MALARIA: Ethiopia: epidemic forecasting in Oromia District,

Joe Keating and Josh Yukich, Tulane University School of Public Health and Tropical Medicine
A unique sentinel surveillance project in Ethiopia uses mobile phone technology to collect weekly malaria data at the health post level to quickly detect and respond to potential malaria outbreaks.
For nearly two years, researchers have been setting up epidemic detection sites in the Oromia Region in Ethiopia as part of a sentinel surveillance and epidemic detection system to detect microclusters of malaria infection. The project, funded by the United States Agency for International Development (USAID), uses trained health workers, enhanced supervision strategies, and mobile phone technology to get weekly data on malaria transmission. While continuing to capture detailed clinical data that can otherwise take months to collect and analyze, the project also operates at the most local of health system levels, using small health facilities often in rural areas as epidemic detection sites for the rapid collection of aggregate data.
Why collect data about malaria transmission at the micro level? When national parasite prevalence is very low, as it is in Ethiopia, malaria becomes a very focal disease, existing largely in hotspots (i.e., microclusters of infection) that, if left undetected, could turn into a full-scale epidemic. Thus, how quickly you can respond to a potential outbreak is extremely important. Population-based surveys such as the Malaria Indicator Surveys (MIS) take three to six months to complete, and health management information systems (HMIS) sometimes fail to collect data on relevant indicators for epidemic detection. In addition, the current paper-based system requires three weeks for microscopists to record data, take it to Addis Ababa, enter it into a database, and send to the program. Using SMS technology, this takes only one week. Another important component of this project is getting the right data to decision-makers in a timely fashion.
Currently, 10 health centers and their satellite health posts are operating as epidemic detection sites in the Oromia Region (nearly 100 sites will be included when the project scales fully), with one or two Health Extension Workers (HEWs) assigned to each health post. Each HEW collects data, enters it into their phone using text messaging, and once a week sends it to a server that analyzes it, makes sure the numbers add up, and streams it into a database. From that moment, the data are accessible; if a report shows higher than normal transmission levels for a particular area, it immediately triggers a warning to relevant personnel. Facilities that participate in the project also receive technical assistance with microscopy and diagnostic issues, indicator data, and data collection, as well as other aspects of clinical malaria care of patients.
Sentinel surveillance sites used in the past have had issues with quality and timeliness of reported data; data often moved slowly and efforts were not expanded to the community level. Many of these systems worked only at higher health system levels and didn’t add value above and beyond HMIS data. The success of this project depends on the usefulness of the data. In the next few years we hope to prove that this model can rapidly generate high quality data to provide a clear geographic picture of what’s happening in infection microclusters at short timescales and effectively trigger the prevention of large-scale malaria epidemics in Ethiopia.
http://www.macepalearningcommunity.org/forecasting.htm

BIOTERRORISM: Africa lags on epidemic detection

Mercy Adhiambo : 6 January 2011
 Flickr/Julien Harneis : African lags in warning of outbreaks of diseases such as cholera, primarily spread through contaminated food and water

[NAIROBI] Africa lags behind in detecting infectious diseases and warning of emerging epidemics, yet bears half the world's outbreaks, says a report.
The study, of nearly 400 WHO-verified disease outbreaks from 1996–2009, found more than half (53 per cent) were in Africa. Yet the continent took the longest to detect the outbreaks and to communicate about them — on average 30 and 43 days respectively after the estimated start of an outbreak.
Globally, the shortest times to discovery and public communication were in the Western Pacific, with an average of four days until discovery and 18 days until communication. In South–East Asia discovery and communication both averaged around 15 days.
Worldwide, time to detection of disease outbreaks has improved overall by just over seven per cent a year, and time to communication by just over six per cent a year, since 1996 — but with considerable regional variation. One reason for this improvement was the rapid expansion of the Internet.
The most common diseases causing epidemic outbreaks were cholera, yellow fever, meningitis, avian influenza and dengue.
Emily Chan, from the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, in the United States, and lead author of the study, said: "Openness in communication ... is crucial for a speedy response once disease has broken out".
Abdisalan Noor, a research scientist at the Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, said the reasons for Africa's poor performance were many and they reflected the general weakness in information systems in the wider public sector.
"Given the serious weaknesses in routine health information systems in Sub-Saharan Africa, it is not surprising the surveillance systems for detecting emerging infections, which require dynamic real-time data collection, are deficient," he told SciDev.Net. But he said that Africa is gradually improving its mechanisms for timely detection of emerging infections.
Noor said that Africa was dealing with major infectious diseases like HIV/AIDS, malaria and tuberculosis, all of which require routine data and prompt detection of epidemics for efficient control.
He called for investment in infrastructure and capacity for early disease detection and response, saying: "The lack of a timely mechanism for case detection and response can lead to rapid spread of disease, making the management of the case even more difficult, and this could have severe health consequences — in many cases, a large number of fatalities".

The study was published in the Proceedings of the National Academy of Sciences (PNAS) (29 November).
http://www.scidev.net/en/news/africa-lags-on-epidemic-detection-1.html