Baertlein Luke, Dubad Bashir Ali, Sahelie Birhanu, Damulak Istifanus Chindong, Osman Mohammed, Stringer Beverley, Bestman Agatha, Kuehne Anna, van Boetzelaer Elburg, Keating Patrick
Médecins Sans Frontières, Addis Ababa, Ethiopia.
Somali Regional Health Bureau, Jigjiga, Ethiopia.
Confl Health. 2024 Jan 30;18(1):13. doi: 10.1186/s13031-024-00571-y.
This study evaluated an early warning, alert and response system for a crisis-affected population in Doolo zone, Somali Region, Ethiopia, in 2019-2021, with a history of epidemics of outbreak-prone diseases. To adequately cover an area populated by a semi-nomadic pastoralist, or livestock herding, population with sparse access to healthcare facilities, the surveillance system included four components: health facility indicator-based surveillance, community indicator- and event-based surveillance, and alerts from other actors in the area. This evaluation described the usefulness, acceptability, completeness, timeliness, positive predictive value, and representativeness of these components.
We carried out a mixed-methods study retrospectively analysing data from the surveillance system February 2019-January 2021 along with key informant interviews with system implementers, and focus group discussions with local communities. Transcripts were analyzed using a mixed deductive and inductive approach. Surveillance quality indicators assessed included completeness, timeliness, and positive predictive value, among others.
1010 signals were analysed; these resulted in 168 verified events, 58 alerts, and 29 responses. Most of the alerts (46/58) and responses (22/29) were initiated through the community event-based branch of the surveillance system. In comparison, one alert and one response was initiated via the community indicator-based branch. Positive predictive value of signals received was about 6%. About 80% of signals were verified within 24 h of reports, and 40% were risk assessed within 48 h. System responses included new mobile clinic sites, measles vaccination catch-ups, and water and sanitation-related interventions. Focus group discussions emphasized that responses generated were an expected return by participant communities for their role in data collection and reporting. Participant communities found the system acceptable when it led to the responses they expected. Some event types, such as those around animal health, led to the community's response expectations not being met.
Event-based surveillance can produce useful data for localized public health action for pastoralist populations. Improvements could include greater community involvement in the system design and potentially incorporating One Health approaches.
本研究评估了2019 - 2021年埃塞俄比亚索马里州杜洛地区一个受危机影响人群的早期预警、警报和响应系统，该地区有易爆发疾病的流行病史。为了充分覆盖一个以半游牧牧民或畜牧为生、获得医疗设施机会稀少的地区，监测系统包括四个组成部分：基于卫生设施指标的监测、基于社区指标和事件的监测，以及来自该地区其他行为者的警报。本评估描述了这些组成部分的有用性、可接受性、完整性、及时性、阳性预测值和代表性。
我们进行了一项混合方法研究，回顾性分析了2叭9年2月至2021年1月监测系统的数据，同时对系统实施者进行了关键信息访谈，并与当地社区进行了焦点小组讨论。使用演绎和归纳相结合的方法分析访谈记录。评估的监测质量指标包括完整性、及时性和阳性预测值等。
分析了1010个信号；这些信号导致168起经核实的事件、58次警报和29次响应。大多数警报（46/58）和响应（22/29）是通过监测系统基于社区事件的分支发起的。相比之下，通过基于社区指标的分支发起了1次警报和1次响应。收到的信号的阳性预测值约为6%。约80%的信号在报告后24小时内得到核实，40%在48小时内进行了风险评估。系统响应包括新的移动诊所地点、麻疹疫苗补种以及与水和卫生相关的干预措施。焦点小组讨论强调，所产生的响应是参与社区因其在数据收集和报告中的作用而预期得到的回报。当系统导致他们预期的响应时，参与社区认为该系统是可接受的。一些事件类型，如与动物健康有关的事件，导致社区的响应期望未得到满足。
基于事件的监测可以为牧民群体的本地化公共卫生行动提供有用的数据。改进措施可包括让社区更多地参与系统设计，并可能纳入“同一健康”方法。
