A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania
Introduction: The Integrated Disease Surveillance and Response system relies mainly on aggregated, paper-based, error-prone routine data from health facilities. Lack of timeliness, inadequate data management and analysis, and weak laboratory capabilities result in low capacity for early detection an...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224005484 |
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| Summary: | Introduction: The Integrated Disease Surveillance and Response system relies mainly on aggregated, paper-based, error-prone routine data from health facilities. Lack of timeliness, inadequate data management and analysis, and weak laboratory capabilities result in low capacity for early detection and rapid response to disease outbreaks.The objective was to evaluate a novel surveillance strategy, based on a clinical e-tool for patient management implemented in primary care health facilities in Tanzania, enhanced by sentinel sites and mobile clinically targeted microbiological investigations. Methods: An electronic clinical decision support algorithm (CDSA) was provided to healthcare workers to guide them during consultations with children aged 1 day to 14 years. A real-time syndromic surveillance dashboard (medAL-outbreak) displaying the recorded clinical data was developed and adapted after feedback from end-users at the health facility and district levels. This syndromic surveillance was supplemented by microbiological investigations using two approaches: 1) A static approach, in 6 sentinel facilities, for children with specific pre-established conditions: severe respiratory disease (nasal swab sample), severe gastrointestinal disease (stool sample), and unspecific or prolonged fever (blood sample); 2) A mobile approach, where a surveillance team intervened in health facilities when alerts were triggered by medAL-outbreak. Priority pathogens of public health relevance were tested for at the two local reference laboratories. Results: From April 2023 to March 2024 (the study is ongoing until September 2024), we included 31,525 acutely ill children across 60 healthcare facilities in 5 districts from 2 regions (Mbeya and Morogoro). MedAL-outbreak allowed monitoring of 22 syndromes, including severe cases, pneumonia, malaria, severe/non-severe acute diarrhea, meningitis, anemia, malnutrition, and sexually transmitted infections. Malaria prevalence was low in Mbeya CC, Mbeya DC, and Ifakara TC (1%, 1%, and 3% of febrile children, respectively), while much higher in Ulanga and Mlimba (45% and 14%, respectively), with some seasonality (42% from April to November, and 53% from December to March in Ulanga). Pneumonia was more prevalent in Mbeya DC, accounting for 22% of all cases (compared with 8% in Mbeya CC and 11% in the 3 Morogoro districts), with no clear seasonal pattern. Acute watery diarrhea was also more frequent in Mbeya CC and DC, occurring in 19% of the cases, against 9% in the other 3 districts. Microbiological surveillance is ongoing until September 2024; results will be presented during the congress. Discussion: Utilization of a CDSA in health facilities enabled reliable real-time syndromic surveillance. Conclusion: Adding static and mobile targeted microbiological surveillance, triggered by alerts based on clinical and spatio-temporal abnormalities, could potentially allow Tanzania to advance to a smart resource-sparing surveillance system with early detection of outbreaks. |
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| ISSN: | 1201-9712 |