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      Evaluation of community based surveillance in the Rohingya refugee camps in Cox’s Bazar, Bangladesh, 2019

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          Abstract

          Background

          Following an influx of an estimated 742,000 Rohingya refugees in Bangladesh, Médecins sans Frontières (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox’s Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019).

          Methods

          Suspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability.

          Results

          Between epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability.

          Discussion

          The CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox’s Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.

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          Most cited references14

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          Ethical issues in epidemiologic research and public health practice

          A rich and growing body of literature has emerged on ethics in epidemiologic research and public health practice. Recent articles have included conceptual frameworks of public health ethics and overviews of historical developments in the field. Several important topics in public health ethics have also been highlighted. Attention to ethical issues can facilitate the effective planning, implementation, and growth of a variety of public health programs and research activities. Public health ethics is consistent with the prevention orientation of public health. Ethical concerns can be anticipated or identified early and effectively addressed through careful analysis and consultation.
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            World Health Organization Early Warning, Alert and Response System in the Rohingya Crisis, Bangladesh, 2017–2018

            The Early Warning, Alert and Response System (EWARS) is a web-based system and mobile application for outbreak detection and response in emergency settings. EWARS provided timely information on epidemic-potential diseases among >700,000 Rohingya refugees across settlements. EWARS helped in targeting new measles vaccination campaigns and investigating suspected outbreaks of acute jaundice syndrome.
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              Assessment of Community Event–Based Surveillance for Ebola Virus Disease, Sierra Leone, 2015

              Case detection improved, but many false alerts were generated, suggesting a need for additional staff training.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Visualization
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draft
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                23 December 2020
                2020
                : 15
                : 12
                : e0244214
                Affiliations
                [1 ] Médecins Sans Frontières, Cox’s Bazar, Dhaka, Bangladesh
                [2 ] International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
                [3 ] Médecins Sans Frontières, Amsterdam, The Netherlands
                [4 ] Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
                [5 ] Médecins Sans Frontières, London, United Kingdom
                [6 ] Médecins Sans Frontières, Berlin, Germany
                University of North Carolina at Greensboro, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-1168-8491
                https://orcid.org/0000-0003-2013-8405
                https://orcid.org/0000-0002-8845-3447
                https://orcid.org/0000-0002-0047-149X
                Article
                PONE-D-20-14072
                10.1371/journal.pone.0244214
                7757896
                33362236
                86b48e6a-22f5-44bf-b692-d529f38a6b7d
                © 2020 Van Boetzelaer et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 May 2020
                : 6 December 2020
                Page count
                Figures: 7, Tables: 6, Pages: 17
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Epidemiology
                Disease Surveillance
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Computer and Information Sciences
                Data Management
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Neglected Tropical Diseases
                Dengue Fever
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Dengue Fever
                Medicine and Health Sciences
                Epidemiology
                Medicine and Health Sciences
                Public and Occupational Health
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Bacterial Diseases
                Cholera
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Neglected Tropical Diseases
                Cholera
                Medicine and Health Sciences
                Health Care
                Environmental Health
                Sanitation
                Medicine and Health Sciences
                Public and Occupational Health
                Environmental Health
                Sanitation
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized
                Uncategorized

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