Development, Use, and Impact of a Global Laboratory Database During the 2014 Ebola Outbreak in West Africa

Durski, Kara; Singaravelu, Shalini; Teo, Junxiong; Naidoo, Dhamari; Bawo, Luke; Jambai, Amara; Keïta, Sakoba; Yahaya, Ali Ahmed; Muraguri, Beatrice; Ahounou, Brice; Katawera, Victoria; Kuti-George, Fredson; Nébié, Yacouba; Kohar, T. Henry; Hardy, Patrick; Djingarey, Mamoudou Harouna; Kargbo, David; Mahmoud, Nuha; Assefa, Yewondwossen; Condell, Orla; N’Faly, Magassouba; Gurp, Léon van; Lamanu, Margaret; Ryan, Julia; Diallo, Boubacar; Daffae, Foday; Jackson, D H; Malik, Fayyaz Ahmed; Raftery, Philomena; Formenty, Pierre

doi:10.1093/infdis/jix236

Cited by 10 publications

(14 citation statements)

References 10 publications

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“…Approximately, 50% of Liberia’s population lives in Montserrado County in which the country’s capital city, Monrovia, is located [17]. Using archived data from WHO Emerging and Dangerous Pathogens Network (EDPLN) for EVD [18] hosted at WHO headquarters in Geneva, Liberia epidemiologic surveillance hosted at the Ministry of Health of Liberia, and individual laboratory log-books available at the respective laboratories, we obtained laboratory characteristics and trend of laboratory capacity before and after interventions. Interventions included: 1) establishing and developing EVD testing at two laboratories; 2) implementing new EVD diagnostic techniques not previously used in Liberia; 3) recruiting and training personnel in EVD molecular diagnostic procedures [13, 15]; 4) creating “partial testing shifts” to enable longer testing hours.…”

Section: Methodsmentioning

confidence: 99%

Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations

Katawera¹,

Kohar²,

Mahmoud³

et al. 2019

Pan Afr Med J

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Introduction Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.

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Section: Methodsmentioning

confidence: 99%

Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations

Katawera¹,

Kohar²,

Mahmoud³

et al. 2019

Pan Afr Med J

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“…At the end of each day the patient and laboratory data were exported into the MoH reporting template (Microsoft Excel) double-checked and reported to a MoH-approved list of recipients including IMS members, County health teams (CHT’s) and stakeholders via email. This information was also uploaded into the WHO EDPLN database which produced WHO weekly situation reports on the outbreak [ 36 ]. Paper records of laboratory specimens and results, specimen submission forms and laboratory logbooks were stored at the laboratory, accessible only to authorized personnel.…”

Section: Methodsmentioning

confidence: 99%

Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening

Raftery¹,

Condell²,

Wasunna

et al. 2018

PLoS Negl Trop Dis

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The 2014–16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64–100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.

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“…The availability of timely and accurate data during a disease outbreak is critical to decision making yet challenging to obtain, as can be seen in the COVID-19 outbreak and other acute public health events. During the 2014 Ebola outbreak in Liberia, Sierra Leone, and Guinea in West Africa, challenges were faced with the collection, management, and reporting of data [1][2][3]. As a rapid and effective response requires the use of data to make operational and strategic decisions, the lack of regular and accurate data limited the understanding of the outbreak, including transmission dynamics and impacted overall operations, planning and allocation of resources, and support from the international community at large [3].…”

Section: Introductionmentioning

confidence: 99%

“…During the 2014 Ebola outbreak in Liberia, Sierra Leone, and Guinea in West Africa, challenges were faced with the collection, management, and reporting of data [1][2][3]. As a rapid and effective response requires the use of data to make operational and strategic decisions, the lack of regular and accurate data limited the understanding of the outbreak, including transmission dynamics and impacted overall operations, planning and allocation of resources, and support from the international community at large [3]. At the end of the outbreak, more than 250, 000 samples were tested in 47 laboratories in the 3 countries and there were an estimated 28,616 suspected, probable, and confirmed cases and 11,310 deaths [4].…”

Section: Introductionmentioning

confidence: 99%

Design thinking during a health emergency: building a national data collection and reporting system

et al. 2020

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Background Design thinking allows challenging problems to be redefined in order to identify alternative user-center strategies and solutions. To address the many challenges associated with collecting and reporting data during the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone, we used a design thinking approach to build the Global Ebola Laboratory Data collection and reporting system. Main text We used the five-stage Design Thinking model proposed by Hasso-Plattner Institute of Design at Stanford in Guinea, Liberia and Sierra Leone. This approach offers a flexible model which focuses on empathizing, defining, ideating, prototyping, and testing. A strong focus of the methodology includes end-users’ feedback from the beginning to the end of the process. This is an iterative methodology that continues to adapt according to the needs of the system. The stages do not need to be sequential and can be run in parallel, out of order, and repeated as necessary. Design thinking was used to develop a data collection and reporting system, which contains all laboratory data from the three countries during one of the most complicated multi-country outbreaks to date. The data collection and reporting system was used to orient the response interventions at the district, national, and international levels within the three countries including generating situation reports, monitoring the epidemiological and operational situations, providing forecasts of the epidemic, and supporting Ebola-related research and the Ebola National Survivors programs within each country. Conclusions Our study demonstrates the numerous benefits that arise when using a design thinking methodology during an outbreak to solve acute challenges within the national health information system and the authors recommend it’s use during future complex outbreaks.

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Development, Use, and Impact of a Global Laboratory Database During the 2014 Ebola Outbreak in West Africa

Cited by 10 publications

References 10 publications

Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations

Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations

Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening

Design thinking during a health emergency: building a national data collection and reporting system

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