Expanded Surveillance Report

Transcription

1 REPUBLIC OF LIBERIA MINISTRY OF HEALTH & SOCIAL WELFARE BOMI COUNTY HEALTH TEAM BOMI COUNTY Expanded Surveillance Report Date: 23 rd October 2015 Report Number: Week Week ending: 18 th October, 2015 CSO: Moses B. Fomba Summary Bomi County is located in the western Region of Liberia and bordered by three counties, Gbapolu on the North, Montserrado on the South and Ground Cape Mount on the west. Bomi has four health districts, Senjeh, Klay, Dewoin and Suehn Mecca Districts and five Administrative Districts, Senjeh, Klay, Dewoin, Suehn Mecca and Tehr districts. The County has a population of 97,291 with five ethnic groups, Gola, Dei, Mandingo, Kpelleh and Kissi. Bomi has 22 health facilities and one referral hospital. The Health facilities report to the District Surveillance office(dso) and the District in turn reports to the County Surveillance office(cso).all immediately reportable disease are expected to reach the County within 24 hours of event. Timeliness and completeness of reporting as well as monitoring trends are key components of surveillance for rapid response and intervention. This report gives an overview of surveillance indicators from Epi-week 31 42, A total of 405 immediately notifiable diseases/events were identified with 44 deaths.suspected cases of EVD and AWD were the highest recorded followed by measles as indicated below; Measles - [suspected 6 (Dead 1,Alive 5)] Acute Watery Diarrhea [Suspected 23 (Dead 0,Alive 23)] Ebola Virus Disease [suspected (suspected 371 (Dead 38, Alive 333) Maternal death ( Cases 3) Neonatal death (cases 2) There was no confirmed case of EVD/ VHF during this period. On an average, timeliness of reporting from all 4 health districts was 70% with 95% completeness of reporting. Activities carried out during the period under review were; Maternal case investigation in Dewoin and Senjeh Districts Roll out of IDSR training in health facilities in the county Roll out of SQS training in health facilities in the county Review meeting for re-establishment of RRT in the county Performance feedback to districts and health facilities Timeliness reflects the speed or delay between steps in a surveillance system for immediate control efforts or for long-term program planning. Failure to completely report all key notifiable diseases makes it a challenge to early detect outbreaks/ events of public health concern to put in interventions. Figure 1 shows timeliness and completeness of reporting by districts for the period under review. 1

2 Figure 1: Timeliness and completeness of reporting by district, Bomi County-Liberia Epi wk31-42, Legend Timeliness and completeness of reporting has increased during the FETP Figure: 3 Summary of key notifiable reportable diseases, Bomi County-Liberia Epi WK31-42, 2015 Legend= C = Case, D=Death, CFR=Case fatality rate YTD = Year to date The zero reporting requirements were met by all six reporting districts. Classification of cases identified is as indicated below; EVD 371(S), 0(C) Acute watery diarrhea 23(S), 0 (C) 2

3 # of Cases # of Cases Measles 6(S), 1 (C) Maternal death 3 Cases Neonatal death 2 Cases Trend of suspected Measles cases and death, Bomi County-Liberia, Week 31-42, Suspected Cases Deaths WK31 WK32 WK33 WK34 WK35 WK36 WK37 WK38 WK39 WK40 WK41 WK42 Epi- Weeks Trend of AWD cases and death, Bomi County-Liberia Epi WK1-42, Epi-Weeks 3

4 Public Health Actions Taken during the period: Environmental health department was contacted through their Coordinator to do mass chlorination in the county as source of AWD cases was attributed to lack of safe drinking water in the communities. We reported the increase of suspected measles to the EPI department and conducted vaccination campaign in affected communities. Active case search was also conducted for new case or cases with massive health education on the prevention and control of measles Challenges: Delay in receiving report from district level Lack of network coverage at some facilities Staff attrition 4

5 Notice of Investigation Maternal death investigation, Dagweh s Town, Bomi County, October, 2015 Date 10 th October, 2015 From : Moses B.Fomba County Surveillance Officer Bomi County Location: Dagweh s Town, Dewoin, Bomi County To :FETP Mentors Ministry of Health Monrovia -Liberia Subject: Maternal death Investigation Introduction: Maternal death is a death of a woman while pregnant or within 42 days of the delivery or termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Globally, approximately 800 women die daily from preventable causes related to pregnancy and childbirth. Maternal death has been on the increase in Liberia over the past years. Based on this the government of Liberia through Ministry of Health asked that maternal death audit should be conducted and reported within 72 hours of event. On the 9th October, 2015, the District Surveillance Officer reported to the County Surveillance Officer on a maternal death of a 43 years old woman from Dagweh s Town which occurred at the Liberia government hospital. As per initial report from the Officer-in-charged of Dagweh Town clinic, the woman visited the facility by 8:30am on the 9 th October, 2015 and complained of stomach pain, she was examined by certified midwife and impressed False Labor and asked her to stay round for few hours but rather refused and went back home walking for about an hour. After 45 minutes on arrival at home, she delivered with the assistance of a trained traditional midwife (TTM). She was taken to the facility in wheel barrow at 2:00pm bleeding with retain placenta on the second visit. She was also examined by the certified midwife and the Officer-in-charge and referred her to Liberia government hospital for further management but ambulance did not response to the call till 3:10pm when family members provided private vehicle to take the woman to Liberia government hospital and arrived at 4:45pm but expired at 5:45pm. On receiving the information an investigation team made up of County Surveillance Officer (CSO), District Health Officer (DHO) and County diagnostic officer (CDO) set out to assess the cause of death and institute public health action based on findings. Method The investigation team visited the village, health facility and the referral hospital. We interviewed the medical staff, Officer in charge of Dagweh Town Clinic, medical director of the hospital, family members of the deceased and the TTM who assisted in the home delivery. 5

6 Medical records of the patient were reviewed to identify any additional risk factors that might have contributed to the event. We also investigated what resulted to the failure of the ambulance team in responding to the call. We implemented public health actions based on our findings to prevent and control similar events in the future. Result: From our investigation we found that the woman was a high risk patient with G12, P11. This assessment was poorly done by the certified midwife (CM). The deceased experienced uncontrolled bleeding during the home delivery under the assistance of the TTM and the deceased was transported in a private vehicle with no professional escorting them. Delay in sending her to the hospital for immediate intervention resulted in excessive blood loss. Negligence of the ambulance team in responding to the call from the health facility resulted in late arrival of the woman at the referral hospital which contributed to late intervention. The ambulance team said there was no fuel but evident from the CHT prove contrary. At the referral hospital there was no resuscitation of the deceased because the certified midwife and the nurses couldn t access the IV line because all vine had collapsed. Discussion: From the results the possible causes of death are: Hypovolemic Shock and Postpartum hemorrhage due to negligence on the part of certified midwife, ambulance team, and lack of skills and required resources to manage such complications at home by a TTM. Recommendations: Base on the issues identified, the following recommendations were made; That moderate to severe high risk pregnant women visiting the health facility should stay around the facilities toward their delivery period. Refresher training for CM/all relevant health workers on MOH protocol or SOP for management of high risk pregnancies. Induction/Orientation of new CM in any facility should also include the above need. Need for clear guideline on ambulance deployment, access to fuel and other logistics/contingencies during shifts and who to contact should there be any problem. That MOH through the government of Liberia should build maternal waiting homes at facilities more than 30 to 40 km from county referral hospitals. Following the recommendation the community people decided to build maternal waiting home at every health facilities in the districts with local materials to prevent home delivery. 6