Behind the data: establishing the Network for Surveillance of Pneumococcal Disease in the East African Region

Abstract

In a region with high rates of mortality among children aged <5 years, the underfunded health care systems of sub-Saharan Africa have few resources available to perform surveillance activities that can help determine the causes of morbidity and mortality in the region. At present, there are few examples of attempts to promote public health care surveillance that might inform current debates about how to expand and improve surveillance, particularly for bacterial diseases. Driven by this gap in knowledge, we attempted to explore the successes and failures of the Network for Surveillance of Pneumococcal Disease in the East African Region and to share the experiences of what are essentially nonresearch public-sector hospitals in East Africa, with the hopes that surveillance systems for other diseases, especially those that require complex diagnostic support, may be informed by these experiences. The state of services essential for surveillance and the measures taken to overcome any shortcomings are described, as is the progress made in improving clinical diagnosis, laboratory processing, and data management. For surveillance to play a role in public health care, ministries of health and associated institutions must own and push forward the surveillance agenda, with support from global partners, and take advantage of the developments that have been achieved within the institutions.

Figure 1

Flow of specimens and data in a functioning health system

Figure 2

netSPEAR surveillance sites, map showing the location (the site in Ethiopia has not been included in the interests of clarity)

Figure 3

Vicious cycle in our health systems

Figure 3A

Summary of major problems and the status of services at sites before arrival of the Network for Surveillance of Pneumococcal Disease in the East African Region (netSPEAR). B, Achievements of netSPEAR at the surveillance sites. BC, blood culture; IT, information technology; LP, lumbar puncture; SOP, standard operating procedure

Figure 3B

Summary of major problems and the status of services at sites before arrival of the Network for Surveillance of Pneumococcal Disease in the East African Region (netSPEAR). B, Achievements of netSPEAR at the surveillance sites. BC, blood culture; IT, information technology; LP, lumbar puncture; SOP, standard operating procedure