EBOLA – SIERRA LEONE

TONKOLILI DISTRICTJanuary

2015

Sierra Leone - Background

Population: ~ 6 million

Civil War: 1991 – 2002: atrocities, child soldiers, mental health challenges – few/no services etc

HealthAverage life expectancy: 57yrsMaternal Mortality Rate: 5th highest in world88% of women: female genital mutilationInfant Mortality Rate: 11th highest in world

Drinking water supply• 20% of urban population, 1% of the rural population - piped home drinking water

– (inclds the) 84% of urban population, 32% of rural population with access to improved water source eg protected wells.

• Remaining 68% of the rural population rely on surface water (50%), unprotected wells (9%) and unprotected springs (9%).

Tonkolili District - Background• District ~ 7,003 sq km.• Rural ----with mines • Estimated population 385,322. • ? Civil War history• Shares boundaries with 7 other Sierra Leone districts ( majority of which - on-going transmission of Ebola Jan ).

• 11 Chiefdoms • Many areas hard to reach by road. • Many areas without mobile phone coverage.• Even more areas without internet/wifi connections

Magburaka - district headquarters - close to the border with Bombali district.

Ebola• The first known case in Tonkolili district - 31 year old male student who presented with fever of two days onset

on the 24th July, 2014 at Magburaka Government Hospital. – He was a Community Health Assistant student who– Escaped from a Private Hospital where he was under quarantine in Freetown – as a health care contact of person with

Ebola.• He moved in with his parents in Magburaka. • He survived. • (Family quarantined – none infected)

A Graph Showing Monthly Trend of Ebola Cases April to November 30th 2014

AprilM

ayJune

July

August

September

October

November0

20406080

100120140160180

0 0 0 1

15

56

132

167

Series1

Report on Ebola outbreak in Tonkolili DistrictFrom 3rd April – 30th November 2014No Data Element No. Of Cases

1 Suspected Cases 705

2 Lab Confirmed Cases 371

3 Negative 256

4 Missing 63

5 Others 14

6 Pending 7

7 Confirmed Death 120

8 Cured/Discharges 146

Nov 30th List of Heath workers affected with Ebola in Tonkolili District

No Cadre Probable Confirmed positive

Out come

Survived Died

1 Doctor 0 1 0 1

2 Mid Wives/Nurses 0 0 0 0

3 Laboratory Technician 0 3 1 2

4 Community Health Assistant & Worker

0 4 2 2

5 SECHN 0 1 1 0

6 M C H Aides 0 3 0 3

7 TBA 0 1 1 0

8 Vaccinator 0 2 0 2

9 Admin 0 0

10 Ambulance Driver 0 2 1 1

11 Cleaner 0 1 0 1

12 Pharmacist Technician 0 1 1 0

TOTAL 0 19 7 12

Total Contacts Line Listed by Chiefdom as at 30th November 2014 vs Later Slide

No Chiefdom Total contacts Line listed

Contacts Completed 21 days

Contacts being Monitored

1 Kholifa Rowalla 625 335 290

2 Kholifa Mabang 11 11 0

3 Mara Malal 75 75 0

4 Tane 502 390 112

5 Gbonkonlenken 543 298 245

6 Kunike 557 539 18

7 Kunike Barina 128 128 0

8 Sambaya Bendugu 0 0 0

9 Kalansogoai 0 0 0

10 Kafe Simira 102 62 40

11 Yoni 610 382 228

Total 3153 2220 933

Yoni

Kholifa Mabang

Malal Mara Kholifa Rowalla

Gbonkolenken

Konike Barina

Konike Tane

Kate Simira

Sambaia Bendugu

Kalansogia

Tonkolili DistrictSurveillance

Map showing Hot spotChiefdoms since outbreak

Treatment Facilities

Primary health CentresCCCs Holding CentresHospital (Magburaka)MaternityLaboratory - EbolaEbola Treatment Centres

November-----------------December

Adjacent Districts

District Ebola Response (DERC)CO-ORDINATION OF REPONSE ACTIVITIES

NERC: National -----

*DERC worked via specified pillars.

Co-ordination committeeTechnical committee for each pillar, each chaired by DHMT & co-chaired by partners: Surveillance & Epidemiology Case Management Burials Contact Tracing Social Mobilisation Psycho-social Logistics Security

*In addition to the District Health Medical Team (DHMT), district response - supported by many agencies – International and local including WHO, UNFPA, World Vision, CDC, Concern Worldwide , AU, MSF, Real Women, Farmers Group etc.

*Daily meeting - update & co-ordination (7/7: 5.30pm)

PARTNERS IN THE EBOLA OUTBREAK –TON - incomplete incomplete - draftNo Name of Partner Area of Involvement

1 Concern World Wide Provide vehicle for transportation of survivorsProvide funds for training Make joint sensitization with DHMT Provision of non food items Fuel support to command center Fund IPC training for PHU staff Food distribution to quarantine homes Give support to CCCSocial mobilization

2 IRC

Train CHWs Maintenance on DHMT vehicle Support staff

3 World Vision Support to burial Teams in four chiefdoms Training of burial teams in four chiefdoms

4 WHO Provide vehicles for surveillance activities Fuel support for surveillance activities Provide Technical support to DHMT on surveillance activities

INVOLVEMENT OF PARTNERS CT………incomplete

No Name of Partner Area of Involvement

5 CDC Through Ehealth provided a 30 KVA generator to DHMT for surveillance activities Give technical support to DHMT on surveillance activities

6 SNAP Food support to quarantine homes Social Mobilization Train contact tracers and supervisors

7 Red Cross Burial of corpses in 7 chiefdoms Social Mobilization Support to burial teams

8 ADAXX Chlorine and veronica buckets

9 • New Harvest Ministry• Action Aid• Care International•Africel• Islamic Group• King Hong

They all gave their own Bits by providing food and none food items

10 •AU, MSF, Lionheart etc

WHO (World Health Organisation)- TonkoliliMy Contract

Purpose:

To contribute to the control of the Ebola outbreak and prevent further spread by breaking the cycle of transmission.

Specific objectives:•Strengthen WHO’s support for the Tonkolili DERC with particular emphasis on surveillance and epidemiological support. •Support a functional responsive Ebola surveillance system which informs intervention planning by quality data analysis, interpretation and review.•Support on-going process evaluation and quality assessment of interventions especially:

Cases:oBy ensuring thorough investigation of all cases, oBy identifying and recommending both prevention and control interventionsoBy identifying and seeking remedies to barriers in the implementation of recommended interventions

Strengthening Contact Tracing activitiesStrengthening Decontamination ActivitiesBy identifying and contributing to training and refresher needs of HCWs

•Support data reporting to national level and feedback to the community•To support the Tonkolili DERC effort through fostering positive relationships with DHMT, DC and other agencies involved in the district response.

Surveillance Systems/Actions

8am daily Alert/Case Investigation meeting (WHO)

9am daily surveillance meeting to Review Lab results, incld sample tracking & other aspects of outbreak –

• Active surveillance based on actions relating to daily surveillance meeting - incld• Cases: source, control• Burials• Contact Tracing• Quarantined homes/Villages: decontamination• Quarantined homes/Villages: supplies – food/non food

( veronica buckets, Chlorine, clothes, IPC training of families etc)• Information/Data flows: local, between districts, national• (Training)• (Co-ordination: local, between districts, national)

Lab Samples & Tracking

Examples

Cases:Alert (Case) Investigation

• 8am daily

• Structure• (Geography)• (Resources)• Links

94 79 3 1 11

11

6

3

6

14

5

4 4

6

26

9

3

1

5

1 1

3

7

8

5

3

6

9

4 4 4

5

23

2

Comparision of sick vs dead

Total Alert Alive Dead

Strengthening Contact Tracing activities

• Contact Tracers• Structure• (Geography)• (Resources)

• Contacts

Strengthen Decontamination Activities

Support data reporting to national level and feedback to the community

Identify and contribute to training and refresher needs of HCWs

Support data reporting

• Quality• Quantity• Data Harmonisation • Sharing/Flow

Ebola Trend in Tonkolili Since late November (epi week 45) the rate of disease has declined.

Outcome

Information - Communications

• Within District– Expectation– Feasibility– Requirement

• Adjoining Districts: patient flows, contact flows

• Nationally– Expectation– Feasibility– Requirement

Week 3 2015

Co-ordination, Gaps, Overlaps, Challenges

• Ebola deaths/illness/effects – other than Ebola disease• Ebola effects on health, health services, basic economy etc –

short term & long term• Move to “normal” health services: volunteers, allowances,

training etc – dismantling, re-structuring• Logistic constraints & supports• Which Organisations will remain? Funding, Sustainability, ?

undermine or support Local solutions

Challenges - Cameos

Burials

Resources at local level

Hard to reach Areas – alerts

Delays

Village 1Village 2Village 3

Practicalities

• Pre-departure• Arrival/1st few days• In the Field• (Irish Connections)• End of Deployment/Return

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