Getting a timely diagnosis of polio, a potentially life-threatening disease is a race against the elements and time. But thanks to this initiative, a network of trained health workers, innovative technology and improved transportation systems are making a critical difference.
The fight against polio requires a comprehensive approach. One aspect that often goes unnoticed is the importance of maintaining the quality of samples transported to the lab for testing. In Ethiopia, Project HOPE with support from VillageReach joined forces with the Ministry of Health (MoH) and the Ethiopian Public Health Institute (EPHI) to contribute to the National Polio Eradication Program by improving the quality of polio sample transportation and increasing the speed of detection and precision of surveillance systems in select regions of Ethiopia.
Challenges Faced in the Transportation of Samples
Ethiopia is classified as a key at-risk country because it is situated along the Wild Polio Virus (WPV) importation belt, has porous cross-border points, has low vaccination coverage, as well as suboptimal surveillance performance.
Ethiopia’s polio sample transport system has faced numerous challenges. Habtamu Alebachew, early warning alert and response (EWARS) data manager at the Amhara Region Public Health Institute outlines some of the hurdles:
“There was no monitoring mechanism that tracked the history of sample temperature and the duration it took from collection to the national laboratory. It was only maintained by the sample transporter. Moreover, there was no sample storage hub for areas facing insecurity or transport shortages.”
These deficiencies led to significant delays and compromised the quality of the samples, thereby hindering timely diagnosis and effective response. Enyew Kebede, Southwest Ethiopia regional public health emergency surveillance team leader, highlights the knowledge gaps and logistical issues:
“Before Project HOPE entered our region, we had problems with polio and other samples collection, handling and transportation due to knowledge gaps. The biggest challenge was transportation with appropriate sample temperature.”
Sample Management Training for Polio and other disease samples for sub-national staff in Oromia Region. Photo credit: Tadesse Bekele
Improving the Transport System
To address these challenges, Project HOPE, with support from VillageReach and the Global Polio Eradication Initiative (GPEI), the Ethiopian Ministry of Health (MoH) and the EPHI, targeted the Oromia; Amhara; Somali; Afar; Benishangul-Gumuz; and Southern Nations, Nationalities, and Peoples’ (SNNP) regions.
The project focused on improving Ethiopia’s National Eradicate Polio Program by:
• Training health care providers on polio and other vaccine-preventable diseases (VPDs), including case identification, investigation, reporting and sample transportation.
• Procuring of deep freezers and log tags
• Conducting feasibility assessments to select the temporary AFP and other VPD specimen collection hubs
• Establishing transit hubs and supporting the hubs with freezers that store samples and produce ice used in transit.
• Developing specimen collection, handling, packaging and transportation manuals (continuing professional development (CPD) accredited).
Sample Storage Hubs
The Power of Improved Sample Quality
This collaboration has improved the quality of polio sample transport in Ethiopia. Enyew Kebede explains, “Project HOPE established temporary AFP and other VPD specimen collection hubs with a deep freezer in our region. This hub supports the remotest woreda (district) in temporarily storing lab samples until transportation is available, producing ice and providing capacity building for catchment districts and health facilities to improve the quality of AFP and other VPD samples.”
Distributing 2,000 digital temperature monitoring devices, such as log tags, has been crucial in maintaining the samples at the right temperature (2-8 degrees Celsius) during transportation.
“Project HOPE provided training and shared standard operating procedures (SOPs) for health care providers to properly utilize the log tags,” Kebede adds. These measures have improved the data quality and effectiveness of the polio lab sample transport program.
Group photo of Regional Surveillance Officers and Temporary Sample Transportation Hub Focal Persons at training on specimen management for polio and other vaccine-preventable diseases (VPDs)
Measurable Progress
Since the intervention, improvements have been observed in polio sample transport. Habtamu Alebachew notes, “We have seen significant improvements in the detection of suspected cases, sample collection and sample quality in the North Wollo zone (Amhara region).”
Kebede echoes this sentiment, highlighting that the quality of sample transportation has increased, particularly in remote areas. “After accessing the hub for the remotest areas and providing log tags for all zones, the quality of sample transportation has increased and health workers are more capable of polio sampling,” he states.
They point out the below data on outcomes (from January 2022- February 2024):
• Turn round time (TAT): 94.7% of the specimens arrived at the central laboratory within 3 or less days of specimen collection.
• Quality: Almost all (99.3%) of the specimens arrived at the national lab in good condition.
Both attribute these changes to the effective support and collaboration facilitated by Project HOPE and VillageReach.
“As a regional surveillance team leader, I participated in the selection of the hub with the EPHI and Project HOPE officers,” Kebede recalls. “I also facilitated training for health care providers, conducted joint supportive supervision, promoted deep freezer utilization and distributed log tags to all concerned.”
Distribution of deep freezers to temporary AFP storage hubs in Gode Hospital, Somali Region, Sep 2023. Photo credit: Tirusew Maru
Some of the notable achievements include:
• Training of 738 sub-national VPD surveillance officers in polio and other VPD specimen management training. This included orientation on log tag utilization and integration with training on VPD specimen transportation rollout at the sub-national level.
• Procurement of 10 deep freezers with stabilizers and 2,000 log tags (U-TRIX remote temperature monitoring (RTM) trackers) to constantly track the temperature of samples in transit.
• Conducting supportive supervision and real-time specimen movement auditing in various regions of Ethiopia.
• Providing a high-capacity computer to collect log tag data at the National Polio and Measles lab
• Establishing ten transit hubs and supported the hubs with freezers to supply ice packs and storage of samples.
Quality of polio sample transportation: July 2023-February 2024
The key lessons learned from these experiences emphasize the importance of standard guidelines and meticulous care in sample collection and transportation. “Polio samples need special care and transportation to get quality results,” Kebede advises. “All surveillance officers should use standard guidelines to collect, handle and transport polio samples to the national lab.”
A Brighter Future Within Reach
The journey toward a polio-free world is marked by collaboration, resilience and hope. The partnership between the Ethiopian Ministry of Health, Project HOPE and VillageReach exemplifies how innovative approaches and collaborative efforts can bring about transformative changes.
As we move closer to eradicating polio, Ethiopia’s success serves as a powerful reminder of what can be achieved when dedicated individuals and organizations work together towards a common goal. Through continued efforts and unwavering commitment, a polio-free world is within our reach.
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For more information about the Polio Lab Sample Transport program in Ethiopia, contact Mr.
Aychiluhim Damtew, Ethiopia Project Hope (adamtew@projecthope.org) or Mr. Dauda Majanbu (Dauda.Majanbu@villagereach.org)