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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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Kallay R, Mbuyi G, Eggers C, Coulibaly S, Kangoye DT, Kubuya J, Soke GN, Mossoko M, Kazambu D, Magazani A, Fonjungo P, Luce R, Aruna A. Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021. BMC Public Health 2024; 24:1150. [PMID: 38658902 PMCID: PMC11044341 DOI: 10.1186/s12889-024-18642-3] [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: 04/11/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018-2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats. METHODS The study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas. RESULTS Thirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times. CONCLUSION Support is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system.
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Affiliation(s)
- Ruth Kallay
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA.
| | - Gisèle Mbuyi
- National Epidemiology Surveillance Direction, DRC Ministry of Health, Hygiene and Prevention Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Carrie Eggers
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Soumaila Coulibaly
- Division of Global Health Protection, Centers for Disease Control and Prevention, Bizzell US, Kinshasa, Democratic Republic of the Congo
| | - David Tiga Kangoye
- Division of Global Health Protection, Centers for Disease Control and Prevention, Bizzell US, Kinshasa, Democratic Republic of the Congo
| | - Janvier Kubuya
- North Kivu Provincial Health Direction, DRC Ministry of Health, Hygiene and Prevention, Goma, Democratic Republic of the Congo
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Mathias Mossoko
- National Epidemiology Surveillance Direction, DRC Ministry of Health, Hygiene and Prevention Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ditu Kazambu
- African Field Epidemiology Network, Kinshasa, Democratic Republic of the Congo
| | - Alain Magazani
- African Field Epidemiology Network, Kinshasa, Democratic Republic of the Congo
| | - Peter Fonjungo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Richard Luce
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Aaron Aruna
- National Epidemiology Surveillance Direction, DRC Ministry of Health, Hygiene and Prevention Kinshasa, Kinshasa, Democratic Republic of the Congo
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Kambalame D, Yelewa M, Iversen BG, Khunga N, Macdonald E, Nordstrand K, Mwale A, Muula A, Chitsa Banda E, Phuka J, Arnesen T. Factors influencing operationalization of Integrated Disease Surveillance in Malawi. Public Health 2024; 228:100-104. [PMID: 38342075 DOI: 10.1016/j.puhe.2023.12.030] [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: 09/25/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Malawi's disease surveillance system is built on several different data sources and systems and is informed by the Integrated Diseases Surveillance and Response (IDSR) strategy. This study was carried out as part of a larger multicountry study to identify context-specific factors, which influence the operationalization of integrated disease surveillance. STUDY DESIGN AND METHODS A total of six focus group discussions were conducted with 43 relevant personnel at the primary and secondary healthcare levels in two districts (Lilongwe and Dowa) and at the national level. The discussions were analyzed and sorted into predefined categories based on the domains of the International Association of Public Health conceptual framework. RESULTS We found ongoing efforts to enhance integrated disease surveillance operationalization, including the establishment of the Public Health Institute of Malawi for coordination, digitalizing the surveillance system through One Health Surveillance Platform, and improving communication among rapid response teams using WhatsApp. The adoption of World Health Organization's third edition IDSR technical guidelines was also underway. Nonetheless, there were major implementation barriers such as parallel and uncoordinated surveillance systems, priority conditions that cannot be diagnosed at the point of reporting, lack of case definitions and diagnostic codes for priority conditions, reporting forms with unexplained acronyms, illegible data sources, unstable electronic data transfers, inadequate supervision and training, poor enforcement of reporting from private health facilities, high reporting burden, and lack of and feedback to those reporting. CONCLUSIONS The results fit well into the predefined categories used. The study reveals basic problems with the operationalization, tools, and reporting forms used for IDSR. These findings may have implications for practice and policy in Malawi and other countries where IDSR is the national strategy for surveillance.
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Affiliation(s)
- D Kambalame
- Public Health Institute of Malawi, Ministry of Health, Malawi; Kamuzu University of Health Sciences (KUHeS), Malawi.
| | - M Yelewa
- Public Health Institute of Malawi, Ministry of Health, Malawi
| | - B G Iversen
- Norwegian Institute of Public Health, Norway
| | - N Khunga
- Public Health Institute of Malawi, Ministry of Health, Malawi
| | - E Macdonald
- Norwegian Institute of Public Health, Norway
| | | | - A Mwale
- Public Health Institute of Malawi, Ministry of Health, Malawi
| | - A Muula
- Kamuzu University of Health Sciences (KUHeS), Malawi
| | - E Chitsa Banda
- Public Health Institute of Malawi, Ministry of Health, Malawi
| | - J Phuka
- Kamuzu University of Health Sciences (KUHeS), Malawi
| | - T Arnesen
- Public Health Institute of Malawi, Ministry of Health, Malawi; Norwegian Institute of Public Health, Norway
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Baličević SA, Elimian KO, King C, Diaconu K, Akande OW, Ihekweazu V, Trolle H, Gaudenzi G, Forsberg B, Alfven T. Influences of community engagement and health system strengthening for cholera control in cholera reporting countries. BMJ Glob Health 2023; 8:e013788. [PMID: 38084475 PMCID: PMC10711916 DOI: 10.1136/bmjgh-2023-013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O'Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community-health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.
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Affiliation(s)
| | - Kelly Osezele Elimian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Diaconu
- Institute of Global Health, Queen Margaret University, Edinburgh, UK
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Hanna Trolle
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Protein Science, SciLifeLab, Stockholm, Sweden
| | - Birger Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
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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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Nyenswah TG, Skrip L, Stone M, Schue JL, Peters DH, Brieger WR. Documenting the development, adoption and pre-ebola implementation of Liberia's integrated disease surveillance and response (IDSR) strategy. BMC Public Health 2023; 23:2093. [PMID: 37880607 PMCID: PMC10601278 DOI: 10.1186/s12889-023-17006-7] [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: 06/29/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014. METHODS We reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it. RESULTS Despite the adoption of the IDSR framework, Liberia failed to secure the resources-human, logistical, and financial-to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease. CONCLUSION Our findings suggest that post-war, Liberia's health system intended to prioritize epidemic preparedness and response with the adoption of IDSR. However, insufficient investment and systems development meant IDSR was not well implemented, leaving the country vulnerable to the devastating impact of the Ebola epidemic.
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Affiliation(s)
- Tolbert G Nyenswah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Laura Skrip
- School of Public Health, University of Liberia, Monrovia, Liberia
| | - Mardia Stone
- Division of Global Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Jessica L Schue
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - William R Brieger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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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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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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Rumunu J, Wamala JF, Konga SB, Igale AL, Adut AA, Lonyik SK, Lasu RM, Kaya RD, Guracha G, Nsubuga P, Ndenzako F, Olu OO. Integrated disease surveillance and response in humanitarian context: South Sudan experience. Pan Afr Med J 2022; 42:13. [PMID: 36158932 PMCID: PMC9474851 DOI: 10.11604/pamj.supp.2022.42.1.33779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION decades of instability continue to impact the implementation of the Integrated Disease Surveillance and Response (IDSR) strategy. The study reviewed the progress and outcomes of rolling out IDSR in South Sudan. METHODS this descriptive cross-sectional study used epidemiological data for 2019, 2020, and other program data to assess indicators for the five surveillance components including surveillance priorities, core and support functions, and surveillance system structure and quality. RESULTS South Sudan expanded the priority disease scope from 26 to 59 to align with national and regional epidemiological trends and the International Health Regulations (IHR) 2005. Completing the countrywide rollout of electronic Early Warning Alert and Response (EWARS) reporting has improved both the timeliness and completeness of weekly reporting to 78% and 90%, respectively, by week 39 of 2020 in comparison to a baseline of 54% on both timeliness and completeness of reporting in 2019. The National Public Health Laboratory confirmatory testing capacities have been expanded to include cholera, measles, HIV, tuberculosis (TB), influenza, Ebola, yellow fever, and Severe Acute Respiratory Syndrome 2 (SARS-COV-2). Rapid response teams have been established to respond to epidemics and pandemics. CONCLUSION since 2006, South Sudan has registered progress towards using indicator and event-based surveillance and continues to strengthen IHR (2005) capacities. Following the adoption of third edition IDSR guidelines, the current emphasis entails maintaining earlier gains and strengthening community and event-based surveillance, formalizing cross-sectoral one-health engagement, optimal EWARS and District Health Information Systems (DHIS2) use, and strengthening cross-border surveillance. It is also critical that optimal government, and donors' resources are dedicated to supporting health system strengthening and disease surveillance.
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Affiliation(s)
- John Rumunu
- Directorate of Preventive Health Services, South Sudan Ministry of Health, Joint Doctoral Program in Global Health, Humanitarian Aid and Disaster Medicine, Universita Del Pemonte Orientale and Vrije University Brussel, Juba, South Sudan,,Corresponding author John Rumunu, Directorate of Preventive Health Services, South Sudan Ministry of Health, Joint Doctoral Program in Global Health, Humanitarian Aid and Disaster Medicine, Universita Del Pemonte Orientale and Vrije University Brussel, Juba, South Sudan.
| | | | | | | | | | | | | | | | - Guyo Guracha
- World Health Organization Country office, Juba, South Sudan
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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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Tshitenge ST, Nthitu JM. COVID-19 frontline primary health care professionals' perspectives on health system preparedness and response to the pandemic in the Mahalapye Health District, Botswana. Afr J Prim Health Care Fam Med 2022; 14:e1-e6. [PMID: 35532107 PMCID: PMC9082081 DOI: 10.4102/phcfm.v14i1.3166] [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: 07/28/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization issued interim guidelines on essential health system preparedness and response measures for the coronavirus disease 2019 (COVID-19) pandemic. The control of the pandemic requires healthcare system preparedness and response. Aim This study aimed to evaluate frontline COVID-19 primary health care professionals’ (PHC-Ps) views on health system preparedness and response to the pandemic in the Mahalapye Health District (MHD). Setting In March 2020, the Botswana Ministry of Health directed health districts to educate their health professionals about COVID-19. One hundred and seventy frontline PHC-Ps were trained in MHD; they evaluated the health system’s preparedness and response. Methods This was a cross-sectional study that involved a self-administered questionnaire using the Integrated Disease Surveillance and Health System response guidelines. Results The majority (72.5%) of participants felt unprepared to deal with the COVID-19 pandemic at their level. Most of the participants (70.7%) acknowledged that the health system response plan has been followed. About half of the participants attributed a low score regarding the health system’s preparedness (44.4%), its response (50.0%), and its overall performance (55.6%) to the COVID-19 pandemic. There was an association between participants’ age and work experience and their overall perceptions of preparedness and response (p = 0.009 and p = 0.005, respectively). Conclusion More than half of the participants gave a low score to the MHD regarding the health system’s preparedness and response to the COVID-19 pandemic. Further studies are required to determine the causes of such attitudes and to be better prepared to respond effectively.
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Affiliation(s)
- Stephane T Tshitenge
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone.
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12
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McNeil C, Verlander S, Divi N, Smolinski M. Straight from the source: Landscape of Participatory Surveillance Systems across the One Health Spectrum (Preprint). JMIR Public Health Surveill 2022; 8:e38551. [PMID: 35930345 PMCID: PMC9391976 DOI: 10.2196/38551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Nomita Divi
- Ending Pandemics, San Francisco, CA, United States
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Hardhantyo M, Djasri H, Nursetyo AA, Yulianti A, Adipradipta BR, Hawley W, Mika J, Praptiningsih CY, Mangiri A, Prasetyowati EB, Brye L. Quality of National Disease Surveillance Reporting before and during COVID-19: A Mixed-Method Study in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052728. [PMID: 35270431 PMCID: PMC8910184 DOI: 10.3390/ijerph19052728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 02/05/2023]
Abstract
Background: Global COVID-19 outbreaks in early 2020 have burdened health workers, among them surveillance workers who have the responsibility to undertake routine disease surveillance activities. The aim of this study was to describe the quality of the implementation of Indonesia’s Early Warning and Response Alert System (EWARS) for disease surveillance and to measure the burden of disease surveillance reporting quality before and during the COVID-19 epidemic in Indonesia. Methods: A mixed-method approach was used. A total of 38 informants from regional health offices participated in Focus Group Discussion (FGD) and In-Depth Interview (IDI) for informants from Ministry of Health. The FGD and IDI were conducted using online video communication. Yearly completeness and timeliness of reporting of 34 provinces were collected from the application. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Results: Major implementation gaps were found in poorly distributed human resources and regional infrastructure inequity. National reporting from 2017–2019 showed an increasing trend of completeness (55%, 64%, and 75%, respectively) and timeliness (55%, 64%, and 75%, respectively). However, the quality of the reporting dropped to 53% and 34% in 2020 concomitant with the SARS-CoV2 epidemic. Conclusions: Report completeness and timeliness are likely related to regional infrastructure inequity and the COVID-19 epidemic. It is recommended to increase report capacities with an automatic EWARS application linked systems in hospitals and laboratories.
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Affiliation(s)
- Muhammad Hardhantyo
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
- Faculty of Health Science, Universitas Respati Yogyakarta, Yogyakarta 55281, Indonesia
- Correspondence:
| | - Hanevi Djasri
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - Aldilas Achmad Nursetyo
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - Andriani Yulianti
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - Bernadeta Rachela Adipradipta
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - William Hawley
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
| | - Jennifer Mika
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
| | - Catharina Yekti Praptiningsih
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
| | - Amalya Mangiri
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
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Mremi IR, George J, Rumisha SF, Sindato C, Kimera SI, Mboera LEG. Twenty years of integrated disease surveillance and response in Sub-Saharan Africa: challenges and opportunities for effective management of infectious disease epidemics. ONE HEALTH OUTLOOK 2021; 3:22. [PMID: 34749835 PMCID: PMC8575546 DOI: 10.1186/s42522-021-00052-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/18/2021] [Indexed: 05/15/2023]
Abstract
INTRODUCTION This systematic review aimed to analyse the performance of the Integrated Disease Surveillance and Response (IDSR) strategy in Sub-Saharan Africa (SSA) and how its implementation has embraced advancement in information technology, big data analytics techniques and wealth of data sources. METHODS HINARI, PubMed, and advanced Google Scholar databases were searched for eligible articles. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. RESULTS A total of 1,809 articles were identified and screened at two stages. Forty-five studies met the inclusion criteria, of which 35 were country-specific, seven covered the SSA region, and three covered 3-4 countries. Twenty-six studies assessed the IDSR core functions, 43 the support functions, while 24 addressed both functions. Most of the studies involved Tanzania (9), Ghana (6) and Uganda (5). The routine Health Management Information System (HMIS), which collects data from health care facilities, has remained the primary source of IDSR data. However, the system is characterised by inadequate data completeness, timeliness, quality, analysis and utilisation, and lack of integration of data from other sources. Under-use of advanced and big data analytical technologies in performing disease surveillance and relating multiple indicators minimises the optimisation of clinical and practice evidence-based decision-making. CONCLUSIONS This review indicates that most countries in SSA rely mainly on traditional indicator-based disease surveillance utilising data from healthcare facilities with limited use of data from other sources. It is high time that SSA countries consider and adopt multi-sectoral, multi-disease and multi-indicator platforms that integrate other sources of health information to provide support to effective detection and prompt response to public health threats.
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Affiliation(s)
- Irene R Mremi
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania.
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.
- National Institute for Medical Research, Dar es Salaam, Tanzania.
| | - Janeth George
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, West Perth, Australia
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania
| | - 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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Ng’etich AKS, Voyi K, Mutero CM. Development and validation of a framework to improve neglected tropical diseases surveillance and response at sub-national levels in Kenya. PLoS Negl Trop Dis 2021; 15:e0009920. [PMID: 34714822 PMCID: PMC8580251 DOI: 10.1371/journal.pntd.0009920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/10/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Assessment of surveillance and response system functions focusing on notifiable diseases has widely been documented in literature. However, there is limited focus on diseases targeted for elimination or eradication, particularly preventive chemotherapy neglected tropical diseases (PC-NTDs). There are limited strategies to guide strengthening of surveillance and response system functions concerning PC-NTDs. The aim of this study was to develop and validate a framework to improve surveillance and response to PC-NTDs at the sub-national level in Kenya. METHODS A multi-phased approach using descriptive cross-sectional mixed-method designs was adopted. Phase one involved a systematic literature review of surveillance assessment studies to derive generalised recommendations. Phase two utilised primary data surveys to identify disease-specific recommendations to improve PC-NTDs surveillance. The third phase utilised a Delphi survey to assess stakeholders' consensus on feasible recommendations. The fourth phase drew critical lessons from existing conceptual frameworks. The final validated framework was based on resolutions and inputs from concerned stakeholders. RESULTS The first phase identified thirty studies that provided a combination of recommendations for improving surveillance functions. Second phase described PC-NTDs specific recommendations linked to simplified case definitions, enhanced laboratory capacity, improved reporting tools, regular feedback and supervision, enhanced training and improved system stability and flexibility. In the third phase, consensus was achieved on feasibility for implementing recommendations. Based on these recommendations, framework components constituted human, technical and organisational inputs, four process categories, ten distinct outputs, outcomes and overall impact encompassing reduced disease burden, halted disease transmission and reduced costs for implementing treatment interventions to achieve PC-NTDs control and elimination. CONCLUSION In view of the mixed methodological approach used to develop the framework coupled with further inputs and consensus among concerned stakeholders, the validated framework is relevant for guiding decisions by policy makers to strengthen the existing surveillance and response system functions towards achieving PC-NTDs elimination.
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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
| | - 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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Saleh F, Kitau J, Konradsen F, Mboera LEG, Schiøler KL. Emerging epidemics: is the Zanzibar healthcare system ready to detect and respond to mosquito-borne viral diseases? BMC Health Serv Res 2021; 21:866. [PMID: 34429111 PMCID: PMC8386054 DOI: 10.1186/s12913-021-06867-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Effective control of emerging mosquito-borne viral diseases such as dengue, chikungunya, and Zika requires, amongst other things, a functional healthcare system, ready and capable of timely detection and prompt response to incipient epidemics. We assessed the readiness of Zanzibar health facilities and districts for early detection and management of mosquito-borne viral disease outbreaks. Methods A cross-sectional study involving all 10 District Health Management Teams and 45 randomly selected public and private health facilities in Zanzibar was conducted using a mixed-methods approach including observations, document review, and structured interviews with health facility in-charges and District Health Management Team members. Results The readiness of the Zanzibar healthcare system for timely detection, management, and control of dengue and other mosquito-borne viral disease outbreaks was critically low. The majority of health facilities and districts lacked the necessary requirements including standard guidelines, trained staff, real-time data capture, analysis and reporting systems, as well as laboratory diagnostic capacity. In addition, health education programmes for creating public awareness and Aedes mosquito surveillance and control activities were non-existent. Conclusions The Zanzibar healthcare system has limited readiness for management, and control of mosquito-borne viral diseases. In light of impending epidemics, the critical shortage of skilled human resource, lack of guidelines, lack of effective disease and vector surveillance and control measures as well as lack of laboratory capacity at all levels of health facilities require urgent attention across the Zanzibar archipelago.
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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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Ibrahim LM, Okudo I, Stephen M, Ogundiran O, Pantuvo JS, Oyaole DR, Tegegne SG, Khalid A, Ilori E, Ojo O, Ihekweazu C, Baraka F, Mulombo WK, Lasuba CLP, Nsubuga P, Alemu W. Electronic reporting of integrated disease surveillance and response: lessons learned from northeast, Nigeria, 2019. BMC Public Health 2021; 21:916. [PMID: 33985451 PMCID: PMC8117577 DOI: 10.1186/s12889-021-10957-9] [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: 07/21/2020] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electronic reporting of integrated disease surveillance and response (eIDSR) was implemented in Adamawa and Yobe states, Northeastern Nigeria, as an innovative strategy to improve disease reporting. Its objectives were to improve the timeliness and completeness of IDSR reporting by health facilities, prompt identification of public health events, timely information sharing, and public health action. We evaluated the project to determine whether it met its set objectives. METHOD We conducted a cross-sectional study to assess and document the lessons learned from the project. We reviewed the performance of the local government areas (LGAs) on timeliness and completeness of reporting, rumors identification, and reporting on the eIDSR and the traditional paper-based system using a checklist. Respondents were interviewed online on the relevance, efficiency, sustainability, project progress and effectiveness, the effectiveness of management, and potential impact and scalability of the strategy using structured questionnaires. Data were cleaned, analyzed, and presented as proportions using an MS Excel spreadsheet. Responses were also presented as direct quotes. RESULTS The number of health facilities reporting IDSR increased from 103 to 228 (117%) before and after implementation of the eIDSR respectively. The timeliness of reporting was 43% in the LGA compared to 73% in health facilities implementing eIDSR. The completeness of IDSR reports in the last 6 months before the evaluation was ≥85%. Of the 201 rumors identified and verified, 161 (80%) were from the eIDSR pilot sites. The majority of the stakeholders interviewed believed that eIDSR met its predetermined objectives for public health surveillance. The benefits of eIDSR included timely reporting and response to alerts and disease outbreaks, improved timeliness, and completeness of reporting, and supportive supervision to the operational levels. The strategy helped stakeholders to appreciate their roles in public health surveillance. CONCLUSION The eIDSR has increased the number of health facilities reporting IDSR, enabled early identification, reporting, and verification of alerts, improved timeliness and completeness of reports, and supportive supervision of staff at the operational levels. It was well accepted by the stakeholder as a system that made reporting easy with the potential to improve the public health surveillance system in Nigeria.
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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
| | | | | | - Jerry Shitta Pantuvo
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | | | - Sisay Gashu Tegegne
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Abdelrahim Khalid
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
| | - Elsie Ilori
- Nigerian Center for Disease Control, Jabi, Abuja, Nigeria
| | - Olubunmi Ojo
- Nigerian Center for Disease Control, Jabi, Abuja, Nigeria
| | | | - Fiona Baraka
- World Health Organization, Rivers House, #83 Ralph Shodeinde Street, Abuja, Nigeria
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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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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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21
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Ng'etich AKS, Voyi K, Mutero CM. Evaluation of health surveillance system attributes: the case of neglected tropical diseases in Kenya. BMC Public Health 2021; 21:396. [PMID: 33622289 PMCID: PMC7903773 DOI: 10.1186/s12889-021-10443-2] [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: 09/10/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Control of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers’ perceptions in relation to PC-NTDs endemic in Kenya. Methods A cross-sectional health facility survey was used to purposively sample respondents involved in disease surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions on surveillance system attributes on a five-point likert scale. Frequency distributions for each point in the likert scale were analysed to determine health workers’ overall perceptions. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson’s chi-square and Fisher’s exact tests examined associations between categorical variables. Thematic analysis was performed for questionnaire open-ended responses. Results Most (88%) respondents worked in public health facilities with 71% stationed in second-tier facilities. Regarding PC-NTDs, respondents perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality data (25%). Facility locality, facility type, respondents’ education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p = 0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p < 0.001) and completeness (p < 0.001) thresholds compared to lower-level facilities. Conclusion Health personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system considering PC-NTDs. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers’ perceptions and improve surveillance system overall performance with regard to PC-NTDs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10443-2.
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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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Bwire G, Orach CG, Aceng FL, Arianitwe SE, Matseketse D, Tumusherure E, Makumbi I, Muruta A, Merrill RD, Debes A, Ali M, Sack DA. Refugee Settlements and Cholera Risks in Uganda, 2016-2019. Am J Trop Med Hyg 2021; 104:1225-1231. [PMID: 33556038 PMCID: PMC8045616 DOI: 10.4269/ajtmh.20-0741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/28/2020] [Indexed: 11/07/2022] Open
Abstract
During 2016 to 2019, cholera outbreaks were reported commonly to the Ministry of Health from refugee settlements. To further understand the risks cholera posed to refugees, a review of surveillance data on cholera in Uganda for the period 2016-2019 was carried out. During this 4-year period, there were seven such outbreaks with 1,495 cases and 30 deaths in five refugee settlements and one refugee reception center. Most deaths occurred early in the outbreak, often in the settlements or before arrival at a treatment center rather than after arrival at a treatment center. During the different years, these outbreaks occurred during different times of the year but simultaneously in settlements that were geographically separated and affected all ages and genders. Some outbreaks spread to the local populations within Uganda. Cholera control prevention measures are currently being implemented; however, additional measures are needed to reduce the risk of cholera among refugees including oral cholera vaccination and a water, sanitation and hygiene package during the refugee registration process. A standardized protocol is needed to quickly conduct case-control studies to generate information to guide future cholera outbreak prevention in refugees and the host population.
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Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | - Freda Loy Aceng
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | | | - Edson Tumusherure
- Department of Health, Isingiro District Local Government, Isingiro, Uganda
| | - Issa Makumbi
- Emergency Operational Centre, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | - Rebecca D. Merrill
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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23
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Nsubuga P, Masiira B, Kihembo C, Byakika-Tusiime J, Ryan C, Nanyunja M, Kamadjeu R, Talisuna A. Evaluation of the Ebola Virus Disease (EVD) preparedness and readiness program in Uganda: 2018 to 2019. Pan Afr Med J 2021; 38:130. [PMID: 33912300 PMCID: PMC8051212 DOI: 10.11604/pamj.2021.38.130.27391] [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: 12/11/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction the Democratic Republic of Congo (DRC) declared its 10thoutbreak of Ebola virus disease (EVD) in 42 years on August 1st 2018. The rapid rise and spread of the EVD outbreak threatened health security in neighboring countries and global health security. The United Nations developed an EVD preparedness and readiness (EVD-PR) plan to assist the nine neighboring countries to advance their critical preparedness measures. In Uganda, EVD-PR was implemented between 2018 and 2019. The World Health Organization commissioned an independent evaluation to assess the impact of the investment in EVD-PR in Uganda. Objectives: i) to document the program achievements; ii) to determine if the capacities developed represented good value for the funds and resources invested; iii) to assess if more cost-effective or sustainable alternative approaches were available; iv) to explore if the investments were aligned with country public health priorities; and v) to document the factors that contributed to the program success or failure. Methods during the EVD preparedness phase, Uganda's government conducted a risk assessment and divided the districts into three categories, based on the potential risk of EVD. Category I included districts that shared a border with the DRC provinces where EVD was ongoing or any other district with a direct transport route to the DRC. Category II were districts that shared a border with the DRC but not bordering the DRC provinces affected by the EVD outbreak. Category III was the remaining districts in Uganda. EVD-PR was implemented at the national level and in 22 category I districts. We interviewed key informants involved in program design, planning and implementation or monitoring at the national level and in five purposively selected category I districts. Results Ebola virus disease preparedness and readiness was a success and this was attributed mainly to donor support, the ministry of health's technical capacity, good coordination, government support and community involvement. The resources invested in EVD-PR represented good value for the funds and the activities were well aligned to the public health priorities for Uganda. Conclusion Ebola virus disease preparedness and readiness program in Uganda developed capacities that played an essential role in preventing cross border spread of EVD from the affected provinces in the DRC and enabled rapid containment of the two importation events. These capacities are now being used to detect and respond to the COVID-19 pandemic.
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Affiliation(s)
- Peter Nsubuga
- Global Public Health Solutions, Atlanta Georgia, United States of America
| | | | | | | | - Caroline Ryan
- World Health Organization, Sub-Regional Office, Nairobi, Kenya
| | - Miriam Nanyunja
- World Health Organization, Sub-Regional Office, Nairobi, Kenya
| | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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24
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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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Ogugua I, Chime O, Obionu I, Ezenwosu I, Ibiok C, Ochie C, Kassy W, Ndu A, Arinze-Onyia S, Agwu-Umahi O, Aguwa E, Okeke A. Assessment of knowledge and practice of disease surveillance and notification among health workers in private hospitals in Enugu State, Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_132_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Sloan ML, Gleason BL, Squire JS, Koroma FF, Sogbeh SA, Park MJ. Cost Analysis of Health Facility Electronic Integrated Disease Surveillance and Response in One District in Sierra Leone. Health Secur 2020; 18:S64-S71. [PMID: 32004122 DOI: 10.1089/hs.2019.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Global health security depends on effective surveillance systems to prevent, detect, and respond to disease threats. Real-time surveillance initiatives aim to develop electronic systems to improve reporting and analysis of disease data. Sierra Leone, with the support of Global Health Security Agenda partners, developed an electronic Integrated Disease Surveillance and Response (eIDSR) system capable of mobile reporting from health facilities. We estimated the economic costs associated with rollout of health facility eIDSR in the Western Area Rural district in Sierra Leone and projected annual direct operational costs. Cost scenarios with increased transport costs, decreased use of partner personnel, and altered cellular data costs were modeled. Cost data associated with activities were retrospectively collected and were assessed across rollout phases. Costs were organized into cost categories: personnel, office operating, transport, and capital. We estimated costs by category and phase and calculated per health facility and per capita costs. The total economic cost to roll out eIDSR to the Western Area Rural district over the 14-week period was US$64,342, a per health facility cost of $1,021. Equipment for eIDSR was the primary cost driver (45.5%), followed by personnel (35.2%). Direct rollout costs were $38,059, or 59.2% of total economic costs. The projected annual direct operational costs were $14,091, or $224 per health facility. Although eIDSR equipment costs are a large portion of total costs, annual direct operational costs are projected to be minimal once the system is implemented. Our findings can be used to make decisions about establishing and maintaining electronic, real-time surveillance in Sierra Leone and other low-resource settings.
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Affiliation(s)
- Michelle L Sloan
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Brigette L Gleason
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - James S Squire
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Fanny F Koroma
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Solomon Aiah Sogbeh
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
| | - Michael J Park
- Michelle L. Sloan, MA, and Michael J. Park, PhD, are Health Scientists, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Brigette L. Gleason, MD, is Surveillance and Program Lead, and Fanny F. Koroma, MSc, is a Public Health Surveillance Specialist; both at the CDC Sierra Leone Country Office, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Freetown, Sierra Leone. James S. Squire, MIPH, is Program Manager, and Solomon Aiah Sogbeh is Senior Public Health Superintendent; both at the National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone. The views expressed are the authors' own and do not necessarily represent the views of the Ministry of Health and Sanitation or the US Centers for Disease Control and Prevention
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Kapesa A, Basinda N, Nyanza EC, Monge J, Ngallaba SE, Mwanga JR, Kweka EJ. Malaria Morbidities Following Universal Coverage Campaign for Long-Lasting Insecticidal Nets: A Case Study in Ukerewe District, Northwestern Tanzania. Res Rep Trop Med 2020; 11:53-60. [PMID: 32801989 PMCID: PMC7406376 DOI: 10.2147/rrtm.s248834] [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: 02/08/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Surveillance of the clinical morbidity of malaria remains key for disease monitoring for subsequent development of appropriate interventions. This case study presents the current status of malaria morbidities following a second round of mass distribution of long-lasting insecticidal nets (LLINs) on Ukerewe Island, northwestern Tanzania. Methods A retrospective review of health-facility registers to determine causes of inpatient morbidities for every admitted child aged <5 years was conducted to ascertain the contribution of malaria before and after distribution of LLINs. This review was conducted from August 2016 to July 2018 in three selected health facilities. To determine the trend of malaria admissions in the selected facilities, additional retrospective collection of all malaria and other causes of admission was conducted for both <5- and >5-year-old patients from July 2014 to June 2018. For comparison purposes, monthly admissions of malaria and other causes from all health facilities in the district were also collected. Moreover, an LLIN-coverage study was conducted among randomly selected households (n=684). Results Between August 2016 and July 2018, malaria was the leading cause of inpatient morbidity, accounting for 44.1% and 20.3% among patients <5 and >5 years old, respectively. Between October 2017 and January 2018, the mean number of admissions of patients aged <5 years increased 2.7-fold at one health center and 1.02-fold for all admissions in the district. Additionally, approximately half the households in the study area had poor of LLIN coverage 1 year after mass distribution. Conclusion This trend analysis of inpatient morbidities among children aged <5 years revealed an upsurge in malaria admissions in some health facilities in the district, despite LLIN intervention. This suggests the occurrence of an unnoticed outbreak of malaria admissions in all health facilities.
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Affiliation(s)
- Anthony Kapesa
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Namanya Basinda
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elias C Nyanza
- Department of Environmental and Occupational Health and GIS, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joshua Monge
- Department of Health, Ukerewe District Council, Mwanza, Tanzania
| | - Sospatro E Ngallaba
- Department of Epidemiology, Biostatisticsand Behavioural Sciences, School of Public Health, Catholic University of Health Sciences and Allied Sciences, Mwanza, Tanzania
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatisticsand Behavioural Sciences, School of Public Health, Catholic University of Health Sciences and Allied Sciences, Mwanza, Tanzania
| | - Eliningaya J Kweka
- Department of Parasitology and Medical Entomology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Division of Livestock and Human Disease Vector Control, Tropical Pesticides Research Institute, Arusha, Tanzania
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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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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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Omondi AJ, Ochieng OG, Eliud K, Yoos A, Kavilo MR. Assessment of Integrated Disease Surveillance Data Uptake in Community Health Systems within Nairobi County, Kenya. East Afr Health Res J 2020; 4:194-199. [PMID: 34308238 PMCID: PMC8279160 DOI: 10.24248/eahrj.v4i2.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Kenya has since independence struggled to restructure its health system to provide services to its entire population especially in outbreak responses. The last decade has seen the country witness disease outbreaks across the country i.e. Rift Valley fever in June 2018, and Chikungunya and Dengue fever in Mombasa in February 2018. This exposed the country's lack of preparedness in handling outbreaks at grass root level. Outbreak incidences tend to prevail at community level before a public health action is established, with the situation becoming dire in the lower tier health facilities. Objective The purpose of the study was to assess the uptake of Integrated Disease Surveillance Response (IDSR) health data and utilisation at community level health systems in the six sub counties within Nairobi County of Kenya. Methodology The study used cross-sectional descriptive research design on a target population of 1840 community health workers. The study used Yamane formula to calculate the sample size of 371 respondents, selected using stratified sampling and simple random sampling methods. The logistic regression model was used to assess the benefits of Integrated Data Surveillance and Response data in health facilities across Nairobi County. Data was collected using questionnaires, analysis done using Statistical Packages for Social Sciences, and findings presented in form of tables and bar graphs. Results The study had 315 questionnaires were duly filled and returned, representing 85% response rate. The findings showed that 268(85%) Healthcare Workers lacked training on using disease surveillance data; 236(75%) cited lack of tools for disease surveillance in facilities, while 173(55%)cited lack of timely IDSR data as hindrance to IDSR data uptake. The regression findings showed that training of healthcare workers on IDSR, installation of disease surveillance system tools, and timely collection and dissemination of surveillance data increases the likelihood of IDSR data uptake in community health facilities. Conclusion The study concluded that IDSR system tools should be installed in community health facilities across the six sub counties in Nairobi County. Training should be emphasised to ensure all health care workers have the required skills to use the IDSR data. There is need to ensure IDSR data is collected and disseminated on time to make it available for interpretation and use by health care workers in their respective facilities.
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Affiliation(s)
- Athanasio Japheth Omondi
- Department of Health Management and Informatics, School of Public Health, Kenyatta University.,Improving Public Health Management for Action (IMPACT).,Ministry of Health Kenya.,Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) (Consultant)
| | - Otieno George Ochieng
- Department of Health Management and Informatics, School of Public Health, Kenyatta University
| | | | - Alison Yoos
- Improving Public Health Management for Action (IMPACT).,Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) (Consultant)
| | - Muli Rafael Kavilo
- Nairobi City County, Department of Integrated Disease Surveillance Nairobi City
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