35-54 years. Males accounted for 52.3% (536/1,025), and 44.0% (451/1,025) were married. About 32% (325/1,025) of the respondents had no formal education. Although only 38% (389/1,025) of the respondents had good knowledge, 91.2% (935/1,025) had good preventive practices with the majority placing emphasis on handwashing, social distancing, and avoiding sick people. About 40.2% (412/1,025) had low-risk perception. One per cent (10/1,025) of respondents thought that it was an Ebola virus outbreak. Some respondents mentioned blood transfusion, sexual intercourse, and mosquito bites as the mode of transmission. Knowledge, preventive practices, and risk perception were not associated with sociodemographic factors in our study.

 

Conclusion: Preventive practices were good although there were poor knowledge and low risk perception among respondents. The memory of the Ebola outbreak could have contributed to this. Our findings were shared with the risk communication team and factored into their messaging.

 

Keywords: Liberia, coronavirus, transmission and Ebola

 

 

Saibana Camara^1,2,&, Bai Janneh², Kawsu Sanyang², Peter Adewuyi¹

¹Gambia Field Epidemiology Training Program, Banjul, Gambia, ²Department of Livestock Services, Ministry of Agriculture, Banjul, Gambia

^&Corresponding author: Saibana Camara, Department of Livestock Services, Ministry of Agriculture, Banjul, Gambia.

 

Email: saibana.camara1979@gmail.com

Introduction: African Animal Trypanosomiasis (AAT) is a zoonotic infection caused by a hemoparasite (Trypanosoms) transmitted by a Tsetse fly during a blood meal. Globally, AAT has caused an annual US $ 1.3 billion losses to the livestock industry. In The Gambia, AAT is endemic and accounts for 53.4% deaths to livestock animals annually. Several attempts in the past to control and eradicate AAT in livestock species failed due to the limited and analyzed data needed guide targeted intervention. We conducted this study to determine the distribution AAT in livestock species in The Gambia.

 

Method: We conducted a descriptive cross-sectional study using AAT surveillance data generated from the Department of Livestock Services, from 2018-2021. We collected data on cases of AAT, and the demographic factors (species, age, sex, breed, region and the year). Data were analyzed using the Epi Info software version and were presented in tables and graphs.

 

Results: Between 2018 to 2021, a total of 1,526 suspected cases of AAT were clinically diagnosed and reported to the ADSR database. An overall prevalence of 0.17% (1526/881555) was observed between 2018 – 2021. A total of 41.1% cases were observed in 2020. Amongst the livestock species, 57% (875/1526) of cases were among cattle and 0.7% (12/1526) were in sheep. A total of 57% (878/1526) cases were from the Central River Region

 

Conclusion: AAT is widely spread in The Gambia and the highest recorded cases were in 2020. Central River Region North (CRR/N) recorded the highest number of cases and amongst the livestock species, cattle were the most affected. Thus, AAT control in cattle with a focus on the implementation of intervention strategies in CRRN should be maximized.

 

Keywords: African Animal Trypanosomiasis, Surveillance, Gambia

 

 

Modou Njie^1,&, Abou Kebbeh², Modou Lamin Fofana¹, Peter Adewuyi³, Chukwuma David Umeokonkwo³, Mustapha Bittaye⁴, Amadou Woury Jallow⁵

¹Ministry of Health, Regional Health Directorate, North Bank West Region, Banjul, The Gambia ²Ministry of Health, National Public Health Laboratory, Banjul, The Gambia ³African Field Epidemiology Network, Banjul, Gambia ⁴Ministry of Health, The Quadrangle, Banjul, The Gambia ⁵Ministry of Health, Epidemiology and Disease Control Unit, Kotu, The Gambia

^&Corresponding author: Modou Njie, Ministry of Health, Regional Health Directorate, North Bank West Region, Banjul, The Gambia.

 

Email: mnjie1299@gmail.com

Background: Snakebites affect about 5.4 million people worldwide resulting in over 137,880 deaths per year. In Sub-Saharan Africa, the incidence of snakebite cases is generally underestimated despite the adverse effect of snakebite when it occurs. We, therefore, conducted this study to describe the incidence of snakebites in the North Bank West Region of the Gambia.

 

Methods: We reviewed snakebite surveillance data from 2017 to 2021 recorded in health facilities registers in North Bank West Region, The Gambia. Variables extracted were age, sex, date reported, health facility name, district of residence, and case outcome. We summarized the data by person, place, and time and results were presented using frequencies and proportions in tables, charts, graphs and maps.

 

Results: A total of 197 cases were reported, the median age was 20 (IQR:13 -30) years, and males were 69.0% (136/197). Thirty-five per cent (69/197) of snakebite victims were in the age group 10-19 years. The 5-year incidence rate was 31 snakebite cases per 100,000 population with a case fatality ratio of 4.1%. Jokadou District recorded the highest number of incidences (14 cases per 10,000) in 2017. Seventy-two per cent, (143/197) of the snakebite cases occurred during the rainy season (June-October). The year 2020 recorded the highest incidence of snakebite in the region, with 59 snakebite cases per 100,000 population.

 

Conclusion: The high incidence of snakebite cases in this study requires that the Regional Health Directorate work with health facilities to regularly organize health education activities for the communities, especially prior to the start of the rainy season.

 

Keywords: Snakebites, Incidence, Surveillance Data, Gambia, Regional

 

 

Antoinette Hawa Wright¹, Joseph Sieka^1,&, Laura Skrip^1,2, Benedictus Dotu Nyan²

¹University of Liberia, College of Health Sciences, Monrovia, Liberia, ²Quantitative Data for Decision Making Lab (Q4Dlab), Near Benson and Buchanan, Monrovia, Liberia

^&Corresponding author: Antoinette H. Wright, University of Liberia, College of Health Sciences, Monrovia, Liberia.

 

Email: geyonce97@gmail.com

Introduction: Liberia's health sector is transitioning from paper to electronic data collection, but advances in the scale and scope of data collection are not being matched by data management efforts. As a result, despite significant investment in mechanisms of data collection, the quality of data may not allow for drawing rigorous analytical conclusions from it. Poor quality has challenged the analysis and use of raw clinical data on COVID-19, for example. Understanding data management practices at the Ministry of Health (MoH) and the specific data management needs of graduate-level student researchers in Liberia is a major step to addressing the gap.

 

Methods: A convergent parallel mixed method study was conducted. From a study population of 394 graduate students working on their thesis and 12 data managers, convenient sampling was used to recruit 200 students to complete a self-administered survey and 6 students along with 6 data managers to participate in key informant interviews. The quantitative survey data were analyzed descriptively using R Statistical Software and the qualitative data were analyzed thematically using Dedoose.

 

Results: Findings from the interviews with data managers suggest that MoH does not have data management protocols specifically for handling data collected during an outbreak; a major challenge to the development and implementation of such protocols is the availability of funding. Among student survey participants, 177 (88.5%) reported needing capacity-building around data management; 148 (74%) had never used a data management plan. Major needs expressed by students included improved awareness about data management and technical assistance to conduct data management.

 

Conclusion: Better case management and policy development are possible when data management precedes data collection. MoH should consider prioritizing data management by advocating for funding. Furthermore, adding data management to the curriculum at local graduate programs, particularly ahead of thesis proposal development, could address some capacity gaps.

 

Keywords: Data, Mix method, Liberia

 

 

Kebeh Kruah^1,&, Ian Wachekwa¹, Coco Vaneway¹, Candy Neima², Joseph Lewis³, Kristina Talbert-Slagle⁴, Lila Kerr⁵, Mukhtar Adeiza⁴, Umar Isa Umar⁴

¹John F. Kennedy Medical Center, Monrovia, Liberia, ²National Public Health Institute of Liberia, Monrovia, Liberia, ³Yale School of Public Health, CT 06520, USA, ⁴Yale Institute for Global Health, New Haven, CT 06510, USA, ⁵BRIDGE-U: Liberia | Yale University, CT 06510, USA

^&Corresponding author: Kebeh Kruah, John F. Kennedy Medical Center, Monrovia, Liberia

 

Email: kebeh1985@gmail.com

Background: Testing infants within the first 4 to 6 weeks of birth for perinatal HIV transmission followed immediately by therapy increases the survival rate among HIV-infected children but remains a challenge in Liberia. We conducted this quality improvement project to improve the use of Early Infant Diagnosis (EID) services at the John F. Kennedy Medical Center (JFKMC), Monrovia.

 

Methods: This was a pre-post intervention study, conducted in the Infectious Disease Clinic at the JFKMC that began in March 2021. Baseline data from hospital records, brainstorming sessions, questionnaires and observational studies were analyzed to determine barriers to EID and inform tailored interventions, which included: fliers and posters in various clinic areas and shared among pregnant mothers with messages of prevention of mother-to-child HIV transmission, and promoting EID, a short video promoting EID, and a one-day training session for all those providing care to pregnant PLWHA focused on counselling and EID. Physical changes were made to the maternity clinic for more conducive counselling. A standard operating procedure was also developed to formalize the process of referring HIV-exposed infants for HIV testing.

 

Results: Following the interventions, the proportion of HIV-positive women who delivered at the facility and brought their babies for HIV testing within the first year increased from 71.8% to 100% (p < 0.001) while the proportion of HIV-exposed infants delivered in the facility and brought for HIV testing within the first 4-6 weeks of age increased from 25.6% to 76.5% (p <0.001).

 

Conclusions: The interventions were successful in improving the use of EID services at the JFKMC and efforts should be made to continue supporting these activities.

 

Keywords: HIV, Early Infant Diagnosis, John F. Kennedy Medical Center

 

 

Francis Jaryan^1,&, Jane McCauley¹, Julius Gilayeneh¹, Chukwuma David Umeokonkwo², Julius Teahton¹, Lawrence Fakoli¹, Bode Shobayo¹

¹National Public Health Institute of Liberia, Monrovia, Oldest Congo Town, Monrovia, Liberia, ²African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Francis D. Jaryan, National Public Health Institute of Liberia, Monrovia, Liberia

 

Email:fjaryan68@gmail.com

Introduction: The aim of this study was to isolate and identify bacteria found on roasted fish sold by street food vendors to consumers and to investigate the prevalence of antibiotic resistance among isolates obtained from samples collected.

 

Methods: Samples were collected from street food vendors selling roasted fish within the Boys market, Margibi County, sold at different market locations. Standard bacteriological methods were used to isolate bacteria while Gram staining and biochemical tests were employed in the confirmation of isolated bacteria. Kirby-Bauer disc diffusion technique was also used for the determination of antibiogram profiles of bacteria isolates.

 

Results: Seventy-seven (77) bacteria isolates belonging to ten (10) genera were isolated and identified. Proteus (28.6%) and Enterobacter (20.3%) had the highest occurrence frequencies follow by Serratia (14.3%). Both Klebsiella and Pantoea had occurrences of 9.1%, Citrobacter (5.2%), Escherichia (2.6%), Shigella (2.6%) and Salmonella (3.9%) and Yersinieae (3.9%). Results showed that 74% of the enterobacteria isolates were resistant to cefixime (6 μg), 67.5% of isolates were resistant to cefuroxime (30 μg), 49.3% to ceftazidime (30 μg), 35% to Augmentin, 32.4% to Nitrofurantoin (300 μg) and 1.2% to Gentamicin. All isolates were susceptible (100%) to ciprofloxacin (5 μg) and ofloxacin (5 μg).

 

Conclusion: Bacterial isolates demonstrated noticeable resistance against second and third class generation cephalosporin. The presence of these bacteria and their resistant patterns on roasted fish sold by street vendors could result in potential health risks for consumers. It is therefore important to caution consumers and sellers on the dangers street food poses to human health.

 

Keywords: Roasted fish, Antibiogram profile, Antibiotic resistance, Contamination, Vendors

 

 

James Godson Junior^1,&

¹National Public Health Institute Liberia, Monrovia, Liberia

^&Corresponding author: James K. Godson, Jr. National Public Health Institute of Liberia, Monrovia, Liberia

 

Email: jgodsonjr@gmail.com

Introduction: About 1.2 million workers are estimated to have died from work-related accidents and diseases, including automobile garage work. Despite their importance, automobile garages have been identified as major sources of environmental pollution, and inadequate safety measures for the prevention of work-related injuries because of their unregulated practices. The nature of occupational health and safety practices in automobile garages has not been explored in Liberia. The study assessed the environmental sanitation, waste management and occupational safety practices of automobile garages in Monrovia, Liberia.

 

Methods: The study used a cross-sectional survey and descriptive design that focused on automobile garages involved with general vehicle repair and maintenance. A total of 280 automobile garages were sampled from five health districts in Monrovia using prepared checklists and observation. The checklists were divided into four sections. “A”, contained demographic information, section “B”, contained health districts of garages, section “C” contained garage type, garages were categorized into low, medium and large based on infrastructure, legality and nature of work performed, section “D”, contained environmental sanitation and section “E”, contained safety practices.

 

Results: Age of garage owners was between 26-70years where the Mean age was 42 as owners of garages. Most garage owners 43% (121/280) had no formal education, 30.4% (85/280) had obtained basic primary education. In regards to environmental sanitation, open space dumping accounted for 44.6% (125/280), whereas oil spill management constituted 16.1% (45/280) for dumping in dug hole. Only a fragment 4.6% (18/280) of garages had simple pit latrine for excretion. The overall safety precautionary measures in the assessed garage s were found to be low, 26.8% (75/280) had available safety boots and safety gloves 15.7% (44/280), respectively.

 

Conclusion: Education and training seem to have an influence on the poor use of PPE and could result in increasing numbers of injuries and ergonomic hazards. The lack of regulatory frameworks to guide garage operations in Monrovia contributed to the lack of safety culture in garages. Poor environmental sanitation practices as established in this study are possible drivers for disease outbreaks among workers in this sector.

 

Keywords: Occupational Health and safety, Automobile Garages, Monrovia

 

 

Taurus Chea¹, Julius Teahton^2,&, Francis Jaryan², Lawrence Fakoli² Bode Shobayo², Julius Gilayeneh², Jane MaCauley²

¹University of Liberia, Monrovia, Liberia 2National Public Health Institute of Liberia, Monrovia, Liberia

^&Corresponding author: Julius Teahton, National Public Health Institute of Liberia, Monrovia, Liberia

 

Email: julteahton84@gmail.com

Background:3 Hepatitis B virus (HBV) is a significant public health threat that is estimated to have infected 257 million individuals on a long-term basis by 2018. Youths between the ages of 18 and 35 have been linked to the spread of HBV in Liberia. Despite current precautions, HBV is still a dangerous transfusion-transmissible illness. In order to formulate public health policies on HBV control, data on the factors associated with HBV among youths is critical. Therefore, this study objective was to identify the factors associated with Hepatitis B among youths aged 18 to 35 years at the ELWA Hospital from May 2019 to May 2020.

 

Methods: The data was acquired from hospital-based records using a cross-sectional method by the researcher, who utilized a quantitative study methodology. The 96 participants in this study were recruited using a convenient sampling technique. Using retrospective data, a self-structured checklist was employed to capture their socio-demographic characteristics and prior exposure to related factors. The data were analyzed in Microsoft Excel.

 

Results: The results from the study revealed that high-risk sex behaviour (unprotected intercourse) accounted for 94 (98%), and exposure to body fluid (blood transfusion, saliva, tears, urine, and perspiration) accounted for 80 (83%) of the risk factors found to be substantially linked with HBV positive. Other risks linked to HBV in this study included: body part piercing (tattooing/traditional scarification) accounting for 64 (67%), intravenous drug use accounting for 50 (52%), and needle stick injuries accounting for 49 (51%). Those related factors continue to have a key role in HBV transmission among youths aged 18-35 years, according to our findings.

 

Conclusions: These findings should be taken into account when developing health policies to reduce the impact of HBV infection in children and adolescents.

 

Keywords: Hepatitis B, Youth, Liberia, Transfusion

 

 

Alpha Umaru Bai-Sesay^1,2,& , Jean Leonard Hakizimana² , Adel Hussein Abdallah², Amara Alhaji Sheriff², Kassim Kamara², Gebrekrstos Negash Gebru²

¹Falaba District Health Management Team/ Ministry of Health and Sanitation, Freetown, Sierra Leone, ²Sierra Leone Field Epidemiology Training Programme, Freetown, Sierra Leone

^&Corresponding author: Alpha Umaru Bai-Sesay, Falaba District Health Management Team/ Ministry of Health and Sanitation, Sierra Leone

 

Email: umarbaisesay@gmail.com

Introduction: Measles remains one of the leading causes of childhood morbidity and mortality. Despite the availability of a safe and effective vaccine, measles cases continue to occur in border districts in Sierra Leone. On 25/01/2022, the Falaba surveillance unit was notified of suspected cases of measles in the border chiefdom of Delmandugu. We investigated the suspected cases to confirm the outbreak, assess the magnitude, identify the risk factors, and institute control measures.

 

Methods: We defined a suspected case as any person with fever and maculopapular rash in Delmandugu chiefdom from 01/12/2021. We reviewed medical records, interviewed parents, and collected samples for confirmation. We collected data on patients' demographic, clinical, vaccination status, and travel history. We conducted an active case search and assessed measles vaccination coverage in the affected chiefdom and calculated the measles-containing vaccine (MCV) dropout rate. We identified contacts and monitored them. We conducted social mobilization and risk communication.

 

Results: Twelve cases including 3 (25%) laboratory-confirmed and 9 (75%) epidemiologic linked, and clinically confirmed cases were identified. The median age was 2 years (Range: 0.6 – 6 years). Twenty contacts were traced and 18 (90%) of them were unvaccinated. Of the laboratory-confirmed, Case one was a 7-month-old girl who has travel history from Guinea on 04 /01/2022 and presented measles-like symptoms on 17 /01/2022. Case two and Case three had contact with Case one respectively at home and at the health facility. Administrative MCV1 coverage was 64.8%, MCV2 36.3% with an MCV dropout rate of 44%. Ring vaccinations were done covering 444 children.

 

Conclusion: A measles outbreak was confirmed in Delmandugu chiefdom. The importation of the case from a neighboring country in a community with low MCV vaccination coverage and a high dropout rate has contributed to the spread of measles in the affected chiefdom. We recommend intensified community mobilization on vaccine uptake.

 

Keywords: Measles, border chiefdom, Measles-containing vaccine, Falaba, Sierra Leone

 

 

Sahr Amara Moiba^1,&, Jean Leonard Hakizimana¹, Adel Hussein Abdallah¹, Amara Alhaji Sheriff¹, Kassim Kamara¹, Gebrekrstos Negash Gebru²

¹Ministry of Health and Sanitation, Freetown, Sierra Leone, 2African Field Epidemiology Network, Freetown, Sierra Leone

^&Corresponding author: Sahr Amara Moiba, Ministry of Health and Sanitation, Freetown, Sierra Leone

 

Email: amarasahrmoiba@gmail.com

Background: Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine. From 20 January – 09 February 2022, the Kono District Surveillance team was notified of nine suspected measles cases from three chiefdoms. We investigated the outbreak to confirm the diagnosis and describe the extent of the outbreak in order to implement control measures.

 

Methods: We reviewed the clinical and vaccination records of suspected cases and conducted active case search using the case definition: resident of Kono district with fever (³38.0°C) and maculopapular rash, cough, coryza or conjunctivitis fever and rash with red eyes or coryza from 15 January to 15 March 2022. We interviewed the patients and caregivers, and we collected blood samples for laboratory confirmation.

 

Results: a total of nine suspected cases were reported. Of these, 77.8% (7) tested positive for measles. The median age of the positive cases was 2 years, range 1-19 years. Of the seven positive cases, 71.4% (5) are females, 57.1% (4) not vaccinated, and 42.9% (3) had travel history from Guinea. Gbense chiefdom was the most affected chiefdom with 57.1% (4) of the cases. Patients were isolated, treated, and discharged. No death was reported.

 

Conclusion: Measles outbreak was confirmed in Kono district. The source could be from unvaccinated patients who travelled from Guinea. We informed authorities in Guinea about the outbreak for necessary action. We recommended an assessment of vaccination services, including vaccine transportation and storage.

 

Keywords: Measles Outbreak, Kono District, Sierra Leone.

 

 

Jallah Kennedy^1,&, Godwin Akpan², Wilfred Taikerweyah¹, Luke Bawo³, Trokon Yeabah⁴, Chea Wesseh³, Peter Adewuyi² , Dikena Jackson³, Peter Clement⁵, Musu Duworko⁵, Julius Monday⁵, Mohammed Kromah⁵, Kwuakuan Yealue⁵, Jeremy Sesay⁵

¹Roads To Health (Roads to Rural and Vulnerable Population Health), Monrovia, Liberia, ²African Field Epidemiology Network (AFENET), Monrovia, Liberia, ³Ministry of Health (MOH), Monrovia, Liberia, ⁴National Public Health Institute of Liberia (NPHIL), Monrovia, Liberia, ⁵World Health Organization, Liberia Office, Monrovia, Liberia

^&Corresponding author: Jallah M. Kennedy Roads to Health (Roads to Rural and Vulnerable Population Health), Liberia and USA

 

Email: info@rthealth.org

Introduction: The coronavirus or SARS-CoV-2 (COVID-19) pandemic first reported in Liberia on March 16, 2020, posed many challenges including data management in the initial phases to improve surveillance. The aims included developing algorithms, standard operating procedures, data capturing tools, and reporting to identify and manage potential cases and evolving the flow of data for making informed decisions. A steady increase in data from cases, identifying and contact tracing, precautionary observational centres, treatment units, ports of entry, and testing centres challenged the health system.

 

Methods: We identified and captured key indicators to develop laboratory line lists, case contact, situation reports, and reports to key policymakers. Data collection, cleaning, aggregation, and analytics processes included using various programs and statistical software. All reported data from Liberia were included, but some were de-identified for exclusions based on reporting targets. Geospatial and trend analyses were key to providing meaningful data that improved surveillance. Discrepancies were mitigated through reconciliation and harmonization.

 

Results: Results were provided to the Incident Management System, pillars, key stakeholders, professional groups, and the public in the forms of tables, graphs, and maps to reflect static, descriptive, and inferential outputs. Trend and geospatial analyses involved predictive models; crude rates; moving averages; estimated reproductive numbers; case trees; contact tracing rolling averages that estimated potential gaps and community transmissions; testing positivity that excluded selected repeated and pending runs; and stratification with emphases on addresses, testing sites, healthcare workers and other population distribution, and enhanced surveillance.

 

Conclusion: Despite significant strives, COVID-19 was overwhelming leading to many gaps to develop and implement cohesive data management. Fragmentation of data sources, reporting, and storage are major lessons to resolve in future surveillance. Development and use of national and institutional databases along with robust training are essential to improve data management and analytics for routine services and in the event of another outbreak.

 

Keywords: Data management. Coronavirus. COVID-19. Liberia. Pandemic. Surveillance

 

 

Cynthia Taylor Yeah^1,&, Chukwuma David Umeokonkwo², Joseph Obafemi Babalola², Himiede Wede Sesay², Lily Sanvee Blebo², Alberta Corvah¹, Godwin Etim Akpan², Faith Kamara Whesseh² , Leroy Maximore², Maame Pokuah Amo-Addae²

¹National Public Health Institute of Liberia, Monrovia, Liberia 2Africa Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Cynthia Taylor Yeah, National Public Health Institute of Liberia, Monrovia, Liberia

 

Email: ctyeah2011@gmail.com

Introduction: Measles remains a major public health problem despite the availability of safe and cost-effective vaccines. Liberia ranked eighth among countries that reported a higher number of measles cases in the first quarter of the year 2022. We described measles cases in Liberia from 2017 to 2022.

 

Methods: A secondary data analysis of confirmed measles surveillance data extracted from National Public Health Institute of Liberia. Measles confirmed case was defined as a suspected case with laboratory confirmation (positive IgM antibody), epidemiologically linked to confirmed cases in an outbreak or clinically confirmed. Variables of interest were age, sex, date of onset, reporting counties, vaccination status, outcome and final classification. Using Epi-Info version 7.2, we calculated the incidence, case fatality rate (CFR) and reviewed the measles vaccine coverage rate.

 

Results: A total of 6,984 cases were reported from 2017 to 2021. The median age is 7 years (interquartile range: 4-12), with males accounting for 50.3%. Age group 0-4 years recorded 41.4% of cases with overall CFR 0.3%. The highest prevalence of 90.3% was reported in 2018. The national incidence was 164/100,000 population with the highest incidence of (453/100,000 population) being reported from River Gee, Grand Kru and Maryland counties. Most of the cases had unknown vaccination status (51.7%) and unvaccinated (15.5%). Cases mostly occurred during the dry season between February to December. The measles vaccine coverage rate declined from 85% in 2017 to 75% in 2021

 

Conclusion: There is recurrent outbreak of measles in Liberia with suboptimal measles coverage rate. There is need for nationwide measles campaign targeting the under-five population especially in the hard-to-reach to boast coverage and reduce measles cases.

 

Keywords: Measles, Surveillance, Liberia, Prevalence, Outbreak

 

 

Ummu Aineini Tunis-Paasewe^1,&, Chukwuma David Umeokonkwo², Joseph Obafemi Babalola², Himiede Wede Sesay², Maame Pokuah Amo-Addae²

¹Ministry of Health, Expanded Program on Immunization, Monrovia, Liberia, ²African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Ummu A. Tunis-Paasewe, Ministry of Health, Expanded Program on Immunization Monrovia Liberia

 

Email: all4tunis@gmail.com

Introduction: Routine immunization is highly effective in the reduction of childhood mortality due to vaccine-preventable diseases (VPD). There are recurrent outbreaks of VPDs in Liberia in recent years. We, therefore, analyzed the administrative data to assess vaccination coverage at national and subnational levels.

 

Methods: We conducted a secondary data analysis of Bacille Calmette-Guérin (BCG), Inactivated Poliovirus (IPV) and Measles vaccines 2017-2021 administrative data retrieved from the Ministry of Health's DHIS2 electronic database. We estimated vaccine coverage at the national and sub-national levels using the target population obtained from the EPI unit of the Ministry of Health and compared with the 90% national coverage target.

 

Results: Overall, in Liberia from 2017 to 2021, BCG coverage declined from 102% to 87%, Measles vaccine coverage declined from 92% to 83% whereas, IPV coverage increased from 32% to 83%. At the sub-national level in 2021, not more than six counties met the national target for BCG, IPV and Measles vaccines. The counties with the lowest coverage in 2021 were BCG {Gbarpolu (68%), Maryland (72%) and Rivercess (76%)}; IPV {Gbarpolu (69%), Rivercess (77%) and River Gee (78%} and Measles {Grand Bassa (59%), Rivercess (62%) and Gbarpolu (67%)}.

 

Conclusion: Coverage for BCG and Measles vaccines took a downward trend whereas IPV vaccine coverage increased. Interventions to strengthen routine immunization are needed to minimize the outbreaks of VPD in Liberia.

 

Keywords: Coverage, Immunization, Liberia, Vaccination

 

 

Alvan Coker^1,2,&, Himiede Wede Sesay², Obafemi Babalola², Momo Tegli¹, Ralph Jetoh¹, Maame Amo-Addae²

¹National Public Health Institute of Liberia, Monrovia, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Alvan A. Coker, National Public Health Institute of Liberia

 

Email: cokeralvan23@gmail.com

Introduction: Bacterial meningitis remains a major public health threat globally and sub-Saharan Africa has the highest burden of the disease with 1.2 million cases reported annually. Liberia, although not part of the meningitis belt reported outbreaks in 2017 with case fatality rate (CFR) of 38% and has been reporting cases sporadically. We describe the epidemiology of meningitis in Liberia, from 2017 to 2021.

 

Methods:. We conducted a secondary data analysis of meningitis surveillance data at the National Public Health Institute of Liberia. The variable of interest was date of onset, age, sex, county of residence, place of detection, outcome and laboratory result. Prevalence and case fatality rates were calculated to describe the severity of the disease and a bivariate analysis was performed to identify risk factors associated with mortality.

 

Results: A total of 99 cases were reported of which 37.3% (37/99) were laboratory confirmed. The median age of the confirmed cases was 17 (IQR:11-30) years and female constituted 64.8%. (24/37). Neisseria meningitidis serogroup C accounted for 94% (35/37) of the cases. The incidence and CFR of meningitis was 8.7 per million population and 37% (12/37) respectively. Cases detected in community (OR: 3.4; CI: 1.29 - 8.94: P=0.010) had higher odds or dying compared to those detected at the facility.

 

Conclusion: Neisseria meningitides serotype C is the mean cause of meningitis especially among unvaccinated children. We recommend mass vaccination campaign to prevent the spread of the disease.

 

Keywords: Epidemiology, Meningitis, Liberia, West Africa, Sub-Saharan

 

 

Rebecca Robinson^1,&, Faith Wesseh², Obafemi Joseph Babalola², Godwin Etim Akpan², John Karmuah Doe¹

¹Montserrado County Health Team, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia Liberia

^&Corresponding author: Rebecca S Robinson, Montserrado County Health Team, Monrovia, Liberia

 

Email: reobinson2013@gmail.com

Background: The coronavirus disease outbreak has become a major public health emergency and a global burden. As of December 31, 2021, Liberia has recorded 7,460 cases with 294 deaths and Montserrado County accounted for 71.8% of the cases with 56.8% death. We conducted the epidemiological description of the COVID-19 cases in Montserrado County.

 

Methods: A retrospective record review of confirmed COVID-19 cases from 15 March 2020 - 31 December 2021 was conducted. Data was obtained from the Montserrado County COVID-19 line list. Variables of interest were age, sex, place of residence, laboratory result, place of treatment, place of monitoring and case outcome. Descriptive analysis was performed using Epi Info version 7.2.

 

Results: The mean age of 5,357 confirmed COVID-19 cases was 40.6+15.2 years. Males constitute 63.4% (3397/5357) and the case fatality rate of deaths was 3.1% (167/5357). About 40.9% (2,180) of the cases participated in home-based care, 12.6% (677/5357) was admitted to treatment units and 40.2% (2,155/5357) were not investigated due to missing address, wrong contacts numbers, and denial of test results. A total of 10,059 contacts were line listed, 84.2%( 8472/10059) completed 14 days of follow-up, 39.2% (3946/10059) were high risk and only 1.7% (166/10059) became cases. Central Monrovia accounted for 75.9% (4065/5357) of the cases, while Todee recorded 0.07 %( 4/5357). There were four waves of the COVID-19 outbreak and the highest peak of cases and deaths occurred in June 2020 and June 2021.

 

Conclusion: COVID-19 outbreak in Montserrado County is a public health concern. There is a need to improve documentation to ensure proper follow-up of cases. Vaccination and interventions are encouraged to control the outbreak.

 

Keywords: COVID-19, Surveillance, Community engagement and prevention

 

 

Thomcelia Mensleh Duoe^1,2,&, Faith Kamara Whesseh^2,3, Himiede Sesay^2,3, Lily Sanvee- Blebo^2,3, Alberta Corvah⁴, Chukwuma Umeokonkwo^2,3, Obafemi Joseph Babalola^2,3, Maame Amo -Addae^2,3

¹Ministry of Health, Monrovia, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia, ³Africa Field Epidemiology Network (AFENET), Monrovia, Liberia, ⁴National Public Health Institute of Liberia, Monrovia, Liberia

^&Corresponding author: Thomcelia Mensleh Duoe, Ministry of Health Monrovia, Liberia,

 

Email:thom.duoe@gmail.com

Background: Neonatal mortality is a public health issue with over 3 million babies dying around the world, annually. The highest number of newborn deaths occurs in Sub-Saharan Africa and South Asia. Liberia's neonatal death rate remains high, at 32.4 fatalities per 1,000 live births. The sustainable development goal (SDG) 3.2, targets reducing neonatal mortality. We characterized neonatal deaths from 2017 to 2021.

 

Methods: This was a secondary data analysis of all neonatal deaths reported to the National Public Health Institute of Liberia from 2017 to 2021 through the IDSR system national line list. The variables available were the age at death, sex, cause of death, place of residence, and place of death. The data was summarized in frequencies, and proportions using Epi Info Version 7.2.

 

Results: The median age of the 2959 neonatal deaths reported during the period was 2 years (Interquartile range: 1-5). Females constituted 51.4% (1522/2959), and the age group one to six days were 81.5% (2263/2959). Most 93.2% (2759/2959) of neonatal deaths occurred in health facilities. The commonest cause of death was birth asphyxia 51.3% (1520/2959), neonatal sepsis 34.6% (1024/2959), and prematurity 6.5% (191/2959). Montserrado County recorded 18.5 deaths per 1000 live births. The annual neonatal mortality rate decreased from 7.2 to 6.1 live births in 2018 and 2021 respectively.

 

Conclusion: Liberia's neonatal death rate remains high. There is a need to improve the quality of neonatal resuscitation interventions available for the newborn.

 

Keywords: Mortality, Neonatal death, Surveillance, SDG 3.2, Liberia

 

 

Joyce Odell Abel^1,&, Obafemi Joseph Babalola², Maame Amo-Addae²

¹National Public Health Institute of Liberia, Monrovia, Liberia, ²African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Joyce Odell Abel, National Public Health Institute of Liberia

 

Email: joyceabel08@gmail.com

Introduction: Despite the availability of effective preventive and control measures, malaria remains a public health burden in Liberia and approximately 4.8 million people including pregnant women and under five children are at risk. We described the epidemiology of malaria among children five years and younger and pregnant women.

 

Methods: We conducted a retrospective record review of the national malaria surveillance data from 2017-2021. Data were obtained from the National Malaria Control Program DHIS-2. Malaria variables such as the method of malaria diagnosis, treatment, ANC visit, Intermittent Preventive Treatment (IPT), LLIN distribution, final classification and county of residence were extracted to Excel and imported to Epi Info 7.2 for descriptive analysis.

 

Results: National annual malaria prevalence was 15% in 2021. Counties with higher annual malaria prevalence were Bomi (31%), Grand Kru (27%), River Gee (27%), Lofa (23%), Grand Gedeh (20%), Margibi (20%), and Montserrado (20%). Malaria diagnosis peaked in the rainy season (April to July) annually. The proportion of pregnant women receiving LLIN increases from 3% in 2017 to 18% in 2021, but IPT2 decreases from 21% to 19%, and the diagnosis of malaria in pregnancy remained at 18%. Annually, 68% of 321,831 under-five children were tested with RDT, and 34% of those who presented within 24 hours were treated with ACT.

 

Conclusion: Malaria is a public health problem in Liberia especially among children under five years and pregnant women. NMCP should strengthen the delivery of malaria control and preventive measures to these vulnerable groups in Liberia.

 

Keywords: Malaria, Surveillance, malaria RDT, malaria in pregnancy, Liberia

 

 

John Karmuah Doe^1,&, Alberta Corvah², Maame Amo-Addae³, Peter Adewuyi³, Himiede Wede Sesay³, Obafemi Joseph Babalola³, Thomas Nagbe², Chukwuma David Umeokonkwo³

¹Montserrado County Health Team, Montserrado, Liberia, ²National Public Health Institute of Liberia, Monrovia Liberia, ³Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: John Karmuah Doe, Montserrado County Health Team, Montserrado, Liberia

 

Email:doejohnka@gmail.com

Background: Approximately 800 women die daily from preventable causes. Sub-Saharan Africa records 68% of all maternal deaths worldwide annually. Maternal death is a priority event under surveillance in Liberia and all reported maternal deaths are audited. Free health care service was introduced in Liberia in February 2007 when the maternal mortality ratio (MMR) was 1072 per 100,000 live births. Montserrado County is the most populated of the 15 counties in Liberia with a third of the national population. We characterized maternal deaths in Liberia from 2017-2020, ten years after the introduction of free maternal services.

 

Methods: We conducted secondary data of all reported maternal deaths in Liberia from 2017 to 2020 obtained from national surveillance records at the National Public Health Institute. Data on live births were obtained from the Health Management Information System at the Ministry of Health. The variables of interest analyzed included maternal age, county of residence, and cause of maternal death. Epi Info Version 7.2 was used to calculate frequencies, proportions, and maternal mortality ratios (MMR).

 

Results: The mean age of the 950 maternal deaths reported over the four years was 28.8±7.7 years. Hemorrhage 38.1% (362/950), sepsis 13.1% (124/950) and eclampsia 12.1% (115/950) were the commonest causes of death. There was a steady yearly decline in the MMR from 1,135/100,000 live births in 2017 to 202/100,000 live births in 2020. Overall, a fifth of the deaths (165/950) occurred in the community however the proportion of deaths occurring in the community compared to health facilities showed a steady downward trend. Montserrado County recorded the highest MMR of 432/100,000 live births compared to the national average of 260/100,000 live births over the study period.

 

Conclusion: Although MMR has steadily declined in Liberia, we recommended further studies to assess the contribution of free maternal services to maternal health.

 

Keywords: Maternal death, haemorrhage, abortion, Maternal Mortality Ratio, Montserrado

 

 

Yolaine Kate Waka-Metzger^1,&, Peter Adewuyi², Obafemi Joseph Babalola², Himiede Wilson Sesay², Chukwuma David Umeokonkwo², Maame Amo-Addae²

¹National Public Health Institute of Liberia, Monrovia, Liberia, ²Africa Field Epidemiology Network, Monrovia Liberia

^&Corresponding author: Yolaine Kate Waka-Metzger, National Public Health Institute of Liberia, Monrovia, Liberia

 

Email: yolainewaka@gmail.com

Introduction: Globally, substance use in 2020 had increased by 26 per cent from the previous decade, and predominantly more in younger people than adults. Alcohol, tobacco, and cannabis are common substances used in West Africa, with regional cannabis use exceeding the global average. There is a paucity of data on patterns of substance use among young adults in Liberia. Therefore, we described the awareness and patterns of substance use among in-school young adults in Liberia.

 

Method: We conducted a cross-sectional study. Using multi-stage sampling, we recruited 818 young adults aged 18 – 24 years from 34 out of 53 tertiary institutions in Liberia. A structured interviewer-administered questionnaire was used to assess the awareness, lifetime and current substance use, and reasons for use. The frequencies and proportions were estimated using Epi Info version 7.2.

 

Results: The median age of participants was 22 (IQR: 20-24) years. Overall, 738 (90%) knew at least one substance of abuse. The median age at first use was 18 years (IQR: 17-19). The commonest substance they knew was alcohol (90.2%), tobacco (81.9%), cannabis (51.3%), and sedatives (44.9%). The commonest sources of information about the substances were friends (75.7%), radio (46.6%), and social media (42.3%). Slightly over half 54.2% of the respondents reported ever using at least one substance of abuse among which 49.7% (220/443) were currently using at least one of the substances. The reasons for use included belonging to a group of friends using the substance 66.7%, desiring to be bold in public speaking 48.9% and improving sexual performance 38.8%.

 

Conclusion: High awareness of alcohol, tobacco, and cannabis in young adults. One-half are currently using and one-third had ever used these substances. Community mobilization and social norms campaign for healthy behaviour and attitude to substance use, is highly recommended.

 

Keywords: Substance abuse, Awareness, Young adults, Patterns, Alcohol, Tertiary institutions, Liberia

 

 

Danny Mukandila Kalala^1,&, Obafemi Joseph Babalola¹, Peter Adewuyi¹, Maame Amo-Addae¹

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Danny Mukandila Kalala, Liberia Field Epidemiology Training Program, Monrovia, Liberia

 

Email: dkalalam@gmail.com

Background: Lassa Fever (LF) is endemic in West Africa including Liberia. Twenty per cent of infected people develop severe illness with a case fatality rate of 10 – 60%. District No. 3 A&B in Grand Bassa County is a LF hotspot in Liberia, recording annual outbreaks. Liberian Agricultural Company (LAC) Hospital is the district referral hospital with a LF treatment unit. We characterized LF cases admitted at LAC Hospital from 2016 – 2020 and determined the predictors of death.

 

Methods: We conducted a secondary analysis of surveillance data extracted from LAC Hospital records and the National Public Health Institute of Liberia. The variables of interest were sex, age, employment status, duration in days from onset of symptoms to hospital admission (OAD) and outcome. We estimated the annual incidence and case fatality rate (CFR) for LF in the district. We also compared the mean age of patients by disease outcome and modelled factors associated with death in a multiple logistic regression at a 5% level of significance using Epi Info version 7.3.5.

 

Results: There were 49 confirmed LF cases reported during the period under review with a median age of 21 (Interquartile range: 11 – 32) years. Thirty-two (65.3%) were females, 23 (47%) were students, and 32 (65.3%) were residents of the LAC concession. The annual average incidence was 2 confirmed LF cases / 10,000 population/year. There were 9 deaths, giving CFR of 18.4%. The mean age of those who died (30.7±18.3 years) was significantly higher than those who survived (20.3±11.6, p=0.036). Only age (aOR: 1.14; 95% CI: 1.018 – 1.285, p=0.024) and OAD (aOR: 1.32; 95% CI: 1.002 – 1.727, p=0.048) were predictors of death.

 

Conclusion: Among the incident cases, the majority were young, female, and residents of the LAC concession. Being older and the duration from onset to presentation were weak predictors of death. Efforts should be targeted at ensuring that cases report to the hospital on time.

 

Keywords: Lassa fever, mortality, Liberia, Ribavirin

 

 

Emmanuel Agu^1,&, Arnold Ayebare², Pacifique Ntirenganya², John Yarngrorble¹, Ibrahim Sanoe¹, Henry Dugulu¹, Diana Gahn-Smith¹, Francis Kateh¹, Jane Amanda Macauley³, Dad Boe⁴, Solomon Larkai⁴, Damien Bishop⁴, Daniel Lohmann⁴, Alois Dörlemann⁵, Abraham Alabi⁵

¹Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia, ²Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia, ³National Public Health Institute of Liberia (NPHIL), Monrovia, Liberia, ⁴German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia, ⁵Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany

^&Corresponding author: Emmanuel Agu, County Pharmacist, Maryland County, Harper City, Liberia

 

Email: agu.emmanuel@yahoo.com

Background: Antimicrobial resistance (AMR) surveillance systems are core components of infectious disease management and the basis for a better understanding of the spread of AMR. Health Focus GmbH (HF), on behalf of the German International Cooperation (GIZ) in collaboration with Partners In Health (PIH) and the Ministry of Health (MOH) implemented AMR surveillance and antimicrobial stewardship (AMS) programmes in Southeast (SE) Liberia to support Liberia`s AMR national action plan (NAP), 2018-2022.

 

Methods: AMR surveillance has been ongoing since October 2019 in 3 County hospitals in SE Liberia: J.J. Dossen Hospital (JJDH), Harper, Maryland County; Fish Town Hospital (FTH), Fish Town, River Gee County, and Rally Town Hospital (RTH), Grand Cess, Grand Kru County. For the first time, GIZ established a Referral Microbiology Laboratory at JJDH to examine patients` specimens by bacterial culture and antibiotic susceptibility testing (AST). Five priority diseases are being investigated: Skin and Soft Tissue Infection (SSTI), Meningitis, Urinary Tract Infection (UTI), Community-Acquired Pneumonia, and Surgical Site Infection (SSI). A local treatment guideline aligned with the National Therapeutic Guidelines of Liberia and international standards was developed and implemented. Health professionals in the 3 hospitals were appropriately trained and they are conducting regular AMR/AMS ward rounds.

 

Result: 1033 patient specimens from the 3 hospitals were analysed at the JJDH Microbiology Lab. Bacterial pathogens isolated include Escherichia coli (21.84%), Klebsiella species (17.47%), Staphylococcus aureus (12.95%), Pseudomonas pseudo alcaligenes (10.69%), Proteus species (8.44%), and Acinetobacter species (8.28%). Resistance to fluoroquinolone and carbapenem were observed, ESBL was 38.26% and MRSA was 9.3%.

 

Conclusion: Implementing AMR surveillance and stewardship has improved clinical practice, patient care, and treatment outcomes in 3 participating hospitals in SE Liberia. Therefore, there is a need for local ownership and institutionalization of the programme to ensure sustainability and long-term benefits.

 

Keywords: Antibiotic, Antimicrobial Resistance, Liberia

 

 

Saibana Camara^1,2,&, Bai Janneh², Kawsu Sanyang², Peter Adewuyi¹

¹Gambia Field Epidemiology Training Program, Gambia, ²Department of Livestock Services, Ministry of Agriculture, Banjul, Gambia

^&Corresponding author: Saibana Camara, Department of Livestock Services, Ministry of Agriculture, Gambia

 

Email: saibana.camara1979@gmail.com

Background: Animal Disease surveillance and response system (ADSR) monitors disease trends, to facilitate the control of infection or infestation, and provide data for use in risk analysis for animal or public health purposes. The ADSR system in the Gambia is an integrated system set to monitor priority diseases of livestock including six zoonotic infections. It aims to demonstrate the absence of diseases, determine the presence or distribution of infections or infestation and early detection and control of infections. Unfortunately, the ADSR system in The Gambia has never been evaluated since its inception in 2018 to determine its usefulness, and meeting of its objectives. Hence, we evaluated some system attributes, determined its usefulness and if it is meeting its objectives.

 

Methods: We conducted key informant interviews and administered questionnaires to 22 key stakeholders involved in the ADSR system. We used the CDC guideline for the evaluation of the public health surveillance system and collected data to determine the usefulness, simplicity, flexibility and stability of the ADSR system and we analyzed the data using Microsoft Excel version 10.

 

Results: From a total of 22 stakeholders interviewed, 73% ( 16/22) were male with ages between 27 - 56 years. The length of time at work for all stakeholders interviewed ranges between 5 – 27 years The length of services of stakeholders A total of 95% ( 21/22) were conversant with the purpose and objective of the ADSR system. 59% ( 13/22) of respondents understood the case definition of priority disease and community participation in disease reporting and outbreak investigation was good. Between 2018 and 2021 a total of 1526 cases of Trypanosomiasis were detected. All outbreaks under surveillance are immediately reported but data quality was poor.

 

Conclusion: The surveillance system was meeting its objective and was useful. It is simple, flexible, and partially stable. The system has a poor data quality issue. We recommended training on data management to help improve the system

 

Keywords: ADSR, Trypanosomiasis, outbreaks, Gambia

 

 

Dauda Kamara^1,&, Jean Leonard Hakizimana¹, Adel Hussein Abdallah², Amara Alhaji Sheriff¹, Kassim Kamara¹, Gebrekrstos Negash Gebru²

¹Ministry of Health and Sanitation, Sierra Leone, ²African Field Epidemiology Network, Field Epidemiology Training Program, Sierra Leone

^&Corresponding author: Dauda Kamara, ¹Ministry of Health and Sanitation, Sierra Leone

 

Email: daudakamara50@gmail.com

Introduction: Diarrhoea is the second leading cause of death among children under five years. Limited information is available on performance of the diarrhoea with severe dehydration surveillance system (DSDSS) among children under-five years. We evaluated the DSDSS among under-five children under-five surveillance system to assess its usefulness, and performance of its system attributes based on its set objectives.

 

Methods: We conducted a descriptive cross-sectional study using the updated CDC guidelines for evaluating public health surveillance systems. We assessed the system from January through December 2021. We interviewed health workers, stakeholders, and partners using the semi-structured questionnaire. We reviewed records including; weekly reporting forms, health facility morbidity registers, and the DHIS2 database. Quantitative attributes were presented using proportions and qualitative attributes were described.

 

Results: In all, 1,530 cases including 19 (1.2%) deaths were reported for the period. All the 30 respondents interviewed understood the case definition for diarrhoea with severe dehydration, and data was only reported to the District Health Management Team (DHMT). Eighteen (90%) health facilities have functional mobile devices for electronic reporting. Twenty-eight (93.3%) of the respondents reported power outages five times a week, unstable internet connectivity, and a breakdown of the District Health Information System (DHIS2) platform for three months or more. Timeliness and completeness of reporting for the 20 facilities was 100%, and blank variables were found in 98 (98%) of the 100 health facility registers reviewed.

 

Conclusion: The DSDSS surveillance system is useful and acceptable but partially meets its set objectives due to its poor data quality, inability in detecting outbreaks, interrupted electricity, unstable internet connectivity, and downtime with DHIS2. We recommend training and supportive supervision to improve data quality, and provision of stable electricity in health facilities.

 

Keywords: DHIS2, Diarrhoae, Children, Surveillance

 

 

Selah Ngangawulor^1,&, Patrick Blamo², Zeela Zaizay¹

¹Reducing the Burden of Severe Stigmatizing Skin Diseases (REDRESS) Liberia, Monrovia, Liberia, ²National Standard Laboratory of Liberia, Monrovia, Liberia

^&Corresponding author: Selah S. Ngangawulor, Reducing the Burden of Severe Stigmatizing Skin Diseases Liberia

 

Email: stannousnganga@gmail.com

Introduction: Bisphenol-A is an unbound chemical from plastic widely used as a monomer or additive in the manufacture of epoxy resins, food storage containers and other polymeric materials. BPA enters the food via heating substances, overuse, and exposure to microwaves, which leads to BPA intake through food. Several literatures reported BPA leaching out into the environment serving as a potential chemical hazard in food, raising concern for the evaluation of assorted food on the Paynesville market. Food packaging has been reported as the main source of food exposure. Several research has shown the impact of BPA on the central nervous system, the endocrine pancreas and the immune system.

 

Method: This study considered 60 kinds of human foods from various markets across Paynesville. Food samples were left in tight and transported to the National Standards Laboratory for analysis to avoid contamination with outside sources of BPA. A qualitative (colour change) method was used to analyze the products.

 

Results: The results showed that no BPA was detected in 46.7% of analyzed samples, 40% detected at an acceptable limit (Conc. ≤ 0.06 mg/kg) and 13.3% detected at an alarming concentration (Conc. > 0.06 mg/kg). Omega market, Red-light and Duport Road constituted 50%, 25% and 25% alarming detection respectively. Dried Crab, dried Turkey neck and Dried Chicken feet where product with alarming detection values.

 

Conclusion: There were variations in the concentration of BPA in food categories and by food types. By food categories, the approximated concentrations of BPA in food ranged from purple (acceptable BPA concentration) to deep blue (alarming concentration of BPA). With the alarming concentration of BPA found in these food products, new food safety measures such as bio-monitoring should be employed to minimize public health risks.

 

Keywords: Food, additive, human health, Liberia

 

 

Trokon Roberts^1,&, Himiede Wede Sesay², Obafemi Joseph Babalola², Peter Adewuyi², Maame Amo-Addae²

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia, ²Africa Field Epidemiology Training Network, Monrovia, Liberia

^&Corresponding author: Trokon Roberts, Liberia Field Epidemiology Training Program, Monrovia, Liberia

 

Email: troberts2384@gmail.com

Introduction: Liberia recorded her first COVID-19 case in March 2020 resulting in the implementation of precautionary methods. Despite the rise in COVID-19 cases, the Integrated Disease Surveillance and Response System (IDSR) are to be sustained. Though, health services might be interrupted during this pandemic due to the unavailability of essential medical supplies, economic hardship, coupled with others. The study aimed to compare the trend of IDSR reporting from January-June 2019 to January-June 2020 in Liberia.

 

Method: A descriptive cross-sectional survey was conducted in 30 health districts, and 42 (31 Urban and 11 Rural) health facilities in the 15 counties of Liberia. We reviewed treatment and diagnosis ledgers, and compared IDSR reports for epidemiological weeks 1-27 (January - June), 2019 & 2020. Calculated frequencies and proportions of IDSR cases and plotted graphs to determine trends and outbreaks that occurred.

 

Result: Between epi weeks 1-27 in 2019 (2,915) cases were recorded compared to 2020 with (2,832). Forty per cent (17/42) of the health facilities conducted epidemiological data analysis, 79% (33/42) had functioning IDSR systems, while 33% (14/42) responded to outbreaks during the COVID-19 pandemic. However, there was a 19% decrease in the number of notifiable diseases reported between epi-week 12 to 27, 2019 compared to the same period in 2020. Only 17 (40.5%) have adequate specimen collection kits and 24 (57.1%) received laboratory results. “Zero reporting” were consistently maintained by 34 (81.0%) health facilities while 13 (31.0%) health facilities were silent throughout the 27 weeks in 2020. Of the 42 health facilities, 9 (21.4%) reported that the COVID-19 outbreak either disrupted or led to the suspension of IDSR and health services in the health facility.

 

Conclusion: There has been a slight decline in trends of disease reporting in 2020 compared to 2019 due to the COVID-19 pandemic.

 

Keywords: Healthcare, COVID-19 Outbreak, Disease, Epidemiology, Malaria, Liberia

 

 

Dedesco Doebia Gweh^1,&, Maryland County Health Team¹, Chukwuma David Umeokonkwo², Maame Amo-Addae², Leroy Maximore³, Himiede Wilson², Faith Kamara Wesseh², Obafemi Joseph Babalola

¹Maryland County Health Team, Maryland, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Dedesco Doebia Gweh, Maryland County Health Team, Liberia

 

Email: dedesco1212@yahoo.com

Background: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The burden of the pandemic has varied across the world, especially in Africa. The epicenter of the pandemic in Liberia just like in most other countries is the capital Monrovia. Maryland County in the southeastern part of Liberia is one of the hotspots. We conducted secondary data analysis to characterize the COVID-19 cases in Maryland from 2020 to 2022.

 

Methods: We conducted secondary data analysis on all the COVID-19 cases reported through the IDSR weekly reporting line list from 2020 to 2022, case-base forms, COVID-19 isolation, and treatment unit records at five (5) health facilities, two treatment units, and three (3) health districts. We extracted variables such as age, sex, travel history, and vaccination status. Using Epi Info version 7 we conducted descriptive analysis. ArcGIS software was used to display the spatial data.

 

Results: A total of 360 confirmed COVID-19 cases were recorded from 2020-2022. Form five Health facilities (5) 97 were confirmed by PCR and 263 were confirmed by Rapid Diagnostic Test. The median age was 36 years (ranging from 2 years to 95 years), and males accounted for 51% (184/360) of the cases reported. The age group 35 - 39 years accounted for 14.7% (53/360. Eleven per cent (40/360) were fully vaccinated against COVID-19, 37% (132/360) were vaccinated with the first dose of the COVID-19 vaccine and 52% (187/360) were not vaccinated. Partial or no vaccination predisposes a person to contract the infection. Maryland County had low COVID vaccination coverage during the second and third waves of the outbreak. The case fatality rate (CFR) was 5.2% (19/360).

 

Conclusion: The age group 35 to 39 years accounted for the highest number of cases reported. Males accounted for the highest number of cases. Low vaccination coverage or lack of immunization were probable causes of COVID-19 cases during the period under review.

 

Keywords: COVID-19, vaccination, probable trend, and case fatality rate

 

 

Ivan Augustine Barrie^1,&, Solomon Aiah Sogbeh^1,2, Binta Bah^1,2, Joel Francis Mansaray^1,2, Mohammed Babah Jalloh^1,2, Philip Gevao^2,3, Elduma Adel⁴, Gebrekrstos Gebru⁴

¹Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone, ²Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone, ³Sierra Leone Ministry of Defense, Freetown, Sierra Leone, ⁴African Field Epidemiology Network, Freetown, Sierra Leone

^&Corresponding author: Ivan Augustine Barrie, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone

 

Email: ivanabarrie@gmail.com

Background: Fertility, mortality, and migration are major determinants of population growth. They are used to project population size between census years. Population size is key in allocating resources for health care planning. We aimed to estimate the crude birth and death rates and causes of death among the general population in Kono District, Sierra Leone to provide more accurate inter-census population estimates.

 

Methods: We conducted a retrospective secondary data analysis of the National Civil Registration Authority (NCRA) data. Health professionals in chiefdoms and healthcare facilities collect and send occurrences of births and deaths to the NCRA platform. The study was conducted in Kono District from January to March 2022. We calculated crude birth and death rates using the estimated Kono District population, July 2021 (per 1000 population). We calculated the proportion of death by cause. In Sierra Leone, facility-based cause of death is determined by physicians, and community death is determined through verbal autopsy, cause of death is documented through the NCRA system.

 

Results: There were 16,684 births and 415 deaths from January 2020 to December 2021. The birth rate increased from 14.1 in 2020 to 16.2 in 2021per 1000. However, the death rate decreased from 12.7 in 2020 to 7.5 per 1000 inhabitants in 2021. The median age of mothers was 25 years (range 19-52 years) and death was 62 years (range 1 day to 120 years). The major causes of death were malaria (24%), cardiac respiratory failure (23%), and liver cirrhosis (16%).

 

Conclusion: Malaria, cardiac respiratory failure, and liver cirrhosis were prominent reasons for mortality in the Kono District, likely owing to inadequate sanitation and mining fumes and dust. Underreporting of deaths in remote villages lowers the district's mortality rate. Kono District health authorities to intensify environmental cleaning and occupational health and safety to safeguard the public from fumes and dust.

 

Keywords: Kono District, National Civil Registration Authority, births, death, Sierra Leone

 

 

Musa Ndow Corr^1,2,&, Peter Adebayo Adewuyi^1,3, Chukwuma David Umeokonkwo³, Frank Ob³, Mustapha Bittaye⁴, Ousman Badjie⁵, Alfa Khan⁵, Lamin Badjie⁵, Sadou Bah⁵, Pa Ousman Bah⁴, Modou Njie¹

¹The Gambia Field Epidemiology Training Program, Banjul, The Gambia, ²Gambia Armed Forces, Banjul, The Gambia, ³African Field Epidemiology Network, Banjul, Gambia, ⁴Directorate of Health Services, Ministry of Health, Banjul, Gambia, ⁵National AIDS Secretariat, Banjul, Gambia

^&Corresponding author: Musa Ndow Corr, Gambia Armed Forces

 

Email: musancorr@gmail.com

Background: HIV infection is still a major public health challenge in The Gambia. Although incidence rates among the general population are relatively low, evidence shows rising infection rates among key populations, threatening current efforts at controlling the disease. This study aimed to describe the epidemiology of HIV infection in The Gambia.

 

Method: We conducted a study among healthcare attendees at the 45 HIV sentinel sites in The Gambia. The data we extracted from the DHIS 2 included demographic information, HIV test results (positive/negative), and treatment enrollment. We conducted univariate and bivariate analyses and presented our results in grafts and charts

 

Results: Of the 177,832 persons tested for HIV, 14,863 (8.4%) were positive and only 8,358 (56.2%) were enrolled into treatment. Test positivity rates were higher among clients aged above 49 years (15.5%), and among females (15.5%). Western 2 region (47.6%) had the highest test positivity rate (13.9%) while NBER had the lowest (3.8%). Females (60.6%) are more likely to enrol for treatment as compared to males (48.4%) [PR: 1.2 (95%CI 0.1581-0.1701)]; and Western 1&2 regions (68.1%) as compared to other regions (39.9%) {PR: 1.1 (95%CI 1.0272-1.0929)}.

 

Conclusion: In this study, females tested more positive, and about half of those who tested positive enrolled in treatment for HIV and mostly among older age groups. We recommend to National AIDS Secretariat to develop innovative strategies to motivate positive cases to enrol in treatment.

 

Keywords: HIV/AIDS, Enrollment, positive tests, The Gambia

 

 

Balla Jatta^1,&, Baba Fofana^2,3, Peter Adewuyi³, Wandifa Samateh⁴

¹Epidemiology and Disease Control Unit, Ministry of Health, Banjul, Gambia, ²Edward Francis Small Teaching Hospital, Banjul, Gambia, ³Africa Field Epidemiology Network (AFENET), Banjul, Gambia, ⁴National Leprosy and TB Program, Ministry of Health, Banjul, Gambia

^&Corresponding author: Balla Jatta, Epidemiology and Disease Control Unit, Ministry of Health, Banjul, Gambia

 

Email: ballajatta07@gmail.com

Background: Despite the availability of a tuberculosis (TB) Control Programme with effective and efficient prevention and control strategies and treatment facilities, TB still continues to be the leading cause of death worldwide, most especially in developing countries like the Gambia. In this study, we aimed to describe Pulmonary TB in The Gambia between 2017-2021.

 

Methods: We reviewed TB Data obtained from the DHIS2 covering 2017-2021. We extracted data on TB types and different types of categories of bacteriologically confirmed treatment outcomes. We validated, tabulated and analyzed data using Microsoft Excel.

 

Results: A total of 11,651 TB Cases were extracted from the DHIS2 for 2017 to 2021, of which new pulmonary TB cases were 7,006 (60.13%) and new extrapulmonary TB cases were 770 (6.61%). Of the 7,006 pulmonary cases, 3,344 (28.70%) were clinically diagnosed, 66 (0.94%) were previously confirmed and treated but defaulted, while 55 (0.78%) were TB cases that had treatment failure and 410 (5.85%) were previously treated after failure relapse.

 

Conclusion: New cases of TB were high during the period under review, and some of them were due to treatment failure, relapse and failure after previous treatments. We recommend further investigations to determine risk factors for treatment failure.

 

Keywords: Pulmonary, Extra Pulmonary, Multi-Drug Resistance, Tuberculosis

 

 

Amadou Woury Jallow^1,&, Peter Adewuyi², Mustapha Bittaye¹, Sana Sambou¹, Bakary Sanneh³, Sidat Fofana⁴, Chukwuma David Umeokonkwo²

¹Epidemiology and Disease Control Unit, Directorate of Health Services, Ministry of Health, Banjul, Gambia, ²African Field Epidemiology Network (AFENET), ³National Public Health Laboratories, Ministry of Health, Banjul Gambia, ⁴Expanded Program on Immunization, Ministry of Health, Banjul, Gambia

^&Corresponding author: Amadou Woury Jallow, Epidemiology and Disease Control Unit, Ministry of Health, Banjul, Gambia

 

Email: amadou.jallow@gmail.com

Background: Measles is a highly infectious, acute illness spread by airborne respiratory droplets or direct contact with infected people's nasal and throat secretions. It is most common in children under the age of five. This study was carried out to assess the country's measles trend and describe measles epidemiologically.

 

Method: We reviewed and extracted data from a national database from 2017 to 2021. The Gambia is divided into seven health regions. We gathered information on demography, vaccination status, and region of residence. Measles IgM antibodies were tested for. We looked for proportions and calculated the prevalence odds ratio at a 95% confidence interval.

 

Results: Of 253 suspected cases reported from 2017 to 2021, 21 (8.3%) were confirmed for measles IgM. Of the confirmed cases, the median age was 5 (1–52) years old, 14 (66.7%) were males, and 15 (71.4%) were from urban areas. The highest proportion came from the Western 1 Region 12, (57.1%) in 2021. Those vaccinated are significantly 14 times less likely to get infected with measles compared with those not vaccinated [POR: 0.0768, (CI: 0.0219 – 0.2691)]. Those living in the western regions (1 & 2) are 3.22 times more likely to have measles compared to those in the other 5 regions (POR 3.22; CI: 1.20–8.61).

 

Conclusion: The incidence of confirmed cases was low during the period, however, it was commoner in the Western 1 region. We recommend further investigations to determine risk factors for the high incidence to provide an informed decision.

 

Keywords: Data analysis, Measles Surveillance, trend, IgM

 

 

Amara Fofana^1,&, Rosie Watts¹, Alfred Flomo¹, Emmanuel Kerkula¹, Stanley Kerkula¹, William Fischer¹, Jean DeMarco¹, Catherine Nimely¹, Sandrena Frischer¹, Carwolo Pewu¹, Sam Tozay¹, David Wohl¹, Jefferson Sibley¹

¹The University of North Carolina - Global Projects Liberia, Phebe Hospital Compound, Gbarnga, Bong County, Liberia

^&Corresponding author: Amara Fofana, The University of North Carolina - Global Projects Liberia, Phebe Hospital Compound, Gbarnga, Bong County, Liberia

 

Email: amara.fofana.unc@gmail.com

Introduction: Lassa Fever (LF) is responsible for an estimated 300,000-500,000 infections and more than 5,000 deaths annually in West Africa - figures likely underestimated given the lack of access to diagnostic testing, challenges collecting epidemiologic data during and following the civil conflict, and limited clinical research infrastructures (1-5). Despite the WHO designating Lassa Fever Virus (LASV) as a “top priority emerging pathogen”, LF remains underdiagnosed and understudied (6-8). Challenges that have prevented complete epidemiological profiling of LF in West Africa also have led to gaps in understanding the extent of other pathogens. We aimed to determine the seroprevalence of LASV and other pathogens among community members in rural Bong County, Liberia.

 

Methods: Serosurvey of participants living in central Liberia. Blood samples were collected from 167 participants from 30/04/2021 to 04/06/2021, and analyzed using the AFRICOM bead panel on a Luminex MAGPIX^® analyzer. The AFRICOM panel works as a direct immunoassay for the detection of either IgG or IgM.

 

Results: Median age was 21 years (range 2-97), 51% female. Seropositivity results; Lassa Fever Virus (LASV), 70%. Among those testing seropositive for LASV, 1.2% indicated they have previously had LF. Panflavivirus, 64%. Previous Yellow Fever vaccination campaigns likely contribute to this prevalence. Ebola Virus (EBOV), 28%. Prior Ebola exposure may correlate with the 2014 Ebola outbreak. Rift Valley Fever Virus (RVFV NP), 34%. Panalphavirus, 41%. Marburg Virus (MARV GP), 19%. Congo Crimean Hemorrhagic Fever Virus (CCHFV NP), 50%.

 

Conclusions: High prevalence of prior LASV exposure in these communities suggests a broad spectrum of clinical disease. As LF can cause life-threatening disease, high LASV seropositivity underscores need for reliable and sustainable diagnostics and treatment infrastructure, alongside support for contact tracing, isolation and quarantining, community education, vector control and other public health interventions. Identification of prior exposure to other viral pathogens merits further study and expanded surveillance.

 

Keywords: LASC, Pathogens, Ebola Virus, Rift Valley Fever, Marburg virus

 

 

Joseph Mehdeh^1,&, Trunos Grison¹, Eugene Gray¹, Ngwarati Mashonga¹

¹Riders for Health Liberia, Monrovia, Liberia

^&Corresponding author: Joseph G Mehdeh, Riders for Health Liberia, Monrovia, Liberia

 

Email: nmashonga@ridersintl.org

Background: Management and laboratory diagnosis during pandemics like COVID-19 and other Infectious Diseases in decentralised health systems require an “Effective Sample Transportation” System. Before the Riders system, only 25% of samples reached laboratories within 24 hours. Currently, Riders for Health Liberia Sample Transport System uses 60 professional couriers mobilized on motorcycles in timely transport samples from 394 pickup points across Liberia's 15 counties, connecting over 857 health centres to the Reference Laboratory. The evaluation showed Riders' effectiveness, evidenced by the increased access to laboratory services during the pandemic, early case detection, reduced sample transport Turn Around Time, and timely containment of disease outbreaks.

 

Method: 354 of the over 857 health facilities were interviewed using stratified random sampling. Data were collected between June 2021 and July 2021 from the 15 Counties mainly from County Health Officers and County Surveillance Officers, 17 (100%) Lab technicians from the National Reference Laboratory, couriers' log sheets, GPS information and Fulcrum database, focus group discussions, key informant and telephone interviews. Quantitative and qualitative methods were used to triangulate those findings.

 

Results: Of the total (354) of the over 857 health facilities interviewed, (344/354), 86% indicated that Riders' sample transport system increased their probability to collect and send specimens to the laboratory. Before Riders came, only 25% of samples reached testing laboratories within 24 hours. Now, an average of 98% reached laboratories within 24hrs. Of the about 23 suspected disease samples transported by the Riders system, COVID-19 constituted 96% of the total 78,606 transported in 2020 and 2021. 96% of the Officers in Charge & health facilities Lab staff interviewed also indicated that Riders' sample transport has addressed their patient specimen transport problems/challenges.

 

Conclusion: Riders' sample transport system has strengthened access to diagnostics services at the primary level and improved patient trust. It is enhancing healthcare-seeking behaviour, timely laboratory testing and enhanced surveillance nationwide.

 

Keywords: COVID-19, health facilities, sample transport, GPS

 

 

Phebe Thomas^1,2,3,&, Irene Amedzro¹, Christian Gohoho⁴

¹Ghana Field Epidemiology and Laboratory Training Program, Accra, Ghana, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia, ³National Public Health Institute of Liberia, Monrovia, Liberia, ⁴Municipal Health Directorate, Ho, Volta Region, Ghana

^&Corresponding author: Phebe J Thomas, National Public Health Institute of Liberia, Monrovia, Liberia

 

Email: phebensthomas@gmail.com

Background: Diarrhea is an increase in the volume of stool or frequency of defecation. Diarrhea affects people of all ages and it is characterized by loose or watery stools occurring more than three times a day. Globally in 2017, Diarrhea accounted for approximately 8 per cent of all deaths among children under age 5. In Ghana, diarrhoea diseases are the fourth leading cause of child mortality, accounting for an estimated 9% of all mortality among children under 5 years of age. We conducted this study to determine the prevalence and spread of diarrhoea cases in Ho Municipality over the period of 5 years.

 

Methods: Retrospective descriptive data analysis study was conducted in Ho Municipality for a five years period (2015- 2019) among children under five and extracted data from District Health Information Management Software II (DHMIS II). Results were presented in graphs and tables using Microsoft Excel.

 

Results: A total of 27,577 suspected cases of Acute Watery Diarrhea (AWD) were reported in Ho Municipality. Of these total cases reported, the proportion of males with AWD was the highest recording 51.8% (14,285) and the majority, 72.7% (20,044) of suspected cases were between the ages 12-59 months. However, age groups 0-11 months had the highest prevalence of 18% (7,533), Ho central sub-municipality accounted for the highest 9.17 % (19, 196) while Hokpeta sub-municipal recorded the lowest 0.23% (487). The overall prevalence of diarrhoea diseases among children under five years was 13.2%. Prevalence among males was 16.8 % while for females was 15.2%. The prevalence of diarrhoea disease decreased significantly with increased age and in the early months of each year.

 

Conclusion: As with most places in the developing world, the prevalence of diarrhoea disease in Ho Central is remarkably high. The age trend and seasonal pattern of diarrhoea disease also imitate that observed in developed world studies.

 

Keywords: Diarrhea, Acute Watery Diarrhea (AWD), District Health Information Management Software II (DHMIS II), Municipality.

 

 

Burgess Gbelee, Junior^1,2,&, Fahn Taweh¹, Helena Tiawoe¹, Vera Yatta Walker¹, Yaw Karikari Asamoah², Elijah Paa Edu-Quansah³, Julius Gilayeneh¹, Jane McCulay¹

¹National Public Health Reference Laboratory, Monrovia, Liberia, ²Ghana Field Epidemiology and Laboratory Training Program, Accra, Ghana, ³African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: G Burgess Gbelee Jr, National Public Health Reference Laboratory, Monrovia, Liberia

 

Email: gburgessg55@gmail.com

Introduction: Measles virus is a highly transmittable infection caused by a single-stranded enveloped RNA virus. Humans are the only natural host. In Liberia, the focus on COVID-19 has resulted in insufficient testing for IDSR illnesses despite Measles being a disease with prolonged outbreaks with a year-round incidence of cases. We evaluated measles epidemic data to offer descriptive epidemiology and calculate laboratory "turnaround time,", a critical indication that the Lab and WHO monitor and target.

 

Method: The specimens (human serum and plasma) were collected from counties in Liberia among persons who presented with suspicion of measles from January through February 2022. The specimens were analyzed by Enzyme Immunoassay (EIA) for the determination of specific antibodies to the Measles. Plates were read at 450-630 nm and results were classified as follows, Anti-Measles virus/ IgM negative ∆A< 0.900 (cut-off), IgM equivocal 0.900≤ ∆A ≥1.1, and IgM positive ∆A> 1.100. We performed descriptive analysis and calculated turnaround time. Data were expressed in frequencies, proportions, and time using Microsoft Excel 2010.

 

Results: Two hundred forty-two samples were tested for measles of which 138(57.5%) were positive for measles. The prevalence of measles was 57%. Of the positive samples, male 71(50.7%) accounted for the highest, the median age was 3 (3 months – 60 years). Children aged 3 months -2 years 61 (47.9%) accounted for most cases. Among the Counties, Montserrado 96 (68.6%) accounted for the highest, while commonwealth and Somalia health districts accounted for 26 (18.6%) each. Two hundred twenty-six (93.4%) and 223 (96.3%) of the results were released within 5 days and 7 days respectively.

 

Conclusion: There was a high prevalence of measles during the outbreak with the highest among males and children aged less than 3 years were five-time more affected as compared to 2019. This might be due to the lack of or low vaccination during the Pandemic. Despite the pandemic, the laboratory exceeded the WHO target of 80%. We recommend vaccination in affected counties.

 

Keywords: Measles, Turnaround time, vaccination, Liberia

 

 

Jacob Timmah^1,2,3,&, Himiede Wilson²

¹Ministry of Health, Monrovia, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia, ³Grand Gedeh County Health Team, Grand Gedeh, Liberia

^&Corresponding author: Jacob S Timmah, Grand Gedeh County Health Team, Grand Gedeh, Liberia

 

Email: jacobtimmah36@gmail.com

Background: Lymphatic Filariasis (LF) is a parasitic disease caused by three species of microscopic, thread-like worms: Wuchereria, Brugia-Malayi and Brugia timori; transmitted to humans through mosquito bites. The results of the LF Immuno-Chromatic Test (ICT) confirmed the endemicity of LF in 13 out of 15 counties in Liberia, with the exceptions of Gbarpolu and Bomi. There is no documented evidence of lymphatic filariasis mass drug administration in Liberia.

 

Method: We conducted a secondary data analysis of surveillance data obtained from the Neglected Tropical Diseases Program Lymphatic Filariasis preventive treatment data of the Ministry of Health (MOH). The data covered 13 of the 15 counties in Liberia for 2016-2017. Data were cleaned and analyzed using Microsoft Excel. The variables of interest were males, females, adverse effects, cases detected, place, and time. We estimated the proportion of adverse effects, cases and measure of associations.

 

Results: A total of 713 cases were recorded or detected in two years (2016-2017). Among the cases, 75% (n=535) in 2016 while in 2017 accounted for 25% (n=178). Out of 15 counties, 9 had at least a LF case. Maryland had 458 (64%) cases followed by Margibi County 77 (11%). South East accounted for 81% (n = 578) of the cases detected in 2 years. A total of 2,991,106 received LF preventive treatment in two years. A total of 1,927,273 (64.4%) males were treated. Treatment coverage in 2017 increased by 51%, (n=2,085,216) and in 2016 it was at 49% (n=2,005,547. A total of 3,082 adverse effects were reported in 2 years out of which 2,163 were minor effects and 922 were severe adverse effects.

 

Conclusion: Lymphatic Filariasis is endemic in Liberia with the majority of cases from the southeast. We recommend that MOH and its partner should continue preventive treatment and care for people living with LF conditions, especially in Southeast Liberia.

 

Keywords: Lymphatic, Filariasis, Hospital, parasitic, microscopic

 

 

Abdoulie Sonko^1,2,&, Mary Grey-Johnson¹, Peter Adewuyi¹, Maimuna Badjie², Lamin Saidyfaye²

¹Gambia Field Epidemiology and Laboratory Training Program, The Gambia, ²Ministry of Health and Social Welfare, The Gambia

 

^&Corresponding author: Abdoulie Sonko, Ministry of Health and Social Welfare, The Gambia

 

Email: soncolley88@gmail.com

Background: The global estimate of maternal deaths in 2017 was 295,000 with Sub-Saharan Africa accounting for approximately 66%. Surveillance is key in monitoring maternal deaths especially in Africa. We therefore evaluated the Maternal Mortality Surveillance System in The Gambia to determine its usefulness and to assess some of its system attributes.

 

Methods: This was a cross-sectional study and we enrolled stakeholders at different health levels using quota sampling. Means and standard deviations were calculated for quantitative variables and the median and range for ordinal variables. Maternal Death Surveillance System attributes indicators evaluated were assessed based on scores “0” for findings that do not support the attribute and “1&rquo; for key findings that support the attribute assessed. Responses were graded excellent (90-100%), good (70-89%), fair (50-69%) and poor <50%. The sum of each attribute was divided by the total indicator number and multiplied by 100% to obtain the attribute's score.

 

Results: Of the 25 surveillance officers interviewed, 88% (22/25) were males, the median age was 37 (26-47) years, and 52% (13/25) were between age group 31-40 years. Fifty-two per cent (13/25) had no FETP Training, while 20% (5/25) were FETP Frontline graduates. The maternal mortality surveillance system was useful (82%), fairly flexible (60%), fairly timely (51%), fairly representative (55%), and fairly stable (68%) but data quality and completeness were poor (37%).

 

Conclusion: The maternal death surveillance system of The Gambia was found to be useful. The quality of data and completeness of reporting were poor, while timeliness, flexibility and representativeness of the surveillance system require improvement to enhance the performance of the system. We recommend sensitizing health workers on the need to timely investigate maternal mortality so informed decisions can be made in a timely manner.

 

Keywords: Data quality, timeliness, mortality, attributes, indicator, respondents, surveillance

 

 

Thomas Kowel^1,3,&, Alberta Corvah², Augustine Alfred^1,3, Horatius Gaye^1,3

¹Ministry of Health, Monrovia, Liberia, ²Field Epidemiology Training Program, Monrovia, Liberia, ³Gbarpolu County Health Team, Garpolu, Liberia

^&Corresponding author: Thomas Z. Kowel, Gbarpolu County Health Team, Ministry of Health, Monrovia, Republic of Liberia

 

Email: zkowel@gmail.com

Introduction: Neonatal mortality continues to be a public health problem, especially in sub-Saharan Africa. The neonatal period represents the most vulnerable time for a child's survival. Globally, 2.5 million children died in the first month of life in 2018. In Liberia, the neonatal mortality rate for 2017 was 25.0 deaths per 1,000 live births. The objective of this study is to determine the causes, distribution and prevalence rate of neonatal deaths

 

Method: Gbarpolu County has an estimated (2008) population of 83,758. The retrospective study record reviewed all Neonatal Deaths surveillance data and neonatal deaths audit forms submitted to the county from 2017-2019. Data were analysed using Microsoft Excel and Epi info, and descriptive analysis was done.

 

Result: A total of 51 Neonatal Deaths were reported by Districts in Gbarpolu County. 0-5 days accounted for 82% (42/51) of Neonatal Deaths. Median age (2) days and Age Range (1-25) days. Of the 51 Neonatal deaths that occurred, males accounted for 55% (28/51); 45 %( 23/51) were female. The leading causes of neonatal deaths were birth asphyxia 39.22%; (27%) were neonatal sepsis. Health Facilities accounted for 63% (32/51); 37% (19/51) occurred at the communities level, Bopolu District reported 49% (25/51); Bokomu 24% (12/51), Belle 8 (15/51), while Gbarma and Kongba accounted for 10% (2/51 and 2% (1/51) respectively for the period under discussion. 2019 recorded 49 recorded 49% (25/51); 2018, 29% (15/51); and 22% (11/51) in 2017. Bopolu District was highly affected with a 3.4% Attack rate, the overall attack rate was 1.5% from 2017-2019.

 

Conclusion: <5 days old were mostly affected with male having the higher proposition of neonatal deaths. The percentage of facilities-based neonatal mortality was unacceptably high with preventable causes. We recommend the provision of essential drugs and medical supplies for maternal and child health (MCH) at every health facilities to help in the management of newborn babies. There is a need for further study be conducted to access increase in neonatal deaths.

 

Keywords: Belle, Gbarpolu County, Neonatal deaths, Liberia

 

 

Melvin Tamba Foday, Junior^1,2,&, Maame Amo-Addae, Peter Adewuyi², Himiede Wede Sesayo², Jimmy Lawubah¹, Elijah Quansah², Obafemi Joseph Babalola², Thomas Nagbe³

¹Grand Kru County Health Team, Grand Kru, Liberia, ²Liberia Field Epidemiology Training Program, Monrovia, Liberia, ³ National Public Health Institute of Liberia, Congo Town, Liberia

^&Corresponding author: Melvin T. Foday, Jr., Grand Kru County Health Team, Liberia

 

Email: fodayjr.m859@gmail.com

Introduction: Globally, maternal mortality is one of the leading causes of death among women of childbearing age. Most of these deaths are due to complications during childbirth and the postpartum period. This scientific study aimed to determine the trend of maternal mortality, its causes and the institution of preventive measures in Grand Kru County, 2017-2021.

 

Methods: Maternal mortality records from 2017 to 2021 obtained from twenty-three (23) health facilities were reviewed. Microsoft Excel 2013 was used to prepare the data generated. Variables analyzed were causes of maternal deaths by age, health districts, reporting site and trends by years. Grand Kru County is located in the South-East of Liberia with five (5) health districts and twenty-three (23) health facilities. The county shared common borders with Sinoe, Maryland and River Gee Counties. Estimated population of 77,469 inhabitants.

 

Results: The total of 27 cases of maternal deaths were recorded from 2017 to 2021 with a median age of 28 years (range: 12-47) years. The most affected age group were 20-39 years 20 (74%). During the five years period, 2020 accounted for the highest number of maternal death, 9 cases (33.3%). Cases of maternal death were reported by the five (5) health districts during this period with Barclayville accounting for the highest 12 (44.4%) followed by Trehn District 7 (25.9%) and Jroah District 5 (18.5). Out of the total cases, 18 (66.6) occurred in the communities. The leading causes of death were Postpartum Hemorrhage (PPH) 12 (44.4), Anemia 4 (14.8%), Rupture Uterus 3 (11.1%) and Eclampsia 3 (11.1%).

 

Conclusion: The causes of maternal deaths in Grand Kru County are potentially preventable. Early identification of high risk pregnancies during ANC and timely intervention are recommended.

 

Keywords: Liberia, Maternal Mortality, Hemorrhage, Postpartum, Eclampsia

 

 

Abdoulie Dibba^1,&, Michael Mendy¹, Lamin Faye¹ Abdoulie Taal¹, Sheriffo Darboe¹, Mustapha Bittaye¹, Muhammed Sahoe², Peter Adewuyi³

¹Ministry of Health, Banjul, Gambia, ²World Health Organization (WHO), Banjul, Gambia, ³Africa Field Epidemiology Network (AFENET), Banjul, Gambia

^&Corresponding author: Abdoulie Dibba, Ministry of Health, Banjul, Gambia

 

Email: liedibbs@yahoo.com

Background: Measles is a highly infectious disease that remains the primary cause of death among children leading to about 367 death in children daily. The Gambia registered high coverage in measles vaccination, however, it still records confirmed cases. We conducted this investigation of a confirmed case in Jalangbereh village, Lower River Region to control the outbreak.

 

Methods: We reviewed the medical and vaccination records of the case and interviewed the caregiver. We reviewed facility registers and conducted an active case search in Jalangbereh and the surrounding communities and traced contacts of the case. Case definition: any person residing in Jallanbereh and the surrounding communities with fever and generalized maculopapular rash and or any person in whom a clinician suspects measles from 1st February to 21st February 2022.

 

Results: Of the total suspected 8 cases in the outbreak, 1 (12.5%) was confirmed, and the mean age of cases was 9.0 (SD 3.5). There were 3 males and 5 females. The index case which was the only confirmed case is an 8-year-old girl who presented with a cough, fever, rashes and a running nose. She was reported to Jalangbereh health centre on the 15th of February 2022 and confirmed on the 25th of February 2022. The date of onset of the rash was on the 14th of February 2022. There was no record of her vaccination. The case had no travel history but there is a history of a visitor to her house who also presented with a rash. A total number of 23 contacts were listed and followed, none turn to be a suspect after 21 days of follow-up. We also vaccinated a total of 301 under five children within the catchment area of Jalangbereh as a containment exercise.

 

Conclusion: This was a confirmed outbreak for measles with no deaths. We sensitized communities on measles disease, vaccinated under-fives and urged caregivers to report suspected cases immediately to the nearest health facility.

 

Keywords: Measles, Elimination, Immunization, Surveillance, Vaccine-preventable disease, Records, Active case search, Vaccination, Measles

 

 

Paul Mansaray^1,&, Alfred Fomba¹, Kwame Oneil¹, Gebrekrstos Negash Gebru², Leonard Hakizimana², Uzoma Ogbonna², Eric Ikoona², Gildo Okure², James Sejvar³ Mohamed Vandi⁴, Jill Moses⁵, Marta Guerra⁵

¹District Health Management Team, Koinadugu District, Ministry of Health and Sanitation, Freetown, Sierra Leone ²African Field Epidemiology Network, Freetown, Sierra Leone, ³Division of High Consequence Pathogens and Pathology, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention Freetown, Sierra Leone, ⁴Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown, Sierra Leone, ⁵Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Freetown, Sierra Leone.

^&Corresponding author: Paul Mansaray, District Health Management Team, Koinadugu District, Ministry of Health and Sanitation, Sierra Leone

 

Email: paulsantimans@gmail.com

Background: Seizures cause disability, discrimination, school drop-out, and premature mortality among children. In September 2018, Koinadugu Disease Surveillance Unit was notified about cases of recurring seizures in one community. After a preliminary investigation in September 2018, new cases continued to develop, including several in a second village. Field Epidemiology Training Program trainees led an investigation in April-May 2019 to characterize the seizures, establish the diagnosis, and determine the etiology.

 

Methods: We collected demographic and clinical information from interviews with cases, parents, and teachers. A case definition was developed. Group discussions with key community members, household surveys, and environmental assessments to identify risk factors and possible exposures were conducted. Environmental and human samples were collected.

 

Result: Of 69 reported cases, 54 were validated by interview and/or direct observation (13) by the investigation team. The median age of validated cases was 12 years (range, 3 – 28) and 33 (61.1 %) were female. Thirty-seven (68.5%) have predominately generalized tonic seizures and 7 (13.0%) have tonic-clonic. Median duration of illness is 1.3 years (range, 0-9), and the median frequency of events is 2/month (range, 0-4). Only 37% of cases sought medical care at the hospital, but traditional or faith healing was common. Although 17 (24.6%) reported taking seizure medication, only 3 (4%) were currently on medication. The communities differ by size, ethnic group, chiefdom, occupations, and water sources, but both report use of unlabeled agricultural and household chemicals, unregulated medication, and traditional herbs. No mining occurs in the region. Sample test results are pending.

 

Conclusion: Clusters of seizure disorders among persons predominantly of school age in two villages were confirmed. The aetiology remains unknown but could be due to toxins, infectious agents, or multifactorial, and cases may be under-reported. Further investigations will be conducted to further characterize the disorder, determine the scope, and identify the aetiology.

 

Keywords: Investigation, Seizure, Cluster, Koinadugu, Sierra Leone

 

 

Karim Darboe^1,2,&, Peter Adewuyi², Momodou Lamin Waggeh^2,3, Abdoulie Taal^2,4, Baba Ceesay^2,3, Chukwuma David Umeokonkwo⁵, Amadou Woury Jallow^2,4, Mustapha Bittaye⁶

¹Regional Health Directorate, Western II Health Region, Ministry of Health, Banjul, The Gambia, ²Gambia Field Epidemiology Training Program (GamFETP), Banjul, Gambia, ³Kanifing General Hospital, Kanifing, Gambia, ⁴Epidemiology and Disease Control Unit, Ministry of Health, Banjul, Gambia, ⁵Africa Field Epidemiology Network, Monrovia, Liberia, ⁶Directorate of Health Services, Ministry of Health, Banjul, The Gambia

^&Corresponding author: Karim Darboe, Regional Health Directorate, Western II Health Region, Ministry of Health, Banjul, The Gambia

 

Email: kdarboe80@gmail.com

Background: Animal bite remains a public health problem in many parts of the world, according to the Centers for Disease Control and Prevention, around 4.5 million people worldwide are bitten by animals every year and often post-exposure prophylaxis is needed. We conducted this study to describe the epidemiology of animal bites in Western II health region, from 2017 to 2021.

 

Methods: A cross-sectional study design was conducted. Data was collected from health facility registers and then imported to Epi-Info version 7 for analysis. Continuous variables were summarized into mean and standard deviation while categorical variables as proportion. The prevalence was calculated by districts using the number of cases as the numerator and population as the denominator and expressed as prevalence per 100,000 populations.

 

Results: Out of 463 cases, males constituted 54.21% (251/463). The mean age of animal bite cases was 24(SD±17) years. From 2018 to 2021 cases increased from 43 to 131 cases. The age group 10-19 years had 32.61% (151/463) animal bites. The populace experienced 65.87% (305/463) dog bites, and 26.57% (123/463) snake bites among others. The regional prevalence was 84/100,000 and Kombo Central district recorded highest prevalence with 112/100,000 population, followed by Kombo South district with 91/100,000 population. Only, 1% of the cases were admitted with no fatality.

 

Conclusion: The regional prevalence is 84/100,000 population mainly from dog bites, commonest among male and teenagers. There was an increase in the incidence of animal bites over the period under review. Preventive measures should be applied adequately to decrease the burden of animal bite.

 

Keywords: Prevalence, animal bites, dog bite, rabies, western II health region

 

 

Abdoulie Dibba^1,&, Alieu Sowe¹, Abdoulie Taal¹, Sheriffo Darboe¹, Mustapha Bittaye¹, Peter Adewuyi²

¹Ministry of Health, Banjul, Gambia, ²Africa Field Epidemiology Network (AFENET), Banjul, Gambia

^&Corresponding author: Abdoulie Dibba, Ministry of Health, Banjul, Gambia

 

Email: liedibbs@yahoo.com

Background: Measles is a highly infectious disease that causes serious illness, lifelong complications, and death. It was targeted for global elimination by 2020 by reducing the annual incidence to less than 1 case/million population. We analyzed the measles data for the past 5 years to describe measles and rubella vaccination coverage, to assess the timeliness and completeness of measles and rubella reporting and the epidemiology of measles in Lower River Region from 2017-2021.

 

Methods: We conducted a retrospective records review of all measles vaccination data and suspected measles cases reported in LRR during the period 2017 – 2021. Data variables extracted were age, sex, district, vaccination status, classification, and timely submission of data.

 

Results: Of the forty-nine suspected cases, 65.3% (32/49) were males, mean age was 8.1(SD 9.6) years. In other suspected cases, 36.7% (18/49) were reported from the Kiang West district, while 34.7% (17/49) were reported in 2018. About 4.1% (2/49) were confirmed positive for measles IgM. One of the two confirmed cases was vaccinated against measles. Those not vaccinated are 2 times more likely to get measles compared with those vaccinated and those under the age of 5 were 1.3 times more likely to get measles compared to those above the age of 5. However, these associations are not significant {PR 2.3 at 95.0% CI (0.2-33.9) and PR 1.3 at 95.0% CI (0.08-20.11) respectively}.

 

Conclusion: Coverage MR1 was generally high compared to MR2 coverage in LRR. Measles mostly affects male children with ages less than 5 years.

 

Keywords: Measles, Measles and Rubella, Elimination, Immunization, Surveillance, Vaccine-preventable disease

 

 

Ian Wachekwa^1,&, Kebeh Kruah¹, Coco Vaneway¹, Candy Neima², Kristina Talbert-Slagle³, Lila Kerr⁴, Umar Isa Umar³, Mukhtar Adeiza³

¹John F. Kennedy Medical Center, Monrovia, Liberia, ²National Public Health Institute of Liberia, Monrovia, Liberia, ³Yale Institute for Global Health, New Haven, CT 06510, USA 4BRIDGE-U: Liberia, Yale University, CT 06510, USA

^&Corresponding author: Ian Wachekwa, John F. Kennedy Medical Center, Monrovia, Liberia

 

Email: wachekwa@gmail.com

Background: Counseling, one of the key modalities in the management of HIV, is aimed at preventing HIV transmission and psychologically supporting those affected by HIV who may suffer psychological and psychosocial stresses due to fear of rejection, stigma, and disease progression. The aim of this quality improvement project was to describe and improve the quality and clients' perceptions of HIV counselling sessions at the John F. Kennedy Medical Center (JFKMC) Infectious Disease Clinic (IDC).

 

Methods: This was a pre-post intervention study conducted in the IDC from November 2021-March 2022 targeting the six volunteer counsellors in the clinic. During the pre-intervention phase, consenting newly diagnosed clients were interviewed using a structured questionnaire to ascertain their perceptions of the counselling services provided at the IDC. The team also observed pre-and-posttest counselling sessions and assessed the quality of the sessions using a predetermined checklist and scoring tool. A one-day counselling training workshop was conducted in which volunteer counsellors were taught about the importance of counselling, and counselling standard operation procedures were developed. Practical training also continued for a period of two months. A post-intervention assessment was done three months later.

 

Results: At pre-intervention, almost all respondents (94%) felt that counsellors were warm and understanding, and cared about them (100%). However, only 7% of respondents felt that the counsellors appeared competent and well-trained; and only 8% were satisfied with the counselling services provided. Post-intervention, 31% of respondents (p <0.001) thought the counsellors were competent and well-trained, and 38% (p <0.001) were satisfied with the services.

 

Conclusions: We observed statistically significant improvement in the perceptions and quality of HIV counselling sessions at the JFKMC, although training of volunteer counsellors needs to continue to improve counselling services at the IDC.

 

Keywords: HIV, Counseling, John F. Kennedy Medical Center, Liberia

 

 

Mohamed Bah^1,&, Jean Leonard Hakizimana¹, Adel Hussein Abdallah¹, Amara Alhaji Sheriff¹, Kassim Kamara¹, Gebrekrstos Negash Gebru²

¹Ministry of Health and Sanitation, Freetown, Sierra Leone, ²African Field Epidemiology Network, Freetown, Sierra Leone

^&Corresponding author: Mohamed S Bah, Ministry of Health and Sanitation, Freetown, Sierra Leone

 

Email: mohamedsbahh9@gmail.com

Background: Lassa fever (LF) is a severe acute viral hemorrhagic illness caused by a virus. The virus is spread to humans through food or household items contaminated with the excreta of infected rats. On 3rd March 2022, the district surveillance unit was notified of a suspected LF case-patient in Masanga Hospital (MH). We investigated to identify the source, identify secondary infections, and institute control and prevention measures.

 

Methods: We reviewed the case patient's medical records to establish the date of symptom onset. Household and hospital contacts were interviewed to determine exposure to the case patient. All cases were identified using the case definition: Any person with two or more of the following symptoms: malaise, sore throat, cough vomiting, diarrhoea myalgia, chest pain, hearing loss, or unexplained death. We line-listed contacts and monitored them twice daily. High-risk contacts were isolated and tested for LF. We conducted an environmental assessment of case-patients residence.

 

Results: The first case patient, a 5-years old male presented with fever and weakness on 25/02/2022. He was admitted at the MH on 01/03/2022, and died on 03/03/2022, swab sample was confirmed for LF on 05/03/2022. One primary contact, the elder sister of the first case was admitted with a fever at MH hospital on 01/03/2022. Blood sample confirmed for LF on 05/03/2022, referred for treatment on 06/03/2020 but died in transit on the same date. We identified twenty-nine contacts from the community and hospital but no additional cases were reported. Case patients live in a grassland environment, poor waste management, food stored in open containers, and rats were not seen in the house.

 

Conclusion: LF outbreak was confirmed in Tonkolili District. Contact with rodents could have led to the outbreak. Increasing health education and sensitization of communities on rodents control and environmental sanitation can help prevent and control future outbreaks. We sensitized community members and healthcare workers on LF prevention and control.

 

Keywords: Lassa fever, Surveillance, Tonkolili, Sierra Leone

 

 

Edward Ellie^1,&, Jean Leonard Hakizimana¹, Adel Hussein Abdallahq¹, Amara Alhaji Sheriff¹, Kassim Kamara¹, Gebrekrstos Negash Gebru²

¹Ministry of Health and Sanitation, Freetown, Sierra Leone, ²African Field Epidemiology Network, Freetown, Sierra Leone

^&Corresponding author: Edward Ellie, Ministry of Health and Sanitation, Sierra Leone

 

Email: edwardellieeffort@gmail.com

Introduction: The surgical site infection (SSI) surveillance in Sierra Leone was initiated to aid the implementation of the World Health Organization (WHO) international guidelines for the prevention of SSIs. The performance of the SSI surveillance system in Western Area Urban has not been assessed since its implementation. We assessed the SSI surveillance system to assess its usefulness and performance of its attributes in meeting its set objectives.

 

Methods: We conducted a descriptive cross-sectional study in four hospitals and the national infection prevention and control IPC using the CDC 2001 updated guidelines for evaluating public health surveillance systems. We reviewed SSI surveillance system records, observed with a checklist, and interviewed 12 stakeholders using a semi-structured questionnaire. We calculated frequencies, means, and proportions.

 

Results: A total of 30 suspected SSI cases were reported. All the 12 respondents understand the SSI case definition and reported that the reporting forms are easy to complete. Weekly SSI data is only reported to the IPC program. The timeliness of reporting was 79% (38/48). Of the 30 suspected SSI cases, 20 were confirmed to have SSI. Of the 30 randomly selected case reporting forms assessed, 65% (20) were completely filled. The SSI system is not integrated with other surveillance systems and is largely paper-based. The system is 100% funded by partners.

 

Conclusion: The SSI surveillance system is useful, acceptable, sensitive, and simple, however, it is flexible, and has poor data quality. The SSI surveillance system is partially meeting its set objectives. We recommend the integration of the system, supervision, and training of surveillance providers in data collection to assure the quality of data.

 

Keywords: Surgical Sites Infection, Western Area Urban, Sierra Leone

 

 

Leroy Maximore ^1,2,3,&, Gyesi Razak Issahaku^1,4 Samuel Sackey¹ Ernest Kenu¹

¹Ghana Field Epidemiology and Laboratory Training Program, Accra, Ghana, ² Ministry of Health, Monrovia, Liberia, ³National Public Health Institute of Liberia, Monrovia, Liberia, ⁴Tamale Teaching Hospital, Tamale, Ghana

^&Corresponding author: Leroy S. Maximore, National Public Health Institute of Liberia, Monrovia, Liberia

 

Email: maximoreleroy@gmail.com

Background: The use of institutional delivery services is essential for improving maternal and child health. However, studies in Liberia reveal over 20% of women still deliver at home. We assessed the prevalence and associated factors of home delivery among women of reproductive age in Margibi County, Liberia.

 

Methods: We conducted a cross-sectional study among 438 women of reproductive age in Margibi County. Obtained data using a semi-structured questionnaire. A systematic random sampling approach was used to select the participants. We performed binary logistic regression to identify factors influencing home delivery. Findings were summarized into tables displaying the frequencies, percentages, crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

 

Results: Out of the 438 respondents, 397 indicated they delivered at home in their most recent delivery. The prevalence of home delivery was 90.6% (95% CI 87.5 – 93.0). The attitude of health workers, the season or period of the year, the place for ANC services and the number of children alive were significantly associated with the choice of place of delivery among the study participants. Women with two or more children had 15.8 times increased odds of home delivery (aOR = 15.77, 95% CI 3.95 - 62.89, p < 0.012). Women who mentioned the good attitude of health workers had 0.01 times decreased odds of home delivery (aOR = 0.01, 95% CI 0.001 - 0.07, p < 0.001). Season or period of the year the women delivered also influenced their place of delivery, women who delivered during the rainy season had 9.87 times increased odds of home delivery (aOR = 9.87, 95% CI 1.17 - 82.89, p< 0.035).

 

Conclusion: The high prevalence of home delivery in the county is a call for urgent interventions by the government of Liberia and various non-governmental organizations. The government may need to supply the county with ambulances and ensure in-service training of health workers on good attitudes.

 

Keywords: Home delivery; institutional delivery; Margibi County; Reproductive age, Liberia

 

 

Kokulo Franklin^1,&

¹Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia

^&Corresponding author: Kokulo Franklin, Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia

 

Email: KFranklin@prevailcr.org

Background: Given the problematic history of research on humans, there has been an effort to put in place nationally relevant legal and ethical benchmarks. However, the mechanisms or efficiency of these ethics and regulatory guardrails are clearer in some countries than in others. One country in need of clarity is Liberia, where the research governance system has been described as poorly coordinated. This study sought to determine the regulatory and ethical framework governing health-related research in Liberia and to explore the perspectives and experiences of key stakeholders – Ministry of Health (MoH), Ethics Committees (ECs) & Regulatory Authorities (RAs), and researchers – on the governance of health research.

 

Method: The study made use of a triangulated qualitative design, involving a desk review to identify national guidelines, policies, procedures, and regulations, coupled with eleven (11) in-depth key informant interviews with purposively-identified participants.

 

Result: Key documents (Public Health Law, National Research for Health Policy, the Clinical Trial Guidelines, National Research Ethics Board Guidelines, and the University of Liberia – Pacific Institute for Research and Evaluation IRB Handbook), along with key institutions (Ministry of Health, the National Public Health Institute of Liberia, the Liberia Medicines and Health Products Regulatory Authority, the National Research Ethics Board, and the University of Liberia – Pacific Institute for Research and Evaluation (UL-PIRE) IRB) were found to be critical to the overall governance of health research in Liberia. While being generally unclear about who does what in the governance framework, Stakeholders broadly expressed a feeling of inadequacy of the system.

 

Conclusion: Overall, Liberia appears to have in place the relevant foundational frameworks for acceptable governance of health research. However, there is an urgent need to address the high degree of uncertainty and at the same time address clear gaps within the documentary and institutional setups.

 

Keywords: Governance, Research, Health, Ethics

 

 

William Mendy^1,2,&, Ebrima Camara³, Lamin Sarr¹, Nuha Fofana^3,4, Peter Adewuyi²

¹Regional Health Directorate, Upper River Region, Mansajang Kunda, Gambia, ²Gambia Field Epidemiology Training Program, Banjul, Gambia, ³Diabugu Health Center, Upper River Region, Diabugu, Gambia, ⁴Epidemiology and Disease Control Unit, Ministry of Health, Banjul, The Gambia

^&Corresponding author: William Mendy, Regional Health Directorate, Upper River Region, Mansajang Kunda, Gambia

 

Email: mendywilliam76@gmail.com

Background: Schistosomiasis is a neglected tropical disease, and more than 220 million people are currently estimated to be infected, predominantly in low-income and middle-income countries Despite the mass drug administration in 2018 in the Gambia, the disease still remains a public health challenge with a national prevalence of 10.2% among primary school children. We conducted this study to describe the prevalence of schistosomiasis in Upper River Region (URR) of The Gambia from 2017 to 2022.

 

Methods: We conducted a cross-sectional study and extracted variables of interest from outpatient registers of 11 health facilities within URR. URR has 7 districts which are Fulladu East, Jimara, Kantora, Sando, Wuli East, Wuli West, and Tumana. We analyzed descriptively for demography, clinical symptoms, and trend, using Epi info version 7.2.4.0 and presented in charts and tables.

 

Results: Of the 434 cases of schistosomiasis 81% (352/434) were males with mean age of 15 (SD ±7.47) years. and 85.48% (371/434) were laboratory confirmed. 82.86% (357/434) were less than 20 years. Prevalence was 16 per 100 000 population while Fulladou East recorded the highest district prevalence of 42 per 10,000 population. Of the cases, 78% (338/434) were seen between the months of October and April, and 37% (160/434) was reported in 2021. Ninety percent (391/434) had haematuria as main clinical symptom.

 

Conclusion: Schistosomiasis is endemic but the prevalence remains low in the Upper River Region even though Fulladou East had a high prevalence. The most affected are males who are less than 20 years. Periodic mass drug administration against the disease could help in curtailing the disease in the region.

 

Keywords: Schistosomiasis, Upper River Region, Prevalence, Endemic

 

 

Jacob Munyan^1,2,&, Augustine Alfred^1,2, Francis Momoh², Thomas Kowel², Bennie Clark², Kelvin Bomiah³

¹Liberia Intermediate Field Epidemiology Training Program, Monrovia, Liberia, ²Ministry of Health, Monrovia, Liberia, ³World Health Organization, Monrovia Office, Liberia.

^&Corresponding author: Jacob Munyan, Liberia Field Epidemiology Training Program, Ministry of Health

 

Email: jacobfm1985@gmail.com

Background: The World Health Organization (WHO) defines maternal death as the death of a pregnant woman due to complications related to pregnancy, underlying conditions worsened by the pregnancy, or management of these conditions. By 2017, the world maternal mortality rate had declined 44% since 1990; however, every day 808 women die from pregnancy or childbirth-related causes. Gbarpolu County is one of the fifteen counties that every year report event of maternal death due to several causes. The study was done to come out with findings and recommendations.

 

Method: The total population was 109,304, Five years of surveillance data from the Gbarpolu County line list was analyzed using secondary data. The eligibility criteria were based on the case definition of maternal death. The results will be presented using percentages.

 

Results: Of the 27 Maternal Death data reviewed and analyzed, the median age was 30 years ranging from 15-40 years. The age category 15-35 years accounted for 37%. Among the reporting district 41% (11/27) of death were reported from Bopolu, and 29% (8/27) dead were recorded from Chief Jallah Lone Medical Center. Of the causes of dead 30% (8/27) of these deaths were attributed to postpartum haemorrhage and the trend of these dead was observed as 2017 accounted for 19% (5/27) dead, 2018 accounted for 22% (6/27) dead, 2019 recorded 15% (4/27) dead, 2019 recorded 30% (8/27) dead and 2021 accounted for 15% (4/27) dead respectively.

 

Conclusion: There was a propagated rise and fall of the death as observed in the various reporting years, mostly in 2019 there was an increase in the trend of report dead but decreased in the trend of the reported dead in 2021. Recommend that there should be adolescent programs in maternal health-related and increase awareness and invest in building maternal waiting homes.

 

Keywords: Maternal death, causes, trends, Gbarpolu

 

 

Facia Glaydor^1,&, Maame Amo-Addae², Peter Adewuyi, Lily Sanvee-Blebo², Readon Ideh¹

¹John F. Kennedy Medical Center, Monroria, Liberia, ²African Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Facia P.G. Glaydor, John F. Kennedy Medical Center, Monrovia Liberia

 

Email: faciaglaydor@gmail.com

Background: Neonatal mortality is a global concern by which 4 million children died every year. All countries aim to have a neonatal mortality rate of 12 or fewer deaths per 1000 live births and an under-five mortality rate of 25 or fewer deaths per 1000 live births by 2030. The neonatal mortality rate for Liberia is 30.6 per 1000 live births a 2.8% decline in 2020. However, we observed an increase in neonatal referrals and mortalities based on that the study aims to investigate the causes associated with neonatal deaths at the nation's tertiary hospitals.

 

Method: Neonatal death secondary data covering the period (2018-2021) was, extracted from the Neonatal Intensive care unit (NICU) Ledger, Death certificates, and Patient charts. Data were cleaned, harmonized, and analyzed in Epi info version 7 and Microsoft Excel. Variables were analyzed by age category, weight per kilogram, length of stay, health districts, referrals, and causes of death using proportions and frequency distribution.

 

Results: A total of 891/14,982 neonatal deaths were recorded over four years (2018-2021). The median age was 4 (IQR 2 - 7) days. During the period males accounted for 52 % (465/891) and the year 2021 accounted for 32.1% (286/891) of deaths. The causes of neonatal mortality were largely due to Birth Asphyxia 50% (442/891) and Neonatal Sepsis which accounted for 26%(236/891). Neonates between the ages of 1 – 6 days (568/891) accounted for 63.7% of cases. Amongst neonates admitted 26% (228/891) were referrals from other facilities and communities (17%).

 

Conclusion: Neonates between the ages of 1 to 6 days of life accounted for the highest and factors contributing to increased neonatal mortality were Birth Asphyxia and Neonatal Sepsis. The majority were among cases referred from other health facilities. We recommend the establishment of a Neonatal Intensive Care Unit in Secondary hospitals, equipping through the availability of medical supplies (Oxygen Concentrators, Incubators, life support monitors) and human resources, improving the referral system pathway and addressing causes.

 

Keywords: Referrals, Mortality, Neonatal unit, John F. Kennedy (JFK)

 

 

Jacob Timmah^1,2,&, Himiede Wilson³

¹Ministry of Health, Monrovia, Liberia, ²Grand Gedeh County Health Team, Zwedru, Liberia, ³Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Jacob S. Timmah, Grand Gedeh County Health Team, Zwedru, Liberia

 

Email: jacobtimmah36@gmail.com

Introduction: A drug allergy reaction is the abnormal reaction of your immune system to a medication. The anaphylactic reaction was the most feared allergic reaction. It can be fatal if it's not treated promptly. It happens when your immune system mistakenly identifies a drug as a harmful substance; it develops an antibody specific to that drug. We investigated with the objectives to establish the cause of death, make hypotheses, recommendations and share findings.

 

Method: Tchien Health District is one of the six health districts in Grand Gedeh County with an estimated population of 35,807 inhabitants. The district is a rural-urban setting. This was a case report of an investigation done in Zwedru City, Grand Gedeh County. We used key informants interviews, and collected bio and clinical data.

 

Results: The 22 years old female sought treatment at the drugstore. At the drug store, she narrated having lower abdominal pain and virginal discharge. Upon explaining this, she was told by the attending dispenser that she had a sexually transmitted infection (STI). Who then administered a penicillin injection, after which the woman gradually lost consciousness. The dispenser allegedly admitted making a mistake by giving the woman a penicillin injection thereby resuscitating her with an intravenous fluid which was going until the woman died. Upon arriving on the scene, we observed white foam coming from the mouth, a puncher wound (needle prick) seen on the left anterior ankle and a black or dark spot on the right anterior arm. Further investigation revealed she was allergic to penicillin which was included in the prescription. And that the dispenser had no formal training.

 

Conclusion: The victim died from a penicillin allergy reaction. Lack of prompt and improper treatment is contributing factor. The information gathered was from key informants and based on the physical examination of the corpse. County pharmacists should do drug store inspections to ensure strict adherence to pharmaceutical policy, and create awareness of the importance of hospital and clinic treatment.

 

Keywords: Allergy, Reactions, penicillin, Dispenser, Drug, Abnorma

 

 

Kemah Tegli^1,&, John Doe¹, Lily Sanvee-Blebo¹, Peter Adewuyi¹, Himiede Sesay¹, Maame Amo-Addae¹, Obafemi Babalola¹

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Kemah Vivian Lymas Tegli, Liberia Field Epidemiology Training Program, Monrovia, Liberia

 

Email: vivianlymas29@gmail.com

Background: During the second and third waves of COVID-19 in Liberia, the Government of Liberia made non-adherence to COVID-19 preventive measures a public health offense. Poor knowledge of these measures was posited as a contributor to low compliance. We estimated the level of knowledge of COVID-19 preventive measures among students of tertiary institutions in Liberia and assessed factors associated with good knowledge.

 

Methods: We applied an analytical cross-sectional design. We enrolled a representative sample of 818 students from the 53 tertiary institutions in Liberia using multi-stage sampling. Demographics and knowledge of COVID-19 prevention data were collected using a structured questionnaire. Participants who answered ?5 out of 8 questions correctly were categorized as having good knowledge of COVID-19 preventive practices. We estimated the proportion of respondents with good knowledge, the measures they were aware of, and factors associated with good knowledge of COVID-19 preventive measures in a multiple logistic regression at a 5% level of significance. Written informed consent was obtained from the participants.

 

Results: The mean age of respondents was 21.8+1.9 years. Overall, 36.4% (298/818) of the students had good knowledge of COVID-19 preventive measures. The commonest known measures were hand washing with soap and water 88.6% (725/818), wearing a face mask 87.7% (717/818), and social distancing 60.8% (497/818). Use of vaccines was the least measure known among the students, 41.9% (343/818). Students with good knowledge were more likely to practice handwashing frequently (aOR:4.3, 2.9-6.2, p<0.001), and avoid handshaking (aOR:3.5, 2.3-5.5, p<0.001). However, avoiding crowd (aOR:1.4, 0.9-2.0, p=0.1185) and use of nose masks (aOR:1.5, 0.9-2.2, p=0.0787) were not significantly associated with good knowledge.

 

Conclusion: Knowledge of COVID-19 preventive measures did not translate into adherence to all COVID-19 protocols among tertiary students in Liberia. Based on our findings and recommendations to the ministry of health, efforts were targeted at risk communication among this group.

 

Keywords: COVID-19, knowledge, vaccines, preventive measures

 

 

Jackie Jackson-Hall^1,&, Himiede Wede Sesay², Obafemi Joseph Babalola², Lily Sanvee Blebo², Faith Kamara Whesseh², Godwin Etim Akpan², Leroy Maximore², Alberta Corvah¹, Maame Amo-Addae²

¹Montserrado County Health Team, Montserrado, Liberia, ²Africa Field Epidemiology Network, Monrovia, Liberia

^&Corresponding author: Jackie Jackson-Hall, Montserrado County Health Team, Montserrado, Liberia

 

Email: halljackie2016@gmail.com

Introduction: Measles is a vaccine-preventable infection caused by paramyxovirus with high morbidity and mortality among unvaccinated children. Globally, 110,000 deaths were reported in 2017. In 2019, the average West African regional coverage for MCV 1 and MCV2 was 66% and 73%, respectively. Measles outbreaks have been recurrent in Liberia, we therefore characterized measles cases in Montserrado County from 2017 – 2021.

 

Method: We conducted a secondary data analysis of measles case-based surveillance data. We included clinically confirmed, Epidemiologically-linked and laboratory-confirmed positive cases extracted from the Montserrado County database. Variables of interest extracted for analysis includes age, sex, districts of residence, case classification, vaccination status, and final outcome. Data were reviewed for completeness, verified, cleaned, and imported to Epi info statistical software for descriptive and bivariate analysis.

 

Result: A total of 1448 measles cases were reported from 2017 to 2021 with median age 5 (IQR 2.0-7.0)years. Female 52.5% (761/1448), 85.5% not vaccinated. Commonwealth district 33.9% (579/1448), Bushrod district 24.37% (417/1449), and 83.6% (1211/1449) of cases were detected in the health facilities. The case fatality rate was 0.2%.

 

Conclusion: measles remains a burden in Montserrado County especially among unvaccinated children. We recommend improved routine immunization to increase measles coverage.

 

Keywords: Paramyxovirus: Measles, Surveillance, Liberia

 

 

Patrick Fitzgerald Stepney^2,&, Obafemi Joseph Babalola¹, Lily Marie Sanvee-Blebo¹, Eddie Farngalo², Maame Amo-Addae¹

¹Liberia Field Epidemiology Training program, Monrovia, Liberia, ²Central Veterinary Epidemiology Unit, Ministry of Agriculture, Monrovia, Liberia

^&Corresponding author: Patrick Fitzgerald Stepney, Central Veterinary and Epidemiology Unit, Ministry of Agriculture, Monrovia, Liberia

 

Email: fpstepney@gmail.com

Introduction: Newcastle Disease (ND) is a highly contagious and often severe disease found worldwide that affects birds including domestic poultry with high morbidity and mortality. ND is one of the epidemic-prone veterinary diseases under surveillance in Liberia. We described the distribution of suspected ND reported to the surveillance unit from 2019 to 2021.

 

Methods: We conducted a secondary data analysis of the ND reported to the Liberia Animal Disease Surveillance and Response System (ADSR) from 2019 to 2021. The details of the cases were retrieved from the ADSR database. The variables included the location of the farm, the species of the animal, the date of onset, and the outcome. Data were cleaned and analyzed using Excel and Epi Info 7.2.5. The findings were summarized using frequency and proportions.

 

Results: A total of 1404 cases of Newcastle disease were reported in 13 out of 15 counties during the period. Chickens reported the highest proportion of cases with 86% (1208/1404) compared to ducks with 1% (14/1404). Most of the cases were reported from Nimba County 32.8% (461/1404). In 2019, and 2020, the peak was reported in March at 90.4% (422/467), whereas in 2021 the peak was reported in August at 41.8% (385/922). Grand Bassa, Grand Kru, and Sinoe recorded the highest case fatality rate (CFR) of 100%. The highest annual CFR (85%) was recorded in 2021.

 

Conclusion: Newcastle Disease (ND) is highly contagious and has been reported in most counties in Liberia with high mortality. There is a need to improve awareness, early warning, and vaccination activities to limit its impact on animals and humans.

 

Keywords: Newcastle Disease, data, Liberia, surveillance

 

 

Ben Karhenye, Junior^1,2,&, Obafemi Joseph Babalola¹, Saysay Kpadeh²

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia, ²Ministry of Health, Monrovia, Liberia

^&Corresponding author: Ben S. Karhenye, Ministry of Health Liberia

 

Email: bkarhenye76@gmail.com

Introduction: Human Papilloma Virus (HPV) is a vaccine-preventable sexually transmitted virus that predisposes infected persons to cervical cancer. The HPV vaccine was introduced into Liberia's routine immunization program in 2019. However, HPV vaccine acceptance and coverage have been low. We described the HPV vaccine coverage at the national and sub-national levels to guide further interventions.

 

Methods: This was a secondary data analysis of the national HPV vaccine administrative data from 2020 to 2021 retrieved from the DHIS2 database. The variables of interest were the target population, the number of eligible populations vaccinated with the first and second dose of the vaccine, time of vaccination and place of residence. We estimated the HPV vaccine coverage by year of vaccination and place of residence and compared it with the national target of 80%. Microsoft Excel and EPI info were used to analyze the data and to produce maps. Coverages and trends were displayed using charts, tables and maps.

 

Results: A total of 117,212 was targeted for the HPV vaccine nationwide out of which only 31,659 (27%) nine-year-old girls were vaccinated. Grand Kru and other six counties achieved targets ?50% while Montserrado and Rivercess counties failed to reach 25% coverage. The trend shows the highest number of HPV vaccination in November 2021.

 

Conclusion: None of the counties has attained the national HPV vaccine coverage target. The Expanded Program on Immunization (EPI) has to design strategies in order to improve HPV vaccine uptake and coverage.

 

Keywords: Human papillomavirus, vaccine coverage, vaccine acceptance

 

 

Emmanuel Dwalu^1,&, Chukwuma David Umeokonkwo¹, Obafemi Babalola¹, Maame Amo-Addae¹

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Emmanuel Dwalu, Liberia Field Epidemiology Training Program, Liberia

 

Email: dwaluemmanuelf@gmail.com

Background: Healthcare worker (HCW) infection accounted for 35% of global COVID-19 cases as of March 2021. In Liberia, 2,042 confirmed cases including 85 deaths had been recorded, with HCWs accounting for 225 (12%) cases and 5 (5.2%) deaths. Adequate risk perception and infection prevention practices could reduce the high risk of infection among them. We assessed the COVID-19 knowledge, attitude, perception & preventive practices (KAPP) among HCW in Liberia, and explored related factors.

 

Methods: We conducted an analytic cross-sectional study among 630 HCWs recruited through multistage sampling from health facilities in Liberia. Data were collected in early 2021 using an interviewer-administered structured questionnaire. Using pre-determined set of criteria, we categorized knowledge, and attitude into good, moderate, and poor, and risk perception into high and low. We estimated the proportion of participants with good knowledge, attitude, and risk perception and examined associated factors using chi-square and logistic regression at 5% level of significance.

 

Results: A majority (78.7%) of the participants were aged 30-49 years, 55.9% were female, 92.6%, had at least secondary school education, and 63.8% had stayed at their job for between 1 and 6 years. Overall, 55% of the respondents had good knowledge, a good attitude, and good practice. About 63% had high risk perception. Radio (84%) was the commonest source of information on COVID-19. HCWs were concerned about stigma, getting infected, and infecting their families. Good knowledge, attitude, perception and practice were associated with being a clinician (POR: 2.5; 95% CI:1.8-3.5); and ever received COVID-19 training (POR:2.7; 95% CI:1.9-3.8) and IPC training (POR:3.6; 95% CI:2.6-5.0).

 

Conclusion: One year after the start of the COVID-19 outbreak in Liberia, HCWs, particularly non-clinicians, had gaps in KAPP of the disease. The research team provided education after the interviews and recommended that the Ministry of health, provide further education for non-clinicians.

 

Keywords: COVID-19, knowledge, risk perception, preventive practice

 

 

Dorissa Bestman^1,&, Lily Sanvee-Blebo1, Faith Whesseh¹, Peter Adewuyi¹, Obafemi Babalola¹, Himiede Sesay¹, Godwin Akpan¹, Maame Amo-Addae¹

¹Liberia Field Epidemiology Training Program, Monrovia, Liberia

^&Corresponding author: Dorissa Bestman, Liberia Field Epidemiology Training Program, Monrovia, Liberia

 

Email: dorissabestman@gmail.com

Background: Vaccination is one of the most cost-effective public health interventions. Despite the established efficacy of vaccines, there are many reasons people are hesitant about vaccination, and these reasons could be complex. This rapid survey estimated the prevalence of COVID-19 vaccine hesitancy and explored contributing factors in two counties of Liberia.

 

Methods: A cross-sectional study was conducted among adults living in Liberia selected through multistage sampling. Vaccine hesitancy was estimated. The relationship between vaccine hesitance and sociodemographic characteristics was examined using chi-square statistics. The variables with a p-value less than 0.2 at the bivariate analysis were modelled in a multiple logistic regression at a 5% level of significance. The adjusted odds ratio and 95% confidence interval are reported.

 

Results: There were 877 participants in the study. The mean age of respondents was 38 ± 13 years. The majority were females (54.1%, 474/877), Christians (85.2%, 747/877) and lived in rural communities (56.1%, 492/ 877). Most of the participants were aware of the COVID-19 vaccine (75%, 656/877) but vaccine hesitancy was 29.1% (95%CI: 26.2-32.2). Adults living in urban areas were more hesitant about taking the vaccine (aOR:1.5, 95%CI: 1.1 - 2.1) compared to persons living in rural communities. Those aged 45-54 years (aOR:0.5, 95%CI: 0.2-0.9) were 50% less likely to be hesitant about the vaccine compared to those aged 55 years of age. The most common source of health information was radio and television (53%, 492/877) and the main reason for being hesitant was self-reported inadequate information about the vaccine and its safety (84%, 215/255).

 

Conclusion: The majority of study participants were aware of the COVID-19 vaccines but a third was vaccine-hesitant. This could pose a challenge to efforts to control the spread of the COVID–19 pandemic. Health authorities should provide more health education about vaccines and their safety through radio and television.

 

Keywords: Vaccine, COVID-19, hesitancy, pandemic