Consultant - Retrospective Analysis of Case Records of Suspect Cholera-SAM Cases of the 2017 Cholera Outbreak in Nigeria at International Rescue Committee (IRC)

Location: Maiduguri, Borno 
Program: Nutrition Program

Background and Rationale

• The International Rescue Committee (IRC) is implementing health, nutrition, environmental health, protection, gender based violence, education and economic recovery and development services for internally displaced people, returnees, and host communities in Northeast Nigeria since 2014.
• In Nigeria, the humanitarian crisis provoked by the ongoing conflict in the northeast has affected more than 14.8 million persons, and 80% of the displaced are in Borno. The majority of Borno state is food insecure and SAM among children under five in conflict-affected states of Yobe, Borno, and Adamawa is high. Humanitarian access to new areas of Borno is increasing, revealing significant humanitarian needs. 5,311 suspected cholera cases have been reported in Borno since August 2017, with an apparent decline at the end of September 2017. The CFR is 1.1%. The burden of co-morbid cholera-SAM cases is currently untallied and unknown.
• The diagnosis and treatment of cholera or acute watery diarrhea (AWD) among children who are also affected by severe acute malnutrition (SAM) is a current topic of importance to the current famine in Borno, and more broadly to those concerned with cholera case management including the US Centers for Disease Control and Prevention and the Global Task Force for Cholera Control (GTFCC). At the moment, no guidelines exist for the management of these children.
• There are three major problems in the management of this patient population. First, measurement protocols are unclear which may result in the routine misclassification of children with cholera only or other diarrhea incorrectly as comorbid cholera-SAM cases given their massive fluid loss. Second, the emphasis on rapid rehydration for comorbid cholera-SAM cases is of the utmost importance for survival. However, they may be rehydrated slowly due to hesitancy in administering ORS too quickly to malnourished children.
• Third, there is likely an unknown degree of under diagnosis of cholera among SAM cases considering the high SAM rates in the target population and the current low proportion (5%) of U5 cases managed for cholera and SAM. Providers must improve triaging processes where appropriate malnutrition assessment methodologies are consistently applied or documented at the CTC during admission, and improve technical skills in relation to identifying and managing co-morbidity, as well as lack of appropriate treatment modalities especially rehydration fluids (for example, in whether to administer ORS to cholera cases or whether ReSoMal for non-cholera U5s with diarrhea only).
• Through a US Centers for Disease Control (CDC) project, the IRC seeks to learn from the health programs past experience in the management of cases with cholera and SAM co-morbidity.

Objectives
Overall objective:

• Conduct a retrospective analysis of case records of all suspected cholera-SAM cases for the 2017 outbreak in Borno State including a comprehensive audit/review of:
  • The operational protocols, both proposed and practiced by health staff, and
  • The existing medical records with regards to management of U5 cases with cholera-SAM at CTCs will be undertaken.
• The review of CTCs in the catchment area will be those run by the Ministry of Health and other partners. This will include analysis of existing CTC treatment protocols, patients’ files, and essential supplies and services.
• Through these efforts, more information on key areas will be elucidated, i.e. identification of comorbid cases through CTCs and nutrition services, referral practices, rehydration practices, length of stay, and treatment outcomes.

Methodology
To achieve the different expected results, the activities for the consultant are as follows:

Activities- Number of Days:

• Inception report, including the methodology, plan on how to use data collection tools provided, preliminary findings, workplan and budget - 3 Days
• Retrospective review of case records in CTC to assess management of cholera and SAM co-morbidity - 15 days
• Travel days - 4 days
• Total = 22 days

The consultant will be expected to coordinate with IRC technical coordinators regarding the methodology and data collection/stakeholder coordination process. S/he will also work closely with the National Medical Doctor Assistant recruited for this project. The consultant is also expected to coordinate with IRC HQ for progress updates and deliverables. The consultant will liaise with other partners like MSF, FHI, and the MOH to review their records. The final datasets of key descriptive, treatment and outcome variables will be the major product and will be analyzed by the IRC Health Unit, and shared with the CDC.

Documents to be produced:

• Inception report
• Original and cleaned datasets of cholera/SAM cases, including field notes

The datasets will be shared with IRC Nigeria and IRC HQ for review and analysis.

Qualifications

• A degree in Public Health or any other area of study related to the terms of reference; training from a Field Epidemiology Training Program is desirable
• Experience in managing/investigating cholera outbreaks, severe acute malnutrition, case reviews and facility assessments
• Experience in writing/editing/formulating research, preferably with INGOs, governments or academia
• Excellent analytical and reporting skills
• Knowledge and experience working for NGOs
• Fluency in written and spoken English

Duration and Location

• The assignment is expected to be undertaken in Maiduguri in March-April 2018 and take a maximum of 22 consultancy days, which includes desk review, development of the inception report (which needs to be approved by IRC), data collection, and validation meetings. The detailed work plan/timeline will be developed by the consultant.

IRCs Responsibility:

• Pay consultancy fees at a mutually agreed rate after successful completion of the consultancy and submission of the specified documents.
• Pay for international flight, visa
• Cater for consultant accommodation and transport to the field

Budget
There is a fixed budget for this piece of work. Payment will be done on the basis of the submitted work plan, daily fees shall be negotiated:

• 20% of the fees will be paid upon signature of contract,
• 40% upon reception of draft report and
• 40% will be paid after validation of the final report by IRC.