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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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Flodgren GM, Bezuidenhoudt JE, Alkanhal N, Brinkwirth S, Lee ACK. Conceptualisation and implementation of integrated disease surveillance globally: a scoping review. Public Health 2024; 230:105-112. [PMID: 38522247 DOI: 10.1016/j.puhe.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The objective of this study was to examine the conceptualisation and operationalisation of Integrated Disease Surveillance (IDS) systems globally and the evidence for their effectiveness. Furthermore, to determine whether the recommendations made by Morgan et al. are supported by the evidence and what the evidence is to inform country development of IDS. STUDY DESIGN The study incorporated a scoping review. METHODS This review summarised evidence meeting the following inclusion criteria: Participants: any health sector; Concept: IDS; and Context: global. We searched Medline, Embase, and Epistemonikos for English publications between 1998 and 2022. Standard review methods were applied. A bespoke conceptual framework guided the narrative analysis. This scoping review is part of a research programme with three key elements, with the other studies being a survey of the International Association of National Public Health Institutes members on the current status of their disease surveillance systems and a deeper analysis and case studies of the surveillance systems in seven countries, to highlight the opportunities and challenges of integration. RESULTS Eight reviews and five primary studies, which were assessed as being of low quality, were included, mostly examining IDS in Africa, the human sector, and communicable diseases. None reported on the effects on disease control or on the evolution of IDS during the COVID-19 pandemic. Descriptions of IDS and of integration varied. Prerequisites of effective IDS systems mostly related to the adequacy of core functions and resourcing requirements. Laws or regulations supporting system integration and data sharing were not addressed. The provision of core functions and resourcing requirements were described as inadequate, financing as non-sustainable, and governance as poor. Enablers included active data sharing, close cooperation between agencies, clear reporting channels, integration of vertical programs, increased staff training, and adopting mobile reporting. Whilst the conceptual framework for IDS and Morgan et al.'s proposed principles were to some extent reflected in the highlighted priorities for IDS in the literature, the evidence base remains weak. CONCLUSIONS Available evidence is fragmented, incomplete, and of poor quality. The review found a lack of robust evaluation studies on the impact of IDS on disease control. Whilst a lack of evidence does not imply a lack of benefit or effect, it should signal the need to evaluate the process and impact of integration in the future development of surveillance systems. A common IDS definition and articulation of the parts that constitute an IDS system are needed. Further robust impact evaluations, as well as country reviews and evaluations of their IDS systems, are required to improve the evidence base.
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Affiliation(s)
| | | | - N Alkanhal
- Public Health Authority of Saudi Arabia, Kingdom of Saudi Arabia
| | | | - A C K Lee
- The University of Sheffield and UK Health Security Agency, UK
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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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Lee ACK, Iversen BG, Lynes S, Desenclos JC, Bezuidenhoudt JE, Flodgren GM, Pyone T. The state of integrated disease surveillance globally: synthesis report of a mixed methods study. Public Health 2024; 228:85-91. [PMID: 38340506 DOI: 10.1016/j.puhe.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Disease surveillance is an essential public health function needed to prevent, detect, monitor and respond to health threats. Integrated disease surveillance (IDS) enhances its utility and has been advocated for decades by the World Health Organization. This study sought to examine the state of IDS implementation worldwide. STUDY DESIGN The study used a concurrent mixed methods approach consisting of a systematic scoping review of the literature on IDS, a survey of International Association of National Public Health Institutes (IANPHI) members and qualitative deep dive case studies in seven countries. METHODS This report collates, analyses and synthesises the findings from the three components. The scoping review consisted of a review of summarised evidence on IDS. Eight reviews and five primary studies were included. The cross-sectional survey was conducted of 110 IANPHI members representing ninety-five countries. Qualitative case studies were conducted in Malawi, Mozambique, Uganda, Pakistan, Canada, Sweden, and England, which involved thirty-four focus group discussions and forty-eight key informant interviews. RESULTS In the different countries, IDS is conceptualised differently and there are differing levels of maturity of IDS functions. Although the role of National Public Health Institutes has not been well defined in the IDS, they play a significant role in IDS in many countries. Fragmentation between sectors and resourcing (human and financial) issues were common. Good governance measures such as appropriate legislative and regulatory frameworks and roles and responsibilities for IDS were often unclear. The COVID-19 pandemic has strengthened some surveillance systems, often through leveraging existing respiratory surveillance systems. In some instances, improvements were seen only for COVID-19 related data but these changes were not sustained. Evaluation of IDS was also reported to be weak. CONCLUSIONS Integration should be driven by a clear purpose and contextualised. Political commitment, clear governance, and resourcing are needed. Technology and the establishment of technical communities of practice may help. However, the complexity and cost of integration should not be under-estimated, and further economic and impact evaluations of IDS are needed.
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Affiliation(s)
- Andrew C K Lee
- The UK Health Security Agency, UK; The University of Sheffield, Sheffield, UK.
| | | | - Sadaf Lynes
- International Association of National Public Health Institutes, Belgium
| | - Jean-Claude Desenclos
- the University of Sheffield, Sheffield, UK; The University of Sheffield, Sheffield, UK
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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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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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Rumunu J, Wamala JF, Sakaya R, Konga SB, Igale AL, Adut AA, Lonyik SK, Lasu RM, Kaya RD, Guracha G, Nsubuga P, Ndenzako F, Talisuna AO. Evaluation of integrated disease surveillance and response (IDSR) and early warning and response network (EWARN) in South Sudan 2021. Pan Afr Med J 2022; 42:6. [PMID: 36158929 PMCID: PMC9474832 DOI: 10.11604/pamj.supp.2022.42.1.33780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/05/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction South Sudan has been implementing the Integrated Disease Surveillance and Response (IDSR) strategy since 2006, along with Early Warning and Alert Response and Network (EWARN). The IDSR/EWARN stakeholders commissioned an independent evaluation to establish performance at national, state, county, health facility, and community levels in the first half of 2021. Methods the evaluation was conducted between June and September 2021 (during the COVID-19 pandemic) and was based on the World Health Organization (WHO) protocols for monitoring and evaluating communicable disease surveillance and response systems and the guidelines for evaluating EWARN. Results integrated disease surveillance and response/early warning and alert response and network indicator data showed improving timeliness and completeness from the beginning of 2021 to week 16 and then a slight depression of timeliness by week 32, while completeness remained high. Event-based surveillance was active at the beginning of 2021 and in week 32. However, there was inadequate sample collection to investigate acute watery diarrhea, bloody diarrhea, and acute jaundice syndrome alerts. Respondents in all cadres had substantial experience working in IDSR/EWARN. All respondents performed the various IDSR/EWARN tasks and duties as expected, but needed more resources and training. Conclusion while IDSR/EWARN is performing relatively well, confirmation of priority diseases by the laboratories needs to be strengthened. Health facilities need more regular supervision from the higher levels. Community health workers need more training on IDSR/EWARN. The whole IDSR/EWARN system needs more resources, particularly for communication and transport and to confirm priority diseases. Staff at all levels requested more training in IDSR/EWARN.
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Affiliation(s)
- John Rumunu
- 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, Doctoral Program in Global Health, Humanitarian Aid and Disaster Medicine, Universita Del Pemonte Orientale and Vrije University Brussel, Juba, South Sudan.
| | | | | | - Sheila Baya Konga
- World Health Organization Country Office for South Sudan, Juba, South Sudan
| | - Alice Lado Igale
- World Health Organization Country Office for South Sudan, Juba, South Sudan
| | | | | | - Robert Martin Lasu
- World Health Organization Country Office for South Sudan, Juba, South Sudan
| | - Rose Dagama Kaya
- World Health Organization Country Office for South Sudan, Juba, South Sudan
| | - Guyo Guracha
- World Health Organization Country Office for South Sudan, Juba, South Sudan
| | | | - Fabian Ndenzako
- World Health Organization Country Office for South Sudan, Juba, South Sudan
| | - Ambrose Otau Talisuna
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
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Furtado KM, Kar A. Private Sector Engagement for Infectious Disease Surveillance in Mixed Health Systems: Lessons from a Model Dengue Reporting Network in India. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221091011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disease estimates from surveillance in mixed health systems is affected by lack of data from the private sector. We aimed to characterize private sector engagement and reporting to a disease surveillance network, and determine the implications on dengue case detection. We developed and set up a public–private network (CODREN—Community Disease Detection and Response Network) with recruitment of eligible health resources ( n = 462) in a municipal ward of Pune city, India (population 209,331). Dengue cases reported through CODREN were compared with reports of the local dengue surveillance (LDS) over 1 year. Private clinics constituted the majority of eligible providers (60%, 276). Retention of participants was 81.7% with 13.9% reporting dengue cases. Phone call was the preferred reporting method (85.5%, 564 reports). CODREN captured a higher number of cases than LDS (78.9%, 251 vs 50.6%, 161), increasing case detection by 18% due to increased private reporting points. A twofold lower number of cases was reported by LDS from shared reporting points with CODREN, due to discrepancies in case definitions and diagnostic test preferences among private providers. We conclude that private sector engagement can improve dengue case detection with the selective inclusion of providers, sustained contact, feedback and simple reporting methods. Testing guidelines and case definitions adopted by the LDS need to address heterogeneity of private practice in mixed health systems, in order to improve dengue estimates in India.
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Affiliation(s)
- Kheya Melo Furtado
- Goa Institute of Management, Sanquelim, Goa, India
- School of Health Sciences-Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Anita Kar
- School of Health Sciences-Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
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Tagurum YO, Dogo MJ, Adah GA, Maimagani IC, Sodipo OO, Adeniji T, Daboer JC, Banwat ME, Lar LA, Akosu TJ, Chingle MP. Comparative Assessment of the Implementation of Integrated Disease Surveillance and Response in Public and Private Health Facilities in Jos North Local Government Area of Plateau State, Nigeria. Ann Afr Med 2022; 21:146-152. [PMID: 35848647 PMCID: PMC9383018 DOI: 10.4103/1596-3519.349974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Due to the continuous increase in the spread of epidemic-prone diseases and the associated morbidity and mortality, integrated disease surveillance and response (IDSR) was introduced as the main strategy in resource-poor settings for the detection and notification of these diseases. Integrated disease surveillance is a combination of active and passive systems using a single infrastructure that gathers information about multiple diseases or behaviors of interest. Methods : A comparative cross-sectional study was conducted between March and July 2018 among selected public and private health facilities in Jos North Local Government Area (LGA), Plateau State. Quantitative data were collected with the aid of a semi-structured interviewer-administered questionnaire and facility-based checklist. Data were analyzed using SPSS version 23. Statistical significance level was set at P ≤ 0.05 at a 95% confidence level. Results A. total of 126 health workers were studied. IDSR-trained health personnel was found in 52.7% of the public health facilities compared with only 16.7% of the private health facilities studied (P < 0.001). Awareness of IDSR was higher in the public health facilities than in the private ones (P < 0.001). IDSR implementation was poorer in the private health facilities 40.7% compared with 76.4% in public health facilities (P < 0.001). Evidence of previous disease notification and reporting was seen only in 33.3% and 16.7% of public and private health facilities, respectively (P < 0.001). Conclusion This study revealed that awareness and attitude of health workers in public health facilities in Jos North were higher than that of those in private health facilities and there is the sub-optimal implementation of IDSR among the health workers in Jos North LGA, especially among the private health facilities.
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Affiliation(s)
- Yetunde Olubusayo Tagurum
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - M Joy Dogo
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - G A Adah
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - I C Maimagani
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - O O Sodipo
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - T Adeniji
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - J C Daboer
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - M E Banwat
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - L A Lar
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - T J Akosu
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - M P Chingle
- Department of Community Medicine, College of Health Sciences, University of Jos; Department of Community Medicine, Jos University Teaching Hospital, Jos, Nigeria
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Uzoka FME, Akwaowo C, Nwafor-Okoli C, Ekpin V, Nwokoro C, El Hussein M, Osuji J, Aladi F, Akinnuwesi B, Akpelishi TF. Risk factors for some tropical diseases in an African country. BMC Public Health 2021; 21:2261. [PMID: 34895220 PMCID: PMC8666074 DOI: 10.1186/s12889-021-12286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Often, non-clinical risk factors could affect the predisposition of an individual to diseases. Understanding these factors and their impacts helps in disease prevention and control. This study identified risk factors for malaria, yellow fever, typhoid, chickenpox, measles, hepatitis B, and urinary tract infection in a population in an African country. METHODS Our study was an observational, correlational, and quantitative one that explored relationships among risk variables and disease prevalence - without modifying or controlling the variables. Data for this study was obtained through random sampling of a population of patients and physicians in the eastern/southern, western, and northern parts of Nigeria in 2015-2016. A total of 2199 patient consultation forms were returned by 102 (out of 125) physicians, and considered useful for analysis. Demographic data of patients, physicians, and diagnosis outcomes were analysed descriptively through frequency distributions, aggregate analysis, and graphs. The influence of risk factors on the disease manifestations (diagnosis outcomes) was determined using regression analysis. RESULTS Our results show that living in a tropical climate is by far a major risk factor associated with tropical diseases (malaria: t = 19.9, typhoid: t = - 3.2, chickenpox: t = - 6.5 and typhoid: t = 12.7). The risk for contracting infections is relative to specific diseases; for example, contact with chickenpox infected person poses a high risk of contracting the virus (t = 41.8), while poor personal hygiene predisposes people to high risk of urinary tract infection (t = 23.6). On the other hand, urbanization and homelessness pose very low risks of disposing the individual to the diseases under consideration, while low fluid intake, lack of voiding, and wearing non-cotton underwear predispose individuals to few diseases. CONCLUSION The risk factors identified in our study exert differential and discriminating influences in the causation, predisposition, and transmission of these disease studied. It is recommended that significant effort be devoted by governments in the tropics to the mitigation of these modifiable risk factors. The most important strategy to mitigate the occurrence of these risk factors will be improving the living conditions of people and the provision of social protection measures to reduce the occurrence and burden of these diseases.
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Affiliation(s)
- F-M E Uzoka
- Dept. of Math and Computing, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, AB, T3E 6K6, Canada.
| | - C Akwaowo
- Dept. of Public Health, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - C Nwafor-Okoli
- Canadian Institute for Innovation and Development, Calgary, Canada
| | - V Ekpin
- Morat Medical Centre, Benin City, Nigeria
| | - C Nwokoro
- Dept of Computer Science, University of Uyo, Uyo, Nigeria
| | - M El Hussein
- School of Nursing, Mount Royal University, Calgary, Canada
| | - J Osuji
- School of Nursing, Mount Royal University, Calgary, Canada
| | - F Aladi
- Health Watch Medical Clinic, Calgary, Canada
| | - B Akinnuwesi
- Dept of Computer Science, University of Eswatini, Kwaluseni, Eswatini
| | - T F Akpelishi
- Health Centre, Bells University of Technology, Otta, Nigeria
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12
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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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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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