Cutaneous leishmaniasis among Syrian refugees in Jordan.

INTRODUCTION: Old World cutaneous leishmaniasis (CL) is one of the most prevalent vector-borne diseases within the World Health Organization's Eastern Mediterranean Region. The conflict in the Syrian Arab Republic generated large population movements and raised concerns about spreading of CL to countries where Syrians have relocated, including Jordan. METHODS: A review of electronic and paper-based registries of CL cases in Jordan was conducted to assess burden of disease and associated socio-demographic factors. RESULTS: Increasing numbers of CL cases have been reported in Jordan between 2010 and 2016 (from 140 to 281), paralleled by significant increases in incidence rate (from 2.09 per 100 000 person-years, 95% CI (1.77-2.47), to 2.87 per 100 000 person-year, 95% CI (2.55-3.22), p = 0.002) and in the proportion of cases who are Syrian (from 8.6%-55.2%, p < 0.001). Syrian refugees have higher odds of presenting with leishmaniasis than Jordanian nationals (adjusted OR 7.1, 95% CI (6.3-8.0), p = 0.000). CONCLUSIONS: Presence of large numbers of Syrian refugees within Jordan has so far not contributed to increased risk of developing CL for Jordanians, however surveillance, diagnosis and case management for CL should be reinforced to meet the increased burden. Electronic surveillance can help identify priority populations and areas for interventions.

Perceptions of use of a case-based, integrated national electronic public health surveillance system in Jordan.

Collection of real-time, standardized data remains a challenge for public health surveillance systems. The use of mobile information technology may facilitate this. A national case-based public health surveillance system was introduced in Jordan in 2015 using mobile tablets and an online framework. After training on the system, users were surveyed about their perceptions of it. Of 596 participants attending the training, 580 (97.3%) completed the survey. The majority of users were nurses (58.5%). Overall perceptions of the system were highly positive across 5 areas of functionality (standardized case definitions, clinical guidance on signs and symptoms, risk factors and laboratory guidance, SMS and Email alerts for notifiable diseases, one-hour reporting of information via an online framework). In all areas, over 80% of participants thought the system would help their work and would save time in identifying notifiable diseases and reporting this information centrally. Further work is encouraged to evaluate the system and consider the application of cloud-based models in other settings.

Design and implementation of a national public health surveillance system in Jordan.

Understanding and improving the health status of communities depend on effective public health surveillance. Adoption of new technologies, standardised case definitions and clinical guidelines for accurate diagnosis, and access to timely and reliable data, remains a challenge for public health surveillance systems however and existing public health surveillance systems are often fragmented, disease specific, inconsistent and of poor quality. We describe the application of an enterprise architecture approach to the design, planning and implementation of a national public health surveillance system in Jordan. This enabled a well planned and collaboratively supported system to be built and implemented using consistent standards for data collection, management, reporting and use. The system is case-based and integrated and employs mobile information technology to aid collection of real-time, standardised data to inform and improve decision-making at different levels of the health system.