A child stays home from school one day with a fever and an unusual rash. That same week, several other children are also absent due to the same symptoms. Noticing the unusually high number of sick children missing from the classroom, the teacher reports this to a local health official.
A pastor posts online that Sunday’s service felt emptier than usual due to a high number of people being sick in the community.
In these examples, the teacher and the pastor are acting as participants in community event-based surveillance, or EBS. Event-based surveillance involves collecting unstructured, non-standardized information in order to detect atypical events that could signal a disease outbreak. Health officials must then assess and verify these reports.
Having a robust EBS system in place is important because serious public health risks can often bypass health care providers and structured ways of reporting diseases to health officials. In addition, when a disease is unknown, it may go undetected by the existing health care infrastructure.
“EBS is the way to reach really remote communities and receive information about potential outbreaks much faster,” says Dominique Bozarth, who works on the project at TEPHINET.
However, EBS can be effective only if participants know how and when to detect and report signals. That is why TEPHINET is working closely with the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC) on a project to develop a standard EBS curriculum and training materials for use at the community, district, health facility, and national levels.
“This project’s goal is to make sure that there’s a high-quality, standard curriculum for EBS training that can be used and adapted by countries all around the world. Until now, individual EBS experts have developed ad hoc materials—there are dozens of existing PowerPoints, for example. This project involves curriculum development experts, instructional designers, and other partners that can work to ensure that the new tools we are developing meet pedagogical needs for adult learning and visualize this information in ways that meet the needs of those who use them.”
Bozarth gives the example of different literacy levels in many communities around the world. “Training materials with lots of text won’t be helpful in these communities, and we want to ensure that as many people as possible in a community can report an event. Therefore, some of these materials will use visuals, like icons and pictures, as the primary way to communicate information.”
Beyond training materials, the project deliverables also include tools that people can use, such as registers and data collections tools for community health workers to record events.
In Cameroon, district-level stakeholders who received EBS training are now champions in leading community training. The Field Epidemiology Training Program (FETP) in Cameroon has integrated with the EBS system, with FETP residents and graduates participating in EBS trainings in partnership with a TEPHINET consultant who is the main EBS point of contact in the country.
“EBS is a matter of training people to think, ‘This person has bloody diarrhea and it could be serious; I need to let someone know about that,’” says Bozarth. “We can’t change individuals’ practices, but at least we’re creating a group of champions that understand that this information needs to be shared outside of their immediate community. EBS gives people more responsibility over their health and their communities.”
Curriculum development is currently ongoing. TEPHINET is working with CDC to organize EBS mentorship workshops in East and West Africa in early 2020. Mentors, who are surveillance experts, will serve as the leads for implementing EBS in their countries.