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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

BACKGROUND: The 2014 outbreak of Ebola virus disease (EVD) in West Africa was the largest ever recorded. Starting in September 2014, International Medical Corps (IMC) managed 5 Ebola treatment units (ETUs) in Liberia and Sierra Leone, which cumulatively cared for about 2,500 patients. We conducted a...

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Autores principales: Roshania, Reshma, Mallow, Michaela, Dunbar, Nelson, Mansary, David, Shetty, Pranav, Lyon, Taralyn, Pham, Kacey, Abad, Matthew, Shedd, Erin, Tran, Anh-Minh A, Cundy, Sarah, Levine, Adam C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Global Health: Science and Practice 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042696/
https://www.ncbi.nlm.nih.gov/pubmed/27688716
http://dx.doi.org/10.9745/GHSP-D-16-00186
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author Roshania, Reshma
Mallow, Michaela
Dunbar, Nelson
Mansary, David
Shetty, Pranav
Lyon, Taralyn
Pham, Kacey
Abad, Matthew
Shedd, Erin
Tran, Anh-Minh A
Cundy, Sarah
Levine, Adam C
author_facet Roshania, Reshma
Mallow, Michaela
Dunbar, Nelson
Mansary, David
Shetty, Pranav
Lyon, Taralyn
Pham, Kacey
Abad, Matthew
Shedd, Erin
Tran, Anh-Minh A
Cundy, Sarah
Levine, Adam C
author_sort Roshania, Reshma
collection PubMed
description BACKGROUND: The 2014 outbreak of Ebola virus disease (EVD) in West Africa was the largest ever recorded. Starting in September 2014, International Medical Corps (IMC) managed 5 Ebola treatment units (ETUs) in Liberia and Sierra Leone, which cumulatively cared for about 2,500 patients. We conducted a retrospective cohort study of patient data collected at the 5 ETUs over 1 year of operations. METHODS: To collect clinical and epidemiological data from the patient care areas, each chart was either manually copied across the fence between the high-risk zone and low-risk zone, imaged across the fence, or imaged in the high-risk zone. Each ETU’s data were entered into a separate electronic database, and these were later combined into a single relational database. Lot quality assurance sampling was used to ensure data quality, with reentry of data with high error rates from imaged records. RESULTS: The IMC database contains records on 2,768 patient presentations, including 2,351 patient admissions with full follow-up data. Of the patients admitted, 470 (20.0%) tested positive for EVD, with an overall case fatality ratio (CFR) of 57.0% for EVD-positive patients and 8.1% for EVD-negative patients. Although more men were admitted than women (53.4% vs. 46.6%), a larger proportion of women were diagnosed EVD positive (25.6% vs. 15.2%). Diarrhea, red eyes, contact with an ill person, and funeral attendance were significantly more common in patients with EVD than in those with other diagnoses. Among EVD-positive patients, age was a significant predictor of mortality: the highest CFRs were among children under 5 (89.1%) and adults over 55 (71.4%). DISCUSSION: While several prior reports have documented the experiences of individual ETUs, this study is the first to present data from multiple ETUs across 2 countries run by the same organization with similar clinical protocols. Our experience demonstrates that even in austere settings under difficult conditions, it is possible for humanitarian organizations to collect high-quality clinical and epidemiologic data during a major infectious disease outbreak.
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spelling pubmed-50426962016-10-06 Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned Roshania, Reshma Mallow, Michaela Dunbar, Nelson Mansary, David Shetty, Pranav Lyon, Taralyn Pham, Kacey Abad, Matthew Shedd, Erin Tran, Anh-Minh A Cundy, Sarah Levine, Adam C Glob Health Sci Pract Original Article BACKGROUND: The 2014 outbreak of Ebola virus disease (EVD) in West Africa was the largest ever recorded. Starting in September 2014, International Medical Corps (IMC) managed 5 Ebola treatment units (ETUs) in Liberia and Sierra Leone, which cumulatively cared for about 2,500 patients. We conducted a retrospective cohort study of patient data collected at the 5 ETUs over 1 year of operations. METHODS: To collect clinical and epidemiological data from the patient care areas, each chart was either manually copied across the fence between the high-risk zone and low-risk zone, imaged across the fence, or imaged in the high-risk zone. Each ETU’s data were entered into a separate electronic database, and these were later combined into a single relational database. Lot quality assurance sampling was used to ensure data quality, with reentry of data with high error rates from imaged records. RESULTS: The IMC database contains records on 2,768 patient presentations, including 2,351 patient admissions with full follow-up data. Of the patients admitted, 470 (20.0%) tested positive for EVD, with an overall case fatality ratio (CFR) of 57.0% for EVD-positive patients and 8.1% for EVD-negative patients. Although more men were admitted than women (53.4% vs. 46.6%), a larger proportion of women were diagnosed EVD positive (25.6% vs. 15.2%). Diarrhea, red eyes, contact with an ill person, and funeral attendance were significantly more common in patients with EVD than in those with other diagnoses. Among EVD-positive patients, age was a significant predictor of mortality: the highest CFRs were among children under 5 (89.1%) and adults over 55 (71.4%). DISCUSSION: While several prior reports have documented the experiences of individual ETUs, this study is the first to present data from multiple ETUs across 2 countries run by the same organization with similar clinical protocols. Our experience demonstrates that even in austere settings under difficult conditions, it is possible for humanitarian organizations to collect high-quality clinical and epidemiologic data during a major infectious disease outbreak. Global Health: Science and Practice 2016-09-28 /pmc/articles/PMC5042696/ /pubmed/27688716 http://dx.doi.org/10.9745/GHSP-D-16-00186 Text en © Roshania et al. http://creativecommons.org/licenses/by/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-16-00186.
spellingShingle Original Article
Roshania, Reshma
Mallow, Michaela
Dunbar, Nelson
Mansary, David
Shetty, Pranav
Lyon, Taralyn
Pham, Kacey
Abad, Matthew
Shedd, Erin
Tran, Anh-Minh A
Cundy, Sarah
Levine, Adam C
Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
title Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
title_full Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
title_fullStr Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
title_full_unstemmed Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
title_short Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned
title_sort successful implementation of a multicountry clinical surveillance and data collection system for ebola virus disease in west africa: findings and lessons learned
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042696/
https://www.ncbi.nlm.nih.gov/pubmed/27688716
http://dx.doi.org/10.9745/GHSP-D-16-00186
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