By Uche Ajene and Sahr Ngaujah
eHealth Africa (eHA) and Statistics Sierra Leone are implementing the Hep B Community-based Serosurvey project funded by U.S. Centers for Disease Prevention and Control (CDC). Technical leadership for the survey is being provided by CDC and Dr. Dennis Marke, Program Manager for the Government of Sierra Leone’s Child Health Program. The purpose of the survey is to
assess the impact of the current childhood Hepatitis B immunization program in Sierra Leone on the prevalence of chronic hepatitis B infections among children
evaluate the need for the Hepatitis B- birth dose in Sierra Leone by determining the burden of chronic hepatitis B virus among mother/child pairs.
In preparation for the survey eHA supported the training of phlebotomists and surveyors for data and sample collection in the field.
Practical session on processing and tracking of venous blood specimen
Strong human resource capacity is crucial to manage a household survey that consists of a detailed questionnaire and a rapid diagnostic test administered to the participant in their home. eHA and CDC trained a team of 50 people (13 surveyors, 13 team supervisors and 3 district coordinators and 20 phlebotomists) from Statistics Sierra Leone and the Ministry of Health and Sanitation. The training took place at Sierra Leone’s Public Health National Emergency Operations Center (EOC) in Freetown, from 20th - 25th August 2018.
The 5-day training consisted of 3 full classroom days and a 2 days of field work. The following topics were covered:
Overview and relevance of the Hepatitis B Serosurvey
Household identification procedure for enrollment
Counseling families about Hepatitis B results
Conducting Hepatitis B rapid diagnostic test
Processing and tracking of venous blood specimens
“I have never worked in a survey field. However, this training did not only add to my knowledge about Hepatitis B, it also gave me the opportunity to go out in the field during the training and conduct a phlebotomy exercise on participants.”
Key beneficiaries of the project are Sierra Leone’s Expanded Programme on Immunization (EPI), Sierra Leone’s Ministry of Health and Sanitation (MOHS), mothers and children in Sierra Leone and the wider public. Participants testified to the value of the training to facilitate learning valuable information needed for effectively administering the questionnaire and conducting rapid diagnostic tests in the field.
Practical sessions with phlebotomists on the use of the mobile refrigerator to store blood samples
“The training was intense. However, I was able to master the purpose of the survey, became conversant with the questions and how to determine the eligibility of participants.”
eHA provided the phones and internet data for the survey and installed the open data kit (ODK) app (which is used for data collection in the field), the age= app for age calculation, and the ODK dashboard. eHA’s provision of the android phones for the survey discourages potentials errors via paper-based methods by presenting an automated approach to health data collection. With ODK, data collection will be done easily and survey activities monitored in near real time.
Next Steps
The Western Area Urban, Bo and Bombali districts have been identified as target areas for the survey. After this training, eHA, CDC, Statistics Sierra Leone and the MOHS (including those trained) will Implement the serosurvey through June 2019, at 14, 200 households in the areas identified. The survey will include infants in the following age categories: 4–24 months; 5-9 year olds and their mothers to evaluate the risk of mother to child transmission (MTCT) of Hepatitis B. Evidence from the survey will be presented to the Sierra Leonean government to inform decision makers on whether to introduce administration of the Hepatitis B vaccine at birth.