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National contact tracing, Cross-border surveillance in Malaba-Busia, and Bungoma experiences during the COVID-19 Response

I have been involved in Kenya COVID-19 response since the confirmation of the first case in Kenya. My roles have been the following:

  • Conducting contact tracing at the national Public Health Emergency Operations Center
  • Capacity building of Bungoma and Busia Counties on active case search
  • Capacity building of county Rapid Response Team and data management teams in Bungoma and Busia Counties
So far, I have participated in the contact tracing, capacity building of counties in active case search, supported Bungoma and Busia counties in rapid response, and data management as outlined in the table below.
# Activity Timeline Venue
1. National Contact tracing at the public Health Operations Emergency Center and consolidation of the national contacts summary reports 16 March-to date PHEOC and NASCOP grounds
2. Capacity building of Rapid Response and data management teams in Bungoma County 8th May- 13th May 2020 Bungoma County
3. Capacity building of Rapid Response and data management teams in Bungoma County 14th – 20th May 2020 Busia County

Over the time that I have been discharging my duties as indicated above, I encountered the following challenges.

  • In contact tracing at the national level, as the number of cases increased by the day and targeted mass testing was introduced, the cases started giving out wrong numbers, and therefore we couldn’t reach most of the confirmed cases and consequently their contacts. This could lead to massive COVID-19 community transmission posing more risk to the general population and the economy at large. Since this was beyond us, a higher level communication was done directing that if the case phone number ain’t going through we forward their names and the phone numbers to the overall contact tracing person for further investigations. Some were traced by the help of the Nairobi County disease surveillance coordinator through physical contact tracing.
  • Most of the contacts did not want to be taken to quarantine centers and some deliberately switched off their phones hence missing out the 14 days follow up. If the phone number failed to get through for two consecutive days, the number was forwarded to National intelligence Security for tracking and most of them were taken to mandatory quarantine centers.
  • Delayed testing of the contacts according to the Ministry of Health guidelines due to inadequate testing kits and constrained human resources. This could lead to missed opportunities to detect COVID-19 regarding its incubation of 2-14 days. The contacts kept on asking when they will get tested since some had exceeded the 14 days by far. I reassured them that even if there is a delay, they will finally get tested of which majority got tested.
  • In Bungoma and Busia counties, I noted that none of the Counties had generated contacts for their cases. I worked with the County Disease Surveillance coordinator who seconded health records officer for on-job training on how to go about it. They were independently able to generate a list of contacts, the summary report, and send it to the national PHOEC which they have continued to report up to date.
  • Bungoma County did not have a clear case definition of who is supposed to be quarantined. I participated in their response of a suspected case as I mentored the County disease surveillance on a stepwise approach on how to clerk the suspected case to weigh whether they meet the case definition.
  • The long ques and trucks traffic jams. We visited Malaba border to ascertain the main cause of the traffic jam along the border. We noted that the Kenyan point of entry side had the following challenges:
    1. Has no parking and the process of verifying the truck driver’s documents was manual. We discussed with the county representative and the Port health KRA on how well can the planned mass testing roll out.
    2. The port has inadequate health care workers and limited space, there was a six-bed isolation center that can only hold 3 men and 3 females.
    3. There isn’t an Ambulance and had to depend on the county government of Busia for evacuation.
    4. There was no space to conduct the sample collection despite having received the testing Kits from the national government.
    5. Inadequate Personal Protective Equipment

Lessons learnt during the response include:

  • Contact tracing is a key element in COVID-19 response. The chain of transmission can be stopped through proper contact tracing
  • Continued cross-border surveillance is key in active case search
  • Proper coordination regarding COVI-19 response is an important aspect
  • Teamwork between the multiagency teams is of the essence in response
  • The COVID-19 response will be incapacitated without human and financial resources
  • Uganda Is using Gene Xpert in the testing of truck drivers and thus no delays in release of the results
  • The use of thermoscanner on the Ugandan point of entry hastened the process on their end.
Generally, Kenya has achieved a great milestone in the fight against COVID-19 with the current measures that the government has put in place like the closure of schools, social gatherings, dawn to dusk curfew, the lockdowns of hotspots, emphasis on handwashing, social distancing, coughing etiquette and wearing of masks. However, the measures put in place have had a lot of economic impacts and therefore rendering some of the measures unsustainable. As the disease continues to spread and the number of cases building up, the government needs to come up with other strategies that are more economic and health-friendly in curbing the disease. COVID-19 is here to stay and before its treatment is discovered, there's a need for the general population to take personal responsibility and protect one another against the disease. Decentralization of the national responses to counties will ease the national government much pressure and hence able to major on COVI-19 capacity strengthening in all counties. Testing to be introduced at the health facility level and involve the community health volunteers in active case search and raising of alerts.

Recommendations:

  • To continue with cross border Surveillance along the border
  • The national government to continue with COVID-19 Counties capacity strengthening
  • The national government to fast track use of Electronic Medical Records (EMR) since it is user friendly
  • Kenya to embrace the use of Gene Xpert machine in testing since they are available up to the sub-county level
  • Harmonize testing protocols and recognition of results between Uganda and Kenya.
  • Digitize the registration process at the entry to the port health to address the delay at port health (self-quarantine forms and police registration)
  • Consider additional staff to support in sample collection
  • Intensify disinfection of persons and vehicles entering the port health
  • Provision of a testing area for sample collection
  • Continuous supply of PPEs
  • Involvement of the truck owners to ensure that they have their drivers tested and issued with a certificate before starting the journey.
  • Multi-agency approach and Strengthen partnership with other agencies and authorities like KENHA, KRA, and NIS at the border is key.

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