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ISDS 2014 Conference Abstracts

Cholera Public Health Surveillance System in Cameroon

Moise C. Ngwa*1, Song Liang1, Leonard Mbam2, Mouhaman Arabi3, Andrew Teboh4, 
Kaousseri Brekmo5, Onana Mevoula6 and John Glenn Morris1

1Emerging Pathogens Institute, Gainesville, FL, USA; 2WHO Country Office, Yaoundé, Cameroon; 3HIS, University of Maroua, 
Maroua, Cameroon; 4FMBS, U of Yaoundé I, Yaoundé, Cameroon; 5RDPH, Far North, Maroua, Cameroon; 6WHO Country Office, Far 
North, Maroua, Cameroon

Objective
To describe cholera public health surveillance systems in Cameroon 

within its hierarchical health system

Introduction
Effective infectious disease public health surveillance systems are 

often lacking in resource poor settings. In response, the World Health 
Organization (WHO) put forword recommnded standards for public 
health surveillence.[1] Following the recommendations, the WHO 
Regional Office for Africa (AFRO) in 1998 proposed the Integrated 
Dieases Surveillance and Response (IDSR) strategy for the prompt 
detection and response to key communicable diseases in the African 
region.[2,3] In 2003, Cameroon adopted the IDSR-strategy to fortify 
surveillance in the country. We describe cholera surveillance within 
IDSR-strategy, and assess whether its goal of data analysis and rapid 
response at the district level have been met.

Methods
Semi-structured key informant interviews besides record reviews 

were conducted in the Far North and Centre regions of Cameroon in 
2013. In the Far North, we interviewed cholera surveillance officials 
at the Regional Delegation of Public Health (RDPH), and the cholera 
command and control center (C4). In the Centre region, we met 
surveillance officials at the Ministry of Health (MoH), C4 for the 
Centre, and WHO-Cameroon office. Interviews lasted about an hour-
and-a-half. About 20 officials in both regions commented on activities 
at all levels.

Results
The health system hierarchy inlcudes the peripheral (community, 

health facility, and health district), intermediate (RDPH), central 
(MoH), and WHO levels (Fig.1). The surveillance system is passive 
and surveillance core activities, response core activities, and support 
functions have been integrated at all hierarchical levels.

Surveillance core activities case definition: Suspected case is 
any patient 5-y or older with severe dehydration or diarrhea with or 
without vomiting or death from acute watery diarrhea. Confirmed 
case is suspected case plus isolation of V. cholerae O1 or O139 in 
stool.  The epidemic threshold is one lab confirmed case. Data 
flow: Cholera data is captured at health facility, forwarded to the 
district that compiles and directs them to the RDPH in paper format 
(Fig.1). RDPH de-identifies the data and sends them to the central 
level via internet and from there to the WHO (Fig.1). There is no 
data analysis and rapid response at the district level. Reponses core 
activities vary across levels. Support functions: Training in public 
health surveillance is weak at the community, health facility, district, 
and regional levels. General administrators and nurses perform 
surveillance activites at district and health facility levels, respectively. 
Central level performs supervisory visits while it is only partially 
executed at both the regional and district levels. Health facility labs 
are ill equipped to confirm V. cholerae. Mobile phone fleet at districts, 
laptops at the RDPHs, and C4 in all ten regions of Cameroon are 
major milestones in the surveillance system.

Conclusions
The surveillance system is passive with neither data analysis nor 

rapid response at health district level. Thus the goal of IDSR strategy 
has not been met yet. Both human (trained surveillance officers) 
and material (computers) resources are needed at the district level to 
achieve this goal.

Keywords
Cholera; Surveillance; Cameroon; Outbreak

Acknowledgments

We are thankful to the cholera command and control centre staff, Joseph 
Koona and Hans M. Cacharel, for their valuable insights during interviews. 
We appreciate funding by supplement to NIH grant #RO1AI097405 
without which this project would not have been realized.

References

1. World Health Organization: WHO Strategic Action Plan for
PandemicInfluenza 2006–2007 (WHO/CDS/EPR/GIP/2006.2). 2006.

2. World Health Organization, Regional Office for Africa: Integrated
Disease Surveillance and Response: A Regional Strategy for
Communicable Diseases 1999–2003 (AFR/RC/48.8). Harare: WHO. 
1999.

3. Kaboré, A., McDonnell, B., Perkins. Technical guidelines for
integrated disease surveillance and response in the African region.  
WHO, Regional Office for Africa, Division of Communicable Disease 
Prevention and Control. 2001

*Moise C. Ngwa

E-mail: ngwam@epi.ufl.edu    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e150, 2015