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Meierkord A, Körner-Nahodilová L, Gotsche CI, Baruch J, Briesemeister V, Correa-Martinez CL, Hanefeld J. Strengthening disease surveillance capacity at national level across five countries: a qualitative study. Public Health 2024; 233:115-120. [PMID: 38870843 DOI: 10.1016/j.puhe.2024.04.040] [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: 01/31/2024] [Revised: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Disease surveillance is an essential component of public health and a core function of National Public Health Institutes (NPHIs), including to better prepare and respond to infectious diseases outbreaks. Strengthening NPHIs in their efforts to establish and maintain efficient surveillance systems is an opportunity to ensure future outbreak preparedness and response; yet, guidance on how to increase and prioritise capacity building efforts is limited. This study sought to investigate approaches to capacity building and training for disease surveillance at national level and understand the potential role of NPHIs. STUDY DESIGN Qualitative study. METHODS This is a qualitative study, based on a literature review and interviews undertaken between June and November 2022. Fifty seven in-depth interviews were conducted in five countries: Côte d'Ivoire, Ecuador, Madagascar, Namibia, and the Kingdom of Saudi Arabia. Participants included a range of professionals from government, NPHIs, academic institutions and the private sector. Interviews were thematically analysed. RESULTS Selected countries varied in terms of their disease surveillance capacities, as well as in the structure of their surveillance systems and decision-making. Research identified shared priority areas for action at national level, identifying common challenges and opportunities: 1) capacity building, here specifically the need for a training agenda at national level to ensure sustainability and guide donor funded training offers; 2) data tools and technology-to help decision-makers select the best software tool to address countries' identified need; 3) data sharing-the need for clear data sharing standards and norms for national to international data sharing; and 4) genomic sequencing-the need for national genomic surveillance strategies and reporting guidelines. CONCLUSION Addressing challenges and using opportunities to strengthen disease surveillance at national level is an important step to build capacity in this area and to help prevent future epidemic and pandemics globally. The findings of this study help decision-makers to identify priority areas for capacity building and understand the potential role and significance of NPHIs.
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Affiliation(s)
- A Meierkord
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Center for Global Health, Institute of International Health, 13353 Berlin, Germany.
| | - L Körner-Nahodilová
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany
| | - C I Gotsche
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany; London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - J Baruch
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany
| | - V Briesemeister
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany
| | - C L Correa-Martinez
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany
| | - J Hanefeld
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, 13353 Berlin, Germany; London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
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Flodgren GM, Bezuidenhoudt JE, Alkanhal N, Brinkwirth S, Lee ACK. Conceptualisation and implementation of integrated disease surveillance globally: a scoping review. Public Health 2024; 230:105-112. [PMID: 38522247 DOI: 10.1016/j.puhe.2024.02.018] [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: 05/22/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The objective of this study was to examine the conceptualisation and operationalisation of Integrated Disease Surveillance (IDS) systems globally and the evidence for their effectiveness. Furthermore, to determine whether the recommendations made by Morgan et al. are supported by the evidence and what the evidence is to inform country development of IDS. STUDY DESIGN The study incorporated a scoping review. METHODS This review summarised evidence meeting the following inclusion criteria: Participants: any health sector; Concept: IDS; and Context: global. We searched Medline, Embase, and Epistemonikos for English publications between 1998 and 2022. Standard review methods were applied. A bespoke conceptual framework guided the narrative analysis. This scoping review is part of a research programme with three key elements, with the other studies being a survey of the International Association of National Public Health Institutes members on the current status of their disease surveillance systems and a deeper analysis and case studies of the surveillance systems in seven countries, to highlight the opportunities and challenges of integration. RESULTS Eight reviews and five primary studies, which were assessed as being of low quality, were included, mostly examining IDS in Africa, the human sector, and communicable diseases. None reported on the effects on disease control or on the evolution of IDS during the COVID-19 pandemic. Descriptions of IDS and of integration varied. Prerequisites of effective IDS systems mostly related to the adequacy of core functions and resourcing requirements. Laws or regulations supporting system integration and data sharing were not addressed. The provision of core functions and resourcing requirements were described as inadequate, financing as non-sustainable, and governance as poor. Enablers included active data sharing, close cooperation between agencies, clear reporting channels, integration of vertical programs, increased staff training, and adopting mobile reporting. Whilst the conceptual framework for IDS and Morgan et al.'s proposed principles were to some extent reflected in the highlighted priorities for IDS in the literature, the evidence base remains weak. CONCLUSIONS Available evidence is fragmented, incomplete, and of poor quality. The review found a lack of robust evaluation studies on the impact of IDS on disease control. Whilst a lack of evidence does not imply a lack of benefit or effect, it should signal the need to evaluate the process and impact of integration in the future development of surveillance systems. A common IDS definition and articulation of the parts that constitute an IDS system are needed. Further robust impact evaluations, as well as country reviews and evaluations of their IDS systems, are required to improve the evidence base.
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Affiliation(s)
| | | | - N Alkanhal
- Public Health Authority of Saudi Arabia, Kingdom of Saudi Arabia
| | | | - A C K Lee
- The University of Sheffield and UK Health Security Agency, UK
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Lee ACK, Iversen BG, Lynes S, Desenclos JC, Bezuidenhoudt JE, Flodgren GM, Pyone T. The state of integrated disease surveillance globally: synthesis report of a mixed methods study. Public Health 2024; 228:85-91. [PMID: 38340506 DOI: 10.1016/j.puhe.2024.01.003] [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: 08/25/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Disease surveillance is an essential public health function needed to prevent, detect, monitor and respond to health threats. Integrated disease surveillance (IDS) enhances its utility and has been advocated for decades by the World Health Organization. This study sought to examine the state of IDS implementation worldwide. STUDY DESIGN The study used a concurrent mixed methods approach consisting of a systematic scoping review of the literature on IDS, a survey of International Association of National Public Health Institutes (IANPHI) members and qualitative deep dive case studies in seven countries. METHODS This report collates, analyses and synthesises the findings from the three components. The scoping review consisted of a review of summarised evidence on IDS. Eight reviews and five primary studies were included. The cross-sectional survey was conducted of 110 IANPHI members representing ninety-five countries. Qualitative case studies were conducted in Malawi, Mozambique, Uganda, Pakistan, Canada, Sweden, and England, which involved thirty-four focus group discussions and forty-eight key informant interviews. RESULTS In the different countries, IDS is conceptualised differently and there are differing levels of maturity of IDS functions. Although the role of National Public Health Institutes has not been well defined in the IDS, they play a significant role in IDS in many countries. Fragmentation between sectors and resourcing (human and financial) issues were common. Good governance measures such as appropriate legislative and regulatory frameworks and roles and responsibilities for IDS were often unclear. The COVID-19 pandemic has strengthened some surveillance systems, often through leveraging existing respiratory surveillance systems. In some instances, improvements were seen only for COVID-19 related data but these changes were not sustained. Evaluation of IDS was also reported to be weak. CONCLUSIONS Integration should be driven by a clear purpose and contextualised. Political commitment, clear governance, and resourcing are needed. Technology and the establishment of technical communities of practice may help. However, the complexity and cost of integration should not be under-estimated, and further economic and impact evaluations of IDS are needed.
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Affiliation(s)
- Andrew C K Lee
- The UK Health Security Agency, UK; The University of Sheffield, Sheffield, UK.
| | | | - Sadaf Lynes
- International Association of National Public Health Institutes, Belgium
| | - Jean-Claude Desenclos
- the University of Sheffield, Sheffield, UK; The University of Sheffield, Sheffield, UK
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Mabona M, Zwane T, Raman J, Kuonza L, Mhlongo B, Phafane P. Evaluation of the malaria case surveillance system in KwaZulu-Natal Province, South Africa, 2022: a focus on DHIS2. Malar J 2024; 23:47. [PMID: 38350921 PMCID: PMC10865712 DOI: 10.1186/s12936-024-04873-7] [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: 09/12/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND South Africa set a target to eliminate malaria by 2023, with KwaZulu-Natal (KZN) Province the malaria-endemic province closest to achieving this goal. Objective two of the National Malaria Elimination Strategic Plan (NMESP) focused on strengthening surveillance systems to support the country's elimination efforts. Regular evaluations of the malaria surveillance systems against the targets of the NMESP objective are crucial in improving their performance and impact. This study aimed to assess whether the malaria surveillance system in KwaZulu-Natal Province meets the NMESP surveillance objective and goals. METHODS A mixed-methods cross-sectional study design was used to evaluate the malaria surveillance system, focusing on the District Health Information System 2 (DHIS2). The study assessed the data quality, timeliness, simplicity, and acceptability of the system. Key personnel from KZN's Provincial malaria control programme were interviewed using self-administered questionnaires to evaluate their perception of the system's simplicity and acceptability. Malaria case data from January 2016 to December 2020 were extracted from the DHIS2 and evaluated for data quality and timeliness. RESULTS The survey respondents generally found the DHIS2-based surveillance system acceptable (79%, 11/14) and easy to use (71%, 10/14), stating that they could readily find, extract, and share data (64%, 9/14). Overall data quality was good (88.9%), although some variables needed for case classification had low completeness and data availability. However, case notifications were not timely, with only 61% (2 622/4 329) of cases notified within 24 h of diagnosis. During the 5-year study period, the DHIS2 captured 4 333 malaria cases. The majority of cases (81%, 3 489/4 330) were categorized as imported, and predominately in males (67%, 2 914/4 333). CONCLUSION While the malaria surveillance system in KZN Province largely met the NMESP surveillance strategic goals, it failed to achieve the overarching surveillance objective of 100% notification of cases within 24 h of diagnosis. The majority of reported cases in KZN Province were classified as imported, emphasizing the importance of complete data for accurate case classification. Engaging with healthcare professionals responsible for case notification and disseminating aggregated data back to them is needed to encourage and improve notification timeliness.
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Affiliation(s)
- Maxwell Mabona
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.
| | - Thembekile Zwane
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Jaishree Raman
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Wits Research Institute for Malaria Control, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- UP Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Babongile Mhlongo
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Poncho Phafane
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
- Division of Public Health Surveillance, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
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Ali VE, Asika MO, Elebesunu EE, Agbo C, Antwi MH. Cognizance and mitigation of falsified immunization documentation: Analyzing the consequences for public health in Nigeria, with a focus on counterfeited COVID-19 vaccination cards: A case report. Health Sci Rep 2024; 7:e1885. [PMID: 38410502 PMCID: PMC10894752 DOI: 10.1002/hsr2.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/03/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024] Open
Abstract
Background and Aims The global immunization campaign against COVID-19 has mandated vaccination certificates, leading to a surge in fake documentation. In Nigeria, the proliferation of counterfeit COVID-19 vaccination cards, facilitated by unscrupulous health workers, raises critical public health concerns. This research spotlights various forms of this malpractice, analyzes the factors contributing to the circulation of fake vaccination cards, their implications on public health, and provides recommendations for addressing the issue. Methods Extensive literature review and analysis were conducted to investigate the emergence of fake COVID-19 vaccination cards in Nigeria. Perspectives from health workers and reports from reputable undercover investigations were examined to identify factors contributing to the circulation of fraudulent records. The research also delved into corruption within the health sector and the impact of low salaries on healthcare workers. Additionally, global instances of fake vaccination cards were explored to provide a comprehensive understanding of the issue. Results Healthcare workers' vaccine hesitancy, corruption, and inadequate salaries were identified as key contributors to the circulation of fake vaccination cards in Nigeria. Instances of health workers accepting bribes to issue cards without administering vaccines were uncovered. The implications on public health included threats to herd immunity, compromised disease surveillance, erosion of public trust, and reinforcement of vaccine hesitancy. The research also highlighted global challenges with fake vaccination cards, emphasizing the need for international cooperation. Conclusion Fake vaccination cards in Nigeria poses challenges to public health, affecting the reliability of immunization data and jeopardizing disease control efforts. It is crucial to strengthen healthcare worker engagement, tackle corruption through increased transparency and improved policies, and implement digital vaccination verification systems. International collaboration is essential to establish standardized security measures and verification checkpoints. Addressing flawed vaccination records requires urgent action to enhance vaccination efforts, and safeguard the population from the resurgence of vaccine-preventable diseases.
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Affiliation(s)
- Victor E. Ali
- Department of Medical Laboratory ScienceUniversity of NigeriaEnuguNigeria
| | | | | | - Chioma Agbo
- Department of Medical Laboratory ScienceUniversity of NigeriaEnuguNigeria
| | - Maxwell Hubert Antwi
- Department of Medical Laboratory ScienceKoforidua Technical UniversityKoforiduaGhana
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Lee ACK, Iversen BG, Lynes S, Rahman-Shepherd A, Erondu NA, Khan MS, Tegnell A, Yelewa M, Arnesen TM, Gudo ES, Macicame I, Cuamba L, Auma VO, Ocom F, Ario AR, Sartaj M, Wilson A, Siddiqua A, Nadon C, MacVinish S, Watson H, Wilburn J, Pyone T. The state of integrated disease surveillance in seven countries: a synthesis report. Public Health 2023; 225:141-146. [PMID: 37925838 DOI: 10.1016/j.puhe.2023.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Integrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. STUDY DESIGN Synthesis of qualitative studies undertaken in seven countries. METHODS Thirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. RESULTS None of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. CONCLUSIONS A plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose.
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Affiliation(s)
- A C K Lee
- UK Health Security Agency, and the University of Sheffield, UK.
| | - B G Iversen
- Norwegian Institute of Public Health, Norway
| | - S Lynes
- International Association of National Public Health Institutes, Belgium
| | | | - N A Erondu
- Global Institute for Disease Elimination, United Arab Emirates
| | - M S Khan
- London School of Hygiene and Tropical Medicine, UK; Aga Khan University, Pakistan
| | | | - M Yelewa
- Public Health Institute of Malawi, Malawi
| | - T M Arnesen
- Norwegian Institute of Public Health, Norway
| | - E S Gudo
- National Institute of Health, Mozambique
| | - I Macicame
- National Institute of Health, Mozambique
| | - L Cuamba
- National Institute of Health, Mozambique
| | - V O Auma
- Uganda National Institute of Public Health, Uganda
| | - F Ocom
- Uganda National Institute of Public Health, Uganda
| | - A R Ario
- Uganda National Institute of Public Health, Uganda
| | - M Sartaj
- UK Health Security Agency, Pakistan
| | | | - A Siddiqua
- Public Health Agency Canada, Canada and McMaster University, Canada
| | - C Nadon
- Public Health Agency Canada, Canada
| | | | | | | | - T Pyone
- World Health Organization, Geneva, Switzerland
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Shannon FQ, Bawo LL, Crump JA, Sharples K, Egan R, Hill PC. Evaluation of Ebola virus disease surveillance system capability to promptly detect a new outbreak in Liberia. BMJ Glob Health 2023; 8:e012369. [PMID: 37532462 PMCID: PMC10401241 DOI: 10.1136/bmjgh-2023-012369] [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: 03/22/2023] [Accepted: 07/09/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Liberia was heavily affected by the 2014-2016 Ebola virus disease (EVD) outbreak. With substantial investments in interventions to combat future outbreaks, it is hoped that Liberia is well prepared for a new incursion. We assessed the performance of the current EVD surveillance system in Liberia, focusing on its ability to promptly detect a new EVD outbreak. METHODS We integrated WHO and US Centers for Disease Control and Prevention guidelines for public health surveillance system evaluation and used standardised indicators to measure system performance. We conducted 23 key informant interviews, 150 health facility assessment surveys and a standardised patient (SP) study (19 visits) from January 2020 to January 2021. Data were summarised and a gap analysis conducted. RESULTS We found basic competencies of case detection and reporting necessary for a functional surveillance system were in place. At the higher (national, county and district) levels, we found performance gaps in 2 of 6 indicators relating to surveillance system structure, 3 of 14 indicators related to core functions, 1 of 5 quality indicators and 2 of 8 indicators related to support functions. The health facility assessment found performance gaps in 9 of 10 indicators related to core functions, 5 of 6 indicators related to support functions and 3 of 7 indicators related to quality. The SP simulations revealed large gaps between expected and actual practice in managing a patient warranting investigation for EVD. Major challenges affecting the system's operations across all levels included limited access to resources to support surveillance activities, persistent stock out of sample collection materials and attrition of trained staff. CONCLUSION The EVD surveillance system in Liberia may fail to promptly detect a new EVD outbreak. Specific improvements are required, and regular evaluations recommended. SP studies could be crucial in evaluating surveillance systems for rarely occurring diseases that are important to detect early.
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Affiliation(s)
- Fulton Quincy Shannon
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Planning Research and Development, Republic of Liberia Ministry of Health, Monrovia, Liberia
| | - Luke L Bawo
- Planning Research and Development, Republic of Liberia Ministry of Health, Monrovia, Liberia
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Richard Egan
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Latorre AAE, Nakamura K, Seino K, Hasegawa T. Vector Autoregression for Forecasting the Number of COVID-19 Cases and Analyzing Behavioral Indicators in the Philippines: Ecologic Time-Trend Study. JMIR Form Res 2023; 7:e46357. [PMID: 37368473 DOI: 10.2196/46357] [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: 02/13/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Traditional surveillance systems rely on routine collection of data. The inherent delay in retrieval and analysis of data leads to reactionary rather than preventive measures. Forecasting and analysis of behavior-related data can supplement the information from traditional surveillance systems. OBJECTIVE We assessed the use of behavioral indicators, such as the general public's interest in the risk of contracting SARS-CoV-2 and changes in their mobility, in building a vector autoregression model for forecasting and analysis of the relationships of these indicators with the number of COVID-19 cases in the National Capital Region. METHODS An etiologic, time-trend, ecologic study design was used to forecast the daily number of cases in 3 periods during the resurgence of COVID-19. We determined the lag length by combining knowledge on the epidemiology of SARS-CoV-2 and information criteria measures. We fitted 2 models to the training data set and computed their out-of-sample forecasts. Model 1 contains changes in mobility and number of cases with a dummy variable for the day of the week, while model 2 also includes the general public's interest. The forecast accuracy of the models was compared using mean absolute percentage error. Granger causality test was performed to determine whether changes in mobility and public's interest improved the prediction of cases. We tested the assumptions of the model through the Augmented Dickey-Fuller test, Lagrange multiplier test, and assessment of the moduli of eigenvalues. RESULTS A vector autoregression (8) model was fitted to the training data as the information criteria measures suggest the appropriateness of 8. Both models generated forecasts with similar trends to the actual number of cases during the forecast period of August 11-18 and September 15-22. However, the difference in the performance of the 2 models became substantial from January 28 to February 4, as the accuracy of model 2 remained within reasonable limits (mean absolute percentage error [MAPE]=21.4%) while model 1 became inaccurate (MAPE=74.2%). The results of the Granger causality test suggest that the relationship of public interest with number of cases changed over time. During the forecast period of August 11-18, only change in mobility (P=.002) improved the forecasting of cases, while public interest was also found to Granger-cause the number of cases during September 15-22 (P=.001) and January 28 to February 4 (P=.003). CONCLUSIONS To the best of our knowledge, this is the first study that forecasted the number of COVID-19 cases and explored the relationship of behavioral indicators with the number of COVID-19 cases in the Philippines. The resemblance of the forecasts from model 2 with the actual data suggests its potential in providing information about future contingencies. Granger causality also implies the importance of examining changes in mobility and public interest for surveillance purposes.
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Affiliation(s)
- Angelica Anne Eligado Latorre
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines-Manila, Manila, Philippines
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Hasegawa
- Department of Integrated Analytics, Medical and Dental Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
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Goel V, Mathew S, Gudi N, Jacob A, John O. A scoping review on laboratory surveillance in the WHO Southeast Asia Region: Past, present and the future. J Glob Health 2023; 13:04028. [PMID: 37083001 PMCID: PMC10119808 DOI: 10.7189/jogh.13.04028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Background The South-East Asia (SEA) region bears a significant proportion of the world's communicable disease burden. The onset of the COVID-19 pandemic has further affected the situation. A well-established laboratory-based surveillance (LBS) can reduce the burden of infectious diseases. In light of this, the review collated the existing literature on LBS system in the region and the modifications adopted by the surveillance systems during the pandemic. Methodology We followed the guidelines for scoping review as prescribed by Arskey and O'Malley. We comprehensively searched three databases (PubMed, Scopus and CINAHL) and supplemented it with grey literature search. The screening of the articles was conducted at the title and abstract followed by full-text screening. This was followed by data extraction using a pre-tested data extraction tool by two independent reviewers. The results were presented narratively. Results Including 75 relevant articles and documents, we compiled a list of surveillance systems. A shift from paper to dual (paper and electronic) modalities was identified across the countries. This largely low- and middle-income countries (LMIC) area face challenges in reporting, resources, and collaboration-related issues. While some countries have well-established National Reference Laboratories; others have more private than public-owned laboratories. Given the COVID-19 pandemic, modifications to the existing laboratory capacities to enable real-time surveillance was identified. Laboratory capacity complemented with genomic surveillance can indubitably aid in disease detection and control. Limitations due to inaccessible government portals, and language barriers are acknowledged. This review identified a comprehensive list of surveillance systems in the region, challenges faced in using these surveillance systems and inform the decision makers about the benefits of integrating fragmented surveillance systems. Conclusion Regionally and nationally integrated genomic and laboratory surveillance systems justify capital investments, as their payoffs rationalise such costs owing to economies of scale over time. Further, as data flows are harmonized and standardized, algorithm- and computing-based pattern recognition methods allow for targeted and accurate disease prediction when integrated with, potentially, climate and weather systems data. Trained human resources are a sine qua non to optimize such investments, but in the medium to long run, such investments will buttress initiatives in other arenas at the regional level.
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Affiliation(s)
- Vidushi Goel
- The George Institute for Global Health, New Delhi, India
| | - Silvy Mathew
- The George Institute for Global Health, New Delhi, India
| | - Nachiket Gudi
- Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil Jacob
- The George Institute Services, New Delhi, India
| | - Oommen John
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Nansikombi HT, Kwesiga B, Aceng FL, Ario AR, Bulage L, Arinaitwe ES. Timeliness and completeness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020-2021. BMC Public Health 2023; 23:647. [PMID: 37016380 PMCID: PMC10072024 DOI: 10.1186/s12889-023-15534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Disease surveillance provides vital data for disease prevention and control programs. Incomplete and untimely data are common challenges in planning, monitoring, and evaluation of health sector performance, and health service delivery. Weekly surveillance data are sent from health facilities using mobile tracking (mTRAC) program, and synchronized into the District Health Information Software version 2 (DHIS2). The data are then merged into district, regional, and national level datasets. We described the completeness and timeliness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020-2021. METHODS We abstracted data on completeness and timeliness of weekly reporting of epidemic-prone diseases from 146 districts of Uganda from the DHIS2.Timeliness is the proportion of all expected weekly reports that were submitted to DHIS2 by 12:00pm Monday of the following week. Completeness is the proportion of all expected weekly reports that were completely filled and submitted to DHIS2 by 12:00pm Wednesday of the following week. We determined the proportions and trends of completeness and timeliness of reporting at national level by year, health region, district, health facility level, and facility ownership. RESULTS National average reporting timeliness and completeness was 44% and 70% in 2020, and 49% and 75% in 2021. Eight of the 15 health regions achieved the target for completeness of ≥ 80%; Lango attained the highest (93%) in 2020, and Karamoja attained 96% in 2021. None of the regions achieved the timeliness target of ≥ 80% in either 2020 or 2021. Kampala District had the lowest completeness (38% and 32% in 2020 and 2021, respectively) and the lowest timeliness (19% in both 2020 and 2021). Referral hospitals and private owned health facilities did not attain any of the targets, and had the poorest reporting rates throughout 2020 and 2021. CONCLUSION Weekly surveillance reporting on epidemic prone diseases improved modestly over time, but timeliness of reporting was poor. Further investigations to identify barriers to reporting timeliness for surveillance data are needed to address the variations in reporting.
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Affiliation(s)
- Hildah Tendo Nansikombi
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda.
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | | | - Alex R Ario
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
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11
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Schuetze L, Srivastava S, Kuunibe N, Rwezaula EJ, Missenye A, Stoermer M, De Allegri M. What Factors Explain Low Adoption of Digital Technologies for Health Financing in an Insurance Setting? Novel Evidence From a Quantitative Panel Study on IMIS in Tanzania. Int J Health Policy Manag 2023; 12:6896. [PMID: 37579470 PMCID: PMC10125074 DOI: 10.34172/ijhpm.2023.6896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Digital information management systems for health financing are implemented on the assumption thatdigitalization, among other things, enables strategic purchasing. However, little is known about the extent to which thesesystems are adopted as planned to achieve desired results. This study assesses the levels of, and the factors associated withthe adoption of the Insurance Management Information System (IMIS) by healthcare providers in Tanzania. METHODS Combining multiple data sources, we estimated IMIS adoption levels for 365 first-line health facilities in2017 by comparing IMIS claim data (verified claims) with the number of expected claims. We defined adoption as abinary outcome capturing underreporting (verified RESULTS We found a median (interquartile range [IQR]) difference of 77.8% (32.7-100) between expected and verifiedclaims, showing a consistent pattern of underreporting across districts, regions, and months. Levels of underreportingvaried across regions (ANOVA: F=7.24, P<.001) and districts (ANOVA: F=4.65, P<.001). Logistic regression resultsshowed that higher service volume, share of people insured, and greater distance to district headquarter were associatedwith a higher probability of underreporting. CONCLUSION Our study shows that the adoption of IMIS in Tanzania may be sub-optimal and far from policy-makers'expectations, limiting its capacity to provide the necessary information to enhance strategic purchasing in the healthsector. Countries and agencies adopting digital interventions such as openIMIS to foster health financing reform areadvised to closely track their implementation efforts to make sure the data they rely on is accurate. Further, our studysuggests organizational and infrastructural barriers beyond the software itself hamper effective adoption.
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Affiliation(s)
- Leon Schuetze
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Siddharth Srivastava
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Naasegnibe Kuunibe
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
- Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
| | | | | | - Manfred Stoermer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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12
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Haregu T, Lim SC, Miranda M, Pham CT, Nguyen N, Suya I, Ilagan R, Poowanasatien A, Kowal P, Oldenburg B. Practical Strategies for Improving Sustainability and Scale-up of Noncommunicable Disease-related Public Health Interventions: Lessons from the Better Health Program in Southeast Asia. WHO South East Asia J Public Health 2023; 12:15-37. [PMID: 37843178 DOI: 10.4103/who-seajph.who-seajph_140_22] [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] [Indexed: 10/17/2023]
Abstract
Introduction The Better Health Program has been addressing key health system issues in the prevention and control of noncommunicable diseases (NCDs) in Malaysia, Thailand, Vietnam, and the Philippines. As the program comes to an end, the sustainability and scaling-up of issues have assumed importance. Objectives The objective is to assess how well sustainability and scale-up strategies have been integrated into the design and implementation of a 3-year multicountry technical program; to explore enablers and barriers of sustainability and scaling up; and to identify practical strategies that can improve sustainability and scale-up of Better Health Program interventions. Methods We applied a staged approach to explore barriers and enablers and to identify practical strategies to improve sustainability and scale-up of four NCD interventions: community-based obesity prevention, front-of-pack labeling, local learning networks (LLNs), and NCD surveillance. We extracted evidence from peer-reviewed literature and local documents. We also conducted in-depth interviews with the implementation teams and key stakeholders. We conducted a thematic synthesis of the resulting information to identify practical strategies that improve sustainability and scale-up of the four interventions. Results Strong engagement of stakeholders at higher levels of the health system was identified as the main enabler, while limited funding and commitment from local governments were identified as a key barrier to sustainability and scale-up. Strengthening the social and institutional anchors of community health volunteers, enhancing evidence-based advocacy for front-of-pack labeling, trailblazing the LLN innovation, and securing the commitment of local governments in the implementation of NCD surveillance were among the key strategies for improving sustainability and scale-up of Better Health Program interventions in Malaysia, Thailand, Philippines, and Vietnam, respectively. Conclusions This study identified practical strategies for improving sustainability and scale-up of NCD-related interventions. Implementation of the strategies that had high priority and feasibility will improve the sustainability of critical elements of the program in the respective countries.
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Affiliation(s)
- Tilahun Haregu
- Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | | | | | - Inthira Suya
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
| | | | | | - Paul Kowal
- Australian National University and Better Health Programme Southeast Asia, Yangon, Myanmar
| | - Brian Oldenburg
- Noncommunicable Disease and Implementation Science Lab, Baker Heart and Diabetes Institute; Baker Department of Cardiovascular Research, Translation and Implementation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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13
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Mremi IR, Sindato C, Kishamawe C, Rumisha SF, Kimera SI, Mboera LEG. Improving disease surveillance data analysis, interpretation, and use at the district level in Tanzania. Glob Health Action 2022; 15:2090100. [PMID: 35916840 PMCID: PMC9351552 DOI: 10.1080/16549716.2022.2090100] [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] [Indexed: 11/24/2022] Open
Abstract
An effective disease surveillance system is critical for early detection and response to disease epidemics. This study aimed to assess the capacity to manage and utilize disease surveillance data and implement an intervention to improve data analysis and use at the district level in Tanzania. Mapping, in-depth interview and desk review were employed for data collection in Ilala and Kinondoni districts in Tanzania. Interviews were conducted with members of the council health management teams (CHMT) to assess attitudes, motivation and practices related to surveillance data analysis and use. Based on identified gaps, an intervention package was developed on basic data analysis, interpretation and use. The effectiveness of the intervention package was assessed using pre-and post-intervention tests. Individual interviews involved 21 CHMT members (females = 10; males = 11) with an overall median age of 44.5 years (IQR = 37, 53). Over half of the participants regarded their data analytical capacities and skills as excellent. Analytical capacity was higher in Kinondoni (61%) than Ilala (52%). Agreement on the availability of the opportunities to enhance capacity and skills was reported by 68% and 91% of the participants from Ilala and Kinondoni, respectively. Reported challenges in disease surveillance included data incompleteness and difficulties in storage and accessibility. Training related to enhancement of data management was reported to be infrequently done. In terms of data interpretation and use, despite reporting of incidence of viral haemorrhagic fevers for five years, no actions were taken to either investigate or mitigate, indicating poor use of surveillance data in monitoring disease occurrence. The overall percentage increase on surveillance knowledge between pre-and post-training was 37.6% for Ilala and 20.4% for Kinondoni indicating a positive impact on of the training. Most of CHMT members had limited skills and practices on data analysis, interpretation and use. The training in data analysis and interpretation significantly improved skills of the participants.
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Affiliation(s)
- Irene R Mremi
- SACIDS Foundation for One Health Sokoine University of Agriculture, Morogoro, Tanzania.,National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Calvin Sindato
- SACIDS Foundation for One Health Sokoine University of Agriculture, Morogoro, Tanzania.,Tabora Research Centre, National Institute for Medical Research, Tabora, Tanzania
| | - Coleman Kishamawe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, Perth Children's Hospital, Western, Nedlands, Western Australia, Australia
| | - Sharadhuli I Kimera
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Leonard E G Mboera
- SACIDS Foundation for One Health Sokoine University of Agriculture, Morogoro, Tanzania
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14
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Koye DN, Melaku YA, Gelaw YA, Zeleke BM, Adane AA, Tegegn HG, Gebreyohannes EA, Erku DA, Tesfay FH, Gesesew HA, Mekonnen A, Dadi AF, Alene KA. Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis. BMJ Open 2022; 12:e065318. [PMID: 36600383 PMCID: PMC9743363 DOI: 10.1136/bmjopen-2022-065318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia. DESIGN AND SETTING Nationwide cross-sectional survey in Ethiopia combined with georeferenced ecological level data from publicly available sources. PARTICIPANTS 9801 participants aged between 15 and 69 years. PRIMARY OUTCOME MEASURES Prevalence of hypertension and diabetes were collected using the WHO's STEPS survey approach. Bayesian model-based geostatistical techniques were used to estimate hypertension and diabetes prevalence at national, regional and pixel levels (1×1 km2) with corresponding 95% credible intervals (95% CrIs). RESULTS The national prevalence was 19.2% (95% CI: 18.4 to 20.0) for hypertension and 2.8% (95% CI: 2.4 to 3.1) for diabetes. Substantial variation was observed in the prevalence of these diseases at subnational levels, with the highest prevalence of hypertension observed in Addis Ababa (30.6%) and diabetes in Somali region (8.7%). Spatial overlap of high hypertension and diabetes prevalence was observed in some regions such as the Southern Nations, Nationalities and People's region and Addis Ababa. Population density (number of people/km2) was positively associated with the prevalence of hypertension (β: 0.015; 95% CrI: 0.003-0.027) and diabetes (β: 0.046; 95% CrI: 0.020-0.069); whereas altitude in kilometres was negatively associated with the prevalence of diabetes (β: -0.374; 95% CrI: -0.711 to -0.044). CONCLUSIONS Spatial clustering of hypertension and diabetes was observed at subnational and local levels in Ethiopia, which was significantly associated with population density and altitude. The variation at the subnational level illustrates the need to include environmental drivers in future NCDs burden estimation. Thus, targeted and integrated interventions in high-risk areas might reduce the burden of hypertension and diabetes in Ethiopia.
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Affiliation(s)
- Digsu Negese Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health research Hub (MISCH), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Yohannes Adama Melaku
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Yalemzewod Assefa Gelaw
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Berihun Megabiaw Zeleke
- Planetary Health Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Akilew Awoke Adane
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
| | - Henok Getachew Tegegn
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Eyob Alemayehu Gebreyohannes
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Hailay Abrha Gesesew
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Alemayehu Mekonnen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Abel Fekadu Dadi
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Menzies Health Research Institute, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kefyalew Addis Alene
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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15
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Njuguna C, Vandi M, Squire JS, Kanu JS, Gachari W, Liyosi E, Githuku J, Chimbaru A, Njeru I, Caulker V, Mugagga M, Sesay S, Yahaya AA, Talisuna A, Yoti Z, Fall IS. Innovative approach to monitor performance of integrated disease surveillance and response after the Ebola outbreak in Sierra Leone: lessons from the field. BMC Health Serv Res 2022; 22:1270. [PMID: 36266711 PMCID: PMC9584265 DOI: 10.1186/s12913-022-08627-6] [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: 03/25/2022] [Revised: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background Supervision of healthcare workers improves performance if done in a supportive and objective manner. Regular supervision is a support function of Integrated Disease Surveillance and Response (IDSR) strategy and allows systematic monitoring of IDSR implementation. Starting 2015, WHO and other development partners supported the Ministry of Health and Sanitation (MoHS) to revitalize IDSR in Sierra Leone and to monitor progress through supportive supervision assessments. We report on the findings of these assessments. Methods This was a cross-sectional study where six longitudinal assessments were conducted in randomly selected health facilities. Health facilities assessed were 71 in February 2016, 99 in July 2016, 101 in May 2017, 126 in August 2018, 139 in February 2019 and 156 in August 2021. An electronic checklist based on selected core functions of IDSR was developed and uploaded onto tablets using the Open Data Kit (ODK) platform. Supervision teams interviewed health care workers, reviewed documents and made observations in health facilities. Supervision books were used to record feedback and corrective actions. Data from the supervisory visits was downloaded from ODK platform, cleaned and analysed. Categorical data was summarized using frequencies and proportions while means and medians were used for continuous variables. Z test was used to test for differences in proportions. Results Completeness of IDSR reporting improved from 84.5% in 2016 to 96% in 2021 (11.5% points; 95% CI 3.6, 21.9; P-value 0.003). Timeliness of IDSR reports improved from 80.3 to 92% (11.7% points; 95% CI 2.4, 22.9; P-value 0.01). There was significant improvement in health worker knowledge of IDSR concepts and tools, in availability of IDSR standard case definition posters and reporting tools and in data analysis practices. Availability of vaccines and temperature monitoring tools in health facilities also improved significantly but some indicators dropped such as availability of IDSR technical guidelines and malaria testing kits and drugs. Conclusion Supervision using electronic tool contributed to health systems strengthening through longitudinal tracking of core IDSR indicators and other program indicators such as essential malaria commodities and availability and status of routine vaccines. Supervision using electronic tools should be extended to other programs.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone.
| | - Mohamed Vandi
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Wilson Gachari
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Evans Liyosi
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Jane Githuku
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Alexander Chimbaru
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Ian Njeru
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Victor Caulker
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Malimbo Mugagga
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Stephen Sesay
- World Health Organization Country office, 21 A & B Riverside Drive, off King Harman Road Brookfield, Freetown, Sierra Leone
| | - Ali Ahmed Yahaya
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Zabulon Yoti
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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16
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Diallo CO, Schiøler KL, Samuelsen H, Drabo KM. Information System as part of epidemic management in Burkina Faso: from plan to reality (Field Findings). BMC Public Health 2022; 22:1726. [PMID: 36096785 PMCID: PMC9465128 DOI: 10.1186/s12889-022-14072-1] [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: 07/26/2021] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health information systems (HIS) in most developing countries face many challenges. In view of the recurrent weaknesses in preparedness and response during the management of epidemics, we have examined the organization and functioning of the health information system in Burkina Faso. METHODS We conducted a cross-sectional study from January 1, 2020 to March 31, 2020 including a review of HIS documents, key informant interviews and direct observations. The study was conducted at the public primary health care (PHC) and community level of Bama and Soumagou, in the rural health districts of Dandé and Tenkodogo. Study participants included community-based health workers (CBHWs) and health workers in the PHC areas, community-based organization animators (CBOAs), CBO monitoring-evaluation officers and members of the District management team (DMT). RESULTS While reporting forms used in all health facilities are standardized, they are not necessarily well understood at community level and at the health centers. Reports prepared by CBHWs are often delayed by the head nurse at the primary health care service. Case definitions of epidemic diseases are not always well understood by community-based health workers and front-line health workers. CONCLUSION The health information system in Burkina Faso can be improved using simple strategies. There is a need to hold regular training/refresher sessions for agents involved in surveillance and to ensure the development of simplified case definitions for emerging diseases and/or diseases of public health interest for community use. Furthermore, existing epidemic management committees need to be revitalized.
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Affiliation(s)
- Cheick Omar Diallo
- University of Ouagadougou, 09 P.O. Box: 480, Ouagadougou 09, Burkina Faso.
| | - Karin Linda Schiøler
- Global health section, Department Public Health, University of Copenhagen (UCPH), Copenhagen, Denmark
| | - Helle Samuelsen
- Department of Anthropology, University of Copenhagen (UCPH), Copenhagen, Denmark
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Continuous Circulation of Yellow Fever among Rural Populations in the Central African Republic. Viruses 2022; 14:v14092014. [PMID: 36146820 PMCID: PMC9503741 DOI: 10.3390/v14092014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Yellow fever remains a public-health threat in remote regions of Africa. Here, we report the identification and genetic characterisation of one yellow-fever case observed during the investigation of a cluster of nine suspected haemorrhagic fever cases in a village in the Central African Republic. Samples were tested using real-time RT-PCR targeting the main African haemorrhagic fever viruses. Following negative results, we attempted virus isolation on VERO E6 cells and new-born mice and rescreened the samples using rRT-PCR. The whole viral genome was sequenced using an Illumina NovaSeq 6000 sequencer. Yellow-fever virus (YFV) was isolated from one woman who reported farming activities in a forest setting several days before disease onset. Phylogenetic analysis shows that this strain belongs to the East–Central African YFV genotype, with an estimated emergence some 63 years ago. Finally, five unique amino-acid changes are present in the capsid, envelop, NS1A, NS3, and NS4B proteins. More efforts are required to control yellow-fever re-emergence in resource-limited settings.
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Desta BN, Gobena T, Macuamule C, Fayemi OE, Ayolabi CI, Mmbaga BT, Thomas KM, Dodd W, Pires SM, Majowicz SE, Hald T. Practicalities of implementing burden of disease research in Africa: lessons from a population survey component of our multi-partner FOCAL research project. Emerg Themes Epidemiol 2022; 19:4. [PMID: 35672710 PMCID: PMC9171481 DOI: 10.1186/s12982-022-00113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background Collaborative research is being increasingly implemented in Africa to study health-related issues, for example, the lack of evidence on disease burden, in particular for the presumptive high load of foodborne diseases. The FOCAL (Foodborne disease epidemiology, surveillance, and control in African LMIC) Project is a multi-partner study that includes a population survey to estimate the foodborne disease burden in four African low- and middle-income countries (LMICs). Our multi-partner study team had members from seven countries, all of whom contributed to the project from the grant application stage, and who play(ed) specific roles in designing and implementing the population survey. Main text In this paper, we applied Larkan et al.’s framework for successful research partnerships in global health to self-evaluate our project’s collaboration, management, and implementation process. Our partnership formation considered the interplay and balance between operations and relations. Using Larkan et al.’s seven core concepts (i.e., focus, values, equity, benefit, communication, leadership, and resolution), we reviewed the process stated above in an African context. Conclusion Through our current partnership and research implementing a population survey to study disease burden in four African LMICs, we observed that successful partnerships need to consider these core concepts explicitly, apply the essential leadership attributes, perform assessment of external contexts before designing the research, and expect differences in work culture. While some of these experiences are common to research projects in general, the other best practices and challenges we discussed can help inform future foodborne disease burden work in Africa.
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Affiliation(s)
- Binyam N Desta
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, N2L 3G1, Canada.
| | - Tesfaye Gobena
- College of Health and Medical Science, Haramaya University, Haramaya, Ethiopia
| | | | - Olanrewaju E Fayemi
- Centre for Research, Innovation, and Collaboration/Department of Biological Sciences, Mountain Top University, Prayer City, Nigeria
| | - Christianah I Ayolabi
- Centre for Research, Innovation, and Collaboration/Department of Biological Sciences, Mountain Top University, Prayer City, Nigeria.,Department of Microbiology, University of Lagos, Lagos, Nigeria
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kate M Thomas
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, N2L 3G1, Canada
| | - Sara M Pires
- Risk-Benefit Research Group, Technical University of Denmark, Lyngby, Denmark
| | - Shannon E Majowicz
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, N2L 3G1, Canada
| | - Tine Hald
- Research Group for Genomic Epidemiology, Technical University of Denmark, Lyngby, Denmark
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Kavulikirwa OK, Sikakulya FK. Recurrent Ebola outbreaks in the eastern Democratic Republic of the Congo: A wake-up call to scale up the integrated disease surveillance and response strategy. One Health 2022; 14:100379. [PMID: 35313715 PMCID: PMC8933533 DOI: 10.1016/j.onehlt.2022.100379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/03/2022] Open
Abstract
Ebola virus disease (EVD) is a dangerous viral zoonotic hemorrhagic fever caused by a deadly pathogenic filovirus. Frugivorous bats are recognized as being the natural reservoir, playing a pivotal role in the epidemiological dynamics. Since its discovery in 1976, the disease has been shown to be endemic in the Democratic Republic of the Congo (DRC). So far, thirteen outbreaks have occurred, and EVD has been prioritized in the national surveillance system. Additionally, EVD is targeted by the Integrated Disease Surveillance and Response (IDSR) strategy in DRC. The IDSR strategy is a collaborative, comprehensive and innovative surveillance approach developed and adopted by WHO's African region member states (WHO/Afro) to strengthen their surveillance capacity at all levels for early detection, response and recovery from priority diseases and public health events. We provide an overview of the IDSR strategy and the issues that can prevent its expected outcome (early detection for timely response) in eastern DRC where there are still delays in EVD outbreaks detection and weaknesses in response capacity and health crisis recovery. Therefore, this paper highlights the advantages linked to the implementation of the IDSR and calls for an urgent need to scale up its materialization against the recurrent Ebola outbreaks in eastern DRC. Consequently, the paper advocates for rapidly addressing the obstacles hindering its operationalization and adapting the approach to the local context using implementation science.
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Furtado KM, Kar A. Private Sector Engagement for Infectious Disease Surveillance in Mixed Health Systems: Lessons from a Model Dengue Reporting Network in India. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221091011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disease estimates from surveillance in mixed health systems is affected by lack of data from the private sector. We aimed to characterize private sector engagement and reporting to a disease surveillance network, and determine the implications on dengue case detection. We developed and set up a public–private network (CODREN—Community Disease Detection and Response Network) with recruitment of eligible health resources ( n = 462) in a municipal ward of Pune city, India (population 209,331). Dengue cases reported through CODREN were compared with reports of the local dengue surveillance (LDS) over 1 year. Private clinics constituted the majority of eligible providers (60%, 276). Retention of participants was 81.7% with 13.9% reporting dengue cases. Phone call was the preferred reporting method (85.5%, 564 reports). CODREN captured a higher number of cases than LDS (78.9%, 251 vs 50.6%, 161), increasing case detection by 18% due to increased private reporting points. A twofold lower number of cases was reported by LDS from shared reporting points with CODREN, due to discrepancies in case definitions and diagnostic test preferences among private providers. We conclude that private sector engagement can improve dengue case detection with the selective inclusion of providers, sustained contact, feedback and simple reporting methods. Testing guidelines and case definitions adopted by the LDS need to address heterogeneity of private practice in mixed health systems, in order to improve dengue estimates in India.
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Affiliation(s)
- Kheya Melo Furtado
- Goa Institute of Management, Sanquelim, Goa, India
- School of Health Sciences-Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Anita Kar
- School of Health Sciences-Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
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21
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Tagurum YO, Dogo MJ, Adah GA, Maimagani IC, Sodipo OO, Adeniji T, Daboer JC, Banwat ME, Lar LA, Akosu TJ, Chingle MP. Comparative Assessment of the Implementation of Integrated Disease Surveillance and Response in Public and Private Health Facilities in Jos North Local Government Area of Plateau State, Nigeria. Ann Afr Med 2022; 21:146-152. [PMID: 35848647 PMCID: PMC9383018 DOI: 10.4103/1596-3519.349974] [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] [Indexed: 11/04/2022] Open
Abstract
Background Due to the continuous increase in the spread of epidemic-prone diseases and the associated morbidity and mortality, integrated disease surveillance and response (IDSR) was introduced as the main strategy in resource-poor settings for the detection and notification of these diseases. Integrated disease surveillance is a combination of active and passive systems using a single infrastructure that gathers information about multiple diseases or behaviors of interest. Methods : A comparative cross-sectional study was conducted between March and July 2018 among selected public and private health facilities in Jos North Local Government Area (LGA), Plateau State. Quantitative data were collected with the aid of a semi-structured interviewer-administered questionnaire and facility-based checklist. Data were analyzed using SPSS version 23. Statistical significance level was set at P ≤ 0.05 at a 95% confidence level. Results A. total of 126 health workers were studied. IDSR-trained health personnel was found in 52.7% of the public health facilities compared with only 16.7% of the private health facilities studied (P < 0.001). Awareness of IDSR was higher in the public health facilities than in the private ones (P < 0.001). IDSR implementation was poorer in the private health facilities 40.7% compared with 76.4% in public health facilities (P < 0.001). Evidence of previous disease notification and reporting was seen only in 33.3% and 16.7% of public and private health facilities, respectively (P < 0.001). Conclusion This study revealed that awareness and attitude of health workers in public health facilities in Jos North were higher than that of those in private health facilities and there is the sub-optimal implementation of IDSR among the health workers in Jos North LGA, especially among the private health facilities.
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Affiliation(s)
- Yetunde Olubusayo Tagurum
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - M Joy Dogo
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - G A Adah
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - I C Maimagani
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - O O Sodipo
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - T Adeniji
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - J C Daboer
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - M E Banwat
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - L A Lar
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - T J Akosu
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - M P Chingle
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
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22
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Worsley-Tonks KEL, Bender JB, Deem SL, Ferguson AW, Fèvre EM, Martins DJ, Muloi DM, Murray S, Mutinda M, Ogada D, Omondi GP, Prasad S, Wild H, Zimmerman DM, Hassell JM. Strengthening global health security by improving disease surveillance in remote rural areas of low-income and middle-income countries. Lancet Glob Health 2022; 10:e579-e584. [PMID: 35303467 PMCID: PMC8923676 DOI: 10.1016/s2214-109x(22)00031-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 01/19/2023]
Abstract
The COVID-19 pandemic has underscored the need to strengthen national surveillance systems to protect a globally connected world. In low-income and middle-income countries, zoonotic disease surveillance has advanced considerably in the past two decades. However, surveillance efforts often prioritise urban and adjacent rural communities. Communities in remote rural areas have had far less support despite having routine exposure to zoonotic diseases due to frequent contact with domestic and wild animals, and restricted access to health care. Limited disease surveillance in remote rural areas is a crucial gap in global health security. Although this point has been made in the past, practical solutions on how to implement surveillance efficiently in these resource-limited and logistically challenging settings have yet to be discussed. We highlight why investing in disease surveillance in remote rural areas of low-income and middle-income countries will benefit the global community and review current approaches. Using semi-arid regions in Kenya as a case study, we provide a practical approach by which surveillance in remote rural areas can be strengthened and integrated into existing systems. This Viewpoint represents a transition from simply highlighting the need for a more holistic approach to disease surveillance to a solid plan for how this outcome might be achieved.
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Affiliation(s)
| | - Jeff B Bender
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sharon L Deem
- Institute for Conservation Medicine, Saint Louis Zoo, Saint Louis, MO, USA
| | - Adam W Ferguson
- Gantz Family Collection Center, Field Museum of Natural History, Chicago, IL, USA
| | - Eric M Fèvre
- International Livestock Research Institute, Nairobi, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Dino J Martins
- Mpala Research Centre, Nanyuki, Kenya; Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
| | - Dishon M Muloi
- International Livestock Research Institute, Nairobi, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Suzan Murray
- Global Health Program, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC, USA
| | - Mathew Mutinda
- Veterinary Services Department, Kenya Wildlife Service, Nairobi, Kenya
| | - Darcy Ogada
- The Peregrine Fund, Boise, ID, USA; National Museums of Kenya, Nairobi, Kenya
| | - George P Omondi
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA; Ahadi Veterinary Resource Center, Nairobi, Kenya
| | - Shailendra Prasad
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, USA
| | - Hannah Wild
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Dawn M Zimmerman
- Department of Clinical Studies, University of Nairobi, Nairobi, Kenya; Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA
| | - James M Hassell
- Global Health Program, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC, USA; Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA
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23
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Alene KA, Elagali A, Barth DD, Rumisha SF, Amratia P, Weiss DJ, Atalell KA, Erena AK, Gething PW, Clements ACA. Spatial codistribution of HIV, tuberculosis and malaria in Ethiopia. BMJ Glob Health 2022; 7:bmjgh-2021-007599. [PMID: 35217531 PMCID: PMC8867247 DOI: 10.1136/bmjgh-2021-007599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background HIV, tuberculosis (TB) and malaria are the three most important infectious diseases in Ethiopia, and sub-Saharan Africa. Understanding the spatial codistribution of these diseases is critical for designing geographically targeted and integrated disease control programmes. This study investigated the spatial overlap and drivers of HIV, TB and malaria prevalence in Ethiopia. Methods HIV, TB and malaria data were obtained from different nationwide prevalence surveys, and geospatial covariates were obtained from publicly available sources. A Bayesian model-based geostatistical framework was applied to each survey leveraging the strength of high-resolution spatial covariates to predict continuous disease-specific prevalence surfaces and their codistribution. Results The national prevalence was 1.54% (95% CI 1.40 to 1.70) for HIV, 0.39% (95% CI 0.34 to 0.45) for TB and 1.1% (95%CI 0.95 to 1.32) for malaria. Substantial subnational variation was predicted with the highest HIV prevalence estimated in Gambela (4.52%), Addis Ababa (3.52%) and Dire Dawa (2.67%) regions. TB prevalence was highest in Dire Dawa (0.96%) and Gambela (0.88%), while malaria was highest in Gambela (6.1%) and Benishangul-Gumuz (3.8%). Spatial overlap of their prevalence was observed in some parts of the country, mainly Gambela region. Spatial distribution of the diseases was significantly associated with healthcare access, demographic, and climatic factors. Conclusions The national distribution of HIV, TB and malaria was highly focal in Ethiopia, with substantial variation at subnational and local levels. Spatial distribution of the diseases was significantly associated with healthcare access, demographic and climatic factors. Spatial overlap of HIV, TB and malaria prevalence was observed in some parts of the country. Integrated control programmes for these diseases should be targeted to these areas with high levels of co-endemicity.
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Affiliation(s)
- Kefyalew Addis Alene
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia .,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Ahmed Elagali
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Dylan D Barth
- University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Susan F Rumisha
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia.,National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Punam Amratia
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Daniel J Weiss
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Kendalem Asmare Atalell
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Peter W Gething
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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24
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Adebisi YA, Rabe A, Lucero-Prisno Iii DE. COVID-19 surveillance systems in African countries. Health Promot Perspect 2022; 11:382-392. [PMID: 35079582 PMCID: PMC8767077 DOI: 10.34172/hpp.2021.49] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Surveillance forms the basis for response to disease outbreaks, including COVID-19. Herein, we identified the COVID-19 surveillance systems and the associated challenges in 13 African countries. Methods: We conducted a comprehensive narrative review of peer-reviewed literature published between January 2020 and April 2021 in PubMed, Medline, PubMed Central, and Google Scholar using predetermined search terms. Relevant studies from the search and other data sources on COVID-19 surveillance strategies and associated challenges in 13 African countries (Mauritius, Algeria, Nigeria, Angola, Cote d’Ivoire, the Democratic Republic of the Congo, Ghana, Ethiopia, South Africa, Kenya, Zambia, Tanzania, and Uganda) were identified and reviewed. Results: Our findings revealed that the selected African countries have ramped up COVID-19 surveillance ranging from immediate case notification, virological surveillance, hospital-based surveillance to mortality surveillance among others. Despite this, there exist variations in the level of implementation of the surveillance systems across countries. Integrated Disease Surveillance and Response (IDSR) strategy is also being leveraged in some African countries, but the implementation across countries remains uneven. Our study also revealed various challenges facing surveillance which included shortage of skilled human resources resulting in poor data management, weak health systems, complexities of ethical considerations, diagnostic insufficiency, the burden of co-epidemic surveillance, and geographical barriers, among others. Conclusion: With the variations in the level of implementation of COVID-19 surveillance strategies seen across countries, it is pertinent to ensure proper coordination of the surveillance activities in the African countries and address all the challenges facing COVID-19 surveillance using tailored strategies.
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Affiliation(s)
- Yusuff Adebayo Adebisi
- Global Health Focus Africa, Nigeria.,African Young Leaders for Global Health, Abuja, Nigeria.,Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adrian Rabe
- Global Health Focus Africa, Nigeria.,Faculty of Medicine, School of Public Health, Imperial College London, UK
| | - Don Eliseo Lucero-Prisno Iii
- Global Health Focus Africa, Nigeria.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
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25
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Eckstein L, Rid A, Kamuya D, Shah SK. The Essential Role of Data and Safety Monitoring Boards (DSMBs) in Ensuring the Ethics of Global Vaccine Trials to Address Coronavirus Disease 2019 (COVID-19O). Clin Infect Dis 2021; 73:2126-2130. [PMID: 33758912 PMCID: PMC8083612 DOI: 10.1093/cid/ciab239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccines are being developed and implemented with unprecedented speed. Accordingly, trials considered ethical at their inception may quickly become concerning. We provide recommendations for Data and Safety Monitoring Boards (DSMBs) on monitoring the ethical acceptability of COVID-19 vaccine trials, focusing on placebo-controlled trials in low- and middle-income countries.
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Affiliation(s)
- Lisa Eckstein
- School of Law, University of Tasmania, Hobart, Australia
| | - Annette Rid
- Clinical Center Department of Bioethics & Division of AIDS, National Institutes of Health, Bethesda, MarylandUSA
| | - Dorcas Kamuya
- Health Systems and Research Ethics (HSRE) Department, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Seema K Shah
- Department of Pediatrics, Chicago, IllinoisUSA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation (SCHORE) Center; Stanley Manne Children’s Research Institute; Lurie Children’s Hospital, Chicago, IllinoisUSA
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26
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Onwe FI, Okedo-Alex IN, Akamike IC, Igwe-Okomiso DO. Vertical disease programs and their effect on integrated disease surveillance and response: perspectives of epidemiologists and surveillance officers in Nigeria. Trop Dis Travel Med Vaccines 2021; 7:28. [PMID: 34593034 PMCID: PMC8483794 DOI: 10.1186/s40794-021-00152-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated Disease Surveillance and Response (IDSR) is a cost-effective surveillance system designed to curb the inefficiency associated with vertical (disease-specific) programs. The study determined the existence and effect of vertical programs on disease surveillance and response in Nigeria. METHODS A cross-sectional study involving 14 State epidemiologists and Disease Notification Surveillance Officers (DSNOs) in 12 states located within the 6 geopolitical zones in Nigeria. Data was collected using mailed electronic semi-structured self-administered questionnaires. Response rate was 33.3%. The data was analyzed using SPSS version 20. RESULTS Half of the respondents were males (50.0%) and State epidemiologists (50.0%). Malaria, HIV/AIDS, tuberculosis, and other diseases were ongoing vertical programs in the States surveyed. In over 90% of cases, vertical programs had different personnel, communication channels and supportive supervision processes different from the IDSR system. Although less than 50% acknowledged the existence of a forum for data harmonization, this forum was ineffectively utilized in 83.3% of cases. Specific disease funding was higher than that of IDSR (92.9%) and only 42.9% reported funding for IDSR activities from development partners in the State. Poor data management, low priority on IDSR priority diseases, and donor-driven programming were major negative effects of vertical programs. Improved funding, political ownership, and integration were major recommendations preferred by the respondents. CONCLUSION We found that vertical programs in the surveyed States in the Nigerian health system led to duplication of efforts, inequitable funding, and inefficiencies in surveillance. We recommend integration of existing vertical programs into the IDSR system, increased resource allocation, and political support to improve IDSR.
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Affiliation(s)
- Francis Idenyi Onwe
- Ebonyi State Ministry of Health, Abakaliki, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Ebonyi State Ministry of Health, Abakaliki, Nigeria.
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Dorothy Ogechi Igwe-Okomiso
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Mboera LEG, Sindato C, Mremi IR, Rumisha SF, George J, Ngolongolo R, Misinzo G, Karimuribo ED, Rweyemamu MM, Haider N, Hamid MA, Kock R. Socio-Ecological Systems Analysis and Health System Readiness in Responding to Dengue Epidemics in Ilala and Kinondoni Districts, Tanzania. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.738758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionSince 2010, Tanzania has been experiencing frequent outbreaks of dengue. The objectives of this study were to carry out a socio-ecological systems (SES) analysis to identify risk factors and interventions and assess the readiness of the district in the prevention and control of dengue.MethodsThe study utilized a cross-sectional purposive selection of key stakeholders responsible for disease surveillance and response in human and animal sectors in Ilala and Kinondoni districts in Tanzania. A SES framework was used to identify drivers and construct perceived thematic causal explanations of the dengue outbreaks in the study districts. A mapping exercise was carried out to analyse the performance of the disease surveillance system at district and facility levels. A semi-structured questionnaire was used to assess the districts’ readiness in the response to dengue outbreak.ResultsThe two districts were characterized by both urban and peri-urban ecosystems, with a mixture of planned and unplanned settlements which support breeding and proliferation of Aedes mosquitoes. The results indicate inadequate levels of readiness in the management and control of dengue outbreaks, in terms of clinical competence, diagnostic capacities, surveillance system and control/prevention measures. Mosquito breeding sites, especially discarded automobile tyres, were reported to be scattered in the districts. Constraining factors in implementing disease surveillance included both intrapersonal and interpersonal factors, lack of case management guidelines, difficult language used in standard case definitions, inadequate laboratory capacity, lack of appropriate rapid response teams, inadequate knowledge on outbreak investigation and inadequate capacities in data management.ConclusionThe two districts had limited readiness in the management and control of dengue, in terms of clinical competence, diagnostic capacities, surveillance system and prevention and control measures. These challenges require the immediate attention by the authorities, as they compromise the effectiveness of the national strategy for community health support.
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Gallandat K, Jeandron A, Ross I, Mufitini Saidi J, Bashige Rumedeka B, Lumami Kapepula V, Cousens S, Allen E, MacDougall A, Cumming O. The impact of improved water supply on cholera and diarrhoeal diseases in Uvira, Democratic Republic of the Congo: a protocol for a pragmatic stepped-wedge cluster randomised trial and economic evaluation. Trials 2021; 22:408. [PMID: 34154636 PMCID: PMC8215491 DOI: 10.1186/s13063-021-05249-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diarrhoeal disease remains a leading cause of mortality and morbidity worldwide. Cholera alone is estimated to cause 95,000 deaths per year, most of which occur in endemic settings with inadequate water access. Whilst a global strategy to eliminate cholera by 2030 calls for investment in improved drinking water services, there is limited rigorous evidence for the impact of improved water supply on endemic cholera transmission in low-income urban settings. Our protocol is designed to deliver a pragmatic health impact evaluation of a large-scale water supply intervention in Uvira (Democratic Republic of the Congo), a cholera transmission hotspot. METHODS/DESIGN A stepped-wedge cluster randomised trial (SW-CRT) was designed to evaluate the impact of a large-scale drinking water supply intervention on cholera incidence among the 280,000 inhabitants of Uvira. The city was divided into 16 clusters, where new community and household taps will be installed following a randomised sequence over a transition period of up to 8 weeks in each cluster. The primary trial outcomes are the monthly incidence of "confirmed" cholera cases (patients testing positive by rapid detection kit) and of "suspected" cholera cases (patients admitted to the cholera treatment centre). Concurrent process and economic evaluations will provide further information on the context, costs, and efficiency of the intervention. DISCUSSION In this protocol, we describe a pragmatic approach to conducting rigorous research to assess the impacts of a complex water supply intervention on severe diarrhoeal disease and cholera in an unstable, low-resource setting representative of cholera-affected areas. In particular, we discuss a series of pre-identified risks and linked mitigation strategies as well as the value of combining different data collection methods and preparation of multiple analysis scenarios to account for possible deviations from the protocol. The study described here has the potential to provide robust evidence to support more effective cholera control in challenging, high-burden settings. TRIAL REGISTRATION This trial is registered on clinicaltrials.gov ( NCT02928341 , 10th October 2016) and has received ethics approval from the London School of Hygiene and Tropical Medicine (8913, 10603) and from the Ethics Committee from the School of Public Health, University of Kinshasa, Democratic Republic of the Congo (ESP/CE/088/2015).
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Affiliation(s)
- Karin Gallandat
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Aurélie Jeandron
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Ross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jaime Mufitini Saidi
- Ministère de la Santé Publique, Division Provinciale de la Santé Publique, District Sanitaire d'Uvira, Uvira, South Kivu, Democratic Republic of the Congo
| | - Baron Bashige Rumedeka
- Ministère de la Santé Publique, Division Provinciale de la Santé Publique, District Sanitaire d'Uvira, Uvira, South Kivu, Democratic Republic of the Congo
| | - Vercus Lumami Kapepula
- Department of Hydrology, Centre de Recherche en Hydrobiologie, Uvira, South Kivu, Democratic Republic of the Congo
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy MacDougall
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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29
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Pires SM, Desta BN, Mughini-Gras L, Mmbaga BT, Fayemi OE, Salvador EM, Gobena T, Majowicz SE, Hald T, Hoejskov PS, Minato Y, Devleesschauwer B. Burden of foodborne diseases: think global, act local. Curr Opin Food Sci 2021; 39:152-159. [PMID: 34178607 PMCID: PMC8216060 DOI: 10.1016/j.cofs.2021.01.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
National burden of foodborne disease (FBD) studies are essential to establish food safety as a public health priority, rank diseases, and inform interventions. In recent years, various countries have taken steps to implement them. Despite progress, the current burden of disease landscape remains scattered, and researchers struggle to translate findings to input for policy. We describe the current knowledge base on burden of FBDs, highlight examples of well-established studies, and how results have been used for decision-making. We discuss challenges in estimating burden of FBD in low-resource settings, and the experience and opportunities deriving from a large-scale research project in these settings. Lastly, we highlight the role of international organizations and initiatives in supporting countries to develop capacity and conduct studies.
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Affiliation(s)
- Sara M Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Binyam N Desta
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Lapo Mughini-Gras
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Olanrewaju E Fayemi
- Department of Biological Sciences, Mountain Top University, Ibafo, Ogun State, Nigeria
| | - Elsa M Salvador
- Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Tesfaye Gobena
- College of Health and Medical Science, Haramaya University, Ethiopia
| | - Shannon E Majowicz
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Tine Hald
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | | | - Yuki Minato
- World Health Organization, Geneva, Switzerland
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
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Kostova D, Richter P, Van Vliet G, Mahar M, Moolenaar RL. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security. Health Secur 2021; 19:288-301. [PMID: 33961498 PMCID: PMC8217593 DOI: 10.1089/hs.2020.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.
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Affiliation(s)
- Deliana Kostova
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Patricia Richter
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Gretchen Van Vliet
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Michael Mahar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Ronald L Moolenaar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
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Saleh F, Kitau J, Konradsen F, Mboera LEG, Schiøler KL. Assessment of the core and support functions of the integrated disease surveillance and response system in Zanzibar, Tanzania. BMC Public Health 2021; 21:748. [PMID: 33865347 PMCID: PMC8052932 DOI: 10.1186/s12889-021-10758-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Disease surveillance is a cornerstone of outbreak detection and control. Evaluation of a disease surveillance system is important to ensure its performance over time. The aim of this study was to assess the performance of the core and support functions of the Zanzibar integrated disease surveillance and response (IDSR) system to determine its capacity for early detection of and response to infectious disease outbreaks. Methods This cross-sectional descriptive study involved 10 districts of Zanzibar and 45 public and private health facilities. A mixed-methods approach was used to collect data. This included document review, observations and interviews with surveillance personnel using a modified World Health Organization generic questionnaire for assessing national disease surveillance systems. Results The performance of the IDSR system in Zanzibar was suboptimal particularly with respect to early detection of epidemics. Weak laboratory capacity at all levels greatly hampered detection and confirmation of cases and outbreaks. None of the health facilities or laboratories could confirm all priority infectious diseases outlined in the Zanzibar IDSR guidelines. Data reporting was weakest at facility level, while data analysis was inadequate at all levels (facility, district and national). The performance of epidemic preparedness and response was generally unsatisfactory despite availability of rapid response teams and budget lines for epidemics in each district. The support functions (supervision, training, laboratory, communication and coordination, human resources, logistic support) were inadequate particularly at the facility level. Conclusions The IDSR system in Zanzibar is weak and inadequate for early detection and response to infectious disease epidemics. The performance of both core and support functions are hampered by several factors including inadequate human and material resources as well as lack of motivation for IDSR implementation within the healthcare delivery system. In the face of emerging epidemics, strengthening of the IDSR system, including allocation of adequate resources, should be a priority in order to safeguard human health and economic stability across the archipelago of Zanzibar.
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Affiliation(s)
- Fatma Saleh
- Department of Parasitology and Entomology, Kilimanjaro Christian Medical University College, Moshi, Tanzania. .,Department of Allied Health Sciences, School of Health and Medical Sciences, The State University of Zanzibar, Zanzibar, Tanzania.
| | - Jovin Kitau
- Department of Parasitology and Entomology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,World Health Organization, Country office, Dar es Salaam, Tanzania
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Karin L Schiøler
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Turke S, Nehrling S, Adebayo SO, Akilimali P, Idiodi I, Mwangi A, Larson E, Moreau C, Anglewicz P. Remote Interviewer Training for COVID-19 Data Collection: Challenges and Lessons Learned From 3 Countries in Sub-Saharan Africa. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:177-186. [PMID: 33795368 PMCID: PMC8087422 DOI: 10.9745/ghsp-d-20-00468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
Remote training of interviewers in low-resource settings can be an effective approach during the COVID-19 pandemic when data are critically needed and in-person learning is not possible. We demonstrate that remote interviewer training is possible when interviewers: have at least an intermittent Internet connection, have select physical materials available, and are experienced and part of a cohesive team. There is an urgent need for data to inform coronavirus disease (COVID-19) pandemic response efforts. At the same time, the pandemic has created challenges for data collection, one of which is interviewer training in the context of social distancing. In sub-Saharan Africa, in-person interviewer training and face-to-face data collection remain the norm, requiring researchers to think creatively about transitioning to remote settings to allow for safer data collection that respects government guidelines. Performance Monitoring for Action (PMA, formerly PMA2020) has collected both cross-sectional and longitudinal data on key reproductive health measures in Africa and Asia since 2013. Relying on partnerships with in-country research institutes and cadres of female interviewers recruited from sampled communities, the project was well-positioned to transition to collecting data on COVID-19 from the onset of the pandemic. This article presents PMA's development of a remote training system for COVID-19 surveys in the Democratic Republic of the Congo, Kenya, and Nigeria, including challenges faced and lessons learned. We demonstrate that remote interviewer training can be a viable approach when data are critically needed and in-person learning is not possible. We also argue against systematic replacement of in-person trainings with remote learning, instead recommending consideration of local context and a project's individual circumstances when contemplating a transition to remote interviewer training.
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Affiliation(s)
- Shani Turke
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Pierre Akilimali
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Ivan Idiodi
- Centre for Research, Evaluation Resources and Development, Abuja, Nigeria
| | - Anthony Mwangi
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Elizabeth Larson
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Soins et santé. Center for Research in Epidemiology and Population Health, INSERM 1018 Villejuif, France
| | - Philip Anglewicz
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ng’etich AKS, Voyi K, Kirinyet RC, Mutero CM. A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: A health workers' perspective. PLoS One 2021; 16:e0248998. [PMID: 33740021 PMCID: PMC7978283 DOI: 10.1371/journal.pone.0248998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/09/2021] [Indexed: 12/01/2022] Open
Abstract
Background The revised integrated disease surveillance and response (IDSR) guidelines adopted by African member states in 2010 aimed at strengthening surveillance systems critical capacities. Milestones achieved through IDSR strategy implementation prior to adopting the revised guidelines are well documented; however, there is a dearth of knowledge on the progress made post-adoption. This study aimed to review key recommendations resulting from surveillance assessment studies to improve implementation of the revitalised IDSR system in the African region based on health workers’ perspectives. The review focused on literature published between 2010 and 2019 post-adopting the revised IDSR guidelines in the African region. Methods A systematic literature search in PubMed, Web of Science and Cumulative Index for Nursing and Allied Health Literature was conducted. In addition, manual reference searches and grey literature searches using World Health Organisation Library and Information Networks for Knowledge databases were undertaken. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist for systematic reviews was utilised for the review process. Results Thirty assessment studies met the inclusion criteria. IDSR implementation under the revised guidelines could be improved considerably bearing in mind critical findings and recommendations emanating from the reviewed surveillance assessment studies. Key recommendations alluded to provision of laboratory facilities and improved specimen handling, provision of reporting forms and improved reporting quality, surveillance data accuracy and quality, improved knowledge and surveillance system performance, utilisation of up-to-date information and surveillance system strengthening, provision of resources, enhanced reporting timeliness and completeness, adopting alternative surveillance strategies and conducting further research to improve surveillance functions. Conclusion Recommendations on strengthening IDSR implementation in the African region post-adopting the revised guidelines mainly identify surveillance functions focused on reporting, feedback, training, supervision, timeliness and completeness of the surveillance system as aspects requiring policy refinement. Systematic review registration PROSPERO registration number CRD42019124108.
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Affiliation(s)
- Arthur K. S. Ng’etich
- School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Kuku Voyi
- School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa
| | - Ruth C. Kirinyet
- Department of Environmental and Occupational Health, School of Public Health, Kenyatta University, Nairobi, Kenya
| | - Clifford M. Mutero
- School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
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Wolfe CM, Hamblion EL, Dzotsi EK, Mboussou F, Eckerle I, Flahault A, Codeço CT, Corvin J, Zgibor JC, Keiser O, Impouma B. Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region. PLoS One 2021; 16:e0245457. [PMID: 33630890 PMCID: PMC7906422 DOI: 10.1371/journal.pone.0245457] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. Objectives This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. Methods A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. Results The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. Conclusions and implications of findings These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.
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Affiliation(s)
- Caitlin M. Wolfe
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
- University of South Florida College of Public Health, Tampa, Florida, United States of America
- * E-mail:
| | - Esther L. Hamblion
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Emmanuel K. Dzotsi
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Franck Mboussou
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Isabelle Eckerle
- Division of Infectious Diseases, Geneva Centre for Emerging Viral Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Antoine Flahault
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Claudia T. Codeço
- National School of Public Health (ENSP/Fiocruz), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Jaime Corvin
- University of South Florida College of Public Health, Tampa, Florida, United States of America
| | - Janice C. Zgibor
- University of South Florida College of Public Health, Tampa, Florida, United States of America
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Benido Impouma
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Masthi R, Jahan A, Bharathi D, Abhilash P, Kaniyarakkal V, Tv S, Gowda G, Ts R, Goud R, Rao S, Hegde A. Postcode based participatory disease surveillance systems : a comparison with traditional risk-based surveillance and its application in the COVID-19 pandemic. JMIR Public Health Surveill 2021. [PMID: 33481758 DOI: 10.2196/20746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Background: The SARS-Cov-2 infection has rapidly saturated health systems and traditional surveillance networks are finding hard to keep pace with its spread. We designed a participatory disease surveillance (PDS) system, to capture symptoms of Influenza-like illness (ILI) to estimate SARS-CoV-2 infection in the community. While data generated by these platforms can help public health organisations find community hotspots and effectively direct control measures, it has never been compared to traditional systems. OBJECTIVE Methods and Objectives: A completely anonymised web based PDS system, www.trackcovid-19.org was developed. We evaluated the symptomatic responses received form the PDS system to the traditional risk based surveillance carried out by the Bruhat Bengaluru Mahanagara Palike over a period of 45 days in the South Indian city of Bengaluru. METHODS Methods and Objectives: A completely anonymised web based PDS system, www.trackcovid-19.org was developed. We evaluated the symptomatic responses received form the PDS system to the traditional risk based surveillance carried out by the Bruhat Bengaluru Mahanagara Palike over a period of 45 days in the South Indian city of Bengaluru. RESULTS Results: The PDS system recorded 11062 entries from 106 Postal codes. A healthy response was obtained from 10863 users while 199 (1.8%) reported symptomatic. Subgroup analysis of a 14 day symptomatic window recorded 33 (0.29%) responses. Risk based surveillance was carried out covering a population of 605,284 with 209 (0.03%) individuals identified symptomatic. CONCLUSIONS Conclusion: Web PDS platforms provide better visualisation of community infection when compared to traditional risk based surveillance systems. They are extremely useful by providing real time information in the extended battle against this pandemic. When integrated into national disease surveillance systems, they can provide long term community surveillance adding an important cost-effective layer to already available data sources.
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Affiliation(s)
- Ramesh Masthi
- Kempegowda Institute of Medical Sciences, Bangalore, IN
| | - Afraz Jahan
- Kempegowda Institute of Medical Sciences, Bangalore, IN
| | | | | | | | - Sanjay Tv
- Kempegowda Institute of Medical Sciences, Bangalore, IN
| | | | - Ranganath Ts
- Bangalore Medical College & Research Institute, Bangalore, IN
| | | | | | - Ajay Hegde
- Trackcovid-19.org, 349, 4th Main, Sadashivananagr, Bangalore, IN
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Ng'etich AKS, Voyi K, Mutero CM. Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya. BMC Public Health 2021; 21:142. [PMID: 33451323 PMCID: PMC7809780 DOI: 10.1186/s12889-021-10185-1] [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] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/06/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. METHODS A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson's Chi-square or Fisher's exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. RESULTS Surveillance core and support functions in relation to PC-NTDs were assessed in comparison to an indicator performance target of 80%. Optimal performance reported on specimen handling (84%; 100%), reports submission (100%; 100%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Facilities achieved the threshold on reports submission (84%), reporting deadlines (88%) and feedback (80%). However, low performance reported on case definitions availability (60%), case registers (19%), functional laboratories (52%) and data analysis (58%). Having well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), PC-NTDs provision in reporting forms (3.20, 95% CI: 1.44, 7.10) and surveillance training (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of functional surveillance systems. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision. CONCLUSION There was evidence of low-performing surveillance functions regarding PC-NTDs especially at the peripheral surveillance levels. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.
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Affiliation(s)
- Arthur K S Ng'etich
- School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa.
| | - Kuku Voyi
- School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa
| | - Clifford M Mutero
- School of Health Systems and Public Health (SHSPH), University of Pretoria, Pretoria, South Africa
- University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
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Guerra J, Davi KM, Rafael FC, Assane H, Imboua L, Diallo FBT, Tamekloe TA, Kuassi AK, Ouro-kavalah F, Tchaniley G, Ouro-Nile N, Nabeth P. Case study of Argus in Togo: An SMS and web-based application to support public health surveillance, results from 2016 to 2019. PLoS One 2020; 15:e0243131. [PMID: 33259550 PMCID: PMC7707507 DOI: 10.1371/journal.pone.0243131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Argus is an open source electronic solution to facilitate the reporting and management of public health surveillance data. Its components include an Android-phone application, used by healthcare facilities to report results via SMS; and a central server located at the Ministry of Health, displaying aggregated results on a web platform for intermediate and central levels. This study describes the results of the use of Argus in two regions of Togo. Methods Argus was used in 148 healthcare facilities from May 2016 to July 2018, expanding to 185 healthcare facilities from July 2018. Data from week 21 of 2016 to week 12 of 2019 was extracted from the Argus database and analysed. An assessment mission took place in August 2016 to collect users’ satisfaction, to estimate the concordance of the received data with the collected data, and to estimate the time required to report data with Argus. Results Overall completeness of data reporting was 76%, with 80% of reports from a given week being received before Tuesday 9PM. Concordance of data received from Argus and standard paper forms was 99.7%. Median time needed to send a report using Argus was 4 minutes. Overall completeness of data review at district, regional, and central levels were 89%, 68%, and 35% respectively. Implementation cost of Argus was 23 760 USD for 148 facilities. Conclusions The use of Argus in Togo enabled healthcare facilities to send weekly reports and alerts through SMS in a user-friendly, reliable and timely manner. Reengagement of surveillance officers at all levels, especially at the central level, enabled a dramatic increase in completeness and timeliness of data report and data review.
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Affiliation(s)
- José Guerra
- Health Emergencies Programme, World Health Organization, Lyon, France
- * E-mail:
| | | | | | - Hamadi Assane
- Division de la Surveillance Intégrée des Urgences Sanitaires et Riposte, Ministère de la Santé, Lomé, Togo
| | - Lucile Imboua
- Country Office, World Health Organization, Lomé, Togo
| | | | - Tsidi Agbeko Tamekloe
- Direction de la lutte contre la maladie et des Programmes de santé publique, Ministère de la Santé, Lomé, Togo
| | | | - Farihétou Ouro-kavalah
- Division de la Surveillance Intégrée des Urgences Sanitaires et Riposte, Ministère de la Santé, Lomé, Togo
| | - Ganiou Tchaniley
- Direction du système national d’information sanitaire, Ministère de la Santé, Lomé, Togo
| | - Nassirou Ouro-Nile
- Direction du système national d’information sanitaire, Ministère de la Santé, Lomé, Togo
| | - Pierre Nabeth
- Health Emergencies Programme, World Health Organization, Lyon, France
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Sindato C, Mboera LEG, Beda E, Mwabukusi M, Karimuribo ED. Community Health Workers and Disease Surveillance in Tanzania: Promoting the Use of Mobile Technologies in Detecting and Reporting Health Events. Health Secur 2020; 19:116-129. [PMID: 33217238 DOI: 10.1089/hs.2019.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This cross-sectional study was conducted in the Kilosa, Morogoro Urban, Ngorongoro, and Ulanga districts of Tanzania to investigate the practices of community health workers (CHWs) related to disease surveillance functions and to establish their needs and technology capacities. We also established the strength of mobile phone networks and internet connections in the study areas to inform the feasibility of using mobile-based applications in community-based disease surveillance. A total of 135 CHWs from 85 villages participated in the study. Health events captured at the community level were entirely paper-based. CHWs submitted reports to higher-level health authorities mainly on foot (100%), but they also used public transport (65%) and telephone calls (56%). The median number of days between the onset of a suspected disease outbreak at the community level and reporting to a primary healthcare facility was 10 days (interquartile range [IQR] 2-30). The median number of days between submitting a report and receiving a response was 7 days (IQR 2-30). Of the 53 CHWs who reported the most recent health events to a higher-level health authority, 39 (74%) never received feedback. All 85 villages had a reliable mobile phone network and 74 (87%) had a mobile phone internet connection that was strong enough to support data transmission using digital technology. Almost all (n = 132, 98%) of the CHWs owned mobile phones. The practices related to detection and reporting of health events could be improved to enhance early warning disease surveillance. Reliable mobile networks and internet connections and the ownership of mobile phones among CHWs in the study areas present opportunities to strengthen community event-based surveillance using mobile-based solutions.
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Affiliation(s)
- Calvin Sindato
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Leonard E G Mboera
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Eric Beda
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Mpoki Mwabukusi
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Esron D Karimuribo
- Calvin Sindato, PhD, is a Principal Research Scientist, National Institute for Medical Research, Tabora, Tanzania. At the time this work was conducted, he was a Postdoctoral Research Associate and One Health Epidemiologist with the SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Leonard E. G. Mboera, PhD, is Leader, Emerging and Vector-Borne Diseases Community of Practice; Eric Beda, MSc, is Regional ICT Specialist; and Mpoki Mwabukusi is an ICT Specialist/Computer System Analyst; all with SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania. Esron D. Karimuribo, PhD, is a One Health Epidemiologist, Professor, and Director of the Directorate of Postgraduate Studies, Research, Technology Transfer and Consultancy, Sokoine University of Agriculture, Morogoro, Tanzania
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Scobie HM, Edelstein M, Nicol E, Morice A, Rahimi N, MacDonald NE, Danovaro-Holliday CM, Jawad J. Improving the quality and use of immunization and surveillance data: Summary report of the Working Group of the Strategic Advisory Group of Experts on Immunization. Vaccine 2020; 38:7183-7197. [PMID: 32950304 PMCID: PMC7573705 DOI: 10.1016/j.vaccine.2020.09.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022]
Abstract
Concerns about the quality and use of immunization and vaccine-preventable disease (VPD) surveillance data have been highlighted on the global agenda for over two decades. In August 2017, the Strategic Advisory Group of Experts (SAGE) established a Working Group (WG) onthe Quality and Use of Global Immunization and Surveillance Data to review the current status and evidence to make recommendations, which were presented to SAGE in October 2019. The WG synthesized evidence from landscape analyses, literature reviews, country case-studies, a data triangulation analysis, as well as surveys of experts. Data quality (DQ) was defined as data that are accurate, precise, relevant, complete, and timely enough for the intended purpose (fit-for-purpose), and data use as the degree to which data are actually used for defined purposes, e.g., immunization programme management, performance monitoring, decision-making. The WG outlined roles and responsibilities for immunization and surveillance DQ and use by programme level. The WG found that while DQ is dependent on quality data collection at health facilities, many interventions have targeted national and subnational levels, or have focused on new technologies, rather than the people and enabling environments required for functional information systems. The WG concluded that sustainable improvements in immunization and surveillance DQ and use will require efforts across the health system - governance, people, tools, and processes, including use of data for continuous quality improvement (CQI) - and that the approaches need to be context-specific, country-owned and driven from the frontline up. At the country level, major efforts are needed to: (1) embed monitoring DQ and use alongside monitoring of immunization and surveillance performance, (2) increase workforce capacity and capability for DQ and use, starting at the facility level, (3) improve the accuracy of immunization programme targets (denominators), (4) enhance use of existing data for tailored programme action (e.g., immunization programme planning, management and policy-change), (5) adopt a data-driven CQI approach as part of health system strengthening, (6) strengthen governance around piloting and implementation of new information and communication technology tools, and (7) improve data sharing and knowledge management across areas and organizations for improved transparency and efficiency. Global and regional partners are requested to support countries in adopting relevant recommendations for their setting and to continue strengthening the reporting and monitoring of immunization and VPD surveillance data through processes periodic needs assessment and revision processes. This summary of the WG's findings and recommendations can support "data-guided" implementation of the new Immunization Agenda 2030.
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Affiliation(s)
| | | | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Health System and Public Health Division, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Ana Morice
- Independent Consultant, San Jose, Costa Rica
| | | | | | | | - Jaleela Jawad
- Public Health Directorate, Ministry of Health, Bahrain
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Olumade TJ, Adesanya OA, Fred-Akintunwa IJ, Babalola DO, Oguzie JU, Ogunsanya OA, George UE, Akin-Ajani OD, Osasona DG. Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice. AIMS Public Health 2020; 7:736-757. [PMID: 33294478 PMCID: PMC7719556 DOI: 10.3934/publichealth.2020057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023] Open
Abstract
Effective disease outbreak response has historically been a challenging accomplishment for the Nigerian health system due to an array of hurdles not unique to Nigeria but also found in other African nations which share its large size and complexity. However, the efficiency of the response mounted against the Ebola Virus Disease (EVD) outbreak of 2014 proved that indeed, though challenging, proactive and effective outbreak response is not impossible. With over 20 public health emergencies and infectious disease outbreaks between 2016 and 2018 alone, Nigeria is one of only five members of the World Health Organization (WHO) African Region to report five or more public health events per annum. There are many lessons that can be drawn from Nigeria's experience in handling outbreaks of infectious diseases. In this review, we discuss the history of emerging and re-emerging infectious disease outbreaks in Nigeria and explore the response strategies mounted towards each. We also highlight the significant successes and note-worthy limitations, which we have then utilized to proffer policy recommendations to strengthen the Nigerian public health emergency response systems.
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Affiliation(s)
- Testimony J Olumade
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | | | | | - David O Babalola
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Judith U Oguzie
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | - Olusola A Ogunsanya
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Uwem E George
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | | | - Damilola G Osasona
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
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Makelele JPK, Ade S, Takarinda KC, Manzi M, Cuesta JG, Acma A, Yépez MM, Mashako M. Outcomes of cholera and measles outbreak alerts in the Democratic Republic of Congo. Public Health Action 2020; 10:124-130. [PMID: 33134127 DOI: 10.5588/pha.19.0074] [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: 11/23/2019] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Setting In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named 'Pool d'Urgence Congo' (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières. Objective To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018. Design This was a retrospective cross-sectional study. Results Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of ⩾14 days (n = 10 outbreaks). Conclusion Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.
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Affiliation(s)
- J P K Makelele
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - S Ade
- Faculté de Médecine, Université de Parakou, Parakou, Bénin.,Center for Operational Research, International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - K C Takarinda
- Center for Operational Research, International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - M Manzi
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit (LuOR), MSF Luxembourg
| | - J Gil Cuesta
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Operational Research Unit (LuOR), MSF Luxembourg
| | - A Acma
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - M M Yépez
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
| | - M Mashako
- Médecins Sans Frontières-Operational Centre Brussels, Mission DRC, Kinshasa, DR Congo
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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Njeru I, Kareko D, Kisangau N, Langat D, Liku N, Owiso G, Dolan S, Rabinowitz P, Macharia D, Ekechi C, Widdowson MA. Use of technology for public health surveillance reporting: opportunities, challenges and lessons learnt from Kenya. BMC Public Health 2020; 20:1101. [PMID: 32660509 PMCID: PMC7359619 DOI: 10.1186/s12889-020-09222-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 07/06/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Effective public health surveillance systems are crucial for early detection and response to outbreaks. In 2016, Kenya transitioned its surveillance system from a standalone web-based surveillance system to the more sustainable and integrated District Health Information System 2 (DHIS2). As part of Global Health Security Agenda (GHSA) initiatives in Kenya, training on use of the new system was conducted among surveillance officers. We evaluated the surveillance indicators during the transition period in order to assess the impact of this training on surveillance metrics and identify challenges affecting reporting rates. METHODS From February to May 2017, we analysed surveillance data for 13 intervention and 13 comparison counties. An intervention county was defined as one that had received refresher training on DHIS2 while a comparison county was one that had not received training. We evaluated the impact of the training by analysing completeness and timeliness of reporting 15 weeks before and 12 weeks after the training. A chi-square test of independence was used to compare the reporting rates between the two groups. A structured questionnaire was administered to the training participants to assess the challenges affecting surveillance reporting. RESULTS The average completeness of reporting for the intervention counties increased from 45 to 62%, i.e. by 17 percentage points (95% CI 16.14-17.86) compared to an increase from 49 to 52% for the comparison group, i.e. by 3 percentage points (95% CI 2.23-3.77). The timeliness of reporting increased from 30 to 51%, i.e. by 21 percentage points (95% CI 20.16-21.84) for the intervention group, compared to an increase from 31 to 38% for the comparison group, i.e.by 7 percentage points (95% CI 6.27-7.73). Major challenges for the low reporting rates included lack of budget support from government, lack of airtime for reporting, health workers strike, health facilities not sending surveillance data, use of wrong denominator to calculate reporting rates and surveillance officers having other competing tasks. CONCLUSIONS Training plays an important role in improving public health surveillance reporting. However, to improve surveillance reporting rates to the desired national targets, other challenges affecting reporting must be identified and addressed accordingly.
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Affiliation(s)
- Ian Njeru
- International Training and Education Centre for Health (I-TECH Kenya), Nairobi, Kenya.
| | | | | | | | - Nzisa Liku
- International Training and Education Centre for Health (I-TECH Kenya), Nairobi, Kenya
| | - George Owiso
- International Training and Education Centre for Health (I-TECH Kenya), Nairobi, Kenya
| | - Samantha Dolan
- International Training and Education Centre for Health (I-TECH Kenya), Nairobi, Kenya
| | - Peter Rabinowitz
- International Training and Education Centre for Health (I-TECH Kenya), Nairobi, Kenya
| | - Daniel Macharia
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Chinyere Ekechi
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya.,Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rumisha SF, Kishimba RS, Mohamed AA, Urio LJ, Rusibayamila N, Bakari M, Mghamba J. Addressing the workforce capacity for public health surveillance through field epidemiology and laboratory training program: the need for balanced enhanced skill mix and distribution, a case study from Tanzania. Pan Afr Med J 2020; 36:41. [PMID: 32774617 PMCID: PMC7388632 DOI: 10.11604/pamj.2020.36.41.17857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/19/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Skill mix refers to the range of professional development and competencies, skills and experiences of staff within a particular working environment that link with specific outcome while responding to client needs. A balanced skill-mix and distribution of core human resources is important to strengthen decision-making process and rapid responses. We analysed graduates´ information of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) between 2008-2016, distribution of skill-mix and the surveillance workforce-gaps within regions. Methods Trainees´ data of nine cohorts enrolled between 2008 and 2016 were extracted from the program database. Distribution by sex, region and cadres/profession was carried out. An indicator to determine enhanced-skill mix was established based on the presence of a clinician, nurse, laboratory scientist and environmental health officer. A complete enhanced skill-mix was considered when all four were available and have received FELTP training. Results The TFELTP has trained 113 trainees (male=71.7%), originated from 17 regions of Tanzania Mainland (65.4% of all) and Zanzibar. Clinicians (34.5%) and laboratory scientists (38.1%) accounted for the most recruits, however, the former were widely spread in regions (83% vs. 56%). Environmental health officers (17.7%) were available in 39% of regions. The nursing profession, predominantly lacking (6.2%) was available in 22% of regions. Only two regions (11.7%) among 17 covered by TFELTP presented complete skill-mix, representing 7.7% of Tanzanian regions. Seven regions (41%) had an average of one trainee. Conclusion The TFELTP is yet to reach the required skill-mix in many regions within the country. The slow fill-rate for competent and key workforce cadres might impede effective response. Strategies to increase program awareness at subnational levels is needed to improve performance of surveillance and response system in Tanzania.
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Affiliation(s)
- Susan Fred Rumisha
- National Institute for Medical Research, 3 Barack Obama Drive, Dar es Salaam, Tanzania.,Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Rogath Saika Kishimba
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Ahmed Abade Mohamed
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Loveness John Urio
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Neema Rusibayamila
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Muhammad Bakari
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Janneth Mghamba
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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Ibrahim LM, Stephen M, Okudo I, Kitgakka SM, Mamadu IN, Njai IF, Oladele S, Garba S, Ojo O, Ihekweazu C, Lasuba CLP, Yahaya AA, Nsubuga P, Alemu W. A rapid assessment of the implementation of integrated disease surveillance and response system in Northeast Nigeria, 2017. BMC Public Health 2020; 20:600. [PMID: 32357933 PMCID: PMC7195793 DOI: 10.1186/s12889-020-08707-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Integrated disease surveillance and response (IDSR) is the strategy adopted for public health surveillance in Nigeria. IDSR has been operational in Nigeria since 2001 but the functionality varies from state to state. The outbreaks of cerebrospinal meningitis and cholera in 2017 indicated weakness in the functionality of the system. A rapid assessment of the IDSR was conducted in three northeastern states to identify and address gaps to strengthen the system. Method The survey was conducted at the state and local government areas using standard IDSR assessment tools which were adapted to the Nigerian context. Checklists were used to extract data from reports and records on resources and tools for implementation of IDSR. Questionnaires were used to interview respondents on their capacities to implement IDSR. Quantitative data were entered into an MS Excel spreadsheet, analysed and presented in proportions. Qualitative data were summarised and reported by thematic area. Results A total of 34 respondents participated in the rapid survey from six health facilities and six local government areas (LGAs). Of the 2598 health facilities in the three states, only 606 (23%) were involved in reporting IDSR. The standard case definitions were available in all state and LGA offices and health facilities visited. Only 41 (63%) and 31 (47.7%) of the LGAs in the three states had rapid response teams and epidemic preparedness and response committees respectively. The Disease Surveillance and Notification Officers (DSNOs) and clinicians’ knowledge were limited to only timeliness and completeness among over 10 core indicators for IDSR. Review of the facility registers revealed many missing variables; the commonly missed variables were patients’ age, sex, diagnosis and laboratory results. Conclusions The major gaps were poor documentation of patients’ data in the facility registers, inadequate reporting tools, limited participation of health facilities in IDSR and limited capacities of personnel to identify, report IDSR priority diseases, analyze and interpret IDSR data for decision making. Training of surveillance focal persons, provision of IDSR reporting tools and effective supportive supervisions will strengthen the system in the country.
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Affiliation(s)
- Luka Mangveep Ibrahim
- World health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria.
| | | | - Ifeanyi Okudo
- World health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | | | - Ibrahim Njida Mamadu
- World health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Isha Fatma Njai
- World health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Saliu Oladele
- World health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Sadiq Garba
- Nigerian Center for Disease Control, Jabi, Abuja, Nigeria
| | - Olubunmi Ojo
- Nigerian Center for Disease Control, Jabi, Abuja, Nigeria
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Okello PE, Majwala RK, Kalani R, Kwesiga B, Kizito S, Kabwama SN, Bulage L, Ndegwa LK, Ochieng M, Harris JR, Hunsperger E, Kajumbula H, Kadobera D, Zhu BP, Chaves SS, Ario AR, Widdowson MA. Investigation of a Cluster of Severe Respiratory Disease Referred from Uganda to Kenya, February 2017. Health Secur 2020; 18:96-104. [PMID: 32324075 DOI: 10.1089/hs.2019.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
On February 22, 2017, Hospital X-Kampala and US CDC-Kenya reported to the Uganda Ministry of Health a respiratory illness in a 46-year-old expatriate of Company A. The patient, Mr. A, was evacuated from Uganda to Kenya and died. He had recently been exposed to dromedary camels (MERS-CoV) and wild birds with influenza A (H5N6). We investigated the cause of illness, transmission, and recommended control. We defined a suspected case of severe acute respiratory illness (SARI) as acute onset of fever (≥38°C) with sore throat or cough and at least one of the following: headache, lethargy, or difficulty in breathing. In addition, we looked at cases with onset between February 1 and March 31 in a person with a history of contact with Mr. A, his family, or other Company A employees. A confirmed case was defined as a suspected case with laboratory confirmation of the same pathogen detected in Mr. A. Influenza-like illness was defined as onset of fever (≥38°C) and cough or sore throat in a Uganda contact, and as fever (≥38°C) and cough lasting less than 10 days in a Kenya contact. We collected Mr. A's exposure and clinical history, searched for cases, and traced contacts. Specimens from the index case were tested for complete blood count, liver function tests, plasma chemistry, Influenza A(H1N1)pdm09, and MERS-CoV. Robust field epidemiology, laboratory capacity, and cross-border communication enabled investigation.
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Affiliation(s)
- Paul Edward Okello
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Robert Kaos Majwala
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Rosalia Kalani
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Benon Kwesiga
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Susan Kizito
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Steven N Kabwama
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Lilian Bulage
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Linus K Ndegwa
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Melvin Ochieng
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Julie R Harris
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Elizabeth Hunsperger
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Henry Kajumbula
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Daniel Kadobera
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Bao-Ping Zhu
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Sandra S Chaves
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Alex Riolexus Ario
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Marc-Alain Widdowson
- Paul Edward Okello, MSc, is an Epidemiologist/Microbiologist; Benon Kwesiga, MPH, is Field Supervisor; Susan Kizito, MSc, Steven N. Kabwama, MPH, and Daniel Kadobera, MSc, are Epidemiologists; all with the Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda. Robert Kaos Majwala, MA, is an Epidemiologist and Data Analyst, National Disease Control, Uganda Ministry of Health, and University Research Co, LLC, Center for Human Services, Kampala. Rosalia Kalani, MSc, is a Public Health Specialist, Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya. Lilian Bulage, MSc, is an Epidemiologist and Scientific Writer, African Field Epidemiology Network-Uganda Public Health Fellowship Program. Linus K. Ndegwa, PhD, is an Epidemiologist; Elizabeth Hunsperger, PhD, is Laboratory Director, Division of Global Health Protection; Sandra S. Chaves, MD, is Director, Influenza Program; and Marc-Alain Widdowson, VetMB, is Director, CDC-Kenya; all with CDC, Nairobi, Kenya. Dr. Widdowson is also Director, Institute of Tropical Medicine, Antwerp, Belgium. Henry Kajumbula, PhD, is Chair, Clinical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda. Melvin Ochieng is a Biochemical Research Assistant, Kenya Medical Research Institute (KEMRI), Nairobi. Julie R. Harris, PhD, is Resident Advisor, Uganda Public Health Fellowship Program, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Kampala, Uganda. Bao-Ping Zhu, MD, is a Medical Epidemiologist, Center for Global Health, CDC, Atlanta, GA. Alex Riolexus Ario, PhD, is Director, Uganda National Institute of Public Health, Kampala. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
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Makinde OA, Odimegwu CO. Compliance with disease surveillance and notification by private health providers in South-West Nigeria. Pan Afr Med J 2020; 35:114. [PMID: 32637012 PMCID: PMC7320761 DOI: 10.11604/pamj.2020.35.114.21188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/19/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Private health facilities are important contributors to health service delivery across several low and middle income countries. In Nigeria, they make up 33% of the health facilities, account for more than 70% of healthcare spending and over 60% of healthcare contacts are estimated to take place within them However, their level of participation in the disease surveillance system has been questioned. Methods We conducted a cross-sectional survey of 507 private health facilities in South-West Nigeria to investigate the level of compliance with disease surveillance reporting and the factors that affect their participation. Results We found only 40% of the private health facilities to be complying with routine disease surveillance reporting which ranged from 17% to 60% across the six states in the region. Thirty-four percent of the private health facilities had the requisite data collection tools, 49% had designated professionals assigned to health records management and only 7% of the clinicians could properly identify the three data collection tools for disease surveillance. Some important factors such as awareness of a law on disease surveillance (OR=1.55 95% CI=1.08-2.24), availability of reporting tools (OR=13.69, 95% CI=8.85-21.62), availability of a designated health records officer (OR=3.9, 95% CI=2.68-5.73), and health records officers (OR=10.51, 95%CI=2.86-67.70) and clinicians (OR=2.49, 95% CI=1.22-5.25) with knowledge of disease surveillance system were important predictive factors to compliance with disease surveillance participation. Conclusion Private health facilities are poorly compliant with disease surveillance in Nigeria resulting in missed opportunities for prompt identification and response to threats of infectious disease outbreaks.
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Affiliation(s)
- Olusesan Ayodeji Makinde
- Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Viable Knowledge Masters, Plot C114 (Platinum Plaza), First Avenue, Gwarinpa, Abuja, Nigeria
| | - Clifford Obby Odimegwu
- Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Goers M, Leidman E, Sultran ASS, Hassan A, Bilukha O. Injury-related deaths before and during the Islamic State insurgency - Baghdad, Iraq, 2010-2015. Confl Health 2020; 14:8. [PMID: 32099578 PMCID: PMC7029473 DOI: 10.1186/s13031-020-0252-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 01/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background Following a period of low intensity conflict during 2009-2012, the emergence of the Islamic State of Iraq and Levant (or Islamic State) in 2013 was associated with a resurgence of violence in Baghdad, Iraq's capital and largest city. We evaluated trends in injury-related deaths in Baghdad before and during the Islamic State insurgency. Methods Iraqi National Injury Mortality Surveillance System prospectively collects information on fatal injuries from governorate coroner offices using standardized reporting forms. Trained coroner clerks collect information on victim demographics, intention of injury and mechanism of injury during medical examinations using reports from police and families. We analyzed data on all deaths reported by the Baghdad Forensic Institute from January 1, 2010 to December 31, 2015. Results There were 17,555 injury-related deaths with documented intent and mechanism (range 2385-3347 per year): 6241 from gunfire (36%), 1381 explosions (8%), 1348 non-gunfire assaults (8%), 3435 traffic accidents (20%), and 5150 other unintentional injuries (29%). Rates of gunfire (23.45 per 100,000) and explosion (5.90 per 100,000) deaths were significantly higher in 2014 than in all other years during the review period (p < 0.001 and p = 0.03, respectively). During the same period from 2010 to 2015, traffic accident deaths declined significantly from 13.29 to 6.35 (p = 0.002), with declines observed primarily among pedestrians. Trends in the rate of non-gunfire-assault and unintentional deaths, comparing 2010 and 2015, were not significant (p = 0.12 and p = 0.63, respectively). Unintentional deaths were mostly attributed to burns (46%) and electricity-related injuries (31%). The proportion of both females and children was highest in unintentional injury deaths. Conclusions During the study period, deaths from both gunfire and explosions in Baghdad peaked in 2014, corresponding with emergence of the Islamic State. Trends suggest a potential impact of insurgency-related activity on other injuries as evidenced by a decrease in the death rate from traffic accidents. The decreased traffic-related death rate could be from decreased vehicle and pedestrian activity during times of violence. Monitoring trends in injury mortality during conflict allows Iraq to identify priority injury causes to inform public health interventions.
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Affiliation(s)
- Matthew Goers
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global Health Protection, Atlanta, GA USA
| | - Eva Leidman
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global Health Protection, Atlanta, GA USA
| | - Abdul-Salam Saleh Sultran
- National Training and Human Development Center, Iraq Ministry of Health, Bab Al Mu’adham Street, Baghdad, Iraq
| | - Ahmed Hassan
- Medical Operations and Specialized Services Directorate, Operations Department, Iraq Ministry of Health, Al Adham Street, Baghdad, Iraq
| | - Oleg Bilukha
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global Health Protection, Atlanta, GA USA
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Martin DW, Sloan M, Gleason BL, de Wit L, Vandi MA, Kargbo DK, Clemens N, Kamara AS, Njuguna C, Sesay S, Singh T. Implementing Nationwide Facility-based Electronic Disease Surveillance in Sierra Leone: Lessons Learned. Health Secur 2020; 18:S72-S80. [PMID: 32004124 PMCID: PMC7465552 DOI: 10.1089/hs.2019.0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Global Health Security Agenda aims to improve countries' ability to prevent, detect, and respond to infectious disease threats by building or strengthening core capacities required by the International Health Regulations (2005). One of those capacities is the development of surveillance systems to rapidly detect and respond to occurrences of diseases with epidemic potential. Since 2015, the US Centers for Disease Control and Prevention (CDC) has worked with partners in Sierra Leone to assist the Ministry of Health and Sanitation in developing an Integrated Disease Surveillance and Response (IDSR) system. Beginning in 2016, CDC, in collaboration with the World Health Organization and eHealth Africa, has supported the ministry in the development of Android device mobile data entry at the health facility for electronic IDSR (eIDSR), also known as health facility-based eIDSR. Health facility-based eIDSR was introduced via a pilot program in 1 district, and national rollout began in 2018. With more than 1,100 health facilities now reporting, the Sierra Leone eIDSR system is substantially larger than most mobile-device health (mHealth) projects found in the literature. Several technical innovations contributed to the success of health facility-based eIDSR in Sierra Leone. Among them were data compression and dual-mode (internet and text) message transmission to mitigate connectivity issues, user interface design tailored to local needs, and a continuous-feedback process to iteratively detect user or system issues and remediate challenges identified. The resultant system achieved high user acceptance and demonstrated the feasibility of an mHealth-based surveillance system implemented on a national scale.
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Malvy D, Gaüzère BA, Migliani R. [Epidemic and emerging prone-infectious diseases: Lessons learned and ways forward]. Presse Med 2019; 48:1536-1550. [PMID: 31784255 PMCID: PMC7127531 DOI: 10.1016/j.lpm.2019.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023] Open
Abstract
Africa along side with south-east Asia are the epicentres of emerging and epidemic prone-infectious diseases and megacity biosecurity threat scenarios. Massive mobility and reluctance in the populations exposed to epidemic and emerging prone-infectious diseases coupled by a weak health system made disease alert and control measures difficult to implement. The investigation of virus detection and persistence in semen across a range of emerging viruses is useful for clinical and public health reasons, in particular for viruses that lead to high mortality or morbidity rates or to epidemics. Innovating built facility to safely treat patients with highly pathogenic infectious diseases is urgently need, not only to prevent the spread of infection from patients to healthcare workers but also to offer provision of relatively invasive organ support, whenever considered appropriate, without posing additional risk to staff. Despite multiple challenges, the need to conduct research during epidemics is inevitable, and candidate products must continue undergoing rigorous trials. Preparedness including management of complex humanitarian crises with community distrust is a cornerstone in response to high consequence emerging infectious disease outbreaks and imposes strengthening of the public health response infrastructure and emergency outbreak systems in high-risk regions.
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Affiliation(s)
- Denis Malvy
- Université de Bordeaux, centre René Labusquière, département universitaire de médecine tropicale et santé internationale clinique, 33000Bordeaux, France; Université de Bordeaux, Inserm 1219, 33000Bordeaux, France; CHU de Bordeaux, établissement de santé de référence risque épidémique et biologique Sud-Ouest, service des maladies infectieuses et tropicales, 33000Bordeaux, France.
| | - Bernard-Alex Gaüzère
- Université de Bordeaux, centre René Labusquière, département universitaire de médecine tropicale et santé internationale clinique, 33000Bordeaux, France
| | - René Migliani
- Université de Bordeaux, centre René Labusquière, département universitaire de médecine tropicale et santé internationale clinique, 33000Bordeaux, France.
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