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Sample Transport Optimization: Mali Pilot Study | Health Security.

[Open Access] [Published Online:31 Jan 2020]

Abstract.

In Mali, qualified laboratories for testing of dangerous pathogens are centralized in Bamako. Creating a specimen transport system respecting timeline, specimen quality, biosafety, and biosecurity standards is a challenge. The current ad hoc system that relies on untrained public transport companies carries risks of spoilage, accidental release of pathogens, and delays, which compromise specimen quality. This pilot study aimed to evaluate the effectiveness (ie, timeline, quality of specimen, and cost) of using the trained postal service for sample transportation from district to central level, compared with the current system. The postal service intervention ran from mid-2016 to mid-2017 and covered 3 districts. Data were collected in the same districts during the same period of the preceding year for comparison. In all, 41 specimens were shipped using public transportation and 51 were shipped using the postal service. These included suspected meningitis, measles, yellow fever, and polio samples. Only 46% of samples sent by public transportation were received in Bamako within 72 hours of collection, compared to 71% of samples shipped via the postal service (p < .05). Further, 93% of samples shipped by public transportation arrived in good condition at the receiving laboratory, compared to 98% by postal service. Although cost comparisons were difficult (flat fee vs per-specimen fare), the average cost per specimen was 8 times higher with the postal service. Shipment of specimens from districts to central level using the postal service was feasible and appeared to be faster than public transportation, thus allowing specimen quality to be preserved. Further analysis regarding the most efficient costing mechanism is needed.

The West Africa Ebola epidemic of 2014-15 revealed serious gaps in national capacities, from laboratories to surveillance to rapid response. In Liberia, poor infrastructure in isolated Ebola-affected communities led to serious delays in sending specimens, with no plan in place to surmount these challenges during an epidemic.1 It is difficult to quantify the extent to which suboptimal specimen transport systems contributed to degraded, damaged, lost, or delayed specimens arriving at testing facilities during the epidemic, due to multiple simultaneous health system weaknesses; nevertheless, it is a documented fact.2 Specimen transport systems are an under-recognized component of a country's laboratory capacity; inefficient specimen transport systems lead to long turnaround time and higher likelihood of loss or breakage in transit, which could be critical during a disease outbreak.3 This contributes to the widespread problem of delays in laboratory results in sub-Saharan Africa.4

The specimen transport system was integrated as a core component of laboratory capacity under the Global Health Security Agenda (GHSA), which assists countries in preventing, detecting, and responding to disease threats. As recommended by the Joint External Evaluation (JEE) tools of the International Health Regulations (IHR, 2005), minimum standards for specimen timeliness, tracking, training, and quality assurance should be consistently met across an increasing percentage of districts to increase a country's capacity score.5 One way to achieve this is to leverage existing logistical systems to improve standardization and efficiency.6 Public-private partnerships with private or parastatal logistical firms (such as many national postal companies) for specimen transport showed feasibility and positive effects on turnaround time in Ethiopia.7 However, literature on specimen transport systems in sub-Saharan Africa is sparse.

Mali's work on the specimen transport system began with initiation of GHSA activities in 2015. Until 2016, there was no official policy on transport of samples of epidemic-prone diseases. An ad hoc system was put into place in which public transport companies are reimbursed per specimen, based on distance between health districts and Bamako. All samples are brought to the National Health Directorate (DNS) in Bamako and then sent onward to the appropriate national reference laboratories or outside of Mali to World Health Organization (WHO) regional laboratories. The district-to-central level transport often involves poor conditions; samples may be transported along with other nonbiological items without sufficient isolation, on unpaved roads, leaving them vulnerable to breakage. Samples are handled by employees untrained to manage biohazard material. And buses very often face breakdowns and delays, increasing transit time.

Weaknesses inherent in this system were identified in an analysis of the specimen transport system carried out by the African Society for Laboratory Medicine (ASLM) in 2015.8 The analysis concluded that the specimen transport system had significant inefficiencies and was fragmented by disease (ie, donors fund shipment of TB samples or HIV samples, rather than taking a more integrated approach). To this challenge is added the lack of consistent, reliable inter-level coordination and questions around the sustainability of financial support for this donor-dependent system.

Following recognized best practices for improving specimen transport systems,9 the analysis recommended selecting and testing alternatives for district-to-central transport, including considering La Poste, a national parastatal postal company with wide operational presence down to district level. Following consultations with government partners, this recommendation was judged feasible; partnership with postal services has been shown to work well in similar settings.8

Catholic Relief Services/Mali, through its CDC-funded Djomi/GHSA laboratory strengthening project, developed a pilot to assess real-world feasibility of this approach. This article reports on the results of the intervention in terms of transit time, specimen quality, and cost. We also reflect on lessons learned and implications for programs aiming to strengthen specimen transport systems in similar resource-constrained settings.


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Pakistan: CM expresses displeasure over detection of polio cases in DG Khan | Pakistan Observer.

[February 2, 2020]

Punjab Chief Minister Sardar Usman Buzdar has taken notice of surfacing of two polio cases in DG Khan reported in news item and expressed displeasure over the performance of the administration and concerned departments. He also sought a report from the Health Department and administration in this regard.

He said that resurgence of polio cases in DG Khan is worrisome matter.

He said that protecting the future of our nation from polio is our collective responsibility. Strong liaison is utmost necessary for the concerned departments and organizations to give results and they have to work wholeheartedly for safeguarding children from polio.


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Pakistan: Two more children crippled by the poliovirus in Sindh | The News International.

[February 2, 2020] M. Waqar Bhatti writes:

KARACHI: The Polio Eradication Initiative officials in Pakistan have confirmed two more polio cases in Sindh, saying two more boys, from the Jaccobabad and Mirpurkhas districts were crippled by the Wild Polio Virus 1 (WPV1) mounting the countrywide total of children crippled by the feared life-crippling disease to 144 across the country and 30 in cases of Sindh.

“Two more children, one each from districts Jaccobabad and Mirpurkhas have been crippled by Wild Polio Virus 1 (WPV1). These are the cases of 2019 as their date of onset was in December last year. This takes the total tally of Sindh to 30 and Pakistan to 144 for the year 2019, an official of the Emergency Operation Center (EOC) Sindh for Polio said on Saturday.

The official said in Jaccobabad, a 4-year-old male child was affected by polio and showed weakness in the right lower limb. The date of onset was 19-12-2019. According to parents the child had received 7 doses of OPV and an investigation is ongoing. Similarly in Mirpurkhas, a 4-year-old male child was affected by the poliovirus and reported weakness in the right upper and lower limb and the neck muscles. His parents also claimed that he had received OPV on multiple occasions and the investigations are underway.

The National EOC and Sindh EOC have restarted their campaign against polio eradication which would hopefully reverse the scary trend.

The first vaccination was successfully completed in Dec NID followed by a case response in January and another campaign will be conducted from February. The vaccinations during Dec - April are likely to decrease the intensity of virus transmission in the second half of 2020. The National and Sindh EOCs have asked the parents to ensure the immunization of their children both during the routine and special campaigns during the next few months.


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Philippines: Polio vaccination must intensify until the last child is reached and fully protected | World Health Organization, UN Children's Fund via ReliefWeb.

[01 Feb 2020]

[Published on 30 Jan 2020 —View Original]

© UNICEF Philippines/2019/Jeoffrey Maitem

A child receives dose of oral polio vaccine from a UNICEF staff member at the launch of the Department of Health's Synchronized Polio Vaccination Campaign in Marawi City in Southern Philippines.

© UNICEF Philippines/2019/Jeoffrey Maitem

January campaign rounds aim to vaccinate ALL children under-5 in Mindanao and in NCR.

MANILA, 30 January 2020—Since the re-emergence of polio in the Philippines was announced by the Department of Health (DOH) in September 2019, the synchronized polio vaccination campaigns rolled out from November to December of 2019 in targeted regions, have reached a total of 1,404,517 (exceeding target) children below 5 years old in the National Capital Region (NCR) and 2,937,327 (95%) children in Mindanao.

The call to vaccinate further intensifies with four new confirmed cases recorded in January, bringing up the total cases to 16 across the country. All new cases are children below 5-years of age. They are from Maguindanao and Sultan Kudarat in Mindanao as well as the first recorded case in NCR, in Quezon City.

“Enhanced surveillance has enabled us to identify new cases; we must not leave any unvaccinated child behind. We would like to congratulate the Department of Health, local government leaders and the health workers in Mindanao, including BARMM and NCR on their efforts for reaching 95% or more of the targeted children during the previous rounds. We must continue this momentum and continue to work together to stop polio transmission in the Philippines,” said WHO Representative in the Philippines Dr Rabindra Abeyasinghe. “Let’s not be complacent – we know that polio is a serious disease, but we also know that it can be prevented with a safe and effective vaccine.”

“Despite the promising coverage, the circulating poliovirus still pose tremendous risk to children, until one child remains infected and not fully vaccinated. This is evidenced by the recent increase in confirmed cases,” said UNICEF Philippines Representative Oyun Dendevnorov. “UNICEF is working in collaboration with DOH, WHO and other partners, to boost up vaccination coverage. We must continue to strive together to reach all target population in the upcoming rounds of immunization. Polio has no cure; complete vaccination offers the only chance to protect our children and to eliminate polio from the Philippines once again.”

UNICEF and WHO have been supporting DOH and the Ministry of Health of the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) in its Sabayang Patak Kontra Polio vaccination campaigns and monitoring of the polio outbreak. Both organizations are long-standing partners of the Philippine Government in working towards routine immunization for all children in the country.

Parents and guardians are urged to have all children under five years vaccinated in the ongoing rounds of Sabayang Patak Kontra Polio from 20 January to 2 February in all regions of Mindanao, and 27 January to 7 February in NCR.

The transmission of polio, spread through faecal-oral route, can only be stopped if the immunisation coverage reaches over 95% of the targeted children. The risk cannot be mitigated as long as some children are not vaccinated regularly and especially during an outbreak.

Media Contacts

Faizza Tanggol
Communications Officer
WHO Philippines
Tel: +63 998 573 1357
Email: tanggolf@who.int

Zafrin Chowdhury
Chief of Communication
UNICEF Philippines
Tel: +63 917 867 8366
Email: zchowdhury@unicef.org

Dan Ramirez
Communication Officer
UNICEF Philippines
Tel: +63 917 5987740
Email: dramirez@unicef.org


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