GET Journal of Biosecurity and One Health (2022)

Integration of Quality Management Systems in a Rural, Low-Resource Environment: The Experience at Phebe Hospital in Bong County, Liberia

Authors: Sibley J1;Quellie SG1; Mendy PO1; Sayee DAN1;EastmanCB2; Stewart GK2; Reid EA2; Kennedy SB3*

GET Journal of Biosecurity and One Health, Volume 1, Issue 2, (2022), Pages 1-7

Article Keywords: Laboratory; Liberia; Quality Management System; Rural Hospital; Resource-Limited Setting


Journal Volume & Issue

Volume 1, Issue 2


Volume 1, No. 4, 2022

Pages 34-40

Ebola Survivors are not at Increased Risk for Gynecologic Surgeries

Gorpudolo-Dennis N1; Kennedy SB2*; Reilly C3 and Sankoh M1

1Department of Obstetrics and Gynecology, Redemption Hospital, New Kru Town, Montserrado County, Monrovia, Liberia.

2UL-PIRE Africa Center, An Infectious Disease Research Center, Ground Floor, Graduate School Building, University of Liberia, Monrovia, Liberia.

3Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA.

*Corresponding Author: Stephen B. Kennedy, MD, MPH, UL-PIRE Africa Center, An Infectious Disease Research Center
Ground Floor, Graduate School Building, University of Liberia, Monrovia, Liberia. Tel: +231 770 645 830

Orchid No:


As the result of multiple signs and symptoms, and complications observed among survivors of the Ebola virus disease (EVD), there is an assumption that survivors might experience perturbations within their clotting parameters. This may eventually lead to increased bleeding time, predisposing them to increased risk for surgical complications. This study aimed to comparatively review specific intra-operative parameters such as uterine fibroids and polyps among a number of EVD survivors and non survivors undergoing elective gynecologic surgeries at Redemption Hospital, a tertiary specialized referral hospital located within one of the EVD hotspots, in Liberia from January to October 2016. A case-control study was conducted wherein cases were referred from the Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), an EVD clinical trial platform, while controls were sampled from the general patient population, at Redemption Hospital. The controls were matched based on age, employment status and parity. All surgeries were performed by single surgeon based on a surgical checklist that included designated intra- and post-operative parameters. Statistical analysis such as counts, percentiles, confidence intervals and relative risks were performed to assess the differences between the cases and controls, respectively. Survivors were between the ages of 42 years and 44 years for controls with an average interval between discharge from the Ebola Treatment Unit (ETU) and surgical intervention of greater than one year. The median duration of surgical procedure was 60 minutes and blood loss of 250 ml in both groups. Besides the relative risks (RR) of receiving antibiotics for more than 3 days of 1.5 (85.7% vs. 57.1%) and hospitalization of more than 7 days of 0.25 (14% vs. 57%) for survivors as compared to controls, most of the indicators were not significantly different. The findings revealed that EVD survivors who present with benign tumors such as uterine fibroids, polyps, or adenomyosis, requiring elective uterine surgery such as myomectomy and/or hysterectomy are generally not at increased risk of surgical complications because most of the indicators (hospitalization, blood loss, antibiotics, etc.) were not significantly different between the two groups. Findings from this study may potentially revise the approaches used by gynecologists and general surgeons during encounters and/or interventions with patient(s) concerning emerging infectious diseases (EIDs).

Keywords: Ebola Virus Disease (EVD), Emerging Infectious Diseases (EIDs), Ebola Survivors, Uterine Surgery, Females, Liberia


Laboratory strengthening programs have been limited to clinical testing for prioritized diseases such as Ebola Virus Disease (EVD), Lassa Fever, COVID-19, Multidrug Resistant Tuberculosis, Malaria, and Human Immunodeficiency Virus (HIV). While patient outcomes are key concerns, limited efforts have
been directed at improving Quality Management Systems (QMS). The benefits of QMS are correlated to improved patient care in resource-limited settings. This article examines the ability of a laboratory in a low-resource setting to integrate QMS into clinical care, describes its challenges, and measures its benefits on improved treatment outcomes. Gap analysis was conducted to implement QMS at Phebe
Hospital, Bongo county, Liberia. We prioritized the framework of workflow processes and reorganization, equipment and inventory management, and documentation as challenges hampering the effective
implementation of QMS. As a stepwise intervention strategy, laboratory workflow and infrastructure were remodeled, staff retrained, partners managed, and system changes were communicated to strengthen the laboratory systems. Improvement in communicating goals to clinicians, following work plans, managing staff time, delegating responsibilities, allocating resources, and strategically managing the presence of multiple partners as effective strategies to improve QMS were observed. We demonstrated
that improving QMS strengthens the laboratory systems at Phebe Hospital. To sustain such initiative, Phebe Hospital must focus efforts on building sustainable laboratory systems and structures. We propose future studies to evaluate the short- and long-term benefits of such interventions.