Trends in mortality at Federal Medical Centre, Owo, Ondo State, Nigeria 2006-2014.

INTRODUCTION: vital events registration is not accurately done in Nigeria. Hence, mortality data is often not available. Health facility-based data can provide useful information on the trends in mortality of a population. This study describes the trend of deaths in a tertiary health facility. METHODS: a retrospective review of the medical records of all patients that died in the Federal Medical Centre, Owo, Ondo State, Nigeria from 2006 to 2014 was conducted. Data extracted from the records included age, sex, primary cause of death and date of admission and death. Frequencies were done and the median age of male and female deaths were compared using Mann-Whitney U test. RESULTS: a total of 1,326 deaths occurred in the hospital. The median age at death was 46 years (range: 0-110), median age was 49 years in males and 43 years in females (p = 0.025). One fifth (20.9%) of deaths was in infants. The median length of hospital stay was 4 days (range: 0-277). The highest proportion of death (16.4%) was in 2009 and on Wednesdays (15.9%). More deaths occurred in January (11.5%) and (10.3%) in February than in other months. The leading cause of communicable disease death in age 1 and above were HIV (15.2%) and TB (2.5%). Birth asphyxia (39.3%) and low birth weight (46%) were the commonest cause of death in infants. CONCLUSION: over the years the leading causes of mortality were preventable. Infant mortality remains a public health problem. Hospital mortality data could guide health decision making and interventions in Nigeria. Interventions to reduce death from communicable diseases and in infants are urgently recommended.

Contact tracing following outbreak of Ebola virus disease in urban settings in Nigeria.

An outbreak of Ebola virus disease occurred in Nigeria between July and September 2014. Contact tracing commenced in Lagos, and extended to Port Harcourt and Enugu as the outbreak continued to spread. A total of 899 contacts were traced. Contact tracing enhanced immediate identification of symptomatic contacts, some of whom eventually became cases. Contact tracing could be challenging in urban cities. However, use of electronic technology, adequate logistics, and highly skilled personnel enhanced the tracing of contacts to facilitate the successful containment of the outbreak. Nigeria was certified to be Ebola free on 21st October 2014. Ebola virus surveillance needs to be maintained to ensure the disease has been contained and to prevent future outbreaks. This case study aims to help trainees to review concepts, apply skills, and address challenges for contact tracing based on the experience of the Nigerian Field Epidemiology Training Network during the 2014 Ebola virus disease outbreak.

Detecting, reporting, and analysis of priority diseases for routine public health surveillance in Liberia.

An essential component of a public health surveillance system is its ability to detect priority diseases which fall within the mandate of public health officials at all levels. Early detection, reporting and response to public health events help to reduce the burden of mortality and morbidity on communities. Analysis of reliable surveillance data provides relevant information which can enable implementation of timely and appropriate public health interventions. To ensure that a resilient system is in place, the World Health Organization (WHO) has provided guidelines for detection, reporting and response to public health events in the Integrated Disease Surveillance and Response (IDSR) strategy. This case study provides training on detection, reporting and analysis of priority diseases for routine public health surveillance in Liberia and highlights potential errors and challenges which can hinder effective surveillance. Table-top exercises and group discussion lead participants through a simulated verification and analyses of summary case reports in the role of the District Surveillance Officer. This case study is intended for public health training in a classroom setting and can be accomplished within 2 hours 30 minutes. The target audience include residents in Frontline Epidemiology Training Programs (FETP-Frontline), Field Epidemiology and Laboratory Training Programs (FELTPs), and others who are interested in this topic.

Investigating an outbreak of measles in Margibi County, Liberia, October 2015.

The emergence and re-emergence of infectious diseases highlights the need to have well-trained field epidemiologists who will be at the forefront in the fight against these diseases, especially during an outbreak. Training for outbreak investigation is most effective when participants can develop their competencies in a practical exercise. To that end, this case study was based on a measles outbreak investigation conducted in Liberia during October 2015 by Liberia Frontline Field Epidemiology Training Program (FETP) residents, simulating steps to perform outbreak investigation in a real-life situation as a field epidemiologist. This case study is ideally suited to reinforce principles and skills already covered in a classroom lecture or in background reading by providing a practical training beyond the scope of theoretical learning. It is primarily intended for training novice public health practitioners who should be able to complete the exercises in approximately 3 hours.

Detecting, reporting, and analysis of priority diseases for routine public health surveillance in Liberia.

Public health officials depend on timely, complete, and accurate surveillance data for decision making. The quality of data generated from surveillance is highly dependent on external and internal factors which may either impede or enhance surveillance activities. One way of identifying challenges affecting the quality of data generated is to conduct a data quality audit. This case study, based on an audit conducted by residents of the Liberia Frontline Field Epidemiology Training Program, was designed to be a classroom simulation of a data quality audit in a health facility. It is suited to enforce theoretical lectures in surveillance data quality and auditing. The target group is public health trainees, who should be able to complete this exercise in approximately 2 hours and 30 minutes.

Conducting a surveillance problem analysis on poor feedback from Reference Laboratory, Liberia, February 2016.

The laboratory plays a major role in surveillance, including confirming the start and end of an outbreak. Knowing the causative agent for an outbreak informs the development of response strategies and management plans for a public health event. However, issues and challenges may arise that limit the effectiveness or efficiency of laboratories in surveillance. This case study applies a systematic approach to analyse gaps in laboratory surveillance, thereby improving the ability to mitigate these gaps. Although this case study concentrates on factors resulting in poor feedback from the laboratory, practise of this general approach to problem analysis will confer skills required in analysing most public health issues. This case study was developed based on a report submitted by the district surveillance officer in Grand Bassa County, Liberia, as a resident of the Liberian Frontline Field Epidemiology Training Program in 2016. This case study will serve as a training tool to reinforce lectures on surveillance problem analysis using the fishbone approach. It is designed for public health training in a classroom setting and can be completed within 2 hours 30 minutes.