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ORIGINAL ARTICLE
Open Access

Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned

Reshma Roshania, Michaela Mallow, Nelson Dunbar, David Mansary, Pranav Shetty, Taralyn Lyon, Kacey Pham, Matthew Abad, Erin Shedd, Anh-Minh A Tran, Sarah Cundy and Adam C Levine
Global Health: Science and Practice September 2016, 4(3):394-409; https://doi.org/10.9745/GHSP-D-16-00186
Reshma Roshania
aInternational Medical Corps, Los Angeles, CA, USA
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Michaela Mallow
aInternational Medical Corps, Los Angeles, CA, USA
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Nelson Dunbar
bMinistry of Health, Monrovia, Liberia
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David Mansary
cInternational Medical Corps Sierra Leone, Freetown, Sierra Leone
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Pranav Shetty
aInternational Medical Corps, Los Angeles, CA, USA
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Taralyn Lyon
aInternational Medical Corps, Los Angeles, CA, USA
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Kacey Pham
aInternational Medical Corps, Los Angeles, CA, USA
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Matthew Abad
aInternational Medical Corps, Los Angeles, CA, USA
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Erin Shedd
aInternational Medical Corps, Los Angeles, CA, USA
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Anh-Minh A Tran
aInternational Medical Corps, Los Angeles, CA, USA
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Sarah Cundy
aInternational Medical Corps, Los Angeles, CA, USA
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Adam C Levine
aInternational Medical Corps, Los Angeles, CA, USA
dThe Warren Alpert Medical School of Brown University, Providence, RI, USA
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  • For correspondence: adam_levine@brown.edu
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Figures

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  • Figure1
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    Dr. Adam Levine of IMC’s Ebola research team trains staff at the Bong County Ebola treatment unit in Liberia on how to don personal protective equipment.

  • Figure2
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    Staff at the Lunsar Ebola treatment unit in Sierra Leone transfer patient data from the high‐risk zone to the low‐risk zone.

  • FIGURE 1.
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    FIGURE 1.

    Study Flow Diagram, Liberia and Sierra Leone ETUs, September 15, 2014, to September 15, 2015

    Abbreviations: EVD, Ebola virus disease; ETU, Ebola treatment unit.

  • FIGURE 2.
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    FIGURE 2.

    Patient Admissions by ETUa and Epidemiological Week, Liberia and Sierra Leone, September 15, 2014, to September 15, 2015 (N=2,351)

    Abbreviation: ETU, Ebola treatment unit.

    a ETUs were located in Bong County and Margibi County in Liberia, and in Kambia, Lunsar, and Makeni in Sierra Leone.

  • FIGURE 3.
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    FIGURE 3.

    Geographic Distribution of Patients (A) Admitted and (B) Confirmed EVD Positive, Liberia and Sierra Leone, September 15, 2014, to September 15, 2015

    Abbreviation: EVD, Ebola virus disease.

  • FIGURE 4.
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    FIGURE 4.

    Final Diagnosis and Outcome of Admitted Patients by Epidemiological Week, Liberia and Sierra Leone, September 15, 2014, to September 15, 2015 (N=2,351)

    Abbreviation: EVD, Ebola virus disease.

  • FIGURE 5.
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    FIGURE 5.

    Final Diagnosis Among Admitted Patients (N=2,351) and Mortality Outcomes Among EVD+ Patients (N=465) by Age and Sex, Liberia and Sierra Leone, September 15, 2014, to September 15, 2015

    Abbreviation: EVD, Ebola virus disease.

  • Figure8
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    An aerial view of the Lunsar Ebola treatment unit in Sierra Leone.

Tables

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    TABLE 1 Quality of Data Entered From Original Patient Charts Into ETU-Specific Databases: Results of LQAS Audit, Liberia and Sierra Leone, November 2015 (N = 627 Patient Forms)
    Patient Form% Data Entered Correctly
    Demographic99.5%
    Triage99.4%
    Rounding98.1%
    Treatment99.1%
    Discharge99.8%
    Overall99.8%
    • Abbreviations: ETU, Ebola treatment unit; LQAS, lot quality assurance sampling.

    • View popup
    TABLE 2 Outcomes Among All Admitted Patients by EVD Status, Sex, Age, and Location, Liberia and Sierra Leone, September 15, 2014, to September 15, 2015
    EVD+ RecoveredEVD+ DeceasedaEVD+ TransferredEVD+ TotalEVD- DischargedEVD- DeceasedEVD- TotalAll Patients
    All patients197 (8.4)268 (11.4)5 (0.2)470 (20.0)1,725 (73.4)156 (6.6)1,881 (80)2,351 (100)
    Sexb
     Men76 (6.1)107 (8.5)3 (0.2)190 (15.2)959 (76.6)97 (7.7)1,062 (84.8)1,252 (53.4)
     Women118 (10.8)159 (14.6)2 (0.2)279 (25.6)754 (69.1)58 (5.3)812 (74.4)1,091 (46.6)
    Age, yearsb
     0 to < 11 (1.9)13 (24.5)0 (0.0)14 (26.4)36 (67.9)3 (5.7)39 (73.6)53 (2.3)
     1 to 44 (2.4)28 (16.5)0 (0.0)32 (18.8)127 (74.7)11 (6.5)138 (81.2)170 (7.3)
     5 to 1436 (15.5)29 (12.4)1 (0.4)66 (28.3)158 (67.8)9 (3.9)167 (71.7)233 (10.0)
     15 to 2444 (10.8)27 (6.7)1 (0.2)72 (17.7)312 (76.8)22 (5.4)334 (82.3)406 (17.4)
     25 to 3445 (8.1)42 (7.6)2 (0.4)89 (16.1)434 (78.5)30 (5.4)464 (83.9)553 (23.6)
     35 to 4433 (8.8)53 (14.2)1 (0.3)87 (23.3)260 (69.5)27 (7.2)287 (76.7)374 (16.0)
     45 to 5417 (5.8)36 (12.3)0 (0.0)53 (18.1)214 (73.0)26 (8.9)240 (81.9)293 (12.5)
     ≥ 5516 (6.2)40 (15.5)0 (0.0)56 (21.7)175 (67.8)27 (10.5)202 (78.3)258 (11.0)
    Country
     Sierra Leone114 (7.5)173 (11.4)5 (0.3)292 (19.2)1,122 (73.6)110 (7.2)1,232 (80.8)1,524 (64.8)
     Liberia83 (10.0)95 (11.5)0 (0.0)178 (21.5)603 (72.9)46 (5.6)649 (78.5)827 (35.2)
    • Abbreviation: EVD, Ebola virus disease.

    • All data reported as No. (%).

    • ↵a Patients with suspected EVD (n = 14) included in EVD+ deceased.

    • ↵b Missing values not included.

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    TABLE 3 Chi-Square Analysis of Symptoms Reported at Triage by Patients With and Without EVD, Liberia and Sierra Leone, September 15, 2014, to September 15, 2014
    EVD+ Patients, No (%)EVD- Patients, No. (%)P Value
    Clinical symptom
     Fever353 (75.3)1,481 (78.7).11
     Asthenia (weakness)337 (71.9)1,338 (71.1).76
     Loss of appetite321 (68.4)1,228 (65.3).20
     Headache273 (58.2)1,109 (59.0).77
     Myalgia or arthralgia (muscle or joint pain)273 (58.2)1,093 (58.1).97
     Nausea or vomiting225 (58.0)947 (60.4).38
     Diarrhea235 (54.0)662 (37.4)< .001
     Abdominal pain204 (43.5)1,016 (54.0)< .001
     Red eyesa129 (27.5)189 (10.1)< .001
     Sore throat or difficulty swallowing112 (23.9)440 (23.4).82
     Dyspnea (shortness of breath)110 (23.5)581 (30.9).002
     Hiccups57 (12.2)246 (13.1).59
     Jaundice24 (5.1)108 (5.7).60
     Bleeding, non-ocular26 (5.5)212 (11.3)< .001
    Epidemiologic variable
     Had contact with someone ill340 (82.1)367 (21.5)< .001
     Attended funeral144 (39.7)146 (8.8)< .001
     Had recent travel outside of home district18 (11.7)122 (20.0).02
     Worked in health sector9 (4.2)62 (6.5).20
     Had contact with bush meat0 (0.0)13 (2.5).06
    • Abbreviation: EVD, Ebola virus disease.

    • ↵a Includes red injected eyes, conjunctivitis, and hemorrhagic eyes.

    • View popup
    TABLE 4 Average Length of Stay (in Days) in ETU by EVD Status, Outcome, Sex, Age, and Location, Liberia and Sierra Leone, September 15, 2014, to September 15, 2015
    EVD+aEVD-All Patients
    RecoveredDeceasedbDischargedDeceased
    nALOSnALOSnALOSnALOSnALOS
    All patients19714.72685.61,7213.61562.32,3464.7
    Sexc
     Men7713.61095.69633.6982.21,2504.2
     Women11815.41595.67513.7582.41,0885.2
    Age, yearsc
     0 to < 1118.0136.0364.231.7534.8
     1 to 4423.0286.61273.8111.91704.6
     5 to 143615.4295.51583.693.22335.7
     15 to 244414.4274.73113.5222.04054.7
     25 to 344413.5425.84333.5302.65514.4
     35 to 443315.0535.42603.6271.93744.8
     45 to 541713.4365.82133.4262.12924.2
     ≥ 551615.3405.31743.9272.42574.7
    Country
     Sierra Leone11314.61735.61,1194.01102.41,5204.9
     Liberia8314.9955.76022.9462.08264.3
    • Abbreviations: ALOS, average length of stay; ETU, Ebola treatment unit; EVD, Ebola virus disease.

    • ↵a EVD+ patients who were transferred (n = 5) not included.

    • ↵b Patients with suspected EVD (n = 14) included in EVD+ deceased.

    • ↵c Missing values not included.

    • View popup
    TABLE 5 Case Fatality Ratios Among Patients With EVD by Gender, Age, and Location, September 15, 2014, to September 15, 2014
    EVD+ Recovered, No. (%)EVD+ Deceased,aNo. (%)Total,bNo. (%)EVD Fatality,OR (95% CI)P Value
    All patients197 (42.4)268 (57.6)465 (100)
    Sexc
     Men78 (41.7)109 (58.3)187 (40.3)--
     Women118 (42.6)159 (57.4)277 (59.7)1.0 (0.7, 1.4).09
    Age, yearsc
     0 to <11 (7.1)13 (92.9)14 (3.1)18.3 (3.3, 463.5)< .001
     1 to 44 (12.5)28 (87.5)32 (7.0)10.8 (3.7, 40.8)< .001
     5 to 1436 (55.4)29 (44.6)65 (14.0)1.3 (0.7, 2.6).49
     15 to 2444 (62.0)27 (38.0)71 (15.3)--
     25 to 3445 (51.7)42 (48.3)87 (18.8)1.5 (0.8, 2.9).20
     35 to 4433 (38.4)53 (61.6)86 (18.5)2.6 (1.4, 5.0).004
     45 to 5417 (32.1)36 (67.9)53 (11.4)3.4 (1.6, 7.4).001
     ≥ 5516 (28.6)40 (71.4)56 (12.1)4.0 (1.9, 8.7)< .001
    Country
     Sierra Leone114 (39.7)173 (60.3)287 (61.7)--
     Liberia83 (46.6)95 (53.4)178 (38.3)0.8 (0.5, 1.1).15
    • Abbreviations: CI, confidence interval; EVD, Ebola virus disease; OR, odds ratio.

    • ↵a Patients with suspected EVD (n = 14) included in EVD+ deceased.

    • ↵b EVD+ patients who were transferred (n = 5) not included.

    • ↵c Missing values not included.

Additional Files

  • Figures
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  • GHSP-D-16-00186 Supplementary Material

    Levine et al. doi: 10.9745/GHSP-D-16-00186

    • Supplementary Material - Levine et al. doi: 10.9745/GHSP-D-16-00186
    • Supplementary Material - Levine et al. doi: 10.9745/GHSP-D-16-00186
    • Supplementary Material - Levine et al. doi: 10.9745/GHSP-D-16-00186
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Global Health: Science and Practice: 4 (3)
Global Health: Science and Practice
Vol. 4, No. 3
September 28, 2016
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Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
Reshma Roshania, Michaela Mallow, Nelson Dunbar, David Mansary, Pranav Shetty, Taralyn Lyon, Kacey Pham, Matthew Abad, Erin Shedd, Anh-Minh A Tran, Sarah Cundy, Adam C Levine
Global Health: Science and Practice Sep 2016, 4 (3) 394-409; DOI: 10.9745/GHSP-D-16-00186

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Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
Reshma Roshania, Michaela Mallow, Nelson Dunbar, David Mansary, Pranav Shetty, Taralyn Lyon, Kacey Pham, Matthew Abad, Erin Shedd, Anh-Minh A Tran, Sarah Cundy, Adam C Levine
Global Health: Science and Practice Sep 2016, 4 (3) 394-409; DOI: 10.9745/GHSP-D-16-00186
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