2014.ISDS.Abstracts.Final.pdf


ISDS Annual Conference Proceedings 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, 
and reproduction in any medium, provided the original work is properly cited.

ISDS 2014 Conference Abstracts

Evaluating Cost and Performance for Improved 
Meningitis Disease Surveillance in Chad
Ngozi Erondu* and Ulla K. Griffiths

London School of Hygiene and Tropical Medicine, London, United Kingdom

Objective
This presentation shares findings of a cost and performance 

evaluation of the meningitis surveillance system in Chad. We will 
also present methods used to design an operational standard for 
meningitis surveillance in Chad and a cost extrapolation model for 
other meningitis affected countries in sub-Saharan Africa.

Introduction
The costs of addressing specific needs to improve surveillance 

systems in sub-Saharan Africa are often unknown. For centuries 
meningococcal meningitis epidemics have occurred every few years 
in the Sahelian and sub-sahel regions of Africa also referred to as the 
“African meningitis belt”. A serogroup A meningococcal conjugate 
vaccine, MenAfriVac®, was licensed in 2009 and introduced in phases 
through mass immunization campaigns for all 1-29 year olds. The 
long term health impact of MenAfriVac® can only be determined if 
strong disease surveillance is in place. The objective was to estimate 
the costs and assess the performance of meningitis surveillance in 
Chad to determine resources needed for implementing a district case-
based surveillance strategy.

Methods
Performance and cost data were obtained through structured 

interviews with laboratory and clinical staff in seven districts and at 
the national level. In each district, three primary care facilities and one 
district laboratory was included. Surveillance officials at intermediate 
and national levels were also interviewed. Resource quantities and 
respective unit costs were collected and categorized according 
to core surveillance functions (detect, report, analysis, feedback, 
investigation, and response), and support activities (training, 
supervision, communication, and co-ordination). Unit costs were 
collected from numerous sources, including financial records of the 
Ministry of Health and international partners. Based on the data, an 
upgraded surveillance standard was developed by 1) defining the gaps 
in the meningitis surveillance system, 2) identifying the needs at each 
jurisdictional level, 3) constructing a feasible operational standard and 
4) estimating the cost of implementing the standard.

Results
Optimal surveillance was severely hampered by limited resources, 

including missing laboratory materials and inadequate staff. In 14 
of the facilities, confusion and misinterpretation of a national policy 
translated into missed opportunities for staff to perform lumbar 
punctures on patients presenting with suspected meningitis; patients 
were referred to district hospitals in the remaining seven.

Missing and unreliable data affected case detection and reporting; 
in three of the districts, no meningitis cases were reported during 
2012. In the other four districts, reported cases varied between 43 and 
232, equivalent to between 11 and 89 per 100,000 populations. 9% 
of specimens were sent to the national laboratory for confirmation 
and 4% of probable meningitis cases had a known outcome reported. 
In facilities with no detected cases, resources spent on surveillance 
were marginal. Costs per detected cases amounted to US$ 49. Costs 

of lumbar puncture comprised 43% and laboratory analysis 41% of 
total costs.

Several features were included in the upgraded surveillance model 
such as, periodic surveillance training for relevant staff, motorbikes 
for district surveillance officers, resources for patient transfer, and 
a courier system for specimen transport from district to national 
laboratories.

Conclusions
The study findings provide cost estimates that were used to 

recommend a feasible and effective meningitis surveillance strategy 
for Chad. While investments are needed across the system in many 
African meningitis belt countries, a systematic approach that assesses 
performance gaps and highlights areas of optimization can provide a 
more sustainable solution for integrated disease surveillance.

Keywords
Costing; Monitoring and Evaluation; Meningitis; MenAfriVac; Chad

Acknowledgments

The authors would like to acknowledge and thank our Chadian 
collaborator, Centre de Support en Santé Internationale. We also are 
grateful for the contributions by the World Health Organization, Agence 
de Médecine Préventive, and our funder, the Bill and Melinda Gates 
Foundation.

References

Daugla DM, Gami JP, Gamougam K, Naibei N, Mbainadji L, Narbe 
M, et al. Effect of a serogroup A meningococcal conjugate vaccine 
(PsA-TT) on serogroup A meningococcal meningitis and carriage in 
Chad: a community study [corrected]. Lancet. 2014;383(9911):40-7.

WHO. Epidemic Meningitis Surveillance in the African Meningitis Belt: 
Deciding on the most appropriate approach. Geneva: 2014.

Kasolo F, Roungou J.B., Perry, H. Technical guidelines for integrated 
disease surveillance and response in the African region. WHO and 
CDC, October 2010.

*Ngozi Erondu
E-mail: ngozierondu@gmail.com    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e72, 2015