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Table 1 Examples of Syndromic Surveillance Systems in Developing Countries

From: Beyond traditional surveillance: applying syndromic surveillance to developing settings – opportunities and challenges

Type of surveillance Country Type of Data Data collection and recording methods Data centralization methods Analysis Frequency Aberration Detection Method Potential and limitations of the system for early detection of outbreaks
Malaria Uganda Incidence rates Health facilities District level Weekly Anomaly measure provides index of deviation from expected weekly incidence rates Early detection documented [20]
Malaria Eritrea Outpatient cases and climate datasets 242 districts via computerized access database Central database Monthly Principal component analysis/non-hierarchical clustering 2–3 month lead time of peak malaria
Climate variables only accurate in El Nino years [21]
Malaria Jamaica Active fever surveillance Fever cases recorded at sentinel sites Analysis at local level, then transmitted centrally Daily then decreased over time Not available Active door to door surveillance [24]
Dengue Fever "2SE FAG" French Guiana Fever, dengue fever and malaria cases Collected by medical provider at individual sites
Recorded on IT system with syndromic software
Reported to French health authorities Data converted to weekly format
Reported immediately in case of alarm, weekly in normal operation
Automated alarm based on current past experience graph (CPEG) Potential: 60 minutes between case presentation and system detection
Improved detection of dengue
Limitations: Sensitivity high but specificity low [30, 31, 33]
Foodborne disease Egypt Hospital based syndromic surveillance Case reports Passive reports from hospital providers Passive surveillance Not available Limitations: Missed outpatients compared to laboratory surveillance [46]
Food-borne disease Pacific Island Countries and Territories Varies: reports of diarrheal disease; laboratory surveillance Data collected by health care providers, reporting of laboratories Pacific Public Health Surveillance Network to organize resources and facilitate centralized data collection and sharing Monthly reports Not available No laboratory surveillance in use except for Samoa [45]
Limitation: No uniform definition for foodborne disease
STI's Burkina Faso Prevalence studies, sentinel surveillance, population based surveys Various methods Not available Not available Not available Decrease in incidence of gonorrhea, chlamydia and syphilis [53]
STIs Ivory Coast Data from three STI syndromes Community and public clinic and hospital data computerized at district level, compiled at regional level Data collated by districts and region then centralized nationally Monthly Annual incidence rates Data provide trends of STI's and are used to estimate quantity of drugs[54]
Various Diseases: Alerta DISAMAR Peru, operated in conjunction DOD-GEIS Suspected or lab-confirmed cases of diseases/syndromes Medical record review for reporting Medical officer transmits site data to Alerta DISAMAR central hub Daily or twice weekly Voxiva software converts data to common format
Graphs of weekly counts
Identified over 31 disease outbreaks [15, 16]
Various Diseases
EWORS (Early Warning Outbreak Recognition System)
Southeast Asia and Peru Standardized questionnaire at clinical sites Questionnaire filled out on computer terminal with EWORS software EWORS data files sent by email to EWORS hub for analysis Once daily; monthly report to each participating hospital
Varying degrees of centralization
Automated statistical outbreak detection algorithm Potential: detection of large cholera outbreak in Indonesia [48];
Limitations: mechanisms for linking suspected outbreaks to response; lack of standardization of procedures (15)