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. 2016 Jun 21;6(2):54-9.
doi: 10.5588/pha.15.0080.

Sparks creating light? Strengthening peripheral disease surveillance in the Democratic Republic of Congo

G Benedetti  1 , M Mossoko  2 , J P Nyakio Kakusu  1 , J Nyembo  1 , J P Mangion  1 , D Van Laeken  1 , R Van den Bergh  3 , W Van den Boogaard  3 , M Manzi  3 , W K Kibango  4 , V Hermans  1 , J Beijnsberger  1 , V Lambert  5 , E Kitenge  2
Affiliations

Sparks creating light? Strengthening peripheral disease surveillance in the Democratic Republic of Congo

G Benedetti et al. Public Health Action. .

Abstract
in English, French, Spanish

Setting: The Democratic Republic of Congo suffers from an amalgam of disease outbreaks and other medical emergencies. An efficient response to these relies strongly on the national surveillance system. The Pool d'Urgence Congo (PUC, Congo Emergency Team) of Médecins Sans Frontières is a project that responds to emergencies in highly remote areas through short-term vertical interventions, during which it uses the opportunity of its presence to reinforce the local surveillance system.

Objective: To investigate whether the ancillary strengthening of the peripheral surveillance system during short-term interventions leads to improved disease notification.

Design: A descriptive paired study measuring disease notification before and after 12 PUC interventions in 2013-2014.

Results: A significant increase in disease notification was observed after seven mass-vaccination campaigns and was sustained over 6 months. For the remaining five smaller-scaled interventions, no significant effects were observed.

Conclusion: The observed improvements after even short-term interventions underline, on the one hand, how external emergency actors can positively affect the system through their punctuated actions, and, on the other hand, the dire need for investment in surveillance at peripheral level.

Contexte : La République Démocratique du Congo souffre d'un amalgame de flambées épidémiques et d'autres urgences médicales. Une réponse efficace à ces problèmes est basée sur le système national de surveillance. Le Pool d'Urgence Congo (PUC) de Médecins Sans Frontières est un projet répondant aux urgences dans les zones très reculées grâce à des interventions verticales à court terme, pendant lesquelles le projet met à profit l'opportunité de sa présence pour renforcer le système de surveillance local.Objectif : Vérifier si le renforcement complémentaire du système de surveillance périphérique pendant des interventions à court terme amène une amélioration de la notification des maladies.Schéma : Une étude descriptive par paires mesurant la notification des maladies avant et après 12 interventions PUC en 2013–2014.Résultats : Une augmentation significative de la notification des maladies a été observée après sept campagnes de vaccination de masse et elle s'est maintenue pendant 6 mois. En ce qui concerne les cinq interventions restantes à plus petite échelle, aucun effet significatif n'a été observé.Conclusion : Les améliorations observées, même après des interventions à court terme, soulignent d'un côté comment des acteurs externes de l'urgence peuvent affecter positivement le système à travers leurs actions ponctuelles et, d'un autre côté, le besoin pressant d'investir dans la surveillance au niveau périphérique.

Marco de referencia: La República Democrática del Congo adolece de una amalgama de brotes epidémicos y otras urgencias médicas y la eficiencia de la respuesta a esta situación depende en gran medida del sistema nacional de vigilancia. El proyecto ‘Pool d'Urgence Congo’ (PUC, en francés) de Médecins Sans Frontières responde a las situaciones de urgencia en zonas muy remotas, mediante intervenciones verticales a corto plazo, durante las cuales se aprovecha la presencia en el terreno con el fin de reforzar el sistema local de vigilancia sanitaria.Objetivo: Investigar si el fortalecimiento complementario del sistema periférico de vigilancia sanitaria durante las intervenciones de corta duración contribuye a mejorar la notificación de las enfermedades.Método: Un estudio descriptivo emparejado, en el cual se midió la notificación de las enfermedades antes y después de 12 intervenciones del PUC del 2013 al 2014.Resultados: Se observó un aumento estadísticamente significativo de la notificación de las enfermedades después de siete campañas de vacunación colectiva, el cual se mantuvo durante 6 meses. En las cinco intervenciones restantes de menor escala no se observaron efectos considerables.Conclusión: El progreso observado incluso después de intervenciones a corto plazo, por una parte, pone de manifiesto que los actores externos en situaciones de emergencia pueden inducir modificaciones positivas del sistema mediante sus actividades puntuales y, en segundo lugar, destaca la necesidad urgente de invertir en el sistema de vigilancia sanitaria a nivel periférico.

Keywords: Integrated Disease Surveillance and Response; Médecins Sans Frontières; Pool d'Urgence Congo; disease notification; emergency response.

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Figures

FIGURE 1
FIGURE 1
Components and functioning of the PUC. PUC = Pool d'Urgence Congo (Congo Emergency Team).
FIGURE 2
FIGURE 2
A) Case notification per disease before and after one intervention of the PUC. B) Unique normalised notification and modelled notification values over the periods of observation before and after one intervention of the PUC; modelled notification observed at 1, 5, 13 and 26 weeks per period of observation. Demonstration for the response in the health zone of Idiofa, 2013–2014. Similar analyses were performed for each intervention (not shown). PUC = Pool d'Urgence Congo (Congo Emergency Team).
FIGURE 3
FIGURE 3
Modelled notification values at 1, 5, 13 and 26 weeks per observation period, before and after intervention by the PUC, 2013–2014; Tukey boxplots for different interventions according to the proportion of population reached in the health zone; median values at different time points compared using the Wilcoxon matched-pairs signed-rank test. PUC = Pool d'Urgence Congo (Congo Emergency Team).
See this image and copyright information in PMC

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