Evaluation of MenAfriNet: A Meningitis Case-Based Surveillance Network in the African Region
Meningococcal meningitis is a bacterial form of meningitis, causing an infection of the meninges surrounding the brain and spinal cord. The disease is highly endemic in the African ‘belt”, an area stretching from Senegal in the west to Ethiopia in the east. About 240 million people live in the seven countries with the highest risk (LaForce & Okwo-Bele, 2011). Neisseria meningitidis A accounts for almost all epidemics. Since the introduction of meningococcal A conjugate vaccine (MenAfriVac ™), more than 235 million Africans have been vaccinated in 16 out of the 26 countries in the Meningitis Belt (WER, 2016). The MenAfriNet surveillance network, a consortium of international partners including CDC, WHO, Agence Medicine Preventive (AMP) and ministries of health, was founded to strengthen case-based meningitis surveillance with the main objective to monitor impact of meningococcal A vaccine.
We evaluated the meningitis case-based surveillance conducted by the MenAfriNet network in four African countries including Burkina Faso, Niger, Mali and Togo based on the 2015 network data. We assessed these countries’ performance based on pre-established performance indicators.
Our objectives were to 1) assess the quality of the data from 84 MenAfriNet health districts, in term of completeness and to 2) evaluate the surveillance system performance of these health districts using the predefined performance indicators.
We used the “CDC updated guideline for evaluating public health surveillance systems” to assess how well the MenAfriNet surveillance operate. We analyzed country data using SAS 9.4 ® statistical software to generate frequency tables. The ArcGIS 10.1 ® was used to map the analyzed data.
MenAfriNet districts had high-quality data expressed by low proportion of missing values (50%), hence resulting in low performance of the indicator.
The proportions of districts in all countries that crossed performance indicators threshold were as follows: Indicator 2: 17/81 (21%), indicator 3: 3/81 (3.7%), indicator 4: 79/81(97.5%), indicator 5: 18/81 (22.22%), indicator 6 (73/81(90%), indicator 7: 18/81 (22.22%), indicator 8: 50/81 (61.72%), and indicator 12: 47/75(62.66%).
Overall, the results of this analysis demonstrated high-quality of data among the variables used to calculate the performance indicators. Additionally, most of the districts in all four countries reached the indicator thresholds. Based on these findings, the project has been successful in improving meningitis case-based surveillance in the health districts that it supports. Nevertheless, we discussed recommendations to improve identified gaps.