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Doras C, Özcelik R, Abakar MF, Issa R, Kimala P, Youssouf S, Bolon I, Dürr S. Community-based symptom reporting among agro-pastoralists and their livestock in Chad in a One Health approach. Acta Trop 2024; 253:107167. [PMID: 38458407 DOI: 10.1016/j.actatropica.2024.107167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
One Health Syndromic Surveillance has a high potential for detecting early epidemiological events in remote and hard-to-reach populations. Chadian pastoralists living close to their animals and being socio-economically unprivileged have an increased risk for zoonosis exposure. Engaging communities in disease surveillance could also strengthen preparedness capacities for outbreaks in rural Chad. This study describes a retrospective cross-sectional survey that collected data on clinical symptoms reported in people and livestock in Chadian agro-pastoral communities. In January-February 2018, interviews were conducted in rural households living in nomadic camps or settled villages in the Yao and Danamadji health districts. The questionnaire covered demographic data and symptoms reported in humans and animals for the hot, wet, and cold seasons over the last 12 months. Incidence rates of human and animal symptoms were comparatively analyzed at the household level. Ninety-two households with a homogeneous socio-demographic distribution were included. We observed cough and diarrhea as the most frequent symptoms reported simultaneously in humans and animals. In all species, the incidence rate of cough was significantly higher during the cold season, and diarrhea tended to occur more frequently during the wet season. However, the incidence rate of cough and diarrhea in animals did not predict the incidence rate of these symptoms in humans. Overall, the variations in reported symptoms were consistent with known seasonal, regional, and sociological influences on endemic diseases. Our retrospective study demonstrated the feasibility of collecting relevant health data in humans and animals in remote regions with low access to health services by actively involving community members. This encourages establishing real-time community-based syndromic surveillance in areas such as rural Chad.
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Affiliation(s)
- Camille Doras
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Veterinary Public Health Institute, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland
| | - Ranya Özcelik
- Veterinary Public Health Institute, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland
| | | | - Ramadan Issa
- Institut de Recherche en Elevage pour le Développement (IRED), N'Djamena, Chad
| | - Pidou Kimala
- Institut de Recherche en Elevage pour le Développement (IRED), N'Djamena, Chad
| | - Soumaya Youssouf
- Institut de Recherche en Elevage pour le Développement (IRED), N'Djamena, Chad
| | - Isabelle Bolon
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Salome Dürr
- Veterinary Public Health Institute, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland.
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Crawley AW, Mercy K, Shivji S, Lofgren H, Trowbridge D, Manthey C, Tebeje YK, Clara AW, Landry K, Salyer SJ. An indicator framework for the monitoring and evaluation of event-based surveillance systems. Lancet Glob Health 2024; 12:e707-e711. [PMID: 38364834 DOI: 10.1016/s2214-109x(24)00034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
Event-based surveillance (EBS) systems have been implemented globally to support early warning surveillance across human, animal, and environmental health in diverse settings, including at the community level, within health facilities, at border points of entry, and through media monitoring of internet-based sources. EBS systems should be evaluated periodically to ensure that they meet the objectives related to the early detection of health threats and to identify areas for improvement in the quality, efficiency, and usefulness of the systems. However, to date, there has been no comprehensive framework to guide the monitoring and evaluation of EBS systems; this absence of standardisation has hindered progress in the field. The Africa Centres for Disease Control and Prevention and US Centers for Disease Control and Prevention have collaborated to develop an EBS monitoring and evaluation indicator framework, adaptable to specific country contexts, that uses measures relating to input, activity, output, outcome, and impact to map the processes and expected results of EBS systems. Through the implementation and continued refinement of these indicators, countries can ensure the early detection of health threats and improve their ability to measure and describe the impacts of EBS systems, thus filling the current evidence gap regarding their effectiveness.
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Affiliation(s)
- Adam W Crawley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kyeng Mercy
- Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sabrina Shivji
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah Lofgren
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniella Trowbridge
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine Manthey
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yenew Kebede Tebeje
- Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Alexey Wil Clara
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Landry
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie J Salyer
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Jung J, Larsen TM, Beledi AH, Takahashi E, Ahmed AO, Reid J, Kongelf IA. Community-based surveillance programme evaluation using the platform Nyss implemented by the Somali Red Crescent Society-a mixed methods approach. Confl Health 2024; 18:20. [PMID: 38448896 PMCID: PMC10919031 DOI: 10.1186/s13031-024-00578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/25/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Somali Red Crescent Society (SRCS), supported by Norwegian Red Cross, has implemented community-based surveillance (CBS) in Somaliland. This methodology aims to reduce the high risk of epidemics by strengthening early warning and response from and at community level, particularly where there is a weak public health surveillance system. CBS is implemented through SRCS community volunteers, who report signals from the community via SMS to the software platform Nyss. This paper presents key findings from the CBS programme evaluation. METHODS A retrospective observational mixed-methods approach to evaluate the CBS programme was conducted, using routine CBS data from 2021 for Awdal and Togdheer regions and qualitative interviews with stakeholders' representatives. RESULTS The usefulness of the CBS programme in preventing, detecting, and responding to disease outbreaks was acknowledged by the stakeholders' representatives. 83% of the signals in Awdal region matched a Community Case Definition (CCD) and were escalated to the Ministry of Health and Development (MoHD)). For Togdheer region, 97% were escalated. Verification of signals by supervisors and escalation to the authorities was done timely.Alert outcome and response action was not well recorded, therefore there is limited evidence on sensitivity. The programme was shown to be simple and can be flexibly adjusted for new diseases and changing CCDs.Stakeholders appreciated being engaged, the good collaboration, their participation throughout the implementation and expressed high acceptance of the programme. CONCLUSION CBS can support early warning and response for a variety of public health risks. Improved documentation for alert outcomes could help to better evaluate the sensitivity of CBS. A participatory approach is vital to achieve successful community volunteer engagement. Software tools, such as the Nyss platform, can be useful to support effective and efficient CBS implementation.
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Affiliation(s)
| | - Tine Mejdell Larsen
- Norwegian Red Cross, now Norad - Norwegian Agency for Development Cooperation, Oslo, Norway
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Tshuma N, Elakpa DN, Moyo C, Soboyisi M, Moyo S, Mpofu S, Chadyiwa M, Malahlela M, Tiba C, Mnkandla D, Ndhlovu TM, Moruthoane T, Mphuthi DD, Mtapuri O. The Transformative Impact of Community-Led Monitoring in the South African Health System: A Comprehensive Analysis. Int J Public Health 2024; 69:1606591. [PMID: 38420516 PMCID: PMC10899425 DOI: 10.3389/ijph.2024.1606591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives: Community-led monitoring (CLM) is an emerging approach that empowers local communities to actively participate in data collection and decision-making processes within the health system. The research aimed to explore stakeholder perceptions of CLM data and establish a CLM Data Value Chain, covering data collection and its impact. Methods: Qualitative data were collected from stakeholders engaged in health programs in South Africa. Data analysis involved a collaborative workshop that integrated elements of affinity diagramming, thematic analysis, and the systematic coding process outlined in Giorgi's method. The workshop fostered joint identification, co-creation of knowledge, and collaborative analysis in developing the data value chain. Results: The findings showed that CLM data enabled community-level analysis, fostering program advocacy and local collaboration. It enhanced program redesign, operational efficiency, and rapid response capabilities. Context-specific solutions emerged through the CLM Data Value Chain, promoting sustainable and efficient program implementation. Conclusion: CLM is a powerful tool for improving program implementation, quality, and advocacy in South African healthcare. It strengthens accountability, trust, and transparency by involving local communities in data-driven decision-making. CLM addresses context-specific challenges and tailors interventions to local needs.
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Affiliation(s)
| | - Daniel Ngbede Elakpa
- The Best Health Solutions, Johannesburg, South Africa
- Center for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clinton Moyo
- The Best Health Solutions, Johannesburg, South Africa
| | - Melikhaya Soboyisi
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Gauteng, South Africa
| | - Sehlule Moyo
- The Best Health Solutions, Johannesburg, South Africa
| | | | - Martha Chadyiwa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | | | | | - David Mnkandla
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Gauteng, South Africa
| | | | | | - David D. Mphuthi
- College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Oliver Mtapuri
- School of Built Environment and Development Studies, College of Humanities, University of KwaZulu-Natal, Durban, South Africa
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Baertlein L, Dubad BA, Sahelie B, Damulak IC, Osman M, Stringer B, Bestman A, Kuehne A, van Boetzelaer E, Keating P. Evaluation of a multi-component early warning system for pastoralist populations in Doolo zone, Ethiopia: mixed-methods study. Confl Health 2024; 18:13. [PMID: 38291440 PMCID: PMC10829173 DOI: 10.1186/s13031-024-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND This study evaluated an early warning, alert and response system for a crisis-affected population in Doolo zone, Somali Region, Ethiopia, in 2019-2021, with a history of epidemics of outbreak-prone diseases. To adequately cover an area populated by a semi-nomadic pastoralist, or livestock herding, population with sparse access to healthcare facilities, the surveillance system included four components: health facility indicator-based surveillance, community indicator- and event-based surveillance, and alerts from other actors in the area. This evaluation described the usefulness, acceptability, completeness, timeliness, positive predictive value, and representativeness of these components. METHODS We carried out a mixed-methods study retrospectively analysing data from the surveillance system February 2019-January 2021 along with key informant interviews with system implementers, and focus group discussions with local communities. Transcripts were analyzed using a mixed deductive and inductive approach. Surveillance quality indicators assessed included completeness, timeliness, and positive predictive value, among others. RESULTS 1010 signals were analysed; these resulted in 168 verified events, 58 alerts, and 29 responses. Most of the alerts (46/58) and responses (22/29) were initiated through the community event-based branch of the surveillance system. In comparison, one alert and one response was initiated via the community indicator-based branch. Positive predictive value of signals received was about 6%. About 80% of signals were verified within 24 h of reports, and 40% were risk assessed within 48 h. System responses included new mobile clinic sites, measles vaccination catch-ups, and water and sanitation-related interventions. Focus group discussions emphasized that responses generated were an expected return by participant communities for their role in data collection and reporting. Participant communities found the system acceptable when it led to the responses they expected. Some event types, such as those around animal health, led to the community's response expectations not being met. CONCLUSIONS Event-based surveillance can produce useful data for localized public health action for pastoralist populations. Improvements could include greater community involvement in the system design and potentially incorporating One Health approaches.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna Kuehne
- Médecins Sans Frontières, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Izquierdo Condoy JS, Tello-De-la-Torre A, Espinosa Del Pozo P, Ortiz-Prado E. Advancing global health equity: the transformative potential of community-based surveillance in developing countries. Front Public Health 2023; 11:1294686. [PMID: 38131023 PMCID: PMC10733442 DOI: 10.3389/fpubh.2023.1294686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
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Wallis K, Mwangale V, Gebre-Mariam M, Reid J, Jung J. Software Tools to Facilitate Community-Based Surveillance: A Scoping Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200553. [PMID: 37903572 PMCID: PMC10615241 DOI: 10.9745/ghsp-d-22-00553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/05/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Public health surveillance traditionally occurs at a health facility; however, there is growing concern that this provides only partial and untimely health information. Community-based surveillance (CBS) enables early warning and the mobilization of early intervention and response to disease outbreaks. CBS is a method of surveillance that can monitor a wide range of information directly from community members. CBS can be done using short message service, phone calls, paper forms, or a specialized software tool. No scoping review of the available software tools with the capability for CBS exists in the literature. This review aims to map software tools that can be used for CBS in both community health programs and emergency settings and demonstrate their use cases. METHODS We conducted a scoping review of academic literature and supplemental resources and conducted qualitative interviews with stakeholders working with digital community health and surveillance tools. RESULTS All of the tools reviewed have features necessary to support the reporting process of CBS; only 3 (CommCare, Community Health Toolkit, and DHIS2 Tracker) provided all 10 attributes included in the mapping. AVADAR and Nyss were the only tools designed specifically for CBS and for use by volunteers, while the other tools were designed for community health workers and have a broader use case. CONCLUSION The findings demonstrate that several software tools are available to facilitate public health surveillance at the community level. In the future, emphasis should be put on contextualizing these tools to meet a country's public health needs and promoting institutionalization and ownership by the national health system. There is also an opportunity to explore improvements in event-based surveillance at the community level.
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Shannon G, Basu P, Peters LER, Clark-Ginsberg A, Herrera Delgado TM, Gope R, Guanilo M, Kelman I, Noelli L, Meriläinen E, Riley K, Wood C, Prost A. Think global, act local: using a translocal approach to understand community-based organisations' responses to planetary health crises during COVID-19. Lancet Planet Health 2023; 7:e850-e858. [PMID: 37821163 DOI: 10.1016/s2542-5196(23)00193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 03/28/2023] [Accepted: 08/17/2023] [Indexed: 10/13/2023]
Abstract
Little is known on how community-based responses to planetary health crises, such as the COVID-19 pandemic, can integrate concerns about livelihoods, equity, health, wellbeing, and the environment. We used a translocal learning approach to co-develop insights on community-based responses to complex health and environmental and economic crises with leaders from five organisations working with communities at the front line of intersecting planetary health challenges in Finland, India, Kenya, Peru, and the USA. Translocal learning supports collective knowledge production across different localities in ways that value local perspectives but transcend national boundaries. There were three main findings from the translocal learning process. First, thanks to their proximity to the communities they served, community-based organisations (CBOs) can quickly identify the ways in which COVID-19 might worsen existing social and health inequities. Second, localised CBO actions are key to supporting communities with unique challenges in the face of systemic planetary health crises. Third, CBOs can develop rights-based, ecologically-minded actions responding to local priorities and mobilising available resources. Our findings show how solutions to planetary health might come from small-scale community initiatives that are well connected within and across contexts. Locally-focused globally-aware actions should be harnessed through greater recognition, funding, and networking opportunities. Globally, planetary health initiatives should be supported by applying the principles of subsidiarity and translocalism.
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Affiliation(s)
- Geordan Shannon
- Institute for Global Health. University College London, London, UK; Stema, London, UK.
| | | | - Laura E R Peters
- Institute for Global Health. University College London, London, UK; College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, OR, USA
| | | | | | | | | | - Ilan Kelman
- Institute for Global Health. University College London, London, UK; Institute for Global Development and Social Planning, University of Agder, Kristiansand, Norway
| | | | - Eija Meriläinen
- Institute for Global Health. University College London, London, UK; School of Humanities, Education and Social Sciences, Örebro University, Örebro, Sweden; Centre for Corporate Responsibility, Hanken School of Economics, Helsinki, Finland
| | | | | | - Audrey Prost
- Institute for Global Health. University College London, London, UK
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Hamblion E, Saad NJ, Greene-Cramer B, Awofisayo-Okuyelu A, Selenic Minet D, Smirnova A, Engedashet Tahelew E, Kaasik-Aaslav K, Alexandrova Ezerska L, Lata H, Allain Ioos S, Peron E, Abdelmalik P, Perez-Gutierrez E, Almiron M, Kato M, Babu A, Matsui T, Biaukula V, Nabeth P, Corpuz A, Pukkila J, Cheng KY, Impouma B, Koua E, Mahamud A, Barboza P, Socé Fall I, Morgan O. Global public health intelligence: World Health Organization operational practices. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002359. [PMID: 37729134 PMCID: PMC10511126 DOI: 10.1371/journal.pgph.0002359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Early warning and response are key to tackle emerging and acute public health risks globally. Therefore, the World Health Organization (WHO) has implemented a robust approach to public health intelligence (PHI) for the global detection, verification and risk assessment of acute public health threats. WHO's PHI operations are underpinned by the International Health Regulations (2005), which require that countries strengthen surveillance efforts, and assess, notify and verify events that may constitute a public health emergency of international concern (PHEIC). PHI activities at WHO are conducted systematically at WHO's headquarters and all six regional offices continuously, throughout every day of the year. We describe four interlinked steps; detection, verification, risk assessment, and reporting and dissemination. For PHI operations, a diverse and interdisciplinary workforce is needed. Overall, PHI is a key feature of the global health architecture and will only become more prominent as the world faces increasing public health threats.
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Affiliation(s)
- Esther Hamblion
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Neil J. Saad
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Blanche Greene-Cramer
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Adedoyin Awofisayo-Okuyelu
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Dubravka Selenic Minet
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Anastasia Smirnova
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Etsub Engedashet Tahelew
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Kaja Kaasik-Aaslav
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Lidia Alexandrova Ezerska
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Harsh Lata
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Sophie Allain Ioos
- Epidemic and Pandemic Preparedness and Prevention Department, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Emilie Peron
- WHO Hub for Pandemic and Epidemic Intelligence, Health Emergencies Programme, World Health Organization, Berlin, Germany
| | - Philip Abdelmalik
- WHO Hub for Pandemic and Epidemic Intelligence, Health Emergencies Programme, World Health Organization, Berlin, Germany
| | - Enrique Perez-Gutierrez
- Health Emergency Information & Risk Assessment, Health Emergencies, World Health Organization Regional Office for the Americas, Washington DC, United States of America
| | - Maria Almiron
- Health Emergency Information & Risk Assessment, Health Emergencies, World Health Organization Regional Office for the Americas, Washington DC, United States of America
| | - Masaya Kato
- Health Emergencies Programme, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Amarnath Babu
- Health Emergencies Programme, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Tamano Matsui
- Health Emergencies Programme, World Health Organization Western Pacific Regional Office, Manilla, Philippines
| | - Viema Biaukula
- Health Emergencies Programme, World Health Organization Western Pacific Regional Office, Manilla, Philippines
| | - Pierre Nabeth
- Health Emergencies Programme, World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Aura Corpuz
- Health Emergencies Programme, World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Jukka Pukkila
- Health Emergencies Programme, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Ka-Yeung Cheng
- Health Emergencies Programme, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Benido Impouma
- Health Emergencies Programme, World Health Organization Africa Regional Office, Brazzaville, Congo
| | - Etien Koua
- Health Emergencies Programme, World Health Organization Africa Regional Office, Brazzaville, Congo
| | - Abdi Mahamud
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Phillipe Barboza
- Office of the Assistant Director-General for Emergencies Response, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Department of Health Emergency Interventions, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Oliver Morgan
- WHO Hub for Pandemic and Epidemic Intelligence, Health Emergencies Programme, World Health Organization, Berlin, Germany
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OKeeffe J, Takahashi E, Otshudiema JO, Malembi E, Ndaliko C, Munihire NM, Caleo G, Martin AIC. Strengthening community-based surveillance: lessons learned from the 2018-2020 Democratic Republic of Congo (DRC) Ebola outbreak. Confl Health 2023; 17:41. [PMID: 37649068 PMCID: PMC10466702 DOI: 10.1186/s13031-023-00536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION There has been little documentation of the large networks of community health workers that contributed to Ebola Virus Disease (EVD) surveillance during the 2018-2020 Democratic Republic of Congo (DRC) epidemic in the form of community-based surveillance (CBS). These networks, comprised entirely of local community members, were a critical and mostly unrecognized factor in ending the epidemic. Challenges with collection, compilation, and analysis of CBS data have made their contribution difficult to quantify. From November 2019 to March 2020, the DRC Ministry of Health (MoH), the World Health Organization (WHO), and Médecins Sans Frontières (MSF) worked with communities to strengthen existing EVD CBS in two key health areas in Ituri Province, DRC. We describe CBS strengthening activities, detail collaboration with communities and present results of these efforts. We also provide lessons learned to inform future outbreak responses. METHODS As the foundation of CBS, community health workers (CHW) completed training to identify and report patients who met the EVD alert definitions. Alerts were investigated and if validated, the patient was sent for isolation and EVD testing. Community members provided early and ongoing input to the CBS system. We established a predefined ratio of community- elected CHW, allocated by population, to assure equal and adequate coverage across areas. Strong performing CHW or local leaders managed the CHWs, providing a robust supervision structure. We made additional efforts to integrate rural villages, revised tools to lighten the reporting burden and focused analysis on key indicators. Phased roll-out of activities ensured time for community discussion and approval. An integrated treatment center (ITC) combined EVD testing and isolation with free primary health care (PHC), referral services, and an ambulance network. RESULTS A total of 247 CHW and supervisors completed training. CBS had a retention rate of 94.3% (n = 233) with an average daily reporting rate of 97.4% (range 75.0-100.0%). Local chiefs and community leaders participated in activities from the early stages. Community feedback, including recommendations to add additional CHW, run separate meetings in rural villages, and strengthen PHC services, improved system coverage and performance. Of 6,711 community referrals made, 98.1% (n = 6,583) were classified as alerts. Of the alerts, 97.4% (n = 6,410) were investigated and 3.0% (n = 190) were validated. Of the community referrals, 73.1% (n = 4,905) arrived for care at the ITC. The contribution of CBS to total alerts in the surveillance system increased from an average of 47.3% in the four weeks prior to system strengthening to 69.0% after. In one of the two health areas, insufficient reporting in rural villages suggested inadequate coverage, with 8.3% of the total population contributing 6.1% of alerts. DISCUSSION CBS demonstrated the capacity of community networks to improve early disease detection and expand access to healthcare. Early and consistent community involvement proved vital to CBS, as measured by system performance, local acceptance of EVD activities, and health service provision. The CBS system had high reporting rates, number of alerts signaled, proportion of alerts investigated, and proportion of community referrals that arrived for care. The change in contribution of CBS to total alerts may have been due in part to system strengthening, but also to the expansion in the EVD suspect case definition. Provision of PHC, referral services, and an ambulance network linked EVD response activities to the existing health system and facilitated CBS performance. More importantly, these activities provided a continuum of care that addressed community prioritized health needs. The involvement of local health promotion teams was vital to the CBS and other EVD and PHC activities. Lessons learned include the importance of early and consistent community involvement in surveillance activities and the recommendation to assure local representation in leadership positions.
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Affiliation(s)
| | - Emi Takahashi
- Médecins Sans Frontières, Goma, Democratic Republic of Congo
- Norwegian Red Cross, Oslo, Norway
| | | | - Emile Malembi
- Minister of Public Health, Kinshasa, Democratic Republic of Congo
| | - Célestin Ndaliko
- World Health Organization, Kinshasa, Democratic Republic of Congo
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Nyagah LM, Bangura S, Omar OA, Karanja M, Mirza MA, Shajib H, Njiru H, Mengistu K, Malik SMMR. The importance of community health workers as frontline responders during the COVID-19 pandemic, Somalia, 2020-2021. Front Public Health 2023; 11:1215620. [PMID: 37663863 PMCID: PMC10469613 DOI: 10.3389/fpubh.2023.1215620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction We examined the contribution of community health workers as frontline responders for the community-based surveillance in Somalia during the first year of the COVID-19 pandemic for detection of COVID-19 cases and identification of contacts. Methods We retrieved COVID-19 surveillance data from 16 March 2020 to 31 March 2021 from the health ministry's central database. These data were collected through community health workers, health facilities or at the points of entry. We compared the number of suspected COVID-19 cases detected by the three surveillance systems and the proportion that tested positive using the chi-squared test. We used logistic regression analysis to assess association between COVID-19 infection and selected variables. Results During the study period, 154,004 suspected cases of COVID-19 were detected and tested, of which 10,182 (6.6%) were positive. Of the notified cases, 32.7% were identified through the community-based surveillance system, 54.0% through the facility-based surveillance system, and 13.2% at points of entry. The positivity rate of cases detected by the community health workers was higher than that among those detected at health facilities (8.6% versus 6.4%; p < 0.001). The community health workers also identified more contacts than those identified through the facility-based surveillance (13,279 versus 1,937; p < 0.001). The odds of COVID-19 detection generally increased by age. Community-based surveillance and health facility-based surveillance had similar odds of detecting COVID-19 cases compared with the points-of-entry surveillance (aOR: 7.0 (95% CI: 6.4, 7.8) and aOR: 7.5 (95% CI: 6.8, 8.3), respectively). Conclusion The community health workers proved their value as first responders to COVID-19. They can be effective in countries with weak health systems for targeted community surveillance in rural and remote areas which are not covered by the facility-based surveillance system.
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12
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McGowan CR, Takahashi E, Romig L, Bertram K, Kadir A, Cummings R, Cardinal LJ. Community-based surveillance of infectious diseases: a systematic review of drivers of success. BMJ Glob Health 2022; 7:bmjgh-2022-009934. [PMID: 35985697 PMCID: PMC9396156 DOI: 10.1136/bmjgh-2022-009934] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/24/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Community-based surveillance may improve early detection and response to disease outbreaks by leveraging the capacity of community members to carry out surveillance activities within their communities. In 2021, the WHO published a report detailing the evidence gaps and research priorities around community-centred approaches to health emergencies. In response, we carried out a systematic review and narrative synthesis of the evidence describing the drivers of success of community-based surveillance systems. Methods We included grey literature and peer-reviewed sources presenting empirical findings of the drivers of success of community-based surveillance systems for the detection and reporting of infectious disease-related events. We searched for peer-reviewed literature via MEDLINE, EMBASE, Global Health, SCOPUS and ReliefWeb. We carried out grey literature searches using Google Search and DuckDuckGo. We used an evaluation quality checklist to assess quality. Results Nineteen sources (17 peer-reviewed and 2 grey literature) met our inclusion criteria. Included sources reported on community-based surveillance for the detection and reporting of a variety of diseases in 15 countries (including three conflict settings). The drivers of success were grouped based on factors relating to: (1) surveillance workers, (2) the community, (3) case detection and reporting, (4) and integration. Discussion The drivers of success were found to map closely to principles of participatory community engagement with success factors reflecting high levels of acceptability, collaboration, communication, local ownership, and trust. Other factors included: strong supervision and training, a strong sense of responsibility for community health, effective engagement of community informants, close proximity of surveillance workers to communities, the use of simple and adaptable case definitions, quality assurance, effective use of technology, and the use of data for real-time decision-making. Our findings highlight strategies for improving the design and implementation of community-based surveillance. We suggest that investment in participatory community engagement more broadly may be a key surveillance preparedness activity. PROSPERO registration number CRD42022303971.
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Affiliation(s)
- Catherine R McGowan
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Emi Takahashi
- Humanitarian Public Health Technical Unit, Save the Children Fund, London, UK
| | - Laura Romig
- Department of Humanitarian Response, Save the Children Federation, Washington, District of Columbia, USA
| | - Kathryn Bertram
- Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ayesha Kadir
- Humanitarian Public Health Technical Unit, Save the Children Fund, London, UK
| | - Rachael Cummings
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK.,Humanitarian Department, Save the Children International, London, UK
| | - Laura J Cardinal
- Department of Humanitarian Response, Save the Children Federation, Washington, District of Columbia, USA
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Ratnayake R, Peyraud N, Ciglenecki I, Gignoux E, Lightowler M, Azman AS, Gakima P, Ouamba JP, Sagara JA, Ndombe R, Mimbu N, Ascorra A, Welo PO, Mukamba Musenga E, Miwanda B, Boum Y, Checchi F, Edmunds WJ, Luquero F, Porten K, Finger F. Effectiveness of case-area targeted interventions including vaccination on the control of epidemic cholera: protocol for a prospective observational study. BMJ Open 2022; 12:e061206. [PMID: 35793924 PMCID: PMC9260795 DOI: 10.1136/bmjopen-2022-061206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cholera outbreaks in fragile settings are prone to rapid expansion. Case-area targeted interventions (CATIs) have been proposed as a rapid and efficient response strategy to halt or substantially reduce the size of small outbreaks. CATI aims to deliver synergistic interventions (eg, water, sanitation, and hygiene interventions, vaccination, and antibiotic chemoprophylaxis) to households in a 100-250 m 'ring' around primary outbreak cases. METHODS AND ANALYSIS We report on a protocol for a prospective observational study of the effectiveness of CATI. Médecins Sans Frontières (MSF) plans to implement CATI in the Democratic Republic of the Congo (DRC), Cameroon, Niger and Zimbabwe. This study will run in parallel to each implementation. The primary outcome is the cumulative incidence of cholera in each CATI ring. CATI will be triggered immediately on notification of a case in a new area. As with most real-world interventions, there will be delays to response as the strategy is rolled out. We will compare the cumulative incidence among rings as a function of response delay, as a proxy for performance. Cross-sectional household surveys will measure population-based coverage. Cohort studies will measure effects on reducing incidence among household contacts and changes in antimicrobial resistance. ETHICS AND DISSEMINATION The ethics review boards of MSF and the London School of Hygiene and Tropical Medicine have approved a generic protocol. The DRC and Niger-specific versions have been approved by the respective national ethics review boards. Approvals are in process for Cameroon and Zimbabwe. The study findings will be disseminated to the networks of national cholera control actors and the Global Task Force for Cholera Control using meetings and policy briefs, to the scientific community using journal articles, and to communities via community meetings.
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Affiliation(s)
- Ruwan Ratnayake
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Epicentre, Paris, France
| | | | | | | | | | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | | | - Placide Okitayemba Welo
- Programme National d'Elimination du Choléra et de lutte contre les autres Maladies Diarrhéiques, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Berthe Miwanda
- Institut National de Recherche Biologique, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Francesco Checchi
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - W John Edmunds
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Francisco Luquero
- Epicentre, Paris, France
- GAVI the Vaccine Alliance, Geneva, Switzerland
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14
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Russell N, Tappis H, Mwanga JP, Black B, Thapa K, Handzel E, Scudder E, Amsalu R, Reddi J, Palestra F, Moran AC. Implementation of maternal and perinatal death surveillance and response (MPDSR) in humanitarian settings: insights and experiences of humanitarian health practitioners and global technical expert meeting attendees. Confl Health 2022; 16:23. [PMID: 35526012 PMCID: PMC9077967 DOI: 10.1186/s13031-022-00440-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/03/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analysing and learning lessons from such deaths in order to respond and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA and UNHCR on 17th-18th October 2019, informed by semi-structured interviews with a range of professionals, including expert attendees. CONSULTATION FINDINGS Interviewees revealed significant obstacles to full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicisation of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalisation and implementation capacity for MPDSR within humanitarian organisations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings. CONCLUSIONS Despite the challenges, examples exist where the lessons learnt from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.
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Affiliation(s)
| | - Hannah Tappis
- grid.21107.350000 0001 2171 9311Jhpiego, Baltimore, MD USA
| | - Jean Paul Mwanga
- Hôpital Générale de Mweso, Nord Kivu, Democratic Republic of the Congo
| | - Benjamin Black
- grid.452780.cMédecins Sans Frontières, Amsterdam, The Netherlands
| | - Kusum Thapa
- grid.21107.350000 0001 2171 9311Jhpiego, Baltimore, MD USA
| | - Endang Handzel
- grid.416738.f0000 0001 2163 0069Centre for Disease Control and Prevention, Atlanta, GA USA
| | - Elaine Scudder
- grid.420433.20000 0000 8728 7745International Rescue Committee, New York, NY USA
| | - Ribka Amsalu
- grid.266102.10000 0001 2297 6811University of California San Francisco, San Francisco, CA USA
| | - Jyoti Reddi
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
| | - Francesca Palestra
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
| | - Allisyn C. Moran
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
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15
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What we do know (and could know) about estimating population sizes of internally displaced people. J Migr Health 2022; 6:100120. [PMID: 35694420 PMCID: PMC9184859 DOI: 10.1016/j.jmh.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/21/2022] [Accepted: 05/28/2022] [Indexed: 11/21/2022] Open
Abstract
The estimation of population denominators of internally displaced people (IDP) and other crisis-affected populations is a foundational step that facilitates all humanitarian assistance. However, the humanitarian system remains somewhat tolerant of irregular and inaccurate estimates of population size and composition, particularly of IDPs. In this commentary, we review how humanitarian organizations currently approach the estimation of IDP populations, and how field approaches and analytical methodologies can be improved and integrated.
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D'Mello-Guyett L, Cumming O, Rogers E, D'hondt R, Mengitsu E, Mashako M, Van den Bergh R, Welo PO, Maes P, Checchi F. Identifying transferable lessons from cholera epidemic responses by Médecins Sans Frontières in Mozambique, Malawi and the Democratic Republic of Congo, 2015-2018: a scoping review. Confl Health 2022; 16:12. [PMID: 35351171 PMCID: PMC8966369 DOI: 10.1186/s13031-022-00445-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cholera epidemics occur frequently in low-income countries affected by concurrent humanitarian crises. Evaluations of these epidemic response remains largely unpublished and there is a need to generate evidence on response efforts to inform future programmes. This review of MSF cholera epidemic responses aimed to describe the main characteristics of the cholera epidemics and related responses in these three countries, to identify challenges to different intervention strategies based on available data; and to make recommendations for epidemic prevention and control practice and policy. Methods Case studies from the Democratic Republic of Congo, Malawi and Mozambique were purposively selected by MSF for this review due to the documented burden of cholera in each country, frequency of cholera outbreaks, and risk of humanitarian crises. Data were extracted on the characteristics of the epidemics; time between alert and response; and, the delivery of health and water, sanitation and hygiene interventions. A Theory of Change for cholera response programmes was built to assess factors that affected implementation of the responses. Results and conclusions 20 epidemic response reports were identified, 15 in DRC, one in Malawi and four in Mozambique. All contexts experienced concurrent humanitarian crises, either armed conflict or natural disasters. Across the settings, median time between the date of alert and date of the start of the response by MSF was 23 days (IQR 14–41). Almost all responses targeted interventions community-wide, and all responses implemented in-patient treatment of suspected cholera cases in either established health care facilities (HCFs) or temporary cholera treatment units (CTUs). In three responses, interventions were delivered as case-area targeted interventions (CATI) and four responses targeted households of admitted suspected cholera cases. CATI or delivery of interventions to households of admitted suspected cases occurred from 2017 onwards only. Overall, 74 factors affecting implementation were identified including delayed supplies of materials, insufficient quantities of materials and limited or lack of coordination with local government or other agencies. Based on this review, the following recommendations are made to improve cholera prevention and control efforts: explore improved models for epidemic preparedness, including rapid mobilisation of supplies and deployment of trained staff; invest in and strengthen partnerships with national and local government and other agencies; and to standardise reporting templates that allow for rigorous and structured evaluations within and across countries to provide consistent and accessible data. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00445-1.
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Affiliation(s)
- Lauren D'Mello-Guyett
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium.
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Elliot Rogers
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Rob D'hondt
- Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
| | | | - Maria Mashako
- Médecins Sans Frontières, Kinshasa, Democratic Republic of Congo
| | - Rafael Van den Bergh
- LuxOR, Luxembourg Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - Placide Okitayemba Welo
- Programme National d'Elimination du Choléra et de lutte contre les autres Maladies Diarrhéiques, Kinshasa, Democratic Republic of Congo
| | - Peter Maes
- WASH Section, UNICEF, Kinshasa, Democratic Republic of Congo
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Villar EB, Magnawa JP. Surveillance and pandemic governance in least‐ideal contexts: The Philippine case. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2022. [PMCID: PMC9111276 DOI: 10.1111/1468-5973.12394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper inquires how surveillance manifests in least‐ideal contexts (LICs), that is, countries with resource constraints, poor governance and proclivity for populism during COVID‐19, and its implications for crisis governance. Using the Philippines as a case, we advance three arguments. First, LICs can become spaces where inappropriate surveillance is undertaken. Second, liminal surveillance practices can become permanent policy fixtures in LICs. Finally, when a prevailing crisis approach of a government is perceived to be inconsistent with the needs of the public, it can lead to a self‐help system among various societal groups and actors. This self‐help system may not necessarily be aligned with the general direction of the national government. As a result, it can perpetuate a disjointed and maladaptive crisis governance approach, where main actors like national governments, and complementary actors like private sector firms, local government units and citizen organizations pursue goals independent of one another.
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Affiliation(s)
- Eula Bianca Villar
- Stephen Zuellig Graduate School of Development Management Asian Institute of Management Makati Philippines
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18
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Zhao F, Bali S, Kovacevic R, Weintraub J. A three-layer system to win the war against COVID-19 and invest in health systems of the future. BMJ Glob Health 2021; 6:bmjgh-2021-007365. [PMID: 34920990 PMCID: PMC8685533 DOI: 10.1136/bmjgh-2021-007365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/19/2021] [Indexed: 11/04/2022] Open
Abstract
The COVID-19 pandemic taught us many lessons, most critically that its human and economic toll would have been significantly smaller if countries had in place strong layers of defence that would have either prevented the spillover of the SARS-CoV-2 into a human population in the first place, or, failing that, contained the outbreak to avert its global spread. Further, the brunt of COVID-19 impacts on some countries considered ‘most prepared’ for pandemics underscored the need for an integrated approach to ensure resilience to future epidemics. Consequently, as countries plan ahead to prevent future pandemics, they should give priority to investments that transform their systems, particularly in the precrises phase, to preparedness and response through a multilayered defence. We propose a three-layered approach for post-COVID-19 investments in public health functions and service delivery, particularly at the community and precrises levels. This framework highlights the interventions that enable countries to better prevent, detect and contain epidemic threats, and that strengthen the efficient use of limited resources towards high-impact precrises systems.
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Affiliation(s)
- Feng Zhao
- Health, Nutrition, and Population, World Bank, Washington, DC 20443, USA
| | - Sulzhan Bali
- Health, Nutrition, and Population, World Bank, Washington, DC 20443, USA
| | - Rialda Kovacevic
- Health, Nutrition, and Population, World Bank, Washington, DC 20443, USA
| | - Jeff Weintraub
- Health, Nutrition, and Population, World Bank, Washington, DC 20443, USA
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D'Mello-Guyett L, Cumming O, Bonneville S, D'hondt R, Mashako M, Nakoka B, Gorski A, Verheyen D, Van den Bergh R, Welo PO, Maes P, Checchi F. Effectiveness of hygiene kit distribution to reduce cholera transmission in Kasaï-Oriental, Democratic Republic of Congo, 2018: a prospective cohort study. BMJ Open 2021; 11:e050943. [PMID: 34649847 PMCID: PMC8522665 DOI: 10.1136/bmjopen-2021-050943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Household contacts of cholera cases are at a greater risk of Vibrio cholerae infection than the general population. There is currently no agreed standard of care for household contacts, despite their high risk of infection, in cholera response strategies. In 2018, hygiene kit distribution and health promotion was recommended by Médecins Sans Frontières for admitted patients and accompanying household members on admission to a cholera treatment unit in the Democratic Republic of Congo. METHODS To investigate the effectiveness of the intervention and risk factors for cholera infection, we conducted a prospective cohort study and followed household contacts for 7 days after patient admission. Clinical surveillance among household contacts was based on self-reported symptoms of cholera and diarrhoea, and environmental surveillance through the collection and analysis of food and water samples. RESULTS From 94 eligible households, 469 household contacts were enrolled and 444 completed follow-up. Multivariate analysis suggested evidence of a dose-response relationship with increased kit use associated with decreased relative risk of suspected cholera: household contacts in the high kit-use group had a 66% lower incidence of suspected cholera (adjusted risk ratio (aRR) 0.34, 95% CI 0.11 to 1.03, p=0.055), the mid-use group had a 53% lower incidence (aRR 0.47, 95% CI 0.17 to 1.29, p=1.44) and low-use group had 22% lower incidence (aRR 0.78, 95% CI 0.24 to 2.53, p=0.684), compared with household contacts without a kit. Drinking water contamination was significantly reduced among households in receipt of a kit. There was no significant effect on self-reported diarrhoea or food contamination. CONCLUSION The integration of a hygiene kit intervention to case-households may be effective in reducing cholera transmission among household contacts and environmental contamination within the household. Further work is required to evaluate whether other proactive localised distribution among patients and case-households or to households surrounding cholera cases can be used in future cholera response programmes in emergency contexts.
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Affiliation(s)
- Lauren D'Mello-Guyett
- London School of Hygiene & Tropical Medicine, London, UK
- Médecins Sans Frontières, Brussels, Belgium
| | - Oliver Cumming
- London School of Hygiene & Tropical Medicine, London, UK
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20
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Maazou AA, Oumarou B, Bienvenu B, Anya BPM, Didier T, Ishagh EK, Nsiari-muzeyi BJ, Katoto P, Wiysonge CS. Community-based surveillance contribution to the response of COVID-19 in Niger. Pan Afr Med J 2021; 40:88. [PMID: 34909077 PMCID: PMC8607942 DOI: 10.11604/pamj.2021.40.88.28175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/14/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the COVID-19 pandemic has spread across all countries in Africa, with much of the model forecasting disastrous results owing to weak health services and political uncertainty. In Niger, an adaptive solution to the COVID-19 pandemic has been implemented by community-based surveillance system (CBS) to complement passive case-finding in health systems. METHODS the CBS program was designed to use the current CBS polio network spanning 37 health districts in six regions. Between April and November 2020, 150 community health workers (CHWs) were equipped to improve integrated disease surveillance and response (IDSR) preparedness and response to the COVID-19 pandemic. We retrospectively analysed the health data of the National Health Information System to describe the effect of CBS in COVID-19 surveillance. RESULTS overall, trained CHWs were able to raise awareness among 2,681,642 persons regarding COVID-19 preventions and controls strategies. They reported 143 (84%) valid alerts resulting in two positive COVID-19 cases missing in the community. In addition, CHWs added to the contact tracing of 37 individuals and informed about the deaths in the community. CONCLUSION community-based surveillance improved COVID-19 response in Niger. Logistic assistance and ongoing training are the foundations for increasing and sustaining the sensitivity of CBS systems in response to the COVID-19 pandemic to deter hotspots across countries.
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Affiliation(s)
- Ahmed Abani Maazou
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - Batouré Oumarou
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - Baruani Bienvenu
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | | | - Tambwe Didier
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - El Khalef Ishagh
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - Biey Joseph Nsiari-muzeyi
- Sub-Regional Office for West Africa, World Health Organization, Independence Street, Gate 0058, Ouagadougou, Burkina Faso
| | - Patrick Katoto
- Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Tygerberg 7505, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Faculty of Medicine, Catholic University of Bukavu, Bugabo 02, Bukavu, Democratic Republic of Congo
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley 7501, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley 7501, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7935, Cape Town, South Africa
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21
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Metuge A, Omam LA, Jarman E, Njomo EO. Humanitarian led community-based surveillance: case study in Ekondo-titi, Cameroon. Confl Health 2021; 15:17. [PMID: 33771200 PMCID: PMC7995751 DOI: 10.1186/s13031-021-00354-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Community-based surveillance (CBS) has been used successfully in many situations to strengthen existing health systems as well as in humanitarian crises. The Anglophone crisis of Northwest Southwest Cameroon, led to burning of villages, targeting of health personnel and destruction of health facilities which, in combination with distrust for the government services led to a collapse of surveillance for outbreak prone diseases. METHODS We evaluated the ability of the CBS system to identify suspected cases of outbreak prone diseases (OPD) as compared to the facility-based surveillance, evaluated the timeliness of the CBS system in identifying an OPD, reporting of OPD to District Health Service (DHS) and timeliness in outbreak response. The paper also assessed the collaboration with the DHS and contribution of the CBS system with regards to strengthening the overall surveillance of the health district and also determine the interventions undertaken to contain suspected/confirmed outbreaks. RESULTS In total 9 alerts of suspected OPDs were generated by the CBS system as compared to 0 by the DHS, with 8 investigated, 5 responses and 3 confirmed outbreaks. Average time from first symptoms to alert generation by the CBS system was 7.3 days. Average time lag from alert generation from the CBS to the DHS was 0.3 days which was essentially within 24 h. There was extensive and synergistic collaboration with the DHS. DISCUSSION CBS generated a higher number of alerts than traditional outbreak reported used in the region, and had timely investigations and if appropriate, responses. Careful selection of CHWs with strong community engagement led to the success of the project, and the use of the mobile health team in situ allowed for rapid responses to potential outbreaks, as well as for feedback to CHWs and communities. CBS was also well utilized for identification of other events, such as displacement and malnutrition. CONCLUSION In conflict settings, CBS can help in outbreak identification as well as other events, and a mobile health team is crucial to the success of the CBS due to the ability to rapidly response to generated alerts. The mobile health team provided timely investigation of 8 of 9 alerts generated. Collaboration with existing DHS structures is important for systems strengthening in such settings.
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Affiliation(s)
| | - Lundi-Anne Omam
- Reach Out N.G.O , .
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK , .
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Ratnayake R, Finger F, Edmunds WJ, Checchi F. Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes. BMC Med 2020; 18:397. [PMID: 33317544 PMCID: PMC7737284 DOI: 10.1186/s12916-020-01865-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. METHODS We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. RESULTS Seventy-six outbreaks from 34 countries were included. Median delays spanned 1-2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5-5), detection (5 days, IQR 5-6), investigation (7 days, IQR 5.8-13.3), response (10 days, IQR 7-18), and confirmation (11 days, IQR 7-16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5-9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7-61.0, p = 0.03). CONCLUSIONS From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.
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Affiliation(s)
- Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - W John Edmunds
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
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