Community-Based Surveillance to Monitor Mortality in a Malaria-Endemic and Ebola-Epidemic Setting in Rural Guinea

Amanda Tiffany Epicentre, Geneva, Switzerland.

Search for other papers by Amanda Tiffany in
Current site
Google Scholar
PubMed
Close
,
Faya Pascal Moundekeno Médecins sans Frontières, Guéckédou, Guinea.

Search for other papers by Faya Pascal Moundekeno in
Current site
Google Scholar
PubMed
Close
,
Alexis Traoré Direction Préfectorale de la Santé, Guéckédou, Guinea.

Search for other papers by Alexis Traoré in
Current site
Google Scholar
PubMed
Close
,
Melat Haile Médecins sans Frontières, Conakry, Guinea.

Search for other papers by Melat Haile in
Current site
Google Scholar
PubMed
Close
,
Esther Sterk Médecins sans Frontières, Geneva, Switzerland.

Search for other papers by Esther Sterk in
Current site
Google Scholar
PubMed
Close
,
Timothé Guilavogui National Malaria Control Program, Conakry, Guinea.

Search for other papers by Timothé Guilavogui in
Current site
Google Scholar
PubMed
Close
,
Micaela Serafini Médecins sans Frontières, Geneva, Switzerland.

Search for other papers by Micaela Serafini in
Current site
Google Scholar
PubMed
Close
,
Blaise Genton Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
Infectious Disease Service, University Hospital, Lausanne, Switzerland.
Department of Ambulatory Care, University Hospital, Lausanne, Switzerland.

Search for other papers by Blaise Genton in
Current site
Google Scholar
PubMed
Close
, and
Rebecca F. Grais Epicentre, Paris, France.

Search for other papers by Rebecca F. Grais in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

Multiple community-based approaches can aid in quantifying mortality in the absence of reliable health facility data. Community-based sentinel site surveillance that was used to document mortality and the systems utility for outbreak detection was evaluated. We retrospectively analyzed data from 46 sentinel sites in three sous-préfectures with a reinforced malaria control program and one sous-préfecture without (Koundou) in Guinea. Deaths were recorded by key informants and classified as due to malaria or another cause. Malaria deaths were those reported as due to malaria or fever in the 3 days before death with no other known cause. Suspect Ebola virus disease (sEVD) deaths were those due to select symptoms in the EVD case definition. Deaths were aggregated by sous-préfecture and analyzed by a 6-month period. A total of 43,000 individuals were monitored by the surveillance system; 1,242 deaths were reported from July 2011–June 2014, of which 55.2% (N = 686) were reported as due to malaria. Malaria-attributable proportional mortality decreased by 26.5% (95% confidence interval [CI] = 13.9–33.1, P < 0.001) in the program area and by 6.6% (95% CI = −17.3–30.5, P = 0.589) in Koundou. Sixty-eight deaths were classified as sEVD and increased by 6.1% (95% CI = 1.3–10.8, P = 0.021). Seventeen sEVD deaths were reported from November 2013 to March 2014 including the first two laboratory-confirmed EVD deaths. Community surveillance can capture information on mortality in areas where data collection is weak, but determining causes of death remains challenging. It can also be useful for outbreak detection if timeliness of data collection and reporting facilitate real-time data analysis.

Author Notes

* Address correspondence to Amanda Tiffany, Epicentre, 78 Rue de Lausanne, Geneva 1211, Switzerland. E-mail: amanda.tiffany@geneva.msf.org

Financial support: Médecins Sans Frontières Operational Center, Geneva, financed this work. Epicentre (Amanda Tiffany and Rebecca F. Grais) received core funding from Médecins Sans Frontières.

Authors' addresses: Amanda Tiffany, Epicentre, Geneva, Switzerland, E-mail: amanda.tiffany@geneva.msf.org. Faya Pascal Moundekeno, World Health Organization, Fria, Guinea, E-mail: moundekenofp84@yahoo.fr. Alexis Traoré, Direction Préfectorale de la Santé, Guéckédou, Guinea, E-mail: alexistraore60@gmail.com. Melat Haile, Médecins sans Frontières, Nairobi, Kenya, E-mail: melatreta5u@yahoo.com. Esther Sterk and Micaela Serafini, Médecins sans Frontières, Geneva, Switzerland, E-mails: esther.sterk@geneva.msf.org and micaela.serafini@geneva.msf.org. Timothé Guilavogui, National Malaria Control Program, Conakry, Guinea, E-mail: gui_timothee@yahoo.fr. Blaise Genton, University Hospital, Lausanne, Switzerland, E-mail: blaise.genton@unibas.ch. Rebecca F. Grais, Epicentre, Paris, France, E-mail: rebecca.grais@epicentre.msf.org.

  • 1.

    Measure DHS, 2012. Guinée Enquête Démographique de la Santé. Available at: http://dhsprogram.com/pubs/pdf/FR280/FR280.pdf. Accessed January 12, 2016.

  • 2.

    Ministere de la Santé et de l'Hygiene Publique–Republique de la Guinée, 2014. Politique Nationale de Lutte Contre Le Paludisme. Conakry, Guinea: National Malaria Control Program.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Streatfield PK, Khan WA, Bhuiya A, Alam N, Diboulo E, Sié A, M, Compaoré Y, Soura AB, Bonfoh B, Jaeger F, Ngoran EK, Utzinger J, Melaku YA, Mulugeta A, Weldearegawi B, Gomez P, Jasseh M, Hodgson A, Oduro A, Welaga P, Williams J, Awini E, Binka FN, Gyapong M, Kant S, Misra P, Srivastava R, Chaudhary B, Juvekar S, Wahab A, Wilopo S, Bauni E, Mochamah G, Ndila C, Williams TN, Desai M, Hamel MJ, Lindblade KA, Odhiambo FO, Slutsker L, Ezeh A, Kyobutungi C, Wamukoya M, Delaunay V, Diallo A, Douillot L, Sokhna C, Gómez-Olivé FX, Kabudula WC, Mee P, Herbst K, Mossong J, Chuc NTK, Arthur SS, Sankoh OA, Tanner M, Byass P, 2014. Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action 7: 25369. Available at: http://www.documentation.ird.fr/hor/fdi:010063236. Accessed March 22, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    World Health Organization (WHO), 2015. Verbal Autopsy Standards: The 2014 WHO Verbal Autopsy Instrument. Geneva, Switzerland: WHO.

  • 5.

    Garenne M, Fauveau V, 2006. Potential and limits of verbal autopsies. Bull World Health Organ 84: 34.

  • 6.

    Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, Soropogui B, Sow MS, Keïta S, De Clerck H, Tiffany A, Dominguez G, Loua M, Traoré A, Kolié M, Malano ER, Heleze E, Bocquin A, Mély S, Raoul H, Caro V, Cadar D, Gabriel M, Pahlmann M, Tappe D, Schmidt-Chanasit J, Impouma B, Diallo AK, Formenty P, Van Herp M, Günther S, 2014. Emergence of Zaire Ebola virus disease in Guinea: preliminary report. N Engl J Med 371: 14181425.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    World Health Organization, 2015. Ebola Situation Report: 25 November 2015. Available at: http://apps.who.int/ebola/current-situation/ebola-situation-report-25-november-2015. Accessed November 28, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Bogus J, Gankpala L, Fischer K, Krentel A, Weil GJ, Fischer PU, Kollie K, Bolay FK, 2015. Community attitudes toward mass drug administration for control and elimination of neglected tropical diseases after the 2014 outbreak of Ebola virus disease in Lofa County, Liberia. Am J Trop Med Hyg 94: 497503.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Plucinski MM, Guilavogui T, Sidikiba S, Diakité N, Diakité S, Dioubaté M, Bah I, Hennessee I, Butts JK, Halsey ES, McElroy PD, Kachur SP, Aboulhab J, James R, Keita M, 2015. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities. Lancet Infect Dis 15: 10171023.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    World Health Organization, 2014. Case Definition Recommendations for Ebola or Marburg Virus Diseases. Interim Guideline. Available at: http://apps.who.int/iris/bitstream/10665/146397/1/WHO_EVD_CaseDef_14.1_eng.pdf?ua=1. Accessed January 12, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    World Health Organization Global Malaria Programme, 2014. Guidance on Temporary Malaria Control Measures in Ebola-Affected Countries.

  • 12.

    Valenciano M, Gergonne B, Morgan O, Aramburu C, Cawthorne A, D'Ancona FP, Doyle A, Fotiadis M, Payne L, 2004. WHO Report: Retrospective Mortality Survey among the Internally Displaced Population, Greater Darfur, Sudan, August 2004. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2548. Accessed March 22, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Carrión Martín AI, Bil K, Salumu P, Baabo D, Singh J, Kik C, Lenglet A, 2014. Mortality rates above emergency threshold in population affected by conflict in North Kivu, Democratic Republic of Congo, July 2012–April 2013. PLoS Negl Trop Dis 8: e3181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Checchi F, Roberts L, 2008. Documenting mortality in crises: what keeps us from doing better? PLoS Med 5: e146.

  • 15.

    Checchi F, Roberts L, 2005. Interpreting and Using Mortality Data in Humanitarian Emergencies. A Primer for Non-Epidemiologists. London: Humanitarian Practice Network.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Tiffany A, Moundekeno FP, Traoré A, Haile M, Sterk E, Guilavogui T, Genton B, Serafini M, Grais RF, 2016. Encouraging impact following 2.5 years of reinforced malaria control interventions in a hyperendemic region of the Republic of Guinea. Malar J 15: 298.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Central Intelligence Agency, 2015. The World Factbook, Guinea. Available at: https://www.cia.gov/library/publications/the-world-factbook/geos/gv.html. Accessed November 30, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Levy PS, Lemeshow S, 2008. Sampling of Populations: Methods and Applications, 4th edition. New York, NY: Wiley.

  • 19.

    WHO Ebola Response Team, 2014. Ebola virus disease in west Africa: the first 9 months of the epidemic and forward projections. N Engl J Med 371: 14811495.

  • 20.

    Rowe AK, Steketee RW, Arnold F, Wardlaw T, Basu S, Bakyaita N, Lama M, Winston CA, Lynch M, Cibulskis RE, Shibuya K, Ratcliffe AA, Nahlen BL; Roll Back Malaria Monitoring and Evaluation Reference Group, 2007. Viewpoint: evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa. Trop Med Int Health 12: 15241539.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    World Health Organization, 2014. WHO Global Health Workforce Statistics, 2014 Update. Available at: http://www.who.int/hrh/statistics/hwfstats/en/. Accessed March 15, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Anker M, Black RE, Coldham C, Kalter HD, Quigley MA, Ross D, Snow RW, 1999. A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and Children. Geneva, Switzerland.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, Marsh K, Snow RW, 2007. The decline in paediatric malaria admissions on the coast of Kenya. Malar J 6: 151.

  • 24.

    Rooth I, Bjorkman A, 1992. Fever episodes in a holoendemic malaria area of Tanzania: parasitological and clinical findings and diagnostic aspects related to malaria. Trans R Soc Trop Med Hyg 86: 479482.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Olaleye BO, Williams LA, D'Alessandro U, Weber MM, Mulholland K, Okorie C, Langerock P, Bennett S, Greenwood BM, 1998. Clinical predictors of malaria in Gambian children with fever or a history of fever. Trans R Soc Trop Med Hyg 92: 300304.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    World Health Organization Regional Office for Africa, 2014. Integrated Disease Surveillance and Response in the African Region: A Guide for Establishing Community Based Surveillance. Brazzaville, Republic of the Congo.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J, 2014. Ebola and indirect effects on health service function in Sierra Leone. PLoS Curr Outbreaks 12: 49.

  • 28.

    Ly J, Sathananthan V, Griffiths T, Kanjee Z, Kenny A, Gordon N, Basu G, Battistoli D, Dorr L, Lorenzen B, Thomson DR, Waters A, Moore UG, Roberts R, Smith WL, Siedner MJ, Kraemer JD, 2016. Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: analysis from a cross-sectional, population-based household survey. PLoS Med 13: 117.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Henning KJ, 2004. Overview of syndromic surveillance. What is syndromic surveillance? Morbidity and Mortality Weekly. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/su5301a3.htm. Accessed March 22, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Crowe S, Hertz D, Maenner M, Ratnayake R, Baker P, Lash RR, Lee-Kwan SH, Williams C, Jonnie GT, Gorina Y, Anderson A, 2015. A plan for community event-based surveillance to reduce Ebola transmission: Sierra Leone, 2014–2015. Morbidity and Mortality Weekly. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6403a7.htm. Accessed March 22, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Roberts B, Morgan OW, Sultani MG, Nyasulu P, Rwebangila S, Myatt M, Sondorp E, Chandramohan D, Checchi F, 2010. A new method to estimate mortality in crisis-affected and resource-poor settings: validation study. Int J Epidemiol 39: 15841596.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 392 288 10
Full Text Views 378 7 1
PDF Downloads 168 9 1
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save