Event-Based Surveillance at Community and Healthcare Facilities, Vietnam, 2016-2017.

Surveillance and outbreak reporting systems in Vietnam required improvements to function effectively as early warning and response systems. Accordingly, the Ministry of Health of Vietnam, in collaboration with the US Centers for Disease Control and Prevention, launched a pilot project in 2016 focusing on community and hospital event-based surveillance. The pilot was implemented in 4 of Vietnam's 63 provinces. The pilot demonstrated that event-based surveillance resulted in early detection and reporting of outbreaks, improved collaboration between the healthcare facilities and preventive sectors of the ministry, and increased community participation in surveillance and reporting.

Establishing a field epidemiology elective for medical students in Kenya: a strategy for increasing public health awareness and workforce capacity.

Medical students have limited exposure to field epidemiology, even though will assume public health roles after graduation. We established a 10-week elective in field epidemiology during medical school. Students attended one-week didactic sessions on epidemiology, and nine weeks in field placement sites. We administered pre- and post-tests to evaluate the training. We enrolled 34 students in 2011 and 2012. In 2011, we enrolled five of 24 applicants from a class of 280 medical students. In 2012, we enrolled 18 of 81 applicants from a class of 360 students; plus 11 who participated in the didactic sessions only. Among the 34 students who completed the didactic sessions, 74% were male, and their median age was 24 years (range: 22-26). The median pre-test score was 64% (range: 47-88%) and the median post-test score was 82% (range: 72-100%). Successful completion of the field projects was 100%. Six (30%) students were not aware of public health as a career option before this elective, 56% rated the field experience as outstanding, and 100% reported it increased their understanding of epidemiology. Implementing an elective in field epidemiology within the medical training is a highly acceptable strategy to increase awareness for public health among medical students.

Prevalence of nodding syndrome--Uganda, 2012-2013.

Nodding syndrome (NS) is a seizure disorder of unknown etiology, predominately affecting children aged 3-18 years in three sub-Saharan countries (Uganda, South Sudan, and Tanzania), with the primary feature of episodic head nodding. These episodes are thought to be one manifestation of a syndrome that includes neurologic deterioration, cognitive impairment, and additional seizure types. NS investigations have focused on clinical features, progression, and etiology; however, none have provided a population-based prevalence assessment using a standardized case definition. In March 2013, CDC and the Ugandan Ministry of Health (MOH) conducted a single-stage cluster survey to perform the first systematic assessment of prevalence of NS in Uganda using a new consensus case definition, which was modified during the course of the investigation. Based on the modified definition, the estimated number of probable NS cases in children aged 5-18 years in three northern Uganda districts was 1,687 (95% confidence interval [CI] = 1,463-1,912), for a prevalence of 6.8 (CI = 5.9-7.7) probable NS cases per 1,000 children aged 5-18 years in the three districts. These findings can guide the MOH to understand and provide the health-care resources necessary to address NS in northern Uganda, and provide a basis for future studies of NS in Uganda and in other areas affected by NS.

Logistics of Guinea worm disease eradication in South Sudan.

From 2006 to 2012, the South Sudan Guinea Worm Eradication Program reduced new Guinea worm disease (dracunculiasis) cases by over 90%, despite substantial programmatic challenges. Program logistics have played a key role in program achievements to date. The program uses disease surveillance and program performance data and integrated technical-logistical staffing to maintain flexible and effective logistical support for active community-based surveillance and intervention delivery in thousands of remote communities. Lessons learned from logistical design and management can resonate across similar complex surveillance and public health intervention delivery programs, such as mass drug administration for the control of neglected tropical diseases and other disease eradication programs. Logistical challenges in various public health scenarios and the pivotal contribution of logistics to Guinea worm case reductions in South Sudan underscore the need for additional inquiry into the role of logistics in public health programming in low-income countries.

Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan.

We have previously documented blinding trachoma to be a serious public health problem in Southern Sudan, with an unusually high prevalence of trachomatous trichiasis (TT) among children. We aimed to investigate risk factors for TT in children in Southern Sudan. Cross-sectional surveys were undertaken in 11 districts between 2001 and 2006, and eligible participants were examined for trachoma signs. Risk factors were assessed through interviews and observations. Using logistic regression, associations between TT in children and potential risk factors were investigated. In total, 11155 children aged 1-14 years from 3950 households were included in the analysis. Overall prevalence of TT was 1.5% (95% CI 1.1-2.1). Factors independently associated with increased odds of TT in children aged 1-14 years were: increasing age (P(trend)<0.001); female gender (odds ratio=1.5; 95% CI 1.1-2.1); increasing proportion of children in the household with trachomatous inflammation-intense (TI) (P(trend)=0.002); and increasing number of adults in the household with TT (P(trend)<0.001). Our study revealed risk factors for TT in children consistent with those previously reported for TT in adults. While the associations of TT in children with TI in siblings and TT in adult relatives merit further investigation, there is an urgent need for trachoma prevention interventions and trichiasis surgery services that are tailored to cater for young children in Southern Sudan.

Examining Media Habits: implications for health promotion programs among the Toposa in Southern Sudan.

Dissemination of appropriate health education messages is essential to any health promotion campaign. This cross-sectional study examined media ownership, access and media preferences by target groups in Kapoeta South County, Southern Sudan. The target groups were segmented into household heads (n = 368); women with children under five years (n = 580); and youth 11-16 years old (n = 349). Interviewees were selected at random from 49 villages. Overall, a small portion owned radios (6.8%) and television sets (0.2%); more had access to radio (27.1%), listened to cassettes (50.8%), and had access to television and movies (21.4%). The majority were interested in programs developed in the vernacular (89.0%). A very low literacy rate (1.3%) and difficulty in understanding signage (29.7%) posed potential obstacles for use of print media as a primary source of health communication. Heads of household were more likely to own radios (P < 0.001), watch TV outside of the home (P = 0.034), and see posters (P = 0.038) than other groups. Traditional entertainment was attended by 94.4% of respondents. Information from chiefs (61.5%) and elders (51.5%) was considered trustworthy by the majority of respondents. This research highlights the utility in understanding media access, habits and preferences of community members when designing a health promotion campaign.

Estimation of population coverage for antibiotic distribution for trachoma control: a comparison of methods.

Trachoma control includes mass drug administration (MDA) with antibiotics targeting coverage of at least 80%. Coverage is traditionally calculated by dividing doses distributed by population estimate, which is unreliable. We compared a verifiable coverage assessment method against self-reported participation and the traditional calculation, and examined factors associated with MDA participation in Akobo County, Southern Sudan. During MDA, recipients were marked with indelible ink and followed-up using a two-stage household survey: 25 clusters from three districts, and 10 households per cluster. All household members were enumerated; asked about self-reported participation and observed for indelible marks. Household heads were interviewed to assess factors associated with MDA. Overall 11 419 treatments were given and 1358 residents from 247 households surveyed. By traditional methods MDA coverage was 20.9% (95% CI: 20.6-21.3); 61.5% (95 % CI: 49.4-73.6) by self-reporting; and 37.5% (95% CI: 25.1%-49.9%) from observed ink marks. Controlling for other factors, presence of a health worker (OR 2.3, 95% CI: 1.5-3.6); head of household knowledge of azithromycin (OR 1.6, 95% CI: 1.5-3.1); and head of household advance notice of MDA (OR 34.9, 18.1-66.3) were independent predictors of participation. Cluster randomised surveys can estimate MDA coverage better than the traditional method and implementation of indelible marking merits investigation.