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Selected Category: health systems strengthening

World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease

 

World Cup soccer ball

 

With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

The tablet-based system and the Epi Info software driving it are seen as an important advance in disease surveillance that gives users the ability to identify outbreaks earlier and with more precision. That ability is especially important in “mass gatherings” such as the World Cup and other major events which is why this disease detection system is being tested this month.

The tablet-based system and the Epi Info software driving it are seen as an important advance in disease surveillance that gives users the ability to identify outbreaks earlier and with more precision.

The tablet-based system and the Epi Info software driving it are seen as an important advance in disease surveillance that gives users the ability to identify outbreaks earlier and with more precision.

The effort also highlights something else – the long and deep relationship between CDC and Brazilian health authorities.

In this case, CDC developed the tools and helped train Brazilian officials to use the technology. Many of the officials trained to use the software are graduates of the Brazil MOH’s FETP, a highly successful program that has taught scores of “disease detectives.”

The roles are clear and distinct. The technology and all the data collected during the mass gatherings, for example, are controlled entirely by Brazilian health authorities and not shared with CDC or any other outside entity. The same is true for where the system is used; the decisions rest solely with the Ministry of Health.

Mass gatherings like the World Cup represent ideal opportunities because they are planned events, fixed in time allowing us to be more prepared for use of this new technology in an unpredictable event such as a natural disaster, said Victor Caceres of CDC’s FETP Branch.

The effort, two years in the making, is being put to the test in the current “mass gathering” of fans, players, and others at the World Cup. It is the first large-scale (both numerically and geographically) system designed to collect, then stream data seamlessly in real time to a central location where public health officials will have access to a comprehensive set of data.

That goal is achieved through a surveillance system that collects real time health data and displays this information in a centrally located dashboard for analysis and response. And by using a popular tech gadget – a computer tablet.

There’s also geographic diversity. The World Cup is being played in 12 locations across Brazil with dramatically different climate and even health profiles of the population.

Analysis of results

Analysis of results

In fact, the system was tested prior to the World Cup in three small events in Brazil that confirmed the design and the promise of the technology. The first test-run was in January at Aparecida, São Paolo when 250,000 people came to the national shrine. The focus was to test the mobile survey tool’s ability and reliability to collect data in real time and observe data collection on a dashboard in the operations center in real time.

“In this partnership, beyond the improvement of these new features of Epi Info, we have the opportunity to enhance surveillance in mass events and to understand the use of data collection in real time in response to public health emergencies,” said Dr. Wanderson Oliveira, Director of Surveillance and Emergency Response for Brazil’s MOH. “The Ministry of Health intends to adopt this strategy to increase the speed in investigations of outbreaks and other emergencies.”

The next trial came in February and March for carnival in the city of Fortaleza where more than 2 million people converged. The final test came in May during a gay pride event in São Paolo attended by 4 million people. The added feature in this trial was that, in addition to providing surveillance at hospitals and clinics the system was also used in major transportation hubs such as airports and rail stations.

The software is the key. Tablets are pre-loaded with specialized CDC developed software known as Epi Info that allows field deployed epidemiologists to collect data for a wide array of categories and indicators. The data is stored offline until Internet connectivity is available, at which point it is sent to “cloud” computer storage for aggregation. At a “home base” that is often an emergency operations center the data can then be viewed on a dashboard that is continuously updated with statistical results, charts, and maps.

The capability will allow outbreaks to be detected far quicker than with previous technology. That ability is important at any time but even more crucial at mass gatherings such as the World Cup or Olympics or in natural disasters where disease can spread faster and in less predictable ways.

Staff responsible for the technologyIlanit Kateb, a public health advisor for the Center for Global Health was deeply involved in developing the project and helping Brazilian officials use it, said Brazil was the perfect collaborative environment. She cited CDC’s long and close relationship with the Ministry of Health and fact that the country’s FETP program is thriving and that Brazil has a long and successful history in public health.

“Brazil is a high-capacity partner,” she said, “and it openly accepted this program and our collaboration.”

This system, Kateb said, shows how FETP is adapting and evolving, using new technology and techniques for a new generation of disease detectives.

With the system functioning well after the first two weeks of the World Cup, Asad Islam, CDC’s Epi Info team lead, said that it is conceivable to take the lessons learned there and apply them to other public health surveillance and response activities related to outbreaks, natural disasters or humanitarian crises.

That remains in the future, however. As successful as the World Cup experience has been to date, Kateb emphasized the system is still in pilot stage. More tests and evaluation are needed before it can be released into wide use by FETP “disease detectives” globally.

No one doubts, however, that that goal will be reached. The only question, they say, is, when?

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FETP Work in South Sudan Benefits the Whole World

Categories: global health security, health systems strengthening

I’ve been with the Field Epidemiology Training Program (FETP) for 2.5 years now, where I am currently the resident advisor (RA) in South Sudan. My epidemiology training has provided me with the opportunity to gain a wide variety of experiences; prior to joining FETP, I served as an epidemiologist with Médecins Sans Frontières-Switzerland (MSF-CH), working in the refugee camp in Dadaab, Kenya, and have also worked in Dawei (Tavoy), Burma . I am glad to be able to pass on my knowledge about epidemiology to future leaders in the field. As an RA I assist with basic FETP implementation for county and state surveillance officers as well as immunization managers and supervisors. I also advise on outbreak response for priority diseases as well as assist with cascade training for the health facility staff who provide immunization services.

Mozambique FELTP fellows evaluate impact of malaria bed net campaign

Categories: health systems strengthening, malaria

One thing is to read a protocol, and quite another to write a protocol, do the field work, and see it through to the end" - Geraldo Chambe, FELTP resident

One thing is to read a protocol, and quite another to write a protocol, do the field work, and see it through to the end" - Geraldo Chambe, FELTP resident

Four Mozambican epidemiologists-in-training spent a month walking up to ten kilometers a day to make sure that one of the most effective malaria control interventions was reaching the poorest Mozambicans. Malaria is the leading cause of death in Mozambique, and insecticide-treated bed nets are one of the key malaria control measures. Since 2007, the U.S. President’s Malaria Initiative (PMI) has supported the Mozambican Ministry of Health and the National Malaria Control Program (NMCP) in efforts to reduce the burden of malaria in the country, not only through distribution of bed nets, but other key components as well: indoor residual spraying, diagnostic testing and treatment with effective antimalarials, and intermittent preventive therapy for pregnant women.

Mateusz Plucinski, PhD, MPH, Epidemic Intelligence Service Officer, Division of Parasitic Diseases and Malaria, Malaria Branch

Mateusz Plucinski, PhD, MPH, Epidemic Intelligence Service Officer, Division of Parasitic Diseases and Malaria, Malaria Branch

In 2013, with PMI support, the NMCP launched a universal bed net distribution campaign in six districts in Nampula Province, located in the northern region of Mozambique. The goal was to provide access to a bed net to the entire population living in the 250,000 households within the target area. The definition of “universal” varies somewhat by country; in Mozambique it means one bed net for every sleeping space. Mass distribution campaigns meant to achieve universal coverage are ambitious, complex, multi-step activities. They involve visiting all households in the distribution area to perform a census, determining how many bed nets to distribute per household, and organizing the logistics of delivering hundreds of thousands of bed nets to remote areas. It is therefore important to evaluate their performance and determine how successful they were in achieving their goal so that lessons learned can inform planning for the next campaign. And for the NMCP, it is important to document how increased bed net ownership and use made possible by campaigns affect malaria transmission.

CDC Supports the Ministry of Health in Guatemala in the Creation of a National Public Health Institute

Categories: health systems strengthening

 

Guatemala National Public Institute Director, Ministry of Health Guatemala, Mayari Centeno MD, MPH (left) and CDC - Central American Regional Office Director, Nelson Arboleda, MD, MPH (right) meet with CDC Director Tom Frieden, MD, MPH (center) in CDC-Atlanta, February 2014.

Guatemala National Public Institute Director, Ministry of Health Guatemala, Mayari Centeno MD, MPH (left) and CDC - Central American Regional Office Director, Nelson Arboleda, MD, MPH (right) meet with CDC Director Tom Frieden, MD, MPH (center) in CDC-Atlanta, February 2014.

Big things often start small. So do success stories.

Nelson Arboleda, MD MPH, Director - CDC Central American Regional Office

Nelson Arboleda, MD MPH, Director - CDC Central American Regional Office

For proof, simply look to CDC’s work – and history – in Central America. From a single field station established more than 40 years ago in El Salvador by CDC’s Division of Parasitic Diseases; CDC today has a broad and respected presence across Central America and other countries in the region.

As in other parts of the world, we are working closely with public health colleagues across the region to strengthen the capacity of Ministries of Health to prevent, detect, and control disease. We work collaboratively to strengthen countries’ abilities to respond to public health threats by providing technical expertise and evidence-based foundations for a wide array of public health programs.

Improving Disease Surveillance and Outbreak Response in the Latin American and Caribbean Region through the Field Epidemiology Training Program

Categories: global health security, health systems strengthening, infectious disease, noncommunicable diseases (NCDs)

 

FETP residents taking water sample to test for cholera (2013)

FETP residents taking water sample to test for cholera (2013)

Dr. Victor Caceres, CDC Field Epidemiology Training Program Branch

Dr. Victor Caceres, CDC Field Epidemiology Training Program Branch

With increased global travel, everyone is more vulnerable to emerging and reemerging public health threats. This vulnerability is why every country needs a team of highly trained epidemiologists that can detect and rapidly respond to outbreaks and is why CDC is committed to working with countries to establish and support Field Epidemiology Training Programs (FETPs) all over the world including the Latin American and Caribbean (LAC) region.

For the last three years, CDC has been working with the Dominican Republic’s Ministry of Health (MoH), in collaboration with the University of Puerto Rico, to strengthen basic and intermediate-level training capacity for epidemiologists and laboratory personnel as part of the three-tiered “pyramid” training model developed and implemented by countries in Central America. 

CDC Collaborations with the Ministry of Health in Dominican Republic Result in Measurable Public Health Gains

Categories: HIV/AIDS, health systems strengthening, malaria, tuberculosis (TB)

CDC Global Health Director Tom Kenyon (right), CDC Global AIDS Director Deborah Birx (second from right), and CDC-Dominican Republic Director Oliver Morgan (second from left) meet with Dr. Miguel A. Gerardino (left), Director of the Juan Pablo Pina Hospital in San Cristobal, Dominican Republic, January 2014.

CDC Global Health Director Tom Kenyon (right), CDC Global AIDS Director Deborah Birx (second from right), and CDC-Dominican Republic Director Oliver Morgan (second from left) meet with Dr. Miguel A. Gerardino (left), Director of the Juan Pablo Pina Hospital in San Cristobal, Dominican Republic, January 2014.

For a relatively small country where CDC established a full-time country office only five years ago, the Dominican Republic is suddenly drawing attention.

Oliver Morgan, MSc PhD FFPH, CDC Country Director for Dominican Republic

Oliver Morgan, MSc PhD FFPH, CDC Country Director for Dominican Republic

It’s easy to see why. The Dominican Republic is a popular vacation destination with 1.4 million Americans visiting each year. The country has a unique relationship with its neighbor, Haiti, the poorest country in the Western Hemisphere, where CDC also supports many programs. 

Earlier this month, Dr. Tom Kenyon, Director of CDC’s Center for Global Health and Dr. Debbi Birx, who leads CDC’s Division of Global HIV/AIDs visited the Dominican Republic to review, with Dominican authorities, CDC programs to protect public health. Kenyon and Birx are the highest level CDC officials to visit the DR since CDC’s country office officially opened in 2009.

The Value of CDC’s Work in Thailand

Categories: HIV/AIDS, global disease detection, global health security, health systems strengthening, infectious disease, noncommunicable diseases (NCDs), refugee health, tuberculosis (TB), violence and injury

 

Thai monk

 

When I became country director in 2013 the relationships between Thailand’s public health officials and CDC were already strong and well established.

Mitch Wolfe, MD MPH, Director, CDC-Thailand

Mitch Wolfe, MD MPH, Director, CDC-Thailand

That wasn’t surprising. CDC’s collaboration with the Ministry of Public Health, after all, began 30 years ago and the partnership has been prospering  – and expanding – ever since. And there is a strong history between the two countries – this year Thailand and the US are celebrating 180 years of Friendship.

The reasons are well established too. And numerous.

Last summer, while visiting family, I was asked by a U.S. border guard, “Why is America working abroad for public health?” I was happy to get this question, as it was an opportunity to deepen understanding for why CDC works abroad – to protect Americans from health threats, to build important relationships with strategic partners, and to learn lessons that can be expanded to other parts of the world.

Fresh Voices From the Field: The Value of Our Global Health Work

Categories: HIV/AIDS, child health, health systems strengthening, noncommunicable diseases (NCDs), violence and injury, water, women's/maternal health

 

Chelsey Beane is pictured near the home of a traditional healer in Andruvu Village, in the Arua District of Uganda.

Chelsey Beane is pictured near the home of a traditional healer in Andruvu Village, in the Arua District of Uganda.

This is the fourth in our ongoing “Fresh Voices From the Field” series, where we hear from ASPPH (Association of School and Programs of Public Health) Global Health Fellows working throughout the world. Global Health Fellows are recent Master of Public Health or Doctoral graduates placed in CDC global health offices in Atlanta and abroad. They work on a range of priority public health issues and bring a fresh perspective to CDC’s efforts in the field. (See other “Fresh Voices” blogs.)

 

Chelsey Beane, MSPH, ASPH Fellow

Chelsey Beane, MSPH, ASPH Fellow

Working at CDC headquarters in Atlanta is an amazing experience. And yet, sometimes, you can feel disconnected from the real world impact of the science that we spend all day discussing, refining, communicating, and implementing. So I was extremely grateful to have the opportunity recently to travel to Uganda to assist the CDC country team with preparation for a visit by CDC Director Dr. Thomas Frieden.

Although I had read the statistics, knew about our programs, and had become familiar with the major health issues in the country, I left impressed and humbled by what I experienced. I visited a rural village that had a recent outbreak of plague, where I met a small girl who had been diagnosed with diabetes, desperately in need of care and treatment, but miles from the nearest health facility. I was welcomed into the home of a family living in a tiny enclosed hut, filled with smoke from a cooking fire by which two toddlers quietly sat, and truly understood the urgent need for clean cookstoves. I saw people living in rural villages, without access to clean water. But I also saw how efforts by CDC and its partners are making a huge impact, not just for the health system as a whole, but for individuals whose lives have been changed. I saw the implementation of growing laboratory systems in the country, that are improving diagnoses of diseases, such as early infant diagnosis of HIV, and more accurate diagnosis for tuberculosis. I heard the story of a young woman who was raped and became infected with HIV, but who later had two children, both of whom were born healthy. I saw an eRanger, or motorcycle ambulance, rush into a maternal health clinic, carrying a pregnant woman whose delivery would be attended by skilled health workers.

Uganda Makes Impressive Progress on Health

Categories: HIV/AIDS, global disease detection, global health security, health systems strengthening, mosquito-borne disease, women's/maternal health

 

This blog was originally posted in the Huffington Post on August 8, 2013.

 

CDC Director Dr. Tom Frieden peers into Python Cave.

CDC Director Dr. Tom Frieden peers into Python Cave.

Last month I was in Uganda. As I planned for this trip, I wasn’t sure what to expect. Uganda is the only country served by the president’s Emergency Plan for AIDS Relief (PEPFAR) with a rising HIV incidence; I anticipated that there might be problems.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

What I saw instead was impressive progress.

Although Uganda will have challenges for many years as a result of increased HIV infections over the past decade, and has much more to do, I was struck by how much headway they’ve made in the past couple of years. The country has scaled up lifesaving anti-HIV treatment as well as voluntary medical male circumcisions, which sharply reduce the chance of becoming infected.

While in Uganda, I got to peer into a cave — the same cave where two tourists got Marburg virus in 2007. This deadly virus, similar to Ebola, was unknown in this location until identified by CDC staff.

This is Python Cave — and I was awed to see the python, which is at least 12 feet long and 24

Saving Mothers, Giving Life Explores “Mother Waiting Sheds”

Categories: child health, health systems strengthening, malaria, parasitic diseases, women's/maternal health

 

This is the fourth installment in a five-part series about efforts to save the lives of mothers in Africa through an initiative called Saving Mothers, Giving Life. Be sure to read the other four blog posts in this series.
 

Nakaliga Deziranta rests in a “Mother Waiting Shed”

Nakaliga Deziranta rests in a “Mother Waiting Shed”

Saving Mothers, Giving Life (SMGL) is exploring an innovative concept aimed at reducing pre-delivery complications – the “Mother Waiting Shed.” The sheds provide at-risk mothers, particularly those traveling from far-off villages, easier access to comprehensive emergency obstetric and neonatal care – essential for averting maternal death and disability. Four waiting sheds, renovated by SMGL with funding from CDC and other partners, have been established at Kibaale Health Center IV, Kakumiro Health Center IV, Kakindo Health Center IV, and Kagadi Hospital. These sheds are just one piece of the comprehensive SMGL program that CDC supports through core strengths in reproductive/maternal health, health systems strengthening, monitoring and evaluation and human resources for health.

Erik Friedly, Associate Director for Communication, CDC-Uganda

Erik Friedly, Associate Director for Communication, CDC-Uganda

The system works this way: mothers with a previous scar, a history of obstetric complications, transport challenges, or mal-presentation of the baby are advised to come early and wait in the shed nearer to the health facility. When mothers arrive to give birth, those who still need time to progress in labor are transferred to the waiting shed where they are constantly monitored by midwives who assess delivery progress. This sort of “triage” system allows mothers to be in a safe environment during a critical touch-and-go period for them and their babies. 

Nakaliga Deziranta, a 26-year old mother of three from Kasambya village, understands the value of these innovative waiting sheds.  She had always attended her antenatal care appointments at Kibaale Health Center IV. During her first visit in January 2013, she was given a dose of intermittent preventive treatment for malaria, mebendazole, an insecticide treated net, and tetanus toxoid, and, over the course of her visits, she was identified as an at-risk patient and consequently advised to travel to the health center early—at the first signs of labor. Heeding this advice, Nakaliga left home when she first began feeling labor pain, and, upon arrival at the health facility, the midwife on duty examined her and established that she was in the latent phase of labor. She made a decision to keep Nakaliga in the facility’s Mother Waiting Shed, and, after three days of progressive labor, Nakaliga finally gave birth to a healthy baby boy. Nakaliga was extremely happy with the care she received while at the shed and then during delivery and has promised to “tell other women to come in time and wait for their time of delivery from the shed.” In rural Uganda, word of mouth may be SMGL’s greatest ally, and other mothers share Nakaliga’s enthusiasm for the waiting shed concept.

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