Random Analytica

Random thoughts, charts, infographics & analysis. Not in that order

Tag: Sierra Leone

Random Analytics: Ebola in Sierra Leone (to 31 Aug 2014)

I noted recently that Crawford Kilian (whom I now read almost daily to give me a break from my current Workforce Planning responsibilities) stated that the Sierra Leone Ministry of Health and Sanitation had moved from an adhoc social media channel to a more developed website and it was very good.

I completely concur.

The Ministry of Health and Sanitation for the Sierra Leone Government has recently updated its Situation Report (SITREP) on the Ebola Virus Disease (EVD) to the 31st August 2014. It is recommended viewing but here is an infographic of the situation, along with a data review for the Government of Sierra Leone for consideration (the latest update comes with a data anomaly) and a couple of laymen questions.

01 - Ebola_SierraLeone_140903

The Ebola in Sierra Leone (by District) infographic details the cases and fatalities from EVD including probable and suspected cases. Each District which is impacted by is listed with each figure representing 10x lives and then colour coded (see notes). The provisional CFR is based on total numbers and might not represent the Ministry of Health and Sanitation figures.

It should be noted that the outbreak is ongoing so these numbers are still very provisional.

2 - SierraLeone_StatsByDistrict_140903

The next is a table which highlights a very minor data anomaly (in red), which I will pass on immediately to the staff at the Ministry of Health and Sanitation.

Data anomaly aside, I hope that my small intrusion into their daily (and more important work that I am currently completing) adds some value. I know that the Ministry is under huge pressure and that their work truly does matter.

Final Thoughts, Predictions or Problems:

I’ve no problem with the data-cleansing itself anymore, outside of a small anomaly. The Sierra Leone government should be congratulated on its better presentation of the data, especially given its background story, low infrastructure prior to this new medical crisis and recent history in terms of civil war etc.

Yet I find some issues with the current data presented. I’m sure there are answers to these issues but there are questions that must be answered:

The Confirmed Fatality Rate for the most impacted regional Districts seems reasonable given the economic constraints of the country. I note the Districts of Kailahun and Kenema have a current total provisional CFR in the 40-percentile range. Yet, a couple of questions:

  • The current CFR in Western Rural is 3.9% (yet including all cases is 57 including four deaths with a CRF of 7%; both totals seem a bit low; and:
  • The big unexplainable for me is the CFR in Port Loko which the latest update currently states is just 2.9%. Given that when I last looked at the data (to 13 August) the CFR was 12% with 25-cases there has been either an anomaly with the data or a health deployment that I am not yet across.

Data Sources

[1] d-maps.com. Africa: states, main cities. Accessed 28 August 2014.
[2] d-maps.com. Sierra Leone / Republic of Sierra Leone: boundaries, districts, main cities. Accessed 2 September 2014.
[3] Ministry of Health and Sanitation. Ebola Virus Disease – Situation Report (Sit-Rep) – 01 September, 2014. Sierra Leone Government. Accessed 2 September 2014.

Random Analytics: Ebola in Sierra Leone (to 14 Aug 2014)

Sherlock Holmes was famously quoted as saying that ‘when you have eliminated the impossible, whatever remains, however improbable, must be the truth?’

Yesterday I had a Twitter conversation with virologist Ian M Mackay and currently Sierra Leone deployed health reporter Jennifer Yang about the disconnect between the official World Health Organisation figures and the Sierra Leone Ministry of Health updates. In brief, the Sierra Leone MoH figures are always lower than those presented by WHO which made no sense to me given that the MoH should be data-prime. The numbers anomaly had recently been noted by key Flublogist Crawford Kilian on his blog H5N1.

During the conversation a number of theories were put forward by various parties including a lack of capacity on the ground, data-chain promulgation/speed issues and even a conspiracy theory where-by the Ebola outbreak is linked to central government suppression of the Kailahun/Kenema districts (which border both Guinea/Liberia) as both districts are opposition strongholds.

Although there is certainly issues around ‘boots on the ground’ capacity (see Jennifer’s excellent article from Sierra Leone) the answer to the question as to why there was a significant difference between the Sierra Leone MoH and the WHO numbers turned out to be blindingly obvious.

Most of the reports coming out directly from Sierra Leone are the Ministerial statements which only include confirmed numbers whereas if you dig a little further you can find the full updates including suspected and probable cases in the Ebola Situation Reports.

Here is the look at the situation in Sierra Leone by District based on the most updated Ebola Situation Report (Vol. 78 dated 14 August 2014).

01 - Ebola_SierraLeone_140815

The above infographic details the cases and fatalities from Ebola in Sierra Leone. Cases include all suspected, probably and confirmed cases and the provisional CFR is based on those total numbers.

As you can see the Kailahun and Kenema Districts are the most impacted regions with Sierra Leone accounting for 84.7% of all cases and 95.8% of all fatalities.

 

Data Sources

[1] Government of Sierra Leone Ministry of Health and Sanitation. EBOLA VIRUS DISEASE – SITUATION REPORT (Sit-Rep) – 14August, 2014. Government of Sierra Leone. Accessed 15 August 2014.

 

Random Analytics: The West African Ebola Outbreak (to 4 Aug 2014)

Here are some updated charts and infographics of the 2014 Ebola Virus Disease outbreak using a number of primary sources including the most recent World Health Organisation Disease Outbreak News (DON) released 6 August 2014.

***** Please note that all EVD infographics in this series were updated with public source information to 4 August 2014 *****

01 - Ebola_Top10OutbreaksByCaseNos_140808

Ebola (Top 10 Outbreaks by Case Numbers)

The first chart displays the top 10 outbreaks in order of case numbers. Each horizontal bar is filled with the flag(s) of the country where the outbreak occurred.

With clinical cases reaching 691 in Guinea, 516 in Liberia, 495 in Liberia and nine in Nigeria the West African outbreak has now become largest Ebola outbreak in history based on both case numbers (1711) and fatalities (932). The second largest outbreak was of the Ebola Sudan strain which occurred in Uganda (2000) when 425 became infected and 224 died. The recent outbreak is the first to migrate across international land borders. The only other recording of an EVD that jumped borders prior to this outbreak was the Gabon/RSA (1996) outbreak. In that instance a doctor caught the disease in Gabon and subsequently took an international flight to South Africa where he became ill and infected other Health Care Workers (HCWs).

02 - Ebola_CasesbyClassYear_140808

Ebola (Cases by Classification and Year)

The second chart shows cases by classification (in order they are Ebola Zaire, Sudan, Bundibugyo, Reston and Ivory Coast) by year and then split into those recovered or those deceased (which follows in a red variant). The West African outbreak has become the most significant in terms of case numbers, eclipsing the 1976 dual outbreaks which saw 603 cases and 431 deaths (a combined Case Fatality Rate of 71.5%).

Currently the provisional Western African outbreak has seen 1711 cases and 932 deaths (a CFR of 54.5%).

Notes: Several years had just one case. They are 1972 (a retrospective fatality of Ebola Zaire in Zaire), 1977 (a single case of Ebola Zaire in Zaire), 1988 (an accidental infection of Ebola Zaire in Porton Down, UK) and 2011 (a single fatality of Ebola Sudan in Uganda).

 03 - WestAfrica_Cases~FatalitiesMonth_140808

The West African Outbreak – Cases & Fatalities by Month

The final chart shows both case numbers and fatalities by month. Each column is split into the current four impacted countries with data represented by the varying national flags.

The very interesting data point that springs out from this chart is that the DON I utilised for this only had data for the first four days of the month yet cases are already 271 and fatalities are 106. It should be noted that those figures are not exact as the DON that covered the month rollover between July and August had to be estimated (using a 50/50% split).

 

Acknowledgements: Data for this infographic was sourced from official reports from the World Health Organisation. I have also utilised resources from the CDC, CIDRAP, FluTrackers, and H5N1. I’m also a big fan of the analytical work of Virology Down Under (Ian Mackay) and Mens et Manus (Maia Majumder).

Random Analytics: Ebola 2014 (to 25 Jun 2014)

Here are some charts and infographics of the 2014 Ebola Virus Disease outbreak.

Ebola Outbreak (Guinea Prefectures 2014)

01 - Ebola_Guinea_140625

 

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The above infographic looks at the breakdowns by Prefecture of EVD cases and fatalities within Guinea. Data sourced from Ebola virus disease, West Africa – update 23 June 2014.

Ebola Outbreak (Sierra Leone Districts 2014)

02 - Ebola_SierraLeone_140625

 

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The above infographic looks at the breakdowns by District of EVD cases and fatalities within Sierra Leone. Data sourced from Ebola virus disease, West Africa – update 23 June 2014 and the latest Sierra Leone Ministry of Health update (via FluTrackers).

Ebola across Africa

03 - Ebola_AcrossAfrica_140625

 

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST). EVD types are EBOV = Ebola Zaire, SUDV = Ebola Sudan, BDBV = Ebola Bundibugyo and TAFV = Ebola Ivory Coast *****

The Ebola across Africa infographic details the country specific outbreaks of the EVD since it was first discovered in 1976 (with a 1972 retrospective case from Zaire included). As the map shows the bulk of the outbreaks have occurred within central Africa and the most deadly, Ebola Zaire causing the most cases in the Democratic Republic of Congo (formally Zaire). The most recent outbreak has actually occurred in West Africa, originating from Guinea and is a new isolate of Ebola Zaire (Gueckedou and Kissidougou).

As an additional point of interest I have also added the Health Expenditure per capita for each country in 2012 $USD (source: World Bank).

Notes: The 1976 – 2004 outbreaks of Ebola Sudan occurred in the bottom half of Sudan (now South Sudan). Zaire was renamed the Democratic Republic of Congo in 1997.

Ebola (Top 10 Outbreaks by Case Numbers)

04 - Ebola_Top10OutbreaksByCaseNo_140625

***** ***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The next chart displays the top 10 outbreaks in order of case numbers and each horizontal bar is filled with the flag of the country where the outbreak occurred. With clinical cases reaching 344 in Guinea, 81 in Sierra Leone and 12 in Liberia the EBOV17 coded outbreak has now become largest (437) based on case numbers. The second largest outbreak (SUDV4) was of Ebola Sudan in Uganda (2000) when 425 became infected and 224 died. The recent outbreak is the first to migrate across international land borders. The only other recording of an EVD that jumped borders prior to this outbreak was the 10th worst outbreak (EBOV8) when a doctor caught the disease in Gabon and subsequently took an international flight to South Africa where he became ill and infected other health workers.

Notes: EBV outbreaks in order from lowest to highest. 10th: EBOV8 (Gabon/South Africa), 9th: EBOV9 (Gabon), 8th: EBOV11 (Republic of Congo), 7th: BDBV01 (Uganda), , 6th: EBOV15 (Democratic Republic of Congo), 5th: SUDV1 (technically Sudan but would now be South Sudan), 4th: EBOV6 (Zaire but now the DRC), 3rd: EBOV2 (Zaire but now the DRC), 2nd: SUDV4 (Uganda) and the current, now deadliest outbreak EBOV17 (Guinea/Liberia/Sierra Leone).

Ebola (Cases by Classification and Year)

05 - Ebola_CasesbyClassYear_140625

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The final chart shows cases by classification (Ebola Zaire, Sudan, Bundibugyo, Reston and Ivory Coast) by year and then split into those recovered or those deceased (following in a red variant). From 24 June this latest outbreak has become the most significant in terms of case numbers, eclipsing the 1976 dual outbreaks which saw 603 cases and 431 deaths (a combined Case Fatality Rate of 71.5%).

Currently the provisional Western African outbreak has seen 604 cases and 350 deaths (a CFR of 57.9%).

Notes: Several years had just one case. They are 1972 (a retrospective fatality of Ebola Zaire in Zaire), 1977 (a single case of Ebola Zaire in Zaire), 1988 (an accidental infection of Ebola Zaire in Porton Down, UK) and 2011 (a single fatality of Ebola Sudan in Uganda).

Key Facts: (source: Fact Sheet 103, WHO, last updated March 2014)

  • The Ebola virus causes Ebola virus disease (EVD; formerly known as Ebola haemorrhagic fever) in humans;
  • EVD outbreaks have a case fatality rate of up to 90%;
  • EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests;
  • The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission;
  • Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus;
  • No specific treatment or vaccine is available for use in people or animals.

Acknowledgements:Data for this infographic was sourced from official reports from the World Health Organisation. I have also utilised resources from the CDC, CIDRAP, FluTrackers, H5N1 and Virology Down Under.

Random Analytics: Ebola 2014 (to 9 Jun 2014)

The latest outbreak of Ebola which had been on the decline in early May has now returned with a vengeance. According to the latest update from the World Health Organisation (Regional Office for Africa) there have been 437-clinical cases and 232 fatalities. Guinea has borne the brunt of the disease with 344-clinical cases (215-deaths), the second impacted country Liberia has had 12-clinical cases (11-deaths) and newly impacted country of Sierra Leone has had 81-cases (6-deaths). These numbers are still likely to change.

According to my notes, this outbreak is now the worst on record in terms of case numbers, extending beyond the 425-cases (224-deaths) experienced during the Ebola Sudan outbreak in Uganda back in 2000-2001. Another two grim milestones is that this is the first Ebola outbreak to cross a land border and the first outbreak to impact on three separate countries.

Here are four charts/infographics looking at the most recent outbreak.

Ebola Virus Disease Outbreak (Guinea Prefectures 2014)

01 - Ebola_GuineaOutbreak_140609

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST) *****

From the World Health Organisation Regional Office for Africa. Ebola virus disease, West Africa (Situation as of 5 June 2014). Excerpt:

Guinea

Between 2 and 3 June 2014, 11 new cases (8 confirmed, 1 probable and 2 suspected) and 3 new deaths were reported from Conakry (7 new cases and 1 death), Guéckédou (2 new cases and 1 death), Telimele (1 new case and 0 death) and Boffa (1 new case and 1 death). This brings the cumulative total number of cases and deaths attributable to EVD in Guinea to 344 (laboratory confirmed 207, probable 81 and suspected 56) including 215 deaths.

The geographical distribution of these cases and deaths is as follows: Conakry (65 cases and 27 deaths; Gueckedou, 193 cases and 143 deaths; Macenta, 44 cases and 26 deaths; Dabola, 4 cases and 4 deaths; Kissidougou, 7 cases and 5 deaths; Dinguiraye, 1 case and 1 death; Telimele, 23 cases and 5 deaths; and Boffa, 7 cases and 4 deaths. In terms of isolation, 31 patients are currently hospitalized (6 in Conakry, 9 in Guéckédou, 15 in Telimele and 1 in Boffa).

Sierra Leone

Between 2 and 5 June 2014, 9 new suspected cases were reported bringing the total number of EVD clinical cases to 81 (31 confirmed, 3 probable, and 47 suspected) including 6 deaths. Kailahun district is the epicentre of the outbreak in Sierra Leone. Eleven (11) cases are currently in isolation at Kenema Hospital. The number of contacts currently being followed-up is 30. Community resistance is hindering the identification and follow-up of contacts.

Notes: The map graphic was taken from Wikipedia (then amended).

Ebola across Africa

02 - Ebola_AcrossAfrica_140609

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST). EBOV = Ebola Zaire, SUDV = Ebola Sudan, BDBV = Ebola Bundibugyo and TAFV = Ebola Ivory Coast *****

The Ebola across Africa infographic details the country specific outbreaks of the EVD since it was first discovered in 1976 (with a 1972 retrospective case from Zaire included). As the map shows the bulk of the outbreaks have occurred within central Africa and the most deadly, Ebola Zaire causing the most cases in the Democratic Republic of Congo (formally Zaire). The most recent outbreak has actually occurred in West Africa, originating from Guinea and is a new isolate of Ebola Zaire (Gueckedou and Kissidougou).

As an additional point of interest I have also added the Health Expenditure per capita for each country in 2012 $USD (source: World Bank).

Notes: The 1976 – 2004 outbreaks of Ebola Sudan occurred in the bottom half of Sudan (now South Sudan). Zaire was renamed the Democratic Republic of Congo in 1997.

Ebola (Top 10 Outbreaks by Case Numbers)

03 - Ebola_Top10OutbreaksByCaseNo_140609

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST) *****

The next chart displays the top 10 outbreaks in order of case numbers and each horizontal bar is filled with the flag of the country where the outbreak occurred. With clinical cases reaching 344 in Guinea, 81 in Sierra Leone and 12 in Liberia the EBOV17 coded outbreak has now become largest (437) based on case numbers. The second largest outbreak (SUDV4) was of Ebola Sudan in Uganda (2000) when 425 became infected and 224 died. The recent outbreak is the first to migrate across international land borders. The only other recording of an EVD that jumped borders prior to this outbreak was the 10th worst outbreak (EBOV8) when a doctor caught the disease in Gabon and subsequently took an international flight to South Africa where he became ill and infected other health workers.

Notes: EBV outbreaks in order from lowest to highest. 10th: EBOV8 (Gabon/South Africa), 9th: EBOV9 (Gabon), 8th: EBOV11 (Republic of Congo), 7th: BDBV01 (Uganda), , 6th: EBOV15 (Democratic Republic of Congo), 5th: SUDV1 (technically Sudan but would now be South Sudan), 4th: EBOV6 (Zaire but now the DRC), 3rd: EBOV2 (Zaire but now the DRC), 2nd: SUDV4 (Uganda) and the current, now deadliest outbreak EBOV17 (Guinea/Liberia/Sierra Leone).

Ebola (Cases by Classification and Year)

04 - Ebola_CasesbyClassYear_140609

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST) *****

The final chart shows cases by classification (Ebola Zaire, Sudan, Bundibugyo, Reston and Ivory Coast) by year and then split into those recovered or those deceased (following in a red variant). As you can see the initial outbreak in 1976 of the both Ebola Zaire and Ebola Sudan was the most significant year with 603 cases and 431 deaths (a combined Case Fatality Rate of 71.5%). With up to 437 clinical cases so far the 2014 Ebola Zaire outbreak is now the second worst in terms of case numbers.

Notes: Several years had just one case. They are 1972 (a retrospective fatality of Ebola Zaire in Zaire), 1977 (a single case of Ebola Zaire in Zaire), 1988 (an accidental infection of Ebola Zaire in Porton Down, UK) and 2011 (a single fatality of Ebola Sudan in Uganda). The 2014 numbers are currently provisional.

Key Facts: (source: Fact Sheet 103, WHO, last updated March 2014)

  • The Ebola virus causes Ebola virus disease (EVD; formerly known as Ebola haemorrhagic fever) in humans;
  • EVD outbreaks have a case fatality rate of up to 90%;
  • EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests;
  • The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission;
  • Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus;
  • No specific treatment or vaccine is available for use in people or animals.

Acknowledgements: Data for this infographic was sourced from official reports from the World Health Organisation. I have also utilised resources from the CDC, CIDRAP, H5N1, Virology Down Under and National Geographic.