Unexplained cluster of deaths - Nana Kru Community, Dugbe River District, Liberia, January 2017

Introduction : an unexplained cluster of deaths (UCD) is deaths from unknown cause occurring closely together. In Liberia, UCD is one of the 14 priority events requiring immediate reporting and investigation. On 11th January, 2017, the Dugbe River District Health Team was notified of five unexplained deaths in Nana Kru Community. We investigated to describe the events, establish the causes of death, implement control measures and make recommendations. Methods : Nana Kru Community has 2000 inhabitants. It is served by one health facility accessible by 4 hours of walk. We interviewed family members and general Community Health Volunteer (gCHV) and reviewed medical records at the health facilities. Results : five children aged 4-8 years (median 4 years) had been ill. Three were males. It was clarified that three children died, not five. Four of the children presented with fever, difficult breathing, vomiting, diarrhoea, weakness and loss of appetite. They all tested positive for malaria and were referred to hospital by the gCHV. Two were treated for malaria at the hospital and discharged. The other two refused the referral and were managed at home but deteriorated and died on 7th January, 2017. None used insecticide treated nets (ITN). The fifth child had rashes all over his body, swollen legs and blisters since July 2016 and died at home on 1st January, 2017. Dead bodies were buried before team arrived. Conclusion : the likely cause of the 7th January, 2017 deaths was severe malaria. Contributing factors were delay in seeking healthcare, long distance to health facility, not sleeping under ITN. The cause of the death on 1st January, 2017 was not established. We conducted community sensitization on good health seeking behavior, use of ITN, safe burial and the importance of collecting specimen from dead bodies before burial. Upon our recommendation, a health-post has been setup in Nana Kru Community.