Integrating technology and data in public health disease surveillance in Africa: case study of the AVADAR program (Preprint)

2021 ◽  
Author(s):  
Chinedu Ejike Anarado ◽  
Loveth Metiboba ◽  
Faye Simmonds ◽  
Tope Falodun
Keyword(s):  
Public Health ◽  
Disease Surveillance ◽  
Data Gathering ◽  
Sub Saharan Africa ◽  
Surveillance Systems ◽  
Wild Poliovirus ◽  
Timely Response ◽  
Sub Saharan ◽  
Traditional Surveillance

BACKGROUND Sub-saharan Africa, Afghanistan and Pakistan are the last frontiers with the prevalence of wild poliovirus (WPV). Following joint efforts and partnerships some of which were instituted in the last 20 years, Africa was declared free of WPV in August 2020. While efforts now focus on eliminating circulating vaccine derived poliovirus (cVDPV), it is important to review some of the interventions that resulted in a polio-free certification for the continent. OBJECTIVE The Auto-visual AFP detection and response (AVADAR) program was one of such interventions. AVADAR helped with a more focused, technology and data driven campaign, to ensure that surveillance was broad, inclusive, and responsive. With the infusion of mobile health technology, the project became a success as it reported, investigated and confirmed more cases of AFP compared to the existing traditional surveillance systems. This study attempts a review of the AVADAR intervention with a view to understand the role played by technology and data. METHODS This study comparatively reviewed the data generated over a three year period, across nine countries where the AVADAR project was implemented. It sought to understand how AVADAR was an improvement over traditional surveillance systems. RESULTS The AVADAR program confirmed more reported AFP cases, when compared with the traditional (paper-based) system. It was found that more true AFP cases were found through the AVADAR system. AVADAR accounted for 76% of cases reported across eight countries. CONCLUSIONS Evidently, data and technology - in this case - the AVADAR tool, addressed most of the challenges of Public Health Surveillance in the target countries. The challenge of erratic surveillance data gathering, and feedback was reduced as the AVADAR program demonstrated coordinated data gathering, active case search, timely response to alerts, and ultimately, improved confirmation of true cases. It contributes lessons that could be useful in enhancing surveillance systems across the developing world particularly in Africa.

Crowdsourcing Covid-19 signals in sub-Saharan Africa: Leveraging digital contributor networks for participatory surveillance of Covid-19 symptoms and deaths (Preprint)

2020 ◽  
Author(s):  
Ngozi A Erondu ◽  
Sagal A Ali ◽  
Mohamed Ali ◽  
Schadrac C Agbla
Keyword(s):  
Public Health ◽  
Sub Saharan Africa ◽  
Specific Information ◽  
Surveillance Systems ◽  
Health Seeking ◽  
African Countries ◽  
Cross Sectional Survey ◽  
Local Networks ◽  
The World ◽  
Sub Saharan

BACKGROUND In sub-Saharan Africa, underreporting of cases and deaths has been attributed to various factors including, weak disease surveillance, low health-seeking behaviour of flu like symptoms, and stigma of Covid-19. There is evidence that SARS-CoV-2 spread mimics transmission patterns of other countries across the world. Since the Covid-19 pandemic has changed the way research can be conducted and in light of restrictions on travel and risks to in-person data collection, innovative approaches to collecting data must be considered. Nearly 50% of Africa’s population is a unique mobile subscriber and it is one of the fastest growing smart-phone marketplaces in the world; hence, mobile phone platforms should be considered to monitor Covid-19 trends in the community. OBJECTIVE We demonstrate the use of digital contributor platforms to survey individuals about cases of flu-like symptoms and instances of unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia, and Zimbabwe. METHODS Rapid cross-sectional survey of individuals with severe flu and pneumonia symptoms and unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia and Zimbabwe RESULTS Using a non-health specific information platform, we found COVID-19 signals in five African countries, specifically: •Across countries, nearly half of the respondents (n=739) knew someone who had severe flu or pneumonia symptoms in recent months. •One in three respondents from Somalia and one in five from Zimbabwe respondents said they knew more than five people recently displaying flu and/or pneumonia symptoms. •In Somalia there were signals that a large number of people might be dying outside of health facilities, specifically in their homes or in IDP or refugee camps. CONCLUSIONS Existing digital contributor platforms with local networks are a non-traditional data source that can provide information from the community to supplement traditional government surveillance systems and academic surveys. We demonstrate that using these distributor networks to for community surveys can provide periodic information on rumours but could also be used to capture local sentiment to inform public health decision-making; for example, these insights could be useful to inform strategies to increase confidence in Covid19 vaccine. As Covid-19 continues to spread somewhat silently across sub-Saharan Africa, regional and national public health entities should consider expanding event-based surveillance sources to include these systems.

scholarly journals PO 8581 ZOONOTIC VIRAL ANTIGENS SURVEILLANCE IN HEALTHY POPULATIONS LIVING IN LAMBARÉNÉ, GABON

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A58.2-A58
Author(s):  
Emmanuel Bache ◽  
Marguerite M Loembe ◽  
Selidji T Agnandji
Keyword(s):  
Disease Transmission ◽  
Disease Surveillance ◽  
Vaccine Trial ◽  
Viral Rna ◽  
Sub Saharan Africa ◽  
Surveillance Systems ◽  
Rt Pcr ◽  
Zoonotic Infections ◽  
Viral Antigens ◽  
Sub Saharan

BackgroundWorldwide, viral zoonotic infections such as filoviruses, flaviviruses, nairoviruses and arenaviruses cause self-limiting to severe diseases. They are endemic in sub-Saharan Africa, causing sporadic outbreaks warranting the development of sustainable surveillance systems. In Gabon, Ebola outbreaks occurred from 1994 to 2002 causing 214 human cases and 150 deaths, while Dengue, Zika and Chikungunya virus outbreaks occurred between 2007 and 2010. Beyond these outbreaks, little is known about the epidemiology. Recently, in collaboration with the Japanese government, the Research and Health Ministries of Gabon supported the implementation of a biosecurity level-3 (BSL-3) laboratory at CERMEL in Lambaréné as a zoonotic disease surveillance unit. Start-off involved antigen detection and characterisation of circulating antibodies to targeted viral antigens in healthy populations. This study reports data from healthy participants (18–50 years) in a phase I rVSV-ZEBOV-GP Ebola vaccine trial.MethodsHundred-six (106) baseline samples were screened for Ebola, Dengue (serotypes) 1–4 and Chikungunya viral RNA by RT-PCR on serum. IgG ELISA on plasma was used to identify antibodies against: Zaire-Ebola-(EBOV-GP and EBOV-VP40), Marburg-(MARV-GP and MARV-VP40), Crimean Congo Haemorrhagic Fever-(CCHFV-GP), Lasa-(LASV-GPC and LASV-NP), Yellow Fever-(YFV-NS1), West-Nile-(WNV-NS1), Zika virus-(ZIKV-NS1), Chikungunya-(CHIKV-VLP) and Dengue-(DENV1-NS1,DENV2-NS1,DENV3-NS1,DENV4-NS1) virus antigens.ResultsNo viral RNA was isolated by RT-PCR in 106 samples. About 9% (10/106), 3% (3/106), 6% (6/106), 24% (25/106), 51% (54/106), 38% (40/106) and 36% (38/106) participants were seropositive for antibodies specific to EBOV-GP, MARV-GP, CCHFV-GP, YFV-NS1, WNV-NS1, ZIKV-NS1 and CHIKV-VLP, respectively. Twelve percent (12%; 13/106) of participants possessed antibodies specific to Zika, Chikungunya and Dengue 1–4 antigens. Six percent (6%; 6/106) of participants were seropositive for EBOV-GP and CCHFV-GP.ConclusionWe found antibodies to viral zoonotic infections among our healthy volunteers. Further assays, including neutralisation assays are being performed to ascertain the specificity of the antibodies. These findings, once confirmed, will provide insights into disease surveillance, vaccine trial designs, evaluation of post-vaccine immune responses, variability in adverse events and overall disease transmission patterns.

scholarly journals Twenty Years of Integrated Disease Surveillance and Response in Sub-Saharan Africa: Challenges and Opportunities for Effective Management of Infectious Disease Epidemics

2020 ◽  
Author(s):  
Irene Mremi ◽  
Janeth George ◽  
Susan F. Rumisha ◽  
Calvin Sindato ◽  
Leonard E.G. Mboera ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Information ◽  
Disease Surveillance ◽  
Sub Saharan Africa ◽  
Health Management Information System ◽  
Support Functions ◽  
Surveillance And Response ◽  
Sub Saharan ◽  
Disease Epidemics

Abstract Background: Public health surveillance requires valid, timely and complete health information for early detection of outbreaks. Countries in Sub-Saharan Africa (SSA) adopted Integrated Disease Surveillance and Response (IDSR) strategy in 1998 in response to an increased frequency of emerging and re-emerging diseases in the region. This systematic review aimed to analyse how IDSR implementation has embraced advancement in information technology, big data analytics techniques and wealth of data sources to strengthen detection and management of infectious disease epidemics in SSA. Methods: A search for eligible articles was done through HINARI, PubMed, and advanced Google Scholar databases. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. Using the key search descriptors, 1,809 articles were identified and screened at two stages and 45 studies met the inclusion criteria for detailed review.Results: Of the 45 studies, 35 were country-specific, seven studies covered the region and three studies covered 3-4 countries. A total of 24 studies assessed the IDSR core functions while 42 studies assessed the support functions. Twenty-three studies addressed both the core and support functions. Most of the studies involved Tanzania (9), Ghana (6) and Uganda (5). The implementation of the IDSR strategy has shown improvements mainly in the support functions. The Health Management Information System (HMIS) has remained the main source of IDSR data. However, the HMIS system is characterised by inadequate data completeness, timeliness, quality, analysis and utilisation as well as lack of integration of data from sources other than health care facilities. Conclusion: In most SSA, HMIS is the main source of IDSR data, characterised by incompleteness, inconsistency and inaccuracy. This data is considered to be biased and reflects only the population seeking care from healthcare facilities. Community-based event-based surveillance is weak and non-existence in the majority of the countries. Data from other systems are not effectively utilized and integrated for surveillance. It is recommended that SSA countries consider and adopt multi-sectoral, multi-disease and multi-indicator platforms that integrate the existing surveillance systems with other sources of health information to provide support to effective detection and prompt response to public health threats.

scholarly journals COVID-19 Crisis in Africa: Revisiting the Contributing Factors

2021 ◽  
Vol 1 (1) ◽  
pp. 64-67
Author(s):  
Ugochukwu A Eze ◽  
Kingsley I Ndoh ◽  
Kehinde K Kanmodi
Keyword(s):  
Disease Surveillance ◽  
Democratic Republic Of Congo ◽  
The United States ◽  
Sub Saharan Africa ◽  
Surveillance Systems ◽  
Contributing Factors ◽  
African Countries ◽  
The World ◽  
Control And Prevention ◽  
Sub Saharan

Abstract The COVID-19 pandemic has been a major threat to people and healthcare systems around the world. Each region of the world has had unique factors such as culture, demographics, socioeconomic and the political landscape that has either fueled or mitigated the severity of the pandemic. For example, the 2021 Indian Kumbh Mela festival fueled a devastating wave of the pandemic in India. Similarly, the pandemic in the United States has in part been fueled an epidemic of disinformation that led to a growing number of anti-vaxxers, and those who are opposed to COVID-19 prevention guidelines set by agencies like the Centers for Disease Control and Prevention. In Africa, burial practices in Liberia and the Democratic Republic of Congo once fueled the Ebola epidemic. Likewise, in the context of COVID-19, there are factors that are unique to Africa that may have either fueled or mitigated the severity of the pandemic. The anti-COVID-19 measures in many African countries significantly affected household income without commensurate deployment of palliative measures to cushion the effect. Fortunately, the pandemic has run a relatively milder course in sub-Saharan Africa—defying earlier devastating projections. Therefore, to be prepared for the next pandemic, African governments must involve critical stakeholders such as religious and traditional leaders, strengthen current disease surveillance systems and invest in systems that encourage private investments in local vaccine manufacturing.

scholarly journals “That was then, this is now” improving public health syndromic surveillance baselines

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Roger Morbey ◽  
Alex J. Elliot ◽  
Paul Loveridge ◽  
Helen Hughes ◽  
Sally Harcourt ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Surveillance ◽  
Syndromic Surveillance ◽  
Regression Models ◽  
Major Change ◽  
Surveillance Systems ◽  
Care Activity ◽  
Working Practices ◽  
Available Information ◽  
Traditional Surveillance

ObjectiveTo improve the ability of syndromic surveillance systems to detectunusual events.IntroductionSyndromic surveillance systems are used by Public Health England(PHE) to detect changes in health care activity that are indicative ofpotential threats to public health. By providing early warning andsituational awareness, these systems play a key role in supportinginfectious disease surveillance programmes, decision making andsupporting public health interventions.In order to improve the identification ofunusualactivity, wecreated new baselines to modelseasonally expectedactivity inthe absence of outbreaks or other incidents. Although historicaldata could be used to model seasonality, changes due to publichealth interventions or working practices affected comparability.Specific examples of these changes included a major change in theway telehealth services were provided in England and the rotavirusvaccination programme introduced in July 2013 that changed theseasonality of gastrointestinal consultations. Therefore, we needed toincorporate these temporal changes in our baselines.MethodsWe used negative binominal regression to model daily syndromicsurveillance, allowing for day of week and public holiday effects.To account for step changes in data caused by changes in healthcaresystem working practices or public health interventions we introducedspecific independent variables into the models. Finally, we smoothedthe regression models to provide short term forecasts of expectedtrends.The new baselines were applied to PHE’s four syndromicsurveillance systems for daily surveillance and public-facing weeklybulletins.ResultsWe replaced traditional surveillance baselines (based on simpleaverages of historical data) with the regression models for dailysurveillance of 53 syndromes across four syndromic surveillancesystems. The improved models captured current seasonal trends andmore closely reflected actual data outside of outbreaks.ConclusionsSyndromic surveillance baselines provide context forepidemiologists to make decisions about seasonal disease activity andemerging public health threats. The improved baselines developedhere showed whether current activity was consistent with expectedactivity, given all available information, and improved interpretationwhen trends diverged from expectations.

scholarly journals Nowcasting Influenza-like Illness Trends in Cameroon

2020 ◽  
Author(s):  
Elaine O. Nsoesie ◽  
Olubusola Oladeji ◽  
Aristide S. Abah Abah ◽  
Martial L. Ndeffo-Mbah
Keyword(s):  
Disease Surveillance ◽  
Respiratory Infections ◽  
Sub Saharan Africa ◽  
Digital Data ◽  
Surveillance Systems ◽  
African Countries ◽  
Influenza Like Illness ◽  
Search Data ◽  
Sub Saharan ◽  
Google Search

ABSTRACTAlthough acute respiratory infections are a leading cause of mortality in sub-Saharan Africa, surveillance of diseases such as influenza is mostly neglected. Evaluating the usefulness of influenza-like illness (ILI) surveillance systems and developing approaches for forecasting future trends is important for pandemic preparedness. We applied statistical and machine learning models to forecast 2012 to 2018 trends in ILI cases reported by the Cameroon Ministry of Health (MOH), using Google searches for influenza symptoms, treatments, natural or traditional remedies as well as, infectious diseases with a high burden (i.e., AIDS, malaria, tuberculosis). The variance explained by the models based on Google search data were 87.7%, 79.1% and 52.0% for the whole country, the Littoral and Centre regions respectively. Our study demonstrates the need for developing contextualized approaches when using digital data for disease surveillance and demonstrates the potential usefulness of search data for monitoring ILI in sub-Saharan African countries.

scholarly journals Evaluation of influenza surveillance systems in sub-Saharan Africa: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023335 ◽  
Author(s):  
Evanson Zondani Sambala ◽  
Duduzile Edith Ndwandwe ◽  
Loveness M Imaan ◽  
Charles S Wiysonge
Keyword(s):  
Systematic Review ◽  
Disease Surveillance ◽  
Database Search ◽  
Sub Saharan Africa ◽  
Influenza Surveillance ◽  
Free Text ◽  
Surveillance Systems ◽  
Wide Range ◽  
Sub Saharan ◽  
Sensitivity Specificity

IntroductionInfluenza infrastructure systems are crucial for maintaining surveillance operations, and for mitigating and responding to the disease. The role of surveillance is to isolate and identify as rapidly as possible any new influenza strains and collate this information for the preparedness for, and response to, an impending influenza activity in humans. However, sources of surveillance information, particularly in Africa, are meagre. This systematic review will critically evaluate the existing influenza surveillance systems in sub-Saharan Africa.Method and analysisWe will build multiple electronic database search strategies for use in PubMed, Scopus, African Journal Online, Web of Science and Google scholar to identify as many studies as possible. The medical subject heading and keywords will include a wide range of synonyms, both in index terms and free-text words. Database search will be followed by hand searching of reference lists of all relevant studies. We will include eligible full-text studies published from 2002 in order to coincide with the establishment of the integrated disease surveillance and response system in Africa by WHO. We will examine the influenza surveillance performance systems using the US Centers for Disease Control and Prevention guidelines on evaluating public health surveillance systems. Our outcome measures will include surveillance system attributes such as timeliness, sensitivity, specificity, acceptability, representativeness, simplicity and usefulness. We will conduct a narrative synthesis of all studies.Ethics and disseminationThis study does not require ethics approval because it uses publicly available data. Our findings will be published in a peer review journal and disseminated to policy makers.PROSPERO registration numberCRD42018103042.

scholarly journals Twenty Years of Integrated Disease Surveillance and Response in Sub-Saharan Africa: Challenges and Opportunities for Effective Management of Infectious Disease Epidemics

2020 ◽  
Author(s):  
Irene Mremi ◽  
Janeth George ◽  
Susan F. Rumisha ◽  
Calvin Sindato ◽  
Leonard E.G. Mboera ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Information ◽  
Disease Surveillance ◽  
Sub Saharan Africa ◽  
Health Management Information System ◽  
Support Functions ◽  
Surveillance And Response ◽  
Sub Saharan ◽  
Disease Epidemics

Abstract Background: Public health surveillance requires valid, timely and complete health information for early detection of outbreaks. Countries in Sub-Saharan Africa (SSA) adopted the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 in response to an increased frequency of emerging and re-emerging diseases in the region. This systematic review aimed to analyse how IDSR implementation has embraced advancement in information technology, big data analytics techniques and wealth of data sources to strengthen detection and management of infectious disease epidemics in SSA. Methods: Three databases were searched for eligible articles: HINARI, PubMed, and advanced Google Scholar databases. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. A total of 1,809 articles were identified using key descriptors and screened at two stages, and 45 studies met the inclusion criteria for detailed review.Results: Of the 45 studies, 35 were country-specific, seven studies covered the region, and three studies covered 3-4 countries. A total of 24 studies assessed the IDSR core functions, while 42 studies evaluated the support functions. Twenty-three studies addressed both the core and support functions. Most of the studies involved Tanzania (9), Ghana (6) and Uganda (5). The implementation of the IDSR strategy has shown improvements, mainly in the support functions. The Health Management Information System (HMIS) has remained the main source of IDSR data. However, the HMIS system is characterised by inadequate data completeness, timeliness, quality, analysis and utilisation as well as lack of integration of data from sources other than health care facilities. Conclusion: In most SSA, HMIS is the main source of IDSR data, characterised by incompleteness, inconsistency and inaccuracy. This data is considered to be biased and reflects only the population seeking care from healthcare facilities. Community-based event-based surveillance is weak and non-existence in the majority of the countries. Data from other systems are not effectively utilised and integrated for surveillance. It is recommended that SSA countries consider and adopt multi-sectoral, multi-disease and multi-indicator platforms that integrate the existing surveillance systems with other sources of health information to provide support to effective detection and prompt response to public health threats.

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