Usefulness of disease surveillance data in enhanced early warning of the cholera outbreak in Southwest Cameroon, 2018.

Introduction: This study assesses the timeliness and completeness of disease surveillance data for early warning of the cholera outbreak during the socio-political crisis of Southwest Cameroon in 2018. It determines how routine integrated disease surveillance and response (IDSR) data was used for preventative actions and the challenges faced by key health staff in IDSR based decision-making. Methods: This was a mixed-methods study conducted from June 1st to September 2021. District Health Information System 2 (DHIS2) data from January 2018 to December 2020 for the Southwest region of Cameroon were analysed using simple linear regression on EPI Info 7.2 to determine a potential association of the sociopolitical crisis with timeliness andcompleteness of data. Qualitative data generated through in-depth interviews of key informants were coded and analyzed using NVivo 12. Results: Routine IDSR data was not a reliable way of providing early warning of the 2018 cholera outbreak due to incomplete and late reports. During high conflict intensity (2018 and 2019), average data timeliness and completeness were 16.3 percent and 67.2 percent, respectively, increasing to 40.7 percent and 80.2 percent, respectively, in 2020 when the conflict intensity had reduced. There was a statistically significant weak correlation between reduced conflict intensity and increased data timeliness (R2 =0.17, p=0.016) and there was also a weak correlation between reduced conflict intensity and data completeness but this was not statistically significant (R2=0.01, p=0.642). Possible reasons for the improvements in early warning included proximity to reporting sites and the presence of the performance based finance scheme. Areas to be maintained included the electronic report aspect of the DHIS2 and the supportive supervision conducted during the outbreak. Staff demotivation, the parallel multiplicity of data entry tools, poor communication, shortage of staff and the non-usability of data generated by the DHIS2 were systemic limitations to the early alert dimension of the IDSR system. Non–systemic limitations included high insecurity, far to reach outbreak sites and health personnel being targeted during the conflict. Conclusion: Reduced conflict intensity correlated with increased timeliness and completeness of data reporting. The IDSR was substantially challenged during the crisis, and erroneous data generated by the DHIS 2 significantly undermined the efforts and resources invested to control the outbreak. The Ministry of Public Health should reinforce efforts to build a reporting system that produces people-centered actionable data that engages health risk management during socio-political crises

Systematic review of therapeutic outcomes of multidrug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and human immuno-deficiency virus in low- and middle-income countries: a study protocol

Background Programs that integrate tuberculosis (TB) and human immunodeficiency virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low- and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs

Usefulness of disease surveillance data in enhanced early warning of the cholera outbreak in Southwest Cameroon, 2018

Introduction: This study assesses the timeliness and completeness of disease surveillance data for early warning of the cholera outbreak during the socio-political crisis of Southwest Cameroon in 2018. It determines how routine integrated disease surveillance and response (IDSR) data was used for preventative actions and the challenges faced by key health staff in IDSR based decision-making. Methods: This was a mixed-methods study conducted from June 1st to September 2021. District Health Information System 2 (DHIS2) data from January 2018 to December 2020 for the Southwest region of Cameroon were analysed using simple linear regression on EPI Info 7.2 to determine a potential association of the sociopolitical crisis with timeliness andcompleteness of data. Qualitative data generated through in-depth interviews of key informants were coded and analyzed using NVivo 12. Results: Routine IDSR data was not a reliable way of providing early warning of the 2018 cholera outbreak due to incomplete and late reports. During high conflict intensity (2018 and 2019), average data timeliness and completeness were 16.3 percent and 67.2 percent, respectively, increasing to 40.7 percent and 80.2 percent, respectively, in 2020 when the conflict intensity had reduced. There was a statistically significant weak correlation between reduced conflict intensity and increased data timeliness (R2 =0.17, p=0.016) and there was also a weak correlation between reduced conflict intensity and data completeness but this was not statistically significant (R2=0.01, p=0.642). Possible reasons for the improvements in early warning included proximity to reporting sites and the presence of the performance based finance scheme. Areas to be maintained included the electronic report aspect of the DHIS2 and the supportive supervision conducted during the outbreak. Staff demotivation, the parallel multiplicity of data entry tools, poor communication, shortage of staff and the non-usability of data generated by the DHIS2 were systemic limitations to the early alert dimension of the IDSR system. Non–systemic limitations included high insecurity, far to reach outbreak sites and health personnel being targeted during the conflict. Conclusion: Reduced conflict intensity correlated with increased timeliness and completeness of data reporting. The IDSR was substantially challenged during the crisis, and erroneous data generated by the DHIS 2 significantly undermined the efforts and resources invested to control the outbreak. The Ministry of Public Health should reinforce efforts to build a reporting system that produces people-centered actionable data that engages health risk management during socio-political crises

Usefulness of disease surveillance data in enhanced early warning of the cholera outbreak in Southwest Cameroon, 2018.

INTRODUCTION: This study assessed the timeliness and completeness of disease surveillance data for early warning of the cholera outbreak during the socio-political crisis of Southwest Cameroon in 2018. It determined how routine integrated disease surveillance and response (IDSR) data was used for preventative actions and the challenges faced by key health staff in IDSR based decision-making. METHODS: This was a mixed-methods study conducted from June 1st to September 30th 2021. District Health Information System 2 (DHIS2) data from January 2018 to December 2020 for the Southwest region of Cameroon were analysed using simple linear regression on EPI Info 7.2 to determine a potential association of the sociopolitical crisis with timeliness and completeness of data. Qualitative data generated through in-depth interviews of key informants were coded and analyzed using NVivo 12. RESULTS: During high conflict intensity (2018 and 2019), average data timeliness and completeness were 16.3% and 67.2%, respectively, increasing to 40.7% and 80.2%, respectively, in 2020 when the conflict intensity had reduced. There was a statistically significant weak correlation between reduced conflict intensity and increased data timeliness (R CONCLUSION: In general, routine IDSR data was not a reliable way of providing early warning of the 2018 cholera outbreak because of incomplete and late reports. Nonetheless, reduced conflict intensity correlated with increased timeliness and completeness of data reporting. The IDSR was substantially challenged during the crisis, and erroneous data generated by the DHIS 2 significantly undermined the efforts and resources invested to control the outbreak. The Ministry of Public Health should reinforce efforts to build a reporting system that produces people-centered actionable data that engages health risk management during socio-political crises