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Global Health

In response to the February 2016 Zika virus (ZIKV) outbreak, an inter-agency agreement between the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Agency for International Development (USAID) commissioned further research on the epidemiology, transmission, diagnosis, and birth defects associated with ZIKV. The surveillance and research activities conducted included ecology studies focusing on the transmission dynamics; pregnancy and infant cohort studies to look for birth defects, developmental outcomes and risk factors associated with ZIKV infection; and laboratory studies evaluating the usefulness of multiple Zika diagnostic platforms. These studies were established by either setting up new systems, or leveraging on existing surveillance systems to include ZIKV research specific data elements. Conducted using country-specific protocols, these research systems included key data elements for cross-site analysis. Challenges faced included collection of non-standardized data, differing functional requirements, varying security and confidentiality protocols and limitations of informatics infrastructure. These challenges highlight an opportunity to evaluate and present the informatics-based components necessary to rapidly deploy surveillance and research study activities during a global health emergency situation. We highlight the key challenges and presents strategies for setting up rapid surveillance and research study activities. Additional areas of focus also include system architecture, global partnerships, and workforce development.

Objective: To assess challenges of establishing surveillance and research study systems and present strategies for rapid deployment in global health for the outbreak response.

Submitted by elamb on

Healthcare systems are often evaluated using comparative health care rankings. Simulations have shown that maximally inequitable health care systems can perform well in published, influential health care system rankings by excelling in non-equity categories, resulting in highly ranked yet grossly inequitable healthcare systems. Recently, despite below average equity rankings, the healthcare systems of Australia and New Zealand ranked among the top four in The Commonwealth Fund's international comparative study Mirror, Mirror 20172. Equity rankings should logically limit non-equity rankings given the insignificance of healthcare system improvements to those lacking adequate healthcare coverage. We analyzed whether an equity-limited ranking methodology would limit overall rankings for significantly inequitable healthcare systems while maintaining the general findings of the Commonwealth Fund study.

Objective: Describe the diverse determinants of national health and how they are compositely graded in health care system rankings. Articulate intrinsic reasons why equity should not be subsumed within other evaluative categories. Design an equity-limited ratings framework for limiting maximum ratings of inequitible healthcare systems.

Submitted by elamb on

All WHO member states are signatories of the IHR (1) to improve global health security. Objectives are to improve countries' capacities to detect, notify and respond to PHEICs. Rapid and transparent information sharing are critical for global coordination and rapid response to minimize an eventÍs impact on the public. The IHR require countries to establish a point of contact, or National Focal Point (NFP), responsible for notifying WHO of potential PHEICs and responding to requests of information. Potential PHEICs are assessed by the country and re-assessed by WHO, which posts its assessment together with information on response measures on a secure IHR Event information Site (EIS) accessible by all NFPs.

Objective

We looked at the public health impact in the US of the notification requirement of potential public health emergencies of international concern (PHEIC) under the 2005 International Health Regulations (IHR) to the World Health Organization (WHO).

Submitted by knowledge_repo… on

While traditional means of surveillance by governments, multi-national agencies, and institutional networks assist in reporting and confirming infectious disease outbreaks, these formal sources of information are limited by their geographic coverage and timeliness of information flow. In contrast, rapid global reach of electronic communication has resulted in the advent of informal sources of information on outbreaks. Informal resources include discussion sites, online news media, individual and organization reports and even individual search records. The earliest descriptions of the severe acute respiratory syndrome outbreak in Guangdon Province, south China came from informal reports. However, system development to date has been geared toward knowledge management and strategies for interpreting these data are underdeveloped. There is a need to move from simple knowledge reorganization to an analytic approach for disseminating timely yet specific signals.

 

Objective

Internet-based resources such as discussion sites and online news sources have become invaluable sources for a new wave of surveillance systems. The WHO relies on these informal sources for about 65% of their outbreak investigations. Despite widespread use of unstructured information there has been little, if any, data evaluation.

Referenced File
Submitted by elamb on

Surveillance of risky behaviors of HIV infection and its manifest diseases has provided a better understanding of the complex nature of the HIV epidemic in India. However, little attempt is made to analyze progress of these surveillance activities.

Objective

To study and analyze the surveillance activities in HIV prevention and control in India.

Submitted by teresa.hamby@d… on

Pilot projects help determine utility and feasibility of a system, but even if considered successful, cost could prevent further scale-up. When evaluating a surveillance system pilot, cost and benefits are key factors to examine. In Cote d’Ivoire and Tanzania, Ministry of Health (MoH) and non-governmental partners receive funding under the Global Health Security Agenda to strengthen disease surveillance for earlier detection and improved response to potential infectious disease outbreaks. To this end, Community based surveillance (CBS) projects were implemented in 2016 as a means for early warning of potential events to facilitate a more rapid response. Currently, these CBS projects are being evaluated collaboratively with the primary stakeholder, the host country government (HCG), as lead, and partners such as CDC providing technical assistance. In other instances, partners may conduct an evaluation and share the results and recommendations with the HCG; however, if the HCG is not actively engaged as the primary executor, outcomes may not be endorsed or implemented. Therefore, these evaluations were approached from an owner’s (HCG) perspective. In this way, the governmental agencies develop capabilities to conduct similar activities in other areas, reduce dependencies on outside entities, and promote enactment of resulting recommendations.

Objective:

We used experiences in multiple countries to determine that owner engagement is critical for successful evaluations of surveillance system viability.

Submitted by elamb on

Effective use of data for disease surveillance depends critically on the ability to trust and quantify the quality of source data. The Scalable Data Integration for Disease Surveillance project is developing tools to integrate and present surveillance data from multiple sources, with an initial focus on malaria. Consideration of data quality is particularly important when integrating data from diverse clinical, population-based, and other sources. Several global initiatives to reduce the burden of malaria (Presidents Malaria Initiative, Roll Back Malaria Initiative and The Global Fund to Fight AIDS, Tuberculosis and Malaria) have published lists of recommended indicators. Values for these indicators can be obtained from different data sources, with each source having different data quality properties as a consequence of the type of data collected and the method used to collect the data. Our goal is to develop a framework for organizing the data quality (DQ) properties of indicators used for disease surveillance in this setting.

Submitted by teresa.hamby@d… on

The global effort of malaria control is in line with the one world one health concept, but then a globally defined ‘‘one-size-fits-all’’ malaria control strategy would be inefficient in endemic areas. Plasmodium falciparum is the type of malaria parasite that most often causes severe and life-threatening malaria. People get malaria by being bitten by an infective female Anopheles mosquito. Regional malaria elimination campaigns in 1940s followed by the Global Malaria Eradication Program in 1955 did not succeed in eliminating malaria from subSaharan Africa, which accounts for 80% of today’s burden of malaria. The basic reproductive number, Ro, has played a central role in epidemiological theory for malaria and other infectious diseases because it provides an index of transmission intensity and establishes threshold criteria.

Objective

To examine the likely impact of malaria parasite intervention points for a steady state regional control program in endemic areas

Submitted by teresa.hamby@d… on

The International Health Regulations (2005) came into effect in 2007 and mandate that each signatory country be capable of detecting, analyzing, reporting, and responding to a public health event of international concern by 2012. Some countries are capable of this at present, but these are generally clustered in resource-limited settings. Many more countries will not be fully capable of compliance by 2012, some because of insufficient surveillance systems.

Globally, disease surveillance systems suffer from a number of resource constraints. These constraints are more pronounced in developing countries, which bear the greatest burden of disease and where pathogens are more likely to emerge, reemerge, and mutate into drug-resistant strains (US-GAO August 2001). It has traditionally been difficult to monitor disease burden and trends in India, and even more difficult to detect, diagnose, and control outbreaks until they had become quite large (Suresh June 2003).

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