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Mercy K, Pokhariyal G, Takah Fongwen N, Kivuti-Bitok L. Evaluation of cholera surveillance systems in Africa: a systematic review. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1353826. [PMID: 38933896 PMCID: PMC11199716 DOI: 10.3389/fepid.2024.1353826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Introduction Despite several interventions on the control of cholera, it still remains a significant public health problem in Africa. According to the World Health Organization, 251,549 cases and 4,180 deaths (CFR: 2.9%) were reported from 19 African countries in 2023. Tools exist to enhance the surveillance of cholera but there is limited evidence on their deployment and application. There is limited evidence on the harmonization of the deployment of tools for the evaluation of cholera surveillance. We systematically reviewed available literature on the deployment of these tools in the evaluation of surveillance systems in Africa. Method Three electronic databases (PubMed, Medline and Embase) were used to search articles published in English between January 2012 to May 2023. Grey literature was also searched using Google and Google Scholar. Only articles that addressed a framework used in cholera surveillance in Africa were included. The quality of articles was assessed using the appropriate tools. Data on the use of surveillance tools and frameworks were extracted from articles for a coherent synthesis on their deployment. Result A total of 13 records (5 frameworks and 8 studies) were fit for use for this study. As per the time of the study, there were no surveillance frameworks specific for the evaluation of surveillance systems of cholera in Africa, however, five frameworks for communicable diseases and public health events could be adapted for cholera surveillance evaluation. None (0%) of the studies evaluated capacities on cross border surveillance, multisectoral one health approach and linkage of laboratory networks to surveillance systems. All (100%) studies assessed surveillance attributes even though there was no synergy in the attributes considered even among studies with similar objectives. There is therefore the need for stakeholders to harmoniously identify a spectrum of critical parameters and attributes to guide the assessment of cholera surveillance system performance.
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Affiliation(s)
- Kyeng Mercy
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Division of Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ganesh Pokhariyal
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Noah Takah Fongwen
- Division of Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Lucy Kivuti-Bitok
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
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Ateudjieu J, Yakum MN, Goura AP, Nafack SS, Chebe AN, Azakoh JN, Chukuwchindun BA, Bayiha EJ, Kangmo C, Tachegno GVB, Bissek ACZK. Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study. BMC Health Serv Res 2019; 19:458. [PMID: 31286934 PMCID: PMC6615310 DOI: 10.1186/s12913-019-4315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 07/01/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The risk of cholera outbreak remains high in Cameroon. This is because of the persistent cholera outbreaks in neighboring countries coupled with the poor hygiene and sanitation conditions in Cameroon. The objective of this study was to assess the readiness of health facilities to respond to cholera outbreak in four cholera-prone districts in Cameroon. METHODOLOGY A cross-sectional study was conducted targeting all health facilities in four health districts, labeled as cholera hotspots in Cameroon in August 2016. Data collection was done by interview with a questionnaire and by observation regarding the availability of resources and materials for surveillance and case management, access to water, hygiene, and sanitation. Data analysis was descriptive with STATA 11. PRINCIPAL FINDINGS A total of 134 health facilities were evaluated, most of which (108/134[81%]) were urban facilities. The preparedness regarding surveillance was limited with 13 (50%) health facilities in the Far North and 22(20%) in the Littoral having cholera case definition guide. ORS for Case management was present in 8(31%) health facilities in the Far North and in 94(87%) facilities in the littoral. Less than half of the health facilities had a hand washing protocol and 7(5.1%) did not have any source of drinking water or relied on unimproved sources like lake. A total of 4(3.0%) health facilities, all in the Far North region, did not have a toilet. CONCLUSIONS The level of preparedness of health facilities in Cameroon for cholera outbreak response presents a lot of weaknesses. These are present in terms of lack of basic surveillance and case management materials and resources, low access to WaSH. If not addressed now, these facilities might not be able to play their role in case there is an outbreak and might even turn to be transmission milieus.
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Affiliation(s)
- Jerome Ateudjieu
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
- Department of Biomedical Sciences, University of Dschang, P.O. Box 067, Dschang, Cameroon
| | | | - Andre Pascal Goura
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Sonia Sonkeng Nafack
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | | | | | | | - Eugene Joel Bayiha
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Corine Kangmo
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
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Sauvageot D, Njanpop-Lafourcade BM, Akilimali L, Anne JC, Bidjada P, Bompangue D, Bwire G, Coulibaly D, Dengo-Baloi L, Dosso M, Orach CG, Inguane D, Kagirita A, Kacou-N’Douba A, Keita S, Kere Banla A, Kouame YJP, Landoh DE, Langa JP, Makumbi I, Miwanda B, Malimbo M, Mutombo G, Mutombo A, NGuetta EN, Saliou M, Sarr V, Senga RK, Sory F, Sema C, Tante OV, Gessner BD, Mengel MA. Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance. PLoS Negl Trop Dis 2016; 10:e0004679. [PMID: 27186885 PMCID: PMC4871502 DOI: 10.1371/journal.pntd.0004679] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cholera burden in Africa remains unknown, often because of weak national surveillance systems. We analyzed data from the African Cholera Surveillance Network (www.africhol.org). METHODS/ PRINCIPAL FINDINGS During June 2011-December 2013, we conducted enhanced surveillance in seven zones and four outbreak sites in Togo, the Democratic Republic of Congo (DRC), Guinea, Uganda, Mozambique and Cote d'Ivoire. All health facilities treating cholera cases were included. Cholera incidences were calculated using culture-confirmed cholera cases and culture-confirmed cholera cases corrected for lack of culture testing usually due to overwhelmed health systems and imperfect test sensitivity. Of 13,377 reported suspected cases, 34% occurred in Conakry, Guinea, 47% in Goma, DRC, and 19% in the remaining sites. From 0-40% of suspected cases were aged under five years and from 0.3-86% had rice water stools. Within surveillance zones, 0-37% of suspected cases had confirmed cholera compared to 27-38% during outbreaks. Annual confirmed incidence per 10,000 population was <0.5 in surveillance zones, except Goma where it was 4.6. Goma and Conakry had corrected incidences of 20.2 and 5.8 respectively, while the other zones a median of 0.3. During outbreaks, corrected incidence varied from 2.6 to 13.0. Case fatality ratios ranged from 0-10% (median, 1%) by country. CONCLUSIONS/SIGNIFICANCE Across different African epidemiological contexts, substantial variation occurred in cholera incidence, age distribution, clinical presentation, culture confirmation, and testing frequency. These results can help guide preventive activities, including vaccine use.
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Affiliation(s)
| | | | | | | | | | - Didier Bompangue
- Universite de Kinshasa, Kinshasa, Republique Democratique du Congo
| | | | | | | | | | | | | | - Atek Kagirita
- Central Public Health Laboratory, Ministry of Health, Kampala, Uganda
| | | | - Sakoba Keita
- Ministere de la sante publique et de l’hygiene publique, Conakry, Guinea
| | | | | | | | | | | | - Berthe Miwanda
- Institut National de Recherche Biomedicale, Kinshasa, Republique Democratique du Congo
| | | | - Guy Mutombo
- Ministere de la santé, Division Provinciale de la santé, Goma, Republique Democratique du Congo
| | - Annie Mutombo
- Ministère de la santé, Kinshasa, Republique Democratique du Congo
| | | | | | - Veronique Sarr
- Ministere de la sante publique et de l’hygiene publique, Conakry, Guinea
| | | | - Fode Sory
- Ministere de la sante publique et de l’hygiene publique, Conakry, Guinea
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