Evaluation of the Functionality and Effectiveness of the CORE Group Polio Project's Community-Based Acute Flaccid Paralysis Surveillance System in South Sudan.

Anthony Kisanga,Bausumo Abiuda,Peter Walyaula,Omongot Samson,Lee Losey

doi:10.4269/ajtmh.19-0120

Abstract

.This article describes the functionality and effectiveness of a community-based acute flaccid paralysis (AFP) surveillance system designed and implemented by the CORE Group Polio Project (CGPP) in conflict-affected and inaccessible areas of South Sudan between October 2015 and September 2017. The findings are based on interviews with key informants and focus group discussions as well as data from the CGPP and the management information system of the WHO. Through the implementing partners, the CGPP identified and built the capacity of the community-based surveillance (CBS) system, a system consisting of county supervisors, payam (sub-county) assistants, and community key informants. This structure played a critical role in the identification and reporting of AFP cases. The CGPP also established partnerships with other key players–local and international–to reach greater numbers of people, particularly displaced populations. Evaluation findings show an increase from 0.0% to 56.4% of cases reported through the CBS system between January 2016 and June 2017, and 80.0% of the cases reported within WHO standards of 24–48 hours were through the CBS system, whereas 20.0% were through the facility-based system. The CBS system also recorded an increase from 36.0% in 2014 to 92.0% in December 2016 for the number of counties that were reporting AFP. A CBS system is, therefore, a valuable complement to facility-based surveillance in insecure environments or where the population has limited access to facilities. Community-based surveillance systems also have the potential to identify cases of other infectious diseases of public health importance.

Highlights

Civil war broke out in South Sudan in 2013 just 2 years after the country gained independence, leading to the internal displacement of 1.9 million people
We reviewed these to assess the progress of the community-based surveillance (CBS) system, challenges encountered, and recommended actions
Field visits to six counties confirmed the presence of CBS personnel in the form of a county supervisor, payam assistants, and community key informants

Summary

Introduction

Civil war broke out in South Sudan in 2013 just 2 years after the country gained independence, leading to the internal displacement of 1.9 million people. More than two million people sought refuge in neighboring countries.[1] Many health facilities were destroyed and a large portion of the health facility staff members were displaced or killed leading to a collapse of the health system, including immunization and surveillance functions. The non-polio acute flaccid paralysis (NPAFP) rate per 100,000 children younger than 15 years as recorded by the surveillance system declined considerably between 2013 and 2014: from 3.3 to 1.0 in Jonglei; 1.7 to 1.4 in Unity State; and 3.5 to 1.3 in Upper Nile–all substantially lower than the expected rate of at least two cases per 100,000 children.[2,3] In addition, there were several silent counties and subcounties that reported no cases at all. South Sudan experienced an outbreak of circulating vaccine-derived poliovirus (cVDPV) in Unity State in 2014 and 2015

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