Economic burden of cholera in the WHO African region

<p>Abstract</p> <p>Background</p> <p>In 2007, various countries around the world notified 178677 cases of cholera and 4033 cholera deaths to the World Health Organization (WHO). About 62% of those cases and 56.7% of deaths were reported from the WHO African Region alone. To date, no study has been undertaken in the Region to estimate the economic burden of cholera for use in advocacy for its prevention and control. The objective of this study was to estimate the direct and indirect cost of cholera in the WHO African Region.</p> <p>Methods</p> <p>Drawing information from various secondary sources, this study used standard cost-of-illness methods to estimate: (a) the direct costs, i.e. those borne by the health-care system and the family in directly addressing cholera; and (b) the indirect costs, i.e. loss of productivity caused by cholera, which is borne by the individual, the family or the employer. The study was based on the number of cholera cases and deaths notified to the World Health Organization by countries of the WHO African Region.</p> <p>Results</p> <p>The 125018 cases of cholera notified to WHO by countries of the African Region in 2005 resulted in a real total economic loss of US$39 million, US$ 53.2 million and US$64.2 million, assuming a regional life expectancies of 40, 53 and 73 years respectively. The 203,564 cases of cholera notified in 2006 led to a total economic loss US$91.9 million, US$128.1 million and US$156 million, assuming life expectancies of 40, 53 and 73 years respectively. The 110,837 cases of cholera notified in 2007 resulted in an economic loss of US$43.3 million, US$60 million and US$72.7 million, assuming life expectancies of 40, 53 and 73 years respectively.</p> <p>Conclusion</p> <p>There is an urgent need for further research to determine the national-level economic burden of cholera, disaggregated by different productive and social sectors and occupations of patients and relatives, and national-level costs and effectiveness of alternative ways of scaling up population coverage of potable water and clean sanitation facilities.</p

Polio eradication initiative in Africa: influence on other infectious disease surveillance development

BACKGROUND: The World Health Organization (WHO) and partners are collaborating to eradicate poliomyelitis. To monitor progress, countries perform surveillance for acute flaccid paralysis (AFP). The WHO African Regional Office (WHO-AFRO) and the U.S Centers for Disease Control and Prevention are also involved in strengthening infectious disease surveillance and response in Africa. We assessed whether polio-eradication initiative resources are used in the surveillance for and response to other infectious diseases in Africa. METHODS: During October 1999-March 2000, we developed and administered a survey questionnaire to at least one key informant from the 38 countries that regularly report on polio activities to WHO. The key informants included WHO-AFRO staff assigned to the countries and Ministry of Health personnel. RESULTS: We obtained responses from 32 (84%) of the 38 countries. Thirty-one (97%) of the 32 countries had designated surveillance officers for AFP surveillance, and 25 (78%) used the AFP resources for the surveillance and response to other infectious diseases. In 28 (87%) countries, AFP program staff combined detection for AFP and other infectious diseases. Fourteen countries (44%) had used the AFP laboratory specimen transportation system to transport specimens to confirm other infectious disease outbreaks. The majority of the countries that performed AFP surveillance adequately (i.e., non polio AFP rate = 1/100,000 children aged <15 years) in 1999 had added 1–5 diseases to their AFP surveillance program. CONCLUSIONS: Despite concerns regarding the targeted nature of AFP surveillance, it is partially integrated into existing surveillance and response systems in multiple African countries. Resources provided for polio eradication should be used to improve surveillance for and response to other priority infectious diseases in Africa

“Rapid-Impact Interventions”: How a Policy of Integrated Control for Africa's Neglected Tropical Diseases Could Benefit the Poor

Controlling seven tropical infections in Africa would cost just 40 cents per person per year, and would permanently benefit hundreds of millions of people

Status of national health research systems in ten countries of the WHO African Region

BACKGROUND: The World Health Organization (WHO) Regional Committee for Africa, in 1998, passed a resolution (AFR/RC48/R4) which urged its Member States in the Region to develop national research policies and strategies and to build national health research capacities, particularly through resource allocation, training of senior officials, strengthening of research institutions and establishment of coordination mechanisms. The purpose of this study was to take stock of some aspects of national resources for health research in the countries of the Region; identify current constraints facing national health research systems; and propose the way forward. METHODS: A questionnaire was prepared and sent by pouch to all the 46 Member States in the WHO African Region through the WHO Country Representatives for facilitation and follow up. The health research focal person in each of the countries Ministry of Health (in consultation with other relevant health research bodies in the country) bore the responsibility for completing the questionnaire. The data were entered and analysed in Excel spreadsheet. RESULTS: The key findings were as follows: the response rate was 21.7% (10/46); three countries had a health research policy; one country reported that it had a law relating to health research; two countries had a strategic health research plan; three countries reported that they had a functional national health research system (NHRS); two countries confirmed the existence of a functional national health research management forum (NHRMF); six countries had a functional ethical review committee (ERC); five countries had a scientific review committee (SRC); five countries reported the existence of health institutions with institutional review committees (IRC); two countries had a health research programme; and three countries had a national health research institute (NHRI) and a faculty of health sciences in the national university that conducted health research. Four out of the ten countries reported that they had a budget line for health research in the Ministry of Health budget document. CONCLUSION: Governments of countries of the African Region, with the support of development partners, private sector and civil society, urgently need to improve the research policy environment by developing health research policies, strategic plans, legislations, programmes and rolling plans with the involvement of all stakeholders, e.g., relevant sectors, research organizations, communities, industry and donors. In a nutshell, development of high-performing national health research systems in the countries of the WHO African Region, though optional, is an imperative. It may be the only way of breaking free from the current vicious cycle of ill-health and poverty

Integrated disease surveillance and response in the African region

In September 1998, the 48th Regional Committee for Africa met in Harare. Through resolution AFRO/RC48/R2, Member States adopted integrated disease surveillance as a regional strategy for early detection and efficacious response to priority communicable diseases for the African region. Communicable diseases are the most common causes of death, disability and illness in the African region. While these diseases present a large threat to the well-being of African communities, there are well-known interventions that are available for controlling and preventing them. Surveillance data can guide health personnel in the decision making needed to implement the proper strategies for disease control and lead to activities for preventing future cases. Surveillance is a watchful, vigilant approach to information gathering that serves to improve or maintain the health of the population. A functional disease surveillance system is essential for defining problems and taking action. Using epidemiological methods in the service of surveillance equips district and local health teams to set priorities, plan interventions, mobilize and allocate resources and predict or provide early detection of outbreaks. Depending on the goal of the disease prevention programme, the surveillance activity objectives guides programme managers towards selecting data that would be the most useful to collect and use for making evidenced-based decisions for public health actions. A disease control program may want to know what progress is being made with its prevention activities. The program collects age and vaccination statues for cases of vaccine-preventable diseases. If the program's goal is to prevent outbreaks, the surveillance unit can monitor the epidemiology of a particular disease so that the program can more accurately identify where the next cases might occur or the populations at highest risk. In addition, improving laboratory support for disease surveillance is essential for confirming causes of illness and early detection of outbreaks. Casebased investigation and laboratory confirmation provide the most precise information about where action must be taken to achieve an elimination target. Monitoring populations at highest risk for a particular disease can help to predict future outbreaks and focus prevention activities in the areas where they are most needed. Too often, however, surveillance data for communicable disease is neither reported nor analyzed. As a result, the opportunity to take action with an appropriate public health response and save lives is lost. Even in cases where adequate information is collected, it is often not available for use at the local level. Experiences with some disease eradication and elimination programs show that disease control and prevention objectives are successfully met when resources are dedicated to improving the ability of health officials to detect the targeted diseases, obtain laboratory confirmation of outbreaks, and use action thresholds at the district level. Building on these successes, the World Health Organization (WHO) Regional Office for Africa (AFRO) proposes a comprehensive strategy for improving communicable disease surveillance and response through integrated disease surveillance (IDS) linking community, health facility, district and national levels in the African region. The IDS strategy provides for a rational use of resources for disease control and prevention. Currently, many intervention programs have their own disease surveillance systems. Each program has made efforts through the years to improve its ability to obtain data for developing timely and reliable information that can be used for action. They involve similar functions especially at district and health facility levels. They often use the same structures, processes and personnel.Introduction -- Section 1. Identify cases of priority diseases, conditions and events -- Section 2. Report priority diseases and conditions -- Section 3. Analyze data -- Section 4. Investigate suspected outbreaks and other public health problems -- Section 5. Respond to outbreaks and other public health problems -- Section 6. Provide feedback -- Section 7. Evaluate and improve surveillance and response -- Section 8. Summary guidelines for specific priority diseases and conditions"July 2001."Compiled and edited by: Antoine Kabore\ucc?, Bradley A. Perkins, Sharon McDonnell.This document was prepared by the WHO Regional Office for Africa (AFRO), Harare, Zimbabwe, in collaboration with the Centers for Disease Control and Prevention (CDC), Atlanta, USA, and supported by USAID.Available via the World Wide Web as an Acrobat .pdf file (1.97 MB, 239 p.).World Health Organization Regional Office for Africa and the Centers for Disease Control and Prevention. Technical Guidelines for Integrated Disease Surveillance and Centers for Disease Control and Prevention. Technical Guidelines for Integrated Disease Surveillance and Response in the African Region. Harare, Zimbabwe and Atlanta, Georgia, USA. July 2001: 1-229

A long-lasting measles epidemic in Maroua, Cameroon 2008-2009: mass vaccination as response to the epidemic.

A measles outbreak occurred in Maroua, Cameroon, from January 2008 to April 2009. In accordance with recent World Health Organization guidelines, an outbreak-response immunization (ORI) was conducted in January 2009. The aim of this study was to investigate the causes of the epidemic in order to guide vaccination strategies

A survey of core and support activities of communicable disease surveillance systems at operating-level CDCs in China

<p>Abstract</p> <p>Background</p> <p>In recent years, problems like insufficient coordination, low efficiency, and heavy working load in national communicable disease surveillance systems in China have been pointed out by many researchers. To strengthen the national communicable disease surveillance systems becomes an immediate concern. Since the World Health Organization has recommended that a structured approach to strengthen national communicable disease surveillance must include an evaluation to existing systems which usually begins with a systematic description, we conducted the first survey for communicable disease surveillance systems in China, in order to understand the situation of core and support surveillance activities at province-level and county-level centers for disease control and prevention (CDCs).</p> <p>Methods</p> <p>A nationwide survey was conducted by mail between May and October 2006 to investigate the implementation of core and support activities of the Notifiable Disease Reporting System (NDRS) and disease-specific surveillance systems in all of the 31 province-level and selected 14 county-level CDCs in Mainland China The comments on the performance of communicable disease surveillance systems were also collected from the directors of CDCs in this survey.</p> <p>Results</p> <p>The core activities of NDRS such as confirmation, reporting and analysis and some support activities such as supervision and staff training were found sufficient in both province-level and county-level surveyed CDCs, but other support activities including information feedback, equipment and financial support need to be strengthened in most of the investigated CDCs. A total of 47 communicable diseases or syndromes were under surveillance at province level, and 20 diseases or syndromes at county level. The activities among different disease-specific surveillance systems varied widely. Acute flaccid paralysis (AFP), measles and tuberculosis (TB) surveillance systems got relatively high recognition both at province level and county level.</p> <p>Conclusions</p> <p>China has already established a national communicable disease surveillance framework that combines NDRS and disease-specific surveillance systems. The core and support activities of NDRS were found sufficient, while the implementation of those activities varied among different disease-specific surveillance systems.</p

Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application

BACKGROUND: The Data Envelopment Analysis (DEA) method has been fruitfully used in many countries in Asia, Europe and North America to shed light on the efficiency of health facilities and programmes. There is, however, a dearth of such studies in countries in sub-Saharan Africa. Since hospitals and health centres are important instruments in the efforts to scale up pro-poor cost-effective interventions aimed at achieving the United Nations Millennium Development Goals, decision-makers need to ensure that these health facilities provide efficient services. The objective of this study was to measure the technical efficiency (TE) and scale efficiency (SE) of a sample of public peripheral health units (PHUs) in Sierra Leone. METHODS: This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone. RESULTS: Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%). CONCLUSION: It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about US$7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government's initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalise health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter

Integrated disease surveillance and response in the African region

"The second edition of the Integrated Disease Surveillance and Response (IDSR) Technical Guidelines was prepared by the Disease Prevention and Control Cluster with active participation and involvement of programmes dealing with disease surveillance at the WHO Regional Office for Africa (AFRO), Brazzaville, Congo as well as Centers for Disease Control and Prevention (CDC), Atlanta, USA. The purpose of the revision was to update existing information, include other priority diseases, conditions and public health events and incorporate aspects of the International Health Regulations (IHR) that deal with disease surveillance. In planning to update these guidelines, suggestions and advice for improving the recommendations were sought and gratefully received from the IDSR development teams who prepared the 1st edition. This revision builds on the technical expertise from more than 100 surveillance and disease experts at WHO, CDC and Ministries of Health in African countries who conceived and produced the 1st edition. The revision process involved internal WHO consultation followed by a wider consultation that involved a series of meetings with various partners and Member States. In addition, an ad hoc IDSR task force was constituted to help with the revision process. The final draft was peer reviewed by the ad hoc task force as well as during a final partner consultative meeting held in August 2010." - t.p. verso"More than ten years ago, the World Health Organization Regional Office for Africa (AFRO) and its Member States, along with their technical partners, adopted a strategy for developing and implementing comprehensive public health surveillance and response systems in African countries. The strategy was called Integrated Disease Surveillance (IDS). To highlight the essential link between surveillance and response, subsequent documents referred to Integrated Disease Surveillance and Response (or IDSR). The first edition of the IDSR Technical Guidelines (2002) was widely adopted and adapted throughout the African region. Progress towards coordinated, integrated surveillance systems has been mixed, but almost every country in the region and their partners has invested human and material resources in strengthening capacities for public health systems in order to detect, confirm and respond to public health threats in time to prevent unnecessary illness, death, and disability. As a result, the second edition of the IDSR Technical Guidelines was developed in response to several factors relevant to the last decade. During the last ten years, many changes have occurred in Africa's health, social, economic, environmental and technical environment. Between 2000 and 2010, the emergence of new diseases, conditions and events resulted in the need to review the recommendations for evolving public health priorities for surveillance and response. For example, while the initial goal of IDSR was to address communicable diseases, many countries have begun to include non-communicable diseases in their IDSR program. Also, the emergence of pandemic influenza (avian and H1N1) emphasized the importance of community surveillance for linking detection to rapid confirmation and response. Disease- specific programs have refocused their objectives to address broader system strengthening objectives. As well, countries continue to work towards achievement of the Millennium Development Goals." - p. 1Introduction -- Section 1. Identify cases of priority diseases, conditions and events -- Section 2. Report priority diseases, conditions and events -- Section 3. Analyze data -- Section 4. Investigate suspected outbreaks and other public health events -- Section 5. Prepare to respond to outbreaks and other public health events -- Section 6. Respond to outbreaks and other public health events -- Section 7. Communicate information -- Section 8. Monitor, evaluate, and improve surveillance and response -- Section 9. Summary guidelines for specific priority diseases and conditions"October 2010."Compiled and edited by: Francis Kasolo, Jean Baptist Roungou, Helen Perry.Available via the World Wide Web as an Acrobat .pdf file (3.13 MB, 416 p.)