Community-Based Surveillance in Côte d'Ivoire

Abstract

Community-based surveillance can be an important component of early warning systems. In 2016, the Côte d'Ivoire Ministry of Health launched a community-based surveillance project in 3 districts along the Guinea border. Community health workers were trained in detection and immediate reporting of diseases and events using a text-messaging platform. In December 2017, surveillance data from before and after implementation of community-based surveillance were analyzed in intervention and control districts. A total of 3,734 signals of priority diseases and 4,918 unusual health events were reported, of which 420 were investigated as suspect diseases and none were investigated as unusual health events. Of the 420 suspected cases reported, 23 (6%) were laboratory confirmed for a specific pathogen. Following implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, were documented. Reporting incidence rates in intervention districts for suspected measles, yellow fever, and acute flaccid paralysis were significantly higher after implementation, with a difference of 29.2, 19.0, and 2.5 cases per 100,000 person-years, respectively. All rate differences were significantly higher in intervention districts (p < 0.05); no significant increase in reporting was noted in control districts. These findings suggest that community-based surveillance strengthened detection and reporting capacity for several suspect priority diseases and events. However, the surveillance program was very sensitive, resulting in numerous false-positives. Learning from the community-based surveillance implementation experience, the ministry of health is revising signal definitions to reduce sensitivity and increase specificity, reviewing training materials, considering scaling up sustainable reporting platforms, and standardizing community health worker roles.

People-centred surveillance: a narrative review of community-based surveillance among crisis-affected populations

“… 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Eight documents were provided by humanitarian organisations (three abstracts, 39 , 40 , 41 two non-indexed articles, 42 , 43 and one thesis 44 ) or by the authors (one older, non-indexed article 45 and one article that did not have MeSH keywords 46 ). The 29 documents retrieved 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 described 25 unique systems in the Central African Republic (two systems), 21 , 33 Chad, 35 Côte d’Ivoire (two systems), 24 , 40 , 43 the Democratic Republic of the Congo (two systems), 26 , 30 Guinea, 37 …”

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

“…A number of CBS systems have been described and have demonstrated their accuracy and sensitivity, their ability to provide more timely measures of disease activity, and their usefulness identifying risk groups, assessing the burden of illness and informing disease transmission models [118][119][120][121]. CBS can be an important component of early warning of emerging events by engaging the communities to detect potential public health events and connecting individuals to health services [3,[122][123][124][125]. In a study in Ivory Coast, following the implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, have been reported [122].…”

“…CBS can be an important component of early warning of emerging events by engaging the communities to detect potential public health events and connecting individuals to health services [3,[122][123][124][125]. In a study in Ivory Coast, following the implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, have been reported [122]. These ndings suggest that CBS strengthened detection and reporting capacity for several suspect priority diseases and events.…”

“…Despite the relevance of the inclusion of community information in surveillance, by end of 2017, of the 44 countries in the WHO Africa region, 32 (68%) had commenced CBS and 35 (74%) had event-based surveillance [23]. However, there is only one report from Sierra Leone that data collected from the two approaches are integrated into the national IDSR system [122]. In some countries, the CBS programmes are still operating as pilot or research projects [126,127] and most cover a limited geographical area and are largely for speci c disease programmes in rural settings [122,128].…”

Lessons Learned in Global Health Security Implementation

“…Based on their findings, they are exploring scale-up of such surveillance partnerships, while considering the best approach to training and achieving balance between system sensitivity and specificity. 15 Standley et al note the importance of partnerships in building health security capacity in Guinea after the 2014-2016 Ebola epidemic. The authors highlight the key components of information sharing, flexible funding mechanisms, and adaptability to local needs.…”