Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-23 (of 23 Records) |
Query Trace: Hersey S [original query] |
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Factors That Affect Opioid Quality Improvement Initiatives in Primary Care: Insights from Ten Health Systems
Childs E , Tano CA , Mikosz CA , Parchman ML , Hersey CL , Keane N , Shoemaker-Hunt SJ , Losby JL . Jt Comm J Qual Patient Saf 2023 49 (1) 26-33 OBJECTIVE: To improve patient safety and pain management, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain (CDC Guideline). Recognizing that issuing a guideline alone is insufficient for transforming practice, CDC supported an Opioid Quality Improvement (QI) Collaborative, consisting of 10 health care systems that represented more than 120 practices across the United States. The research team identified factors related to implementation success using domains described by the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) implementation science framework. METHODS: Data from interviews, notes from check-in calls, and documents provided by systems were used. The researchers collected data throughout the project through interviews, meeting notes, and documents. RESULTS: The iPARIHS framework was used to identify factors that affected implementation related to the context, innovation (implementing recommendations from the CDC Guideline), recipient (clinicians), and facilitation (QI team). Contextual characteristics were at the clinic, health system, and broader external context, including staffing and leadership support, previous QI experience, and state laws. Characteristics of the innovation were its adaptability and challenges operationalizing the measures. Recipient characteristics included belief in the importance of the innovation but challenges engaging in the initiative. Finally, facilitation characteristics driving differential outcomes included staffing and available time of the QI team, the ability to make changes, and experience with QI. CONCLUSION: As health care systems continue to implement the CDC Guideline, these insights can advance successful implementation efforts by describing common implementation challenges and identifying strategies to prepare for and overcome them. |
Findings the graves: SLED Family Reunification Program: SLED Family Reunification Program.
Bensyl D , Bangura B , Cundy S , Gegbai F , Gorina Y , Harding JD , Hersey S , Jambai A , Kamara AS , Kargbo A , Kamara MAM , Lansana P , Otieno D , Redd JT , Samba TT , Singh T , Vandi MA . Ann Epidemiol 2021 64 15-22 In 2015, the Sierra Leone Ministry of Health and Sanitation (MoHS) and the Centers for Disease Control and Prevention (CDC) agreed to consolidate data recorded by MoHS and international partners during the Ebola epidemic and create the Sierra Leone Ebola Database (SLED). The primary objectives were helping families to identify the location of graves of their loved ones who died from any cause at the time of the Ebola epidemic and creating a data source for epidemiological research. The Family Reunification Program fulfils the first SLED objective. The purpose of this paper is to describe the Family Reunification Program (Program) development, functioning and results. The MoHS, CDC, SLED Team, and Concern Worldwide developed, tested, and implemented methodology and tools to conduct the Program. Family liaisons were trained in protection of the personally identifiable information. The SLED Family Reunification Program allows families in Sierra Leone, who did not know the final resting place of their loved ones, to be reunited with their graves and to bring them relief and closure. Continuing family requests in search of the burial place of loved ones five years after the end of the epidemic shows that the emotional burden of losing a family member and not knowing the place of burial does not diminish with time. As of February 2021, the Program continues and is described to allow its replication for other emergency events including COVID-19 and new Ebola outbreaks. |
Building the Sierra Leone Ebola Database: organization and characteristics of data systematically collected during 2014-2015 Ebola epidemic
Agnihotri S , Alpren C , Bangura B , Bennett S , Gorina Y , Harding JD , Hersey S , Kamara AS , Kamara MAM , Klena JD , McLysaght F , Patel N , Presser L , Redd JT , Samba TT , Taylor AK , Vandi MA , Van Heest S . Ann Epidemiol 2021 60 35-44 BACKGROUND: During the 2014-2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS), the US Centers for Disease Control and Prevention, and responding partners under the coordination of the National Ebola Response Center (NERC) and the MoHS's Emergency Operation Center (EOC) systematically recorded information from the 117 Call Center system and district alert phone lines, case investigations, laboratory sample testing, clinical management, and safe and dignified burial records. Since 2017, CDC assisted MoHS in building and managing the Sierra Leone Ebola Database (SLED) to consolidate these major data sources. The primary objectives of the project were helping families to identify the location of graves of their loved ones who died at the time of the Ebola epidemic through the SLED Family Reunification Program and creating a data source for epidemiological research. The objective of this paper is to describe the process of consolidating epidemic records into a useful and accessible data collection and to summarize data characteristics, strength, and limitations of this unique information source for public health research. METHODS: Because of the unprecedented conditions during the epidemic, most of the records collected from responding organizations required extensive processing before they could be used as a data source for research or the humanitarian purpose of locating burial sites. This process required understanding how the data were collected and used during the outbreak. To manage the complexity of processing the data obtained from various sources, the Sierra Leone Ebola Database (SLED) Team used an organizational strategy that allowed tracking of the data provenance and lifecycle. RESULTS: The SLED project brought raw data into one consolidated data collection. It provides researchers with secure and ethical access to the SLED data and serves as a basis for the research capacity building in Sierra Leone. The SLED Family Reunification Program allowed Sierra Leonean families to identify location of the graves of loved ones who died during the Ebola epidemic. DISCUSSION: The SLED project consolidated and utilized epidemic data recorded during the Sierra Leone Ebola Virus Disease outbreak that were collected and contributed to SLED by national and international organizations. This project has provided a foundation for developing a method of ethical and secure SLED data access while preserving the host nation's data ownership. SLED serves as a data source for the SLED Family Reunification Program and for epidemiological research. It presents an opportunity for building research capacity in Sierra Leone and provides a foundation for developing a relational database. Large outbreak data systems such as SLED provide a unique opportunity for researchers to improve responses to epidemics and indicate the need to include data management preparedness in the plans for emergency response. |
Data on the implementation of VaxTrac electronic immunization registry in Sierra Leone
Namageyo-Funa A , Jalloh MF , Gleason B , Wallace AS , Friedman M , Sesay T , Ocansey D , Jalloh MS , Feldstein LR , Conklin L , Hersey S , Singh T , Kaiser R . Data Brief 2020 32 106167 Following the piloting of VaxTrac, an electronic immunization registry (EIR), we conducted a rapid assessment in November-December 2017 to evaluate the use of the EIR in 10 health facilities in Western Area Urban district in Sierra Leone [1]. In this data-in-brief report, we provide additional descriptive data from the assessment of the VaxTrac EIR in Sierra Leone. The assessment comprised aggregate data on vaccine doses administered that were abstracted from VaxTrac and three paper-based sources (daily tally sheets, register of children under the age of 2 years, and a summary form of doses administered). Data were abstracted for the following six vaccine doses in the immunization schedule in Sierra Leone: 1) Bacillus Calmette-Guérin vaccine, 2) first dose of pentavalent vaccine, 3) second dose of pentavalent vaccine, 4) third dose of pentavalent vaccine, 5) first dose of measles-containing vaccine, and 6) second dose of measles-containing vaccine. We descriptively analysed the abstracted data to examine the congruity between VaxTrac records and the three paper-based sources. Bar graphs were generated to visually depict the variations in number of administered vaccine doses by data source for each health facility. We provide the aggregated data for each vaccine dose abstracted by data source from each health facility as supplemental material (Excel file). The supplementary data reveal patterns in the congruity of vaccine doses captured that have implications for policy and programmatic decisions regarding the use of VaxTrac and other similar EIRs in low resource urban settings. |
National reporting of deaths after enhanced Ebola surveillance in Sierra Leone
Jalloh MF , Kaiser R , Diop M , Jambai A , Redd JT , Bunnell RE , Castle E , Alpren C , Hersey S , Ekstrom AM , Nordenstedt H . PLoS Negl Trop Dis 2020 14 (8) e0008624 BACKGROUND: Sierra Leone experienced the largest documented epidemic of Ebola Virus Disease in 2014-2015. The government implemented a national tollfree telephone line (1-1-7) for public reporting of illness and deaths to improve the detection of Ebola cases. Reporting of deaths declined substantially after the epidemic ended. To inform routine mortality surveillance, we aimed to describe the trends in deaths reported to the 1-1-7 system and to quantify people's motivations to continue reporting deaths after the epidemic. METHODS: First, we described the monthly trends in the number of deaths reported to the 1-1-7 system between September 2014 and September 2019. Second, we conducted a telephone survey in April 2017 with a national sample of individuals who reported a death to the 1-1-7 system between December 2016 and April 2017. We described the reported deaths and used ordered logistic regression modeling to examine the potential drivers of reporting motivations. FINDINGS: Analysis of the number of deaths reported to the 1-1-7 system showed that 12% of the expected deaths were captured in 2017 compared to approximately 34% in 2016 and over 100% in 2015. We interviewed 1,291 death reporters in the survey. Family members reported 56% of the deaths. Nearly every respondent (94%) expressed that they wanted the 1-1-7 system to continue. The most common motivation to report was to obey the government's mandate (82%). Respondents felt more motivated to report if the decedent exhibited Ebola-like symptoms (adjusted odds ratio 2.3; 95% confidence interval 1.8-2.9). CONCLUSIONS: Motivation to report deaths that resembled Ebola in the post-outbreak setting may have been influenced by knowledge and experiences from the prolonged epidemic. Transitioning the system to a routine mortality surveillance tool may require a robust social mobilization component to match the high reporting levels during the epidemic, which exceeded more than 100% of expected deaths in 2015. |
Assessment of VaxTrac electronic immunization registry in an urban district in Sierra Leone: Implications for data quality, defaulter tracking, and policy
Jalloh MF , Namageyo-Funa A , Gleason B , Wallace AS , Friedman M , Sesay T , Ocansey D , Jalloh MS , Feldstein LR , Conklin L , Hersey S , Singh T , Kaiser R . Vaccine 2020 38 (39) 6103-6111 BACKGROUND: In 2016, the Sierra Leone Ministry of Health and Sanitation (MoHS) piloted VaxTrac, an electronic immunization registry (EIR), in an urban district to improve management of vaccination records and tracking of children who missed scheduled doses. We aimed to document lessons learned to inform decision-making on VaxTrac and similar EIRs' future use. METHODS: Ten out of 50 urban health facilities that implemented VaxTrac were purposively selected for inclusion in a rapid mixed-method assessment from November to December 2017. For a one-month period, records of six scheduled vaccine doses among children < 2 years old in VaxTrac were abstracted and compared to three paper-based records (register of under-two children, daily tally sheet, and monthly summary form). We used the under-two register as the reference gold standard for comparison purposes. We interviewed and observed 10 heath workers, one from each selected facility, who were using VaxTrac. RESULTS: Overall, VaxTrac captured < 65% of the vaccine doses reported in the paper-based sources, but in the largest health facility VaxTrac captured the highest number of doses. Two additional notable patterns emerged: 1) the aggregated data sources reported higher doses administered compared to the under-two register and VaxTrac; 2) data sources that need real-time data capture during the vaccination session reported fewer doses administered compared to the monthly HF2 summary form. Health workers expressed that the EIR helped them to shorten the time to manage, summarize, and report vaccination records. Workflows for data entry in VaxTrac were inconsistent among facilities and rarely integrated into existing processes. Data sharing restrictions contributed to duplicate records. CONCLUSION: Although VaxTrac helped to shorten the time to manage, summarize, and report vaccination records, data sharing restrictions coupled with inconsistent and inefficient workflows were major implementation challenges. Readiness-to-introduce and sustainability should be carefully considered before implementing an EIR. |
Ensuring ethical data access: the Sierra Leone Ebola Database (SLED) model
Gorina Y , Redd JT , Hersey S , Jambai A , Meyer P , Kamara AS , Kamara A , Harding JD , Bangura B , Kamara MAM . Ann Epidemiol 2020 46 1-4 Purpose: Organizations responding to the 2014–2016 Ebola epidemic in Sierra Leone collected information from multiple sources and kept it in separate databases, including distinct data systems for Ebola hot line calls, patient information collected by field surveillance officers, laboratory testing results, clinical information from Ebola treatment and isolation facilities, and burial team records. Methods: After the conclusion of the epidemic, the Sierra Leone Ministry of Health and Sanitation and the U.S. Centers for Disease Control and Prevention partnered to collect these disparate records and consolidate them in the Sierra Leone Ebola Database. Results: The Sierra Leone Ebola Database data are providing a lasting resource for postepidemic data analysis and epidemiologic research, including identifying best strategies in outbreak response, and are used to help families locate the graves of family members who died during the epidemic. Conclusion: This report describes the Ministry of Health and Sanitation and Centers for Disease Control and Prevention processes to safeguard Ebola records while making the data available for public health research. |
Evidence of behaviour change during an Ebola virus disease outbreak, Sierra Leone
Jalloh MF , Sengeh P , Bunnell RE , Jalloh MB , Monasch R , Li W , Mermin J , Deluca N , Brown V , Nur SA , August EM , Ransom RL , Namageyo-Funa A , Clements SA , Dyson M , Hageman K , Pratt SA , Nuriddin A , Carroll DD , Hawk N , Manning C , Hersey S , Marston BJ , Kilmarx PH , Conteh L , Ekström AM , Zeebari Z , Redd JT , Nordenstedt H , Morgan O . Bull World Health Organ 2020 98 (5) 330-340B Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9–9.1); and (ii) wait for a burial team following a relative’s death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2–6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4–4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1–0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2–9.1) than low-transmission (aOR: 2.3; 95% CI: 1.4–3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4–2.5) and aOR: 0.8 (95% CI: 0.6–1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. |
Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey
Kharsany ABM , Cawood C , Khanyile D , Lewis L , Grobler A , Puren A , Govender K , George G , Beckett S , Samsunder N , Madurai S , Toledo C , Chipeta Z , Glenshaw M , Hersey S , Abdool Karim Q . Lancet HIV 2018 5 (8) e427-e437 BACKGROUND: In high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities. METHODS: We did a cross-sectional community survey in the adjacent Greater Edendale and Vulindlela areas in the uMgungundlovu district, KwaZulu-Natal, South Africa. Using a multistage cluster sampling method, we randomly selected enumeration areas, households, and individuals. One household member (aged 15-49 years) selected at random was invited for survey participation. After obtaining consent, questionnaires were administered to obtain sociodemographic, psychosocial, and behavioural information, and exposure to HIV prevention and treatment programmes. Clinical samples were collected for laboratory measurements. Statistical analyses were done accounting for multilevel sampling and weighted to represent the population. A multivariable logistic regression model assessed factors associated with HIV infection. FINDINGS: Between June 11, 2014, and June 22, 2015, we enrolled 9812 individuals. The population-weighted HIV prevalence was 36.3% (95% CI 34.8-37.8, 3969 of 9812); 44.1% (42.3-45.9, 2955 of 6265) in women and 28.0% (25.9-30.1, 1014 of 3547) in men (p<0.0001). HIV prevalence in women aged 15-24 years was 22.3% (20.2-24.4, 567 of 2224) compared with 7.6% (6.0-9.3, 124 of 1472; p<0.0001) in men of the same age. Prevalence peaked at 66.4% (61.7-71.2, 517 of 760) in women aged 35-39 years and 59.6% (53.0-66.3, 183 of 320) in men aged 40-44 years. Consistent condom use in the last 12 months was 26.5% (24.1-28.8, 593 of 2356) in men and 22.7% (20.9-24.4, 994 of 4350) in women (p=0.0033); 35.7% (33.4-37.9, 1695 of 5447) of women's male partners and 31.9% (29.5-34.3, 1102 of 3547) of men were medically circumcised (p<0.0001), and 45.6% (42.9-48.2, 1251 of 2955) of women and 36.7% (32.3-41.2, 341 of 1014) of men reported antiretroviral therapy (ART) use (p=0.0003). HIV viral suppression was achieved in 54.8% (52.0-57.5, 1574 of 2955) of women and 41.9% (37.1-46.7, 401 of 1014) of men (p<0.0001), and 87.2% (84.6-89.8, 1086 of 1251) of women and 83.9% (78.5-89.3, 284 of 341; p=0.3670) of men on ART. Age, incomplete secondary schooling, being single, having more than one lifetime sex partner (women), sexually transmitted infections, and not being medically circumcised were associated with HIV-positive status. INTERPRETATION: The HIV burden in specific age groups, the suboptimal differential coverage, and uptake of HIV prevention strategies justifies a location-based approach to surveillance with finer disaggregation by age and sex. Intensified and customised approaches to seek, identify, and link individuals to HIV services are crucial to achieving epidemic control in this community. FUNDING: The President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention. |
Implementing a multisite clinical trial in the midst of an Ebola outbreak: Lessons learned from the Sierra Leone Trial to Introduce a Vaccine against Ebola
Carter RJ , Idriss A , Widdowson MA , Samai M , Schrag SJ , Legardy-Williams JK , Estivariz CF , Callis A , Carr W , Webber W , Fischer ME , Hadler S , Sahr F , Thompson M , Greby SM , Edem-Hotah J , Momoh RM , McDonald W , Gee JM , Kallon AF , Spencer-Walters D , Bresee JS , Cohn A , Hersey S , Gibson L , Schuchat A , Seward JF . J Infect Dis 2018 217 S16-s23 The Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE), a phase 2/3 trial of investigational rVSVG-ZEBOV-GP vaccine, was conducted during an unprecedented Ebola epidemic. More than 8600 eligible healthcare and frontline response workers were individually randomized to immediate (within 7 days) or deferred (within 18-24 weeks) vaccination and followed for 6 months after vaccination for serious adverse events and Ebola virus infection. Key challenges included limited infrastructure to support trial activities, unreliable electricity, and staff with limited clinical trial experience. Study staff made substantial infrastructure investments, including renovation of enrollment sites, laboratories, and government cold chain facilities, and imported equipment to store and transport vaccine at </=-60oC. STRIVE built capacity by providing didactic and practical research training to >350 staff, which was reinforced with daily review and feedback meetings. The operational challenges of safety follow-up were addressed by issuing mobile telephones to participants, making home visits, and establishing a nurse triage hotline. Before the Ebola outbreak, Sierra Leone had limited infrastructure and staff to conduct clinical trials. Without interfering with the outbreak response, STRIVE responded to an urgent need and helped build this capacity. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220]. |
Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015
Jalloh MF , Li W , Bunnell RE , Ethier KA , O'Leary A , Hageman KM , Sengeh P , Jalloh MB , Morgan O , Hersey S , Marston BJ , Dafae F , Redd JT . BMJ Glob Health 2018 3 (2) e000471 Background: The mental health impact of the 2014-2016 Ebola epidemic has been described among survivors, family members and healthcare workers, but little is known about its impact on the general population of affected countries. We assessed symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population in Sierra Leone after over a year of outbreak response. Methods: We administered a cross-sectional survey in July 2015 to a national sample of 3564 consenting participants selected through multistaged cluster sampling. Symptoms of anxiety and depression were measured by Patient Health Questionnaire-4. PTSD symptoms were measured by six items from the Impact of Events Scale-revised. Relationships among Ebola experience, perceived Ebola threat and mental health symptoms were examined through binary logistic regression. Results: Prevalence of any anxiety-depression symptom was 48% (95% CI 46.8% to 50.0%), and of any PTSD symptom 76% (95% CI 75.0% to 77.8%). In addition, 6% (95% CI 5.4% to 7.0%) met the clinical cut-off for anxiety-depression, 27% (95% CI 25.8% to 28.8%) met levels of clinical concern for PTSD and 16% (95% CI 14.7% to 17.1%) met levels of probable PTSD diagnosis. Factors associated with higher reporting of any symptoms in bivariate analysis included region of residence, experiences with Ebola and perceived Ebola threat. Knowing someone quarantined for Ebola was independently associated with anxiety-depression (adjusted OR (AOR) 2.3, 95% CI 1.7 to 2.9) and PTSD (AOR 2.095% CI 1.5 to 2.8) symptoms. Perceiving Ebola as a threat was independently associated with anxiety-depression (AOR 1.69 95% CI 1.44 to 1.98) and PTSD (AOR 1.86 95% CI 1.56 to 2.21) symptoms. Conclusion: Symptoms of PTSD and anxiety-depression were common after one year of Ebola response; psychosocial support may be needed for people with Ebola-related experiences. Preventing, detecting, and responding to mental health conditions should be an important component of global health security efforts. |
Ebola response impact on public health programs, West Africa, 2014-2017
Marston BJ , Dokubo EK , van Steelandt A , Martel L , Williams D , Hersey S , Jambai A , Keita S , Nyenswah TG , Redd JT . Emerg Infect Dis 2017 23 (13) S25-32 Events such as the 2014-2015 West Africa epidemic of Ebola virus disease highlight the importance of the capacity to detect and respond to public health threats. We describe capacity-building efforts during and after the Ebola epidemic in Liberia, Sierra Leone, and Guinea and public health progress that was made as a result of the Ebola response in 4 key areas: emergency response, laboratory capacity, surveillance, and workforce development. We further highlight ways in which capacity-building efforts such as those used in West Africa can be accelerated after a public health crisis to improve preparedness for future events. |
Reporting deaths among children aged <5 years after the Ebola virus disease epidemic - Bombali District, Sierra Leone, 2015-2016
Wilkinson AL , Kaiser R , Jalloh MF , Kamara M , Blau DM , Raghunathan PL , Kamara A , Kamara U , Houston-Suluku N , Clarke K , Jambai A , Redd JT , Hersey S , Osaio-Kamara B . MMWR Morb Mortal Wkly Rep 2017 66 (41) 1116-1118 Mortality surveillance and vital registration are limited in Sierra Leone, a country with one of the highest mortality rates among children aged <5 years worldwide, approximately 120 deaths per 1,000 live births (1,2). To inform efforts to strengthen surveillance, stillbirths and deaths in children aged <5 years from multiple surveillance streams in Bombali Sebora chiefdom were retrospectively reviewed. In total, during January 2015-November 2016, 930 deaths in children aged <5 years were identified, representing 73.3% of the 1,269 deaths that were expected based on modeled estimates. The "117" telephone alert system established during the Ebola virus disease (Ebola) epidemic captured 683 (73.4%) of all reported deaths in children aged <5 years, and was the predominant reporting source for stillbirths (n = 172). In the absence of complete vital events registration, 117 call alerts markedly improved the completeness of reporting of stillbirths and deaths in children aged <5 years. |
The 117 call alert system in Sierra Leone: from rapid Ebola notification to routine death reporting
Alpren C , Jalloh MF , Kaiser R , Diop M , Kargbo S , Castle E , Dafae F , Hersey S , Redd JT , Jambai A . BMJ Glob Health 2017 2 (3) e000392 A toll-free, nationwide phone alert system was established for rapid notification and response during the 2014-2015 Ebola epidemic in Sierra Leone. The system remained in place after the end of the epidemic under a policy of mandatory reporting and Ebola testing for all deaths, and, from June 2016, testing only in case of suspected Ebola. We describe the design, implementation and changes in the system; analyse calling trends during and after the Ebola epidemic; and discuss strengths and limitations of the system and its potential role in efforts to improve death reporting in Sierra Leone. Numbers of calls to report deaths of any cause (death alerts) and persons suspected of having Ebola (live alerts) were analysed by province and district and compared with numbers of Ebola cases reported by the WHO. Nearly 350 000 complete, non-prank calls were made to 117 between September 2014 and December 2016. The maximum number of daily death and live alerts was 9344 (October 2014) and 3031 (December 2014), respectively. Call volumes decreased as Ebola incidence declined and continued to decrease in the post-Ebola period. A national social mobilisation strategy was especially targeted to influential religious leaders, traditional healers and women's groups. The existing infrastructure and experience with the system offer an opportunity to consider long-term use as a death reporting tool for civil registration and mortality surveillance, including rapid detection and control of public health threats. A routine social mobilisation component should be considered to increase usage. |
The WHO global reference list of 100 core health indicators: The example of Sierra Leone
Kaiser R , Johnson N , Jalloh MF , Dafae F , Redd JT , Hersey S , Jambai A . Pan Afr Med J 2017 27 (246) The global reference list of 100 core health indicators is a standard set of indicators published by the World Health Organization in 2015. We reviewed core health indicators in the public domain and in-country for Sierra Leone, the African continent and globally. Review objectives included assessing available sources, accessibility and feasibility of obtaining data and informing efforts to monitor program progress. Our search strategy was guided by feasibility considerations targeting mainly national household surveys in Sierra Leone and topic-specific and health statistics reports published annually by WHO. We also included national, regional and worldwide health indicator estimates published with open access in the literature and compared them with cumulative annual indicators from the weekly national epidemiological bulletin distributed by the Sierra Leone Ministry of Health and Sanitation. We obtained 70 indicators for Sierra Leone from Internet sources and 2 (maternal mortality and malaria incidence) from the national bulletin. Of the 70 indicators, 14 (20%) were modified versions of WHO indicators and provided uncertainty intervals. Maternal mortality showed considerable differences between 2 international sources for 2015 and the most recent national bulletin. We were able to obtain the majority of core indicators for Sierra Leone. Some indicators were similar but not identical, uncertainty intervals were limited and estimates differed for the same year between sources. Current efforts to improve health and mortality surveillance in Sierra Leone will improve availability and quality of reporting in the future. A centralized core indicator reporting website should be considered. |
Assessments of Ebola knowledge, attitudes and practices in Forecariah, Guinea and Kambia, Sierra Leone, July-August 2015
Jalloh MF , Bunnell R , Robinson S , Jalloh MB , Barry AM , Corker J , Sengeh P , VanSteelandt A , Li W , Dafae F , Diallo AA , Martel LD , Hersey S , Marston B , Morgan O , Redd JT . Philos Trans R Soc Lond B Biol Sci 2017 372 (1721) The border region of Forecariah (Guinea) and Kambia (Sierra Leone) was of immense interest to the West Africa Ebola response. Cross-sectional household surveys with multi-stage cluster sampling procedure were used to collect random samples from Kambia (n = 635) in July 2015 and Forecariah (n = 502) in August 2015 to assess public knowledge, attitudes and practices related to Ebola. Knowledge of the disease was high in both places, and handwashing with soap and water was the most widespread prevention practice. Acceptance of safe alternatives to traditional burials was significantly lower in Forecariah compared with Kambia. In both locations, there was a minority who held discriminatory attitudes towards survivors. Radio was the predominant source of information in both locations, but those from Kambia were more likely to have received Ebola information from community sources (mosques/churches, community meetings or health workers) compared with those in Forecariah. These findings contextualize the utility of Ebola health messaging during the epidemic and suggest the importance of continued partnership with community leaders, including religious leaders, as a prominent part of future public health protection.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'. |
Exposure patterns driving Ebola transmission in West Africa: a retrospective observational study
Agua-Agum J , Ariyarajah A , Aylward B , Bawo L , Bilivogui P , Blake IM , Brennan RJ , Cawthorne A , Cleary E , Clement P , Conteh R , Cori A , Dafae F , Dahl B , Dangou JM , Diallo B , Donnelly CA , Dorigatti I , Dye C , Eckmanns T , Fallah M , Ferguson NM , Fiebig L , Fraser C , Garske T , Gonzalez L , Hamblion E , Hamid N , Hersey S , Hinsley W , Jambei A , Jombart T , Kargbo D , Keita S , Kinzer M , George FK , Godefroy B , Gutierrez G , Kannangarage N , Mills HL , Moller T , Meijers S , Mohamed Y , Morgan O , Nedjati-Gilani G , Newton E , Nouvellet P , Nyenswah T , Perea W , Perkins D , Riley S , Rodier G , Rondy M , Sagrado M , Savulescu C , Schafer IJ , Schumacher D , Seyler T , Shah A , Van Kerkhove MD , Wesseh CS , Yoti Z . PLoS Med 2016 13 (11) e1002170 BACKGROUND: The ongoing West African Ebola epidemic began in December 2013 in Guinea, probably from a single zoonotic introduction. As a result of ineffective initial control efforts, an Ebola outbreak of unprecedented scale emerged. As of 4 May 2015, it had resulted in more than 19,000 probable and confirmed Ebola cases, mainly in Guinea (3,529), Liberia (5,343), and Sierra Leone (10,746). Here, we present analyses of data collected during the outbreak identifying drivers of transmission and highlighting areas where control could be improved. METHODS AND FINDINGS: Over 19,000 confirmed and probable Ebola cases were reported in West Africa by 4 May 2015. Individuals with confirmed or probable Ebola ("cases") were asked if they had exposure to other potential Ebola cases ("potential source contacts") in a funeral or non-funeral context prior to becoming ill. We performed retrospective analyses of a case line-list, collated from national databases of case investigation forms that have been reported to WHO. These analyses were initially performed to assist WHO's response during the epidemic, and have been updated for publication. We analysed data from 3,529 cases in Guinea, 5,343 in Liberia, and 10,746 in Sierra Leone; exposures were reported by 33% of cases. The proportion of cases reporting a funeral exposure decreased over time. We found a positive correlation (r = 0.35, p < 0.001) between this proportion in a given district for a given month and the within-district transmission intensity, quantified by the estimated reproduction number (R). We also found a negative correlation (r = -0.37, p < 0.001) between R and the district proportion of hospitalised cases admitted within ≤4 days of symptom onset. These two proportions were not correlated, suggesting that reduced funeral attendance and faster hospitalisation independently influenced local transmission intensity. We were able to identify 14% of potential source contacts as cases in the case line-list. Linking cases to the contacts who potentially infected them provided information on the transmission network. This revealed a high degree of heterogeneity in inferred transmissions, with only 20% of cases accounting for at least 73% of new infections, a phenomenon often called super-spreading. Multivariable regression models allowed us to identify predictors of being named as a potential source contact. These were similar for funeral and non-funeral contacts: severe symptoms, death, non-hospitalisation, older age, and travelling prior to symptom onset. Non-funeral exposures were strongly peaked around the death of the contact. There was evidence that hospitalisation reduced but did not eliminate onward exposures. We found that Ebola treatment units were better than other health care facilities at preventing exposure from hospitalised and deceased individuals. The principal limitation of our analysis is limited data quality, with cases not being entered into the database, cases not reporting exposures, or data being entered incorrectly (especially dates, and possible misclassifications). CONCLUSIONS: Achieving elimination of Ebola is challenging, partly because of super-spreading. Safe funeral practices and fast hospitalisation contributed to the containment of this Ebola epidemic. Continued real-time data capture, reporting, and analysis are vital to track transmission patterns, inform resource deployment, and thus hasten and maintain elimination of the virus from the human population. |
CDC's response to the 2014-2016 Ebola epidemic - Guinea, Liberia, and Sierra Leone
Dahl BA , Kinzer MH , Raghunathan PL , Christie A , De Cock KM , Mahoney F , Bennett SD , Hersey S , Morgan OW . MMWR Suppl 2016 65 (3) 12-20 CDC's response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa was the largest in the agency's history and occurred in a geographic area where CDC had little operational presence. Approximately 1,450 CDC responders were deployed to Guinea, Liberia, and Sierra Leone since the start of the response in July 2014 to the end of the response at the end of March 2016, including 455 persons with repeat deployments. The responses undertaken in each country shared some similarities but also required unique strategies specific to individual country needs. The size and duration of the response challenged CDC in several ways, particularly with regard to staffing. The lessons learned from this epidemic will strengthen CDC's ability to respond to future public health emergencies. These lessons include the importance of ongoing partnerships with ministries of health in resource-limited countries and regions, a cadre of trained CDC staff who are ready to be deployed, and development of ongoing working relationships with U.S. government agencies and other multilateral and nongovernment organizations that deploy for international public health emergencies. CDC's establishment of a Global Rapid Response Team in June 2015 is anticipated to meet some of these challenges. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Ebola surveillance - Guinea, Liberia, and Sierra Leone
McNamara LA , Schafer IJ , Nolen LD , Gorina Y , Redd JT , Lo T , Ervin E , Henao O , Dahl BA , Morgan O , Hersey S , Knust B . MMWR Suppl 2016 65 (3) 35-43 Developing a surveillance system during a public health emergency is always challenging but is especially so in countries with limited public health infrastructure. Surveillance for Ebola virus disease (Ebola) in the West African countries heavily affected by Ebola (Guinea, Liberia, and Sierra Leone) faced numerous impediments, including insufficient numbers of trained staff, community reticence to report cases and contacts, limited information technology resources, limited telephone and Internet service, and overwhelming numbers of infected persons. Through the work of CDC and numerous partners, including the countries' ministries of health, the World Health Organization, and other government and nongovernment organizations, functional Ebola surveillance was established and maintained in these countries. CDC staff were heavily involved in implementing case-based surveillance systems, sustaining case surveillance and contact tracing, and interpreting surveillance data. In addition to helping the ministries of health and other partners understand and manage the epidemic, CDC's activities strengthened epidemiologic and data management capacity to improve routine surveillance in the countries affected, even after the Ebola epidemic ended, and enhanced local capacity to respond quickly to future public health emergencies. However, the many obstacles overcome during development of these Ebola surveillance systems highlight the need to have strong public health, surveillance, and information technology infrastructure in place before a public health emergency occurs. Intense, long-term focus on strengthening public health surveillance systems in developing countries, as described in the Global Health Security Agenda, is needed.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Public confidence in the health care system 1 year after the start of the Ebola virus disease outbreak - Sierra Leone, July 2015
Li W , Jalloh MF , Bunnell R , Aki-Sawyerr Y , Conteh L , Sengeh P , Redd JT , Hersey S , Morgan O , Jalloh MB , O'Leary A , Burdette E , Hageman K . MMWR Morb Mortal Wkly Rep 2016 65 (21) 538-42 Ensuring confidence in the health care system has been a challenge to Ebola virus disease (Ebola) response and recovery efforts in Sierra Leone (1). A national multistage cluster-sampled household survey to assess knowledge, attitudes, and practices (KAP) related to Sierra Leone's health care system was conducted in July 2015. Among 3,564 respondents, 93% were confident that a health care facility could treat suspected Ebola cases, and approximately 90% had confidence in the health system's ability to provide non-Ebola services, including immunizations, antenatal care, and maternity care. Respondents in districts with ongoing Ebola transmission ("active districts") and respondents with higher educational levels reported more confidence in the health care system than did respondents in nonactive districts and respondents with less education. Active districts were the focus of the Ebola response; these districts implemented intensified social mobilization and communication efforts, and established district response centers, Ebola-specific health care facilities, and ambulances. Greater infrastructure and response capacity might have resulted in higher confidence in the health care system in these areas. Respondents ranked Ebola and malaria as the country's most important health issues. Health system recovery efforts in Sierra Leone can build on existing public confidence in the health system. |
Notes from the Field: Development of a Contact Tracing System for Ebola Virus Disease - Kambia District, Sierra Leone, January-February 2015
Levine R , Ghiselli M , Conteh A , Turay B , Kemoh A , Sesay F , Kamara A , Gaeta A , Davis C , Hersey S . MMWR Morb Mortal Wkly Rep 2016 65 (15) 402 Kambia District is located in northwestern Sierra Leone along the international border with Guinea. The district is dominated by forest and swamp habitat and has a population of approximately 270,000 persons (approximately 5% of the nation's population) who live in rural villages and predominantly subsist on farming and trading. During 2014-2015, the remoteness of the area, a highly porous border with Guinea, and strong traditional beliefs about health care and sickness led to unique challenges in controlling the Ebola Virus Disease (Ebola) outbreak within the district. |
Ebola virus disease - Sierra Leone and Guinea, August 2015
Hersey S , Martel LD , Jambai A , Keita S , Yoti Z , Meyer E , Seeman S , Bennett S , Ratto J , Morgan O , Akyeampong MA , Sainvil S , Worrell MC , Fitter D , Arnold KE . MMWR Morb Mortal Wkly Rep 2015 64 (35) 981-4 The Ebola virus disease (Ebola) outbreak in West Africa began in late 2013 in Guinea (1) and spread unchecked during early 2014. By mid-2014, it had become the first Ebola epidemic ever documented. Transmission was occurring in multiple districts of Guinea, Liberia, and Sierra Leone, and for the first time, in capital cities (2). On August 8, 2014, the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern (3). Ministries of Health, with assistance from multinational collaborators, have reduced Ebola transmission, and the number of cases is now declining. While Liberia has not reported a case since July 12, 2015, transmission has continued in Guinea and Sierra Leone, although the numbers of cases reported are at the lowest point in a year. In August 2015, Guinea and Sierra Leone reported 10 and four confirmed cases, respectively, compared with a peak of 526 (Guinea) and 1,997 (Sierra Leone) in November 2014. This report details the current situation in Guinea and Sierra Leone, outlines strategies to interrupt transmission, and highlights the need to maintain public health response capacity and vigilance for new cases at this critical time to end the outbreak. |
Menthol cigarette use: the challenge to improve measurement and monitoring among adolescent smokers
Rock VJ , Davis SP , Thorne SL , Caraballo RS . Nicotine Tob Res 2011 14 (2) 251–252 This letter is in response to Dr. Polednak’s comments regarding our study entitled, “Menthol Cigarette Use Among Racial and Ethnic Groups in the United States, 2004–2008” (Rock, Davis, Thorne, Asman, & Caraballo, 2010). We appreciate Dr. Polednak’s interest in the article and his critical examination of the issue of misclassification and potential underreporting of menthol cigarette use in the U.S. population, particularly among African American youth. Specifically, Dr. Polednak highlights discrepancies in self-reported menthol cigarette use and self-reported cigarette brand smoked (i.e., menthol/non-menthol) at the time of data collection. This issue has been discussed and examined in published scientific literature (Giovino et al., 2004; Hersey, Nonnemaker, & Homsi, 2010; Hyland, Garten, Giovino, & Cummings, 2002) and in unpublished scientific presentations and reports submitted to the Food and Drug Administration Tobacco Products Scientific Advisory Committee (FDA TPSAC) (FDA TPSAC, 2011). The scientific evidence indeed suggests that self-reports of type or brand of cigarette smoked are subject to bias. This may be especially true for menthol cigarette use among adolescents who are first trying or experimenting with smoking and among those who do not normally purchase their own cigarettes. That is why our study addressed the need to improve accurate monitoring of menthol cigarette smoking among youth and adults in order to improve the validity of self-reports. |
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