Integrated Disease Surveillance Research Articles

Digitalizing disease surveillance: experience from Sierra Leone.

The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aimed to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data was collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy, and DHIS2 documentation. Content and thematic data analysis were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS, integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform is analyzed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio, and Anthrax have been tracked in real-time through the eCBDS.

Effectiveness of Measles Mass Vaccination in the Reduction of Childhood Morbidity and Mortality in Yobe State, Northeast Nigeria

Measles is an issue of public health concern responsible for outbreaks and death of children especially in Sub-Saharan Africa. This study sought to determine the effectiveness of mass vaccination against measles in Yobe State, Northeast Nigeria. An ecological epidemiological study design involving the collection of secondary data from the same population was carried out over a period of two years. These data were collected from Epidemiology Unit of Yobe State Primary Healthcare Development Board from the Integrated Disease Surveillance Response database which collects records of notifiable diseases in Nigeria. All cases of measles within the period under review (2016-2017) were included and a comparison of the number of cases and deaths from measles reported in two different periods before supplementary immunization activity or mass vaccination against measles (2016) and after supplementary immunization activity against measles in the state (2017) was done. The mass vaccination intervention was conducted within first week of January 2017 as a measure to address outbreaks of measles in the state. Data were analyzed using the Statistical Package for Social Sciences (SPSS) windows version 22. A total of 4242 cases were reported during the study period. 3780(89.1%) in 2016 (before mass vaccination) and 462(10.9%) were reported in 2017 (after mass vaccination). A total of 556 deaths with case fatality rate of 13.1% was recorded during the study period. Majority of the deaths 525(94.4%) occurred in 2016 when there was no mass vaccination while few 31(5.6%) occurred in 2017 after the mass vaccination. Mass vaccination resulted in a 78.2% decline in number of cases and 88.8% decline in the number of deaths from measles. There was a statistical significant difference in the number of cases and mortality from measles pre and post mass vaccination against the disease in Yobe state. Paired sample t-test done revealed a monthly case distribution mean of 276.6 (95% CI 89.8 to 463.3) with alpha set at 0.05, P = 0.008 while monthly mortality mean was 41.1 (95% CI 15.5 to 66.7) with alpha set at 0.05, P = 0.005. Mass vaccination against measles therefore confers immunity and herd immunity to populations with a subsequent significant decline in morbidity and mortality associated with the measles infection. It is therefore recommended that this initiative be sustained for every two years or possibly yearly to ensure elimination of measles in the Sub-Saharan Africa region and the World at large.

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.

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria.

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance. We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

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.

IJCM_292A: Chikungunya Outbreak Investigation at Village Bolasa, Petlawat, Jhabua, Madhya Pradesh, India, September 2023

Background: Chikungunya, a resurging vector-borne disease caused by chikungunya virus, remains a global health challenge. In 2023, globally 4.4 lakhs suspected cases and 365 fatalities were estimated; India accounting for 21% of the global burden. On 5 September 2023, suspected outbreak of chikungunya was reported at Bolasa village, Jhabua, Madhya Pradesh by local newspaper. Objective: We investigated to confirm the outbreak, describe the epidemiology and provide evidence-based recommendations. Methodology: We compared past three years Integrated Disease Surveillance System (IDSP) data to confirm the outbreak. We defined a suspect case as fever with arthralgia in a resident of Bolasa village, during 20 August-30 October 2023, searched cases by reviewing patients register from health-care-facilities and house-to-house in Bolasa village. Cases were interviewed using semi- structured questionnaire prepared by modifying WHO chikungunya toolbox and data analyzed using Microsoft-Excel. We conducted environmental survey at domestic and peri-domestic areas and serum samples collected for laboratory confirmation. Results: No chikungunya case was reported in the last three years. We identified 117 suspected cases (56% females) with median age of 40 years (range 27-52 years). Other than fever and arthralgia, the other symptoms included bodyache (78%) and headache (67%). Overall attack rate (AR) was 8%; highest AR in Tadvifaliya of 18% followed by Harijan and Patidar faliya with 12% each. Among the cases, 76% stored water in containers without cover, mosquito larvae were found in the containers in the house or nearby place of 60% cases. Of the 20 serum samples tested, nine were positive for chikungunya IgM-antibody. Conclusion: We detected a confirmed chikungunya outbreak in a rural setting with vector breeding sites identified in a community. Outbreak investigation led to vector control by eliminating breeding sites and community sensitization on water storage practices. We recommended early case reporting, periodic entomological surveys and source reduction.

IJCM_305A: Forecasting Dengue and Chikungunya incidence using Time Series Analysis Modelling

Background: In recent years, the rise in vector-borne diseases, particularly Dengue and Chikungunya, has posed a significant public health challenge globally. Epidemiological data from the Integrated Disease Surveillance Program (IDSP) is a useful resource for forecasting and early outbreak identification by applying effective models like Sessional Autoregressive Integrated Moving Average (SARIMA) models has proven effective in capturing temporal dependencies in various fields. Objective: To forecast the dengue and chikungunya cases in India using Seasonal Autoregressive Integrated Moving Average models. Methodology: we preprocessing the IDSP dataset to extract relevant temporal patterns and trends. Subsequently, SARIMA models are applied to capture the time dependent dynamics of disease occurrences. The model’s performance is evaluated through rigorous validation processes, including cross-validation techniques, to ensure its reliability and generalizability. Results: This study considered a secondary data set of weekly dengue and chikungunya cases over the period of 2019 to 2023. The time plot shows several spikes in the data, indicating periods where the number of dengue cases increased significantly in the most recent years. Forecast of the future dengue and chikungunya cases was done for the next one year (2024). we observed that the number of dengue and chikungunya cases has fluctuated over time but has generally remained within a certain range. The forecast predicts a significant increase in cases as we move towards the latter half of 2024, with a very sharp spike towards the end of the forecast period. Conclusion: In conclusion, utilizing a secondary dataset spanning from 2019 to 2023, this study employed time series analysis to forecast future Dengue and Chikungunya cases. The forecast predicts a significant increase in dengue cases during 2024 which can lead to potential implications for public health practitioners, policymakers, and researchers involved in infectious disease management.

IJCM_369A: Notification of malaria and dengue outbreaks during COVID-19 pandemic: A secondary analysis of weekly IDSP reporting

Background: Like many other diseases, vector borne diseases related health activities got affected during COVID-19 due to disruption in health services. The preventive measures, vector surveillance, diagnostics, early diagnosis, and management are likely to have been affected. Objective: To explore the vector-borne disease trends as outbreaks from January 2021 to December 2023 using weekly reports of Integrated Disease Surveillance Programme (IDSP). Methodology: We used the secondary data of the weekly reports of IDSP weekly reports from Jan 2020 Dec 2023. We included dengue and malaria as two important diseases to represent the prevailing vector borne diseases in the country. The outbreak data collected were entered in MS Excel and reported as frequency and proportions to visualize the time trends during the COVID-19 pandemic. Results: The outbreaks of malaria were found to occur mainly in the second half of the year with 63% and 80% outbreaks in the years 2020 and 2021 respectively, coinciding with the onset of monsoons. Maximum number of outbreaks was reported in the year of 2021, followed by 2022 with number of outbreaks being 20 and 19 respectively. Maximum number of dengue outbreaks were reported in the year 2021 followed by year 2022 with the numbers being 114 and 81 respectively. The year 2020 had around half the number of outbreaks as of the year 2022 (42 outbreaks). The first half of the year 2023 reported 25 outbreaks. Conclusion: Both malaria and dengue had maximum number of outbreaks in the year 2021 followed by a slight dip in the year 2022. At the onset of pandemic, the number of outbreaks were quite less compared to the subsequent years, probably due to the lockdown imposed.

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.

Factors influencing operationalization of Integrated Disease Surveillance in Malawi

ObjectivesMalawi's disease surveillance system is built on several different data sources and systems and is informed by the Integrated Diseases Surveillance and Response (IDSR) strategy. This study was carried out as part of a larger multicountry study to identify context-specific factors, which influence the operationalization of integrated disease surveillance. Study design and methodsA total of six focus group discussions were conducted with 43 relevant personnel at the primary and secondary healthcare levels in two districts (Lilongwe and Dowa) and at the national level. The discussions were analyzed and sorted into predefined categories based on the domains of the International Association of Public Health conceptual framework. ResultsWe found ongoing efforts to enhance integrated disease surveillance operationalization, including the establishment of the Public Health Institute of Malawi for coordination, digitalizing the surveillance system through One Health Surveillance Platform, and improving communication among rapid response teams using WhatsApp. The adoption of World Health Organization's third edition IDSR technical guidelines was also underway. Nonetheless, there were major implementation barriers such as parallel and uncoordinated surveillance systems, priority conditions that cannot be diagnosed at the point of reporting, lack of case definitions and diagnostic codes for priority conditions, reporting forms with unexplained acronyms, illegible data sources, unstable electronic data transfers, inadequate supervision and training, poor enforcement of reporting from private health facilities, high reporting burden, and lack of and feedback to those reporting. ConclusionsThe results fit well into the predefined categories used. The study reveals basic problems with the operationalization, tools, and reporting forms used for IDSR. These findings may have implications for practice and policy in Malawi and other countries where IDSR is the national strategy for surveillance.

The state of integrated disease surveillance globally: synthesis report of a mixed methods study

ObjectivesDisease surveillance is an essential public health function needed to prevent, detect, monitor and respond to health threats. Integrated disease surveillance (IDS) enhances its utility and has been advocated for decades by the World Health Organization. This study sought to examine the state of IDS implementation worldwide. Study designThe study used a concurrent mixed methods approach consisting of a systematic scoping review of the literature on IDS, a survey of International Association of National Public Health Institutes (IANPHI) members and qualitative deep dive case studies in seven countries. MethodsThis report collates, analyses and synthesises the findings from the three components. The scoping review consisted of a review of summarised evidence on IDS. Eight reviews and five primary studies were included. The cross-sectional survey was conducted of 110 IANPHI members representing ninety-five countries. Qualitative case studies were conducted in Malawi, Mozambique, Uganda, Pakistan, Canada, Sweden, and England, which involved thirty-four focus group discussions and forty-eight key informant interviews. ResultsIn the different countries, IDS is conceptualised differently and there are differing levels of maturity of IDS functions. Although the role of National Public Health Institutes has not been well defined in the IDS, they play a significant role in IDS in many countries. Fragmentation between sectors and resourcing (human and financial) issues were common. Good governance measures such as appropriate legislative and regulatory frameworks and roles and responsibilities for IDS were often unclear. The COVID-19 pandemic has strengthened some surveillance systems, often through leveraging existing respiratory surveillance systems. In some instances, improvements were seen only for COVID-19 related data but these changes were not sustained. Evaluation of IDS was also reported to be weak. ConclusionsIntegration should be driven by a clear purpose and contextualised. Political commitment, clear governance, and resourcing are needed. Technology and the establishment of technical communities of practice may help. However, the complexity and cost of integration should not be under-estimated, and further economic and impact evaluations of IDS are needed.

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.

Penggunaan Kobotoolbox sebagai Prosesor Data Surveilans Terpadu Penyakit (STP) Puskesmas Guntung Manggis

The Integrated Disease Surveillance (IDS) Program at the Guntung Manggis Public Health Center has a problem: the data processing stage only changes tabulation. Data processing is not continued in the form of diagrams, graphs, and mapping, so it will not describe disease trends based on epidemiological characteristics. This will complicate the next stage, namely analyzing the data to produce follow-up recommendations that are not on target. This problem is solved by using the kobotoolbox application for processing IDS data. The use of the kobotoolbox application in processing IDS data was monitored from October to November 2022. The evaluation results used the TAM evaluation model with a score of 95%, and all variables were declared good to very good with a score of (?68,01%), indicating that the kobotoolbox application was very effective in processing IDS data both through questionnaires and interviews. Then the supporting media used, both modules and tutorial videos, are feasible to use with a score of (&gt;61%) in understanding data processing using the kobotoolbox application. It’s hoped that the Surveillance Unit of the Guntung Manggis Public Health Center will continue to use the kobotoolbox application in processing IDS data so that the resulting recommendations are more targeted.

Characteristics and related factors of waterborne and foodborne infectious disease outbreaks before and after the onset of the COVID-19 pandemic (2017-2021) in the Republic of Korea: a descriptive study.

The incidence of waterborne and foodborne infectious diseases (WFIDs) continues to increase annually, attracting significant global attention. This study examined trends in WFID outbreaks in the Republic of Korea over the 5-year period before and during the coronavirus disease 2019 (COVID-19) pandemic and provided foundational data to establish measures for the prevention and control of WFID outbreaks. We analyzed 2,541 WFID outbreaks from 2017 to 2021 (42,805 cases) that were reported through the Integrated Disease Surveillance System of the Korea Disease Control and Prevention Agency. Outbreaks were defined as the occurrence of gastrointestinal symptoms in ≥2 individuals within a group with temporal and regional epidemiological associations. The related factors associated with WFID outbreaks during the observation period were statistically analyzed. The total number of WFID outbreaks significantly decreased in 2020 during the COVID-19 pandemic and increased to the pre-pandemic level in 2021. Different patterns were observed for each pathogen. The incidence of Salmonella outbreaks more than doubled, while norovirus outbreaks decreased significantly. WFID outbreaks in the Republic of Korea showed different patterns before and during the COVID-19 pandemic, influenced by infection control measures and changes in dietary consumption patterns. Outbreaks of some diseases increased, but the infection control measures applied during the pandemic resulted in a significant decrease in the overall number of WFID outbreaks. This highlights the importance of strengthening the management strategies for outbreak prevention through hygiene inspections, long-term monitoring, education, and promotion by conducting multidimensional analyses to understand the complex related factors.

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.

Mapping cholera risk in Nairobi County, Kenya: a comprehensive analysis of environmental, socio-economic, and WASH factors

Background : Cholera, a globally prevalent waterborne disease, is closely monitored in Kenya as part of the Integrated Disease Surveillance and Response strategy. Understanding regional variations in cholera risk factors and trends is crucial, particularly in Sub-Saharan Africa. This study aimed to construct a risk map for cholera outbreaks in Nairobi County, based on the spatial-temporal dynamics of environmental and socio-cultural factors, Water, Sanitation, and Hygiene (WASH) conditions, and historical cases reported between 2009 and 2019.&#x0D; Methodology : We retrospectively analyzed historical cholera cases in Nairobi, employing spatial analysis to map the spatiotemporal variations in factors associated with cholera outbreaks. A cross-sectional descriptive research design was adopted to investigate the relationship between WASH conditions and cholera outbreaks. Stratified random sampling selected 399 respondents from all 85 wards in Nairobi County. We employed descriptive statistics (percentages and frequencies) and inferential statistics (Chi-square) to assess variable relationships.&#x0D; Results : Cholera cases are concentrated in densely populated, especially informal, settlements. Population size significantly correlated with cholera cases (p-value=0.03). Dumping sites in Nairobi emerged as potential cholera sources within residential areas, with the vicinity showing a slight association with reported cases. Rainfall patterns and humidity levels across Nairobi County also influenced cholera risk.&#x0D; Conclusions : Areas within 400 meters of rivers and sewage lines faced elevated cholera risk. Most cases occurred in slum or regular residential areas. Proximity to dumping sites increased the risk of cholera outbreaks. These findings offer valuable insights for cholera prevention and control strategies in Nairobi County.

Mhealth tools for community-based infectious disease surveillance in Africa: a scoping review protocol

IntroductionCountries in the WHO’s African region have found community-based surveillance useful in ensuring the effectiveness of the Integrated Disease Surveillance and Response strategy. This approach encourages community participation in the...

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.

Challenges to Effective Implementation of Integrated Disease Surveillance and Response Among Health Workers in Nigeria: A Systematic Review

Challenges to Effective Implementation of Integrated Disease Surveillance and Response Among Health Workers in Nigeria: A Systematic Review