Integrated Disease Surveillance And Response 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 integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021

BackgroundThe Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018–2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats.MethodsThe study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas.ResultsThirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times.ConclusionSupport is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system.

Online capacity building for the health workforce: the case of the Integrated Disease Surveillance and Response for the African region.

The World Health Organisation (WHO) Regional Office for Africa (AFRO) has developed a comprehensive capacity devel-opment programme to support the successful implementation of the Integrated Disease Surveillance and Response 3rd edition Technical Guidelines (IDSR). As part of the learning program, a series of asyn-chronous online courses are offered on OpenWHO in English, French and Portuguese. This paper describes the use of five IDSR online courses and reports on feedback received from learners on Course 1 in the English series. An online learner survey was developed, and a descriptive analysis was conducted. This paper also reports on use related empirical metadata from the OpenWHO platform. Overall, learners (97%-n/N) of Course 1 IDSR English series indicated a positive perception toward their online learning experience because of the quality of course content, its organization, ease of use and relevance to their workplace needs. In addition, 88% (n/N) of learners reported that they had used their acquired knowledge at least sometimes and 54.4% (n/N) had shared their learning with others. Lastly, the quiz analyses showed an average of right answers of 78.97% for quiz 1 and 69.94% for quiz 2. Online learning is an essential component of a blended capacity development programme and provides cost effective, equitable and impactful learning. Learners who have a learning goal and find their needs met in courses tend to show more satisfaction and motivation to share their learning.

Mortality Associated with Priority Diseases in Flood-Affected Areas Using District Health Information System (DHIS2) During September-December 2022: Pakistan Experience.

To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan. The study's design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan. In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases]). The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

Community health surveillance via digital collection of syndromic and behavior data by community healthcare workers in rural Kenya: a pilot study

Disease surveillance is essential to enable adequate detection and response to disease outbreaks. Syndromic surveillance is used to augment traditional approaches, especially in community-based surveillance. Here we demonstrate that Community Healthcare Workers (CHWs) supported by a mobile phone application can provide community-based syndromic disease surveillance in low-resource settings, and that they are able to generate relevant symptom-based and behavior data such as cough symptoms, use of mosquito nets and availability of household handwashing facilities. We analyzed 1.6 million data points collected by CHWs during home visits in rural Kenya as a proof of principle that the symptoms and behavior they observe can be used as a community-based health surveillance tool. To demonstrate the relevance of the data, we show that national covid-19 case numbers did not align with reported cough symptoms in remote populations, which implies that rural populations did not experience covid-19 outbreaks in tandem with urban populations. We also found that the behavior of using long-lasting insecticidal nets could be tracked by the CHWs, and it followed the seasonality of the mosquito burden. Strengthening community-based syndromic and behavior surveillance through CHWs is therefore a great opportunity to strengthen national public health surveillance and response in Africa and should be included in the Integrated Disease Surveillance and Response (IDSR) strategy.

The role of digital surveillance during outbreaks: the Ghana experience from COVID-19 response.

Over the years, Ghana has made notable strides in adopting digital approaches to address societal challenges and meet demands. While the health sector, particularly the disease surveillance structure, has embraced digitization to enhance case detection, reporting, analysis, and information dissemination, critical aspects remain to be addressed. Although the Integrated Disease Surveillance and Response (IDSR) structure has experienced remarkable growth in digitization, certain areas require further attention as was observed during the COVID-19 pandemic. Ghana during the COVID-19 pandemic, recognized the importance of leveraging digital technologies to bolster the public health response. To this end, Ghana implemented various digital surveillance tools to combat the pandemic. These included the 'Surveillance Outbreak Response Management and Analysis System (SORMAS)', the digitalized health declaration form, ArcGIS Survey123, Talkwalker, 'Lightwave Health information Management System' (LHIMS), and the 'District Health Information Management System (DHIMS)'. These digital systems significantly contributed to the country's success in responding to the COVID-19 pandemic. One key area where digital systems have proved invaluable is in the timely production of daily COVID-19 situational updates. This task would have been arduous and delayed if reliant solely on paper-based forms, which hinder efficient reporting to other levels within the health system. By adopting these digital systems, Ghana has been able to overcome such challenges and provide up-to-date information for making informed public health decisions. This paper attempts to provide an extensive description of the digital systems currently employed to enhance Ghana's paper-based disease surveillance system in the context of its response to COVID-19. The article explores the strengths and challenges or limitations associated with these digital systems for responding to outbreaks, offering valuable lessons that can be learned from their implementation.

Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy

BackgroundIn the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014.MethodsWe reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it.ResultsDespite the adoption of the IDSR framework, Liberia failed to secure the resources—human, logistical, and financial—to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease.ConclusionOur findings suggest that post-war, Liberia’s health system intended to prioritize epidemic preparedness and response with the adoption of IDSR. However, insufficient investment and systems development meant IDSR was not well implemented, leaving the country vulnerable to the devastating impact of the Ebola epidemic.

Collaboration between the National Institute of Health Somalia and the Public Health Agency of Sweden

Abstract Public Health Agency Sweden (PHAS) has been funded by Sida to provide support and assist in capacity building of the National Institute of Health (NIH) Somalia for six years (2019-2025). The PHAS work closely with the Federal Ministry of Health Somalia, Member States and partners like WHO Somalia, Africa CDC and academic institutions to establish NIHS as an institution that can be sustained and grow over time, and that can contribute to the public health and health system infrastructure of Somalia. Main areas of collaboration 2019-2023 have been technical support to the joint taskforce on Integrated Disease Surveillance and Response (IDSR); supporting basic level field epidemiology training to front line health care workers; organizing workshops in data analyses, visualisation and reporting together with SPIDER/Stockholm University and Statistics Sweden. Building research capacity has included organizing a digital workshop: Reconstructing public health institutions in Somalia at the16th World Congress on Public Health 2020, Rome, Italy and support to the 1st NIH Research Conference 30 January - 1 February 2022 in Garowe, Puntland: “Laying the Foundation for Health Research in Somalia”. The hybrid conference attracted more than 180 participants from different universities. The tentative plan for the remaining project period include recruiting two Somali-speaking public health experts to develop the human resources and institutional capacities in order for NIH to become a centre of excellence for public health in Somalia. The main focus area for the remaining project period is supporting the development of the disease surveillance system including methods for analysis and reporting data. Research capacity workshops will be organized and supported, as well as a 2nd NIH Research Conference in 2024. Another important task is resource mobilization for long-term sustainability and coordination with other stakeholders. Key messages • Supporting the development of the disease surveillance system including analytical skills and reporting of data is key. • Coordination with other stakeholders and resource mobilization for long-term sustainability is essential.

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.

Epidemiology of influenza in Ghana, 2011 to 2019.

Influenza virus is an important contributor to acute respiratory illnesses and is estimated to cause up to 650,000 respiratory deaths each year. Ghana recorded influenza viruses as far back as 1918 when the Spanish influenza pandemic led to the death of >100,000 people in a population of 4 million at the time. An outbreak of highly pathogenic avian influenza A(H5N1) among poultry in Ghana in 2007, led to the establishment of virological surveillance for influenza-like illness (ILI) by the Noguchi Memorial Institute for Medical Research (NMIMR). This surveillance system, supported by the U.S. Naval Medical Research Unit-No. 3 (NAMRU-3) and the Ghana Health Service (GHS), monitors circulating influenza strains and activity to better understand the epidemiology of influenza in Ghana. We present here the results of this surveillance system from 2011 to 2019. As part of the Integrated Disease Surveillance and Response (IDSR) system of the GHS under the Ministry of Health (MOH), oropharyngeal and nasopharyngeal swabs were collected from patients who met a modified World Health Organization (WHO) case definition for ILI or severe acute respiratory illness (SARI) through a sentinel surveillance system in the country. Samples were transported to the National Influenza Centre (NIC) at the NMIMR and tested for influenza virus using protocols defined by the United States Centers for Disease Control and Prevention (CDC). Selected isolates were sent to the WHO collaborating centre in the United Kingdom for further antigenic characterization. From 2011 to 2019, the NIC tested a total of 21,747 ILI samples and 3,429 SARI samples. Influenza positivity rates were highest in the 5-14 year old group for both ILI (20.8%) and SARI (23.8%). Compared to females, more males were seen at the health facilities for ILI and SARI symptoms with a statistically significant difference in influenza positive ILI (15% vs 13.2%, p <0.001). In terms of absolute numbers, more cases were seen at the health centres during the wet seasons (April to October) compared to the dry seasons (November to March) in Ghana. This study presents 9 years of surveillance data from outpatient and inpatient setting on influenza activity as well as the influenza A subtypes and B lineages that drive the activity. This presents useful information for influenza vaccine selection and administration. Ghana's unique influenza activity patterns also present a challenge in predicting when an outbreak could occur.

The Role of the Ward Health System in COVID-19 Pandemic Response in Nigeria: A Case Study of Edo State

Background: Preventive measures remain the hallmark of effective containment of epidemics such as the recent Coronavirus Disease 2019 (COVID-19) pandemic. These measures are best applied using existing framework for healthcare delivery and epidemic response such as the ward health system (WHS). The structure of the WHS is interrelated to that of the Integrated Disease Surveillance and Response (IDSR) system for effective surveillance and outbreak response in the community. This paper examines the established pattern in disease prevention and the role of the WHS system in COVID-19 pandemic response in Edo State, Nigeria.&#x0D; Discussion: Disease prevention seeks to avert the occurrence of disease, arrest its progress, and reduce its consequences once it is established. The various taskforce and committees that were formed in response to the COVID-19 pandemic in Edo State were not integrated with existing local government Epidemic Preparedness and Response committees and the Rapid Response Teams. They also had no links with the already established ward development and village development committees in the communities.&#x0D; Conclusion: There is an existing framework for disease prevention and control based on the WHS in Edo State, however, this system was not integrated into the COVID-19 pandemic response activities. Incorporating and strengthening partnerships with the existing WHS framework would be key for effective pandemic response in the future.

Innovative approach to monitor performance of integrated disease surveillance and response after the Ebola outbreak in Sierra Leone: lessons from the field

BackgroundSupervision of healthcare workers improves performance if done in a supportive and objective manner. Regular supervision is a support function of Integrated Disease Surveillance and Response (IDSR) strategy and allows systematic monitoring of IDSR implementation. Starting 2015, WHO and other development partners supported the Ministry of Health and Sanitation (MoHS) to revitalize IDSR in Sierra Leone and to monitor progress through supportive supervision assessments. We report on the findings of these assessments.MethodsThis was a cross-sectional study where six longitudinal assessments were conducted in randomly selected health facilities. Health facilities assessed were 71 in February 2016, 99 in July 2016, 101 in May 2017, 126 in August 2018, 139 in February 2019 and 156 in August 2021. An electronic checklist based on selected core functions of IDSR was developed and uploaded onto tablets using the Open Data Kit (ODK) platform. Supervision teams interviewed health care workers, reviewed documents and made observations in health facilities. Supervision books were used to record feedback and corrective actions. Data from the supervisory visits was downloaded from ODK platform, cleaned and analysed. Categorical data was summarized using frequencies and proportions while means and medians were used for continuous variables. Z test was used to test for differences in proportions.ResultsCompleteness of IDSR reporting improved from 84.5% in 2016 to 96% in 2021 (11.5% points; 95% CI 3.6, 21.9; P-value 0.003). Timeliness of IDSR reports improved from 80.3 to 92% (11.7% points; 95% CI 2.4, 22.9; P-value 0.01). There was significant improvement in health worker knowledge of IDSR concepts and tools, in availability of IDSR standard case definition posters and reporting tools and in data analysis practices. Availability of vaccines and temperature monitoring tools in health facilities also improved significantly but some indicators dropped such as availability of IDSR technical guidelines and malaria testing kits and drugs.ConclusionSupervision using electronic tool contributed to health systems strengthening through longitudinal tracking of core IDSR indicators and other program indicators such as essential malaria commodities and availability and status of routine vaccines. Supervision using electronic tools should be extended to other programs.

The Role of Implementation of IDSR Strategy on Indicators of the Core and Supportive Surveillance Functions at the Head of Localities

Background: Disease surveillance is a cornerstone of outbreak detection and control. The evaluation of a disease surveillance system is important to ensure its performance over time.&#x0D; Objectives: The role of implementation; of IDSR strategy on indicators of the core and supportive surveillance functions at the head of localities.&#x0D; Materials and methods: An intervention approach (one group pre-test post-test design) was conducted and baseline data of communicable diseases surveillance was obtained from selected Kassala state, four localities, and 60 health facilities. After implementing an integrated disease surveillance and response (IDSR) strategy for six months to evaluate core and support functions. The same questionnaire (WHO- guided modified and tested questionnaire) that was used in the baseline was applied.&#x0D; Results: The study showed that indicators of the supportive at the head of locality was improved at the head of four localities in terms of standards and guidelines, training, supervision and resources which witnessed significant improvement during pre and post intervention more than 90%.&#x0D; Conclusion: Improvements in indicators of core and support functions at the locality and state levels are inextricably linked to the quality of activities carried out at health facility levels. This was noticed when the value of intervention-supported functions increased, which may also be justified by the technique of computation technique, which is based on the aggregate of indicators of health facilities.

Article Retracted

Background: Disease surveillance is a cornerstone of outbreak detection and control. The evaluation of a disease surveillance system is important to ensure its performance over time.&#x0D; Objectives: The role of implementation; of IDSR strategy on indicators of the core and supportive surveillance functions at the head of localities.&#x0D; Materials and methods: An intervention approach (one group pre-test post-test design) was conducted and baseline data of communicable diseases surveillance was obtained from selected Kassala state, four localities, and 60 health facilities. After implementing an integrated disease surveillance and response (IDSR) strategy for six months to evaluate core and support functions. The same questionnaire (WHO- guided modified and tested questionnaire) that was used in the baseline was applied.&#x0D; Results: The study showed that indicators of the supportive at the head of locality was improved at the head of four localities in terms of standards and guidelines, training, supervision and resources which witnessed significant improvement during pre and post intervention more than 90%.&#x0D; Conclusion: Improvements in indicators of core and support functions at the locality and state levels are inextricably linked to the quality of activities carried out at health facility levels. This was noticed when the value of intervention-supported functions increased, which may also be justified by the technique of computation technique, which is based on the aggregate of indicators of health facilities.

Setting the stage for Acute Febrile Illness Surveillance Network in West Africa: Report of a Regional Experts and Stakeholders Workshop in Accra, Ghana, April 2021

A three-day regional workshop of stakeholders, partners, and experts from the West African countries was held from April 14 -16, 2021 in Accra, Ghana to conduct a situational analysis on the existing knowledge, expertise, previous accomplishments, and current activities in laboratory and syndrome based Acute Febrile Illness (AFI) surveillance that will guide a regional strategy for AFI surveillance. Technical presentations were made by participants from ministries of health, national public health institutes, West African Health Organization, Food Agricultural Organization, and the United States Centers for Disease Control and Prevention (USCDC) on existing AFI surveillance activities and infrastructure. In groups, the participants conducted Strength, Weaknesses, Opportunities and Threat (SWOT) analysis on AFI surveillance followed by a prioritization of actionable steps. Thirty-eight participants from 9 West African countries attended the meeting. The strengths recognized from the SWOT analysis include the existence and implementation of Integrated Disease Surveillance and Response (IDSR) within the region for priority diseases and a regional collaborative platform. However, there was inadequate information and data sharing platforms, non-availability of accurate diagnostic tools, knowledge gap on AFI and lack of harmonized framework. The opportunities that can be tapped into include supporting partners and global bodies, existing laboratory networks in Africa and infrastructure built during the COVID-19 pandemic. The meeting unveiled opportunities and challenges associated with establishing a regional AFI surveillance framework. It provided opportunity for stakeholders and experts to discuss the way forward on laying a foundation for a regional AFI surveillance system in the region.

Geographical and time trends of measles incidence and measles vaccination coverage and their correlation in Nigeria

ABSTRACT Nigeria has one of the highest measles burdens in the world. While measles-containing vaccine is proven to be effective in reducing measles cases, empirical studies on the correlation between measles incidence and measles vaccine coverage in Nigeria has been limited. The aim of this study was to conduct a detailed analysis on measles incidence, measles vaccine coverage, and their correlation between 2012 and 2021. A retrospective observational study was conducted based on the Integrated Disease Surveillance and Response (IDSR) data for the measles incidence in each Nigerian state over time, District Health Information System, V.2 (DHIS2) and Nigeria Demographic and Health Survey (DHS) for the coverage of the first dose of measles containing vaccine (MCV1) over time (2012–2021). We observed the trend of measles incidence and measles vaccine coverage, as well as their correlation. Out of the study period from 2012 to 2021, we found that the majority of measles outbreaks occurred in the northeastern states in recent years after 2019, especially in Borno state, where Boko Haram insurgency has negatively impacted health service delivery, including routine vaccination. We observed a significant negative correlation between measles incidence and measles vaccine coverage across Nigerian states. However, there was no sudden drop in measles vaccine coverage before the recent outbreak in Borno state in 2019, which could be due to various factors other than the overall vaccine coverage.

Implementation of maternal and neonatal death surveillance and response in Cameroon.

To analyze implementation of maternal and neonatal death surveillance and response (MNDSR) in Cameroon to determine to what extent monitoring objectives are being met and highlight the main obstacles and facilitating factors. Secondary analysis of a cross-sectional study using a qualitative method and routine data on maternal health. Semistructured interviews were conducted with participants involved in MNDSR at the central, regional, and district levels. Notification of maternal deaths has been incorporated into the Integrated Disease Surveillance and Response (IDSR) system since January 2014. However, maternal deaths are underreported in most hospitals and neonatal and community deaths are not recorded. Comprehensive review of maternal deaths does not occur in all hospitals despite training of providers in 2013 on how to conduct reviews. Implementation of MNDSR in Cameroon is insufficient. More commitment from the Ministry of Health is needed to develop an action plan and secure funding.

Epidemiological studies on urinary schistosomiasis and bacterial co-infection in some rural communities of Abia State, Nigeria

Urinary Schistosomiasis though being second to malaria as the most economically devastating disease is highly neglected in Nigeria. Infant it was only in 2010 that it was introduced into the Integrated Disease Surveillance and Response (IDSR). This has made the control of the disease more challenging despite its known high endemicity in the country. Several studies have shown that the disease can lead some dangerous complications ranging from gross mental retardation in children to renal complications such as bladder cancer. In Abia State Urinary Schistosomiasis is endermic is same rural communities, however not much attempt has been made on bacteria co-infection and to establish some socio – economic variable and clinical presentations carried out a cross – sectional survey of some school children between the ages of 5 – 16 years and above. A questionnaire was administered also. Urine samples were subjected to parasitological and bacteriology studies to determine prevalence, intensity tract infection. A Urinary Schistosomiasis pooled prevalence of 23.1% in Akwete community, 33.9% in Ozuitem and 0% in Ohuruisinmiri communities. Escherichia coli was the most prevalent micro-organism in co-infection with the prevalence rate of 37.5%, Klebsiella spp 15.6%, Pseudomonas spp 9.4%, Streptococcus spp 6.3% and Proteus spp 3.1%.

Integrated disease surveillance and response in humanitarian context: South Sudan experience.

Introductiondecades of instability continue to impact the implementation of the Integrated Disease Surveillance and Response (IDSR) strategy. The study reviewed the progress and outcomes of rolling out IDSR in South Sudan.Methodsthis descriptive cross-sectional study used epidemiological data for 2019, 2020, and other program data to assess indicators for the five surveillance components including surveillance priorities, core and support functions, and surveillance system structure and quality.ResultsSouth Sudan expanded the priority disease scope from 26 to 59 to align with national and regional epidemiological trends and the International Health Regulations (IHR) 2005. Completing the countrywide rollout of electronic Early Warning Alert and Response (EWARS) reporting has improved both the timeliness and completeness of weekly reporting to 78% and 90%, respectively, by week 39 of 2020 in comparison to a baseline of 54% on both timeliness and completeness of reporting in 2019. The National Public Health Laboratory confirmatory testing capacities have been expanded to include cholera, measles, HIV, tuberculosis (TB), influenza, Ebola, yellow fever, and Severe Acute Respiratory Syndrome 2 (SARS-COV-2). Rapid response teams have been established to respond to epidemics and pandemics.Conclusionsince 2006, South Sudan has registered progress towards using indicator and event-based surveillance and continues to strengthen IHR (2005) capacities. Following the adoption of third edition IDSR guidelines, the current emphasis entails maintaining earlier gains and strengthening community and event-based surveillance, formalizing cross-sectoral one-health engagement, optimal EWARS and District Health Information Systems (DHIS2) use, and strengthening cross-border surveillance. It is also critical that optimal government, and donors’ resources are dedicated to supporting health system strengthening and disease surveillance.

Evaluation of integrated disease surveillance and response (IDSR) and early warning and response network (EWARN) in South Sudan 2021.

IntroductionSouth Sudan has been implementing the Integrated Disease Surveillance and Response (IDSR) strategy since 2006, along with Early Warning and Alert Response and Network (EWARN). The IDSR/EWARN stakeholders commissioned an independent evaluation to establish performance at national, state, county, health facility, and community levels in the first half of 2021.Methodsthe evaluation was conducted between June and September 2021 (during the COVID-19 pandemic) and was based on the World Health Organization (WHO) protocols for monitoring and evaluating communicable disease surveillance and response systems and the guidelines for evaluating EWARN.Resultsintegrated disease surveillance and response/early warning and alert response and network indicator data showed improving timeliness and completeness from the beginning of 2021 to week 16 and then a slight depression of timeliness by week 32, while completeness remained high. Event-based surveillance was active at the beginning of 2021 and in week 32. However, there was inadequate sample collection to investigate acute watery diarrhea, bloody diarrhea, and acute jaundice syndrome alerts. Respondents in all cadres had substantial experience working in IDSR/EWARN. All respondents performed the various IDSR/EWARN tasks and duties as expected, but needed more resources and training.Conclusionwhile IDSR/EWARN is performing relatively well, confirmation of priority diseases by the laboratories needs to be strengthened. Health facilities need more regular supervision from the higher levels. Community health workers need more training on IDSR/EWARN. The whole IDSR/EWARN system needs more resources, particularly for communication and transport and to confirm priority diseases. Staff at all levels requested more training in IDSR/EWARN.