CIMTRADZ - Mississippi State University · CIMTRADZ Capacity building in ... respectively....

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John Kaneene, John David Kabasa , Michael Muleme, Joyce Nguna, Richard Mafigiri, Doreen Birungi

CIMTRADZ Capacity building in Integrated Management of

Trans-boundary Animal Diseases and Zoonoses

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Assessment of Human and Animal Disease Surveillance Systems in

the East-Central Africa Infectious Disease Hotspot

A Case Study of Uganda

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Michael Muleme1, Joyce Nguna1, Richard Mafigiri1, Doreen Birungi1, John David Kabasa1, John B. Kaneene2

1. College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda

2. Center for Comparative Epidemiology, Michigan State University, Michigan, United States of America

Corresponding author

John Kaneene

Center for Comparative Epidemiology 736 Wilson Rd, Room A-109 Michigan State University East Lansing, MI 48824

Email: [email protected]

Phone: (517) 355-2269

OBJECTIVES: This study aimed to assess the extent of human disease surveillance systems in East -Central Africa’s

infectious disease hotspot using Uganda as a case study.

METHODS: Questionnaires, face-to-face interviews, and site-visits to selected health units in Uganda’s four regions were used

to describe the types of disease surveillance systems used, diseases and population targeted, and surveillance support infrastructure

(laboratories, communication, and data management).

RESULTS: 93% , 76% , 92% , and 83% of surveyed health units car r ied out disease-specific, syndromic, passive, and active

surveillance, respectively. Surveillance in >67% of the health facilities targeted malaria, AIDS, and immunizable diseases, while

<16% of the health units carried out surveillance for non-infectious and zoonotic diseases. The majority (99%) of health units re-

ported weekly surveillance data using phones. Only 33% of health units used electronic data management tools. Processing of

surveillance data was done by clinical personnel in 55% of the health units.

CONCLUSIONS: Human disease surveillance targeted malar ia, AIDS, and immunizable diseases. Non -infectious and zo-

onotic disease surveillance, establishing electronic data management systems, and training of personnel must be implemented to

improve human disease surveillance in Uganda.

Assessment of Human Disease Surveillance Systems in the East-Central

Africa Infectious Disease Hotspot: A Case Study of Uganda

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Michael Mulemea, Richard Mafigiria, Joyce Ngunaa, Doreen Birungia, John David Kabasaa, John B. Kaneeneb

a College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda

b Center for Comparative Epidemiology, Michigan State University, East-Lansing, United States of America

Corresponding author:

Michael Muleme

Email: [email protected]

Tel: +256777866551

Abstract:

This study aimed to compare the current status of the veterinary surveillance system to that of the human sur-

veillance system as well as to assess the ability of the two systems in dealing with emerging infectious diseas-

es. The human surveillance system in Uganda had a better layed-out structure with health units of all levels

(HC II, III, IV hospitals and central units all involved in disease surveillance and laboratory disease detection

depending on the resources and skills of the health personnel managing that level of facility. The human health

data management was also boasted by an efficient mobile-based data transfer system which was used by 74 out

of the 75 health units involved in the study. Conversely, the veterinary surveillance system which has limited

functionality and few laboratory infrastructure at units (1 out of 11) below the District Veterinary Office. The

veterinary surveillance systems also lacked a real-time data management programs which necessitates the need

to improve animal disease laboratory units, data management and recruitment of veterinary personnel at sub-

counties. More veterinary health units (64%), however, targeted zoonotic diseases compared to the human

surveillance systems (12%) which underscores the need to integrate zoonotic disease surveillance in both hu-

man and animal health services. None the less both human and veterinary disease surveillance systems had in-

adequate data management personnel and were characterized by limited integration of communication and sur-

veillance reports systems generated by human and animal health units.

Acknowledgement: This report was made possible by the generous support of the American people through the United States Agency

for International Development (USAID). The contents are the responsibility of the Africa‐U.S. Integrated Disease Management Network

(AFRUS-IDM) and do not necessarily reflect the views of USAID or the United States Government.

A comparative assessment of the animal and human disease surveillance systems in the East-Central

Africa infectious disease hot-spot, 2013: A case study of Uganda

mailto:[email protected]

ASSESSING CURRENT SURVEILLANCE SYSTEMS IN UGANDA Prof. John B. Kaneene

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INTRODUCTION Thank you for participating in this survey. By completing this questionnaire, you will provide us with valuable information needed to assess current disease surveillance systems in Uganda. SECTION 1: TYPES OF SURVEILLANCE SYSTEMS CURRENTLY PRESENT IN

UGANDA Please describe the surveillance systems that you are aware of that have been used in Uganda

1. List any disease-specific surveillance Programs: These are Programs for disease outbreaks where a single cause has been identified (e.g., anthrax, Ebola)

1.1 Human surveillance systems:_______________________________________________

_______________________________________________________________________

1.2 Animal surveillance systems: ______________________________________________

_______________________________________________________________________

2. List any syndromic surveillance Programs: These are Programs for outbreaks or epidemics

of syndromes with no single cause identified (e.g., diarrheal disease, pneumonia)


_______________________________________________________________________


_______________________________________________________________________

Problem–based Surveillance: These are surveillance systems designed to investigate specific disease problems (e.g., tuberculosis, abortions)


Part 1

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3. List any passive surveillance systems for:


_______________________________________________________________________


_______________________________________________________________________

4. List any active surveillance systems for:

4.1 Human surveillance systems: __________________________________________ _______________________________________________________________________ 4.2 Animal surveillance systems: ___________________________________________

_____________________________________________________________________

Active surveillance: These are surveillance systems designed to seek out disease data from selected and targeted groups (e.g., sentinel surveillance for influenza, HIV health surveys)

Passive surveillance: These are surveillance systems designed to passively collect data about trends in disease, and risk factors for disease control and prevention, by using routine methods (e.g., reports of TB from clinics, cattle carcass inspection for disease)


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SECTION 2: COMPONENTS OF UGANDAN SURVEILLANCE SYSTEMS Please describe the following components of surveillance systems that you are aware of that have been used in Uganda

5. Please identify any diseases and syndromes affecting humans that have been the focus of

recent surveillance programs, by placing a check/mark next to all that apply:

a) _____ Malaria b) _____ Tuberculosis c) _____ HIV/AIDS d) _____ Pneumonia e) _____ Dysentery/cholera f) _____ Influenza g) _____ Others: please list below:

_______________________________________________________________________

6. Please identify any diseases and syndromes affecting animals that have been the focus of recent surveillance programs, by placing a check/mark next to all that apply:

a) _____ Abortions b) _____ Anthrax c) _____ Brucellosis d) _____ Diarrhea e) _____ Influenza f) _____ Foot & Mouth Dis. g) _____ Others: please list below:

_______________________________________________________________________

7. Human populations 7.1 By location: a. _____ Urban b. _____ Rural c. _____ Not by location 7.2 By gender: a. _____ Male b. _____ Female c. _____ Not by gender 7.3 By age: a. _____ Adults b. _____ Children c. _____ Not by age

8. Animal populations

8.1 By type: a. _____ Wild b. _____ Domestic c. _____ Not by type 8.2 By gender: a. _____ Male b. _____ Female c. _____ Not by gender 8.3 By age: a. _____ Adults b. _____ Young c. _____ Not by age 8.4 By breeds: a. _____ Yes b. _____ No c. _____ Not by breed 8.5 By usage: a. _____ Milk b. _____ Meat c. _____ Not by usage d. _____ Other usages, please list below:

_______________________________________________________________________

Please identify the populations of interest (or targets) of the aforementioned surveillance Programs, by placing a check/mark next to all that apply:

Targets for Surveillance Programs in Uganda


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Please describe the types and levels of laboratories available for disease surveillance

9. Primary field facilities: These are clinics or laboratories that are capable of sample and data collection, and that can conduct screening tests and some diagnostic tests)

Estimate the numbers of: 9.1 Health Care Clinics, by level:

a. _____ Health Care I Clinics b. _____ Health Care II Clinics

c. _____ Health Care III Clinics d. _____ Health Care IV Clinics

9.2 Veterinary Field Laboratories, by level:

a. _____ Sub-county level b. _____ County level c. _____ District level

10. Secondary facilities: These are referral hospitals or laboratories that are capable of accepting referrals from primary facilities, can conduct screening tests and sample and data collection, and are capable of confirmatory diagnostic testing. 10.1 Human referral hospitals/diagnostic laboratories:

a. _____ Number of hospitals b. _____ Number of laboratories

c. Locations: ________________________________________________________

10.2 Veterinary diagnostic laboratories

a. _____ Number of laboratories

b. Locations: ________________________________________________________

Laboratory Facilities for Surveillance Programs in Uganda


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11. Please describe how information is communicated between different levels of public health

and veterinary health, by placing a check/mark next to all that apply:

Method

11.1 Between Primary and Secondary

facilities for human disease information

11.2 Between Primary and Secondary

facilities for animal disease information

11.3 Between Human and Animal health

institutions

Telephone/cell a. _____ a. _____ a. _____

Email/Website b. _____ b. _____ b. _____

FAX c. _____ c. _____ c. _____

Regular meetings d. _____ d. _____ d. _____

Meetings when needed e. _____ e. _____ e. _____

Other, please describe: f. ________________

f. ________________

f. ________________

Communications Available for Surveillance Programs in Uganda


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12. For any surveillance programs that have been conducted in Uganda, please describe how field data is collected, stored, and transmitted, by placing a check/mark next to all that apply.

Method: Humans Animals

12.1 Data Collection in the Field

Notes written by hand (hard copy) a) _____ f) _____

Questionnaire (hard copy) b) _____ g) _____

Electronic (computer) c) _____ h) _____

Audio or video recording d) _____ i) _____

Other: __________________________________________ e) _____ j) _____

12.2 Data Storage in the Field

Paper/hard copy a) _____ e) _____

Electronic (computer files, flash drive, CD, DVD) b) _____ f) _____

Audio or video recording c) _____ g) _____

Other: __________________________________________ d) _____ h) _____

12.3 Transferring Data from the Field to Diagnostic Referral Laboratories




Other: __________________________________________ d) _____ h) _____

Surveillance Data Collection, Storage, and Transmission


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13. For any surveillance programs that have been conducted in Uganda, please describe how laboratory data is collected and stored, by placing a check/mark next to all that apply.

Method: Humans Animals

13.1 Data Collection in the Laboratory

Notes written by hand (hard copy) a) _____ e) _____

Electronic (computer input, instrument output files) b) _____ f) _____


Other: ___________________________________ d) _____ h) _____

13.2 Data Storage in the Laboratory




Other: ___________________________________ d) _____ h) _____

Laboratory Data Collection and Storage


Part 1

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14. For any surveillance programs that have been conducted in Uganda, please describe how data are analyzed and reported, by placing a check/mark next to all that apply.

Humans Animals

14.1 Describe which agencies or institutions are responsible for processing surveillance data from:

Regional diagnostic laboratories: a) _______________ c) ________________

Field clinics and laboratories: b) _______________ d) _______________

14.2 Describe the types of reports produced from surveillance data:

Annual summaries of diseases a) _____ d) _____

Disease outbreak reports b) _____ e) _____

Reports from special Programs c) _____ f) _____

15. Describe how summary data reports are distributed:

15.1 Who are the stakeholders receiving reports?

For Human diseases: a) ______________________________________

For Animal diseases: b) _______________________________________

15.2 What is the frequency of reporting?

For Human diseases: a) ______________________________________

For Animal diseases: b) _______________________________________

15.3 What is the format of these reports?

Please place a check/mark next to all that apply Humans Animals

Printed reports or brochures a) _____ e) _____

Electronic (email, text messaging) b) _____ f) _____


Other: ________________________________________ d) _____ h) _____

END OF PART 1: CONTINUE TO PART 2: GENDER AUDIT SURVEY

Analysis and Reporting of Surveillance Data

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