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. 2020 Sep 18;20(1):1422.
doi: 10.1186/s12889-020-09460-4.

Assessment of electronic disease early warning system for improved disease surveillance and outbreak response in Yemen

Fekri Dureab  1   2 , Kamran Ahmed  3 , Claudia Beiersmann  4 , Claire J Standley  5 , Ali Alwaleedi  6 , Albrecht Jahn  4
Affiliations

Assessment of electronic disease early warning system for improved disease surveillance and outbreak response in Yemen

Fekri Dureab et al. BMC Public Health. .

Abstract

Background: Diseases Surveillance is a continuous process of data collection, analysis interpretation and dissemination of information for swift public health action. Recent advances in health informatics have led to the implementation of electronic tools to facilitate such critical disease surveillance processes. This study aimed to assess the performance of the national electronic Disease Early Warning System in Yemen (eDEWS) using system attributes: data quality, timeliness, stability, simplicity, predictive value positive, sensitivity, acceptability, flexibility, and representativeness, based on the Centres for Disease Control & Prevention (US CDC) standard indicators.

Methods: We performed a mixed methods study that occurred in two stages: first, the quantitative data was collected from weekly epidemiological bulletins from 2013 to 2017, all alerts of 2016, and annual eDEWS reports, and then the qualitative method using in-depth interviews was carried out in a convergent strategy. The CDC guideline used to describe the following system attributes: data quality (reporting, and completeness), timeliness, stability, simplicity, predictive value positive, sensitivity, acceptability, flexibility and representativeness.

Results: The finding of this assessment showed that eDEWS is a resilient and reliable system, and despite the conflict in Yemen, the system is still functioning and expanding. The response timeliness remains a challenge, since only 21% of all eDEWS alerts were verified within the first 24 h of detection in 2016. However, identified gaps did not affect the system's ability to identify outbreaks in the current fragile situation. Findings show that eDEWS data is representative, since it covers the entire country. Although, eDEWS covers only 37% of all health facilities, this represents 83% of all functional health facilities in all 23 governorates and all 333 districts.

Conclusion: The quality and timeliness of responses are major challenges to eDEWS' functionality, the eDEWS remains the only system that provides regular data on communicable diseases in Yemen. In particular, public health response timeliness needs improvement.

Keywords: Assessment; Disease surveillance; Early warning system; Outbreak response; Performance indicators; Public health emergencies; Yemen; eDEWS.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow of data in all levels of eDEWS
Fig. 2
Fig. 2
Flowchart of mixed method research approach
Fig. 3
Fig. 3
The total reporting rate of sentinel sites by week from 2014 to 2017
See this image and copyright information in PMC

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