@article{Higgins_Polich_Sahu_Mearns_Ratnayake_2017, title={Sustaining community event-based surveillance in Sierra Leone}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7706}, DOI={10.5210/ojphi.v9i1.7706}, abstractNote={<div style="left: 78.2727px; top: 278.962px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.0823);" data-canvas-width="55.467823232323234">Objective</div><div style="left: 91.3182px; top: 291.965px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03309);" data-canvas-width="329.93375050505057">To assess whether the change in death swabbing policy in Sierra</div><div style="left: 78.2727px; top: 306.46px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04377);" data-canvas-width="343.2795404040403">Leon has begun to affect community death reporting, we analyzed</div><div style="left: 78.2727px; top: 320.955px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00119);" data-canvas-width="294.9330858585858">trends in death reporting before and after the policy change.</div><div style="left: 78.2727px; top: 348.538px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.11884);" data-canvas-width="71.86668434343434">Introduction</div><div style="left: 91.3182px; top: 361.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0297);" data-canvas-width="330.0717424242424">Stemming from the 2014-6 Ebola virus disease (EVD) outbreak,</div><div style="left: 78.2727px; top: 376.036px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.977391);" data-canvas-width="343.4224606060605">community event based surveillance (CEBS) was implemented in</div><div style="left: 78.2727px; top: 390.531px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02196);" data-canvas-width="342.9702906565657">Sierra Leone using community health workers to generate alerts for</div><div style="left: 78.2727px; top: 405.026px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0191);" data-canvas-width="343.02943005050497">trigger events suggestive of EVD transmission. Through September</div><div style="left: 78.2727px; top: 419.521px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.981776);" data-canvas-width="341.88730050505063">30, 2015 (last month of active EVD transmission), the majority (86%)</div><div style="left: 78.2727px; top: 434.016px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04094);" data-canvas-width="339.0165757575758">of alerts reflected community deaths; this was beneficial as Ebola-</div><div style="left: 78.2727px; top: 448.511px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02068);" data-canvas-width="342.8815815656565">related deaths were detected with delay during the epidemic’s peak.</div><div style="left: 78.2727px; top: 463.006px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01873);" data-canvas-width="342.9210078282829">The Government had implemented a policy of mandatory swabbing</div><div style="left: 78.2727px; top: 477.501px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01588);" data-canvas-width="342.6733616161615">and testing of all dead bodies. The policy changed on June 30, 2016</div><div style="left: 78.2727px; top: 491.996px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01035);" data-canvas-width="342.54399419191924">wherein only swabbing of deaths deemed to be high-risk for EVD is</div><div style="left: 78.2727px; top: 506.491px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04787);" data-canvas-width="343.3694815656564">required. To assess whether this policy change has begun to affect</div><div style="left: 78.2727px; top: 520.985px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.965527);" data-canvas-width="343.55059595959614">community death reporting, we analyzed trends in death reporting</div><div style="left: 78.2727px; top: 535.48px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00114);" data-canvas-width="171.060696969697">before and after the policy change.</div><div style="left: 78.2727px; top: 563.063px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.07424);" data-canvas-width="50.65042676767676">Methods</div><div style="left: 91.3182px; top: 576.066px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01305);" data-canvas-width="329.5973952020201">This analysis was conducted using data from nine districts during</div><div style="left: 78.2727px; top: 590.561px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.995046);" data-canvas-width="344.25287626262633">period 1 (January-June 2016) and period 2 (July 2016). Weekly</div><div style="left: 78.2727px; top: 605.056px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02144);" data-canvas-width="342.81135353535336">changes in the reporting of death alerts during the two periods were</div><div style="left: 78.2727px; top: 619.551px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0049);" data-canvas-width="342.3862891414141">assessed. An interrupted time series analysis (ITS) with a segmented</div><div style="left: 78.2727px; top: 634.046px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.999368);" data-canvas-width="342.2335123737374">linear regression was also used to assess the immediate impact of the</div><div style="left: 78.2727px; top: 648.541px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00145);" data-canvas-width="71.85436363636363">policy change.</div><div style="left: 78.2727px; top: 676.124px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.08542);" data-canvas-width="44.50239393939395">Results</div><div style="left: 91.3182px; top: 689.127px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03296);" data-canvas-width="330.06435">During period 1, monthly changes in death alerts across districts</div><div style="left: 78.2727px; top: 703.622px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.988383);" data-canvas-width="344.27012525252525">were variable (-8% to 16%). Comparison of the weekly average</div><div style="left: 78.2727px; top: 718.117px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.956519);" data-canvas-width="343.6614823232325">between periods 1 and 2 showed a 33% reduction in death alerts.</div><div style="left: 78.2727px; top: 732.612px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.974351);" data-canvas-width="344.05944116161606">During period 1 (before the policy change), there was an overall</div><div style="left: 78.2727px; top: 747.107px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03267);" data-canvas-width="345.3247777777777">significant increase of 3.2 death alerts per week (p=0.00) and</div><div style="left: 78.2727px; top: 761.602px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.989938);" data-canvas-width="344.1518464646464">no immediate impact or changes in the trend afterwards. At the</div><div style="left: 78.2727px; top: 776.097px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02635);" data-canvas-width="343.0392866161616">district level, on average 354 death alerts were generated weekly in</div><div style="left: 78.2727px; top: 790.592px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.957892);" data-canvas-width="343.48406414141414">June, compared to 237 in July (33% reduction); Moyamba district</div><div style="left: 78.2727px; top: 805.086px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00188);" data-canvas-width="318.896861111111">experienced the largest drop in death alerts from 46 to 16 (65%).</div><div style="left: 78.2727px; top: 832.669px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.10408);" data-canvas-width="73.93656313131314">Conclusions</div><div style="left: 91.3182px; top: 845.672px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02983);" data-canvas-width="332.2907017676767">Community death reporting provides early warning of EVD</div><div style="left: 78.2727px; top: 860.167px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.991572);" data-canvas-width="341.9107098484848">transmission by rapidly capturing death alerts where vital registration</div><div style="left: 78.2727px; top: 874.662px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.951661);" data-canvas-width="339.2987199494946">is not fully functional. Although we have one month of data post-</div><div style="left: 78.2727px; top: 889.157px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.985344);" data-canvas-width="343.86847020202055">policy change, this preliminary analysis suggests that the change</div><div style="left: 78.2727px; top: 903.652px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04567);" data-canvas-width="343.43354924242425">in swabbing policy may have halted an observed increase in death</div><div style="left: 78.2727px; top: 918.147px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.96725);" data-canvas-width="343.2770762626262">reporting. Further community mobilization efforts and training are</div><div style="left: 78.2727px; top: 932.642px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00122);" data-canvas-width="229.9290353535353">warranted to prevent a drop in death reporting.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Higgins, Eilidh M. and Polich, Erin and Sahu, Maitreyi and Mearns, Stacey and Ratnayake, Ruwan}, year={2017}, month={May} }