Abstract
The aim of this study was to better understand the effectiveness of Integrated Disease Surveillance and Response (IDSR) facility-based surveillance in detecting newly emerging infectious diseases (EIDs) in rural West African settings. A six-month ethnographic study was undertaken in 2012 in the Techiman Municipality of the Brong-Ahafo Region of Ghana, aimed at documenting the trajectories of febrile illness cases of unknown origin occurring within four rural communities. Particular attention was paid to where these trajectories involved the use of formal healthcare facilities and the diagnostic practices that occurred there. Seventy-six participants were enrolled in the study, and 24 complete episodes of illness were documented. While participants routinely used hospital treatment when confronted with enduring or severe illness, the diagnostic process within clinical settings meant that an unusual diagnosis, such as an EID, was unlikely to be considered. Facility-based surveillance is unlikely to be effective in detecting EIDs due to a combination of clinical care practices and the time constraints associated with individual episodes of illness, particularly in the resource-limited settings of rural West Africa, where febrile illness due to malaria is common and specific diagnostic assays are largely unavailable. The success of the ‘One Health' approach to EIDs in West Africa is predicated on characterization of accurately diagnosed disease burdens. To this end, we must address inefficiencies in the dominant approaches to EID surveillance and the weaknesses of health systems in the region generally.This article is part of the themed issue ‘One Health for a changing world: zoonoses, ecosystems and human well-being'.
Highlights
Emerging infectious diseases (EIDs) represent a major threat to global health
West Africa has been identified as an environment prone to zoonotic spillover and as & 2017 The Authors
In common with much of sub-Saharan Africa, West African countries rely on the Integrated Disease Surveillance and Response (IDSR) to implement the revised International Health Regulations (IHR, 2005)
Summary
Emerging infectious diseases (EIDs) represent a major threat to global health. In recent years, re-emerging and newly emerging wildlife-associated zoonoses such as Ebola virus in West Africa, Severe Acute Respiratory Syndrome (SARS), Human Immunodeficiency Virus (HIV) and numerous novel strains of influenza have led to substantial economic and human losses [1]. Prior to constituting a major outbreak, many zoonoses may exist within communities for some time as isolated or small clusters of cases [2,3] Such cases represent an important opportunity for early intervention but often proceed undetected due to a range of poorly defined clinical and social factors, many of which are exacerbated by the remote and tropical environments in which wildlife-associated spillover events tend to occur. License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited Such requires special attention for this role in global health [4]. In common with much of sub-Saharan Africa, West African countries rely on the IDSR to implement the revised International Health Regulations (IHR, 2005). The IDSR primarily relies on facility-based surveillance for the detection of individual or small numbers of cases [6] This approach involves a healthcare worker, typically a doctor, identifying a significant disease within their normal professional activities treating patients. It is of great concern that current systems must be missing a significant burden of disease
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