Lessons learned for surveillance system strengthening through capacity building and partnership engagement in post-Ebola Guinea, 2015-2019.

The 2014-2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system, which contributed to delayed detection, underreporting of cases, widespread transmission in Guinea and cross-border transmission to neighboring Sierra Leone and Liberia, leading to the largest Ebola epidemic ever recorded. Efforts to understand the epidemic's scale and distribution were hindered by problems with data completeness, accuracy, and reliability. In 2017, recognizing the importance and usefulness of surveillance data in making evidence-based decisions for the control of epidemic-prone diseases, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in their post-Ebola transition plan and requested the support of partners to attain its objectives. The U.S. Centers for Disease Control and Prevention (US CDC) and four of its implementing partners-International Medical Corps, the International Organization for Migration, RTI International, and the World Health Organization-worked in collaboration with the Government of Guinea to strengthen the country's surveillance capacity, in alignment with the Global Health Security Agenda and International Health Regulations 2005 objectives for surveillance and reporting. This paper describes the main surveillance activities supported by US CDC and its partners between 2015 and 2019 and provides information on the strategies used and the impact of activities. It also discusses lessons learned for building sustainable capacity and infrastructure for disease surveillance and reporting in similar resource-limited settings.

Barriers to Cervical Cancer Screening in Burkina Faso: Needs for Patient and Professional Education.

Cervical cancer is among the leading causes of cancer deaths for women in low-income African countries, such as Burkina Faso. Given that cervical cancer is a preventable disease through early detection and vaccination, this study aimed at understanding the barriers to cervical cancer early detection in Ouagadougou, the capital city of Burkina Faso. Women seeking screening and treatment for cervical cancer (n = 351) during the period of May-August 2014, at the Yalgado Ouedraogo University Hospital, were interviewed about their knowledge, attitudes, and practices toward cervical cancer. Interview questions elicited information about sociodemographic of participants, history of screening, knowledge of cervical cancer, and attitudes toward cervical screening. Scores were assigned to responses of questions and knowledge, and tertitles of distributions were used for comparison. A multivariate logistic regression was performed to predict cervical screening. Study participants were relatively young (37.5 ± 10.7 years) and predominately resident of urban areas (83.8 %), and over half had no or less than high school education. Over 90 % of participants had heard about cervical cancer, and about 55 % of them had intermediate-level knowledge of the disease, its screening, and/or risk factors. Knowledge level was lower among rural than urban residents. Predictors of screening included higher level of education (odds ratio (OR) = 2.2; 95 % confidence interval (CI) 1.48-3.23), older age (OR = 1.1; 95 % CI 1.06-1.12), higher socioeconomic standard (SES) (OR = 1.5; 95 % CI 1-2.37), urban residence (OR = 2.0; 95 % CI 1.19-3.25), encouragement for screening by a health care worker (1.98; 95 % CI 1.06-3.69), and employment (OR = 1.9; 95 % CI 1.13-3.11). Low awareness and socioeconomic barriers lead to underutilization of screening services of women. Motivation and education by healthcare workers are important factors for increasing screening rates. Organized patient and professional education programs in gynecologic services are warranted for improving screening in Burkina Faso and other low-resource countries in Africa.