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Community-Based Surveillance in Côte d'Ivoire
Alexey Clara1, Serigne M Ndiaye1, Benie Joseph1
1Alexey Clara, MD, Karen A. Alroy, DVM, and Djebo C. Gourmanon, MD, are Epidemiologists, and S. Arunmozhi Balajee, PhD, is Associate Director of Global Health Security; all in the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Serigne M. Ndiaye, PhD, is Program Director; Mamadou Diarrassouba, MD, is Emergency Management Lead; and Ramatou Toure-Adechoubou, PharmD, is a Public Health Specialist for Laboratory; all in the Division of Global Health Protection, Country Office Côte d'Ivoire, Center for Global Health, Centers for Disease Control and Prevention (CDC), Abidjan, Côte d'Ivoire. Benie Joseph is a Professor and Director of Public Health, and Daouda Coulibaly, MD, MPH, is Deputy Director, Epidemiology Hygiene Research; both at the National Institute of Public Hygiene, Abidjan, Côte d'Ivoire. Maurice A. Nzogu holds a master's degree in humanitarian aid and international cooperation and is the Deputy Health Coordinator; Koffi Ange Houngbedji, MD, MPH, is Health Coordinator; and Henry Banny Attiey has a master's degree in monitoring evaluation and is Monitoring Evaluation Health Coordinator Health Sector; all at the International Rescue Committee, Abidjan, Côte d'Ivoire. Dr. Clara and Dr. Ndiaye contributed equally to this article. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Abstract:
Community-based surveillance can be an important component of early warning systems. In 2016, the Côte d'Ivoire Ministry of Health launched a community-based surveillance project in 3 districts along the Guinea border. Community health workers were trained in detection and immediate reporting of diseases and events using a text-messaging platform. In December 2017, surveillance data from before and after implementation of community-based surveillance were analyzed in intervention and control districts. A total of 3,734 signals of priority diseases and 4,918 unusual health events were reported, of which 420 were investigated as suspect diseases and none were investigated as unusual health events. Of the 420 suspected cases reported, 23 (6%) were laboratory confirmed for a specific pathogen. Following implementation of community-based surveillance, 5-fold and 8-fold increases in reporting of suspected measles and yellow fever clusters, respectively, were documented. Reporting incidence rates in intervention districts for suspected measles, yellow fever, and acute flaccid paralysis were significantly higher after implementation, with a difference of 29.2, 19.0, and 2.5 cases per 100,000 person-years, respectively. All rate differences were significantly higher in intervention districts (p < 0.05); no significant increase in reporting was noted in control districts. These findings suggest that community-based surveillance strengthened detection and reporting capacity for several suspect priority diseases and events. However, the surveillance program was very sensitive, resulting in numerous false-positives. Learning from the community-based surveillance implementation experience, the ministry of health is revising signal definitions to reduce sensitivity and increase specificity, reviewing training materials, considering scaling up sustainable reporting platforms, and standardizing community health worker roles.
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