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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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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| author | Ms Happy Mkali MD Alix Miauton Dr. Alexandra Kulinkina Ms. Magreth Joram MD Caroline Enos Mr. Lazar Pavicevic Mr. Vincent Faivre Dr. MD Rainer Tan Dr. Sabine Renggli Ms. Theopista Lotto Mr. Sinamgoda Ngailla MD Godfrey Kavishe Mr. Ibrahim Mtebene Mr. Peter Agrea MD Lameck Luwanda Mr Geofrey Ashery MD Chacha Mangu Dr. MD Nyanda Ntinginya Prof. Dr. Honorati Masanja Prof. Dr. MD Isabella Eckerle Prof. Dr. MD Valerie D'Acremont |
| author_facet | Ms Happy Mkali MD Alix Miauton Dr. Alexandra Kulinkina Ms. Magreth Joram MD Caroline Enos Mr. Lazar Pavicevic Mr. Vincent Faivre Dr. MD Rainer Tan Dr. Sabine Renggli Ms. Theopista Lotto Mr. Sinamgoda Ngailla MD Godfrey Kavishe Mr. Ibrahim Mtebene Mr. Peter Agrea MD Lameck Luwanda Mr Geofrey Ashery MD Chacha Mangu Dr. MD Nyanda Ntinginya Prof. Dr. Honorati Masanja Prof. Dr. MD Isabella Eckerle Prof. Dr. MD Valerie D'Acremont |
| author_sort | Ms Happy Mkali |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-aeef2d2c3dea4c889df85b1bbcede5eb |
| institution | DOAJ |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | International Journal of Infectious Diseases |
| spelling | doaj-art-aeef2d2c3dea4c889df85b1bbcede5eb2025-08-20T02:55:13ZengElsevierInternational Journal of Infectious Diseases1201-97122025-03-0115210747310.1016/j.ijid.2024.107473A novel smart surveillance approach to strengthen health facility-based disease surveillance in TanzaniaMs Happy Mkali0MD Alix Miauton1Dr. Alexandra Kulinkina2Ms. Magreth Joram3MD Caroline Enos4Mr. Lazar Pavicevic5Mr. Vincent Faivre6Dr. MD Rainer Tan7Dr. Sabine Renggli8Ms. Theopista Lotto9Mr. Sinamgoda Ngailla10MD Godfrey Kavishe11Mr. Ibrahim Mtebene12Mr. Peter Agrea13MD Lameck Luwanda14Mr Geofrey Ashery15MD Chacha Mangu16Dr. MD Nyanda Ntinginya17Prof. Dr. Honorati Masanja18Prof. Dr. MD Isabella Eckerle19Prof. Dr. MD Valerie D'Acremont20Ifakara Health Institute; Geneva Centre for Emerging Viral Diseases, University Hospital of Geneva; Faculty of Medicine, Department of Microbiology and Molecular Medicine, University of GenevaIfakara Health Institute; Centre for Primary Care and Public Health (Unisanté), University of LausanneSwiss Tropical and Public Health Institute; University of BaselIfakara Health InstituteNational Institute for Medical Research-Mbeya Medical Research CentreCentre for Primary Care and Public Health (Unisanté), University of LausanneCentre for Primary Care and Public Health (Unisanté), University of LausanneCentre for Primary Care and Public Health (Unisanté), University of LausanneIfakara Health InstituteIfakara Health InstituteNational Institute for Medical Research-Mbeya Medical Research CentreNational Institute for Medical Research-Mbeya Medical Research CentreIfakara Health InstituteNational Institute for Medical Research-Mbeya Medical Research CentreIfakara Health InstituteIfakara Health InstituteNational Institute for Medical Research-Mbeya Medical Research CentreNational Institute for Medical Research-Mbeya Medical Research CentreIfakara Health InstituteGeneva Centre for Emerging Viral Diseases, University Hospital of Geneva; Faculty of Medicine, Department of Microbiology and Molecular Medicine, University of GenevaCentre for Primary Care and Public Health (Unisanté), University of Lausanne; Swiss Tropical and Public Health InstituteIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S1201971224005484 |
| spellingShingle | Ms Happy Mkali MD Alix Miauton Dr. Alexandra Kulinkina Ms. Magreth Joram MD Caroline Enos Mr. Lazar Pavicevic Mr. Vincent Faivre Dr. MD Rainer Tan Dr. Sabine Renggli Ms. Theopista Lotto Mr. Sinamgoda Ngailla MD Godfrey Kavishe Mr. Ibrahim Mtebene Mr. Peter Agrea MD Lameck Luwanda Mr Geofrey Ashery MD Chacha Mangu Dr. MD Nyanda Ntinginya Prof. Dr. Honorati Masanja Prof. Dr. MD Isabella Eckerle Prof. Dr. MD Valerie D'Acremont A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania International Journal of Infectious Diseases |
| title | A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania |
| title_full | A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania |
| title_fullStr | A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania |
| title_full_unstemmed | A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania |
| title_short | A novel smart surveillance approach to strengthen health facility-based disease surveillance in Tanzania |
| title_sort | novel smart surveillance approach to strengthen health facility based disease surveillance in tanzania |
| url | http://www.sciencedirect.com/science/article/pii/S1201971224005484 |
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