Community-based surveillance: A pilot experiment in the Kabadougou-Bafing-Folon health region in Côte d´Ivoire

Abstract

Introduction: This paper aims to assess the contribution of community-based surveillance to traditional surveillance systems through a pilot project launched in the Kabadougou – Bafing – Folon health region in Côte d’Ivoire by the International Rescue Committee with funding from the US Government through the Centers of Disease Control and Prevention. The system was initiated following the outbreak of Ebola Virus Disease in 2014 in Guinea and Liberia, which both share borders with Côte d'Ivoire. Methods: This is a descriptive cross-sectional study, covering the period from October 1, 2017 to September 30, 2018. Data collection, conducted from November 6-11, 2018, included document review, observations and individual interviews. The quantitative data analysis was completed using an Excel spreadsheet to calculate the proportion of alert cases (signals) investigated and reported and the proportion of suspected cases reported and confirmed biologically by the Institut Pasteur of Côte d'Ivoire. A comparison was made between cases confirmed through routine surveillance and those confirmed through community-based surveillance. Qualitative data were analyzed by theme. Results: A total of 2459 cases were reported at the community level, the majority of which concern watery diarrhea (51%), fever and rash (28%) and fever and yellow eyes (15%). The remaining cases reported (6%) included other reported morbid events. In total 4265 other unusual events were reported, majority of which relate to "the number of people who had died in the community" (48%) and "the number of sick or dead animals and fish" (42%).Investigation of unusual events increased from 44% (n=601) to 76% (n=543) during the study period. Data from community-based surveillance reports accounted for 33% of cases of confirmed diseases of epidemiological significance (n=30) in the Kabadougou-Bafing-Folon health region. These cases include yellow fever, measles, and rubella. No cases of meningitis, neonatal tetanus, or Guinea worm were reported by CHWs. Conclusion: Community-based reporting complemented and strengthened the surveillance system which otherwise focused on routine data reported at health centers. however, the initiative remains contingent on external funding.