Health Facility Surveillance Research Articles

Clinical profiles, epidemiological characteristics and treatment outcomes of COVID-19 patients in North-eastern Ethiopia: A retrospective cohort study.

COVID-19 is a rapidly emerging global health threat and economic disaster. The epidemiology and outcomes of COVID-19 patients in Ethiopia are scarce. Thus, the present study aimed to assess clinical profiles, epidemiological characteristics, and treatment outcomes of patients with COVID-19 and to identify determinants of the disease outcome among COVID-19 patients in North-eastern Ethiopia. A retrospective observational cohort study was conducted in North-eastern Ethiopia, from May 2020 to Jan 2022 on a total of 364 SARS-COV-2 infected patients. Demographic and clinical data were abstracted from the medical records of patients. Bivariable and multivariable analyses were conducted to determine the factors associated with the mortality of COVID-19 patients and variables with a P-value < 0.05 were considered statistically significant. Among 364 COVID-19 patients included in this study, two-thirds (68.1%) were males with a median age of 34 years. The majority; 42.9% & 33.0% respectively cases were detected at the health facility and community level surveillance. Furthermore, 6.6% of patients had pre-existing comorbidities of which diabetes mellitus (23.1%) and hypertension (15.3%) had the highest frequency. The symptomatic rate of COVID-19 patients was 30.5%. The most common clinical presentations were cough (26.9%), fever (26.1%), and shortness of breath (15.2%). Moreover, the mortality rate of COVID-19 patients was 4.1% which was independently predicted by a history of underlining co-morbidity (AHR:6.09; 95%CI:1.299-28.56; P = 0.022) and a history of severe or critical conditions (AHR 11.8; 95%CI:4.89-28.83; P = 0.003). Severe or critical acute COVID-19 and underlining comorbidities are associated with higher mortality. Therefore, critical follow-up and management should be given to patients with underlying diseases is required.

Mapping malaria incidence using routine health facility surveillance data in Uganda

IntroductionMaps of malaria risk are important tools for allocating resources and tracking progress. Most maps rely on cross-sectional surveys of parasite prevalence, but health facilities represent an underused and powerful...

Resurgence of malaria in Uganda despite sustained indoor residual spraying and repeated long lasting insecticidal net distributions.

Five years of sustained indoor residual spraying (IRS) of insecticide from 2014 to 2019, first using a carbamate followed by an organophosphate, was associated with a marked reduction in the incidence of malaria in five districts of Uganda. We assessed changes in malaria incidence over an additional 21 months, corresponding to a change in IRS formulations using clothianidin with and without deltamethrin. Using enhanced health facility surveillance data, our objectives were to 1) estimate the impact of IRS on monthly malaria case counts at five surveillance sites over a 6.75 year period, and 2) compare monthly case counts at five facilities receiving IRS to ten facilities in neighboring districts not receiving IRS. For both objectives, we specified mixed effects negative binomial regression models with random intercepts for surveillance site adjusting for rainfall, season, care-seeking, and malaria diagnostic. Following the implementation of IRS, cases were 84% lower in years 4-5 (adjusted incidence rate ratio [aIRR] = 0.16, 95% CI 0.12-0.22), 43% lower in year 6 (aIRR = 0.57, 95% CI 0.44-0.74), and 39% higher in the first 9 months of year 7 (aIRR = 1.39, 95% CI 0.97-1.97) compared to pre-IRS levels. Cases were 67% lower in IRS sites than non-IRS sites in year 6 (aIRR = 0.33, 95% CI 0.17-0.63) but 38% higher in the first 9 months of year 7 (aIRR = 1.38, 95% CI 0.90-2.11). We observed a resurgence in malaria to pre-IRS levels despite sustained IRS. The timing of this resurgence corresponded to a change of active ingredient. Further research is needed to determine causality.

Evaluation of public health surveillance systems in refugee settlements in Uganda, 2016\u20132019: lessons learned

BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda. With associated disease epidemics related to this conflict, a disease surveillance system was established aiming for timely detection of diseases and rapid response to outbreaks. We describe the evaluation of and lessons learned from the public health surveillance system set up in refugee settlements in Uganda.MethodsWe conducted a cross-sectional survey using the US Centers for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems and the Uganda National Technical Guidelines for Integrated Disease Surveillance and Response in four refugee settlements in Uganda—Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed 53 health facility leaders, 12 key personnel and 224 village health team members from 53 health facilities and 112 villages and assessed key surveillance functions and attributes.ResultsAll health facilities assessed had key surveillance staff; 60% were trained on Integrated Disease Surveillance and Response and most village health teams were trained on disease surveillance. Case detection was at 55%; facilities lacked standard case definitions and were using parallel Implementing Partner driven reporting systems. Recording was at 79% and reporting was at 81%. Data analysis and interpretation was at 49%. Confirmation of outbreaks and events was at 76%. Preparedness was at 72%. Response was at 34%. Feedback was at 82%. Evaluate and improve the system was at 67%. There was low capacity for detection, response and data analysis and interpretation of cases (< 60%).ConclusionThe surveillance system in the refugee settlements was functional with many performing attributes but with many remaining gaps. There was low capacity for detection, response and data analysis and interpretation in all the refugee settlements. There is need for improvement to align surveillance systems in refugee settlements with the mainstream surveillance system in the country. Implementing Partners should be urged to offer support for surveillance and training of surveillance staff on Integrated Disease Surveillance and Response to maintain effective surveillance functions. Functionalization of district teams ensures achievement of surveillance functions and attributes. Regular supervision of and support to health facility surveillance personnel is essential. Harmonization of reporting improves surveillance functions and attributes and appropriation of funds by government to districts to support refugee settlements is complementary to maintain effective surveillance of priority diseases in the northern and central part of Uganda.

Leveraging Polio Geographic Information System Platforms in the African Region for Mitigating COVID-19 Contact Tracing and Surveillance Challenges: Viewpoint.

BackgroundThe ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic.ObjectiveThis paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization via the WHO’s polio program in the African region.MethodsWe repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to enable actionable insights.ResultsThe contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility–based surveillance app has been used more extensively, as it has been used in 27 countries in the region.ConclusionsIn light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field. From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries’ efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19.

A protocol for a longitudinal, observational cohort study of infection and exposure to zoonotic and vector-borne diseases across a land-use gradient in Sabah, Malaysian Borneo: a socio-ecological systems approach

Introduction. Landscape changes disrupt environmental, social and biological systems, altering pathogen spillover and transmission risks. This study aims to quantify the impact of specific land management practices on spillover and transmission rates of zoonotic and vector-borne diseases within Malaysian Borneo. This protocol describes a cohort study with integrated ecological sampling to assess how deforestation and agricultural practices impact pathogen flow from wildlife and vector populations to human infection and detection by health facilities. This will focus on malaria, dengue and emerging arboviruses (Chikungunya and Zika), vector-borne diseases with varying contributions of simian reservoirs within this setting. Methods. A prospective longitudinal observational cohort study will be established in communities residing or working within the vicinity of the Stability of Altered Forest Ecosystems (SAFE) Project, a landscape gradient within Malaysian Borneo encompassing different plantation and forest types. The primary outcome of this study will be transmission intensity of selected zoonotic and vector-borne diseases, as quantified by changes in pathogen-specific antibody levels. Exposure will be measured using paired population-based serological surveys conducted at the beginning and end of the two-year cohort study. Secondary outcomes will include the distribution and infection rates of Aedes and Anopheles mosquito vectors, human risk behaviours and clinical cases reported to health facilities. Longitudinal data on human behaviour, contact with wildlife and GPS tracking of mobility patterns will be collected throughout the study period. This will be integrated with entomological surveillance to monitor densities and pathogen infection rates of Aedes and Anopheles mosquitoes relative to land cover. Within surrounding health clinics, continuous health facility surveillance will be used to monitor reported infections and febrile illnesses. Models will be developed to assess spillover and transmission rates relative to specific land management practices and evaluate abilities of surveillance systems to capture these risks.

A protocol for a longitudinal, observational cohort study of infection and exposure to zoonotic and vector-borne diseases across a land-use gradient in Sabah, Malaysian Borneo: a socio-ecological systems approach.

Introduction. Landscape changes disrupt environmental, social and biological systems, altering pathogen spillover and transmission risks. This study aims to quantify the impact of specific land management practices on spillover and transmission rates of zoonotic and vector-borne diseases within Malaysian Borneo. This protocol describes a cohort study with integrated ecological sampling to assess how deforestation and agricultural practices impact pathogen flow from wildlife and vector populations to human infection and detection by health facilities. This will focus on malaria, dengue and emerging arboviruses (Chikungunya and Zika), vector-borne diseases with varying contributions of simian reservoirs within this setting. Methods. A prospective longitudinal observational cohort study will be established in communities residing or working within the vicinity of the Stability of Altered Forest Ecosystems (SAFE) Project, a landscape gradient within Malaysian Borneo encompassing different plantation and forest types. The primary outcome of this study will be transmission intensity of selected zoonotic and vector-borne diseases, as quantified by changes in pathogen-specific antibody levels. Exposure will be measured using paired population-based serological surveys conducted at the beginning and end of the two-year cohort study. Secondary outcomes will include the distribution and infection rates of Aedes and Anopheles mosquito vectors, human risk behaviours and clinical cases reported to health facilities. Longitudinal data on human behaviour, contact with wildlife and GPS tracking of mobility patterns will be collected throughout the study period. This will be integrated with entomological surveillance to monitor densities and pathogen infection rates of Aedes and Anopheles mosquitoes relative to land cover. Within surrounding health clinics, continuous health facility surveillance will be used to monitor reported infections and febrile illnesses. Models will be developed to assess spillover and transmission rates relative to specific land management practices and evaluate abilities of surveillance systems to capture these risks.

Design and methods for a quasi-experimental pilot study to evaluate the impact of dual active ingredient insecticide-treated nets on malaria burden in five regions in sub-Saharan Africa

BackgroundVector control tools have contributed significantly to a reduction in malaria burden since 2000, primarily through insecticidal-treated bed nets (ITNs) and indoor residual spraying. In the face of increasing insecticide resistance in key malaria vector species, global progress in malaria control has stalled. Innovative tools, such as dual active ingredient (dual-AI) ITNs that are effective at killing insecticide-resistant mosquitoes have recently been introduced. However, large-scale uptake has been slow for several reasons, including higher costs and limited evidence on their incremental effectiveness and cost-effectiveness. The present report describes the design of several observational studies aimed to determine the effectiveness and cost-effectiveness of dual-AI ITNs, compared to standard pyrethroid-only ITNs, at reducing malaria transmission across a variety of transmission settings.MethodsObservational pilot studies are ongoing in Burkina Faso, Mozambique, Nigeria, and Rwanda, leveraging dual-AI ITN rollouts nested within the 2019 and 2020 mass distribution campaigns in each country. Enhanced surveillance occurring in select study districts include annual cross-sectional surveys during peak transmission seasons, monthly entomological surveillance, passive case detection using routine health facility surveillance systems, and studies on human behaviour and ITN use patterns. Data will compare changes in malaria transmission and disease burden in districts receiving dual-AI ITNs to similar districts receiving standard pyrethroid-only ITNs over three years. The costs of net distribution will be calculated using the provider perspective including financial and economic costs, and a cost-effectiveness analysis will assess incremental cost-effectiveness ratios for Interceptor® G2, Royal Guard®, and piperonyl butoxide ITNs in comparison to standard pyrethroid-only ITNs, based on incidence rate ratios calculated from routine data.ConclusionsEvidence of the effectiveness and cost-effectiveness of the dual-AI ITNs from these pilot studies will complement evidence from two contemporary cluster randomized control trials, one in Benin and one in Tanzania, to provide key information to malaria control programmes, policymakers, and donors to help guide decision-making and planning for local malaria control and elimination strategies. Understanding the breadth of contexts where these dual-AI ITNs are most effective and collecting robust information on factors influencing comparative effectiveness could improve uptake and availability and help maximize their impact.

Sensitivity and representativeness of one-health surveillance for diseases of zoonotic potential at health facilities relative to household visits in rural Guatemala

Most human and animal disease notification systems are unintegrated and passive, resulting in underreporting. Active surveillance can complement passive efforts, but because they are resource-intensive, their attributes must be evaluated. We assessed the sensitivity and representativeness of One-Health surveillance conducted at health facilities compared to health facilities plus monthly household visits in three rural communities of Guatemala.From September 2017 to November 2018, we screened humans for acute diarrheal, febrile and respiratory infectious syndromes and canines, swine, equines and bovines for syndromic events or deaths. We estimated the relative sensitivity as the incidence rate ratio of detecting an event in health facility surveillance compared to household surveillance from Poisson models. We used interaction terms between the surveillance method and sociodemographic factors or time trends to assess effect modification as a measure of relative representativeness. We used generalized additive models with smoothing splines to model incidence over time by surveillance method.We randomized 216 households to health facility surveillance and 198 to health facility surveillance plus monthly household visits. Health facility surveillance alone was less sensitive than when combined with household surveillance by 0.42 (95% CI: 0.34, 0.53), 0.56 (95% CI: 0.39, 0.79), 0.02 (95% CI: 0.00, 0.10), 0.28 (95% CI: 0.15, 0.50) and 0.22 (95% CI: 0.03, 0.92) times for human acute infections, human severe acute infections, and deaths in canines, swine and equines, respectively. Health facility surveillance alone underrepresented Spanish speakers (interaction p-value = 0.0003) and persons in higher economic assets (interaction p-values = 0.0008). The trend in incidence over time was different between the two study groups, with a larger decrease in the group with household surveillance (all interaction p-values <0.10).Surveillance at health facilities under ascertains syndromes in humans and animals which leads to underestimation of the burden of zoonotic disease. The magnitude of under ascertainment was differentially by sociodemographic factors, yielding an unrepresentative sample of health events. However, it is less time-intensive, thus might be sustained over time longer than household surveillance. The choice between methodologies should be evaluated against surveillance goals and available resources.

Spatio-temporal associations between deforestation and malaria incidence in Lao PDR.

As countries in the Greater Mekong Sub-region (GMS) increasingly focus their malaria control and elimination efforts on reducing forest-related transmission, greater understanding of the relationship between deforestation and malaria incidence will be essential for programs to assess and meet their 2030 elimination goals. Leveraging village-level health facility surveillance data and forest cover data in a spatio-temporal modeling framework, we found evidence that deforestation is associated with short-term increases, but long-term decreases confirmed malaria case incidence in Lao People's Democratic Republic (Lao PDR). We identified strong associations with deforestation measured within 30 km of villages but not with deforestation in the near (10 km) and immediate (1 km) vicinity. Results appear driven by deforestation in densely forested areas and were more pronounced for infections with Plasmodium falciparum (P. falciparum) than for Plasmodium vivax (P. vivax). These findings highlight the influence of forest activities on malaria transmission in the GMS.

Integrated disease surveillance and response implementation in Liberia, findings from a data quality audit, 2017.

Introductionin spite of the efforts and resources committed by the division of infectious disease and epidemiology (DIDE) of the national public health institute of Liberia (NPHIL)/Ministry of health to strengthening integrated disease surveillance and response (IDSR) across the country, quality data management system remains a challenge to the Liberia NPHIL/MoH (Ministry of health), with incomplete and inconsistent data constantly being reported at different levels of the surveillance system. As part of the monitoring and evaluation strategy for IDSR continuous improvement, data quality assessment (DQA) of the IDSR system to identify successes and gaps in the disease surveillance information system (DSIS) with the aim of ensuring data accuracy, reliability and credibility of generated data at all levels of the health system; and to inform an operational plan to address data quality needs for IDSR activities is required.Methodsmulti-stage cluster sampling that included stage 1: simple random sample (SRS) of five counties, stage 2: simple random sample of two districts and stage 3: simple random sample of three health facilities was employed during the study pilot assessment done in Montserrado County with Liberia institute of bio medical research (LIBR) inclusive. A total of thirty (30) facilities was targeted, twenty nine (29) of the facilities were successfully audited: one hospital, two health centers, twenty clinics and respondents included: health facility surveillance focal persons (HFSFP), zonal surveillance officers (ZSOs), district surveillance officers (DSOs) and County surveillance officers (CSOs).Resultsthe assessment revealed that data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the subnational level. The findings indicated the following: 23% (7/29) of health facilities having dedicated phone for reporting, 20% (6/29) reported no cell phone network, 17% (5/29) reported daily access to internet, 56.6% (17/29) reported a consistent supply of electricity, and no facility reported access to functional laptop. It was also established that 40% of health facilities have experienced a stock out of laboratory specimens packaging supplies in the past year. About half of the surveyed health facilities delivered specimens through riders and were assisted by the DSOs. There was a large variety in the reported packaging process, with many staff unable to give clear processes. The findings during the exercise also indicated that 91% of health facility staff were mentored on data quality check and data management including the importance of the timeliness and completeness of reporting through supportive supervision and mentorship; 65% of the health facility assessed received supervision on IDSR core performance indicator; and 58% of the health facility officer in charge gave feedback to the community level.Conclusionpublic health is a data-intensive field which needs high-quality data and authoritative information to support public health assessment, decision-making and to assure the health of communities. Data quality assessment is important for public health. In this review completeness, accuracy, and timeliness were the three most-assessed attributes. Quantitative data quality assessment primarily used descriptive surveys and data audits, while qualitative data quality assessment methods include primarily interviews, questionnaires administration, documentation reviews and field observations. We found that data-use and data-process have not been given adequate attention, although they were equally important factors which determine the quality of data. Other limitations of the previous studies were inconsistency in the definition of the attributes of data quality, failure to address data users’ concerns and a lack of triangulation of mixed methods for data quality assessment. The reliability and validity of the data quality assessment were rarely reported. These gaps suggest that in the future, data quality assessment for public health needs to consider equally the three dimensions of data quality, data use and data process. Measuring the perceptions of end users or consumers towards data quality will enrich our understanding of data quality issues. Data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the sub national level.

Investigation of a typhoid fever epidemic in Moyale Sub-County, Kenya, 2014\u20132015

AimTyphoid fever is a vaccine-preventable bacterial disease that causes significant morbidity and mortality throughout Africa. This paper describes an upsurge of typhoid fever cases in Moyale Sub-County (MSC), Kenya, 2014–2015.MethodsWe conducted active hospital and health facility surveillance and laboratory and antimicrobial sensitivity testing for all patients presenting with headache, fever, stomach pains, diarrhea, or constipation at five MSC health facilities between December 2014 and January 2015. We also conducted direct observation of the residential areas of the suspected cases to assess potential environmental exposures and transmission mechanisms. Demographic, clinical, and laboratory data were entered into, and descriptive statistics were calculated with, MS Excel.ResultsA total of 317 patients were included in the study, with mean age 24 ± 8.1 years, and 51% female. Of the 317 suspect cases, 155 (49%) were positive by Widal antigen reaction test. A total of 188 (59%) specimens were subjected to culture and sensitivity testing, with 71 (38%) culture positive and 54 (76%), 43 (60%), and 33 (46%) sensitive to ceftriaxone, cefuroxime, and ciprofloxacin, respectively. Environmental assessments through direct observations showed that commercial and residential areas had limited (1) clean water sources, (2) latrines, and (3) hygiene stations for street food hawkers and their customers.ConclusionsTyphoid fever is endemic in MSC and causes significant disease across age and sex groups. The local health department should develop policies to (1) assure community access to potable water and hygiene stations and (2) vaccinate specific occupations, such as food and drink handlers, against typhoid.

Rapid improvements to rural Ugandan housing and their association with malaria from intense to reduced transmission: a cohort study

SummaryBackgroundRapid population growth in Africa requires an urgent expansion and improvement of housing options. Improving housing presents a promising opportunity for malaria control by reducing indoor exposure to mosquitoes. We measured recent changes in house design in rural Uganda and evaluated their association with malaria in relation to a mass scale-up of control efforts.MethodsThis analysis was part of a cohort study designed to compare temporal changes in malaria incidence from a cohort of children and adults with temporal changes in malaria test positivity rate from health facility surveillance. All children aged 6 months to 10 years (n=384) living in 107 households in Nagongera sub-country, Tororo, Uganda, were given long-lasting insecticide-treated nets and followed between Aug 19, 2011, and June 30, 2017. Repeat rounds of indoor residual spraying of insecticide were initiated on Dec 5, 2014. Socioeconomic data were collected at two timepoints (Sept 25–Oct 9, 2013 and June 21–July 11, 2016) and houses were classified as modern (cement, wood, or metal walls, tiled or metal roof, and closed eaves) or traditional (all other homes). Associations between house design and three outcomes were evaluated before and after the introduction of indoor residual spraying: human biting rate estimated monthly in each household using US Centers for Disease Control and Prevention light traps; parasite prevalence measured routinely by microscopy every 3 months before indoor residual spraying and monthly after indoor residual spraying; and malaria incidence measured by passive surveillance.FindingsThe implementation of indoor residual spraying was associated with significant declines in human biting rate (33·5 vs 2·7 Anopheles per house per night after indoor residual spraying, p<0·0001), parasite prevalence (32·0% vs 14·0%, p<0·0001), and malaria incidence (3·0 vs 0·5 episodes per person-year at risk, p<0·0001). The prevalence of modern housing increased from 23·4% in 2013 to 45·4% in 2016 (p=0·001). Compared with traditional houses, modern houses were associated with a 48% reduction in human biting rate before indoor residual spraying (adjusted incidence rate ratio [aIRR] 0·52, 95% CI 0·36–0·73, p=0·0002), and a 73% reduction after indoor residual spraying (aIRR 0·27, 0·17–0·42, p<0·0001). Before indoor residual spraying, there was no association between house type and parasite prevalence, but after indoor residual spraying there was a 57% reduction in the odds of parasitaemia in modern houses compared with traditional houses, controlling for age, sex, and socioeconomic position (adjusted odds ratio 0·43, 95% CI 0·24–0·77, p=0·004). House type was not associated with malaria incidence before or after indoor residual spraying.InterpretationHouse design improved rapidly in rural Uganda and was associated with additional reductions in mosquito density and parasite prevalence following the introduction of indoor residual spraying. Changes to house design in endemic Africa, including closing eaves and the replacement of traditional building materials, might help further the gains achieved with more widely accepted malaria control interventions.FundingUS National Institutes of Health, Bill & Melinda Gates Foundation, and Medical Research Council UK.

Trends and spatial distribution of animal bite injuries and rabies deaths in Uganda, 2013-2015

Introduction : rabies is one of the most deadly infectious diseases, with a case fatality rate approaching 100%. Despite availability of effective post exposure treatment, rabies still kills 50,000 to 60,000 people worldwide each year, majority of whom in the developing world. There is paucity of information on burden and trends of rabies in developing countries to guide planning processes and rabies control strategies. We analyzed surveillance data on animal bite injuries, a proxy of rabies, to describe trends and geographical distribution of animal bites and deaths due to suspected rabies in Uganda. We described trends and geographical distribution of animal bite injuries and rabies suspected deaths in Uganda from 2013 to 2015. Methods : we retrospectively analyzed health facility surveillance data collected from January 2013 to December 2015. We used line graphs to describe monthly trends and used logistical regression to test significance of observed trends at p Results : a total of 55,592 cases of animal bites were reported during the study period of which 25% (n=13,869) were in Central region, 15% (n=8,488) in Eastern region, 38% (n=21,239) in Northern region and 22% (n=11,996) in Western region. Up to 59% of animal bite injuries were inflicted on males and 80% were persons aged above 5 years. The overall incidence of animal bites was 285 bites per 100,000 population in Northern region, 141 per 100,000 in Central region, 130 per 100,000 in Western region and 91 per 100,000 in Eastern region. Cases of animal bites increased significantly in all regions of the country (p Conclusion : the increase in number of animal bite injuries implies that rabies remains an important public health challenge in Uganda which requires special attention at all levels of planning. There is need to strengthen surveillance and rabies prevention and control strategies to address this public health problem.

Gender Dimensions of Acute Flaccid Paralysis Surveillance in Nigeria

Gender Dimensions of Acute Flaccid Paralysis Surveillance in Nigeria Abdullahi Walla Hamisu, G.C. Onyemelukwe, Sume Etapelong Gerald, Isiaka Ayodeji Hassan, Braka Fiona, Richard Banda, Ajiboye Oyetunji, Alemu W, Faisal Shuaib Abstract Background: After nearly two years without reporting any case of Wild Poliovirus (WPV), Nigeria has of recent (2016) witnessed a setback in its struggle to eradicate polio. Four cases of Acute Flaccid Paralysis (AFP) from three Local Government Areas (LGAs) of the security challenged state of Borno were confirmed as WPV cases with the latest case having a date of onset of paralysis on 21st August, 2016. A case of circulating Vaccine Derived Poliovirus type 2 (cVDPV2) from a healthy contact of one of the WPV cases was confirmed. In addition, cVDPV2 was confirmed in a sample from one of the seven environmental sample collection sites in Borno. Another case of cVDPV2 with date of onset of paralysis on 28thOctober 2016 was confirmed in Sokoto state. Gender inequities and inequalities are a major cause of inequity in health. Gender equality in health means that women and men have equal chances of realizing their full rights and potential to be healthy, and contribute to health development. It is therefore important to mainstream gender dimension in the engagement of women through improving their employability in the disease surveillance sector of public health. Objectives: The objective of this study is to determine whether there is gender disparity among boys and girls in the incidence of reported AFP cases in Nigeria during the reporting period (2007-2016); and also to identify any gender bias among male and females in the number of AFP surveillance workforce. Methods: We conducted a retrospective review of reported AFP cases in Nigeria between 2007 and 2016 from the AFP database at the World Health Organization Country Office. We conducted gender analysis of the datato identify any inequities and subjected any observed difference to a statistical test of significance. We also conducted literature search on gender dimensions of AFP surveillance. Results: The AFP detection rate in Nigeria has consistently increased from 2007 to 2016, with the highest number of AFP cases reported being 17,867 in 2016. Of the total AFP cases reported, 81.5% and 18.5% were under and over five years of age respectively. The proportion of male and female AFP cases that were under five years was 81% and 82% respectively. There was a consistent decline in the proportion of OPV zero dose AFP cases with the least (0.3%) 2016. There was increase in the proportion of 3+ OPV doses with the highest (91%) also in 2016. In the year 2016, there were more male (29) state epidemiologists than females (8), more male (23) state DSNOs than females (14), more male (609) LGA DSNOs the females (218) and more male (543) LGA assistant DSNOs than females (274). The number of health facility surveillance focal persons however is almost equal in both sexes (2814 males Vs 2879 females). Conclusion: There was no gender disparity among boys and girls in the incidence of reported AFP cases and in their status of OPV immunization. Gender disparity however exists at the disadvantage of females with regards to the number of key personnel involved in the conduct of surveillance activities. Mainstreaming gender sues in the health human resource policy and planning in states and LGAs to enable engagement of more women in the disease surveillance sector of public health is crucial. Full Text: PDF DOI: 10.15640/ijgws.v5n2a8

Assessment of the usefulness of integrated disease surveillance and response on suspected ebola cases in the Brong Ahafo Region, Ghana.

BackgroundThis 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.MethodsData 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.ResultsThe 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.ConclusionGhana 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 materialThe online version of this article (doi:10.1186/s40249-015-0051-3) contains supplementary material, which is available to authorized users.

Healthcare-seeking Behaviour for Common Infectious Disease-related Illnesses in Rural Kenya: A Community-based House-to-house Survey

Community surveys of healthcare-use determine the proportion of illness episodes not captured by health facility-based surveillance, the methodology used most commonly to estimate the burden of disease in Africa. A cross-sectional survey of households with children aged less than five years was conducted in 35 of 686 census enumeration areas in rural Bondo district, western Kenya. Healthcare sought for acute episodes of diarrhoea or fever in the past two weeks or pneumonia in the past year was evaluated. Factors associated with healthcare-seeking were analyzed by logistic regression accounting for sample design. In total, 6,223 residents of 981 households were interviewed. Of 1,679 children aged less than five years, 233 (14%) had diarrhoea, and 736 (44%) had fever during the past two weeks; care at health facilities was sought for one-third of these episodes. Pneumonia in the past year was reported for 64 (4%) children aged less than five years; 88% sought healthcare at any health facility and 48% at hospitals. Seeking healthcare at health facilities was more likely for children from households with higher socioeconomic status and with more symptoms of severe illness. Health facility and hospital-based surveillance would underestimate the burden of disease substantially in rural western Kenya. Seeking healthcare at health facilities and hospitals varied by syndrome, severity of illness, and characteristics of the patient.

Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal

Objective To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services. Methods Implemented in one district in Nepal. The primary measure of performance was uterotonic protection after childbirth, measured using pre- and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy. Results Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas. Conclusion Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged.

Mumps caused by an inadequately attenuated measles, mumps and rubella vaccine.

Reports of mumps following measles, mumps and rubella (MMR) immunization. To determine whether mumps was caused by immunization or whether there was a concurrent epidemic of a wild strain of mumps. Analysis of surveillance data and a cohort study of three schools that participated in the campaign. Cases of clinical mumps and orchitis, and immunization history and records were reviewed. The MMR vaccine was produced by the Serum Institute of India and contained the Leningrad-Zagreb strain of mumps virus. Four lots were used in the specific immunization campaign. Sentinel health facility surveillance showed an increase in mumps after two school immunization campaigns in western Suriname and a mass immunization campaign in the same region. There was also an increase in a geographically separate region following a mass campaign with the same vaccine. Three hundred fifteen children from three schools that were targeted in the immunization campaign were interviewed. The attack rate for mumps in those immunized was 15.1%; in those not immunized, the attack rate was 4.7%. In the affected males, the attack rate for orchitis was five of 19 (21%). Assuming 90% protection by the MMR vaccine, the incidence ratio (observed to expected) was 32. The mumps outbreak was caused by an inadequately attenuated MMR vaccine. Because this vaccine had not been used in these populations before in Suriname, it was not possible to determine wether the outbreak was due the virulence of the Leningrad-Zagreb mumps strain or due to production problems with one or more specific lots of vaccine. The vaccine was withdrawn from further use.

Sexually transmitted disease syndromes in rural South Africa. Results from health facility surveillance.

Surveillance for sexually transmitted diseases (STD) is important for priority setting, service development, and evaluating interventions. To conduct health facility-based surveillance for STDs to inform design of a control program and to provide baseline measures for evaluation of interventions. Surveillance system for patients with STD syndromes in public and private sector health facilities in Hlabisa, South Africa. Over a 5-month period, 4,781 patients with an STD were reported, 3,126 (65%) by clinics and 1,655 (35%) by general practitioners; 2,582 (54%) were in men. Most were diagnosed with a single syndrome. Discharge was most common (49% of both male and female patients), followed by ulcer (36% of men and 14% of women). Mean symptom duration was 18 days for women and 10 days for men (p < 0.0001). A quarter reported having another STD in the previous 3 months. The highest age-specific incidence was estimated at 16.4% among women 20 to 24 years of age. The burden of STDs is high in rural South Africa. There is considerable scope for improved disease control, and the private sector has an important role to play.