Sustainable Laboratory Capacity Building After the 2014 Ebola Outbreak in the Republic of Guinea

Assessing barriers and opportunities for the improvement of laboratory performance and robust surveillance of antimicrobial resistance in Nigeria- a quantitative study

BACKGROUND

Good quality data is essential in optimising containment strategies for antimicrobial resistance, a global public health threat estimated to cause around 10 million deaths yearly and up-to 5% loss in GDP by 2050 if left unaddressed. The laboratory system plays an important role in the collection of high-quality data as well as ensuring validity, reliability and timeliness of data. However, in many low-medium income countries including Nigeria, the technical capacity of the laboratory for fulfilling these responsibilities is unknown. This paucity of information limits piloting of strategies to complement existing surveillance and planning improvement of subsequent laboratory iterations into the surveillance system. The focus of this study was to assess the gaps, vulnerabilities and enablers of laboratory strengthening processes in the scope of technical capacity for clinical and public health functions and to provide a roadmap for improved surveillance of antimicrobial resistance in Nigeria.

METHODS

A cross-sectional study design utilising structured questionnaire administered online via Qualtrics and reported in accordance with strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data analysis involved descriptive and inferential statistics as well as bivariate and multivariate logistics to test predictive analysis of relationship between variables.

RESULTS

A total of 302 laboratories completed the questionnaire, 107 (53.4%) government laboratories and 195 (64.6%) private sector laboratories. 18.2% reported excellent knowledge, 25.5% has excellent capacity, 7.3% are fully ready for surveillance, 12.3% are participating in some surveillance, and 1.0% record important microbiological data that correlates with epidemiological information.

CONCLUSION

Tertiary laboratories reported highest performance across all surveillance quality indicators (SQIs). AMR surveillance is skewed toward government and tertiary laboratories, leaving lower-level and rural facilities underutilized despite their potential. This results in missing community-level data and undermines the representativeness of surveillance. The study identifies gaps in recruitment, assessment, and oversight but also offers strategies to address these issues.

Laboratory capacity-building during COVID-19 in Somalia: improving access to essential diagnostics for national health security in a fragile setting

INTRODUCTION

Even before the COVID-19 pandemic, Somalia's national laboratory services had insufficient diagnostic capacities. We describe how the country moved rapidly from no testing capability to molecular testing and genomic sequencing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other pathogens.

METHODS

We reviewed primary sources information as well as data and records from secondary sources from 1 January 2020 to 31 December 2023. We also analyzed laboratory surveillance data of cases of COVID-19 and other epidemic diseases reported during the same period and the number of laboratory tests performed during the same period. We used this information to demonstrate improvements in laboratory diagnostic capacity in Somalia before, during and after the COVID-19 pandemic.

RESULTS

The country was able to rapidly scale up testing for SARS-CoV-2 using reverse-transcriptase polymerase chain reaction assays. At the same time, other innovative solutions were used for testing, such as repurposing tuberculosis GeneXpert diagnostic platforms to increase access to testing at points-of-care and introducing antigen rapid diagnostic tests for hard-to-reach communities. Somalia also acquired new generation sequencing capability for detection and characterization of circulating SARS-CoV-2. These laboratory and testing enhancements have enabled Somalia to participate in surveillance for priority diseases and detection of outbreaks caused by emerging pathogens.

CONCLUSION

Somalia's strategic approach to COVID-19 is an inspiring example of resilience and adaptability. Utilizing resources, technology and lessons from COVID-19 enabled the country to increase and improve laboratory services, expand testing capacity, and strengthen workforce capability. As such, Somalia can now better respond to other infectious disease threats and has significantly improved national health security.

How has Guinea learnt from the response to outbreaks? A learning health system analysis

INTRODUCTION

Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021.

METHODS

We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022.

RESULTS

The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system.

CONCLUSION

Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.

Epidemiological Trends of Coronavirus Disease 2019 in Sierra Leone From March 2020 to October 2021

Coronavirus disease 2019 (COVID-19), a serious public health challenge the world over, has led to significant health concerns in Sierra Leone. In the present study, epidemic indices, such as the number of cases, positivity rate, reproduction rate (R0), case fatality rate (CFR), age, and sex, were used to characterize the epidemiological trends of COVID-19. As of October 31, 2021, a total of 6,398 cases and 121 related deaths had been confirmed. The total number of COVID-19 reverse transcription polymerase chain reaction (RT-PCR) tests conducted to October 31, 2021, was 249,534, and the average positivity rate was 2.56%. Three waves of COVID-19 were recorded, occurring during weeks 15–46 in 2020 (2,369 cases), week 47 in 2020 to week 16 in 2021 (1,665 cases), and weeks 17–43 in 2021 (2,364 cases), respectively. Remarkably, there was no increase in the numbers of confirmed COVID-19 cases despite rising test numbers throughout the three waves. Moreover, three high R0 values were observed before each wave. The number of positive cases significantly correlated with positive numbers of international arrivals (P < 0.01), deaths (P < 0.01), and the positivity rate of tested samples (P < 0.01). Moreover, all of the deaths occurred during the peak of the three waves. Our results indicate that there was a low level of COVID-19 epidemic in Sierra Leone and that COVID-19's introduction led to local transmission. It is vital to fight against the spread of SARS-CoV-2 from the source of origin by strengthening testing and management of people entering the country. Our findings will provide important clues for expanding sample screening and will contribute to the reasonable allocation of medical resources.

Pacing Forward in the Face of Fragility: Lessons From African Institutions and Governments' Response to Public Health Emergencies

Africa is home to 54 United Nation member states, each possessing a wealth of ethno-cultural, physiographic, and economic diversity. While Africa is credited as having the youngest population in the world, it also exhibits a unique set of “unfortunate realties” ranging from famine and poverty to volatile politics, conflicts, and diseases. These unfortunate realities all converge around social inequalities in health, that are compounded by fragile healthcare systems and a lack of political will by the continent's leaders to improve smart investment and infrastructure planning for the benefit of its people. Noteworthy are the disparities in responsive approaches to crises and emergencies that exist across African governments and institutions. In this context, the present article draws attention to 3 distinct public health emergencies (PHEs) that have occurred in Africa since 2010. We focus on the 2013–2016 Ebola outbreak in Western Africa, the ongoing COVID-19 pandemic which continues to spread throughout the continent, and the destructive locust swarms that ravaged crops across East Africa in 2020. Our aim is to provide an integrated perspective on how governments and institutions handled these PHEs and how scientific and technological innovation, along with educational response played a role in the decision-making process. We conclude by touching on public health policies and strategies to address the development of sustainable health care systems with the potential to improve the health and well-being of the African people.