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Papers by Alex Gasasira

The Pan African medical journal, 2018

Introduction: In August 2014, WHO declared that Ebola outbreak ravaging West Africa including Lib... more Introduction: In August 2014, WHO declared that Ebola outbreak ravaging West Africa including Liberia had become a Public Health Emergency of International Concern (PHEIC). Infection prevention and control (IPC) among healthcare workers was pivotal in reducing healthcare worker infection and containing the recent EVD outbreak. Hard to reach areas (HTRA) presents peculiar challenges in public health emergencies. We present the result of IPC capacity building strategies deployed in Gbarpolu County: an HTRA of Liberia. Methods: Between April to October 2015, we conducted IPC training and mentorship at the county, district and facility levels in a selected HTRA of Liberia using the keep Safe, Keep Serving manual and the WHO core components of infection control. Serial follow-up assessments and mentoring using the Liberian Minimum standard tool for safe care in Liberian health facilities (MST) were done. Results: 180 (100%) facility based healthcare workers were trained: including 59 clinicians (32%) and 121 (67%) non-clinicians. 100% of the healthcare workers in four selected very HTRAs were trained and underwent facility based-mentorship. Compliance with IPC practice increased: the MST score increased from 75% to 90% and for the MST score for waste management and isolation increased 60% to 87%. Conclusion: Strengthening the capacity of healthcare workers for IPC was instrumental for containing the EVD epidemic but also critical for routine safe and quality services. A culture of IPC among healthcare workers in HTRA can be implemented through capacity building and training.

IntechOpen eBooks, Jun 7, 2021

The recommended approach for response to severe acute respiratory syndrome coronavirus 2, was to ... more The recommended approach for response to severe acute respiratory syndrome coronavirus 2, was to test to enable timely detection, isolation and contact tracing so as to reduce the rapid spread of the disease. This highlighted that the laboratory as one of the core capacities of the International Health Regulations and key technical area in the International Health Security was critical in curbing the spread of the virus. Zimbabwe embarked on testing for SARS-CoV-2 in February 2020 following the guidance and support from WHO leveraging the existing testing capacity. Testing was guided by a laboratory pillar which constituted members from different organizations partnering with the Ministry of Health and Child Care. SARS-CoV-2 testing expansion was based on a phased approach using a tiered system in which laboratory staff from lower tiers were seconded to test for coronavirus using RT-PCR with National Microbiology Reference Laboratory (NMRL) being the hub for centralized consolidation of all results. As the pandemic grew nationally, there was an increase in testing per day and reduction in turnaround time as five laboratories were fully capacitated to test using RT-PCR open platforms, thirty-three provincial and district laboratories to test using TB GeneXpert and 5 provincial laboratories to use Abbott platforms.

PubMed, 2022

The COVID-19 pandemic was declared a Public Health Emergency of International Concern on January ... more The COVID-19 pandemic was declared a Public Health Emergency of International Concern on January 30, 2020. The government of Zimbabwe through the Ministry of Health and Child Care set up the COVID-19 national preparedness and response plan in which the laboratory was a key pillar. The implementation of PCR testing, genomic sequencing, and the establishment of quality management systems during the COVID-19 response strengthened the capacity of the public health laboratory system in responding to the pandemic. Here we present the different strategies taken by the government that strengthened laboratory capacity, the lessons learned during the COVID-19 response, and recommendations on how the capacity can be sustained and leveraged for outbreak response in the future.

Epidemiology and Infection, Jun 20, 2023

Although Africa is home to about 14% of the global population (1.14 billion people), it is growin... more Although Africa is home to about 14% of the global population (1.14 billion people), it is growing three times faster than the global average [1]. The continent carries a high burden of disease, but there has been real progress in eradication, elimination, and control since 2015. Examples are the eradication of wild polio in 2020 [2] and the eradication or elimination of neglected tropical diseases, such as dracunculiasis in Kenya in 2018; Human African trypanosomiasis in Togo in 2022; and trachoma in Togo, Gambia, Ghana, and Malawi in 2022 [3]. New HIV infections reduced by 44% in 2021 compared to 2010 [4], and in 2021 the African region passed the 2020 milestone of the End TB Strategy, with a 22% reduction in new infections compared with 2015 [5]. However, these major gains in health are under threat from climate change, which adversely affects food and health security and socioeconomic development. These pressures, together with the significant after-effects of the COVID-19 pandemic, are creating potential conditions for explosive outbreaks of communicable diseases and, at the same time, an increasing burden of non-communicable diseases resulting from the demographic transition [6]. The impact of the COVID-19 pandemic is central to all discussion on moving forward in disease control in the WHO African region. It has threatened decades of progress in health globally, including such positive trends as decreasing inequality. In 2020, the pandemic disrupted essential health services in 92% of countries worldwide; 22.7 million children missed basic immunisation; there was an increase in malaria and TB; and global deaths from TB rose for the first time since 2015 [7]. The African region was no exception, and the momentum towards achieving the 2030 Sustainable Development Goals disease burden reduction targets (to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases, and other communicable diseases) has stalled. Nevertheless, these threats, and the long experience of responding to major disease outbreaks and emergencies in the region, have provided us with important lessons as we get back on track to accelerate progress towards achieving universal health coverage and the sustainable development goals. This requires a shift in mindset and a new way of working. The WHO Regional Office for Africa, as the lead UN health agency in the region, has accordingly initiated a change in its organisational structure, in alignment with the General Programme of Work 2019-2030 (GPW 13) [8] and the Transformation Agenda of the WHO Secretariat in the African Region 2015-2020 [9]. The WHO/AFRO Universal Health Coverage | Communicable and Non-communicable diseases cluster (UCN) was established in 2019 to better integrate the WHO African region disease prevention and control progammes within a health-systems strengthening framework using a data-centric, results-focused, and integrated cluster management approach. UCN is responsible for delivering the WHO African region's strategic agenda for the four priority areas of the SDGs. The core success factors of the COVID-19 pandemic response have informed the four UCN special initiativesgovernance and system capacity, institutional capacity, data science capacity, and research and innovation capacityexemplified in the Capacity Triangle for disease control (Figure 1). These will be operationalised from 2023 to 2030. The Capacity Triangle outlines three essential enabling capacities aligned with national governance and systems stewardship to drive sustainable, efficient disease control investment, and impact. As well as maintaining the momentum towards the 2030 disease burden reduction targets, this business model sets the stage for building resilient systems and promoting readiness for the next pandemic. These capacities, in addition to the central strategic area of governance and systems stewardship, are recommended as investment pillars for prioritisation by countries, partners, and donors in the deployment of available disease control resources. S1 1 Strengthening Systems and Governance (SYGO) will enhance national disease prevention and control programmes through evidence-informed leadership, policies, workflows, programme management, resource allocation, and service delivery models. SI 2 Strengthening Institutional Capacity (SICA) will expand the pool of technical partners and advisory bodies equipped to support national disease prevention and control programmes, with a focus on localising technical support from institutions in the region.

The Journal of Infectious Diseases, Oct 14, 2014

Background. Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Paki... more Background. Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone. Methods. This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria. Results. Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states. Conclusions. Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.

The Pan African medical journal, 2019

Introduction Although Liberia adapted the integrated diseases surveillance and response (IDSR) in... more Introduction Although Liberia adapted the integrated diseases surveillance and response (IDSR) in 2004 as a platform for implementation of International Health Regulation (IHR (2005)), IDSR was not actively implemented until 2015. Some innovations and best practices were observed during the implementation of IDSR in Liberia after Ebola virus disease outbreak. This paper describes the different approaches used for implementation of IDSR in Liberia from 2015 to 2017. Methods We conducted a cross-sectional study using the findings from IDSR supervisions conducted from September to November 2017 and perused the outbreaks linelists submitted by the counties to the national level from January to December 2017 and key documents available at the national level. Results In 2017, the country piloted the use of mobile phones application to store and send data from the health facilities to the national level. In addition, an electronic platform for acute flaccid paralysis (AFP) surveillance called Auto-Visual AFP Detection and Reporting (AVADAR) was piloted in Montserrado County during the first semester of 2017. The timeliness and completeness of reports submitted from the counties to national level were above the target of 80% stable despite the challenges like insufficient resources, including skilled staff. Conclusion IDSR is being actively implemented in Liberia since 2015. Although the country is facing the same challenges as other countries during the early stages of implementation of IDSR, the several innovations were implemented in a short time. The surveillance system reveled to be resilient, despite the challenges.

Pan African Medical Journal, 2019

Introduction: Liberia remains at high risk of poliovirus outbreaks due to importation. The countr... more Introduction: Liberia remains at high risk of poliovirus outbreaks due to importation. The country maintained certification level acute flaccid paralysis (AFP) surveillance indicators each year until 2014 due to Ebola outbreak. During this time, there was a significant drop in non-polio AFP rate to (1.2/100,000 population under 15 years) in 2015 from 2.9/100, 000 population in 2013, due to a variety of reasons including suspension on shipment of acute flaccid paralysis stool specimen to the polio regional lab in Abidjan, refocusing of surveillance officers attention solely on Ebola virus disease (EVD) surveillance, inactivation of national polio expert committee (NPEC) and National Certification Committee (NCC). The Ministry of Health (MOH) supported by partners worked to restore AFP surveillance post EVD outbreak and ensure that Liberia maintains its polio free certification. Methods: we conducted a desk review to summarize key activities conducted to restore acute flaccid paralysis (AFP) surveillance based on World Health Organization (WHO) AFP surveillance guidelines for Africa region. We also reviewed AFP surveillance indicators and introduction of new technologies. Data sources were from program reports, scientific and gray literature, AFP database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel and access spread sheets, ONA software and Geographic Information System (Arc GIS). Results: AFP surveillance indicators improved with a rebound of non-polio AFP rate (NPAFP) rate from 1.2/100, 000 population under 15 years in 2015 to 4.3 in 2017. The stool adequacy rate at the national level also improved from 79% in 2016 to 82% in 2017, meeting the global target. The percentage of counties meeting the two critical AFP surveillance indicators NPAFP rate and stool adequacy improved from 47% in 2016 to 67% in 2017.The Last polio case reported in Liberia was in late 2010.

International Journal of Infectious Diseases, 2018

Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is en... more Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein. Methods: In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken. Results: From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases. Conclusions: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks.

Public Health Action, 2017

Recognising the importance of infection prevention and control (IPC), a minimum standards tool (M... more Recognising the importance of infection prevention and control (IPC), a minimum standards tool (MST) was developed in Liberia to guide the safe (re-) opening and provision of care in health facilities. Objectives: To analyse the implementation of specific IPC measures after the 2014 Ebola virus outbreak between June 2015 and May 2016, and to compare the relative improvements in IPC between the public and private sectors. Design: A retrospective comparative cohort study. Results: We evaluated 723 (94%) of the 769 health facilities in Liberia. Of these, 437 (60%) were public and 286 (40%) were private. There was an overall improvement in the MST scores from a median of 13 to 14 out of a maximum possible score of 16. While improvements were observed in all aspects of IPC in both public and private health facilities, IPC implementation was systematically higher in public facilities. Conclusions: We demonstrate the feasibility of monitoring IPC implementation using the MST checklist in post-Ebola Liberia. Our study shows that improvements were made in key aspects of IPC after 1 year of evaluations and tailored recommendations. We also highlight the need to increase the focus on the private sector to achieve further improvements in IPC.

International Journal of Infectious Diseases, 2016

Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is en... more Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein. Methods: In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken. Results: From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases. Conclusions: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks.

The Journal of Infectious Diseases, Oct 14, 2014

A renewed commitment at the regional and the global levels led to substantial progress in the fig... more A renewed commitment at the regional and the global levels led to substantial progress in the fight for polio eradication in the African Region (AFR) of the World Health Organization (WHO) during 2008-2012. In 2008, there were 912 reported cases of wild poliovirus (WPV) infection in 12 countries in the region. This number had been reduced to 128 cases in 3 countries in 2012, of which 122 were in Nigeria, the only remaining country with endemic circulation of WPV in AFR. During 2008-2012, circulation apparently ceased in the 3 AFR countries with reestablished WPV transmission-Angola, the Democratic Republic of the Congo, and Chad. Outbreaks in West Africa continued to occur in 2008-2010 but were more rapidly contained, with fewer cases than during earlier years. This progress has been attributed to better implementation of core strategies, increased accountability, and implementation of innovative approaches. During this period, routine coverage with 3 doses of oral polio vaccine in AFR, as measured by WHO-United Nations Children's Fund estimates, increased slightly, from 72% to 74%. Despite this progress, challenges persist in AFR, and 2013 was marked by new setbacks and importations. High population immunity and strong surveillance are essential to sustain progress and assure that AFR reaches its goal of eradicating WPV.

Summary Background The completion of poliomyelitis eradication is a global emergency for public h... more Summary Background The completion of poliomyelitis eradication is a global emergency for public health. In 2012, more than 50% of the world's cases occurred in Nigeria following an unanticipated surge in incidence. We aimed to quantitatively analyse the key factors sustaining transmission of poliomyelitis in Nigeria and to calculate clinical effi cacy estimates for the oral poliovirus vaccines (OPV) currently in use.

Pan African Medical Journal, 2019

Introduction Early detection of disease outbreaks is paramount to averting associated morbidity a... more Introduction Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis.

International Journal of Infectious Diseases, 2016

Science Journal of Public Health, 2015

Introduction: Nigeria is one of the three polio endemic countries in the world along Pakistan and... more Introduction: Nigeria is one of the three polio endemic countries in the world along Pakistan and Afghanistan. The detection of persons with Acute Flaccid Paralysis (AFP) and testing of stool specimens from these patients is the surveillance standard for detection of poliovirus. World Health Organization recommends complementary surveillance by testing sewage samples and stool of healthy children. Kano is the epi-center of polio in Nigeria. Environmental surveillance was introduced in June 2011 in Kano State and in April 2012 in Sokoto State. Methods: Grab method was used to collect sewage samples by trained environmental health workers. The samples were tested in Ibadan Polio Laboratory which is part of the Global Polio Laboratory Network. The Samples were concentrated using the two-phase separation method. Isolation of Poliovirus was carried out in RD and L20B cell lines. Poliovirus identification was done using the micro neutralization techniques. Results: In Kano State, from week 28 of 2011 to week 52 of 2012, a total of 60 samples were collected. In Sokoto State, from week 13-52 of 2012, a total of 80 sewage samples were collected from four sewage sites. In Kano and Sokoto, 62 and 93 single or mixed isolates were detected from the samples. In Kano, 39 (63%) of the isolates were Sabin viruses, 16 (26%) were circulating vaccine derived polio viruses type 2 (cVDPV2), 2 (3%) were wild polio virus type 1 (WPV1), 4 (6%) were non polio enteroviruses (NPENT) and 1 (3%) were wild polio virus type 3 (WPV3). In Sokoto, 33 (35%) of the isolates were cVDPV2, 27 (29%) were Sabin viruses, 16 (17%) were wild virus type 1 and 17 (18%) were non polio enteroviruses. No wild virus type 3 was detected from AFP cases and environmental samples in Sokoto State in 2012. Conclusion: The results confirm the prevailing immunity gap in polio high risk areas of Nigeria and pronounced immunity gap against type 2 polio virus in Sokoto. Long distance travelers such as nomads play important role in disseminating poliovirus. Special focus should be given to reach and vaccinate such underserved and migrant communities. In addition to the national campaigns with bivalent oral polio vaccine (bOPV) and trivalent oral polio vaccine (tOPV), an aggressive strategy should be adopted to mop up any detection of cVDPV in cases, contacts, or the environment.

Pan African Medical Journal, 2019

Introduction The Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already... more Introduction The Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already fragile health system which was recovering from the effects of civil unrest. This led to significant decline in immunization coverage and key polio free certification indicators. The Liberia investment plan was developed to restore immunization service delivery and overall health system. Methods We conducted a desk review to summarize performance of immunization coverage, polio eradication, measles control, new vaccines and technologies. Data sources include program reports, scientific and grey literature, District Health Information System (DHIS2), Integrated Diseases Surveillance and Response (IDSR) database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel spreadsheets, ONA software and Arc GIS. Results There was a 36% increase in national coverage for Penta 3 in 2017 compared to 2014 from WUENIC data. Penta 3 dropout rate reduced by 2.5 fold from 15.3% in 2016 to 6.4% in 2017; while MCV1 coverage improved by 23% from 64% in 2015 to 87% in 2017. There was a rebound of non-polio AFP rate (NPAFP) rate from 1.2 in 2015 to 4.3 in 2017. Furthermore, there was a 2-fold increase in the number of AFP cases receiving 3 or more doses of OPV from 36% in 2015 to 61% in 2017. Conclusion Liberia demonstrated strong rebound of immunization services following the largest and most devastating EVD outbreak in West Africa in 2014 - 2015. Immunization coverage improved and dropout rates reduced. However, there are still opportunities for improvement in the immunization program both at national and sub-national levels.

Frontiers in Public Health, Jul 19, 2022

to all the ten provinces, from central testing laboratory to more than , testing centers. WhatsAp... more to all the ten provinces, from central testing laboratory to more than , testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.

Pan African Medical Journal, 2019

Introduction The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importan... more Introduction The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017. Methods Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained. Results The ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events. Conclusion No infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings.

The Pan African medical journal, 2018

Introduction: In August 2014, WHO declared that Ebola outbreak ravaging West Africa including Lib... more Introduction: In August 2014, WHO declared that Ebola outbreak ravaging West Africa including Liberia had become a Public Health Emergency of International Concern (PHEIC). Infection prevention and control (IPC) among healthcare workers was pivotal in reducing healthcare worker infection and containing the recent EVD outbreak. Hard to reach areas (HTRA) presents peculiar challenges in public health emergencies. We present the result of IPC capacity building strategies deployed in Gbarpolu County: an HTRA of Liberia. Methods: Between April to October 2015, we conducted IPC training and mentorship at the county, district and facility levels in a selected HTRA of Liberia using the keep Safe, Keep Serving manual and the WHO core components of infection control. Serial follow-up assessments and mentoring using the Liberian Minimum standard tool for safe care in Liberian health facilities (MST) were done. Results: 180 (100%) facility based healthcare workers were trained: including 59 clinicians (32%) and 121 (67%) non-clinicians. 100% of the healthcare workers in four selected very HTRAs were trained and underwent facility based-mentorship. Compliance with IPC practice increased: the MST score increased from 75% to 90% and for the MST score for waste management and isolation increased 60% to 87%. Conclusion: Strengthening the capacity of healthcare workers for IPC was instrumental for containing the EVD epidemic but also critical for routine safe and quality services. A culture of IPC among healthcare workers in HTRA can be implemented through capacity building and training.

IntechOpen eBooks, Jun 7, 2021

The recommended approach for response to severe acute respiratory syndrome coronavirus 2, was to ... more The recommended approach for response to severe acute respiratory syndrome coronavirus 2, was to test to enable timely detection, isolation and contact tracing so as to reduce the rapid spread of the disease. This highlighted that the laboratory as one of the core capacities of the International Health Regulations and key technical area in the International Health Security was critical in curbing the spread of the virus. Zimbabwe embarked on testing for SARS-CoV-2 in February 2020 following the guidance and support from WHO leveraging the existing testing capacity. Testing was guided by a laboratory pillar which constituted members from different organizations partnering with the Ministry of Health and Child Care. SARS-CoV-2 testing expansion was based on a phased approach using a tiered system in which laboratory staff from lower tiers were seconded to test for coronavirus using RT-PCR with National Microbiology Reference Laboratory (NMRL) being the hub for centralized consolidation of all results. As the pandemic grew nationally, there was an increase in testing per day and reduction in turnaround time as five laboratories were fully capacitated to test using RT-PCR open platforms, thirty-three provincial and district laboratories to test using TB GeneXpert and 5 provincial laboratories to use Abbott platforms.

PubMed, 2022

The COVID-19 pandemic was declared a Public Health Emergency of International Concern on January ... more The COVID-19 pandemic was declared a Public Health Emergency of International Concern on January 30, 2020. The government of Zimbabwe through the Ministry of Health and Child Care set up the COVID-19 national preparedness and response plan in which the laboratory was a key pillar. The implementation of PCR testing, genomic sequencing, and the establishment of quality management systems during the COVID-19 response strengthened the capacity of the public health laboratory system in responding to the pandemic. Here we present the different strategies taken by the government that strengthened laboratory capacity, the lessons learned during the COVID-19 response, and recommendations on how the capacity can be sustained and leveraged for outbreak response in the future.

Epidemiology and Infection, Jun 20, 2023

Although Africa is home to about 14% of the global population (1.14 billion people), it is growin... more Although Africa is home to about 14% of the global population (1.14 billion people), it is growing three times faster than the global average [1]. The continent carries a high burden of disease, but there has been real progress in eradication, elimination, and control since 2015. Examples are the eradication of wild polio in 2020 [2] and the eradication or elimination of neglected tropical diseases, such as dracunculiasis in Kenya in 2018; Human African trypanosomiasis in Togo in 2022; and trachoma in Togo, Gambia, Ghana, and Malawi in 2022 [3]. New HIV infections reduced by 44% in 2021 compared to 2010 [4], and in 2021 the African region passed the 2020 milestone of the End TB Strategy, with a 22% reduction in new infections compared with 2015 [5]. However, these major gains in health are under threat from climate change, which adversely affects food and health security and socioeconomic development. These pressures, together with the significant after-effects of the COVID-19 pandemic, are creating potential conditions for explosive outbreaks of communicable diseases and, at the same time, an increasing burden of non-communicable diseases resulting from the demographic transition [6]. The impact of the COVID-19 pandemic is central to all discussion on moving forward in disease control in the WHO African region. It has threatened decades of progress in health globally, including such positive trends as decreasing inequality. In 2020, the pandemic disrupted essential health services in 92% of countries worldwide; 22.7 million children missed basic immunisation; there was an increase in malaria and TB; and global deaths from TB rose for the first time since 2015 [7]. The African region was no exception, and the momentum towards achieving the 2030 Sustainable Development Goals disease burden reduction targets (to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases, and other communicable diseases) has stalled. Nevertheless, these threats, and the long experience of responding to major disease outbreaks and emergencies in the region, have provided us with important lessons as we get back on track to accelerate progress towards achieving universal health coverage and the sustainable development goals. This requires a shift in mindset and a new way of working. The WHO Regional Office for Africa, as the lead UN health agency in the region, has accordingly initiated a change in its organisational structure, in alignment with the General Programme of Work 2019-2030 (GPW 13) [8] and the Transformation Agenda of the WHO Secretariat in the African Region 2015-2020 [9]. The WHO/AFRO Universal Health Coverage | Communicable and Non-communicable diseases cluster (UCN) was established in 2019 to better integrate the WHO African region disease prevention and control progammes within a health-systems strengthening framework using a data-centric, results-focused, and integrated cluster management approach. UCN is responsible for delivering the WHO African region's strategic agenda for the four priority areas of the SDGs. The core success factors of the COVID-19 pandemic response have informed the four UCN special initiativesgovernance and system capacity, institutional capacity, data science capacity, and research and innovation capacityexemplified in the Capacity Triangle for disease control (Figure 1). These will be operationalised from 2023 to 2030. The Capacity Triangle outlines three essential enabling capacities aligned with national governance and systems stewardship to drive sustainable, efficient disease control investment, and impact. As well as maintaining the momentum towards the 2030 disease burden reduction targets, this business model sets the stage for building resilient systems and promoting readiness for the next pandemic. These capacities, in addition to the central strategic area of governance and systems stewardship, are recommended as investment pillars for prioritisation by countries, partners, and donors in the deployment of available disease control resources. S1 1 Strengthening Systems and Governance (SYGO) will enhance national disease prevention and control programmes through evidence-informed leadership, policies, workflows, programme management, resource allocation, and service delivery models. SI 2 Strengthening Institutional Capacity (SICA) will expand the pool of technical partners and advisory bodies equipped to support national disease prevention and control programmes, with a focus on localising technical support from institutions in the region.

The Journal of Infectious Diseases, Oct 14, 2014

Background. Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Paki... more Background. Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone. Methods. This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria. Results. Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states. Conclusions. Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.

The Pan African medical journal, 2019

Introduction Although Liberia adapted the integrated diseases surveillance and response (IDSR) in... more Introduction Although Liberia adapted the integrated diseases surveillance and response (IDSR) in 2004 as a platform for implementation of International Health Regulation (IHR (2005)), IDSR was not actively implemented until 2015. Some innovations and best practices were observed during the implementation of IDSR in Liberia after Ebola virus disease outbreak. This paper describes the different approaches used for implementation of IDSR in Liberia from 2015 to 2017. Methods We conducted a cross-sectional study using the findings from IDSR supervisions conducted from September to November 2017 and perused the outbreaks linelists submitted by the counties to the national level from January to December 2017 and key documents available at the national level. Results In 2017, the country piloted the use of mobile phones application to store and send data from the health facilities to the national level. In addition, an electronic platform for acute flaccid paralysis (AFP) surveillance called Auto-Visual AFP Detection and Reporting (AVADAR) was piloted in Montserrado County during the first semester of 2017. The timeliness and completeness of reports submitted from the counties to national level were above the target of 80% stable despite the challenges like insufficient resources, including skilled staff. Conclusion IDSR is being actively implemented in Liberia since 2015. Although the country is facing the same challenges as other countries during the early stages of implementation of IDSR, the several innovations were implemented in a short time. The surveillance system reveled to be resilient, despite the challenges.

Pan African Medical Journal, 2019

Introduction: Liberia remains at high risk of poliovirus outbreaks due to importation. The countr... more Introduction: Liberia remains at high risk of poliovirus outbreaks due to importation. The country maintained certification level acute flaccid paralysis (AFP) surveillance indicators each year until 2014 due to Ebola outbreak. During this time, there was a significant drop in non-polio AFP rate to (1.2/100,000 population under 15 years) in 2015 from 2.9/100, 000 population in 2013, due to a variety of reasons including suspension on shipment of acute flaccid paralysis stool specimen to the polio regional lab in Abidjan, refocusing of surveillance officers attention solely on Ebola virus disease (EVD) surveillance, inactivation of national polio expert committee (NPEC) and National Certification Committee (NCC). The Ministry of Health (MOH) supported by partners worked to restore AFP surveillance post EVD outbreak and ensure that Liberia maintains its polio free certification. Methods: we conducted a desk review to summarize key activities conducted to restore acute flaccid paralysis (AFP) surveillance based on World Health Organization (WHO) AFP surveillance guidelines for Africa region. We also reviewed AFP surveillance indicators and introduction of new technologies. Data sources were from program reports, scientific and gray literature, AFP database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel and access spread sheets, ONA software and Geographic Information System (Arc GIS). Results: AFP surveillance indicators improved with a rebound of non-polio AFP rate (NPAFP) rate from 1.2/100, 000 population under 15 years in 2015 to 4.3 in 2017. The stool adequacy rate at the national level also improved from 79% in 2016 to 82% in 2017, meeting the global target. The percentage of counties meeting the two critical AFP surveillance indicators NPAFP rate and stool adequacy improved from 47% in 2016 to 67% in 2017.The Last polio case reported in Liberia was in late 2010.

International Journal of Infectious Diseases, 2018

Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is en... more Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein. Methods: In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken. Results: From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases. Conclusions: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks.

Public Health Action, 2017

Recognising the importance of infection prevention and control (IPC), a minimum standards tool (M... more Recognising the importance of infection prevention and control (IPC), a minimum standards tool (MST) was developed in Liberia to guide the safe (re-) opening and provision of care in health facilities. Objectives: To analyse the implementation of specific IPC measures after the 2014 Ebola virus outbreak between June 2015 and May 2016, and to compare the relative improvements in IPC between the public and private sectors. Design: A retrospective comparative cohort study. Results: We evaluated 723 (94%) of the 769 health facilities in Liberia. Of these, 437 (60%) were public and 286 (40%) were private. There was an overall improvement in the MST scores from a median of 13 to 14 out of a maximum possible score of 16. While improvements were observed in all aspects of IPC in both public and private health facilities, IPC implementation was systematically higher in public facilities. Conclusions: We demonstrate the feasibility of monitoring IPC implementation using the MST checklist in post-Ebola Liberia. Our study shows that improvements were made in key aspects of IPC after 1 year of evaluations and tailored recommendations. We also highlight the need to increase the focus on the private sector to achieve further improvements in IPC.

International Journal of Infectious Diseases, 2016

Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is en... more Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein. Methods: In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken. Results: From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases. Conclusions: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks.

The Journal of Infectious Diseases, Oct 14, 2014

A renewed commitment at the regional and the global levels led to substantial progress in the fig... more A renewed commitment at the regional and the global levels led to substantial progress in the fight for polio eradication in the African Region (AFR) of the World Health Organization (WHO) during 2008-2012. In 2008, there were 912 reported cases of wild poliovirus (WPV) infection in 12 countries in the region. This number had been reduced to 128 cases in 3 countries in 2012, of which 122 were in Nigeria, the only remaining country with endemic circulation of WPV in AFR. During 2008-2012, circulation apparently ceased in the 3 AFR countries with reestablished WPV transmission-Angola, the Democratic Republic of the Congo, and Chad. Outbreaks in West Africa continued to occur in 2008-2010 but were more rapidly contained, with fewer cases than during earlier years. This progress has been attributed to better implementation of core strategies, increased accountability, and implementation of innovative approaches. During this period, routine coverage with 3 doses of oral polio vaccine in AFR, as measured by WHO-United Nations Children's Fund estimates, increased slightly, from 72% to 74%. Despite this progress, challenges persist in AFR, and 2013 was marked by new setbacks and importations. High population immunity and strong surveillance are essential to sustain progress and assure that AFR reaches its goal of eradicating WPV.

Summary Background The completion of poliomyelitis eradication is a global emergency for public h... more Summary Background The completion of poliomyelitis eradication is a global emergency for public health. In 2012, more than 50% of the world's cases occurred in Nigeria following an unanticipated surge in incidence. We aimed to quantitatively analyse the key factors sustaining transmission of poliomyelitis in Nigeria and to calculate clinical effi cacy estimates for the oral poliovirus vaccines (OPV) currently in use.

Pan African Medical Journal, 2019

Introduction Early detection of disease outbreaks is paramount to averting associated morbidity a... more Introduction Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis.

International Journal of Infectious Diseases, 2016

Science Journal of Public Health, 2015

Introduction: Nigeria is one of the three polio endemic countries in the world along Pakistan and... more Introduction: Nigeria is one of the three polio endemic countries in the world along Pakistan and Afghanistan. The detection of persons with Acute Flaccid Paralysis (AFP) and testing of stool specimens from these patients is the surveillance standard for detection of poliovirus. World Health Organization recommends complementary surveillance by testing sewage samples and stool of healthy children. Kano is the epi-center of polio in Nigeria. Environmental surveillance was introduced in June 2011 in Kano State and in April 2012 in Sokoto State. Methods: Grab method was used to collect sewage samples by trained environmental health workers. The samples were tested in Ibadan Polio Laboratory which is part of the Global Polio Laboratory Network. The Samples were concentrated using the two-phase separation method. Isolation of Poliovirus was carried out in RD and L20B cell lines. Poliovirus identification was done using the micro neutralization techniques. Results: In Kano State, from week 28 of 2011 to week 52 of 2012, a total of 60 samples were collected. In Sokoto State, from week 13-52 of 2012, a total of 80 sewage samples were collected from four sewage sites. In Kano and Sokoto, 62 and 93 single or mixed isolates were detected from the samples. In Kano, 39 (63%) of the isolates were Sabin viruses, 16 (26%) were circulating vaccine derived polio viruses type 2 (cVDPV2), 2 (3%) were wild polio virus type 1 (WPV1), 4 (6%) were non polio enteroviruses (NPENT) and 1 (3%) were wild polio virus type 3 (WPV3). In Sokoto, 33 (35%) of the isolates were cVDPV2, 27 (29%) were Sabin viruses, 16 (17%) were wild virus type 1 and 17 (18%) were non polio enteroviruses. No wild virus type 3 was detected from AFP cases and environmental samples in Sokoto State in 2012. Conclusion: The results confirm the prevailing immunity gap in polio high risk areas of Nigeria and pronounced immunity gap against type 2 polio virus in Sokoto. Long distance travelers such as nomads play important role in disseminating poliovirus. Special focus should be given to reach and vaccinate such underserved and migrant communities. In addition to the national campaigns with bivalent oral polio vaccine (bOPV) and trivalent oral polio vaccine (tOPV), an aggressive strategy should be adopted to mop up any detection of cVDPV in cases, contacts, or the environment.

Pan African Medical Journal, 2019

Introduction The Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already... more Introduction The Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already fragile health system which was recovering from the effects of civil unrest. This led to significant decline in immunization coverage and key polio free certification indicators. The Liberia investment plan was developed to restore immunization service delivery and overall health system. Methods We conducted a desk review to summarize performance of immunization coverage, polio eradication, measles control, new vaccines and technologies. Data sources include program reports, scientific and grey literature, District Health Information System (DHIS2), Integrated Diseases Surveillance and Response (IDSR) database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel spreadsheets, ONA software and Arc GIS. Results There was a 36% increase in national coverage for Penta 3 in 2017 compared to 2014 from WUENIC data. Penta 3 dropout rate reduced by 2.5 fold from 15.3% in 2016 to 6.4% in 2017; while MCV1 coverage improved by 23% from 64% in 2015 to 87% in 2017. There was a rebound of non-polio AFP rate (NPAFP) rate from 1.2 in 2015 to 4.3 in 2017. Furthermore, there was a 2-fold increase in the number of AFP cases receiving 3 or more doses of OPV from 36% in 2015 to 61% in 2017. Conclusion Liberia demonstrated strong rebound of immunization services following the largest and most devastating EVD outbreak in West Africa in 2014 - 2015. Immunization coverage improved and dropout rates reduced. However, there are still opportunities for improvement in the immunization program both at national and sub-national levels.

Frontiers in Public Health, Jul 19, 2022

to all the ten provinces, from central testing laboratory to more than , testing centers. WhatsAp... more to all the ten provinces, from central testing laboratory to more than , testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.

Pan African Medical Journal, 2019

Introduction The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importan... more Introduction The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017. Methods Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained. Results The ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events. Conclusion No infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings.