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Title: BARRIERS TO DISEASE SURVEILLANCE AND NOTIFICATION OF COMMUNICABLE DISEASES: LESSONS LEARNT FROM EBOL

Authors: Adebimpe Wasiu Olalekan

Topic: Public Health

Abstract:

The WHO relies on accurate, timely and complete data in order to make forecast and advice on the trend of infections. This requires that diseases should be notified through a organized flow and reporting system. The outbreak of Ebola Viral Disease (EVD) in the West African sub region is a testimony to a dire need for a strong and sustained surveillance and disease reporting system for all member countries. Despite the Afro-region moving towards IDSR as an improvement on the conventional DSN systems, disease reporting and notification faces a lot of challenges and barriers which affects the timeliness, completeness, accuracy and effectiveness on disease notification., leading to weakness in the surveillance system.

Major challenges to effective DSN include political and technical, poor health infrastructure, poor DSN methodology, poor level of electronic surveillance, inadequate financial and human Resources: barriers of tools, forms, timeliness, completion and feedback and inadequate data system. The eventual implications on the health systems, international travels and movements and changing epidemiology of infectious diseases are enormous. In addition, Nigeria may have to step up emergency disease preparedness, reduce health resources brain drain, strengthen the health system and generally improve EVD awareness. This review used systematic methodologies to appraise challenges facing effective disease surveillance and notification with an emphasis on the ongoing and first major EVD outbreak in Nigeria

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    COMMENT - 1

  • JACKSON KIHUHA KAGUAMBA (Viewer) 28th Jan 2015 - 8:35 PM
    Very timely article and one that is very relevant given the EVD threat. Some clarifications please
    1. Article has some grammar issues that should be sorted out. For example under the subheading “ political challenges” there is a hanging sentence - Global Public Health Intelligence Network (GPHIN)
    2. According to the article, Nigerians achieved a high level of awareness and dispelling of rumours and myths in the EVD outbreak. This is impressive since EVD did not last very long in Nigeria compared to other West African countries. EVD was very difficult to control in Liberia and other countries in the region due to myths and rumours. It would have been interesting to elaborate on what contributed to the difference between these other countries and Nigeria as far as myths and rumours are concerned. What methods were used?
    3. In the subsection on timeliness- does Nigeria have standards on timeliness? For example, we do have some in Botswana. Data is supposed to have arrived at the National level by the 10th of the following month. The length of delay might have given a better idea on how bad things were.
    4. Under the subheading Knowledge of health care workers and the community about DSN- there is a study quoted. Figures of number of subjects and their percentage contribution do not rhyme. There are 55 respondents - equivalent to 38.5% while 39 respondents is allocated an equivalence of 70.9%. The latter should be lower
    5. In the subheading Barriers of tools, forms, timeliness, completion and feedback- the point highlighting on the deficiencies is clear. However, the articles quoted as support are more than 10 years old. Maybe there should be a statement to the effect that the situation is still the same or something like that.
    • OLALEKAN WASIU ADEBIMPE (Author) 29th Jan 2015 - 3:49 AM
      Thanks for your review

      I have reviewed the article once again by reading and reading over again and again. I have removed several grammatical and editing errors observed and noticed. This revised version is better now as saved.

      in Nigeria, EVD was first regarded as an emerging brand new disease. The social media was the first source of rumour and misconceptions among youths. As the disease ravaged then, the media greatly assisted in dispelling the rumour and misconceptions to the extent that even children had awareness about EVD, its modes and non modes of transmission. State Governments complimented efforts of the Federal Government in educating people about EVD. Some local social media sites were shut down once found guilty of wrong blogs about EVD. Perhaps the most important approach that contributed to the Nigerian success story was the coordination of DSN efforts by the Federal Government. The Minister for Health addressed the nation almost on daily basis to give an idea of magnitude of EVD spread, complimented by series of awareness campaigns in areas of worship, markets, higher education institutions and other public places among others. Eventually, the misconceptions disappeared, thus contributing to control efforts.

      Nigeria have standards. The National guideline on DSN by the Federal Ministry of Health is hereby quoted in this revised version of this manuscript. From Local to State; and from States to Federal or National level requires meeting the deadline of the 5th and 10th day of next month respectively just like in your country Botswana. However, there may be some delays here in Nigeria that could prolong this timeline as stated: such as incomplete reporting and poor motivation and attitude of DSN officers among others. Situation is better now that every local government council have their own DSN officers. The advent of modern computer and internet technology has made submissions and hence timeliness a less issue.

      Your observation is good though all figures and percentages quoted are still correct. However I have modified the sentence since its a subset. The denominator are those who are aware (55) and not the total population of 144. the numerator (39) are those who ever reported, and this was taken as a subset of those who are aware. So 39/55 as a percentage gives 70.9%. Hence the statement now reads : Thirty nine (70.9%) of those who are aware reported to have ever reported,

      Thanks for your observation about the 2003 reference. though I did not see it as old, I have now substituted all relevant old references with new one in order to avoid use of ole references

      Corrections effected appropriately

  • COMMENT - 2

  • JACKSON KIHUHA KAGUAMBA (Viewer) 28th Jan 2015 - 8:40 PM
    Very timely article and one that is very relevant given the EVD threat. Some clarifications please
    1. Article has some grammar issues that should be sorted out. For example under the subheading “ political challenges” there is a hanging sentence - Global Public Health Intelligence Network (GPHIN)
    2. According to the article, Nigerians achieved a high level of awareness and dispelling of rumours and myths in the EVD outbreak. This is impressive since EVD did not last very long in Nigeria compared to other West African countries. EVD was very difficult to control in Liberia and other countries in the region due to myths and rumours. It would have been interesting to elaborate on what contributed to the difference between these other countries and Nigeria as far as myths and rumours are concerned. What methods were used?
    3. In the subsection on timeliness- does Nigeria have standards on timeliness? For example, we do have some in Botswana. Data is supposed to have arrived at the National level by the 10th of the following month. The length of delay might have given a better idea on how bad things were.
    4. Under the subheading Knowledge of health care workers and the community about DSN- there is a study quoted. Figures of number of subjects and their percentage contribution do not rhyme. There are 55 respondents - equivalent to 38.5% while 39 respondents is allocated an equivalence of 70.9%. The latter should be lower. Kindly clarify

    5. In the subheading Barriers of tools, forms, timeliness, completion and feedback- the point highlighting on the deficiencies is clear. However, the articles quoted as support are more than 10 years old. Maybe there should be a statement to the effect that the situation is still the same or something like that.
    • OLALEKAN WASIU ADEBIMPE (Author) 29th Jan 2015 - 3:51 AM
      Comments repeated
      My responses are as stated above

  • COMMENT - 3

  • JACKSON KIHUHA KAGUAMBA (Viewer) 29th Jan 2015 - 7:55 PM
    Thank you for the clear clarification.
    Kindly note, I never meant to criticize the AGE of the article. I think it’s still fine to (occasionally) quote an old article if its key and information has not changed very much. I just thought it appropriate to mention whether the situation has been just the same or things had changed. Science and also societies are dynamic.
    • OLALEKAN WASIU ADEBIMPE (Author) 9th Feb 2015 - 10:01 PM
      Thank you for your comments once again. These issues are fixed as discussed

  • COMMENT - 4

  • ABDULLAHI BUKAR (Viewer) 1st Feb 2015 - 3:24 AM
    Thanks Olalekan

    This is well understood and It is important other countries learn from this and develop emergency plans to respond quickly to stop it spreading. Nigeria’s health system is fragile but the country is lucky to have a comparatively high number of specially trained health workers and a polio surveillance system, which helped prevent an exponential spread.
    • OLALEKAN WASIU ADEBIMPE (Author) 9th Feb 2015 - 10:02 PM
      Thanks for your positive comments

  • COMMENT - 5

  • REGINA EROMOMEN OWHE (Viewer) 2nd Feb 2015 - 2:47 PM
    This is a good report and it was also timely and precised
    • OLALEKAN WASIU ADEBIMPE (Author) 9th Feb 2015 - 10:03 PM
      Thanks for your positive comments

  • COMMENT - 6

  • ANNA KADAA GWANFOGBE (Viewer) 3rd Feb 2015 - 1:23 AM
    The is a great and timely study. In this era where HIV has ravaged Africa, proper surveillance and reporting of emerging diseases like Ebola will help in the prevention and spread. Not only Nigeria will benefit from this but other African countries and the world at large.
    • OLALEKAN WASIU ADEBIMPE (Author) 9th Feb 2015 - 10:07 PM
      Thanks for your positive comments

  • COMMENT - 7

  • CLEMENTINA OBBY EZENWUBA (Viewer) 4th Feb 2015 - 12:22 PM
    I think your observations are right especially in the area of challenges faced. I equally agree with you that Nigeria should step up emergency disease preparedness and also strengthen the health system because if not for God's intervention during the ebola viral disease out break, many things would happen

  • COMMENT - 8

  • OLALEKAN WASIU ADEBIMPE (Author) 9th Feb 2015 - 10:08 PM
    Thanks for your positive comments