Critical issues in the development of health information systems in supporting environmental health: a case study of ciguatera

Abstract

Background: Emerging environmental pressures resulting from climate change and globalization challenge the capacity of health information systems (HIS) in the Pacific to inform future policy and public health interventions. Ciguatera, a globally common marine food-borne illness, is used here to illustrate specific HIS challenges in the Pacific and how these might be overcome proactively to meet the changing surveillance needs resulting from environmental change.

Objectives: We review and highlight inefficiencies in the reactive nature of existing HIS in the Pacific to collect, collate, and communicate ciguatera fish poisoning data currently used to inform public health intervention. Further, we review the capacity of existing HIS to respond to new data needs associated with shifts in ciguatera disease burden likely to result from coral reef habitat disruption.

Discussion: Improved knowledge on the ecological drivers of ciguatera prevalence at local and regional levels is needed, combined with enhanced surveillance techniques and data management systems, to capture environmental drivers as well as health outcomes data.

Conclusions: The capacity of public HIS to detect and prevent future outbreaks is largely dependent on the future development of governance strategies that promote proactive surveillance and health action. Accordingly, we present an innovative framework from which to stimulate scientific debate on how this might be achieved by using existing larger scale data sets and multidisciplinary collaborations.

Figure 1

The ecology of ciguatera fish poisoning (adapted from Laurent et al. 2005). (1) Environmental factors such as cyclones, tsunamis, coral bleaching, reef blasting, and overfishing are all considered likely drivers of coral reef disruption linked to ciguatoxic microalgae Gambierdiscus spp. (2) Disruptions to the reef environment are thought to create an imbalance in the ecosystem, which increases the distribution of ciguatoxic microalgae throughout the reef and the likelihood of toxins entering the food chain. (3) Ciguatoxins enter the food chain via grazing herbivorous fish, which are in turn eaten by carnivorous fish, passing the toxin up through the food chain in a more concentrated form. (4) Eating toxic fish from any part of the food chain can poison humans, with more severe cases generally caused by consuming larger predatory fish, although this is not universally the case. (5) Signs occur between 2 and 12 hr after consuming toxic fish and include nausea, vomiting, diarrhea, slow pulse with normal temperature, and sweating. Other symptoms include numb or prickly sensations around lips, nose, hands, feet, and skin; temperature sensation reversal; muscle and joint aches; headaches; tiredness; shivering; and itchiness. (6) No treatment is available for ciguatera, only remedies to relieve discomfort or pain, comprising prescriptions and traditional practices.

Figure 2

Linking environmental and human health outcome data to close the HIS loop. SST, sea surface temperature. The equal sign (=) indicates that increased distribution leads to increased probability.

Figure 3

Three-phase approach to improving HIS for ciguatera in the Pacific. As presented, the health system loop (adapted from Health Metrics Network Framework; WHO 2009) depicts the dependence of government and donor research on reliable surveillance data to enable timely interpretation and dissemination of information products to trigger public health action (see “Strategies toward Developing Ciguatera Interventions: Linking Human and Environmental Information Systems”). In Phase 3, the drawing represents the use and integration of different technologies and methods of communication to best inform community-scale risk assessment. The plus signs (+) refer to the integration of these resources.