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Sasie SD, Ayano G, Mamo F, Azage M, Spigt M. Assessing the performance of the integrated disease surveillance and response systems: a systematic review of global evidence. Public Health 2024; 231:71-79. [PMID: 38636279 DOI: 10.1016/j.puhe.2024.03.013] [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: 11/11/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Public health surveillance systems are critical for detecting and responding to health threats. This review aims to analyze international literature on the performance of these systems in terms of core, support, and attributes of surveillance system. STUDY DESIGN Systematic review. METHODS Following the preregistered protocol (PROSPERO: CRD42022366051), a systematic search was conducted on PubMed/MEDLINE, CINHAL, CABI, Web of Science, and Google Scholar for articles evaluating Public Health Surveillance System performance from inception to July 21, 2023. Various study designs were included, and quality assessment was performed. Thematic analysis categorized findings into key surveillance system functions. RESULTS Nine studies from different countries assessed core and supportive functions, as well as surveillance attributes. Performance varied among countries, with some excelling overall and others showing poor performance in specific areas. Many countries' surveillance systems had inadequate performance in key measures in terms of the core and supportive functions, as well as the attributes of the surveillance system. CONCLUSION This review shows significant variations in the performance of public health surveillance systems across countries. Further research is needed to understand underperformance reasons and inform global policymaking for strengthening surveillance systems.
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Affiliation(s)
- S D Sasie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia; Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - G Ayano
- School of Population Health, Curtin University, Australia.
| | - F Mamo
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - M Azage
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - M Spigt
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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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, 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: 0] [Impact Index Per Article: 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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Ngingo BL, Mchome ZS, Bwana VM, Chengula A, Mwanyika G, Mremi I, Sindato C, Mboera LEG. Socioecological systems analysis of potential factors for cholera outbreaks and assessment of health system's readiness to detect and respond in Ilemela and Nkasi districts, Tanzania. BMC Health Serv Res 2023; 23:1261. [PMID: 37968626 PMCID: PMC10652585 DOI: 10.1186/s12913-023-10263-7] [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: 12/05/2022] [Accepted: 11/01/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Cholera outbreaks are a recurrent issue in Tanzania, with Ilemela and Nkasi districts being particulary affected. The objective of this study was to conduct a socio-ecological system (SES) analysis of cholera outbreaks in these districts, identifying potential factors and assessing the preparedness for cholera prevention and control. METHODS A cross-sectional study was carried out in Ilemela and Nkasi districts of Mwanza and Rukwa regions, respectively in Tanzania between September and October 2021. A SES framework analysis was applied to identify potential factors associated with cholera outbreaks and assess the readiness of the districts to cholera prevention and control. RESULTS Ilemela is characterised by urban and peri-urban ecosystems while Nkasi is mainly rural. Cholera was reported to disproportionately affect people living along the shores of Lake Victoria in Ilemela and Lake Tanganyika in Nkasi, particularly fishermen and women involved infish trading. The main potential factors identified for cholera outbreaks included defecation in the shallow ends and along the edges of lakes, open defecation, bathing/swimming in contaminated waters and improper waste disposal. The preparedness of both districts for cholera prevention and response was found to be inadequate due to limited laboratory capacity, insufficient human resources, and budget constraints. CONCLUSION People of Ilemela and Nkasi districts remain at significant risk of recurrent cholera outbreaks and the capacity of the districts to detect the disease is limited. Urgent preventive measures, such as conducting considerable community awareness campaigns on personal hygiene and environmental sanitation are needed to alleviate the disease burden and reduce future cholera outbreaks.
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Affiliation(s)
- Baraka L Ngingo
- Department of Applied Sciences, Mbeya University of Science and Technology, Mbeya, Tanzania.
| | - Zaina S Mchome
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Augustino Chengula
- Department of Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Gaspary Mwanyika
- Department of Applied Sciences, Mbeya University of Science and Technology, Mbeya, Tanzania
| | - Irene Mremi
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Calvin Sindato
- National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
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Kaburi BB, Wyss K, Kenu E, Asiedu-Bekoe F, Hauri AM, Laryea DO, Klett-Tammen CJ, Leone F, Walter C, Krause G. Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews. JMIR Form Res 2023; 7:e45715. [PMID: 37862105 PMCID: PMC10625076 DOI: 10.2196/45715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. OBJECTIVE This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. METHODS Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. RESULTS The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. CONCLUSIONS The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding.
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Affiliation(s)
- Basil Benduri Kaburi
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Braunschweig-Hannover, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana, Accra, Ghana
| | | | - Anja M Hauri
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | | | - Frédéric Leone
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Christin Walter
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Braunschweig-Hannover, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Braunschweig, Germany
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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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Kabantiyok D, Ninyio N, Shittu I, Meseko C, Emeto TI, Adegboye OA. Human Respiratory Infections in Nigeria: Influenza and the Emergence of SARS-CoV-2 Pandemic. Vaccines (Basel) 2022; 10:vaccines10091551. [PMID: 36146628 PMCID: PMC9506385 DOI: 10.3390/vaccines10091551] [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: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
The increasing outbreak of zoonotic diseases presents challenging times for nations and calls for a renewed effort to disrupt the chain of events that precede it. Nigeria's response to the 2006 bird flu provided a platform for outbreak response, yet it was not its first experience with Influenza. This study describes the impact of SARS-CoV-2 on Influenza surveillance and, conversely, while the 1918 Influenza pandemic remains the most devastating (500,000 deaths in 18 million population) in Nigeria, the emergence of SARS CoV-2 presented renewed opportunities for the development of vaccines with novel technology, co-infection studies outcome, and challenges globally. Although the public health Intervention and strategies left some positive outcomes for other viruses, Nigeria and Africa's preparation against the next pandemic may involve prioritizing a combination of technology, socioeconomic growth, and active surveillance in the spirit of One Health.
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Affiliation(s)
- Dennis Kabantiyok
- Laboratory Diagnostic Services Division, National Veterinary Research Institute, PMB 01, Vom 930001, Nigeria
| | - Nathaniel Ninyio
- School of Medical Sciences, Örebro University, 70182 Örebro, Sweden
| | - Ismaila Shittu
- Department of Avian Influenza and Transboundary Animal Diseases, National Veterinary Research Institute, PMB 01, Vom 930010, Nigeria
| | - Clement Meseko
- Department of Avian Influenza and Transboundary Animal Diseases, National Veterinary Research Institute, PMB 01, Vom 930010, Nigeria
| | - Theophilus I. Emeto
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, Department, James Cook University, Townsville, QLD 4811, Australia
- World Health Organization Collaborating Center for Vector-Borne, Neglected Tropical Diseases Department, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - Oyelola A. Adegboye
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, Department, James Cook University, Townsville, QLD 4811, Australia
- World Health Organization Collaborating Center for Vector-Borne, Neglected Tropical Diseases Department, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
- Correspondence:
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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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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: 15] [Impact Index Per Article: 5.0] [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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Hamalaw SA, Bayati AH, Babakir-Mina M, Benvenuto D, Fabris S, Guarino M, Giovanetti M, Ciccozzi M. Assessment of core and support functions of the communicable disease surveillance system in the Kurdistan Region of Iraq. J Med Virol 2021; 94:469-479. [PMID: 34427927 PMCID: PMC9290747 DOI: 10.1002/jmv.27288] [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: 06/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022]
Abstract
Early detection and prompt response are crucial measures to prevent and control outbreaks. Public health agencies, therefore, designed the Communicable Disease Surveillance System (CDSS) to obtain essential data instantaneously to be used for appropriate action. However, a periodic evaluation of CDSS is indispensable to ensure the functionality of the system. For this reason, this study aims to assess the performance of the core and support functions of the CDSS in the Kurdistan Region of Iraq. A descriptive cross‐sectional study was used. From a total of 291 health facilities HFs (Primary health care centers and Hospitals) in the Kurdistan region of Iraq that have surveillance activities, 74 HFs were selected using a random stratified sampling approach. The World Health Organization (WHO) generic questionnaire has been used to interview the surveillance staff, together with direct collection of the data. Our analysis shows a lack of surveillance guiding manual in the HFs. Even at the district level, where a surveillance manual existed, case definitions, thresholds, and control measures were still missing. To note, more than 93% of HFs had organized and comprehensive patients registers for the collection of their clinical and secondary data. Also, all HFs had functioning laboratories. The majority of them (almost 93%) were equipped to collect, process, and store blood, stool, and urine specimens. About 72% of these laboratories were also able to transport timely the specimens to more specialized laboratories. At all levels, data reporting to the higher level exceeded the recommended minimum rate of 80%. The reporting system at the district level was based on emails, while in the periphery on hand‐delivered in paper‐based formats (50%), telephone (22%), and social media (22%). Furthermore, our analysis highlights the lack of data analysis: only 3.8% of Primary Health Care Centers conduct simple data analysis regularly, while hospitals do not do any sort of analysis. Also, only a few HFs investigated an outbreak, though using system routine sources to capture these public health events. Our findings show a lack in epidemic preparedness (3%), in feedback (53%), in standard guidelines, training, supervision, and resource allocations in HFs (0%). Taken together, our data show the importance of strengthening the CDSS in the Kurdistan region of Iraq, by reinforcing the surveillance system with continuous feedback, supervision, well‐trained and motivated staff, technical support, and coordination between researchers and physicians.
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Affiliation(s)
- Soran Amin Hamalaw
- Department of Community Health, College of Health and Medical Technology, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Ali Hattem Bayati
- Department Nursing, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Muhammed Babakir-Mina
- Department of Medical Laboratory, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Domenico Benvenuto
- Medical Statistic and Molecular Epidemiology Unit, University of Biomedical Campus, Rome, Italy
| | - Silvia Fabris
- Medical Statistic and Molecular Epidemiology Unit, University of Biomedical Campus, Rome, Italy
| | - Michele Guarino
- Department of Gastrointestinal Diseases, Campus Bio-Medico University, Rome, Italy
| | - Marta Giovanetti
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Massimo Ciccozzi
- Medical Statistic and Molecular Epidemiology Unit, University of Biomedical Campus, Rome, Italy
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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: 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: 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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12
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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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13
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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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14
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Varma J, Maeda J, Magafu MGMD, Onyebujoh PC. Africa Centres for Disease Control and Prevention Is Closing Gaps in Disease Detection. Health Secur 2020; 18:483-488. [PMID: 33085528 DOI: 10.1089/hs.2019.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2017, the African Union established a new continent-wide public health agency, the Africa Centres for Disease Control and Prevention (Africa CDC). Many outbreaks are never detected in Africa, and among outbreaks that are detected, countries often respond slowly and ineffectively. To address these problems, Africa CDC is working to increase early detection and reporting, improve access to diagnostic tests, promote novel laboratory approaches, help establish national public health institutes, improve information exchange between health agencies, and enhance recording and reporting of acute public health events and vital statistics. The health security of Africa will be strengthened by this new public health agency's ability to build comprehensive, timely disease surveillance that rapidly detects and contains health threats.
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Affiliation(s)
- Jay Varma
- Jay Varma, MD, is a Senior Advisor and Philip C. Onyebujoh, MD, PhD, was a Senior Advisor (now an Independent Consultant), Office of the Director; Justin Maeda, MD, MSc, is Principal Medical Epidemiologist and Mgaywa G. M. D. Magafu, MD, MPHM, MPH, MSc, PhD, is Head, Division of Surveillance and Disease Intelligence; all at the Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia. Jay Varma is also a Senior Advisor, US Centers for Disease Control and Prevention, Atlanta, GA. 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. Use of trade names and commercial sources is for identification only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the US Department of Health and Human Services
| | - Justin Maeda
- Jay Varma, MD, is a Senior Advisor and Philip C. Onyebujoh, MD, PhD, was a Senior Advisor (now an Independent Consultant), Office of the Director; Justin Maeda, MD, MSc, is Principal Medical Epidemiologist and Mgaywa G. M. D. Magafu, MD, MPHM, MPH, MSc, PhD, is Head, Division of Surveillance and Disease Intelligence; all at the Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia. Jay Varma is also a Senior Advisor, US Centers for Disease Control and Prevention, Atlanta, GA. 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. Use of trade names and commercial sources is for identification only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the US Department of Health and Human Services
| | - Mgaywa G M D Magafu
- Jay Varma, MD, is a Senior Advisor and Philip C. Onyebujoh, MD, PhD, was a Senior Advisor (now an Independent Consultant), Office of the Director; Justin Maeda, MD, MSc, is Principal Medical Epidemiologist and Mgaywa G. M. D. Magafu, MD, MPHM, MPH, MSc, PhD, is Head, Division of Surveillance and Disease Intelligence; all at the Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia. Jay Varma is also a Senior Advisor, US Centers for Disease Control and Prevention, Atlanta, GA. 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. Use of trade names and commercial sources is for identification only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the US Department of Health and Human Services
| | - Philip C Onyebujoh
- Jay Varma, MD, is a Senior Advisor and Philip C. Onyebujoh, MD, PhD, was a Senior Advisor (now an Independent Consultant), Office of the Director; Justin Maeda, MD, MSc, is Principal Medical Epidemiologist and Mgaywa G. M. D. Magafu, MD, MPHM, MPH, MSc, PhD, is Head, Division of Surveillance and Disease Intelligence; all at the Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia. Jay Varma is also a Senior Advisor, US Centers for Disease Control and Prevention, Atlanta, GA. 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. Use of trade names and commercial sources is for identification only and does not constitute endorsement by the US Centers for Disease Control and Prevention or the US Department of Health and Human Services
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15
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George J, Häsler B, Mremi I, Sindato C, Mboera L, Rweyemamu M, Mlangwa J. A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats. ONE HEALTH OUTLOOK 2020; 2:11. [PMID: 33829132 PMCID: PMC7993536 DOI: 10.1186/s42522-020-00017-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 05/05/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Health surveillance is an important element of disease prevention, control, and management. During the past two decades, there have been several initiatives to integrate health surveillance systems using various mechanisms ranging from the integration of data sources to changing organizational structures and responses. The need for integration is caused by an increasing demand for joint data collection, use and preparedness for emerging infectious diseases. OBJECTIVE To review the integration mechanisms in human and animal health surveillance systems and identify their contributions in strengthening surveillance systems attributes. METHOD The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Peer-reviewed articles were searched from PubMed, HINARI, Web of Science, Science Direct and advanced Google search engines. The review included articles published in English from 1900 to 2018. The study selection considered all articles that used quantitative, qualitative or mixed research methods. Eligible articles were assessed independently for quality by two authors using the QualSyst Tool and relevant information including year of publication, field, continent, addressed attributes and integration mechanism were extracted. RESULTS A total of 102 publications were identified and categorized into four pre-set integration mechanisms: interoperability (35), convergent integration (27), semantic consistency (21) and interconnectivity (19). Most integration mechanisms focused on sensitivity (44.1%), timeliness (41.2%), data quality (23.5%) and acceptability (17.6%) of the surveillance systems. Generally, the majority of the surveillance system integrations were centered on addressing infectious diseases and all hazards. The sensitivity of the integrated systems reported in these studies ranged from 63.9 to 100% (median = 79.6%, n = 16) and the rate of data quality improvement ranged from 73 to 95.4% (median = 87%, n = 4). The integrated systems were also shown improve timeliness where the recorded changes were reported to be ranging from 10 to 91% (median = 67.3%, n = 8). CONCLUSION Interoperability and semantic consistency are the common integration mechanisms in human and animal health surveillance systems. Surveillance system integration is a relatively new concept but has already been shown to enhance surveillance performance. More studies are needed to gain information on further surveillance attributes.
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Affiliation(s)
- Janeth George
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, Tanzania
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
| | - Barbara Häsler
- Department of Pathobiology and Population Sciences, Veterinary Epidemiology, Economics, and Public Health Group, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL97TA UK
| | - Irene Mremi
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, Tanzania
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
- National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania
| | - Leonard Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
| | - Mark Rweyemamu
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Morogoro, Tanzania
| | - James Mlangwa
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, Tanzania
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16
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Talisuna A, Yahaya AA, Rajatonirina SC, Stephen M, Oke A, Mpairwe A, Diallo AB, Musa EO, Yota D, Banza FM, Wango RK, Roberts NA, Sreedharan R, Kandel N, Rashford AM, Boulanger LL, Huda Q, Chungong S, Yoti Z, Fall IS. Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region. BMJ Glob Health 2019; 4:e001312. [PMID: 31798983 PMCID: PMC6861072 DOI: 10.1136/bmjgh-2018-001312] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/24/2022] Open
Abstract
The International Health Regulations (IHR, 2005) are an essential vehicle for addressing global health security. Here, we report the IHR capacities in the WHO African from independent joint external evaluation (JEE). The JEE is a voluntary component of the IHR monitoring and evaluation framework. It evaluates IHR capacities in 19 technical areas in four broad themes: ‘Prevent’ (7 technical areas, 15 indicators); ‘Detect’ (4 technical areas, 13 indicators); ‘Respond’ (5 technical areas, 14 indicators), points of entry (PoE) and other IHR hazards (chemical and radiation) (3 technical areas, 6 indicators). The IHR capacity scores are graded from level 1 (no capacity) to level 5 (sustainable capacity). From February 2016 to March 2019, 40 of 47 WHO African region countries (81% coverage) evaluated their IHR capacities using the JEE tool. No country had the required IHR capacities. Under the theme ‘Prevent’, no country scored level 5 for 12 of 15 indicators. Over 80% of them scored level 1 or 2 for most indicators. For ‘Detect’, none scored level 5 for 12 of 13 indicators. However, many scored level 3 or 4 for several indicators. For ‘Respond’, none scored level 5 for 13 of 14 indicators, and less than 10% had a national multihazard public health emergency preparedness and response plan. For PoE and other IHR hazards, most countries scored level 1 or 2 and none scored level 5. Countries in the WHO African region are commended for embracing the JEE to assess their IHR capacities. However, major gaps have been identified. Urgent collective action is needed now to protect the WHO African region from health security threats.
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Affiliation(s)
- Ambrose Talisuna
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Ali Ahmed Yahaya
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Mary Stephen
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Antonio Oke
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Allan Mpairwe
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Amadou Bailo Diallo
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Emmanuel Onuche Musa
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Daniel Yota
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Freddy Mutoka Banza
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Roland Kimbi Wango
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Rajesh Sreedharan
- WHO Health Emergency Programme, World Health Organisation, Geneva, Switzerland
| | - Nirmal Kandel
- WHO Health Emergency Programme, World Health Organisation, Geneva, Switzerland
| | | | | | - Qudsia Huda
- WHO Health Emergency Programme, World Health Organisation, Geneva, Switzerland
| | - Stella Chungong
- WHO Health Emergency Programme, World Health Organisation, Geneva, Switzerland
| | - Zabulon Yoti
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Ibrahima Soce Fall
- WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
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17
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Fall IS, Rajatonirina S, Yahaya AA, Zabulon Y, Nsubuga P, Nanyunja M, Wamala J, Njuguna C, Lukoya CO, Alemu W, Kasolo FC, Talisuna AO. Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa. BMJ Glob Health 2019; 4:e001427. [PMID: 31354972 PMCID: PMC6615866 DOI: 10.1136/bmjgh-2019-001427] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 11/04/2022] Open
Abstract
In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.
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Affiliation(s)
- Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Soatiana Rajatonirina
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Yoti Zabulon
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, USA
| | | | - Joseph Wamala
- World Health Organization, Country Office, Juba, South Sudan
| | - Charles Njuguna
- World Health Organization, Country Office, Free Town, Sierra Leone
| | - Charles Okot Lukoya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | | | - Francis Chisaka Kasolo
- World Health Organization, Regional Office for Africa, Country Support, Brazzaville, Congo
| | - Ambrose Otau Talisuna
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
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Nakiire L, Masiira B, Kihembo C, Katushabe E, Natseri N, Nabukenya I, Komakech I, Makumbi I, Charles O, Adatu F, Nanyunja M, Nsubuga P, Woldetsadik SF, Tusiime P, Yahaya AA, Fall IS, Wondimagegnehu A. Healthcare workers' experiences regarding scaling up of training on integrated disease surveillance and response (IDSR) in Uganda, 2016: cross sectional qualitative study. BMC Health Serv Res 2019; 19:117. [PMID: 30760259 PMCID: PMC6374884 DOI: 10.1186/s12913-019-3923-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Integrated Disease Surveillance and Response (IDSR) strategy was adopted as the framework for implementation of International Health Regulation (2005) in the African region of World Health Organisation (WHO AFRO). While earlier studies documented gains in performance of core IDSR functions, Uganda still faces challenges due to infectious diseases. IDSR revitalisation programme aimed to improve prevention, early detection, and prompt response to disease outbreaks. However, little is known about health worker’s perception of the revitalised IDSR training. Methods We conducted focus group discussions of health workers who were trained between 2015 and 2016. Discussions on benefits, challenges and possible solutions for improvement of IDSR training were recorded, transcribed, translated and coded using grounded theory. Results In total, 22/26 FGDs were conducted. Participants cited improved completeness and timeliness of reporting, case detection and data analysis and better response to disease outbreaks as key achievements after the training. Programme challenges included an inadequate number of trained staff, funding, irregular supervision, high turnover of trained health workers, and lack of key logistics. Suggestions to improve IDSR included pre-service and community training, mentorship, regular supervision and improving funding at the district level. Conclusion Health workers perceived that scaling up revitalized IDSR training in Uganda improved public health surveillance. However, they acknowledge encountering challenges that hinder their performance after the training. Ministry of Health should have a mentorship plan, integrate IDSR training in pre-service curricula and advocate for funding IDSR activities to address some of the gaps highlighted in this study.
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Affiliation(s)
- Lydia Nakiire
- Public Health Emergency Operation Centre, Ministry of Health, P.O BOX 7072, Kampala, Uganda.
| | - Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health Kampala, Kampala, Uganda
| | - Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health Kampala, Kampala, Uganda
| | | | - Nasan Natseri
- World Health Organization, Country Office, Kampala, Uganda
| | - Immaculate Nabukenya
- Epidemiology and Surveillance Division, Ministry of Health Kampala, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, P.O BOX 7072, Kampala, Uganda
| | - Okot Charles
- World Health Organization, Country Office, Kampala, Uganda
| | | | | | - Peter Nsubuga
- Global Public Health Solutions Inc, Atlanta, Georgia, USA
| | | | - Patrick Tusiime
- National Disease Control, Ministry of Health, Kampala, Uganda
| | - Ali Ahmed Yahaya
- World Health Organization Africa Regional Office, Brazzaville, Congo
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Masiira B, Nakiire L, Kihembo C, Katushabe E, Natseri N, Nabukenya I, Komakech I, Makumbi I, Charles O, Adatu F, Nanyunja M, Woldetsadik SF, Fall IS, Tusiime P, Wondimagegnehu A, Nsubuga P. Evaluation of integrated disease surveillance and response (IDSR) core and support functions after the revitalisation of IDSR in Uganda from 2012 to 2016. BMC Public Health 2019; 19:46. [PMID: 30626358 PMCID: PMC6327465 DOI: 10.1186/s12889-018-6336-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Uganda is a low income country that continues to experience disease outbreaks caused by emerging and re-emerging diseases such as cholera, meningococcal meningitis, typhoid and viral haemorrhagic fevers. The Integrated Disease Surveillance and Response (IDSR) strategy was adopted by WHO-AFRO in 1998 as a comprehensive strategy to improve disease surveillance and response in WHO Member States in Africa and was adopted in Uganda in 2000. To address persistent inconsistencies and inadequacies in the core and support functions of IDSR, Uganda initiated an IDSR revitalisation programme in 2012. The objective of this evaluation was to assess IDSR core and support functions after implementation of the revitalised IDSR programme. METHODS The evaluation was a cross-sectional survey that employed mixed quantitative and qualitative methods. We assessed IDSR performance indicators, knowledge acquisition, knowledge retention and level of confidence in performing IDSR tasks among health workers who underwent IDSR training. Qualitative data was collected to guide the interpretation of quantitative findings and to establish a range of views related to IDSR implementation. RESULTS Between 2012 and 2016, there was an improvement in completeness of monthly reporting (69 to 100%) and weekly reporting (56 to 78%) and an improvement in timeliness of monthly reporting (59 to 93%) and weekly reporting (40 to 68%) at the national level. The annualised non-polio AFP rate increased from 2.8 in 2012 to 3.7 cases per 100,000 population < 15 years in 2016. The case fatality rate for cholera decreased from 3.2% in 2012 to 2.1% in 2016. All districts received IDSR feedback from the national level. Key IDSR programme challenges included inadequate numbers of trained staff, inadequate funding, irregular supervision and high turnover of trained staff. Recommendations to improve IDSR performance included: improving funding, incorporating IDSR training into pre-service curricula for health workers and strengthening support supervision. CONCLUSION The revitalised IDSR programme in Uganda was associated with improvements in performance. However in 2016, the programme still faced significant challenges and some performance indicators were still below the target. It is important that the documented gains are consolidated and challenges are continuously identified and addressed as they emerge.
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Affiliation(s)
- Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | - Lydia Nakiire
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | - Edson Katushabe
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Nasan Natseri
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Immaculate Nabukenya
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Okot Charles
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Francis Adatu
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | - Miriam Nanyunja
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | | | | | - Patrick Tusiime
- National Disease Control, Ministry of Health, Kampala, Uganda
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Odun-Ayo F, Odaibo G, Olaleye D. Influenza virus A (H1 and H3) and B co-circulation among patient presenting with acute respiratory tract infection in Ibadan, Nigeria. Afr Health Sci 2018; 18:1134-1143. [PMID: 30766579 PMCID: PMC6354865 DOI: 10.4314/ahs.v18i4.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Influenza is an acute respiratory disease that continues to cause global epidemics and pandemics in human with significant mortality and morbidity. Objectives This study was designed to identify the circulating influenza virus in Ibadan, Nigeria during the 2006/2007 season. Methods Throat swab samples were collected from patients presenting with acute respiratory tract infection at the Out-Patient Departments of major hospitals in Ibadan over a period of seven months from November 2006 to May 2007. Isolation of influenza virus was performed using Madin-Darby Canine Kidney cell line and 10 days old chicken embryonated egg. Isolates was identified by haemagglutination and haemagglutination-inhibition assays using selected CDC Influenza reference antisera (A, B, subtype H1 and H3). Results Out of 128 patients tested, 21(16.4%) yielded positive for virus isolation. Identification of the isolates showed that 19(14.8%) were positive for influenza virus out of which 11(8.6%) and 8(6.2%) were influenza A and B viruses respectively. Influenza A virus 6(4.7%) were subtype H1; 4(3.1%) were co-subtype H1 and H3; and 1(0.8%) was not inhibited by subtype H1 and H3. Conclusion The circulation of influenza virus A and B in this study is important to contributing knowledge and data to influenza epidemiology and surveillance in Nigeria.
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Joseph Wu TS, Kagoli M, Kaasbøll JJ, Bjune GA. Integrated Disease Surveillance and Response (IDSR) in Malawi: Implementation gaps and challenges for timely alert. PLoS One 2018; 13:e0200858. [PMID: 30496177 PMCID: PMC6264833 DOI: 10.1371/journal.pone.0200858] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Objective The recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon global efforts to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening. Methods This was a mixed-method research study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2) during October 2014 to September 2016. Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and 7 key informants of the IDSR system implementation and administration at district and national levels. Findings The current IDSR system showed relatively good completeness (73.1%) but poor timeliness (40.2%) of total expected monthly reports nationwide and zero weekly reports during the study period. Major implementation gaps were lack of weekly report and trainings. The challenges of IDSR implementation revealed through qualitative data included case identification, compiling reports for timely submission and inadequate resources. Conclusions The differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.
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Affiliation(s)
- Tsung-Shu Joseph Wu
- Department of Informatics, University of Oslo, Oslo City, Norway
- Research Department, Luke International, Mzuzu City, Malawi
- Overseas Mission Department, Pingtung Christian Hospital, Pingtung County, Taiwan
- Department of Public Health, National Taiwan University, Taipei City, Taiwan
- * E-mail: ,
| | - Matthew Kagoli
- Department of Epidemiology, Ministry of Health, Lilongwe City, Malawi
- Public Health Institute of Malawi, Lilongwe, Malawi
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Kihembo C, Masiira B, Nakiire L, Katushabe E, Natseri N, Nabukenya I, Komakech I, Okot CL, Adatu F, Makumbi I, Nanyunja M, Woldetsadik SF, Tusiime P, Nsubuga P, Fall IS, Wondimagegnehu A. The design and implementation of the re-vitalised integrated disease surveillance and response (IDSR) in Uganda, 2013-2016. BMC Public Health 2018; 18:879. [PMID: 30005613 PMCID: PMC6045850 DOI: 10.1186/s12889-018-5755-4] [Citation(s) in RCA: 10] [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: 01/30/2018] [Accepted: 06/26/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Uganda adopted and has been implementing the Integrated Disease Surveillance (IDSR) strategy since 2000. The goal was to build the country's capacity to detect, report promptly, and effectively respond to public health emergencies and priorities. The considerable investment into the program startup realised significant IDSR core performance. However, due to un-sustained funding from the mid-2000s onwards, these achievements were undermined. Following the adoption of the revised World Health Organization guidelines on IDSR, the Uganda Ministry of Health (MoH) in collaboration with key partners decided to revitalise IDSR and operationalise the updated IDSR guidelines in 2012. METHODS Through the review of both published and unpublished national guidelines, reports and other IDSR program records in addition to an interview of key informants, we describe the design and process of IDSR revitalisation in Uganda, 2013-2016. The program aimed to enhance the districts' capacity to promptly detect, assess and effectively respond to public health emergencies. RESULTS Through a cascaded, targeted skill-development training model, 7785 participants were trained in IDSR between 2015 and 2016. Of these, 5489(71%) were facility-based multi-disciplinary health workers, 1107 (14%) comprised the district rapid response teams and 1188 (15%) constituted the district task forces. This training was complemented by other courses for regional teams in addition to the provision of logistics to support IDSR activities. Centrally, IDSR implementation was coordinated and monitored by the MoH's national task force (NTF) on epidemics and emergencies. The NTF and in close collaboration with the WHO Country Office, mobilised resources from various partners and development initiatives. At regional and district levels, the technical and political leadership were mobilised and engaged in monitoring and overseeing program implementation. CONCLUSION The IDSR re-vitalization in Uganda highlights unique features that can be considered by other countries that would wish to strengthen their IDSR programs. Through a coordinated partner response, the program harnessed resources which primarily were not earmarked for IDSR to strengthen the program nation-wide. Engagement of the local district leadership helped promote ownership, foster accountability and sustainability of the program.
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Affiliation(s)
- Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Lydia Nakiire
- Public Health Emergency Operations Centre, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Edson Katushabe
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Nasan Natseri
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Immaculate Nabukenya
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Innocent Komakech
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Charles Lukoya Okot
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Francis Adatu
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Issa Makumbi
- Public Health Emergency Operations Centre, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Miriam Nanyunja
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | | | - Patrick Tusiime
- National Disease Control, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Peter Nsubuga
- Global Public Health Solutions LLC, Atlanta, GA 30326 USA
| | - Ibrahima Soce Fall
- World Health Organization, Africa Regional Office, Brazzaville, Republic of Congo
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Randriamiarana R, Raminosoa G, Vonjitsara N, Randrianasolo R, Rasamoelina H, Razafimandimby H, Rakotonjanabelo AL, Lepec R, Flachet L, Halm A. Evaluation of the reinforced integrated disease surveillance and response strategy using short message service data transmission in two southern regions of Madagascar, 2014-15. BMC Health Serv Res 2018; 18:265. [PMID: 29631631 PMCID: PMC5891931 DOI: 10.1186/s12913-018-3081-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/28/2018] [Indexed: 01/17/2023] Open
Abstract
Background The Integrated Disease Surveillance and Response (IDSR) strategy was introduced in Madagascar in 2007. Information was collected by Healthcare structures (HS) on paper forms and transferred to the central level by post or email. Completeness of data reporting was around 20% in 2009–10. From 2011, in two southern regions data were transmitted through short messages service using one telephone provider. We evaluated the system in 2014–15 to determine its performance before changing or expanding it. Methods We randomly selected 80 HS and interviewed their representatives face-to-face (42) or by telephone (38). We evaluated knowledge of surveillance activities and selected case definitions, number of SMS with erroneous or missing information among the last ten transferred SMS, proportion of weekly reports received in the last 4 weeks and of the last four health alerts notified within 48 h, as well as mobile phone network coverage. Results Sixty-four percent of 80 interviewed HS representatives didn’t know their terms of reference, 83% were familiar with the malaria case definition and 32% with that of dengue. Ninety percent (37/41) of visited HS had five or more errors and 47% had missing data in the last ten SMS they transferred. The average time needed for weekly IDSR data compilation was 24 min in the Southern and 47 in the South-eastern region. Of 320 expected SMS 232 (73%) were received, 136 (43%) of them in time. Out of 38 alerts detected, four were notified on time. Nine percent (7/80) of HS had no telephone network with the current provider. Conclusions SMS transfer has improved IDSR data completeness, but timeliness and data quality remain a problem. Healthcare staff needs training on guidelines and case definitions. From 2016, data are collected and managed electronically to reduce errors and improve the system’s performance.
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Affiliation(s)
- Rado Randriamiarana
- Indian Ocean Field Epidemiology Training Programme, SEGA One Health Network, Indian Ocean Commission, Ebène, Mauritius.,Epidemiological Surveillance Department, Ministry of Health, Antananarivo, Madagascar
| | - Grégoire Raminosoa
- Epidemiological Surveillance Department, Ministry of Health, Antananarivo, Madagascar
| | - Nikaria Vonjitsara
- Epidemiological Surveillance Department, Ministry of Health, Antananarivo, Madagascar
| | - Rivo Randrianasolo
- Epidemiological Surveillance Department, Ministry of Health, Antananarivo, Madagascar
| | - Harena Rasamoelina
- Health Surveillance Unit, SEGA One Health Network, Indian Ocean Commission, Ebène, Mauritius
| | | | | | - Richard Lepec
- Health Surveillance Unit, SEGA One Health Network, Indian Ocean Commission, Ebène, Mauritius
| | - Loïc Flachet
- Health Surveillance Unit, SEGA One Health Network, Indian Ocean Commission, Ebène, Mauritius
| | - Ariane Halm
- Health Surveillance Unit, SEGA One Health Network, Indian Ocean Commission, Ebène, Mauritius.
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Toda M, Zurovac D, Njeru I, Kareko D, Mwau M, Morita K. Health worker knowledge of Integrated Disease Surveillance and Response standard case definitions: a cross-sectional survey at rural health facilities in Kenya. BMC Public Health 2018; 18:146. [PMID: 29343225 PMCID: PMC5772726 DOI: 10.1186/s12889-018-5028-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The correct knowledge of standard case definition is necessary for frontline health workers to diagnose suspected diseases across Africa. However, surveillance evaluations commonly assume this prerequisite. This study assessed the knowledge of case definitions for health workers and their supervisors for disease surveillance activities in rural Kenya. METHODS A cross-sectional survey including 131 health workers and their 11 supervisors was undertaken in two counties in Kenya. Descriptive analysis was conducted to classify the correctness of knowledge into four categories for three tracer diseases (dysentery, measles, and dengue). We conducted a univariate and multivariable logistic regression analyses to explore factors influencing knowledge of the case definition for dysentery. RESULTS Among supervisors, 81.8% knew the correct definition for dysentery, 27.3% for measles, and no correct responses were provided for dengue. Correct knowledge was observed for 50.4% of the health workers for dysentery, only 12.2% for measles, and none for dengue. Of 10 examined factors, the following were significantly associated with health workers' correct knowledge of the case definition for dysentery: health workers' cadre (aOR 2.71; 95% CI 1.20-6.12; p = 0.017), and display of case definition poster (aOR 2.24; 95% CI 1.01-4.98; p = 0.048). Health workers' exposure to the surveillance refresher training, supportive supervision and guidelines were not significantly associated with the knowledge. CONCLUSION The correct knowledge of standard case definitions was sub-optimal among health workers and their supervisors, which is likely to impact the reliability of routine surveillance reports generated from health facilities.
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Affiliation(s)
- Mitsuru Toda
- Nagasaki University Institute of Tropical Medicine, KEMRI-NUITM, Kenyatta Hospital Grounds, Nairobi, Kenya.
| | - Dejan Zurovac
- Oxford University, Oxford, UK.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ian Njeru
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - David Kareko
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Kouichi Morita
- Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
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Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015. PLoS One 2017; 12:e0184549. [PMID: 28886171 PMCID: PMC5590970 DOI: 10.1371/journal.pone.0184549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/26/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice. METHODS An IDSR alert was defined as ≥1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as ≥1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having ≥80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012-2015. RESULTS A total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of ≥80%. The PPV of CBS between 2013 and 2015 was 8.6%. CONCLUSION In conclusion, the effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020.
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Hoff NA, Doshi RH, Colwell B, Kebela-Illunga B, Mukadi P, Mossoko M, Spencer D, Muyembe-Tamfum JJ, Okitolonda-Wemakoy E, Lloyd-Smith J, Rimoin AW. Evolution of a Disease Surveillance System: An Increase in Reporting of Human Monkeypox Disease in the Democratic Republic of the Congo, 2001-2013. ACTA ACUST UNITED AC 2017; 25. [PMID: 30123790 PMCID: PMC6095679 DOI: 10.9734/ijtdh/2017/35885] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Evaluating the effectiveness of a surveillance system, and how it improves over time has significant implications for disease control and prevention. In the Democratic Republic of Congo (DRC), the Integrated Disease Surveillance and Response (IDSR) was implemented to estimate the burden of disease, monitor changes in disease occurrence, and inform resource allocation. For this effort we utilized national passive surveillance data from DRC's IDSR to explore reporting trends of human monkeypox (MPX) from 2001 to 2013. Methods We obtained surveillance data on MPX cases occurring between January 2001 and December 2013 from the DRC Ministry of Health (MoH). Phases of the surveillance system, yearly trends in reporting and estimated incidence for MPX were analyzed using SAS v9.2 and Health Mapper. Results Between 2001 and 2013, three discrete surveillance phases were identified that described the evolution of the surveillance system. Overall, an increase in suspected MPX cases was reported, beyond what would be expected from simply an improved reporting system. When restricting the analysis to the "stable phase," national estimated incidence increased from 2.13 per 100,000 in 2008 to 2.84 per 100,000 in 2013. Conclusions The reported increase in MPX, based on an evolving surveillance system, is likely to be a true increase in disease occurrence rather than simply improvements to the surveillance system. Further analyses should provide critical information for improved prevention and control strategies and highlight areas of improvement for future data collection efforts.
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Affiliation(s)
- Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Brian Colwell
- Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Benoit Kebela-Illunga
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Democratic Republic of the Congo
| | - Mathias Mossoko
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - D'Andre Spencer
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | | | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Toda M, Njeru I, Zurovac D, Kareko D, O-Tipo S, Mwau M, Morita K. Understanding mSOS: A qualitative study examining the implementation of a text-messaging outbreak alert system in rural Kenya. PLoS One 2017. [PMID: 28628629 PMCID: PMC5476271 DOI: 10.1371/journal.pone.0179408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks of epidemic diseases pose serious public health risks. To overcome the hurdles of sub-optimal disease surveillance reporting from the health facilities to relevant authorities, the Ministry of Health in Kenya piloted mSOS (mobile SMS-based disease outbreak alert system) in 2013-2014. In this paper, we report the results of the qualitative study, which examined factors that influence the performances of mSOS implementation. In-depth interviews were conducted with 11 disease surveillance coordinators and 32 in-charges of rural health facilities that took part in the mSOS intervention. Drawing from the framework analysis, dominant themes that emerged from the interviews are presented. All participants voiced their excitement in using mSOS. The results showed that the technology was well accepted, easy to use, and both health workers and managers unanimously recommended the scale-up of the system despite challenges encountered in the implementation processes. The most challenging components were the context in which mSOS was implemented, including the lack of strong existing structure for continuous support supervision, feedback and response action related to disease surveillance. The study revealed broader health systems issues that should be addressed prior to and during the intervention scale-up.
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Affiliation(s)
- Mitsuru Toda
- Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Japan International Cooperation Agency (JICA), Tokyo, Japan
- * E-mail:
| | - Ian Njeru
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Dejan Zurovac
- Oxford University, Oxford, United Kingdom
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Kareko
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Shikanga O-Tipo
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Kouichi Morita
- Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
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Toda M, Njeru I, Zurovac D, O-Tipo S, Kareko D, Mwau M, Morita K. Effectiveness of a Mobile Short-Message-Service-Based Disease Outbreak Alert System in Kenya. Emerg Infect Dis 2016; 22:711-5. [PMID: 26981628 PMCID: PMC4806970 DOI: 10.3201/eid2204.151459] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted a randomized, controlled trial to test the effectiveness of a text-messaging system used for notification of disease outbreaks in Kenya. Health facilities that used the system had more timely notifications than those that did not (19.2% vs. 2.6%), indicating that technology can enhance disease surveillance in resource-limited settings.
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Ameme DK, Nyarko KM, Afari EA, Antara S, Sackey SO, Wurapa F. Training Ghanaian frontline healthcare workers in public health surveillance and disease outbreak investigation and response. Pan Afr Med J 2016; 25:2. [PMID: 28149433 PMCID: PMC5257016 DOI: 10.11604/pamj.supp.2016.25.1.6179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/26/2016] [Indexed: 02/01/2023] Open
Abstract
Introduction Beyond initial formal academic education, the need for continuous professional development through in-service workforce capacity improvement programs that are aimed at enhancing knowledge and skills of public healthcare workers has assumed immense priority worldwide. This has been heightened by the on-going Ebola Virus Disease outbreak, which is exposing the weak public health systems in West Africa. In response to this need, the Ghana Field Epidemiology and Laboratory Program organized a short-course for frontline health workers in the Greater Accra region of Ghana in order to augment their surveillance and outbreak response capacity. Methods Human and veterinary health workers were trained using Field Epidemiology and Laboratory Training Program short course model. A two-week didactic course was conducted with a 10-week field placement. Evaluation of the course was done by assessment of participants’ outputs during the training as well as pretest and posttest methods. Results A total of 32 frontline health workers from both the human and veterinary health services benefited from the two-week initial training of the 12-week course. There was a significant gain in knowledge by the participants after the training course. Participants developed concept papers and implemented their fieldwork projects. Overall assessment of the workshop by the participants was very good. Conclusion Capacity of the health workers has been improved in the area of public health surveillance, outbreak investigation and response. We recommend a scale-up of this training course to other regions.
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Affiliation(s)
- Donne Kofi Ameme
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana
| | - Kofi Mensah Nyarko
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana; Disease Control and Prevention Department, Ghana Health Service, Accra, Ghana
| | - Edwin Andrews Afari
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana
| | | | - Samuel Oko Sackey
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana
| | - Fred Wurapa
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana
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Mwengee W, Okeibunor J, Poy A, Shaba K, Mbulu Kinuani L, Minkoulou E, Yahaya A, Gaturuku P, Landoh DE, Nsubuga P, Salla M, Mihigo R, Mkanda P. Polio Eradication Initiative: Contribution to improved communicable diseases surveillance in WHO African region. Vaccine 2016; 34:5170-5174. [PMID: 27389170 DOI: 10.1016/j.vaccine.2016.05.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, there has been a tremendous progress in the reduction of cases of poliomyelitis. The world is on the verge of achieving global polio eradication and in May 2013, the 66th World Health Assembly endorsed the Polio Eradication and Endgame Strategic Plan (PEESP) 2013-2018. The plan provides a timeline for the completion of the GPEI by eliminating all paralytic polio due to both wild and vaccine-related polioviruses. METHODS We reviewed how GPEI supported communicable disease surveillance in seven of the eight countries that were documented as part of World Health Organization African Region best practices documentation. Data from WHO African region was also reviewed to analyze the performance of measles cases based surveillance. RESULTS All 7 countries (100%) which responded had integrated communicable diseases surveillance core functions with AFP surveillance. The difference is on the number of diseases included based on epidemiology of diseases in a particular country. The results showed that the polio eradication infrastructure has supported and improved the implementation of surveillance of other priority communicable diseases under integrated diseases surveillance and response strategy. CONCLUSION As we approach polio eradication, polio-eradication initiative staff, financial resources, and infrastructure can be used as one strategy to build IDSR in Africa. As we are now focusing on measles and rubella elimination by the year 2020, other disease-specific programs having similar goals of eradicating and eliminating diseases like malaria, might consider investing in general infectious disease surveillance following the polio example.
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Affiliation(s)
- William Mwengee
- World Health Organization, Country Representative Office, Dar Es Salaam, Tanzania
| | - Joseph Okeibunor
- World Health Organization, Regional Office for Africa, Brazzaville, Congo.
| | - Alain Poy
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Keith Shaba
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Leon Mbulu Kinuani
- World Health Organization, Country Representative Office, Kinshasa, Democratic Republic of Congo
| | - Etienne Minkoulou
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Peter Gaturuku
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | - Mbaye Salla
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Poy A, Minkoulou E, Shaba K, Yahaya A, Gaturuku P, Dadja L, Okeibunor J, Mihigo R, Mkanda P. Polio Eradication Initiative contribution in strengthening immunization and integrated disease surveillance data management in WHO African region, 2014. Vaccine 2016; 34:5181-5186. [PMID: 27389171 DOI: 10.1016/j.vaccine.2016.05.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The PEI Programme in the WHO African region invested in recruitment of qualified staff in data management, developing data management system and standards operating systems since the revamp of the Polio Eradication Initiative in 1997 to cater for data management support needs in the Region. This support went beyond polio and was expanded to routine immunization and integrated surveillance of priority diseases. But the impact of the polio data management support to other programmes such as routine immunization and disease surveillance has not yet been fully documented. This is what this article seeks to demonstrate. METHODS We reviewed how Polio data management area of work evolved progressively along with the expansion of the data management team capacity and the evolution of the data management systems from initiation of the AFP case-based to routine immunization, other case based disease surveillance and Supplementary immunization activities. RESULTS IDSR has improved the data availability with support from IST Polio funded data managers who were collecting them from countries. The data management system developed by the polio team was used by countries to record information related to not only polio SIAs but also for other interventions. From the time when routine immunization data started to be part of polio data management team responsibility, the number of reports received went from around 4000 the first year (2005) to >30,000 the second year and to >47,000 in 2014. CONCLUSION Polio data management has helped to improve the overall VPD, IDSR and routine data management as well as emergency response in the Region. As we approach the polio end game, the African Region would benefit in using the already set infrastructure for other public health initiative in the Region.
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Affiliation(s)
- Alain Poy
- World Health Organization, Regional Office for Africa, Brazzaville, Congo.
| | - Etienne Minkoulou
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Keith Shaba
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Peter Gaturuku
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Landoh Dadja
- World Health Organization, Country Representative Office, Lome, Togo
| | - Joseph Okeibunor
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Adokiya MN, Awoonor-Williams JK. Ebola virus disease surveillance and response preparedness in northern Ghana. Glob Health Action 2016; 9:29763. [PMID: 27146443 PMCID: PMC4856840 DOI: 10.3402/gha.v9.29763] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/07/2016] [Accepted: 03/23/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The recent Ebola virus disease (EVD) outbreak has been described as unprecedented in terms of morbidity, mortality, and geographical extension. It also revealed many weaknesses and inadequacies for disease surveillance and response systems in Africa due to underqualified staff, cultural beliefs, and lack of trust for the formal health care sector. In 2014, Ghana had high risk of importation of EVD cases. OBJECTIVE The objective of this study was to assess the EVD surveillance and response system in northern Ghana. DESIGN This was an observational study conducted among 47 health workers (district directors, medical, disease control, and laboratory officers) in all 13 districts of the Upper East Region representing public, mission, and private health services. A semi-structured questionnaire with focus on core and support functions (e.g. detection, confirmation) was administered to the informants. Their responses were recorded according to specific themes. In addition, 34 weekly Integrated Disease Surveillance and Response reports (August 2014 to March 2015) were collated from each district. RESULTS In 2014 and 2015, a total of 10 suspected Ebola cases were clinically diagnosed from four districts. Out of the suspected cases, eight died and the cause of death was unexplained. All the 10 suspected cases were reported, none was confirmed. The informants had knowledge on EVD surveillance and data reporting. However, there were gaps such as delayed reporting, low quality protective equipment (e.g. gloves, aprons), inadequate staff, and lack of laboratory capacity. The majority (38/47) of the respondents were not satisfied with EVD surveillance system and response preparedness due to lack of infrared thermometers, ineffective screening, and lack of isolation centres. CONCLUSION EVD surveillance and response preparedness is insufficient and the epidemic is a wake-up call for early detection and response preparedness. Ebola surveillance remains a neglected public health issue. Thus, disease surveillance strengthening is urgently needed in Ghana.
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Affiliation(s)
- Martin N Adokiya
- Department of Community Health, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana;
| | - John K Awoonor-Williams
- Regional Health Directorate, Ghana Health Service, Upper East Region, Bolgatanga, Ghana
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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Mphande FA. Surveillance. INFECTIOUS DISEASES AND RURAL LIVELIHOOD IN DEVELOPING COUNTRIES 2016. [PMCID: PMC7120209 DOI: 10.1007/978-981-10-0428-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health surveillance is the continuous observation, a strategic and systematic collection, analysis and interpretation of health-related data for public health purposes. The data collected from surveillance systems can be stored in databases and can be used for scientific research, proving facts and identifying trends that can be used to make informed decisions. Surveillance systems do provide information that can be used as an early warning system for disease outbreaks and epidemics. Health surveillance, active or passive, provides a window into the health conditions and risks in communities and how these conditions are affecting the populations and their livelihoods. Developing countries should install systems of registration in place in order to track behaviour, traditions, diet and other ways of life that could contribute to infectious disease occurrence. Lack of knowledge has cost many lives especially for the poor communities in developed countries. Promoting the use of information and data in public decision-making is cardinal in managing infectious diseases and controlling disease outbreaks.
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Irurzun-Lopez M, Erondu NA, Djibo A, Griffiths U, Stuart JM, Fernandez K, Ronveaux O, Le Gargasson JB, Gessner BD, Colombini A. The actual and potential costs of meningitis surveillance in the African meningitis belt: Results from Chad and Niger. Vaccine 2015; 34:1133-8. [PMID: 26603955 DOI: 10.1016/j.vaccine.2015.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of serogroup A meningococcal conjugate vaccine in the African meningitis belt required strengthened surveillance to assess long-term vaccine impact. The costs of implementing this strengthening had not been assessed. METHODOLOGY The ingredients approach was used to retrospectively determine bacterial meningitis surveillance costs in Chad and Niger in 2012. Resource use and unit cost data were collected through interviews with staff at health facilities, laboratories, government offices and international partners, and by reviewing financial reports. Sample costs were extrapolated to national level and costs of upgrading to desired standards were estimated. RESULTS Case-based surveillance had been implemented in all 12 surveyed hospitals and 29 of 33 surveyed clinics in Niger, compared to six out of 21 clinics surveyed in Chad. Lumbar punctures were performed in 100% of hospitals and clinics in Niger, compared to 52% of the clinics in Chad. The total costs of meningitis surveillance were US$ 1,951,562 in Niger and US$ 338,056 in Chad, with costs per capita of US$ 0.12 and US$ 0.03, respectively. Laboratory investigation was the largest cost component per surveillance functions, comprising 51% of the total costs in Niger and 40% in Chad. Personnel resources comprised the biggest expense type: 37% of total costs in Niger and 26% in Chad. The estimated annual, incremental costs of upgrading current systems to desired standards were US$ 183,299 in Niger and US$ 605,912 in Chad, which are 9% and 143% of present costs, respectively. CONCLUSIONS Niger's more robust meningitis surveillance system costs four times more per capita than the system in Chad. Since Chad spends less per capita, fewer activities are performed, which weakens detection and analysis of cases. Countries in the meningitis belt are diverse, and can use these results to assess local costs for adapting surveillance systems to monitor vaccine impact.
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Affiliation(s)
- Maite Irurzun-Lopez
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1).
| | - Ngozi A Erondu
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2)
| | - Ali Djibo
- Faculté de Médecine Université de Niamey, Niger(3)
| | - Ulla Griffiths
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2)
| | - James M Stuart
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2); World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Katya Fernandez
- World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Olivier Ronveaux
- World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Jean-Bernard Le Gargasson
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
| | - Bradford D Gessner
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
| | - Anaïs Colombini
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
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Adokiya MN, Awoonor-Williams JK, Beiersmann C, Müller O. The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions. BMC Health Serv Res 2015. [PMID: 26216356 PMCID: PMC4515924 DOI: 10.1186/s12913-015-0960-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The integrated disease surveillance and response (IDSR) strategy was adopted in Ghana over a decade ago, yet gaps still remain in its proper functioning. The objective of this study was to assess the core and support functions of the IDSR system at the periphery level of the health system in northern Ghana. Methods A qualitative study has been conducted among 18 key informants in two districts of Upper East Region. The respondents were from 9 health facilities considered representative of the health system (public, private and mission). A semi-structured questionnaire with focus on core and support functions (e.g. case detection, confirmation, reporting, analysis, investigation, response, training, supervision and resources) of the IDSR system was administered to the respondents. The responses were recorded according to specific themes. Results The majority (7/9) of health facilities had designated disease surveillance officers. Some informants were of the opinion that the core and support functions of the IDSR system had improved over time. In particular, mobile phone reporting was mentioned to have made IDSR report submission easier. However, none of the health facilities had copies of the IDSR Technical Guidelines for standard case definitions, laboratories were ill-equipped, supervision was largely absent and feedback occurred rather irregular. Informants also reported, that the community perceived diagnostic testing at the health facilities to be unreliable (e.g. tuberculosis, Human Immunodeficiency Virus). In addition, disease surveillance activities were of low priority for nurses, doctors, administrators and laboratory workers. Conclusions Although the IDSR system was associated with some benefits to the system such as reporting and accessibility of surveillance reports, there remain major challenges to the functioning and the quality of IDSR in Ghana. Disease surveillance needs to be much strengthened in West Africa to cope with outbreaks such as the recent Ebola epidemic.
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Affiliation(s)
- Martin N Adokiya
- Institute of Public Health, University of Heidelberg, INF 324, D-69120, Heidelberg, Germany. .,School of Medicine & Health Sciences, University for Development Studies, Box TL 1350, Tamale, Ghana.
| | - John K Awoonor-Williams
- Regional Health Directorate, Ghana Health Service, Upper East Region, Bolgatanga, Ghana, Swiss Tropical and Public Health Institute, Switzerland, and University of Basel, Basel, Switzerland.
| | - Claudia Beiersmann
- Institute of Public Health, University of Heidelberg, INF 324, D-69120, Heidelberg, Germany.
| | - Olaf Müller
- Institute of Public Health, University of Heidelberg, INF 324, D-69120, Heidelberg, Germany.
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Issah K, Nartey K, Amoah R, Bachan EG, Aleeba J, Yeetey E, Letsa T. Assessment of the usefulness of integrated disease surveillance and response on suspected ebola cases in the Brong Ahafo Region, Ghana. Infect Dis Poverty 2015; 4:17. [PMID: 25878792 PMCID: PMC4397731 DOI: 10.1186/s40249-015-0051-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 04/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background This study assessed the quality, core and support functions of the integrated disease surveillance and response (IDSR) system relating to 18 suspected cases of Ebola virus disease (EVD) in the Brong Ahafo Region, Ghana. Methods Data was collected on selected indicators of the surveillance system relating to 18 suspected cases of EVD, from epidemiological week 19 to 45 of 2014. We conducted in-depth interviews with seven medical directors and two district directors of health services, and also reviewed documentation on the implementation of the core, support and quality functions of the IDSR system. We also monitored news in the media and rumours about EVD within the community as well as in health facility surveillance registers. Results The study identified gaps in the implementation of IDSR relating to 18 suspected cases of EVD. Health staff heavily relied on haemorrhage as the only symptom for detection of suspected EVD cases. Twelve blood samples and a swab of secretions from the mouth of the thirteenth patient (who died) tested negative for EVD using PCR assay in laboratory confirmation. The blood samples of three patients were discarded, as they did not fit the case definition for suspected cases, whilst two refused for their blood samples to be taken. The community-based surveillance (CBS) system has not been given a prominent role in EVD surveillance and response, as demonstrated by CBS volunteers and health staff not receiving any training in these processes. There was intense public interest in EVD in August and September 2014. That interest has since waned for reasons that have to be formally ascertained. Unfounded fear of and anxiety about EVD still remain challenges due to a lack of in-depth knowledge about the disease in Ghana. Conclusion Ghana has been one of the pioneers in the implementation of IDSR in Africa. Despite this, gaps have been identified in the implementation of IDSR relating to EVD in the Brong Ahafo Region. To address these gaps, the CBS system has to actively partner with health facility surveillance to achieve effective IDSR in the region. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0051-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kofi Issah
- Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana
| | - Kennedy Nartey
- Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana
| | - Richard Amoah
- Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana
| | - Emmanuel George Bachan
- Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana
| | - Jacob Aleeba
- Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana
| | - Enuamah Yeetey
- Kintampo Health Centre, Ghana Health Service, Kintampo, Brong Ahafo Region Ghana
| | - Timothy Letsa
- Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana
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Adokiya MN, Awoonor-Williams JK, Barau IY, Beiersmann C, Mueller O. Evaluation of the integrated disease surveillance and response system for infectious diseases control in northern Ghana. BMC Public Health 2015; 15:75. [PMID: 25648630 PMCID: PMC4331174 DOI: 10.1186/s12889-015-1397-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/12/2015] [Indexed: 12/02/2022] Open
Abstract
Background Well-functioning surveillance systems are crucial for effective disease control programs. The Integrated Disease Surveillance and Response (IDSR) strategy was developed and adopted in 1998 for Africa as a comprehensive public health approach and subsequently, Ghana adopted the IDSR technical guidelines in 2002. Since 2012, the IDSR data is reported through the new District Health Information Management System II (DHIMS2) network. The objective was to evaluate the Integrated Disease Surveillance and Response (IDSR) system in northern Ghana. Methods This was an observational study using mixed methods. Weekly and monthly IDSR data on selected infectious diseases were downloaded and analyzed for 2011, 2012 and 2013 (the years before, of and after DHIMS2 implementation) from the DHIMS2 databank for the Upper East Region (UER) and for two districts of UER. In addition, key informant interviews were conducted among local and regional health officers on the functioning of the IDSR. Results Clinically diagnosed malaria was the most prevalent disease in UER, with an annual incidence rate close to 1. Around 500 suspected HIV/AIDS cases were reported each year. The highest incidence of cholera and meningitis was reported in 2012 (257 and 392 cases respectively). Three suspected cases of polio and one suspected case of guinea worm were reported in 2013. None of the polio and guinea worm cases and only a fraction of the reported cases of the other diseases were confirmed. A major observation was the large and inconclusive difference in reported cases when comparing weekly and monthly reports. This can be explained by the different reporting practice for the sub-systems. Other challenges were low priority for surveillance, ill-equipped laboratories, rare supervision and missing feedback. Conclusions The DHIMS2 has improved the availability of IDSR reports, but the quality of data reported is not sufficient. Particularly the inconsistencies between weekly and monthly data need to be addressed. Moreover, support for and communication within the IDSR system is inadequate and calls for attention.
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Affiliation(s)
- Martin Nyaaba Adokiya
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany. .,Department of Allied Health Sciences, School of Medicine & Health Sciences, University for Development Studies, Tamale, Ghana.
| | | | - Inuwa Yau Barau
- National Primary Health Care Development Agency, Ministry of Health, Abuja, Nigeria.
| | - Claudia Beiersmann
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany.
| | - Olaf Mueller
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany.
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Phalkey RK, Yamamoto S, Awate P, Marx M. Challenges with the implementation of an Integrated Disease Surveillance and Response (IDSR) system: systematic review of the lessons learned. Health Policy Plan 2013; 30:131-43. [PMID: 24362642 DOI: 10.1093/heapol/czt097] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite a realistic strategy and availability of resources, multiple challenges still overwhelm countries grappling with the challenges of communicable disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy is by far the most pragmatic strategy in resource-poor settings. The objective of this study was to systematically review and document the lessons learned and the challenges identified with the implementation of the IDSR in low- and middle-income countries and to identify the main barriers that contribute to its sub-optimal functioning. METHODS A systematic review of literature published in English using Web of Knowledge, PubMed, and databases of the World Health Organization (WHO) and the Centers for Disease Control (CDC) between 1998 and 2012 was undertaken. Additionally, manual reference and grey literature searches were conducted. Citations describing core and support functions or the quality attributes of the IDSR as described by WHO and CDC were included in the review. RESULTS Thirty-three assessment studies met the inclusion criteria. IDSR strategy has been best adopted and implemented in the WHO-AFRO region. Although significant progress is made in overcoming the challenges identified with vertical disease surveillance strategies, gaps still exist. Mixed challenges with core and support IDSR functions were observed across countries. Main issues identified include non-sustainable financial resources, lack of co-ordination, inadequate training and turnover of peripheral staff, erratic feedback, inadequate supervision from the next level, weak laboratory capacities coupled with unavailability of job aids (case definitions/reporting formats), and poor availability of communication and transport systems particularly at the periphery. Best outcomes in core functions and system attributes were reported when support surveillance functions performed optimally. Apart from technical and technological issues, human resources and the health care system structures that receive the IDSR determine its output. CONCLUSIONS The challenges identified with IDSR implementation are largely 'systemic'. IDSR will best benefit from skill-based training of personnel and strengthening of the support surveillance functions alongside health care infrastructures at the district level.
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Affiliation(s)
- Revati K Phalkey
- Institute of Public Health (Former Department of Tropical Hygiene and Public Health), University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany and Integrated Disease Surveillance Project, Ministry of Health and Family Welfare, Pune, Maharashtra, India
| | - Shelby Yamamoto
- Institute of Public Health (Former Department of Tropical Hygiene and Public Health), University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany and Integrated Disease Surveillance Project, Ministry of Health and Family Welfare, Pune, Maharashtra, India
| | - Pradip Awate
- Institute of Public Health (Former Department of Tropical Hygiene and Public Health), University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany and Integrated Disease Surveillance Project, Ministry of Health and Family Welfare, Pune, Maharashtra, India
| | - Michael Marx
- Institute of Public Health (Former Department of Tropical Hygiene and Public Health), University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany and Integrated Disease Surveillance Project, Ministry of Health and Family Welfare, Pune, Maharashtra, India
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Phalkey RK, Shukla S, Shardul S, Ashtekar N, Valsa S, Awate P, Marx M. Assessment of the core and support functions of the Integrated Disease Surveillance system in Maharashtra, India. BMC Public Health 2013; 13:575. [PMID: 23764137 PMCID: PMC3693947 DOI: 10.1186/1471-2458-13-575] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 05/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded "project" to a state owned surveillance "program". METHODS Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study. RESULTS Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance. CONCLUSIONS Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state.
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Affiliation(s)
- Revati K Phalkey
- Institute of Public Health (Former Department of Tropical Hygiene and Public Health) Im Neuenheimer Feld 324, University of Heidelberg, Heidelberg, Germany D-69120.
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Dalhatu IT, Medina-Marino A, Olsen SJ, Hwang I, Gubio AB, Ekanem EE, Coker EBA, Akpan H, Adedeji AA. Influenza viruses in Nigeria, 2009-2010: results from the first 17 months of a national influenza sentinel surveillance system. J Infect Dis 2013; 206 Suppl 1:S121-8. [PMID: 23169957 DOI: 10.1093/infdis/jis584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Influenza surveillance data from tropical, sub-Saharan African countries are limited. To better understand the epidemiology of influenza, Nigeria initiated influenza surveillance in 2008. METHODS Outpatients with influenza-like illness (ILI) and inpatients with severe acute respiratory illness (SARI) were enrolled at 4 sentinel facilities. Epidemiologic data were obtained, and respiratory specimens were tested for influenza viruses, using real-time reverse-transcription polymerase chain reaction assays. RESULTS During April 2009-August 2010, 2841 patients were enrolled. Of 2803 specimens tested, 217 (7.7%) were positive for influenza viruses (167 [8%] were from subjects with ILI, 17 [5%] were from subjects with SARI, and 33 were from subjects with an unclassified condition). During the prepandemic period, subtype H3N2 (A[H3N2]) was the dominant circulating influenza A virus subtype; 2009 pandemic influenza A virus subtype H1N1 (A[H1N1]pdm09) replaced A(H3N2) as the dominant circulating virus during November 2009. Among persons with ILI, A(H1N1)pdm09 was most frequently found in children aged 5-17 years, whereas among subjects with SARI, it was most frequently found in persons aged ≥ 65 years. The percentage of specimens that tested positive for influenza viruses peaked at 18.9% in February 2010, and the majority were A(H1N1)pdm09. CONCLUSIONS Influenza viruses cause ILI and SARI in Nigeria. Data from additional years are needed to better understand the epidemiology and seasonality of influenza viruses in Nigeria.
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Affiliation(s)
- Ibrahim T Dalhatu
- Centers for Disease Control and Prevention-Nigeria, Maina Court, Central Business District, Federal Capital Territory, Abuja, Nigeria.
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Talisuna AO, Karema C, Ogutu B, Juma E, Logedi J, Nyandigisi A, Mulenga M, Mbacham WF, Roper C, Guerin PJ, D'Alessandro U, Snow RW. Mitigating the threat of artemisinin resistance in Africa: improvement of drug-resistance surveillance and response systems. THE LANCET. INFECTIOUS DISEASES 2013; 12:888-96. [PMID: 23099083 DOI: 10.1016/s1473-3099(12)70241-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Artemisinin-resistant Plasmodium falciparum malaria has emerged in western Cambodia and has been detected in western Thailand. The situation is ominously reminiscent of the emergence of resistance to chloroquine and to sulfadoxine-pyrimethamine several decades ago. Artemisinin resistance is a major threat to global public health, with the most severe potential effects in sub-Saharan Africa, where the disease burden is highest and systems for monitoring and containment of resistance are inadequate. The mechanisms that underlie artemisinin resistance are not fully understood. The main phenotypic trait associated with resistance is a substantial delay in parasite clearance, so far reported in southeast Asia but not in Africa. One of the pillars of the WHO global plan for artemisinin resistance containment is to increase monitoring and surveillance. In this Personal View, we propose strategies that should be adopted by malaria-endemic countries in Africa: resource mobilisation to reactivate regional surveillance networks, establishment of baseline parasite clearance profiles to serve as benchmarks to track emerging artemisinin resistance, improved data sharing to allow pooled analyses to identify rare events, modelling of risk factors for drug resistance, and development and validation of new approaches to monitor resistance.
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Affiliation(s)
- Ambrose O Talisuna
- Malaria Public Health and Epidemiology Group, University of Oxford and KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
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Jima D, Wondabeku M, Alemu A, Teferra A, Awel N, Deressa W, Adissie A, Tadesse Z, Gebre T, Mosher AW, Richards FO, Graves PM. Analysis of malaria surveillance data in Ethiopia: what can be learned from the Integrated Disease Surveillance and Response System? Malar J 2012; 11:330. [PMID: 22985409 PMCID: PMC3528460 DOI: 10.1186/1475-2875-11-330] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routine malaria surveillance data is useful for assessing incidence and trends over time, and in stratification for targeting of malaria control. The reporting completeness and potential bias of such data needs assessment. METHODS Data on 17 malaria indicators were extracted from the Integrated Disease Surveillance and Response System database for July 2004 to June 2009 (Ethiopian calendar reporting years 1997 to 2001). Reporting units were standardized over time with 2007 census populations. The data were analysed to show reporting completeness, variation in risk by reporting unit, and incidence trends for malaria indicators. RESULTS Reporting completeness, estimated as product of unit-month and health facility reporting, was over 80% until 2009, when it fell to 56% during a period of reorganization in the Ministry of Health. Nationally the average estimated annual incidence of reported total malaria for the calendar years 2005 to 2008 was 23.4 per 1000 persons, and of confirmed malaria was 7.6 per 1,000, with no clear decline in out-patient cases over the time period. Reported malaria in-patient admissions and deaths (averaging 6.4 per 10,000 and 2.3 per 100,000 per year respectively) declined threefold between 2005 and 2009, as did admissions and deaths reported as malaria with severe anaemia. Only 8 of 86 reporting units had average annual estimated incidence of confirmed malaria above 20 per 1,000 persons, while 26 units were consistently below five reported cases per 1,000 persons per year. CONCLUSION The Integrated Disease Surveillance and Response System functioned well over the time period mid 2004 to the end of 2008. The data suggest that the scale up of interventions has had considerable impact on malaria in-patient cases and mortality, as reported from health centres and hospitals. These trends must be regarded as relative (over space and time) rather than absolute. The data can be used to stratify areas for improved targeting of control efforts to steadily reduce incidence. They also provide a baseline of incidence estimates against which to gauge future progress towards elimination. Inclusion of climate information over this time period and extension of the dataset to more years is needed to clarify the impact of control measures compared to natural cycles on malaria.
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Affiliation(s)
- Daddi Jima
- Public Health Emergency Management, Ethiopian Health and NutritionResearch Institute, Addis Ababa, Ethiopia
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Abstract
Ebola hemorrhagic fever (EHF) and Marburg hemorrhagic fever (MHF) are rare viral
diseases, endemic to central Africa. The overall burden of EHF and MHF is small
in comparison to the more common protozoan, helminth, and bacterial diseases
typically referred to as neglected tropical diseases (NTDs). However, EHF and
MHF outbreaks typically occur in resource-limited settings, and many aspects of
these outbreaks are a direct consequence of impoverished conditions. We will
discuss aspects of EHF and MHF disease, in comparison to the
“classic” NTDs, and examine potential ways forward in the prevention
and control of EHF and MHF in sub-Saharan Africa, as well as examine the
potential for application of novel vaccines or antiviral drugs for prevention or
control of EHF and MHF among populations at highest risk for disease.
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Affiliation(s)
- Adam MacNeil
- Viral Special Pathogens Branch, the Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Lukwago L, Nanyunja M, Ndayimirije N, Wamala J, Malimbo M, Mbabazi W, Gasasira A, Nabukenya IN, Musenero M, Alemu W, Perry H, Nsubuga P, Talisuna A. The implementation of Integrated Disease Surveillance and Response in Uganda: a review of progress and challenges between 2001 and 2007. Health Policy Plan 2012; 28:30-40. [PMID: 22669899 PMCID: PMC3538461 DOI: 10.1093/heapol/czs022] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions. Methods We used a monitoring framework recommended by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC)-Atlanta to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. To determine the performance of IDSR at district and health facility levels over a 5-year period, we compared the evaluation results of a 2004 surveillance survey with findings from a baseline assessment in 2000. We also examined national-level funding for IDSR implementation during 2000–07. Results Our findings show improvements in the performance of IDSR, including: (1) improved reporting at the district level (49% in 2001; 85% in 2007); (2) an increase and then decrease in timeliness of reporting from districts to central level; and (3) an increase in analysed data at the local level (from 10% to 47% analysing at least one target disease, P < 0.01). The case fatality rate (CFR) for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. A comparison before and after implementation showed increased funding for IDSR from government and development partners. However, funding support decreased ten-fold from the government budget of 2000/01 through to 2007/08. Per capita input for disease surveillance activities increased from US$0.0046 in 1996–99 to US$0.0215 in 2000–07. Conclusion Implementation of IDSR was associated with improved surveillance and response efforts. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
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