Health Surveillance System Research Articles

Dietary patterns and their socioeconomic factors of adherence among adults in urban Burkina Faso: a cross-sectional study

BackgroundSub-Saharan African populations undergo a nutrition transition towards diets associated with increased risk for metabolic and cardiovascular diseases. For targeted prevention, we aimed to characterize dietary patterns and determine their sociodemographic factors of adherence.MethodsWe recruited 1,018 adults aged > = 25 years from two formal and three informal settlements within the Health and Demographic Surveillance System, Ouagadougou, Burkina Faso, between February and April 2021. In a cross-sectional sample, a culture-specific food-propensity questionnaire with 134 food items and a sociodemographic questionnaire were used to collect the data. Exploratory dietary patterns were derived using principal component analysis, and sociodemographic factors of adherence were calculated using multivariable linear regression models.ResultsIn this study population (median age: 42 years, interquartile range 21 years; male: 35.7%), the diet relied on starchy foods and other plant-based staples with rare consumption of animal-based products. We identified three dietary patterns, explaining 10.2%, 9.8%, and 8.9% of variation in food intake, respectively: a meat and egg-based pattern associated with younger age, male sex, better education, and economic situation; a fish-based pattern prevailed among women, higher educational levels, and better economic situation; and a starchy food-based was associated with younger age and sharing a home with other adults.ConclusionsThis study population is at an early stage of the nutrition transition and shows low intakes of health-beneficial food groups. Yet, progress along the nutrition transition varies according to age, educational attainment, and economic status. Particularly, younger and well-off people seem to adhere more strongly to diets high in animal-based products. These findings can inform strategies in public health nutrition for sub-Saharan African populations.

Accelerating the healing of hard-to-heal wounds with food supplements: nutritional analysis in the Côte d'Ivoire.

Hard-to-heal wounds are an important, yet often neglected, public health issue in low- and middle-income countries (LMICs). Malnutrition has been identified as a risk factor for prolonged healing times. However, nutritional supplements are not routinely provided for patients with hard-to-heal wounds, and so this study aimed to investigate their benefits. This 9-month study was conducted in the Taabo Health and Demographic Surveillance System in the south-central part of Côte d'Ivoire. Patients with wounds (≥30mm2) were recruited. Treatment was standardised for inpatients (72%) and outpatients (28%). There were three intervention groups: supplemented with soy; orange flesh sweet potato (OFSP); or both. Another group was included without supplement, serving as control. General linear models were employed to assess the effects of log initial wound size, type of wound, food treatment group, haemoglobin, sex, age, place of treatment and body mass index on the rate of wound closure. The cohort consisted of 56 patients, 41 of whom were placed in intervention groups, and the remainder as controls. Within the cohort, 37 (66%) patients suffered from Buruli ulcer, 15 (27%) from traumatic wounds and four (7%) from erysipelas. We found a significant effect (p=0.004) of diet supplemented with OFSP on the wound healing rate. OFSP is a nutritional rehabilitation supplement, characterised by a high content of beta-carotene and carbohydrates. It is associated with shortened wound healing times, reduced discomfort and reduced cost of wound care. Further research should investigate the effect of a diet rich in beta-carotene, in combination with standard medical care, on hard-to-heal wound healing in LMICs.

Development, implementation, and evaluation of a local community-based ophthalmology sentinel surveillance system in a remote rural area in Japan.

Solid and sensitive infectious disease surveillance systems need to be developed and implemented to prevent and control epidemics. Although statutory national infectious disease surveillance systems have been developed in many countries, some challenges remain, such as their limited timeliness, representativeness, and sensitivity, as well as the fact that they cannot capture all local outbreaks that occur in small communities. To overcome these limitations, local community-based infectious disease surveillance systems that meet local needs and can operate with constrained resources need to be developed, especially in remote and rural low-resource areas. This study aimed to develop, implement, and evaluate a voluntary and unique local community-based ophthalmology sentinel surveillance system in Isa city (OSSS-Isa), a remote rural area in Japan. For the development of OSSS-Isa, one hospital in Isa city assumed a leading role and developed a network with all medical institutions - 20 hospitals and clinics in the local community, including two ophthalmology clinics - as sentinel reporting sites. Surveillance was conducted on a weekly basis from Monday to Sunday. The collection, aggregation, and reporting of the surveillance data were implemented promptly on the same day, Monday, using a paper-based form and fax. For the evaluation of OSSS-Isa, the study followed the updated guidelines for evaluating public health surveillance systems proposed by the Centers for Disease Control and Prevention to select the evaluation criteria and develop a questionnaire. The questionnaires were then distributed to 20 hospitals and clinics, with the responses evaluated on a five-point Likert scale. For the implementation of OSSS-Isa, the system issued alerts twice to the networked hospitals and clinics when signs of an increase in the prevalence of a target infectious eye disease appeared in Isa city. After the alerts, the number of cases decreased in the community. Regarding the evaluation survey, physicians from 18 hospitals and clinics responded to the questionnaire (response rate 90%). In contrast to flexibility, more than 75% of the respondents gave high ratings to simplicity, data quality, acceptability, timeliness, and stability in evaluating OSSS-Isa, with the mean score for these evaluation criteria higher than 3.67. The present results indicate that OSSS-Isa has high simplicity, data quality, acceptability, timeliness, and stability, which is highly embedded with the local healthcare providers in Isa city. OSSS-Isa contributed to the early and accurate detection of signs of infectious eye disease outbreaks emerging in a small remote rural local community. The success factors seem to include its simple well-designed implementation methods, good external factors, and active human factors suited to the characteristics of the small remote rural community. The OSSS-Isa initiative appears to be a meaningful practical example of successful health advocacy by healthcare providers by developing a system at the local social level while going beyond the boundaries of routine medical practice. If voluntary small-scale surveillance systems can complement statutory large-scale ones and work together locally, nationally, and internationally, it might be possible to detect small, unusual happenings that occur in the community, such as emerging infectious diseases, and thereby help avert global outbreaks.

Development of the Longitudinal Study of Health and Ageing in Kenya (LOSHAK).

In Kenya, the number of adults aged ≥60 is expected to nearly quadruple by 2050, making it one of the most rapidly aging countries in Sub-Saharan Africa (SSA). Accordingly, we designed the Longitudinal Study of Health and Ageing in Kenya (LOSHAK) to generate novel data to address the health and economic consequences of this demographic transition. Specifically, LOSHAK will investigate the social, economic, environmental, biological, and policy processes that shape late-life health and economic well-being in Kenya. Modeled on the U.S. Health and Retirement Study (HRS), LOSHAK joins a network of harmonized studies on aging in >45 countries worldwide; however, LOSHAK will be only the 2nd such study in SSA. The current feasibility and pilot phase of LOSHAK will validate measures and data collection procedures in a purposive sample of Kenyan adults aged ≥45 years. We have linguistically and culturally translated instruments while aiming to maintain harmonization with both existing HRS network studies and the ongoing Kenya Life Panel Survey. The current phase of LOSHAK is nested within the Kaloleni/Rabai Community Health and Demographic Surveillance System on the coast of Kenya. LOSHAK will advance population aging research in low- and middle-income countries through the study of (a) biomarkers and physiological measures; (b) the impacts of air pollution and climate vulnerability; (c) Alzheimer's disease and related dementias, mental health, disability, caregiving, and psychosocial wellbeing; and (d) economic security, including the impact of social welfare. LOSHAK will inform future public health and economic policy to address challenges related to rapid aging in Kenya and throughout SSA. Accordingly, this paper aims to introduce and provide a description of LOSHAK and its aims and objectives, as well as to inform the scientific community of current study activities being used to build toward the full population-representative study.

Evaluation of the Design and Development of the HeLe Newborn Hearing Screening Tele-Audiology Systems for the Philippines

Introduction. There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, “Hearing for Life’’ Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines.Objective. As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe.Methods. The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review.Results. The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, “technologies are validated in a relevant environment”. The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public healthsurveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research.Conclusions. Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technologybased NHS system, HeLe is a potentially powerfultool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics,NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/county or subnational health departments for policy andresource mobilization to better manage those identified with congenital hearing loss.

Age and socio-economic status affect dengue and COVID-19 incidence: spatio-temporal analysis of the 2020 syndemic in Buenos Aires City.

In early 2020, Argentina experienced the worst dengue outbreak in its history, concomitant with first-to-date increasing COVID-19 cases. Dengue epidemics in temperate Argentina have already been described as spatially heterogeneous; in the previous 2016 outbreak, transmission occurred 7.3 times more frequently in slums compared to the rest of Buenos Aires City (CABA). These informal settlements have deficient sanitary conditions, precarious housing and high incidence of social vulnerabilities. The purpose of this work was to study the spatio-temporal patterns of the 2020 dengue epidemic in CABA in relation to socio-economic living conditions of its inhabitants and its interaction with the onset of COVID-19. The study considered the period between Jan 1st and May 30th 2020. Dengue and COVID-19 databases were obtained from the National Health Surveillance System; each record was anonymized and geo-localized. The city was divided according to census tracts and grouped in four socio-economic strata: slums, high, mid and low residential. An aligned-rank transform ANOVA was performed to test for differences in the incidence of dengue and COVID-19, and age at death due to COVID-19, among socio-economic strata, four age categories and their interaction. The incidence by cluster was calculated with a distance matrix up to 600 m from the centroid. Spatial joint dengue and COVID-19 risk was estimated by multiplying the nominal risk for each disease, defined from 1 (low) to 5 (high) according to their quantiles. During the study period, 7,175 dengue cases were registered in CABA (incidence rate 23.3 cases per 10,000 inh), 29.2% of which occurred in slums. During the same period, 8,809 cases of COVID-19 were registered (28.6 cases per 10,000 inh); over half (51.4%) occurred in slums, where the median age of cases (29 years old) was lower than in residential areas (42 years old). The mean age of the deceased was 58 years old in slums compared to 79 years old outside. The percentage of deaths in patients under 60 years old was 56% in slums compared to 8% in the rest of the city. The incidence of both diseases was higher in slums than in residential areas for most age categories. Spatial patterns were heterogeneous: dengue presented higher incidence values in the southern sector of the city and the west, and low values in highly urbanized quarters, whereas COVID-19 presented higher values in the east, south, high populated areas and slums. The lowest joint risk clusters were located mainly in high residential areas, whereas high joint risk was observed mainly in the south, some western clusters, the historical part of the city and center north. The social epidemiological perspective of dengue and COVID-19 differed, given that socio environmental heterogeneity influenced the burden of both viruses in a different manner. Despite the overwhelming effect of the COVID-19 pandemic, health care towards other diseases, especially in territories with pre-existing vulnerabilities, should not be unattended.

Association between contextual factors and coverage of the Acwy meningococcal vaccine, after three years of its overdue, in the vaccination calendar of adolescents in the state of Minas Gerais, Brazil: global space regressions

The objective of the study was to analyze the spatial distribution of vaccination coverage of bacterial meningitis vaccine: A, C, W and Y (menacwy) and identify the association between socioeconomic and social environment factors with menacwy vaccine coverage among adolescents in the state of Minas Gerais (MG), Brazil. This is an ecological, mixed study, conducted with secondary data from the 853 municipalities of the State of MG, Brazil, from 2020 to 2022, provided by the information system of the National Immunization Program. For spatial statistical analysis, spatial dependence and the presence of spatial clusters formed by municipalities with high and low vaccination coverage of Menacwy were evaluated. In the year 2021, MG presented the largest vaccination coverage (60.58%) since the introduction of the Menacwy vaccine by the PNI. Regarding the analysis of global regressions, it is observed that for the year 2020, as the MG Index of Social Responsibility-Health increased and MG Index of Social Responsibility—Public Security increased, increased the vaccination coverage of the municipalities of the Menacwy vaccine. Finally, compared to 2021, similar association was observed in relation to the proportion of the population served by the Family Health Strategy of the municipalities of the state of MG and per capita spending on education activities: as this indicator increased, with increased coverage of the Vaccine of the Menacwy vaccine of the state municipalities. They reinforce the importance of assessing the quality-of-care management and health surveillance system, professional training, and damage reduction to populations, especially adolescents.

Dynamic household structure and composition: a manual for longitudinal analysis of living arrangements

ObjectiveThis research note introduces a set of tools to conduct analysis of household structure and composition with either limited or comprehensive longitudinal data. The data used here are from Health and Demographic Surveillance Systems in Africa, but the methods can be adapted and applied to other longitudinal micro-data such as register data. A training manual describing the procedures for creating time-varying household measures step-by-step is supplied as supplementary material to this note. Code is provided in STATA but can easily be translated for other statistical software, and the logic for each step remains the same.ResultsThe analysis of household structure demonstrates how with limited data (such as a household identifier), it is possible to construct time-varying measures of household membership, including household size or the number of members in specific age and sex groups. The analysis of household composition demonstrates how with expanded data (including links to parents in addition to residence status in the same household), it is possible to construct time-varying measures of household membership of specific kin, i.e. mother, sibling or grandparent. The results illustrated in this research note are a taste of what can be achieved by following the training manual in the supplementary material.

Patterns and trends in household food security in rural Mpumalanga Province, South Africa

ABSTRACT This study examines patterns and trends in household food security in Bushbuckridge, Mpumalanga Province, South Africa, from 2010 to 2019. We use data from a household panel nested in the Agincourt Health and Socio-Demographic Surveillance System. Findings indicate that there have been improvements in household food security in this rural setting over the last decade. By polychoric principal component analysis, an aggregate food security index was constructed and we observed a small, yet important, proportion of households (7.8%) that remained chronically food insecure. An ordered probit model was used to estimate the determinants of food security. Findings reveal that the observed differences in household food security status are as a result of differences in socioeconomic status. We therefore recommend that focus must be placed on identifying economic opportunities and empowering the chronically food insecure households if universal household food security is to be attained in rural South Africa and beyond.

Detection of plasma anti-lipopolysaccharide (LPS) antibodies against enterohemorrhagic Escherichia coli (EHEC) in asymptomatic kindergarten teachers from Buenos Aires province

In Argentina, hemolytic uremic syndrome (HUS) caused by EHEC has the highest incidence in the world. EHEC infection has an endemo-epidemic behavior, causing 20–30% of acute bloody diarrhea syndrome in children under 5 years old. In the period 2016–2020, 272 new cases per year were notified to the National Health Surveillance System. Multiple factors are responsible for HUS incidence in Argentina including person-to-person transmission. In order to detect possible EHEC carriers, we carried out a preliminary study of the frequency of kindergarten teachers with anti-LPS antibodies against the most prevalent EHEC serotypes in Argentina. We analyzed 61 kindergarten teachers from 26 institutions from José C. Paz district, located in the suburban area of Buenos Aires province, Argentina. Fifty-one percent of the plasma samples had antibodies against O157, O145, O121 and O103 LPS: 6.4% of the positive samples had IgM isotype (n=2), 61.3% IgG isotype (n=19) and 32.3% IgM and IgG (n=10). Given that antibodies against LPS antigens are usually short-lived specific IgM detection may indicate a recent infection. In addition, the high percentage of positive samples may indicate a frequent exposure to EHEC strains in the cohort studied, as well as the existence of a large non-symptomatic population of adults carrying pathogenic strains that could contribute to the endemic behavior through person-to-person transmission. The improvement of continuous educational programs in kindergarten institutions could be a mandatory measure to reduce HUS cases not only in Argentina but also globally.

A survey of performance of public health risk assessment in emergencies of institutions for disease control and prevention at different levels in China

Objective: To understand the performance of public health risk assessment in emergencies of institutions for disease control and prevention at different levels in China, and provide suggestions for the improvement of public health risk assessment. Methods: A self-administered survey was conducted in professionals involved in public health risk assessment in emergencies from national institution, provincial institutions and some prefectural institutions for disease control and prevention (1-2 prefectural institutions were selected using convenience sampling in each province) between March and April in 2021. Results: A total of 79 institutions for disease control and prevention were investigated, including 1 national institution, 32 provincial institutions and 46 prefectural institutions. By April 2021, all the 79 institutions surveyed had conducted risk assessment of public health emergencies, in which 61 (77.2%) had established departments responsible for the public health risk assessment, i.e. emergency management office or communicable disease prevention and control office (section), and regular risk assessment mechanisms. The main sources of information for public health risk assessment were public health surveillance systems, including the National Notifiable Diseases Reporting System (100.0%) and Public Health Emergencies Management Information System (97.5%). Compared with the provincial institutions, the prefectural institutions were more likely to use specific disease surveillance systems (84.8% vs. 62.5%; χ2=5.09, P=0.024). The risk management recommendations made by 43 institutions for disease control and prevention (54.4%) after the risk assessment were accepted by the superior health administrative departments and used in epidemic prevention and control. Conclusions: Public health risk assessment in emergencies has been widely carried out by national, provincial and prefectural institutions for disease control and prevention in China. Specialized departments and mechanisms have been established, but the information sources are still confined to public health surveillance systems and the application of the risk assessment results still needs to be further improved.

Components of Health Surveillance System in Natural Disasters that Affect Military Health Services: A Systematic Review.

Military health surveillance system, as the first responder in natural disasters, plays an important role in public health. This study aimed to identify those components of the health surveillance system, which influence military health services in natural disasters. Five databases of Medline, SCOPUS, Web of Science, ProQuest, Cochrane Library, and search engines of Scholar Google, scienceopen.com, openGery.eu, and WHO.int were reviewed from Jan 1990 to Jan 2022. Due to the heterogeneity of the included studies, various JBI quality assessment tools were applied and the extracted data were analyzed by meta-synthesis method. Out of 6538 retrieved studies, after the duplicates and irrelevant studies identified in screening stage were removed, 174 studies extracted from the electronic search of databases and 16 studies retrieved from the manual search of other sources were reviewed based on the study inclusion criteria. Finally, 24 studies with inclusion criteria were selected for data extraction. Ten criteria of monitoring, detecting, data collection and reporting, tracking, type of surveillance system, operational readiness, coordination and interaction, feasibility, flexibility, and acceptability were identified as effective components in the surveillance system of military health services. The identified components were classified into two main categories of structural and operational components. The structural components of the military health surveillance system describe the important infrastructural features of the health surveillance system to preparing for natural disasters; and the operational components explains the effective functional features of military health surveillance system in response of natural disasters. The results of this study help policymakers in military health services implement a more effective health surveillance system in natural disasters.

Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study.

Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.

Knowledge, attitude and preventative practice of tuberculosis in rural communities of Dikgale, Mamabolo and Mothiba health and demographic surveillance system in Limpopo province, South Africa

BackgroundTuberculosis continues to be a serious public health issue. To reduce the transmission of the disease, it is imperative to address the major obstacle of inadequate understanding regarding the causes, risk factors, treatments, and prevention of pulmonary TB. The study assessed knowledge, attitude, and preventative practices of tuberculosis among community members in Dikgale, Mamabolo and Mothiba (DIMAMO) Health Demographic Surveillance system, Limpopo Province South Africa.MethodsA cross-sectional clinic-based survey involving 360 participants was conducted at clinics at Dikgale, Mamabolo and Mothiba (DIMAMO) Health and Demographic Surveillance System. A standardised questionnaire on socio-demographic, knowledge, attitude and preventative practices towards tuberculosis based on (WHO) KAP-TB template guidelines was used to collect data. Descriptive statistics on Statistical Package for Social Sciences (SPSS) version 27.0 was used to analyse data.ResultsThe results of the cross-sectional survey on KAP-TB illustrated that the participants have good knowledge, attitude, and perception of TB. Majority of the participants (n = 270, 75%) had good general knowledge, while (n = 90, 25%) had poor knowledge about TB. However, the study reports (n = 57, 15.6%) having knowledge of causative agents of TB. Participants showed a favourable attitude toward people who are infected with TB. 87% showed a favourable attitude while only 12.46% showed an unfavourable attitude towards TB. Participants showed a good practice of (71.7%) while (28.3%) of participants had poor practice towards TB.ConclusionHealth education interventions programme on TB needs to be intensified among the community members to improve TB awareness and reduce transmission. Focused educational interventions on TB aetiology and mode of transmission are required to increase TB preventative practices and improve health-seeking behaviour among community members.

SARS-CoV-2 seroprevalence and implications for population immunity: Evidence from two Health and Demographic Surveillance System sites in Kenya, February-December 2022.

We sought to estimate SARS-CoV-2 antibody seroprevalence within representative samples of the Kenyan population during the third year of the COVID-19 pandemic and the second year of COVID-19 vaccine use. We conducted cross-sectional serosurveys among randomly selected, age-stratified samples of Health and Demographic Surveillance System (HDSS) residents in Kilifi and Nairobi. Anti-spike (anti-S) immunoglobulin G (IgG) serostatus was measured using a validated in-house ELISA and antibody concentrations estimated with reference to the WHO International Standard for anti-SARS-CoV-2 immunoglobulin. HDSS residents were sampled in February-June 2022 (Kilifi HDSS N= 852; Nairobi Urban HDSS N= 851) and in August-December 2022 (N= 850 for both sites). Population-weighted coverage for ≥1 doses of COVID-19 vaccine were 11.1% (9.1-13.2%) among Kilifi HDSS residents by November 2022 and 34.2% (30.7-37.6%) among Nairobi Urban HDSS residents by December 2022. Population-weighted anti-S IgG seroprevalence among Kilifi HDSS residents increased from 69.1% (65.8-72.3%) by May 2022 to 77.4% (74.4-80.2%) by November 2022. Within the Nairobi Urban HDSS, seroprevalence by June 2022 was 88.5% (86.1-90.6%), comparable with seroprevalence by December 2022 (92.2%; 90.2-93.9%). For both surveys, seroprevalence was significantly lower among Kilifi HDSS residents than among Nairobi Urban HDSS residents, as were antibody concentrations (p< 0.001). More than 70% of Kilifi residents and 90% of Nairobi residents were seropositive for anti-S IgG by the end of 2022. There is a potential immunity gap in rural Kenya; implementation of interventions to improve COVID-19 vaccine uptake among sub-groups at increased risk of severe COVID-19 in rural settings is recommended.

Adult mortality trends in Matlab, Bangladesh: an analysis of cause-specific risks

ObjectiveWith socioeconomic development, improvement in preventing and curing infectious diseases, and increased exposure to non-communicable diseases (NCDs) risk factors (eg, overweight/obesity, sedentary lifestyle), the majority of adult deaths in Bangladesh...

Active Surveillance of Engineered Stone Workers Facilitates Early Identification of Silicosis: A Discussion of Surveillance of Occupational Lung Diseases.

Silicosis in workers exposed to respirable crystalline silica while fabricating engineered stone products is an emerging respiratory health issue. We describe silicosis in engineered stone workers in California and examine clinical features by the source of identification. Cases were identified passively using hospital-based patient discharge data or actively through outreach and medical testing following enforcement investigation. Outcomes were examined based on the source of case identification. We identified 18 cases diagnosed between 2006 and 2020. Cases identified passively compared to other identification methods were associated with lower percent predicted forced vital capacity (FVC) (P ≤ .01), forced expiratory volume in 1 s (FEV1) (P ≤ .01), and diffusing capacity of the lungs for carbon monoxide (DLCO) (P < .01) at the time of diagnosis and were more likely to be identified following death or lung transplant (P = .01). Our experience demonstrates delays in diagnosis and case identification when relying on passive surveillance methods. Enhanced public health surveillance systems can improve the early detection of occupational lung disease and inform future prevention policies.

One Health Surveillance System in Gujarat, India: A Health Policy and Systems Research Protocol for Exploring the Cross-Sectoral Collaborations to Detect Emerging Threats at the Human-Animal-Environment Interface.

The close interaction between humans, animals and the ecosystem has been a reason for the emergence and re-emergence of zoonotic diseases worldwide. Zoonoses are estimated to be responsible for 2.5 billion human illnesses and 2.7 million deaths worldwide. Gujarat is a western state in India with more than 65 million people and 26 million livestock, and includes surveillance systems for humans and animals; however, more evidence is needed on joint collaborative activities and their effect on the early warning response for zoonoses. Thus, this study aims to investigate sectoral collaborations for early warning and response systems for emerging and re-emerging zoonoses, aiming to develop a One Health surveillance (OHS) system in Gujarat, India. This case study uses policy content analysis followed by qualitative and quantitative data collection among state- and district-level surveillance actors to provide insight into the current cross-sectoral collaborations among surveillance actors. It helps identify triggers and documents factors helpful in strengthening cross-sectoral collaborations among these systems and facilitates the establishment of an OHS system in Gujarat, India.

Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation.

Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6% (95% CI 24.4%-36.8%) sensitive and 79.7% (95% CI 76.4%-82.9%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8% (95% CI 27.9%-41.7%) at >0 RNA copies/mL and increased to 75% (95% CI 60%-90%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US $144.50, which included transportation, labor, and materials expenses. The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data.

Provider-mother interactions are associated with birth outcome misclassifications in household surveys: A case-control study in Guinea-Bissau.

Approximately 4.4 million children die peripartum annually, primarily in low- and middle-income countries. Accurate mortality tracking is essential to prioritising prevention efforts but is undermined by misclassification between stillbirths (SBs) and early neonatal deaths (ENNDs) in household surveys, which serve as key data sources. We explored and quantified associations between peripartum provider-mother interactions and misclassification of SBs and ENNDs in Guinea-Bissau. Using a case-control design, we followed up on women who had reported a SB or ENND in a retrospective household survey nested in the Bandim Health Project's Health and Demographic Surveillance Systems (HDSS). Using prospective HDSS registration as the reference standard, we linked the survey-reported deaths to the corresponding HDSS records and cross-tabulated SB/ENND classification to identify cases (discordant classification between survey and HDSS) and controls (concordant classification). We further interviewed cases and controls on peripartum provider-mother interactions and analysed data using descriptive statistics and logistic regressions. We interviewed 278 women (cases: 63 (23%); controls: 215 (77%)). Most cases were SBs misclassified as ENNDs (n/N = 49/63 (78%)). Three-fourths of the interviewed women reported having received no updates on the progress of labour and baby's health intrapartum, and less than one-fourth inquired about this information. In comparison with births where women did inquire for information, misclassification was less likely when women did not inquire and recalled no doubts about progress of labour (odds ratio (OR) = 0.51; 95% confidence interval (CI) = 0.28-0.91), or baby's health (OR = 0.54; 95% CI = 0.30-0.97). Most women reported that service providers' death notifications lasted <5 minutes (cases: 23/27 (85%); controls: 61/71 (86%)), and most often encompassed neither events leading to the death (cases: 19/27 (70%); controls: 55/71 (77%)) nor causes of death (cases: 20/27 (74%); controls: 54/71 (76%)). Misclassification was more likely if communication lasted <1 compared to 1-4 minutes (OR = 1.83; 95% CI = 1.10-3.06) and if a formal service provider had informed the mother of the death compared to a family member (OR = 1.57; 95% CI = 1.04-2.36). Peripartum provider-mother interactions are limited in Guinea-Bissau and associated with birth outcome misclassifications in retrospective household surveys. In our study population, misclassification led to overestimated neonatal mortality.