18 research outputs found
Conceptual framework of public health surveillance and action and its application in health sector reform
BACKGROUND: Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. METHODS: To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. RESULTS: In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback) and acute (epidemic-type) and planned (management-type) responses composing the two core activities of public health action. Four support activities – communications, supervision, training, and resource provision – enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. CONCLUSIONS: This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system
Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, southern Sudan
Background: Nodding syndrome (repetitive nodding and progressive
generalized seizures) is assuming epidemic proportions in South Sudan,
Tanzania and Uganda. Objective: To describe clinical and
epidemiological features of nodding syndrome in southern Sudan based on
preliminary investigations conducted in 2001 and 2002. Method:
Household surveys, clinical, electrophysiological (EEG) assessments,
informant interviews and case-control studies were conducted in the
town of Lui and the village of Amadi in southern Sudan. Results:
Nodding syndrome is characterized by involuntary repetitive nodding of
the head, progressing to generalized seizures; mental and physical
deterioration. The EEGs were consistent with progressive epileptic
encephalopathy. Prevalence of Nodding syndrome in Lui and Amadi was
2.3% and 6.7% respectively. All case control studies showed a positive
association between cases and Onchocerca volvulus. A history of measles
was negatively associated with being a case: 2/13 of cases and 11/19 of
controls had had measles: odds ratio 0.13 (95% CI 0.02, 0.76).
Environmental assessment did not reveal any naturally occurring or
manmade neurotoxic factors to explain Nodding Syndrome, although fungal
contamination of food could not be ruled out. Conclusion: Nodding
Syndrome was strongly associated with Onchocerca volvulus. There was no
evidence to suggest an environmental pollutant, chemical agent, or
other toxic facto
Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, southern Sudan
Background: Nodding syndrome (repetitive nodding and progressive
generalized seizures) is assuming epidemic proportions in South Sudan,
Tanzania and Uganda. Objective: To describe clinical and
epidemiological features of nodding syndrome in southern Sudan based on
preliminary investigations conducted in 2001 and 2002. Method:
Household surveys, clinical, electrophysiological (EEG) assessments,
informant interviews and case-control studies were conducted in the
town of Lui and the village of Amadi in southern Sudan. Results:
Nodding syndrome is characterized by involuntary repetitive nodding of
the head, progressing to generalized seizures; mental and physical
deterioration. The EEGs were consistent with progressive epileptic
encephalopathy. Prevalence of Nodding syndrome in Lui and Amadi was
2.3% and 6.7% respectively. All case control studies showed a positive
association between cases and Onchocerca volvulus. A history of measles
was negatively associated with being a case: 2/13 of cases and 11/19 of
controls had had measles: odds ratio 0.13 (95% CI 0.02, 0.76).
Environmental assessment did not reveal any naturally occurring or
manmade neurotoxic factors to explain Nodding Syndrome, although fungal
contamination of food could not be ruled out. Conclusion: Nodding
Syndrome was strongly associated with Onchocerca volvulus. There was no
evidence to suggest an environmental pollutant, chemical agent, or
other toxic facto