Integrated Disease Surveillance And Response System Research Articles

Perceptions of Healthcare Workers on the Attributes of the Integrated Disease Surveillance and Response System in Zimbabwe.

To investigate healthcare workers' perceptions of the integrated disease surveillance and response (IDSR) strategy. A cross-sectional survey of healthcare workers (HCWs) was conducted from December 2021 to June 2022 to assess their perceptions of the IDSR system attributes. Of the 409 respondents, 12 (2.9%) reported no prior training on disease surveillance. The IDSR was deemed simple, acceptable, useful, and timely by most participants. There were sharp differences in perceptions of flexibility and simplicity between doctors and the other healthcare professionals. However, acceptability, timeliness, and usefulness were uniformly perceived. Healthcare workers with at least 11-years' experience perceived the usefulness of the IDSR system significantly higher than those with lesser years of experience. However, work experience did not have an impact on HCWs perceptions of the simplicity, timeliness, and flexibility of the IDSR system. Most healthcare workers have positive perceptions of the IDSR approach. However, there are reservations about how well the system can adapt to changing conditions and demands (flexibility) and how well it simplifies the implementation processes. These findings demonstrate the necessity of adopting cutting-edge strategies for capacity building as well as ongoing professional development of healthcare professionals responsible for the implementation of the IDSR strategy.

Assessment of the impact of integrated disease surveillance and response system on surveillance management at healthcare facilities in Pakistan.

Disease surveillance is very crucial especially in high vulnerability settings like Pakistan. However, surveillance and outbreak response management are still evolving in the country and research studies are needed to assess the existing system. To assess the impact of integrated disease surveillance and response system (IDSRS) implemented by the provincial government to strengthen infectious disease surveillance and reporting in 6 districts of Pakistan in 2016. A baseline cross-sectional assessment of health facilities and the healthcare workforce was conducted in 2016 to identify needs and gaps in public sector health facilities and the health system of 6 selected districts of Khyber Pakhtunkhwa Province, Pakistan. This was followed by a 2018 endline survey of the same facilities using the same variables. Overall, there was improvement in district management and facility level performance (χ2 (1, 314) = 21.19, P < 0.001, V = 0.26). District level management improved significantly in areas with relatively lower Gross Domestic Product (GDP)? χ2(1, 154) = 30.41, P <0.001, V = 0.44). Facilitation domain variables improved in the lower GDP districts (χ2 (1, 74) = 5.76, P = 0.016, V = 0.28) and showed counterintuitive deterioration (χ2 (1, 74) = 4.80, P = 0.028, V = 0.25) in relatively higher GDP areas. IDSRS is effective in improving surveillance and response systems, however, its effectiveness appears to depend on locale-specific economies and can be enhanced by modifying the implementation approach. Better empowerment of the local workforce can contribute to such improvement.

Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016-2023.

In 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023. We reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia's IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed. Between 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines. From 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response.

Usefulness of disease surveillance data in enhanced early warning of the cholera outbreak in Southwest Cameroon, 2018

IntroductionThis study assessed the timeliness and completeness of disease surveillance data for early warning of the cholera outbreak during the socio-political crisis of Southwest Cameroon in 2018. It determined how routine integrated disease surveillance and response (IDSR) data was used for preventative actions and the challenges faced by key health staff in IDSR based decision-making.MethodsThis was a mixed-methods study conducted from June 1st to September 30th 2021. District Health Information System 2 (DHIS2) data from January 2018 to December 2020 for the Southwest region of Cameroon were analysed using simple linear regression on EPI Info 7.2 to determine a potential association of the sociopolitical crisis with timeliness and completeness of data. Qualitative data generated through in-depth interviews of key informants were coded and analyzed using NVivo 12.ResultsDuring high conflict intensity (2018 and 2019), average data timeliness and completeness were 16.3% and 67.2%, respectively, increasing to 40.7% and 80.2%, respectively, in 2020 when the conflict intensity had reduced. There was a statistically significant weak correlation between reduced conflict intensity and increased data timeliness (R2 = 0.17, p = 0.016) and there was also a weak correlation between reduced conflict intensity and data completeness but this was not statistically significant (R2 = 0.01, p = 0.642). During high conflict intensity, the Kumba and Buea health districts had the highest data timeliness (17.2% and 96.2%, respectively) and data completeness (78.8% and 40.4%, respectively) possibly because of proximity to reporting sites and effective performance based financing. Components of IDSR that should be maintained included the electronic report aspect of the DHIS2 and the supportive supervision conducted during the outbreak. Staff demotivation, the parallel multiplicity of data entry tools, poor communication, shortage of staff and the non-usability of data generated by the DHIS2 were systemic challenges to the early alert dimension of the IDSR system. Non–systemic challenges included high levels of insecurity, far to reach outbreak sites and health personnel being targeted during the conflict.ConclusionIn general, routine IDSR data was not a reliable way of providing early warning of the 2018 cholera outbreak because of incomplete and late reports. Nonetheless, reduced conflict intensity correlated with increased timeliness and completeness of data reporting. The IDSR was substantially challenged during the crisis, and erroneous data generated by the DHIS 2 significantly undermined the efforts and resources invested to control the outbreak. The Ministry of Public Health should reinforce efforts to build a reporting system that produces people-centered actionable data that engages health risk management during socio-political crises.

Assessment of the core and support functions of the integrated disease surveillance and response system in Zanzibar, Tanzania

BackgroundDisease surveillance is a cornerstone of outbreak detection and control. Evaluation of a disease surveillance system is important to ensure its performance over time. The aim of this study was to assess the performance of the core and support functions of the Zanzibar integrated disease surveillance and response (IDSR) system to determine its capacity for early detection of and response to infectious disease outbreaks.MethodsThis cross-sectional descriptive study involved 10 districts of Zanzibar and 45 public and private health facilities. A mixed-methods approach was used to collect data. This included document review, observations and interviews with surveillance personnel using a modified World Health Organization generic questionnaire for assessing national disease surveillance systems.ResultsThe performance of the IDSR system in Zanzibar was suboptimal particularly with respect to early detection of epidemics. Weak laboratory capacity at all levels greatly hampered detection and confirmation of cases and outbreaks. None of the health facilities or laboratories could confirm all priority infectious diseases outlined in the Zanzibar IDSR guidelines. Data reporting was weakest at facility level, while data analysis was inadequate at all levels (facility, district and national). The performance of epidemic preparedness and response was generally unsatisfactory despite availability of rapid response teams and budget lines for epidemics in each district. The support functions (supervision, training, laboratory, communication and coordination, human resources, logistic support) were inadequate particularly at the facility level.ConclusionsThe IDSR system in Zanzibar is weak and inadequate for early detection and response to infectious disease epidemics. The performance of both core and support functions are hampered by several factors including inadequate human and material resources as well as lack of motivation for IDSR implementation within the healthcare delivery system. In the face of emerging epidemics, strengthening of the IDSR system, including allocation of adequate resources, should be a priority in order to safeguard human health and economic stability across the archipelago of Zanzibar.

A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: A health workers' perspective.

The revised integrated disease surveillance and response (IDSR) guidelines adopted by African member states in 2010 aimed at strengthening surveillance systems critical capacities. Milestones achieved through IDSR strategy implementation prior to adopting the revised guidelines are well documented; however, there is a dearth of knowledge on the progress made post-adoption. This study aimed to review key recommendations resulting from surveillance assessment studies to improve implementation of the revitalised IDSR system in the African region based on health workers' perspectives. The review focused on literature published between 2010 and 2019 post-adopting the revised IDSR guidelines in the African region. A systematic literature search in PubMed, Web of Science and Cumulative Index for Nursing and Allied Health Literature was conducted. In addition, manual reference searches and grey literature searches using World Health Organisation Library and Information Networks for Knowledge databases were undertaken. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist for systematic reviews was utilised for the review process. Thirty assessment studies met the inclusion criteria. IDSR implementation under the revised guidelines could be improved considerably bearing in mind critical findings and recommendations emanating from the reviewed surveillance assessment studies. Key recommendations alluded to provision of laboratory facilities and improved specimen handling, provision of reporting forms and improved reporting quality, surveillance data accuracy and quality, improved knowledge and surveillance system performance, utilisation of up-to-date information and surveillance system strengthening, provision of resources, enhanced reporting timeliness and completeness, adopting alternative surveillance strategies and conducting further research to improve surveillance functions. Recommendations on strengthening IDSR implementation in the African region post-adopting the revised guidelines mainly identify surveillance functions focused on reporting, feedback, training, supervision, timeliness and completeness of the surveillance system as aspects requiring policy refinement. PROSPERO registration number CRD42019124108.

Revitalization of integrated disease surveillance and response in Sierra Leone post Ebola virus disease outbreak

BackgroundThe Ministry of Health and Sanitation (MOHS) in Sierra Leone partially rolled out the implementation of Integrated Disease Surveillance and Response (IDSR) in 2003. After the Ebola virus disease outbreak in 2014–2015, there was need to strengthen IDSR to ensure prompt detection and response to epidemic-prone diseases. We describe the processes, successes and challenges of revitalizing public health surveillance in a country recovering from a protracted Ebola virus disease outbreak.MethodsThe revitalization process began with adaptation of the revised IDSR guidelines and development of customized guidelines to suit the health care systems in Sierra Leone. Public health experts defined data flow, system operations, case definitions, frequency and channels of reporting and dissemination. Next, phased training of IDSR focal persons in each health facility and the distribution of data collection and reporting tools was done. Monitoring activities included periodic supportive supervision and data quality assessments. Rapid response teams were formed to investigate and respond to disease outbreak alerts in all districts.ResultsSubmission of reports through the IDSR system began in mid-2015 and by the 35th epidemiologic week, all district health teams were submitting reports. The key performance indicators measuring the functionality of the IDSR system in 2016 and 2017 were achieved (WHO Africa Region target ≥80%); the annual average proportion of timely weekly health facility reports submitted to the next level was 93% in 2016 and 97% in 2017; the proportion of suspected outbreaks and public health events detected through the IDSR system was 96% (n = 87) in 2016 and 100% (n = 85) in 2017.ConclusionWith proper planning, phased implementation and adequate investment of resources, it is possible to establish a functional IDSR system in a country recovering from a public health crisis. A functional IDSR system requires well trained workforce, provision of the necessary tools and guidelines, information, communication and technology infrastructure to support data transmission, provision of timely feedback as well as logistical support.

Establishment of an electronic integrated disease surveillance and response system in Sierra Leone

Purpose: The 2014–16 Ebola epidemic exposed weaknesses within Sierra Leone's disease surveillance system and served as a catalyst to improve detection systems. In 2015, the national Integrated Disease Surveillance and Response (IDSR) system consisted of health facilities (HF) calling/texting or hand-delivering reports to their District Health Management Team (DHMT), DHMT staff entering IDSR data from all HF into a spreadsheet, and each DHMT emailing the file weekly to the national level. When districts lacked adequate bandwidth to upload attachments, DHMT staff emailed a curtailed IDSR data summary to the national level, which jeopardized data timeliness and accuracy. In 2016, Sierra Leone introduced an electronic IDSR (eIDSR) system to gauge feasibility and efficacy in a resource-constrained setting. Methods & Materials: The U.S. Centers for Disease Control and Prevention and eHealth Africa supported the Ministry of Health and Sanitation to establish eIDSR, which transmits data into the web-based District Health Information System (DHIS2). In 2016, district-level eIDSR was piloted then rolled out to all fourteen districts. District-level eIDSR entails HF staff calling the DHMT, then DHMT staff entering data directly into the national DHIS2 database. From 2016–17, facility-level eIDSR was piloted in one district to enable data entry using tablets at all 112 HF in the district, and in 2018, a national scale-up of facility-level eIDSR is underway to reach all 1285 HF in Sierra Leone. Results: After implementing district-level eIDSR, IDSR reporting increased from <40% of HF in 2016 to >97% in 2017, an increase maintained in 2018. The district-level pilot revealed that data-entry time decreased by 63% and errors decreased by 45%. Analyses from the facility-level eIDSR pilot found that data accuracy was 12% higher than data reported through district-level eIDSR. The Joint External Evaluation (JEE) score for real-time surveillance went from “limited” to “developed” capacity between 2016 and 2017. Conclusion: District-level eIDSR improved the timeliness and accuracy of surveillance data. Additional benefits are anticipated with completion of the national scale-up of facility-level eIDSR, and JEE scores are projected to reach the next level of “demonstrated” capacity. Lessons learned in Sierra Leone can inform other low-resource settings considering implementation of electronic disease surveillance systems.

Dengue Outbreaks in Khyber Pakhtunkhwa (KPK), Pakistan in 2017: An Integrated Disease Surveillance and Response System (IDSRS)-Based Report.

The current study is a retrospective epidemic report regarding dengue fever (DF) virus infection cases (2017) from fifteen districts of KPK, Pakistan. Medical records of 120 948 patients were reviewed retrospectively for demographic, clinical and laboratory data. The presence of dengue infection was confirmed by NS1-ELISA and RT-PCR, respectively. The total positive cases (of suspected DF samples) were 24 938 (20.6%), whereas seventy cases (0.28%) had a fatal outcome. Mean age ± SD of the dengue patients was 26 ± 19.8 years, while; the most affected age group was from 16 to 30 years (Chi-square: 12 820.125, p: 0.00). The infected males were 65.3%, and that of the female was 34.7%. All the dengue-infected patients were observed with symptoms of severe fever (100%), body aches (95%), gums and nose bleeding (5%), skin rashes (30%), vomiting (70%). The highest infection rate was found in district Peshawar and that of the lowest was in Bannu, Hungu and Luki Marwat. A high rate of dengue infection was found in post-monsoon months i.e. October (41%) and September (32%) of the year. The results proved that if the dengue outbreaks reveal further in KPK, it could alarmingly increase the mortality rate. Therefore, the Department of Public Health in KPK, Pakistan may take proper measures to avoid and control dengue epidemics in the future.

Integrated Disease Surveillance and Response (IDSR) in Malawi: Implementation gaps and challenges for timely alert.

ObjectiveThe recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon global efforts to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening.MethodsThis was a mixed-method research study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2) during October 2014 to September 2016. Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and 7 key informants of the IDSR system implementation and administration at district and national levels.FindingsThe current IDSR system showed relatively good completeness (73.1%) but poor timeliness (40.2%) of total expected monthly reports nationwide and zero weekly reports during the study period. Major implementation gaps were lack of weekly report and trainings. The challenges of IDSR implementation revealed through qualitative data included case identification, compiling reports for timely submission and inadequate resources.ConclusionsThe differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.

Driving towards malaria elimination in Botswana by 2018: progress on case-based surveillance, 2013-2014.

Background: Reliable information reporting systems ensure that all malaria cases are tested, treated and tracked to avoid further transmission. Botswana aimed to eliminate malaria by 2018, and surveillance is key. This study focused on assessing the uptake of the new malaria case-based surveillance (CBS) system introduced in 2012, which captures information on malaria cases reported in the Integrated Disease Surveillance and Response (IDSR) system. Methods: This was a retrospective descriptive study based on routine data focusing on Ngami, Chobe and Okavango, three high-risk districts in Botswana. Aggregated data variables were extracted from the IDSR and compared with data from the CBS. Results: The IDSR reported 456 malaria cases in 2013 and 1346 in 2014, of which respectively only 305 and 884 were reported by the CBS. The CBS reported 34% fewer cases than the IDSR system, indicating substantial differences between the two systems. The key malaria indicators with the greatest variability among the districts included in the study were case identification number and date of diagnosis. Conclusion: The IDSR and CBS systems are essential for malaria elimination, as shown by the significant gaps in reporting between the two systems. These findings highlight the need for further investigation into these discrepancies. Strengthening the CBS system will help to reach the objective of malaria elimination in Botswana.

Evaluation of timeliness and completeness of reporting of the integrated disease surveillance and response system in District Health Information Management System II in Western Region, Ghana, 2017

Introduction : the Integrated Disease Surveillance and Response (IDSR) and District Health Information Management System II (DHIMS2) approaches were introduced and implemented in 2002 and 2012 respectively in Ghana to improve surveillance data submission rate and data quality. Timeliness of reporting is the proportion of all expected IDSR summary reports that were actually submitted on the DHIMS2 on time (reports received before a specified deadline). Completeness of reporting is the proportion of all expected IDSR summary reports that were actually submitted on the DHIMS2. Timely and complete data submission are used by health managers to pre-empt major outbreak, detect changes in trends of diseases and permit assessment of implemented control programs. We evaluated the timeliness and completeness of reporting of the IDSR system in the Western Region of Ghana. Methods : we conducted a cross-sectional study to evaluate IDSR system of reporting timeliness and completeness in the Western Region from 2012 to 2016. We assessed two urban districts; Tarkwa Nsuaem Municipality and Sekondi Takoradi Metropolis and two rural districts of BIA West and Juabeso, and their 145 health facilities representing public, private and mission providers were assessed. Weekly and monthly disease surveillance reports on timeliness and completeness were extracted from DHIMS2 database and analyzed using Epi Info. Univariate analyses were expressed as frequencies and proportions. Results : the IDSR monthly reporting timeliness increased from 21% in 2012 to 91.9% in 2016 whilst completeness increased from 67.5% in 2012 to 99.1% in 2016. The IDSR weekly reporting timeliness increased from 4.6% in 2012 to 55% in 2016 whilst weekly report completeness increased from 39.7% in 2012 to 84.6% in 2016. Lower timeliness and completeness of reports from private health facilities was identified. Conclusion : there has been an improvement in the reporting of disease surveillance through DHIMS2 at the regional level. Challenges with timeliness and completeness of reporting from private health facilities were identified. Training and sensitization was conducted for private health facilities on timeliness and completeness of reporting of IDSR to DHIMS 2 based on our recommendation. This contributed immensely to improved timeliness and completeness from private health facilities.

Assessment of Factors Affecting the Implementation of the Integrated Disease Surveillance and Response in Public Health Care Facilities - The Case of Rufunsa District, Zambia

Late detection of disease out- break and other health related events of public health significance have been linked to poor implementation of the Integrated Disease Surveillance and Response (IDSR). As such strengthening the capacity of health workers involved in IDSR implementation is required. The main objective of this study was to assess the factors affecting the implementation of the IDSR in public health care facilities in Rufunsa District, Zambia. A cross-sectional facility based descriptive study design as well as observation was done in which 34 study subjects were conveniently sampled from the 9 health facilities in the district. Data collection was done using a pretested semi structured questionnaire and an institutional- tailored observational checklist. Analyses were done using SPSS version18. The study revealed that factors that affected the implementation of the IDSR were low knowledge levels among Health Workers about IDSR as only 36.3% of them received training in IDSR in the last 12 months at the time of this study. Other factors that created gaps in the implementation of IDSR were negative attitudes of the health workers as 9.0% of them were of the opinion that the IDSR system wasted much of their time, as its implementation interfered with their clinical work and about 51.5% were demoralised as they felt that support from the managers at the District, Province and Ministry of Health Headquarters was inadequate. Poor practices of health workers towards IDSR was also identified as a factor affecting IDSR Implementation. For instance, it was revealed that about 27.3% of the health workers either infrequently or never reported a disease which required mandatory reporting in the last 12 months as they stated that the process of reporting was cumbersome as the forms were too many and complicated. They further echoed that IDSR implementation lacked prompt feedback from the Managers at the District. Resource- wise, all facilities in the district lacked adequate resources for IDSR implementation. For example between 11.1 to 44.4% of the health facilities lacked one or more types of reporting forms. Other resources lacking were electricity, and good network connectivity since about 51.5% relied on mobile phones for sending reports which required prompt feedback. Therefore, to ensure effective IDSR implementation, adequate funding directed to the strengthening of IDSR activities should be deliberately put in the budget’s yellow book. Regular IDSR trainings are to be offered to health workers which should be followed by mentorship and supervision by the District and Provincial Health Offices as well as the Ministry of Health.

Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria.

Background:The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. The goal of the study was to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina State, Nigeria.Methods:The study is a retrospective record review using extracted data from NNT records and analyzed using descriptive statistics.Results:The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100 000 population, respectively, whereas the prevalence of NNT and mortality rate reported through the Integrated Disease Surveillance and Response (IDSR) system were 111 cases and 1.0 death per 100 000 population, respectively.Conclusion:The study shows underreporting of NNT in the existing IDSR system.Implications:Active surveillance is a good strategy for verifying underreporting of NNT in the surveillance system. The IDSR system should be strengthened with the capacity to detect events associated with a disease toward global elimination.

Evaluation of the reporting completeness and timeliness of the integrated disease surveillance and response system in northern Ghana.

The integrated disease surveillance and response (IDSR) and district health information management system II (DHIMS2) strategies were implemented in 2002 and 2012 respectively to improve surveillance data reporting and quality. The objective of this study was to evaluate the reporting completeness and timeliness of the IDSR system at the sub-national level in northern Ghana. This was an observational study in Upper East Region (UER). Weekly and monthly disease surveillance reports on completeness and timeliness were downloaded and analysed for 2012 and 2013 from the DHIMS2 in UER, the two Kassena-Nankana districts and their nine health facilities representing public, private and mission providers. Comparison of paper-based and DHIMS2 reporting from the periphery health facilities were assessed. IDSR monthly reporting completeness and timeliness in UER increased by 9% and 37% respectively in 2013 compared to 2012 and weekly completeness and timeliness improved by 79% and 24% respectively in 2013. Similar reporting increases were seen in the districts and health facilities over the same period, except the Kassena-Nankana Municipal which showed decrease of 2% in monthly completeness for 2013. At the health facilities, the paper-based reporting completeness was 96% and timeliness 45% while DHIMS2 completeness was 83% and timeliness 18% in 2012. However, DHIMS2 reporting completeness and timeliness improved in 2013 reaching 100% and 61% respectively. Disease surveillance reporting through DHIMS2 became more complete over time, but there remain problems with timeliness. Surveillance data need to be timely to enable rapid responses to disease outbreaks.

The effect of immunization on measles incidence in the Democratic Republic of Congo: Results from a model of surveillance data

BackgroundMeasles continues to be a leading cause of vaccine-preventable disease mortality among children under five despite a safe and efficacious vaccine being readily available. While global vaccination coverage has improved tremendously, measles outbreaks persist throughout sub-Saharan Africa. Since 2010, the Democratic Republic of Congo (DRC) has seen a resurgence of measles outbreaks affecting all 11 provinces. These outbreaks are mainly attributed to gaps in routine immunization (RI) coverage compounded with missed supplementary immunization activities (SIAs). We utilized national passive surveillance data from DRC's Integrated Disease Surveillance and Response (IDSR) system to estimate the effect of immunization on measles incidence in DRC. MethodsWe investigated the decline in measles incidence post-immunization with one dose of measles containing vaccine (MCV1) with and without the addition of supplementary immunization activities (SIAs) and outbreak response immunization (ORI) campaigns. Measles case counts by health zone were obtained from the IDSR system between January 1, 2010 and December 31, 2013. The impact of measles immunization was modeled using a random effects multi-level model for count data with RI coverage levels and mass campaign activities from one year prior. ResultsThe presence of an SIA (aIRR [95% CI] 0.86 [0.60–1.25]) and ORI (0.28 [0.20–0.39]) in the year prior were both associated with a decrease in measles incidence. When interaction terms were included, our results suggested that the high levels of MCV1 reported in the year prior and the presence of either mass campaign was associated with a decrease in measles incidence. ConclusionsOur results highlight the importance of a two-dose measles vaccine schedule and the need for a strong routine immunization program coupled with frequent SIAs. Repeated occurrences of large-scale outbreaks in DRC suggest that vaccination coverage rates are grossly overestimated and signify the importance of the evaluation and modification of measles prevention and control strategies.

The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions.

BackgroundThe integrated disease surveillance and response (IDSR) strategy was adopted in Ghana over a decade ago, yet gaps still remain in its proper functioning. The objective of this study was to assess the core and support functions of the IDSR system at the periphery level of the health system in northern Ghana.MethodsA qualitative study has been conducted among 18 key informants in two districts of Upper East Region. The respondents were from 9 health facilities considered representative of the health system (public, private and mission). A semi-structured questionnaire with focus on core and support functions (e.g. case detection, confirmation, reporting, analysis, investigation, response, training, supervision and resources) of the IDSR system was administered to the respondents. The responses were recorded according to specific themes.ResultsThe majority (7/9) of health facilities had designated disease surveillance officers. Some informants were of the opinion that the core and support functions of the IDSR system had improved over time. In particular, mobile phone reporting was mentioned to have made IDSR report submission easier. However, none of the health facilities had copies of the IDSR Technical Guidelines for standard case definitions, laboratories were ill-equipped, supervision was largely absent and feedback occurred rather irregular. Informants also reported, that the community perceived diagnostic testing at the health facilities to be unreliable (e.g. tuberculosis, Human Immunodeficiency Virus). In addition, disease surveillance activities were of low priority for nurses, doctors, administrators and laboratory workers.ConclusionsAlthough the IDSR system was associated with some benefits to the system such as reporting and accessibility of surveillance reports, there remain major challenges to the functioning and the quality of IDSR in Ghana. Disease surveillance needs to be much strengthened in West Africa to cope with outbreaks such as the recent Ebola epidemic.

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.

Evaluation of the integrated disease surveillance and response system for infectious diseases control in northern Ghana.

BackgroundWell-functioning surveillance systems are crucial for effective disease control programs. The Integrated Disease Surveillance and Response (IDSR) strategy was developed and adopted in 1998 for Africa as a comprehensive public health approach and subsequently, Ghana adopted the IDSR technical guidelines in 2002. Since 2012, the IDSR data is reported through the new District Health Information Management System II (DHIMS2) network. The objective was to evaluate the Integrated Disease Surveillance and Response (IDSR) system in northern Ghana.MethodsThis was an observational study using mixed methods. Weekly and monthly IDSR data on selected infectious diseases were downloaded and analyzed for 2011, 2012 and 2013 (the years before, of and after DHIMS2 implementation) from the DHIMS2 databank for the Upper East Region (UER) and for two districts of UER. In addition, key informant interviews were conducted among local and regional health officers on the functioning of the IDSR.ResultsClinically diagnosed malaria was the most prevalent disease in UER, with an annual incidence rate close to 1. Around 500 suspected HIV/AIDS cases were reported each year. The highest incidence of cholera and meningitis was reported in 2012 (257 and 392 cases respectively). Three suspected cases of polio and one suspected case of guinea worm were reported in 2013. None of the polio and guinea worm cases and only a fraction of the reported cases of the other diseases were confirmed. A major observation was the large and inconclusive difference in reported cases when comparing weekly and monthly reports. This can be explained by the different reporting practice for the sub-systems. Other challenges were low priority for surveillance, ill-equipped laboratories, rare supervision and missing feedback.ConclusionsThe DHIMS2 has improved the availability of IDSR reports, but the quality of data reported is not sufficient. Particularly the inconsistencies between weekly and monthly data need to be addressed. Moreover, support for and communication within the IDSR system is inadequate and calls for attention.

Establishing a national influenza sentinel surveillance system in a limited resource setting, experience of Sierra Leone

BackgroundAcute respiratory infections remain a leading cause of morbidity and mortality in Sierra Leone; however, similar to other African countries, little is known regarding the contribution of influenza. Routine influenza surveillance is thus a key element to improve understanding of the burden of acute respiratory infections in Africa. In 2011, the World Health Organization (WHO) funded the Strengthening Influenza Sentinel Surveillance in Africa (SISA) project with the goal of developing and strengthening influenza surveillance in eight countries in sub-Saharan Africa, including Sierra Leone. This paper describes the process of establishing a functional Influenza Sentinel Surveillance (ISS) system in Sierra Leone, a post-conflict resource-poor country previously lacking an influenza monitoring system.MethodsSierra Leone utilized a systematic approach, including situational assessment, selection of sentinel sites, preparation of implementation plan, adaptation of the standard operating procedures, supervision and training of staff, and monitoring of influenza surveillance activities. The methods used in Sierra Leone were adapted to its specific context, using the Integrated Disease Surveillance and Response (IDSR) strategy as a platform for establishing ISS.ResultsThe ISS system started functioning in August 2011 with subsequent capacity to contribute surveillance activity data to global influenza databases, FluID and FluNet, demonstrating a functional influenza surveillance system in Sierra Leone within the period of the WHO SISA project support. Several factors were necessary for successful implementation, including a systematic approach, national ownership, appropriate timing and external support.ConclusionsThe WHO SISA project demonstrated the feasibility of building a functional influenza surveillance system in Sierra Leone, integrated into existing national IDSR system. The ISS system, if sustained long-term, would provide valuable data to determine epidemiological and virological patterns and seasonal trends to assess the influenza disease burden that will ultimately guide national control strategies.