This manuscript describes the process and impact of strengthening the WHO Regional Office for Africa (WHO AFRO)'s COVID-19 vaccination information system. This system plays a critical role in tracking vaccination coverage, guiding resource allocation and supporting vaccination campaign roll-out for countries in the African region. Recognising existing data management issues, including complex reporting prone to human error, compromised data quality and underutilisation of collected data, WHO AFRO introduced significant system improvements during the COVID-19 pandemic. These improvements include shifting from an Excel-based to an online Azure-based data collection system, automating data processing and validation, and expansion of collected data. These changes have led to improvements in data quality and quantity including a decrease in data non-validity, missingness, and record duplication, and expansion of data collection forms to include a greater number of data fields, offering a more comprehensive understanding of vaccination efforts. Finally, the creation of accessible information products-including an interactive public dashboard, a weekly data pack and a public monthly bulletin-has improved data use and reach to relevant partners. These resources provide crucial insights into the region's vaccination progress at national and subnational levels, thereby enabling data-driven decision-making to improve programme performance. Overall, the strengthening of the WHO AFRO COVID-19 vaccination information system can serve as a model for similar efforts in other WHO regions and contexts. The impact of system strengthening on data quality demonstrated here underscores the vital role of robust data collection, capacity building and management systems in achieving high-quality data on vaccine distribution and coverage. Continued investment in information systems is essential for effective and equitable public health efforts.
The coronavirus disease (COVID-19) presented a unique opportunity for the World Health Organization (WHO) to utilise public health intelligence (PHI) for pandemic response. WHO systematically captured mainly unstructured information (e.g. media articles, listservs, community-based reporting) for public health intelligence purposes. WHO used the Epidemic Intelligence from Open Sources (EIOS) system as one of the information sources for PHI. The processes and scope for PHI were adapted as the pandemic evolved and tailored to regional response needs. During the early months of the pandemic, media monitoring complemented official case and death reporting through the International Health Regulations mechanism and triggered alerts. As the pandemic evolved, PHI activities prioritised identifying epidemiological trends to supplement the information available through indicator-based surveillance reported to WHO. The PHI scope evolved over time to include vaccine introduction, emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, unusual clinical manifestations and upsurges in cases, hospitalisation and death incidences at subnational levels. Triaging the unprecedented high volume of information challenged surveillance activities but was managed by collaborative information sharing. The evolution of PHI activities using multiple sources in WHO's response to the COVID-19 pandemic illustrates the future directions in which PHI methodologies could be developed and used.
Declaring the end of an outbreak is an important step in controlling infectious disease outbreaks. An objective estimation of the probability of cases arising in the future is important to reduce the risk of post-declaration flare-ups. We developed a simulation-based model to quantify that probability. We tested it on simulated Ebola Virus Disease (EVD) data and found this probability was most sensitive to the instantaneous reproduction number, the reporting rate, and the delay between symptom onset and recovery or death of the last detected case. For EVD, our results suggest that the current WHO criterion of 42 days since the outcome of the last detected case is too short and very sensitive to underreporting. The 90 days of enhanced surveillance period after the end-of-outbreak declaration is therefore crucial to capture potential flare-ups of cases. Hence, we suggest a shift to a preliminary end-of-outbreak declaration after 63 days from the symptom onset day of the last detected case. This should be followed by a 90-day enhanced surveillance, after which the official end-of-outbreak can be declared. This corresponds to less than 5% probability of flare ups in most of the scenarios examined. Our quantitative framework could be adapted to define end-of-outbreak criteria for other infectious diseases.
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Universal access to childhood vaccination is important to child health and sustainable development. Here we identify, at a fine spatial scale, under-immunized children and zero-dose children. Using Chad, as an example, the most recent nationally representative household survey that included recommended vaccine antigens was assembled. Age-disaggregated population (12-23 months) and vaccination coverage were modelled at a fine spatial resolution scale (1km × 1 km) using a Bayesian geostatistical framework adjusting for a set of parsimonious covariates. There was a variation at fine spatial scale in the population 12-23 months a national mean of 18.6% (CrI 15.8%-22.6%) with the highest proportion in the South-East district of Laremanaye 20.0% (14.8-25.0). Modelled coverage at birth was 49.0% (31.2%-75.3%) for BCG, 44.8% (27.1-74.3) for DTP1, 24.7% (12.5-46.3) for DTP3 and 47.0% (30.6-71.0) for measles (MCV1). Combining coverage estimates with the modelled population at a fine spatial scale yielded 312,723 (Lower estimate 156055-409266) zero-dose children based on DTP1. Improving routine immunization will require investment in the health system as part of enhancing primary health care. The uncertainties in our estimates highlight areas that require further investigation and higher quality data to gain a better understanding of vaccination coverage.
The emergence of COVID-19 in January, 2020, has led to the largest pandemic in recent history. With fragile health systems, limited testing capacities, and potentially vulnerable populations, Africa was projected to be the worst affected continent.1The LancetCOVID-19 in Africa: no room for complacency.Lancet. 2020; 3951669Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar However, as of Dec 31, 2020, the African region, with 14% of the global population and 47 member states, remains among the least affected of the WHO regions, accounting for 2·4% of confirmed cases and 2·4% of deaths globally. In 2020, following substantial increases in June and July, COVID-19 cases declined in August and September, before plateauing in October and steadily increasing again in November and December. Although several countries in Europe are experiencing second waves of the pandemic,2Looi MK Covid-19: is a second wave hitting Europe?.BMJ. 2020; 371m4113Crossref PubMed Scopus (95) Google Scholar there is rising fear of a COVID-19 resurgence in the African region. The recent upsurge seen in South Africa, Nigeria, and Senegal indicates possible resurgence, with notable signs of reduced adherence to public health and social measures (PHSM). As a result, transmission in households, schools, prisons, and other close settings has increased. This increase in transmission might force member states to reinstate lockdown measures with the associated negative socio-economic consequences. Three interventions are crucial to prepare for and respond to a possible COVID-19 resurgence. First, communities should be empowered as first responders. The experiences during recurrent Ebola outbreaks, and the HIV pandemic, suggest that member states should invest more in engaging the community in the COVID-19 response by involving community leaders as partners, so improving buy-ins for PHSM, and mitigating harm from misinformation. Member states are urged to form local committees responsible for community dialogues on preventive measures with tailored messaging based on feedback around COVID-19 risk perceptions. Second, the risk of continued spread at subnational levels should be assessed to inform tailored responses. We recommend WHO's new guidance on implementing and adjusting PHSM in the context of COVID-19,3WHOConsiderations for implementing and adjusting public health and social measures in the context of COVID-19.https://www.who.int/publications/i/item/considerations-in-adjusting-public-health-and-social-measures-in-the-context-of-covid-19-interim-guidanceDate: Nov 4, 2020Date accessed: November 7, 2020Google Scholar which uses a risk–benefit approach at the lowest administrative level, with transmission intensity and health systems' response capacity used to assign a risk level to each area. Third, member states should plan for the worst-case scenario by anticipating when health system capacity might be overwhelmed, developing contingency plans aimed at improving and adjusting testing strategy and capacity,4Seidu AA Hagan Jr, JE Ameyaw EK Ahinkorah BO Schack T The role of testing in the fight against COVID-19: current happenings in Africa and the way forward.Int J Infect Dis. 2020; 98: 237-240Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar scaling up active case finding in areas with widespread community transmission, increasing capacity to isolate all cases, and maximising the current health workforce including redeploying health workers to high-need areas. Sustainable and rapidly implemented interventions require strengthened response coordination to reduce transmission to levels that allow economic activity to continue across the region. We declare no competing interests. The views expressed in this Correspondence are those of the authors and do not necessarily represent the official position of WHO. COVID-19 in Africa: no room for complacencyDespite over 100 000 confirmed cases and infections in every country, the passage of COVID-19 through the African continent remains somewhat enigmatic. High numbers of deaths were expected in the region due to fragile health systems, lack of access to preventive measures, barriers to testing, and potentially vulnerable populations. But, according to WHO, Africa is the least affected region globally, with 1·5% of the world's reported COVID-19 cases and 0·1% of the world's deaths. Although comparisons are inaccurate, mortality rates have been lower compared with outbreaks of similar size elsewhere. Full-Text PDF
Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region, disrupted by the COVID-19 pandemic. In 2022, the coverage with the first and third dose of diphtheria-tetanus-pertussis containing vaccine (DTP1 and DTP3 respectively) and with the first dose of measles-containing vaccine (MCV1), in the region, was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose were recorded (19.0% of target population). Ten countries of the region accounted for 80.3% of all zero-dose children including the four most populous countries (Nigeria, Ethiopia, Democratic Republic of the Congo, United Republic of Tanzania). Reported administrative coverage greater than WUENIC was found in 19 countries, highlighting routine immunization data quality issues. The WHO African region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for Governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching-up on vaccination of zero-dose and un-der-vaccinated children and improving data quality.
BACKGROUND The ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic. OBJECTIVE This paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization via the WHO’s polio program in the African region. METHODS We repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to enable actionable insights. RESULTS The contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility–based surveillance app has been used more extensively, as it has been used in 27 countries in the region. CONCLUSIONS In light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field. From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries’ efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19.
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