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

Abstract

Background: The 2014-2016 West Africa Ebola virus disease outbreak heavily impacted the Republics of Guinea, Sierra Leone, and Liberia. The outbreak uncovered the weaknesses of the public health systems, including inadequately trained and insufficient health personnel as well as limited and poorly equipped health infrastructures. These weaknesses represent significant threats to global health security. In the wake of the outbreak, affected countries made urgent requests for international engagement to help strengthening the public health systems. Methods: This work describes the successful multi-year implementation of a laboratory capacity building program in the Republic of Guinea. The program integrated biorisk and quality management systems training, infectious diseases diagnostic training, facility engineering and maintenance training, and mentorship to strengthen Guinea's bio-surveillance capacity. Results: The major outcome of these efforts was an established and local staff-operated public health laboratory that performs disease surveillance and reporting and diagnostic of priority diseases and pathogens of security concerns. Conclusions: This work has improved the Guinea country's capabilities to address country public health issues and preparedness to respond to future infectious disease threats.

Keywords: Republic of Guinea; biorisk management system; capacity building; infectious diseases; laboratory diagnostics; laboratory systems strengthening; quality systems.

Figure 1

Training curricula. Topics covered for the biosafety & biosecurity, quality management and molecular and serological diagnostics are shown. RT-PCR, reverse transcription polymerase chain reaction; ELISA, enzyme-linked immunosorbent assay.

Figure 2

Number of trainees per institution and per training topic. INSP, national institute of public health; CVDL, central veterinary diagnostic laboratory; CMC, medical communal center; VHFPL, viral hemorrhagic fever project laboratory; IgDHL, ignace deen hospital laboratory; NTBLab, national tuberculosis laboratory; MoF, ministry of fisheries; MoH, ministry of health; BRM & QM, biorisk management and quality management.

Figure 3

Leadership training impact. Questionnaires were designed for self-evaluation of leadership participant's knowledge impact on their professional activities. Trainees were asked to score 1 to 4 with 1 being the least score and 4 the highest. The mean and median were then calculated. MoH, ministry of health; BS&S, biosafety and biosecurity; QM, quality management.

Figure 4

Staff training impact. Questionnaires were designed for self-evaluation of staff participant's knowledge impact on their professional activities. Trainees were asked to score 1 to 4 with 1 being the least score and 4 the highest. The mean and median were then calculated. MoH, ministry of health; BS&S, biosafety and biosecurity; QM, quality management.

Figure 5

Leadership training sustainability. Questionnaires were designed to assess the sustainability of the lessons learnt and skills gained on leadership participant's professional activities at their institution. Trainees were asked to respond “yes” or “no” to each question and the percentage of respondents selecting each answer was calculated. MoH, ministry of health; BS&S, biosafety and biosecurity; QM, quality management.

Figure 6

Staff training sustainability. Questionnaires were designed to assess the sustainability of the lessons learnt and skills gained on staff participant's professional activities at their institution. Trainees were asked to respond “yes” or “no” to each of these questions and the percentage of respondents selecting each answer was calculated. MoH, ministry of health; BS&S, biosafety and biosecurity; QM, quality management.

Figure 7

Diagnostic testing activities. Number of tests conducted in the laboratory during 2017–2018 by local laboratory personnel under the mentorship of the country Program Lead. Diagnostic activities included anthrax testing, bacterial meningitis testing and sero-grouping, and influenza testing and subtyping. The category “Others” refers to multiplex PCR testing for yellow fever virus, Dengue virus, Chikungunya virus, West Nile virus, Coxiella burnetii, Plasmodium, Rickettsia, Streptococcus pneumonia, Brucella, Leptospira and Salmonella.