Community-based surveillance advances the Global Health Security Agenda in Ghana.

Ghana Health Service (GHS) has strengthened community-based surveillance (CBS) to facilitate early detection and rapid reporting of health events of all origins. Since June 2017, GHS has employed an event-based surveillance approach at the community level in a phased manner. CBS coverage has broadened from 2 to 30 districts across Ghana. Through this effort, capacity was built across all administrative levels in these districts to detect, report, triage, and verify signals, and to perform risk assessment and investigate events. Data were collected and analyzed during an evaluation of initial 2-district implementation in March 2018 and during expanded 30-district implementation in March 2019. Between September 2018 and March 2019, 317 health events were detected through CBS. These events included vaccine-preventable disease cases, acute hemorrhagic conjunctivitis outbreaks, clusters of unexpected animal deaths, and foodborne illness clusters. Eighty-nine percent of the 317 events were reported to district-level public health staff within 24 hours of detection at the community level, and 87% of all detected events were responded to within 48 hours of detection. CBS detected 26% of all suspected vaccine-preventable disease cases that were reported from implementing districts through routine disease surveillance. GHS strengthened CBS in Ghana to function as an early warning system for health events of all origins, advancing the Global Health Security Agenda

Is HbA1c associated with birth weight? A multivariable analysis of Pakistani pregnant women

Aim: Globally, one in seven infants is born with low birth weight and 3%–7% of infants are born with high birth weight, with the greatest burden noted in low-and middle-income countries. This study investigated the association between maternal prenatal glucose regulation and birth weight and the moderating effect of fetal sex among Pakistani women. Methods: Secondary data from a prospective longitudinal study of healthy pregnant women from Pakistan (N=189) was used. Participants provided a blood sample (12–19 weeks \u27gestational age) for the assessment of HbA1c (%). Birthweight (g) was collected following delivery. Results: Higher maternal HbA1c was associated with higher birth weight(b=181.81,t[189]=2.15,p=0.03), which was moderated by fetal sex(b=-326.27,t[189]=-2.47,p=0.02), after adjusting for gestational age at birth, ethnicity, and pregnancy weight. Among women carrying a male fetus ,every 1% increase in HbA1c predicted a 182 g increase in birth weight(b=181.81,t[189]=2.15,p=0.03). Conclusions: Results extend research from high-income countries and indicate that fetal sex may have implications for glucose regulation in early to mid-pregnancy. Future research should examine sociocultural factors, which could elucidate potential mediating factors in the relation between HbA1c and birth weight in healthy pregnancie

Sustainable Model for Public Health Emergency Operations Centers for Global Settings

Capacity to receive, verify, analyze, assess, and investigate public health events is essential for epidemic intelligence. Public health Emergency Operations Centers (PHEOCs) can be epidemic intelligence hubs by 1) having the capacity to receive, analyze, and visualize multiple data streams, including surveillance and 2) maintaining a trained workforce that can analyze and interpret data from real-time emerging events. Such PHEOCs could be physically located within a ministry of health epidemiology, surveillance, or equivalent department rather than exist as a stand-alone space and serve as operational hubs during nonoutbreak times but in emergencies can scale up according to the traditional Incident Command System structure