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Craig AT, Leong RNF, Donoghoe MW, Muscatello D, Mojica VJC, Octavo CJM. Comparison of statistical methods for the early detection of disease outbreaks in small population settings. IJID REGIONS 2023; 8:157-163. [PMID: 37694222 PMCID: PMC10482728 DOI: 10.1016/j.ijregi.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
Objectives This study examines the performance of 6 aberration detection algorithms for the early detection of disease outbreaks in small population settings using syndrome-based early warning surveillance data collected by the Pacific Syndromic Surveillance System (PSSS). Although previous studies have proposed statistical methods for detecting aberrations in larger datasets, there is limited knowledge about how these perform in the presence of small numbers of background cases. Methods To address this gap a simulation model was developed to test and compare the performance of the 6 algorithms in detecting outbreaks of different magnitudes, durations, and case distributions. Results The study found that while the Early Aberration Reporting System-C1 algorithm developed by Hutwagner et al. outperformed others, no single approach provided reliable monitoring across all outbreak types. Furthermore, aberration detection approaches could only detect very large and acute outbreaks with any reliability. Conclusion The findings of this study suggest that algorithm-based approaches to outbreak signal detection perform poorly when applied to settings with small numbers of background cases and should not be relied upon in these contexts. This highlights the need for alternative approaches for accurate and timely outbreak detection in small population settings, particularly those that are resource-constrained.
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Affiliation(s)
- Adam T. Craig
- School of Public Health, The University of Queensland, Herston, Australia
- School of Population Health, University of New South Wales, Sydney, Kensington, Australia
| | - Robert Neil F. Leong
- School of Population Health, University of New South Wales, Sydney, Kensington, Australia
| | - Mark W. Donoghoe
- Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Kensington, Australia
| | - David Muscatello
- School of Population Health, University of New South Wales, Sydney, Kensington, Australia
| | - Vio Jianu C. Mojica
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, Philippines
| | - Christine Joy M. Octavo
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, Philippines
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Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders' Discussions, Challenges, Priorities and Solutions, 2015-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074108. [PMID: 35409794 PMCID: PMC8998582 DOI: 10.3390/ijerph19074108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/05/2023]
Abstract
In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as ‘a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.’ Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015–2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.
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Matthews RJ, Kaluthotage I, Russell TL, Knox TB, Horwood PF, Craig AT. Arboviral Disease Outbreaks in the Pacific Islands Countries and Areas, 2014 to 2020: A Systematic Literature and Document Review. Pathogens 2022; 11:74. [PMID: 35056022 PMCID: PMC8779081 DOI: 10.3390/pathogens11010074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 12/10/2022] Open
Abstract
Arthropod-borne diseases pose a significant public health threat, accounting for greater than 17% of infectious disease cases and 1 million deaths annually. Across Pacific Island countries and areas (PICs), outbreaks of dengue, chikungunya, and Zika are increasing in frequency and scale. Data about arbovirus outbreaks are incomplete, with reports sporadic, delayed, and often based solely on syndromic surveillance. We undertook a systematic review of published and grey literature and contacted relevant regional authorities to collect information about arboviral activity affecting PICs between October 2014 and June 2020. Our literature search identified 1176 unique peer-reviewed articles that were reduced to 25 relevant publications when screened. Our grey literature search identified 873 sources. Collectively, these data reported 104 unique outbreaks, including 72 dengue outbreaks affecting 19 (out of 22) PICs, 14 chikungunya outbreaks affecting 11 PICs, and 18 Zika outbreaks affecting 14 PICs. Our review is the most complete account of arboviral outbreaks to affect PICs since comparable work was published in 2014. It highlights the continued elevated level of arboviral activity across the Pacific and inconsistencies in how information about outbreaks is reported and recorded. It demonstrates the importance of a One-Health approach and the role that improved communication and reporting between different governments and sectors play in understanding the emergence, circulation, and transboundary risks posed by arboviral diseases.
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Affiliation(s)
- Rosie J. Matthews
- Department of Medicine, Cairns Hospital, Cairns, QID 4870, Australia
| | - Ishani Kaluthotage
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QID 4870, Australia; (I.K.); (T.L.R.)
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QID 4870, Australia
| | - Tanya L. Russell
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QID 4870, Australia; (I.K.); (T.L.R.)
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QID 4870, Australia
| | - Tessa B. Knox
- Vanuatu Country Liaison Office, World Health Organization, Port Vila, Vanuatu;
| | - Paul F. Horwood
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QID 4811, Australia;
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QID 4811, Australia
| | - Adam T. Craig
- School of Population Health, University of New South Wales, Sydney, NSW 1466, Australia
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4
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Rendell N, Sheel M. Expert perspectives on priorities for supporting health security in the Pacific region through health systems strengthening. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000529. [PMID: 36962587 PMCID: PMC10021329 DOI: 10.1371/journal.pgph.0000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022]
Abstract
The COVID-19 pandemic has reiterated the interdependence of health security and health systems, and the need for resilient health systems to prevent large-scale impacts of infectious disease outbreaks and other acute public health events. Three years into the COVID-19 pandemic has led to discussions on how to "build back better", making it important to identify lessons to strengthen health systems and prevent future shocks from health security threats. Limited data exist on effective implementable initiatives, especially for the Pacific region. We explored the perceptions of a selection of experts with field experience in the Pacific region to identify and prioritise areas for future health system investments that strengthen health security. We conducted a qualitative cross-sectional study, collecting data using four focus group discussions. We analysed the data using a content analysis of notes recorded from each of the sessions. There were 24 participants, representing 15 research and academic institutions, nongovernment agencies, UN agencies and government as well as independent consultants. All were health sector stakeholders with field experience in the Pacific region and expertise in either health systems or health security. The analysis revealed four areas to prioritise future efforts, namely workforce development, risk communication, public health surveillance and laboratory capacity. A fifth theme, localisation, was identified as a cross cutting theme that should be applied to implementation of other identified priority areas. These findings provide a starting point to apply in practice this relatively new concept, of targeted health systems strengthening for health security development, in the Pacific. Evaluation of these initiatives will strengthen knowledge on the value of integrating these two concepts.
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Affiliation(s)
- Nicole Rendell
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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5
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Carlisle K, Larkins S, Whittaker M, MacLaren D, Harrington H, Delai M. Research capacity training for surveillance and response in the Indo-Pacific: a case study of implementation. Public Health Action 2021; 11:61-68. [PMID: 34159064 DOI: 10.5588/pha.20.0067] [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] [Received: 11/02/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Surveillance and response workforce in the Indo-Pacific region, including Papua New Guinea (PNG), Solomon Islands, Fiji, Eastern Indonesia and Timor-Leste. OBJECTIVE To evaluate the implementation of a modified WHO SORT IT research training programme which included a workplace-based research project. The training was designed for surveillance and response frontline workforce in the Indo-Pacific region. DESIGN This was a programme evaluation using mixed methods. Fifty-three health and biosecurity workers from Fiji, Indonesia, PNG, Solomon Islands and Timor-Leste participated in the research training programme. RESULTS Implementation of the programme was modified to reflect the context of participant countries. Work-place research projects focused on priority issues identified by local policy makers and in-country stakeholders. Self-reported research skills showed a significant increase (P < 0.01) after the completion of training. Participants reported high scores for satisfaction with training. CONCLUSIONS This case study provides lessons learnt for future research training, and demonstrates that the SORT IT model can be modified to reflect the context of implementation without compromising purpose or outcomes.
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Affiliation(s)
- K Carlisle
- College of Medicine and Dentistry, Anton Breinl Research Centre for Health Systems Strengthening and Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, Douglas, QLD, Australia
| | - S Larkins
- College of Medicine and Dentistry, Anton Breinl Research Centre for Health Systems Strengthening and Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, Douglas, QLD, Australia
| | - M Whittaker
- College of Public Health, Medical & Veterinary Sciences, Anton Breinl Research Centre for Health Systems Strengthening and Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Bebegu Yumba Campus, Douglas, QLD, Australia
| | - D MacLaren
- College of Medicine and Dentistry, Anton Breinl Research Centre for Health Systems Strengthening and Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Ngumabada Campus, Smithfield, QLD, Australia
| | - H Harrington
- College of Medicine and Dentistry, Anton Breinl Research Centre for Health Systems Strengthening and Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Ngumabada Campus, Smithfield, QLD, Australia.,Atoifi Health Research Group, Atoifi Adventist Hospital, Atoifi, Malaita, Solomon Islands
| | - M Delai
- Ministry of Health and Medical Services, Suva, Fiji
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6
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Craig AT, Kama N, Fafale G, Bugoro H. Citizen science as a tool for arboviral vector surveillance in a resourced-constrained setting: results of a pilot study in Honiara, Solomon Islands, 2019. BMC Public Health 2021; 21:509. [PMID: 33726697 PMCID: PMC7962342 DOI: 10.1186/s12889-021-10493-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Recent arboviral disease outbreaks highlight the value a better understanding of the spread of disease-carrying mosquitoes across spatial-temporal scales can provide. Traditional surveillance tools are limited by jurisdictional boundaries, workforce constraints, logistics, and cost; factors that in low- and middle-income countries often conspire to undermine public health protection efforts. To overcome these, we undertake a pilot study designed to explore if citizen science provides a feasible strategy for arboviral vector surveillance in small developing Pacific island contexts. Methods We recruited, trained, and equipped community volunteers to trap and type mosquitos within their household settings, and to report count data to a central authority by short-message-service. Mosquito catches were independently assessed to measure participants’ mosquito identification accuracy. Other data were collected to measure the frequency and stability of reporting, and volunteers’ experiences. Results Participants collected data for 78.3% of the study period, and agreement between the volunteer citizen scientists’ and the reviewing entomologist’s mosquito identification was 94%. Opportunity to contribute to a project of social benefit, the chance to learn new skills, and the frequency of engagement with project staff were prime motivators for participation. Unstable electricity supply (required to run the trap’s fan), insufficient personal finances (to buy electricity and phone credit), and inconvenience were identified as barriers to sustained participation. Conclusions While there are challenges to address, our findings suggest that citizen science offers an opportunity to overcome the human resource constraints that conspire to limit health authorities’ capacity to monitor arboviral vectors across populations. We note that the success of citizen science-based surveillance is dependent on the appropriate selection of equipment and participants, and the quality of engagement and support provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10493-6.
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Affiliation(s)
- Adam T Craig
- University of New South Wales (Sydney), Sydney, New South Wales, Australia
| | - Nathan Kama
- Vector-borne Disease Unit, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - George Fafale
- Environmental Health Unit, Honiara City Council, Honiara, Solomon Islands
| | - Hugo Bugoro
- Solomon Islands National University, Honiara, Solomon Islands.
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7
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Larkins S, Carlisle K, Harrington H, MacLaren D, Lovo E, Harrington R, Fernandes Alves L, Rafai E, Delai M, Whittaker M. From the Frontline: Strengthening Surveillance and Response Capacities of the Rural Workforce in the Asia-Pacific Region. How Can Grass-Roots Implementation Research Help? Front Public Health 2020; 8:507. [PMID: 33042947 PMCID: PMC7524875 DOI: 10.3389/fpubh.2020.00507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022] Open
Abstract
Health systems in the Asia-Pacific region are poorly prepared for pandemic threats, particularly in rural/provincial areas. Yet future emerging infectious diseases are highly likely to emerge in these rural/provincial areas, due to high levels of contact between animals and humans (domestically and through agricultural activities), over-stretched and under-resourced health systems, notably within the health workforce, and a diverse array of socio-cultural determinants of health. In order to optimally implement health security measures at the frontline of health services where the people are served, it is vital to build capacity at the local district and facility level to adapt national and global guidelines to local contexts, including health systems, and community and socio-cultural realities. During 2017/18 James Cook University (JCU) facilitated an implementation research training program (funded by Australian Department of Foreign Affairs and Trade) for rural/provincial and regional health and biosecurity workers and managers from Fiji, Indonesia, Papua New Guinea (PNG), Solomon Islands and Timor-Leste. This training was designed so frontline health workers could learn research in their workplace, with no funding other than workplace resources, on topics relevant to health security in their local setting. The program, based upon the WHO-TDR Structured Operational Research and Training IniTiative (SORT-IT) consists of three blocks of teaching and a small, workplace-based research project. Over 50 projects by health workers including surveillance staff, laboratory managers, disease control officers, and border security staff included: analysis and mapping of surveillance data, infection control, IHR readiness, prevention/response and outbreak investigation. Policy briefs written by participants have informed local, provincial and national health managers, policy makers and development partners and provided on-the-ground recommendations for improved practice and training. These policy briefs reflected the socio-cultural, health system and disease-specific realities of each context. The information in the policy briefs can be used collectively to assess and strengthen health workforce capacity in rural/provincial areas. The capacity to use robust but simple research tools for formative and evaluative purposes provides sustainable capacity in the health system, particularly the rural health workforce. This capacity improves responses to infectious diseases threats and builds resilience into fragile health systems.
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Affiliation(s)
- Sarah Larkins
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia
| | - Karen Carlisle
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia
| | - Humpress Harrington
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Atoifi Health Research Group, Atoifi Adventist Hospital, Malaita, Solomon Islands
| | - David MacLaren
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Atoifi Health Research Group, Atoifi Adventist Hospital, Malaita, Solomon Islands
| | - Etivina Lovo
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Fiji Institute of Pacific Health Research, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Relmah Harrington
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Atoifi Health Research Group, Atoifi Adventist Hospital, Malaita, Solomon Islands
| | - Lucsendar Fernandes Alves
- Menzies School of Health Research, Darwin, NT, Australia.,World Health Organization, Dili, Timor-Leste
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Mere Delai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Maxine Whittaker
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia
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8
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Craig AT, Kaldor J, Schierhout G, Rosewell AE. Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta-analysis of published literature, 2010-2019. Trop Med Int Health 2020; 25:906-918. [PMID: 32446271 DOI: 10.1111/tmi.13448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Due to their tropical location, development status and the limited capacity of health systems, Pacific island counties and territories are particularly susceptible to infectious disease outbreaks; but evidence as to the optimal way in which outbreaks are detected is scarce. In this review, we synthesise evidence from literature about how outbreaks are detected in Pacific island countries and territories and critique factors identified as inhibiting surveillance practice. METHOD For this systematic review, we searched electronic databases Embase, Global Health, MEDLINE and MEDLINE Epub from 1 January 2010 and 31 March 2019 for reports describing infectious disease outbreaks occurring in the Pacific islands. Reports were included if they reported the method by which an outbreak was detected or the time between an outbreak's onset and its detection. We extracted information about the report type and authors, the outbreak and its method/s of detection, and pertinent issues inhibiting surveillance practice. RESULTS Of 860 articles identified, 37 reports describing 39 outbreaks met the inclusion criteria. Most outbreaks (n = 30) were identified through formal event-based surveillance; six through syndromic surveillance; and two by ad hoc notification from the community. Barriers to early outbreak detection included population isolation; lack of resources and infrastructure to support surveillance implementation and signal investigation; and broader health system factors such as preparedness planning and availability of laboratory services. CONCLUSION Most surveillance-related gain in the Pacific islands may be made through building formal event-based surveillance systems and streamlining reporting processes to facilitate outbreak notification. This observation is pertinent given the focus on establishing and expanding syndromic surveillance approaches for outbreak detection in the islands over the last decade.
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Affiliation(s)
- Adam T Craig
- University of New South Wales, Sydney, NSW, Australia
| | - John Kaldor
- University of New South Wales, Sydney, NSW, Australia
| | - Gill Schierhout
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Alexander E Rosewell
- University of New South Wales, Sydney, NSW, Australia.,World Health Organization, Geneva, Switzerland
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9
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Abstract
On 30 January 2020, WHO declared coronavirus (COVID-19) a global public health emergency. As of 12 March 2020, 125 048 confirmed COVID-19 cases in 118 countries had been reported. On 12 March 2020, the first case in the Pacific islands was reported in French Polynesia; no other Pacific island country or territory has reported cases. The purpose of our analysis is to show how travellers may introduce COVID-19 into the Pacific islands and discuss the role robust health systems play in protecting health and reducing transmission risk. We analyse travel and Global Health Security Index data using a scoring tool to produce quantitative estimates of COVID-19 importation risk, by departing and arriving country. Our analysis indicates that, as of 12 March 2020, the highest risk air routes by which COVID-19 may be imported into the Pacific islands are from east Asian countries (specifically, China, Korea and Japan) to north Pacific airports (likely Guam, Commonwealth of the Northern Mariana Islands or, to a less extent, Palau); or from China, Japan, Singapore, the United States of America or France to south Pacific ports (likely, Fiji, Papua New Guinea, French Polynesia or New Caledonia). Other importation routes include from other east Asian countries to Guam, and from Australia, New Zealand and other European countries to the south Pacific. The tool provides a useful method for assessing COVID-19 importation risk and may be useful in other settings.
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10
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Sheel M, Collins J, Kama M, Nand D, Faktaufon D, Samuela J, Biaukula V, Haskew C, Flint J, Roper K, Merianos A, Kirk MD, Nilles E. Evaluation of the early warning, alert and response system after Cyclone Winston, Fiji, 2016. Bull World Health Organ 2019; 97:178-189C. [PMID: 30992631 DOI: 10.2471/blt.18.211409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the performance of an early warning, alert and response system (EWARS) developed by the World Health Organization (WHO) - EWARS in a Box - that was used to detect and control disease outbreaks after Cyclone Winston caused destruction in Fiji on 20 February 2016. Methods Immediately after the cyclone, Fiji's Ministry of Health and Medical Services, supported by WHO, started to implement EWARS in a Box, which is a smartphone-based, automated, early warning surveillance system for rapid deployment during health emergencies. Both indicator-based and event-based surveillance were employed. The performance of the system between 7 March and 29 May 2016 was evaluated. Users' experience with the system was assessed in interviews using a semi-structured questionnaire and by a cross-sectional survey. The system's performance was assessed using data from the EWARS database. Findings Indicator-based surveillance recorded 34 113 cases of the nine syndromes under surveillance among 326 861 consultations. Three confirmed outbreaks were detected, and no large outbreak was missed. Users were satisfied with the performance of EWARS and judged it useful for timely monitoring of disease trends and outbreak detection. The system was simple, stable and flexible and could be rapidly deployed during a health emergency. The automated collation, analysis and dissemination of data reduced the burden on surveillance teams, saved human resources, minimized human error and ensured teams could focus on public health responses. Conclusion In Fiji, EWARS in a Box was effective in strengthening disease surveillance during a national emergency and was well regarded by users.
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Affiliation(s)
- Meru Sheel
- National Centre for Epidemiology and Population Health, Australian National University, Building 62, Mills Road, Canberra, ACT 2610, Australia
| | - Julie Collins
- National Centre for Epidemiology and Population Health, Australian National University, Building 62, Mills Road, Canberra, ACT 2610, Australia
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Devina Nand
- Ministry of Health and Medical Services, Suva, Fiji
| | - Daniel Faktaufon
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | | | - Viema Biaukula
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Christopher Haskew
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - James Flint
- Hunter New England Population Health, Wallsend, Australia
| | - Katrina Roper
- National Centre for Epidemiology and Population Health, Australian National University, Building 62, Mills Road, Canberra, ACT 2610, Australia
| | - Angela Merianos
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Building 62, Mills Road, Canberra, ACT 2610, Australia
| | - Eric Nilles
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
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11
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Craig AT, Joshua CA, Sio AR, Donoghoe M, Betz-Stablein B, Bainivalu N, Dalipanda T, Kaldor J, Rosewell AE, Schierhout G. Epidemic surveillance in a low resource setting: lessons from an evaluation of the Solomon Islands syndromic surveillance system, 2017. BMC Public Health 2018; 18:1395. [PMID: 30572942 PMCID: PMC6302379 DOI: 10.1186/s12889-018-6295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background Solomon Islands is one of the least developed countries in the world. Recognising that timely detection of outbreaks is needed to enable early and effective response to disease outbreaks, the Solomon Islands government introduced a simple syndromic surveillance system in 2011. We conducted the first evaluation of the system and the first exploration of a national experience within the broader multi-country Pacific Syndromic Surveillance System to determine if it is meeting its objectives and to identify opportunities for improvement. Methods We used a multi-method approach involving retrospective data collection and statistical analysis, modelling, qualitative research and observational methods. Results We found that the system was well accepted, highly relied upon and designed to account for contextual limitations. We found the syndromic algorithm used to identify outbreaks was moderately sensitive, detecting 11.8% (IQR: 6.3–25.0%), 21.3% (IQR: 10.3–36.8%), 27.5% (IQR: 12.8–52.3%) and 40.5% (IQR: 13.5–65.7%) of outbreaks that caused small, moderate, large and very large increases in case presentations to health facilities, respectively. The false alert rate was 10.8% (IQR: 4.8–24.5%). Rural coverage of the system was poor. Limited workforce, surveillance resourcing and other ‘upstream’ health system factors constrained performance. Conclusions The system has made a significant contribution to public health security in Solomon Islands, but remains insufficiently sensitive to detect small-moderate sized outbreaks and hence should not be relied upon as a stand-alone surveillance strategy. Rather, the system should sit within a complementary suite of early warning surveillance activities including event-based, in-patient- and laboratory-based surveillance methods. Future investments need to find a balance between actions to address the technical and systems issues that constrain performance while maintaining simplicity and hence sustainability. Electronic supplementary material The online version of this article (10.1186/s12889-018-6295-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam T Craig
- University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Cynthia A Joshua
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - Alison R Sio
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - Mark Donoghoe
- University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Nemia Bainivalu
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - Tenneth Dalipanda
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - John Kaldor
- University of New South Wales, Sydney, NSW, 2052, Australia
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12
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Abstract
Objective To understand the global outbreak surveillance needs of stakeholders involved in epidemic response in selected countries and areas in the Asia-Pacific region to inform development of an epidemic observatory, Epi-watch. Methods We designed an online, semi-structured stakeholder questionnaire to collect information on global outbreak surveillance sources and limitations from participants who use epidemic intelligence and outbreak alert services in their work in government and nongovernment organizations in the Asia-Pacific region. Results All respondents agreed that it was important to remain up to date with global outbreaks. The main reason cited for following global outbreak news was as an early warning for serious epidemics. Mainstream media and specialist Internet sources such as the World Health Organization (n = 54/91; 59%), the Program for Monitoring Emerging Diseases (ProMED)-mail (n = 45/91; 49%) and the United States Centers for Disease Control and Prevention (n = 31/91; 34%) were the most common sources for global outbreak news; rapid intelligence services such as HealthMap were less common (n = 9/91; 10%). Only 51% (n = 46/91) of respondents thought that their sources of outbreak news were timely and sufficient for their needs. Conclusion For those who work in epidemic response, epidemic intelligence is important and widely used. Stakeholders are less aware of and less frequently use rapid sources such as HealthMap and rely more on validated but less timely traditional sources of disease surveillance. Users identified a need for more timely and reliable epidemic intelligence.
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Craig AT, Joshua CA, Sio AR, Lauri M, Kaldor J, Rosewell AE, Schierhout G. Towards effective outbreak detection: a qualitative study to identify factors affecting nurses' early warning surveillance practice in Solomon Islands. BMC Health Serv Res 2018; 18:702. [PMID: 30200946 PMCID: PMC6131946 DOI: 10.1186/s12913-018-3508-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Intelligence generated by a surveillance system is dependent on the quality of data that are collected. We investigated the knowledge, attitudes and practices of nurses responsible for outbreak early warning surveillance data collection in Solomon Islands to identify factors that influence their ability to perform surveillance-related tasks with rigour. Methods We interviewed 12 purposively selected surveillance nurses and conducted inductive analysis on resulting data. Results Interviewees were knowledgeable and willing to contribute to the surveillance system. Constraining factors included the perception that surveillance was less important than patient care and could be ‘deferred’ during busy periods and wide variability in the application of case definitions. Motivating factors were frequent in-clinic training, formal recognition for good performance, incentives and designation of a focal point. Nurses held mixed views about the effect of mobile technologies on surveillance practice. Conclusions This study identified several challenges to consistent and accurate data collection and reporting. Engagement of different parts of the health system, including human resources and health facilities’ management, is needed to address these challenges. Electronic supplementary material The online version of this article (10.1186/s12913-018-3508-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam T Craig
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.
| | - Cynthia A Joshua
- Solomon Islands Ministry of Health and Medical Services, PO Box 349, Honiara, Solomon Islands
| | - Alison R Sio
- Solomon Islands Ministry of Health and Medical Services, PO Box 349, Honiara, Solomon Islands
| | - Michael Lauri
- Solomon Islands Ministry of Health and Medical Services, PO Box 349, Honiara, Solomon Islands
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Alexander E Rosewell
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Gill Schierhout
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
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Manogaran G, Lopez D. Disease Surveillance System for Big Climate Data Processing and Dengue Transmission. ACTA ACUST UNITED AC 2017. [DOI: 10.4018/ijaci.2017040106] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ambient intelligence is an emerging platform that provides advances in sensors and sensor networks, pervasive computing, and artificial intelligence to capture the real time climate data. This result continuously generates several exabytes of unstructured sensor data and so it is often called big climate data. Nowadays, researchers are trying to use big climate data to monitor and predict the climate change and possible diseases. Traditional data processing techniques and tools are not capable of handling such huge amount of climate data. Hence, there is a need to develop advanced big data architecture for processing the real time climate data. The purpose of this paper is to propose a big data based surveillance system that analyzes spatial climate big data and performs continuous monitoring of correlation between climate change and Dengue. Proposed disease surveillance system has been implemented with the help of Apache Hadoop MapReduce and its supporting tools.
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Affiliation(s)
| | - Daphne Lopez
- School of Information Technology and Engineering, VIT University, Vellore, India
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