World Journal of Public Health 2020; 5(3): 53-59 http://www.sciencepublishinggroup.com/j/wjph doi: 10.11648/j.wjph.20200503.12 ISSN: 2637-6040 (Print); ISSN: 2637-6059 (Online) Assessment of the Epidemiological Surveillance System for Bacterial Meningitis in Benin from 2016 to 2018: Case-by-Case Surveillance Togbemabou Primous Martial Godjedo 1, 2 , Moussiliou Noël Paraiso 3 , Alidehou Jerrold Agbankpe 4, * , Tamegnon Victorien Dougnon 4 , Yves Eric Denon 2 , Marie Hidjo 4 , Honore Bankole 2, 4 1 Epidemiological Surveillance Service, Ministry of Public Health, Cotonou, Benin 2 National Health Laboratory, Ministry of Public Health, Cotonou, Benin 3 Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin 4 Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin Email address: * Corresponding author To cite this article: Togbemabou Primous Martial Godjedo, Moussiliou Noël Paraiso, Alidehou Jerrold Agbankpe, Tamegnon Victorien Dougnon, Yves Eric Denon, Marie Hidjo, Honore Bankole. Assessment of the Epidemiological Surveillance System for Bacterial Meningitis in Benin from 2016 to 2018: Case-by-Case Surveillance. World Journal of Public Health. Vol. 5, No. 3, 2020, pp. 53-59. doi: 10.11648/j.wjph.20200503.12 Received: July 31, 2020; Accepted: August 17, 2020; Published: August 27, 2020 Abstract: With the introduction of the new meningitis A conjugate vaccine in 2012, Benin has opted for case-by-case surveillance for bacterial meningitis. The study aims to assess the case-by-case surveillance system for the meningitis epidemic in Benin during the period 2016 to 2018. A retrospective and evaluative study with a mixed approach (qualitative and quantitative) was conducted, on the three sites identified for sentinel surveillance of meningitis in Benign. The evaluation of the performance of the surveillance system was based on the updated guidelines of the Center for Disease Prevention and Control to evaluate a public health surveillance system. All criteria except sensitivity, specificity and positive predictive value were measured. Semi-structured individual interviews were conducted with the agents of the surveillance system surveyed and the normative documents as well as the notice forms were examined. This study reveals that all the centers had the case definition and notification forms. The ratio of notified cases to registered cases was 0.77. We found that the monitoring system in place had five levels. The system performance was recognized with simplicity at 80.8%, good acceptability (completeness: 98.5%; Promptitude: 88.9%) and responsiveness of 85%. The completeness of the health facilities was 45%. This study shows that it is imperative to strengthen the knowledge of the actors involved in epidemiological surveillance through periodic training to improve the performance of the surveillance system. Keywords: Surveillance System Evaluation, Meningitis Epidemic, Benin from 2016 to 2018, Case-by-Case Surveillance 1. Introduction Among the potentially epidemic diseases, meningococcal cerebrospinal meningitis remains a cyclical threat in Africa, particularly in the meningitis belt area. The dry season combined with the harmattan, the movements and habits of the populations favor its transmission. Vaccination with polysaccharide vaccines (bivalent AC, trivalent ACW135), accessible in the area does not allow obtaining sufficient "collective immunity" [1]. Indeed, these vaccines protect those who have received them, but do not lead to the development of antibodies in the nasopharynx and therefore do not stop the circulation of the bacteria. In addition, they cannot be used before the age of two, and after 30 years, individuals are off target for vaccination campaigns. The immunity granted lasts only three to five years [2]. These
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World Journal of Public Health 2020; 5(3): 53-59
http://www.sciencepublishinggroup.com/j/wjph
doi: 10.11648/j.wjph.20200503.12
ISSN: 2637-6040 (Print); ISSN: 2637-6059 (Online)
Assessment of the Epidemiological Surveillance System for Bacterial Meningitis in Benin from 2016 to 2018: Case-by-Case Surveillance
Togbemabou Primous Martial Godjedo1, 2
, Moussiliou Noël Paraiso3,
Alidehou Jerrold Agbankpe4, *
, Tamegnon Victorien Dougnon4, Yves Eric Denon
2, Marie Hidjo
4,
Honore Bankole2, 4
1Epidemiological Surveillance Service, Ministry of Public Health, Cotonou, Benin 2National Health Laboratory, Ministry of Public Health, Cotonou, Benin 3Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin 4Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic
School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
Email address:
*Corresponding author
To cite this article: Togbemabou Primous Martial Godjedo, Moussiliou Noël Paraiso, Alidehou Jerrold Agbankpe, Tamegnon Victorien Dougnon, Yves Eric
Denon, Marie Hidjo, Honore Bankole. Assessment of the Epidemiological Surveillance System for Bacterial Meningitis in Benin from 2016
to 2018: Case-by-Case Surveillance. World Journal of Public Health. Vol. 5, No. 3, 2020, pp. 53-59. doi: 10.11648/j.wjph.20200503.12
Received: July 31, 2020; Accepted: August 17, 2020; Published: August 27, 2020
Abstract: With the introduction of the new meningitis A conjugate vaccine in 2012, Benin has opted for case-by-case
surveillance for bacterial meningitis. The study aims to assess the case-by-case surveillance system for the meningitis epidemic
in Benin during the period 2016 to 2018. A retrospective and evaluative study with a mixed approach (qualitative and
quantitative) was conducted, on the three sites identified for sentinel surveillance of meningitis in Benign. The evaluation of
the performance of the surveillance system was based on the updated guidelines of the Center for Disease Prevention and
Control to evaluate a public health surveillance system. All criteria except sensitivity, specificity and positive predictive value
were measured. Semi-structured individual interviews were conducted with the agents of the surveillance system surveyed and
the normative documents as well as the notice forms were examined. This study reveals that all the centers had the case
definition and notification forms. The ratio of notified cases to registered cases was 0.77. We found that the monitoring system
in place had five levels. The system performance was recognized with simplicity at 80.8%, good acceptability (completeness:
98.5%; Promptitude: 88.9%) and responsiveness of 85%. The completeness of the health facilities was 45%. This study shows
that it is imperative to strengthen the knowledge of the actors involved in epidemiological surveillance through periodic
training to improve the performance of the surveillance system.
Keywords: Surveillance System Evaluation, Meningitis Epidemic, Benin from 2016 to 2018, Case-by-Case Surveillance
1. Introduction
Among the potentially epidemic diseases, meningococcal
cerebrospinal meningitis remains a cyclical threat in Africa,
particularly in the meningitis belt area. The dry season
combined with the harmattan, the movements and habits of
the populations favor its transmission. Vaccination with
problems...). Nevertheless, it has raised interesting questions
in the management of meningitis epidemics in the various
municipalities. It can thus be noted that the case-by-case
epidemiological surveillance system set up in health
establishments is accessible and well functional. Monitoring
tools are available at all levels and case definition is within
the reach of officers; no shortage of notice was noted.
However, the ratio of the number of cases notified to the
number of cases registered is less than 1 (0.77), reflecting
under-reporting of cases. Similarly, the registration of cases
and the updating of the database are insufficient. The poor
quality of surveillance in health facilities in Africa is
conventionally reported in the literature [10-12]. However,
the inadequacies of archiving (premises, furniture, bad
weather, etc.), the insufficiency of human resources usually
observed in health establishments in the northern zone of
58 Togbemabou Primous Martial Godjedo et al.: Assessment of the Epidemiological Surveillance System for
Bacterial Meningitis in Benin from 2016 to 2018: Case-by-Case Surveillance
Benin, with the multiplication of the workload due to
management other epidemics other than meningitis, could
contribute to the loss of information and to the filling in of
certain items on the meningitis case notification sheets. It is
important to know key items such as the age of the patient,
their place of residence and their time to consult after the
onset of symptoms. This makes it possible to describe the
profile of cases, to list the areas affected by the epidemic and
to assess the impact of awareness-raising messages,
regarding the early attendance of centers [1, 12].
Compared to the functioning of the surveillance system, its
average simplicity was 80.8%, with little knowledge of the
epidemic threshold (42.5%) and an average knowledge of the
alert threshold (52.8%) (Table 4). These results are
comparable to those obtained by Djila et al., where the
simplicity of the epidemiological surveillance system for
meningitis in the health district of commune VI of Bamako
from 2011 to 2013 was 81.86% with little knowledge of the
alert threshold (47.1%) and an average knowledge of the
epidemic threshold (51%) [13]. We found that the availability
of meningitis guidelines was 95.8% and that of the national
technical guide to integrated disease surveillance and
response 62.7%. These results show that the structure of the
case-by-case epidemiological surveillance system for
meningitis in Benin is light, but must be reinforced by
training agents on knowledge of the alert and epidemic
threshold as well as updating the national guide. and standard
operating procedures for case-by-case surveillance of
bacterial meningitis in Benin and its availability at the level
of all the hospitals involved in epidemiological surveillance.
Our results are comparable to those found by Dolo in the
2011 Katide evaluation with the availability of meningitis
guidelines which was 96.4% [14].
How responsive was the surveillance system? The average
reactivity observed in this study was 85%. The deadline for
compiling the files, analyzing and transmitting the data was
one week, from the health establishments to the
epidemiological surveillance center of the health zone office.
Can we be satisfied with a weekly notification in the
surveillance of meningitis at the level of health
establishments? The strengthening of the surveillance system
should tend to reduce this period to health establishments for
better preparation for epidemics and response. The means of
communication, such as the mobile phone, the social network
whatsApp, generally available in health facilities, should
currently be used to compile daily data from these health
establishments, to a center, the office's epidemiological
surveillance center. of the sanitary area. In the short term, the
surveillance system for diseases with epidemic potential
would benefit from the establishment of computerized
registers in health facilities [1].
The acceptability of the functioning of epidemiological
surveillance was shown through an average completeness of
98.5% and an average of promptnesses of 88.9%. This shows
that the actors are strongly involved in the surveillance
system with a high participation rate and a lot of time
devoted to collecting and transferring information.
Motorcycles are used to transport CSF samples from
peripheral health centers to surveillance laboratories.
Although precautions are usually taken to keep these samples
in good temperature conditions, their quality on arrival is
dependent on the delivery time. Transport is an important
element, the meningococcus being a very fragile germ. This
could explain the large number of samples found to be
defective in the laboratory. In addition, the insufficiency of
human resources, that of equipment (weakness of storage
capacity for samples) and laboratory inputs (culture media)
could also account for part of the wide gap observed between
the number of CSF samples received and the number actually
examined. The interviews revealed that in several health
establishments in the northern zone, doctors to rule out
meningitis in suspected patients systematically make a
lumbar portion. This state of affairs pushes the
epidemiological surveillance agents to mention these cases as
suspect cases, which means that some municipalities are
constantly in an epidemic situation.
5. Conclusion
This study shows an acceptable functioning of the case by
case surveillance of meningitis in Benin. Despite the existence
of a functional surveillance and supervision system, there is an
under-notification of cases, a poor knowledge of alert and
epidemic thresholds and a weak contribution of the laboratory
in the identification of germs. It is therefore imperative to
strengthen the knowledge of actors involved in
epidemiological surveillance through periodic training. In
addition, the capacity of diagnostic laboratories must be
strengthened by providing them with materials and equipment
for rapid and efficient diagnostics. Finally, an update of the
national guide and standard operating procedures for case-by-
case surveillance of bacterial meningitis in Benin published in
September 2013 and its availability at the level of all the health
establishments involved in epidemiological surveillance would
be essential for improving case-by-case surveillance of
meningitis in Benin.
Acknowledgements
The authors thank all the staff of the epidemiological
surveillance service of the Ministry of Health of Benin and
all the health personnel who participated in this study.
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