Finding the fragments: community-based epidemic surveillance in Sudan

Sudan faces inter-sectional health risks posed by escalating violent conflict, natural hazards and epidemics. Epidemics are frequent and overlapping, particularly resurgent seasonal outbreaks of diseases such as malaria, cholera. To improve response, the Sudanese Ministry of Health manages multiple disease surveillance systems, however, these systems are fragmented, under resourced, and disconnected from epidemic response efforts. Inversely, civic and informal community-led systems have often organically led outbreak responses, despite having limited access to data and resources from formal outbreak detection and response systems. Leveraging a communal sense of moral obligation, such informal epidemic responses can play an important role in reaching affected populations. While effective, localised, and organised-they cannot currently access national surveillance data, or formal outbreak prevention and response technical and financial resources. This paper calls for urgent and coordinated recognition and support of community-led outbreak responses, to strengthen, diversify, and scale up epidemic surveillance for both national epidemic preparedness and regional health security

Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide

Population mortality before and during the COVID-19 epidemic in two Sudanese settings: a key informant study

Abstract Background Population mortality is an important metric that sums information from different public health risk factors into a single indicator of health. However, the impact of COVID-19 on population mortality in low-income and crisis-affected countries like Sudan remains difficult to measure. Using a community-led approach, we estimated excess mortality during the COVID-19 epidemic in two Sudanese communities. Methods Three sets of key informants in two study locations, identified by community-based research teams, were administered a standardised questionnaire to list all known decedents from January 2017 to February 2021. Based on key variables, we linked the records before analysing the data using a capture-recapture statistical technique that models the overlap among lists to estimate the true number of deaths. Results We estimated that deaths per day were 5.5 times higher between March 2020 and February 2021 compared to the pre-pandemic period in East Gezira, while in El Obeid City, the rate was 1.6 times higher. Conclusion This study suggests that using a community-led capture-recapture methodology to measure excess mortality is a feasible approach in Sudan and similar settings. Deploying similar community-led estimation methodologies should be considered wherever crises and weak health infrastructure prevent an accurate and timely real-time understanding of epidemics’ mortality impact in real-time

Additional file 1 of Population mortality before and during the COVID-19 epidemic in two Sudanese settings: a key informant study

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