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Jul 11, 2024   |   Blog Post

Faster Samples, Faster Response: Fighting Polio in Tanzania

A lab technician from Kitete Regional Hospital in Tabora Province, hands over samples to Tanzania postal corporation staff ready for transport to the National Lab in Dar es Salaam

By Dr Christina Mmasa

Technical Lead Polio Lab Sample Transport (PLST), CIHEB Tanzania

By Ronald Ng'eno

Program Communication Manager

Dr. Fausta Michael, a pediatrician leading the Ministry of Health (MoH) Surveillance Unit in Tanzania, beams with pride as she talks about the recent strides her country has made in the fight against polio. A key factor in this success story? A seemingly simple yet important change: improved transportation of polio samples.

In her role, Dr. Fausta coordinates the surveillance of vaccine-preventable diseases (VPDs), including polio, measles, and rubella, and oversees the transportation of polio samples from subnational levels to the laboratory at the Uganda Virus Research Institute (UVRI).

Dr Fausta Michael in her office at the Tanzania Ministry of Health Surveillance Unit, Dar es Salaam. Photo credit: Dr Christina Mmasa

Initial Challenges Faced
In 2022, a VillageReach assessment identified roadblocks in transporting polio samples in Tanzania. First, at the national level (Mabibo, Dar es Salaam), the samples were stored, packaged and shipped twice a week to UVRI, a process which often led to delays, as samples would pile up at the national level, waiting for the twice-a-week shipment days.

One of the primary challenges was batching samples at the national level before their transfer to UVRI. “We were performing acute flaccid paralysis (AFP) surveillance alongside environmental surveillance, but the lack of a dedicated person for processing and packaging caused delays at the national level. Some samples took up to 16 days,” says Dr. Fausta.

Second, maintaining the quality of samples during transport was another concern. The samples were kept in ice-packed carriers, ensuring they remained at the recommended 2-8 degrees Celsius during transport. However, infrastructure issues and inconsistent handling practices contributed to some problems.

Third, the system relied on an incentivized model where health care workers were reimbursed the cost of shipping samples. Dr. Fausta explains, “Health care workers would notify the District Focal Person upon suspecting a case, collect the samples and then personally bring them to the national level in Dar es Salaam.”

Improvements Made Through Partnerships
The partnership between the Global Polio Eradication Initiative (GPEI), VillageReach and the Center for International Health, Education and Biosecurity (CIHEB) in Tanzania has enhanced the polio sample transportation system. While the incentivized model remains in place, a pilot project (between July 2023 and March 2024) in Tabora region introduced a courier service to streamline the process.

During the pilot, in Tabora, health care workers transport samples to the regional level. There, Tanzania Postal Corporation stepped in, ensuring delivery to the national lab via their courier service. This not only improved sample delivery times but also minimized travel risks for health care workers.

Dr. Fausta highlights the significant improvements, particularly at the national level. “With support from VillageReach and a dedicated Vaccine Preventable Disease (VPD) focal person from CIHEB-Tz, we increased the frequency of shipments from twice a week to daily. This has drastically reduced the turnaround time for samples to reach UVRI.” Introducing a VPD focal person ensured meticulous processing, packaging, and tracking of each sample, minimizing the risk of mix-ups and improving traceability.

For environmental samples, the collection schedule was optimized to coincide with shipment times, further reducing delays. For instance, in the last quarter of the pilot project (December 2023-February 2024), transport to the national level averaged 2.5 days, compared to 4.6 days at baseline. “By Friday, we no longer have any samples left in the fridge, allowing us to start afresh,” Dr. Fausta explains.

Other notable achievements include:
– Rolling out of polio and other VPD specimen management training for 209 sub-national staff in Zanzibar, Dar es Salaam and Tabora regions.
– Community engagement and engagement of traditional healers which led to an increase in the polio samples collected.
– Printing and distributing Information Education and Communication materials to support polio surveillance and response.
– Supporting active case search for Vaccine-Preventable Diseases at facility levels in Tabora region.
– Review of surveillance data to identify gaps in data/performance and recommend remedial actions for the Surveillance Technical Working Group.

Ms. Elizabeth Shirima, MoH Surveillance Focal Person, stores samples before shipment to the UVRI lab in Uganda.

Importance of Timely Intervention
Dr. Fausta shares a compelling example from 2023 when Tanzania confirmed two cases of circulating vaccine-derived poliovirus (cVDPV). “Tanzania had one of the earliest confirmations of polio cVDPV in Africa, within three weeks. Quick testing and response helped prevent severe complications and halted the disease’s spread.” The first case recovered swiftly, while the second case highlighted the critical role of timely intervention in managing outbreaks despite a longer recovery period.

The partnership’s success is evident in the significant reduction in the turnaround time for sample processing. “Over 80% of environmental samples in 2023 and 2024 reached the labs within the stipulated three days,” Dr. Fausta notes.

This efficiency has facilitated quicker responses to potential outbreaks and bolstered community trust in the health care system. Increased awareness and sensitization efforts have led to better disease surveillance and higher vaccination campaign attendance, contributing to the broader goal of polio elimination.

Looking Ahead
Dr. Fausta envisions a future where Tanzania sustains and builds upon these achievements. “We need to ensure continuous training for health care workers and integrate vaccine-preventable disease surveillance into pre-service training. Additionally, having dedicated budget lines for AFP surveillance activities is crucial.” One of the aspirations is to develop in-country testing capacity for polio (human and environmental) samples, reducing reliance on external laboratories and speeding up response times.

She emphasizes the importance of collaboration and innovation in the fight against polio. “What we have achieved with CIHEB and VillageReach demonstrates that there is always room for improvement. Together, we can achieve more and ensure that vaccine-preventable outbreaks are no longer a threat to our children.”

Dr. Fausta’s message to other organizations and local governments is clear: “Investing in efficient sample transportation and response systems is vital. Embrace new technologies, prioritize continuous training and foster partnerships to build resilient health care systems capable of eradicating polio and other vaccine-preventable diseases.”

“Investing in efficient sample transportation and response systems is vital. Embrace new technologies, prioritize continuous training and foster partnerships to build resilient health care systems capable of eradicating polio and other vaccine-preventable diseases.” Dr Fausta leading the Ministry of Health (MoH) Surveillance Unit in Tanzania.

She is grateful to the EPI Program Manager Dr Florian Tinuga, Mr Abdul Salehe, EPI Program Manager, Zanzibar and Ms. Joseline Ishengoma, the National Coordinator of Immunization Services at President’s Office, Regional Administrative and Local Government (PORALG) for endorsing the implementation of the project. She also appreciates Dr Honoratha Rutatinisibwa the Regional Medical Officer (RMO) in the Tabora region for supporting the implementation of the Pilot study on alternative VPD sample referral systems and her colleagues at the National, Regional, District and facility for the commitment to ensuring the success of the project.

A Message of Hope
The partnership between Tanzania’s MoH, PORALG, CIHEB, World Health Organization (WHO) and VillageReach has significantly improved polio sample transportation, leading to timely disease detection and response.

Dr. Fausta’s message is one of optimism and a call to action. “What we have achieved with VillageReach & CIHEB is evidence that there is always room for improvement,” she says. “Together, we can achieve more. We can kick out polio for good.”

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For more information about the Polio Lab Sample Transport (PLST) program in Tanzania, contact Dr. Christina Mmasa, Technical Lead PLST at CIHEB Tanzania (CMmasa@cihebtanzania.org), or Mr. Dauda Majanbu, Senior Manager, VillageReach (dauda.majanbu@villagereach.org)

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