Ebola Outbreak Containment: Real-Time Task and Resource Coordination With SORMAS

Background: Since the beginning of the Ebola outbreak in West Africa in 2014, more than 11,000 people died. For outbreaks of infectious diseases like this, the rapid implementation of control measures is a crucial factor for containment. In West African countries, outbreak surveillance is a paper-based process with significant delays in forwarding outbreak information, which affects the ability to react adequately to situational changes. Our objective therefore was to develop a tool that improves data collection, situation assessment, and coordination of response measures in outbreak surveillance processes for a better containment. Methods: We have developed the Surveillance and Outbreak Response Management System (SORMAS) based on findings from Nigeria's 2014 Ebola outbreak. We conducted a thorough requirements engineering and defined personas and processes. We also defined a data schema with specific variables to measure in outbreak situations. We designed our system to be a cloud application that consists of interfaces for both mobile devices and desktop computers to support all stakeholders in the process. In the field, health workers collect data on the outbreak situation via mobile applications and directly transmit it to control centers. At the control centers, health workers access SORMAS via desktop computers, receive instant updates on critical situations, react immediately on emergencies, and coordinate the implementation of control measures with SORMAS. Results: We have tested SORMAS in multiple workshops and a field study in July 2015. Results from workshops confirmed derived requirements and implemented features, but also led to further iterations on the systems regarding usability. Results from the field study are currently under assessment. General feedback showed high enthusiasm about the system and stressed its benefits for an effective outbreak containment of infectious diseases. Conclusions: SORMAS is a software tool to support health workers in efficiently handling outbreak situations of infectious diseases, such as Ebola. Our tool enables a bi-directional exchange of situational data between individual stakeholders in outbreak containment. This allows instant and seamless collection of data from the field and its instantaneous analysis in operational centers. By that, SORMAS accelerates the implementation of control measures, which is crucial for a successful outbreak containment.Peer Reviewe

Cervical Cancer Knowledge,Screening Service Utilization and Predictors of Precancerous Cervical Changes: A Population Based Survey of Sexually Active Women in Lagos, South Western Nigeria

Cervical cancer is a significant cause of morbidity and mortality among women in developing countries. This study set out to determine the knowledge of cervical cancer, utilization of cervical cancer screening services  and predictors of precancerous cervical changes among sexually active women in Lagos, Nigeria. The study was cross sectional in design. A multistage sampling technique was used to select 332 women.Questionnaire was used to collect data. In addition, Visual Inspection with Acetic Acid (VIA) and Visual Inspection with Lugol's Iodine (VILI) of the cervix. Data were summarized and tests for association were done. The mean age of respondents' mean age was 39.0 years +_ 10. Only (135) 41.9% of respondents were aware of cervical cancer. Eleven respondents (3.3%) had ever had a cervical cancer screening done. On logistic regression,multiple sexual partnering and early coitache predicted having precancerous cervical changes. There was poor knowledge and low utilization of cervical cancer screening services

Cervical Cancer Knowledge,Screening Service Utilization and Predictors of Precancerous Cervical Changes: A Population Based Survey of Sexually Active Women in Lagos, South Western Nigeria

Cervical cancer is a significant cause of morbidity and mortality among women in developing countries. This study set out to determine the knowledge of cervical cancer, utilization of cervical cancer screening services  and predictors of precancerous cervical changes among sexually active women in Lagos, Nigeria. The study was cross sectional in design. A multistage sampling technique was used to select 332 women.Questionnaire was used to collect data. In addition, Visual Inspection with Acetic Acid (VIA) and Visual Inspection with Lugol's Iodine (VILI) of the cervix. Data were summarized and tests for association were done. The mean age of respondents' mean age was 39.0 years +_ 10. Only (135) 41.9% of respondents were aware of cervical cancer. Eleven respondents (3.3%) had ever had a cervical cancer screening done. On logistic regression,multiple sexual partnering and early coitache predicted having precancerous cervical changes. There was poor knowledge and low utilization of cervical cancer screening services

Case Based Surveillance for Measles in Lagos, South Western Nigeria, September 2011

OBJECTIVE: The objective of this study was to describe the performance of the measles surveillance in Lagos, characterize the epidemiologic pattern of measles infection and determine the measles vaccine efficacy. INTRODUCTION: Measles is a vaccine preventable disease that has been successfully eliminated in some parts of the world. It causes high morbidity and mortality with the potential of large outbreaks. About a third of reported measles cases involve one or more complications including diarrhea, pneumonia, otitis media, blindness, post infections encephalitis and subacute sclerosing panencephalitis. It is however, one of the leading causes of childhood morbidity and mortality in Nigeria despite availability of safe and effective vaccines METHODS: We obtained the measles surveillance data for all the 20 Local Governments Areas (LGAs) in Lagos and reviewed all the measles case based investigation forms between the period 1st January to 31st December 2010.The WHO Recommended Surveillance Standards for Measles was used. Data was analyzed using EPI INFO version 3.5.3. RESULTS: Of the 615 suspected measles cases, 63(10.2%) were laboratory confirmed (measles IGM+) and 3(0.5%) clinically confirmed. Cases investigated within 48 hours was 222 (36%) (target ≥ 80%), 510 (83%) had adequate blood sample collected (target ≥ 80%) and 595 (97%) of sample results were received from the lab within 7 days (target ≥ 80%). The surveillance system sensitivity was 6.5/100,000 (target >2/100,000) with a predictive value positive of 10.73%. The overall attack rate was 0.73/100,000 population with 1 mortality (case fatality rate 1.5%). The Under 1 year attack rate (8.33/100,000) was higher than the 1– 4 years attack rate (3.48/100,000) (p= 0.01). Those vaccinated with at least 1 dose of measles vaccine had a 3 times lower risk of measles infection than the unvaccinated. The proportion of unvaccinated cases was 36%. The measles vaccine efficacy was 60%. CONCLUSIONS: The quality of surveillance need to be strengthened by improving the time lapse between notification and investigation of suspected cases. Measles is still a significant cause of morbidity particularly among the under 1 year age group.The proportion of unvaccinated cases is also high, suggesting a low vaccine coverage among susceptibles. Prompt investigation of cases, good vaccine coverage and high vaccine efficacy are all vital in eliminating measles from Nigeria. [Table: see text] [Figure: see text] [Figure: see text

Case Based Surveillance for Measles in Lagos, South Western Nigeria, September 2011

Measles is a significant cause of childhood morbidity and mortality in Nigeria. We described the epidemiologic pattern of measles infection and the performance of the surveillance. The measles surveillance data for Lagos between 1st January and 31st December was reviewed. A total of 615 suspected measles cases were seen. Cases investigated within 48 hours was 222 (36%) (target % less than 80%). Under 1year attack rate (8.33/100,000) was higher than 1- 4 years attack rate (3.48/100,000) (p= 0.01). Proportion of unvaccinated cases was 36%. The surveillance needs to be strengthened. Proportion of unvaccinated cases is high suggesting low vaccine coverage among susceptible

Open heart surgery in Ilorin: case report and experience with the first two cases

Open heart surgery is uncommonly done in Nigeria and restricted to few centres despite the burden of congenital heart disease. We present our first experience with open heart surgery at the University of Ilorin Teaching Hospital. A 15 years old female adolescent presented with a 2 years history of easy fatigability, dyspnoea on exertion and chest pain. Echocardiography revealed a large ostium secundum atrial septal defect. She had patch closure of the atrial septal defect. The second case was a 7 years old female child with stunted growth. Echocardiography confirmed an ostium secundum atrial septal defect and severe pulmonary valvular stenosis. She had patch closure of the atrial septal defect and pulmonary valvulotomy. Both patients are being followed up and doing well.The hospital has achieved a major milestone by performing its first open heart surgeries. A coordinated team approach yields good results in the development of capacity and facilities for performing open heart surgery in Nigeria.Keywords: Heart disease, congenital; surgery, open heart; Ilori

The Epidemiologic Charateristics, Healthcare Associated and Household Transmission Dynamics of EVD Outbreak in a South-Southern City of Nigeria

On July 23, 2014, the EVD outbreak was declared in Nigeria following the confirmation of EVD in a traveller, who arrived acutely ill at the international airport in Lagos, South Western Nigeria from Liberia .The outbreak subsequently filtered to a south southern Nigeria city, by a symptomatic contact who escaped surveillance in Lagos and flew to the city, generating 527 contacts, 4 cases and 2 deaths. The cases were household and hospital contacts. Active surveillance should be promptly enforced at domestic airports and inter-state borders as soon as an outbreak is declared to contain its spread locall

The Epidemiologic Charateristics, Healthcare Associated and Household Transmission Dynamics of EVD Outbreak in a South-Southern City of Nigeria

On July 23, 2014, the EVD outbreak was declared in Nigeria following the confirmation of EVD in a traveller, who arrived acutely ill at the international airport in Lagos, South Western Nigeria from Liberia .The outbreak subsequently filtered to a south southern Nigeria city, by a symptomatic contact who escaped surveillance in Lagos and flew to the city, generating 527 contacts, 4 cases and 2 deaths. The cases were household and hospital contacts. Active surveillance should be promptly enforced at domestic airports and inter-state borders as soon as an outbreak is declared to contain its spread locall

User Evaluation Indicates High Quality of the Surveillance Outbreak Response Management and Analysis System (SORMAS) After Field Deployment in Nigeria in 2015 and 2018

During the West African Ebola virus disease outbreak in 2014–15, health agencies had severe challenges with case notification and contact tracing. To overcome these, we developed the Surveillance, Outbreak Response Management and Analysis System (SORMAS). The objective of this study was to measure perceived quality of SORMAS and its change over time. We ran a 4-week-pilot and 8-week-implementation of SORMAS among hospital informants in Kano state, Nigeria in 2015 and 2018 respectively. We carried out surveys after the pilot and implementation asking about usefulness and acceptability. We calculated the proportions of users per answer together with their 95% confidence intervals (CI) and compared whether the 2015 response distributions differed from those from 2018. Total of 31 and 74 hospital informants participated in the survey in 2015 and 2018, respectively. In 2018, 94% (CI: 89–100%) of users indicated that the tool was useful, 92% (CI: 86–98%) would recommend SORMAS to colleagues and 18% (CI: 10–28%) had login difficulties. In 2015, the proportions were 74% (CI: 59–90%), 90% (CI: 80–100%), and 87% (CI: 75–99%) respectively. Results indicate high usefulness and acceptability of SORMAS. We recommend mHealth tools to be evaluated to allow repeated measurements and comparisons between different versions and users.Peer Reviewe