Assessment of electronic disease early warning system for improved disease surveillance and outbreak response in Yemen

Abstract

Background Diseases Surveillance is a continuous process of data collection, analysis interpretation and dissemination of information for swift public health action. Recent advances in health informatics have led to the implementation of electronic tools to facilitate such critical disease surveillance processes. This study aimed to assess the performance of the national electronic Disease Early Warning System in Yemen (eDEWS) using system attributes: data quality, timeliness, stability, simplicity, predictive value positive, sensitivity, acceptability, flexibility, and representativeness, based on the Centres for Disease Control & Prevention (US CDC) standard indicators. Methods We performed a mixed methods study that occurred in two stages: first, the quantitative data was collected from weekly epidemiological bulletins from 2013 to 2017, all alerts of 2016, and annual eDEWS reports, and then the qualitative method using in-depth interviews was carried out in a convergent strategy. The CDC guideline used to describe the following system attributes: data quality (reporting, and completeness), timeliness, stability, simplicity, predictive value positive, sensitivity, acceptability, flexibility and representativeness. Results The finding of this assessment showed that eDEWS is a resilient and reliable system, and despite the conflict in Yemen, the system is still functioning and expanding. The response timeliness remains a challenge, since only 21% of all eDEWS alerts were verified within the first 24 h of detection in 2016. However, identified gaps did not affect the system’s ability to identify outbreaks in the current fragile situation. Findings show that eDEWS data is representative, since it covers the entire country. Although, eDEWS covers only 37% of all health facilities, this represents 83% of all functional health facilities in all 23 governorates and all 333 districts. Conclusion The quality and timeliness of responses are major challenges to eDEWS’ functionality, the eDEWS remains the only system that provides regular data on communicable diseases in Yemen. In particular, public health response timeliness needs improvement.

The impact of the fragile health system on the implementation of health policies in Yemen

“…In Yemen, there are several examples to clarify the interrelationship between the different health agendas: for example, literatures from Yemen show that the establishment of the electronic Disease Early Warning System (eDEWS) was established to strengthen health security in the country and focused on specific epidemic prone diseases by using representative samples of health facilities (sentinel sites) 15 . The program was designed by the World Health Organization to support the routine surveillance system in Yemen, but due to the weakness of the disease surveillance system, eDEWS became the main source of information in the health system and currently covers most of the operating health facilities and including all diseases reported in the routine disease surveillance system, it called now the electronic Integrated Disease Early Warning System (eIDEWS) 16 . Table 1 shows the increasing number of the involved governorates, districts and health facilities from 2013 to 2017, accordingly the number of consultations increased from one million in 2013 to cover more than 12 million in 2017.…”

Evaluation of the Kenya Livestock and Wildlife Syndromic Surveillance System for Rift Valley Fever, Narok County, Kenya, 2018-2019

“…For a very long time, the animal health surveillance system in Kenya lacked a tool for real-time disease reporting [6]. With the recent experiences of rapidly emerging and spreading global outbreaks across borders and continents, there was a need to develop an effective surveillance system for Zoonotic diseases, which account for 60% of emerging diseases [7][8][9]. This was to be able to quickly detect and report diseases in human and animal populations to trigger timely investigations and responses.…”

Community-based surveillance in internally displaced people’s camps and urban settings during a complex emergency in Yemen in 2020

“…When the novel coronavirus disease (COVID-19) epidemic was confirmed in Yemen on 10 April 2020, the country had an insufficient number of trained rapid response teams (RRTs) to investigate the suspected cases because of concurrent disease outbreaks, including cholera, diphtheria, arboviral diseases and others [ 1 , 2 ]. One RRT was available in each district to cover more than 300,000 people, and most of the COVID-19 cases did not report to the health facilities [ 1 , 3 ].…”

“…The surveillance system in Yemen is exclusively based on the electronic diseases early warning system (eDEWS), in which most health facilities are used as reporting sites for epidemic-prone diseases. Data from the health facilities are reported in real-time and visualized at all levels, allowing early detection of abnormal disease trends [ 3 ]. The rumours from the communities are detected by the governorate health office (GHO) through information provided by general public, media, and others.…”

“…More than 40,000 community volunteers recruited by national and international organizations were available in Yemen, and they mainly implemented health promotion activities [ 4 ]. These volunteers were also encouraged to report rumours of suspected outbreaks to the GHO to deploy RRTs [ 3 ].…”