Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study
BackgroundThe escalation of the conflict in Sudan has created a major humanitarian challenge for neighboring countries, especially in the Eastern regions of Chad. This humanitarian setting's health needs are unique in that they are more vulnerable to both outbreak-prone disease and a lack of es...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Epidemiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fepid.2025.1604446/full |
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| author | Stephane Tewo Balde Thierno Freddy M. Banza Idriss M. Mahamat N'dri K. Eric-Didier Djinguebey N. Raoul John Otokoye Otshudiema Castilla Echenique Jorge Moussa Brahimi Djoumbarina Maina Evers Egmond Marcel Woung Kazuki Shimizu Boris I. Pavlin Jacques L. Tamuzi Jacques L. Tamuzi Patrick D. M. C. Katoto Patrick D. M. C. Katoto Patrick D. M. C. Katoto Charles S. Wiysonge Charles S. Wiysonge Blanche-Philomene Melanga Anya |
| author_facet | Stephane Tewo Balde Thierno Freddy M. Banza Idriss M. Mahamat N'dri K. Eric-Didier Djinguebey N. Raoul John Otokoye Otshudiema Castilla Echenique Jorge Moussa Brahimi Djoumbarina Maina Evers Egmond Marcel Woung Kazuki Shimizu Boris I. Pavlin Jacques L. Tamuzi Jacques L. Tamuzi Patrick D. M. C. Katoto Patrick D. M. C. Katoto Patrick D. M. C. Katoto Charles S. Wiysonge Charles S. Wiysonge Blanche-Philomene Melanga Anya |
| author_sort | Stephane Tewo |
| collection | DOAJ |
| description | BackgroundThe escalation of the conflict in Sudan has created a major humanitarian challenge for neighboring countries, especially in the Eastern regions of Chad. This humanitarian setting's health needs are unique in that they are more vulnerable to both outbreak-prone disease and a lack of essential services. To address these challenges, the World Health Organization has supported implementing the Early Warning Alert and Response System (EWARS) Mobile. The purpose of this study was to evaluate the application of the EWARS Mobile epidemiological surveillance tool in Sudanese children’s refugees in Eastern Chad.MethodsThis was a retrospective and population-based surveillance study that provided an overview of the pattern of cases and deaths in time and space related to potential outbreaks.ResultsIn total, 1,645 alerts were reported among children in vulnerable provinces of Quaddai, Sila, and Wadi Fira. There were 41,738 alerted cases and 236 deaths, for a 0.56% projected fatality rate. The EWARS Mobile successfully reported alerted increases in cases of acute flaccid paralysis (AFP), acute jaundice syndrome (AJS), acute respiratory infection (ARI), acute watery diarrhea in children (AWD), measles, meningitis, diphtheria, neonatal tetanus (NT), dengue, dysentery, and atypical events in vulnerable children in time and space. Case reporting, alert recording, and weekly reporting were completed successfully at all levels (camps, district, zone, and province) (≥80% completion rate). In contrast, the timeliness of alert reporting, weekly reporting, and probable outbreaks did not perform well across levels (≥80% timeliness rate). Epidemic curves indicated multiple probable outbreak types, characterized by a point source (AJS and AWD under 5 years), common source (AWD in 5 years and above), propagated source (ARI and dysentery), and intermittent source (AFP, measles, meningitis, diphtheria, NT, and unusual events). The sensitivity and positive predictive value were estimated at 81% (79%–83%) and 72.0% (68%–75%), respectively.ConclusionsThe EWARS Mobile is a practical solution for Eastern Chad provinces to implement throughout the pre-epidemic and outbreak periods in vulnerable children in this severe humanitarian crisis. However, efforts should be made to improve timeliness indicators at all subnational levels and incorporate alarm indicators. |
| format | Article |
| id | doaj-art-588737efdeda4bfb9467b7cf16afecfa |
| institution | Kabale University |
| issn | 2674-1199 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Epidemiology |
| spelling | doaj-art-588737efdeda4bfb9467b7cf16afecfa2025-08-20T03:55:59ZengFrontiers Media S.A.Frontiers in Epidemiology2674-11992025-07-01510.3389/fepid.2025.16044461604446Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance studyStephane Tewo0Balde Thierno1Freddy M. Banza2Idriss M. Mahamat3N'dri K. Eric-Didier4Djinguebey N. Raoul5John Otokoye Otshudiema6Castilla Echenique Jorge7Moussa Brahimi8Djoumbarina Maina9Evers Egmond10Marcel Woung11Kazuki Shimizu12Boris I. Pavlin13Jacques L. Tamuzi14Jacques L. Tamuzi15Patrick D. M. C. Katoto16Patrick D. M. C. Katoto17Patrick D. M. C. Katoto18Charles S. Wiysonge19Charles S. Wiysonge20Blanche-Philomene Melanga Anya21WHO Country Office,N’djamena, ChadEmergency Preparedness and Response, World Health Organization (WHO), African Regional Office (AFRO), Dakar, SenegalEmergency Preparedness and Response, World Health Organization (WHO), African Regional Office (AFRO), Dakar, SenegalWHO Country Office,N’djamena, ChadWHO Country Office,N’djamena, ChadWHO Country Office,N’djamena, ChadEmergency Preparedness and Response, World Health Organization (WHO), African Regional Office (AFRO), Dakar, SenegalDepartment of Health Emergencies Intervention, World Health Organization, Headquarters, Geneva, SwitzerlandIncident Management Team, Ministry of Health,N’djamena, ChadIncident Management Team, Ministry of Health,N’djamena, ChadDepartment of Health Emergencies Intervention, World Health Organization, Headquarters, Geneva, SwitzerlandDepartment of Health Emergencies Intervention, World Health Organization, Headquarters, Geneva, SwitzerlandDepartment of Alert and Response Coordination, World Health Organization, Headquarters, Geneva, SwitzerlandDepartment of Alert and Response Coordination, World Health Organization, Headquarters, Geneva, SwitzerlandWHO Country Office,N’djamena, ChadDepartment of Global Health, Faculty of Medicine and Health Sciences, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South AfricaDepartment of Global Health, Faculty of Medicine and Health Sciences, Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South AfricaOffice of the President and CEO, South African Medical Research Council, Cape Town, South AfricaDepartment of Medicine, Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of the CongoCochrane South Africa, South African Medical Research Council, Cape Town, South Africa0World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of CongoWHO Country Office,N’djamena, ChadBackgroundThe escalation of the conflict in Sudan has created a major humanitarian challenge for neighboring countries, especially in the Eastern regions of Chad. This humanitarian setting's health needs are unique in that they are more vulnerable to both outbreak-prone disease and a lack of essential services. To address these challenges, the World Health Organization has supported implementing the Early Warning Alert and Response System (EWARS) Mobile. The purpose of this study was to evaluate the application of the EWARS Mobile epidemiological surveillance tool in Sudanese children’s refugees in Eastern Chad.MethodsThis was a retrospective and population-based surveillance study that provided an overview of the pattern of cases and deaths in time and space related to potential outbreaks.ResultsIn total, 1,645 alerts were reported among children in vulnerable provinces of Quaddai, Sila, and Wadi Fira. There were 41,738 alerted cases and 236 deaths, for a 0.56% projected fatality rate. The EWARS Mobile successfully reported alerted increases in cases of acute flaccid paralysis (AFP), acute jaundice syndrome (AJS), acute respiratory infection (ARI), acute watery diarrhea in children (AWD), measles, meningitis, diphtheria, neonatal tetanus (NT), dengue, dysentery, and atypical events in vulnerable children in time and space. Case reporting, alert recording, and weekly reporting were completed successfully at all levels (camps, district, zone, and province) (≥80% completion rate). In contrast, the timeliness of alert reporting, weekly reporting, and probable outbreaks did not perform well across levels (≥80% timeliness rate). Epidemic curves indicated multiple probable outbreak types, characterized by a point source (AJS and AWD under 5 years), common source (AWD in 5 years and above), propagated source (ARI and dysentery), and intermittent source (AFP, measles, meningitis, diphtheria, NT, and unusual events). The sensitivity and positive predictive value were estimated at 81% (79%–83%) and 72.0% (68%–75%), respectively.ConclusionsThe EWARS Mobile is a practical solution for Eastern Chad provinces to implement throughout the pre-epidemic and outbreak periods in vulnerable children in this severe humanitarian crisis. However, efforts should be made to improve timeliness indicators at all subnational levels and incorporate alarm indicators.https://www.frontiersin.org/articles/10.3389/fepid.2025.1604446/fullEWARSsurveillancevulnerable childrenrefugeesoutbreakshumanitarian crisis |
| spellingShingle | Stephane Tewo Balde Thierno Freddy M. Banza Idriss M. Mahamat N'dri K. Eric-Didier Djinguebey N. Raoul John Otokoye Otshudiema Castilla Echenique Jorge Moussa Brahimi Djoumbarina Maina Evers Egmond Marcel Woung Kazuki Shimizu Boris I. Pavlin Jacques L. Tamuzi Jacques L. Tamuzi Patrick D. M. C. Katoto Patrick D. M. C. Katoto Patrick D. M. C. Katoto Charles S. Wiysonge Charles S. Wiysonge Blanche-Philomene Melanga Anya Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study Frontiers in Epidemiology EWARS surveillance vulnerable children refugees outbreaks humanitarian crisis |
| title | Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study |
| title_full | Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study |
| title_fullStr | Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study |
| title_full_unstemmed | Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study |
| title_short | Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: a retrospective and population-based surveillance study |
| title_sort | evaluation of the implementation of the ewars mobile epidemiological surveillance tool in sudanese refugee camps in eastern chad a retrospective and population based surveillance study |
| topic | EWARS surveillance vulnerable children refugees outbreaks humanitarian crisis |
| url | https://www.frontiersin.org/articles/10.3389/fepid.2025.1604446/full |
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