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

Abstract

Outbreaks of disease in settings affected by crises grow rapidly due to late detection and weakened public health systems. Where surveillance is underfunctioning, community-based surveillance can contribute to rapid outbreak detection and response, a core capacity of the International Health Regulations. We reviewed articles describing the potential for community-based surveillance to detect diseases of epidemic potential, outbreaks, and mortality among populations affected by crises. Surveillance objectives have included the early warning of outbreaks, active case finding during outbreaks, case finding for eradication programmes, and mortality surveillance. Community-based surveillance can provide sensitive and timely detection, identify valid signals for diseases with salient symptoms, and provide continuity in remote areas during cycles of insecurity. Effectiveness appears to be mediated by operational requirements for continuous supervision of large community networks, verification of a large number of signals, and integration of community-based surveillance within the routine investigation and response infrastructure. Similar to all community health systems, community-based surveillance requires simple design, reliable supervision, and early and routine monitoring and evaluation to ensure data validity. Research priorities include the evaluation of syndromic case definitions, electronic data collection for community members, sentinel site designs, and statistical techniques to counterbalance false positive signals.

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

“…Detailed case studies of cholera outbreaks provide practical observations on the mechanisms of surveillance, diagnosis, and response which can reduce delays. Early detection with high-quality epidemiological data has been augmented with the use of sentinel site surveillance at hospitals equipped with RDTs and trained and vigilant health workers in Kathmandu, Nepal [ 162 ]; community-based surveillance using existing community health worker or Red Cross volunteer networks to enable early warning of clusters in the community before patients appear at health facilities in Central African Republic and Haiti [ 71 , 152 , 182 , 183 ]; and other event-based surveillance mechanisms, including phone hotlines and mobile phone fleets, to enable immediate notification of suspect events in public, private, and NGO clinics and in the community, as seen in Northern Nigeria and Cameroon [ 171 , 184 , 185 ]. Response should not be delayed by poor laboratory capacity.…”

Identifying transferable lessons from cholera epidemic responses by Médecins Sans Frontières in Mozambique, Malawi and the Democratic Republic of Congo, 2015–2018: a scoping review

“…All epidemics reviewed here occurred in identified cholera hotpots in Sub-Saharan Africa [ 21 ], which have documented weak surveillance systems [ 34 ], low coverage of WASH services [ 35 ] and high global acute malnutrition (GAM) prevalence (2.7%, 6.1%, and 8.10% in Malawi, Mozambique and DRC, respectively [ 36 ]), which all increase risk and severity of outbreaks. Additionally, presence of armed conflict and population displacement likely exacerbated V. cholerae transmissibility and case fatality among symptomatic cases, as demonstrated by other research documenting the overlap between crises and cholera epidemics [ 37 – 40 ].…”

“…In most case studies described here, epidemics were confirmed but the methods were not specified. Additionally, our data indicated that epidemiological data were often inaccurate or incomplete: reliance on under-resourced surveillance systems may have led to the data delays in the alert, delayed confirmation and delays to the resulting response [ 34 ].…”

Surveillance and pandemic governance in least‐ideal contexts: The Philippine case

“…Epidemiological surveillance is an expected measure to be undertaken in a pandemic (Holmes et al, 2018; Thomas, 2014) but COVID‐19 also enabled other forms of surveillance to be exercised (Eck & Hatz, 2020; Wenger et al, 2020). Examples include technological surveillance using contact tracing apps (Shaw et al, 2020; Sonn & Lee, 2020), community‐based surveillance through systematic community reporting especially in hard‐to‐reach regions (Ratnayake et al, 2020), and security surveillance via increased uniformed presence (Chretien et al, 2007; Kalkman, 2020).…”