Lubogo Mutaawe, Karanja Mary Joan, Mdodo Rennatus, Elnossery Sherein, Osman Ali Abdirahman, Abdi Abdulkadir, Buliva Evans, Tayyab Muhammad, Omar Omar Abdulle, Ahmed Mirza Mashrur, Abera Solomon Chane, Abubakar Abdinasir, Malik Sk Md Mamunur Rahman
World Health Organization, Country Office, Mogadishu, Somalia.
World Health Organization, East Mediterranean Regional Office, Cairo, Egypt.
Confl Health. 2022 Apr 16;16(1):18. doi: 10.1186/s13031-022-00450-4.
In 2008, Somalia introduced an electronic based Early Warning Alert and Response Network (EWARN) for real time detection and response to alerts of epidemic prone diseases in a country experiencing a complex humanitarian situation. EWARN was deactivated between 2008 to 2016 due to civil conflict and reactivated in 2017 during severe drought during a cholera outbreak. We present an assessment of the performance of the EWARN in Somalia from January 2017 to December 2020, reflections on the successes and failures, and provide future perspectives for enhancement of the EWARN to effectively support an Integrated Disease Surveillance and Response strategy.
We described geographical coverage of the EWARN, system attributes, which included; sensitivity, flexibility, timeliness, data quality (measured by completeness), and positive predictive value (PPV). We tested for trends of timeliness of submission of epidemiological reports across the years using the Cochran-Mantel-Haenszel stratified test of association.
By December 2020, all 6 states and the Banadir Administrative Region were implementing EWARN. In 2017, only 24.6% of the records were submitted on time, but by 2020, 96.8% of the reports were timely (p < 0.001). Completeness averaged < 60% in all the 4 years, with the worst-performing year being 2017. Overall, PPV was 14.1%. Over time, PPV improved from 7.1% in 2017 to 15.4% in 2019 but declined to 9.7% in 2020. Alert verification improved from 2.0% in 2017 to 52.6% by 2020, (p < 0.001). In 2020, EWARN was enhanced to facilitate COVID-19 reporting demonstrating its flexibility to accommodate the integration of reportable diseases.
During the past 4 years of implementing EWARN in Somalia, the system has improved significantly in timeliness, disease alerts verification, and flexibility in responding to emerging disease outbreaks, and enhanced coverage. However, the system is not yet optimal due to incompleteness and lack of integration with other systems suggesting the need to build additional capacity for improved disease surveillance coverage, buttressed by system improvements to enhance data quality and integration.
2008年，索马里引入了基于电子的早期预警警报与应对网络（EWARN），用于在这个处于复杂人道主义局势的国家实时检测和应对易流行疾病的警报。由于内战，EWARN在2008年至2016年期间停用，并于2017年在霍乱疫情期间的严重干旱期间重新启用。我们对2017年1月至2020年12月索马里EWARN的性能进行了评估，反思了其成功与失败之处，并为加强EWARN以有效支持综合疾病监测与应对策略提供了未来展望。
我们描述了EWARN的地理覆盖范围、系统属性，包括敏感性、灵活性、及时性、数据质量（以完整性衡量）和阳性预测值（PPV）。我们使用 Cochr an - Mantel - Haenszel 分层关联检验来测试多年来提交流行病学报告的及时性趋势。
到2020年12月，所有6个州和巴纳迪尔行政区都在实施EWARN。2017年，只有24.6%的记录按时提交，但到2020年，96.8%的报告是及时提交的（p < 0.001）。在这4年中，完整性平均<60%，表现最差的年份是2017年。总体而言，PPV为14.1%。随着时间的推移，PPV从2017年的7.1%提高到2019年的15.4%，但在2020年降至9.7%。警报核实率从2017年的2.0%提高到2020年的52.6%（p < 0.001）。2020年，EWARN得到加强以促进COVID - 19报告，表明其具有适应可报告疾病整合的灵活性。
在索马里实施EWARN的过去4年中，该系统在及时性、疾病警报核实以及应对新出现疾病爆发的灵活性和覆盖范围方面有了显著改善。然而，由于数据不完整以及与其他系统缺乏整合，该系统尚未达到最佳状态，这表明需要建立更多能力以改善疾病监测覆盖范围，并通过系统改进来提高数据质量和整合程度。
