Improving influenza surveillance in sub-Saharan Africa.

PROBLEM: Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. APPROACH: A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance. LOCAL SETTING: Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. RELEVANT CHANGES: Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. LESSONS LEARNT: Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.

Community and facility surveys illuminate the pathway to child survival in Liben Woreda, Ethiopia.

OBJECTIVES: To apply "Pathway to Survival" analysis to baseline assessments to inform integrated management of childhood illness programmes. DESIGN: A cross-sectional survey evaluating community-based knowledge, practices and coverage and health facility quality. SETTING: Liben Woreda (population 122, 410), a district in Borana Zone, of Ethiopia's Oromia region, from August 1997-Febuary 1998. SUBJECTS: Three hundred and sixty eight mother-child pairs (age < 24 months) seen in the community and 28 children (age < 5 years) in health facilities. RESULTS: Of the 368 mothers interviewed 50% reported that their child was ill in the previous two weeks (184/368). Amongst the 101 mothers of children under the age of six months only 24% reported exclusive breast-feeding (24/101). There were 194 children who should have completed their immunisation schedule; only 17% of them had done so (33/194). Amongst the 111 children who had diarrhoea, only 17% had received home treatment with ORS (19/111). Thirty per cent of mothers of children with possible pneumonia (25/83) and 28% who reported malaria (14/50) sought appropriate care. Amongst those caregivers seen at the health facility only 26% had an understanding of treatment recommendations. CONCLUSIONS: Based on the pathway to survival analysis, mother's knowledge of illness recognition is limited and they practice both home care and care seeking poorly. Thus few children are likely to receive and comply with standard case management.