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Joseph JJ, Mkali HR, Reaves EJ, Mwaipape OS, Mohamed A, Lazaro SN, Aaron S, Chacky F, Mahendeka A, Rulagirwa HS, Mwenesi M, Mwakapeje E, Ally AY, Kitojo C, Serbantez N, Nyinondi S, Lalji SM, Wilillo R, Al-mafazy AW, Kabula BI, John C, Bisanzio D, Eckert E, Reithinger R, Ngondi JM. Improvements in malaria surveillance through the electronic Integrated Disease Surveillance and Response (eIDSR) system in mainland Tanzania, 2013-2021. Malar J 2022; 21:321. [PMID: 36348409 PMCID: PMC9641756 DOI: 10.1186/s12936-022-04353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tanzania has made remarkable progress in reducing malaria burden and aims to transition from malaria control to sub-national elimination. In 2013, electronic weekly and monthly reporting platforms using the District Health Information System 2 (DHIS2) were introduced. Weekly reporting was implemented through the mobile phone-based Integrated Disease Surveillance and Response (eIDSR) platform and progressively scaled-up from 67 to 7471 (100%) public and private health facilities between 2013 and 2020. This study describes the roll-out and large-scale implementation of eIDSR and compares the consistency between weekly eIDSR and monthly DHIS2 malaria indicator data reporting, including an assessment of its usefulness for malaria outbreak detection and case-based surveillance (CBS) in low transmission areas. METHODS The indicators included in the analysis were number of patients tested for malaria, number of confirmed malaria cases, and clinical cases (treated presumptively for malaria). The analysis described the time trends of reporting, testing, test positivity, and malaria cases between 2013 and 2021. For both weekly eIDSR and monthly DHIS2 data, comparisons of annual reporting completeness, malaria cases and annualized incidence were performed for 2020 and 2021; additionally, comparisons were stratified by malaria epidemiological strata (parasite prevalence: very low < 1%, low 1 ≤ 5%, moderate 5 ≤ 30%, and high > 30%). RESULTS Weekly eIDSR reporting completeness steadily improved over time, with completeness being 90.2% in 2020 and 93.9% in 2021; conversely, monthly DHIS2 reporting completeness was 98.9% and 98.7% in 2020 and 2021, respectively. Weekly eIDSR reporting completeness and timeliness were highest in the very low epidemiological stratum. Annualized malaria incidence as reported by weekly eIDSR was 17.5% and 12.4% lower than reported by monthly DHIS2 in 2020 and 2021; for both 2020 and 2021, annualized incidence was similar across weekly and monthly data in the very low stratum. CONCLUSION The concurrence of annualized weekly eIDSR and monthly DHIS2 reporting completeness, malaria cases and incidence in very low strata suggests that eIDSR could be useful tool for early outbreak detection, and the eIDSR platform could reliably be expanded by adding more indicators and modules for CBS in the very low epidemiological stratum.
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Affiliation(s)
| | | | - Erik J. Reaves
- U.S. President’s Malaria Initiative, U.S. Center for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | | | - Ally Mohamed
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Samwel N. Lazaro
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Sijenunu Aaron
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Frank Chacky
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Anna Mahendeka
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Hermes S. Rulagirwa
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Mwendwa Mwenesi
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Elibariki Mwakapeje
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Ally Y. Ally
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Chonge Kitojo
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, United Republic of Tanzania
| | - Naomi Serbantez
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, United Republic of Tanzania
| | - Ssanyu Nyinondi
- RTI International, Dar es Salaam, United Republic of Tanzania
| | | | | | | | | | - Claud John
- U.S. President’s Malaria Initiative, U.S. Center for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Donal Bisanzio
- grid.62562.350000000100301493RTI International, Washington, DC USA
| | - Erin Eckert
- grid.62562.350000000100301493RTI International, Washington, DC USA
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Bodenham RF, Mtui-Malamsha N, Gatei W, Woldetsadik MA, Cassell CH, Salyer SJ, Halliday JE, Nonga HE, Swai ES, Makungu S, Mwakapeje E, Bernard J, Bebay C, Makonnen YJ, Fasina FO. Multisectoral cost analysis of a human and livestock anthrax outbreak in Songwe Region, Tanzania (December 2018-January 2019), using a novel Outbreak Costing Tool. One Health 2021; 13:100259. [PMID: 34013015 PMCID: PMC8113743 DOI: 10.1016/j.onehlt.2021.100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES We applied a novel Outbreak Costing Tool (OCT), developed by the US Centers for Disease Control and Prevention (CDC), to estimate the costs of investigating and responding to an anthrax outbreak in Tanzania. We also evaluated the OCT's overall utility in its application to a multisectoral outbreak response. METHODS We collected data on direct costs associated with a human and animal anthrax outbreak in Songwe Region (December 2018 to January 2019) using structured questionnaires from key-informants. We performed a cost analysis by entering direct costs data into the OCT, grouped into seven cost categories: labor, office, travel and transport, communication, laboratory support, medical countermeasures, and consultancies. RESULTS The total cost for investigating and responding to this outbreak was estimated at 102,232 United States dollars (USD), with travel and transport identified as the highest cost category (62,536 USD) and communication and consultancies as the lowest, with no expenditure, for the combined human and animal health sectors. CONCLUSIONS Multisectoral investigation and response may become complex due to coordination challenges, thus allowing escalation of public health impacts. A standardized framework for collecting and analysing cost data is vital to understanding the nature of outbreaks, in anticipatory planning, in outbreak investigation and in reducing time to intervention. Pre-emptive use of the OCT will also reduce overall and specific (response period) intervention costs for the disease. Additional aggregation of the costs by government ministries, departments and tiers will improve the use of the tool to enhance sectoral budget planning for disease outbreaks in a multisectoral response.
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Affiliation(s)
- Rebecca F. Bodenham
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam, United Republic of Tanzania
| | - Niwael Mtui-Malamsha
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam, United Republic of Tanzania
| | - Wangeci Gatei
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Mahlet A. Woldetsadik
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Cynthia H. Cassell
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Stephanie J. Salyer
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Jo E.B. Halliday
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Hezron E. Nonga
- Directorate of Veterinary Services, Ministry of Livestock and Fisheries, Dodoma, United Republic of Tanzania
| | - Emmanuel S. Swai
- Directorate of Veterinary Services, Ministry of Livestock and Fisheries, Dodoma, United Republic of Tanzania
| | - Selemani Makungu
- Directorate of Veterinary Services, Ministry of Livestock and Fisheries, Dodoma, United Republic of Tanzania
| | - Elibariki Mwakapeje
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam, United Republic of Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Jubilate Bernard
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
- One Health Coordination Desk, Office of the Prime Minister, Dodoma, United Republic of Tanzania
| | - Charles Bebay
- Emergency Centre for Transboundary Animal Diseases (ECTAD) Regional Office for Eastern Africa, Food and Agriculture Organization of the United Nations (FAO), Nairobi, Kenya
| | - Yilma J. Makonnen
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Folorunso O. Fasina
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam, United Republic of Tanzania
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Holst C, Isabwe GMN, Sukums F, Ngowi H, Kajuna F, Radovanović D, Mansour W, Mwakapeje E, Cardellichio P, Ngowi B, Noll J, Winkler AS. Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach. JMIR Mhealth Uhealth 2021; 9:e25558. [PMID: 34550081 PMCID: PMC8495580 DOI: 10.2196/25558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/09/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. OBJECTIVE The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. METHODS The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania's national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. RESULTS Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. CONCLUSIONS Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government's objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/25128.
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Affiliation(s)
- Christine Holst
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ghislain Maurice Norbert Isabwe
- Future Competence International, Kigali, Rwanda.,Department of Information and Communication Technology, University of Agder, Grimstad, Norway
| | - Felix Sukums
- Directorate of Information and Communication Technology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Helena Ngowi
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, United Republic of Tanzania
| | - Flora Kajuna
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, United Republic of Tanzania
| | | | | | - Elibariki Mwakapeje
- Epidemiology and Diseases Control Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | | | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania.,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, United Republic of Tanzania
| | - Josef Noll
- Basic Internet Foundation, Kjeller, Norway.,Department of Technology Systems, University of Oslo, Oslo, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.,Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany
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Vairo F, Mboera LE, De Nardo P, Oriyo NM, Meschi S, Rumisha SF, Colavita F, Mhina A, Carletti F, Mwakapeje E, Capobianchi MR, Castilletti C, Di Caro A, Nicastri E, Malecela MN, Ippolito G. Clinical, Virologic, and Epidemiologic Characteristics of Dengue Outbreak, Dar es Salaam, Tanzania, 2014. Emerg Infect Dis 2016; 22:895-9. [PMID: 27088845 PMCID: PMC4861515 DOI: 10.3201/eid2205.151462] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated a dengue outbreak in Dar es Salaam, Tanzania, in 2014, that was caused by dengue virus (DENV) serotype 2. DENV infection was present in 101 (20.9%) of 483 patients. Patient age and location of residence were associated with infection. Seven (4.0%) of 176 patients were co-infected with malaria and DENV.
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McMorrow ML, Wemakoy EO, Tshilobo JK, Emukule GO, Mott JA, Njuguna H, Waiboci L, Heraud JM, Rajatonirina S, Razanajatovo NH, Chilombe M, Everett D, Heyderman RS, Barakat A, Nyatanyi T, Rukelibuga J, Cohen AL, Cohen C, Tempia S, Thomas J, Venter M, Mwakapeje E, Mponela M, Lutwama J, Duque J, Lafond K, Nzussouo NT, Williams T, Widdowson MA. Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries. J Infect Dis 2015; 212:853-60. [PMID: 25712970 PMCID: PMC4826902 DOI: 10.1093/infdis/jiv100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Background. Data on causes of death due to respiratory illness in Africa are limited. Methods. From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)–associated deaths identified from influenza surveillance during 2009–2012. Results. Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%–25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%–5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus–negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0–4 years, 462 (43.1%) involved people aged 5–49 years, and 209 (19.5%) involved people aged ≥50 years. Conclusions. Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.
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Affiliation(s)
- Meredith L McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland
| | | | | | | | - Joshua A Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-Kenya, Nairobi
| | - Henry Njuguna
- Centers for Disease Control and Prevention-Kenya, Nairobi
| | - Lilian Waiboci
- Centers for Disease Control and Prevention-Kenya, Nairobi
| | | | | | | | - Moses Chilombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | | | - Thierry Nyatanyi
- Division of Epidemic Infectious Diseases, Rwanda Biomedical Center
| | | | - Adam L Cohen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Centers for Disease Control and Prevention-South Africa
| | - Juno Thomas
- Outbreak Response Unit, National Institute for Communicable Diseases
| | - Marietjie Venter
- Centers for Disease Control and Prevention-South Africa Zoonoses Research Unit, Department of Medical Virology, University of Pretoria Centre for Respiratory Diseases and Meningitis
| | - Elibariki Mwakapeje
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Ministry of Health and Social Welfare-Tanzania
| | - Marcelina Mponela
- Ministry of Health and Social Welfare-Tanzania Centers for Disease Control and Prevention-Tanzania, Dar es Salaam
| | - Julius Lutwama
- Centers for Disease Control and Prevention-Tanzania, Dar es Salaam Uganda Virus Research Institute, Entebbe
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Battelle, Atlanta, Georgia
| | - Kathryn Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Thelma Williams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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