Background Event-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward.  Methods The review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. SPSS software was used to perform descriptive statistical analysis for quantitative data, while qualitative data was analysed manually using thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate. Results Sudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high academic qualification (Diploma or MSc) were noticed as inhibiting factors. Conclusion The review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted.

Background Event-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward. Methods The review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. The quantitative data was analysed using SPSS, and the qualitative data were analysed using a thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate. Results Sudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, the presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high training degree (Diploma or MSc) were noticed as inhibiting factors. Conclusion The review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted.

Background: Since the first case of COVID-19 in Sudan was reported in March 2020, the Federal Ministry of Health adopted an active surveillance system to collect and analyze information from the isolation centers and public and private laboratories about all suspected and confirmed COVID-19 cases. This study used the surveillance data to better understand the distribution and determinants of COVID-19 in Sudan and to construct a threshold level beyond which the dramatic surge may occur. Methods: Data of suspected and confirmed COVID-19 cases were extracted from the line list prepared by the Surveillance and Information Department at the Federal Ministry of Health after obtaining ethical approval from the National Ethics Committee. Data were cleaned, coded, and analyzed using SPSS version 21. Frequencies and proportions were used to describe data. A univariate logistic regression analysis was used to determine the association of variables with the positivity of COVID-19. Variables with p-values < 0.05 in the univariate logistic analyses were included in multivariable logistic regression to determine the adjusted odds ratios (ORs) and their 95% confidence interval (CI). A two-sided α of less than 0.05 (p < 0.05) was considered statistically significant.Results: Out of 48,545 suspected cases, 27,453 were positive. Four waves were seen, with a distinct explosion point of around 200 cases observed nationwide. Khartoum reported the highest number of cases. Of those tested positive, 16,444 (59.9%) were male and 11,009 (40.1%) were female. The mean (SD) age of cases was 41.1 (19.0) years with 21.6% of cases above 60 years. 14,780 (53.8%) of cases were asymptomatic. Fever, cough, shortness of breath, and loss of smell and taste were reported in 32.7%, 26.4%, 19.1 and 4.5% of confirmed cases, respectively. A total of 1,793 confirmed cases died; the case fatality rate was 6.5%. A considerable proportion of infection was reported among health workers. A univariate logistic regression analysis revealed that being symptomatic is significantly associated with testing negative for COVID-19 (odds ratio < 1). Conclusions: COVID-19 was widely spread in Sudan with more cases in Khartoum, the capital of Sudan. The country experienced four waves with an observable epidemic explosion point of around 200 positive cases per week nationwide. Around half of the patients were asymptomatic; however, fever, cough, and shortness of breath were the commonest symptoms. The CFR all through was 6.5%, with death having a strong association with age. Further studies are recommended to clarify the image, especially among health workers. The study also highlighted the need to improve the quality of surveillance data.

Background: Since the first case of COVID-19 in Sudan was reported in March 2020, the Federal Ministry of Health adopted an active surveillance system to collect and analyze information from the isolation centers and public and private laboratories about all suspected and confirmed COVID-19 cases. This study used the surveillance data to better understand the distribution and determinants of COVID-19 in Sudan and to construct a threshold level beyond which the dramatic surge may occur. Methods: Data of suspected and confirmed COVID-19 cases were extracted from the line list prepared by the Surveillance and Information Department at the Federal Ministry of Health after obtaining ethical approval from the National Ethics Committee. Data were cleaned, coded, and analyzed using SPSS version 21. Frequencies and proportions were used to describe data. A univariate logistic regression analysis was used to determine the association of variables with the positivity of COVID-19. Variables with p-values < 0.05 in the univariate logistic analyses were included in multivariable logistic regression to determine the adjusted odds ratios (ORs) and their 95% confidence interval (CI). A two-sided α of less than 0.05 (p < 0.05) was considered statistically significant.Results: Out of 48,545 suspected cases, 27,453 were positive. Four waves were seen, with a distinct explosion point of around 200 cases observed nationwide. Khartoum reported the highest number of cases. Of those tested positive, 16,444 (59.9%) were male and 11,009 (40.1%) were female. The mean (SD) age of cases was 41.1 (19.0) years with 21.6% of cases above 60 years. 14,780 (53.8%) of cases were asymptomatic. Fever, cough, shortness of breath, and loss of smell and taste were reported in 32.7%, 26.4%, 19.1 and 4.5% of confirmed cases, respectively. A total of 1,793 confirmed cases died; the case fatality rate was 6.5%. A considerable proportion of infection was reported among health workers. A univariate logistic regression analysis revealed that being symptomatic is significantly associated with testing negative for COVID-19 (odds ratio < 1). Conclusions: COVID-19 was widely spread in Sudan with more cases in Khartoum, the capital of Sudan. The country experienced four waves with an observable epidemic explosion point of around 200 positive cases per week nationwide. Around half of the patients were asymptomatic; however, fever, cough, and shortness of breath were the commonest symptoms. The CFR all through was 6.5%, with death having a strong association with age. Further studies are recommended to clarify the image, especially among health workers. The study also highlighted the need to improve the quality of surveillance data.

Background Since the first case of COVID-19 in Sudan was reported in March 2020, the Federal Ministry of Health adopted an active surveillance system to collect and analyze information from the isolation centers and public and private laboratories about all suspected and confirmed COVID-19 cases. This study used the surveillance data to better understand the distribution and determinants of COVID-19 in Sudan and to construct a threshold level beyond which the dramatic surge may occur. Methods Data of suspected and confirmed COVID-19 cases were extracted from the line list prepared by the Surveillance and Information Department at the Federal Ministry of Health after obtaining ethical approval from the National Ethics Committee. Data were cleaned, coded, and analyzed using SPSS version 21. Frequencies and proportions were used to describe data. A univariate logistic regression analysis was used to determine the association of variables with the positivity of COVID-19. Variables with p-values < 0.05 in the univariate logistic analyses were included in multivariable logistic regression to determine the adjusted odds ratios (ORs) and their 95% confidence interval (CI). A two-sided α of less than 0.05 (p < 0.05) was considered statistically significant. Results Out of 48,545 suspected cases, 27,453 were positive. Four waves were seen, with a distinct explosion point of around 200 cases observed nationwide. Khartoum reported the highest number of cases. Of those tested positive, 16,444 (59.9%) were male and 11,009 (40.1%) were female. The mean (SD) age of cases was 41.1 (19.0) years with 21.6% of cases above 60 years. 14,780 (53.8%) of cases were asymptomatic. Fever, cough, shortness of breath, and loss of smell and taste were reported in 32.7%, 26.4%, 19.1 and 4.5% of confirmed cases, respectively. A total of 1,793 confirmed cases died; the case fatality rate was 6.5%. A considerable proportion of infection was reported among health workers. A univariate logistic regression analysis revealed that being symptomatic is significantly associated with testing negative for COVID-19 (odds ratio < 1). Conclusions COVID-19 was widely spread in Sudan with more cases in Khartoum, the capital of Sudan. The country experienced four waves with an observable epidemic explosion point of around 200 positive cases per week nationwide. Around half of the patients were asymptomatic; however, fever, cough, and shortness of breath were the commonest symptoms. The CFR all through was 6.5%, with death having a strong association with age. Further studies are recommended to clarify the image, especially among health workers. The study also highlighted the need to improve the quality of surveillance data.