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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2015 | Research article

The usefulness of school-based syndromic surveillance for detecting malaria epidemics: experiences from a pilot project in Ethiopia

Authors: Ruth A. Ashton, Takele Kefyalew, Esey Batisso, Tessema Awano, Zelalem Kebede, Gezahegn Tesfaye, Tamiru Mesele, Sheleme Chibsa, Richard Reithinger, Simon J. Brooker

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Syndromic surveillance is a supplementary approach to routine surveillance, using pre-diagnostic and non-clinical surrogate data to identify possible infectious disease outbreaks. To date, syndromic surveillance has primarily been used in high-income countries for diseases such as influenza -- however, the approach may also be relevant to resource-poor settings. This study investigated the potential for monitoring school absenteeism and febrile illness, as part of a school-based surveillance system to identify localised malaria epidemics in Ethiopia.

Methods

Repeated cross-sectional school- and community-based surveys were conducted in six epidemic-prone districts in southern Ethiopia during the 2012 minor malaria transmission season to characterise prospective surrogate and syndromic indicators of malaria burden. Changes in these indicators over the transmission season were compared to standard indicators of malaria (clinical and confirmed cases) at proximal health facilities. Subsequently, two pilot surveillance systems were implemented, each at ten sites throughout the peak transmission season. Indicators piloted were school attendance recorded by teachers, or child-reported recent absenteeism from school and reported febrile illness.

Results

Lack of seasonal increase in malaria burden limited the ability to evaluate sensitivity of the piloted syndromic surveillance systems compared to existing surveillance at health facilities. Weekly absenteeism was easily calculated by school staff using existing attendance registers, while syndromic indicators were more challenging to collect weekly from schoolchildren. In this setting, enrolment of school-aged children was found to be low, at 54 %. Non-enrolment was associated with low household wealth, lack of parental education, household size, and distance from school.

Conclusions

School absenteeism is a plausible simple indicator of unusual health events within a community, such as malaria epidemics, but the sensitivity of an absenteeism-based surveillance system to detect epidemics could not be rigorously evaluated in this study. Further piloting during a demonstrated increase in malaria transmission within a community is recommended.
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Metadata
Title
The usefulness of school-based syndromic surveillance for detecting malaria epidemics: experiences from a pilot project in Ethiopia
Authors
Ruth A. Ashton
Takele Kefyalew
Esey Batisso
Tessema Awano
Zelalem Kebede
Gezahegn Tesfaye
Tamiru Mesele
Sheleme Chibsa
Richard Reithinger
Simon J. Brooker
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2680-7

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