Submission ID 130243
| Issue/Objective | Title: Evaluation of Neglected Tropical Diseases Surveillance System in Gadarif State, Sudan Applicant: Mohamed Mahmoud Talib Abstract / Application Statement: Neglected Tropical Diseases (NTDs) remain a significant public health challenge in Sudan, particularly in regions affected by limited resources, recurrent outbreaks, and conflict. In Gadarif State, eastern Sudan, diseases such as visceral leishmaniasis, schistosomiasis, trachoma, and soil-transmitted helminths continue to impact vulnerable populations. Surveillance systems operate across health facilities, locality offices, and the State Ministry of Health, but coordination, training, and logistics remain uneven, limiting timely detection and response. My study aimed to evaluate the NTD surveillance system in Gadarif State in 2024, with objectives to assess core surveillance functions and supportive activities at three administrative levels, and to measure improvements following targeted interventions. Using a cross-sectional design with pre- and post-intervention assessments, data were collected from health facility surveillance units, locality offices, and the State Ministry of Health. Key interventions included staff training, improved supervision, enhanced communication, and strengthening laboratory and logistical capacities. Findings demonstrated that while health facilities and localities had moderate compliance pre-intervention, the state-level system achieved full compliance post-intervention, with rapid response teams, comprehensive training plans, functional communication, and laboratory capacity. This highlights that even modest, targeted investments can substantially improve surveillance performance in resource-limited settings. The study is highly relevant to the conference theme on strengthening health systems and improving outbreak preparedness. It provides practical strategies for building resilient, integrated disease surveillance systems that enhance early detection, improve outbreak response, and contribute to achieving Sustainable Development Goal 3 (Good Health and Well-being). |
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| Methodology/Approach | Setting: The study was conducted in Gadarif State, eastern Sudan, a border region with Ethiopia, characterized by diverse ethnic communities and extensive agricultural activity. The state has a population of approximately 2.4 million across 12 localities. In 2024, the health system faced additional challenges due to regional conflict and instability, which disrupted routine health services and complicated disease surveillance. Neglected Tropical Diseases (NTDs) such as visceral leishmaniasis, schistosomiasis, trachoma, and soil-transmitted helminths were prevalent, and surveillance operated through 158 sentinel sites within health facilities. Research Design / Implementation Strategy: I used a cross-sectional study design combined with a one-group pre-test/post-test intervention. Data were collected from health facility surveillance units, locality offices, and the State Ministry of Health using a modified WHO surveillance evaluation questionnaire. The study assessed both core surveillance functions (case detection, confirmation, and response) and supportive functions (training, supervision, and resource availability). Targeted interventions included staff training, supervision strengthening, improved communication systems, and enhanced laboratory and logistical capacity to address identified gaps. Timeframe: The study was implemented in three sequential phases: Preparatory Phase (Feb-Apr 2023): Literature review, tool development, protocol writing, ethical approvals, and pilot testing. Operational Phase (May 2023-Jun 2024): Data collection across 19 health facilities, 12 locality offices, and the State Ministry of Health. Analytical Phase (Jul-Aug 2024): Data cleaning, coding, and statistical analysis using SPSS and Kobo Toolbox, followed by post-intervention assessment of system improvements. |
| Results | Results / Key Findings: The evaluation revealed strong core surveillance performance at health facility level, but notable gaps in training and logistics before intervention: Health Facilities (Pre-Intervention): 100% of facilities were able to detect, record, and report unusual health events promptly. Laboratory officers could confirm priority cases and send samples to reference laboratories on time. Training gaps existed: 10.5% of staff had not received Integrated Disease Surveillance and Response (IDSR) training, and 21% lacked training in infection control. 84% of facilities reported regular supervision and had functional communication channels. Locality Surveillance Units (Pre-Intervention): 91.7% of localities used standardized case definitions. 83.3% maintained rumor registers and reference lab lists. Logistical challenges included limited vehicles for sample transport and supervision, which hindered rapid response. State-Level Surveillance Unit (Post-Intervention): Following targeted interventions, 100% compliance was achieved across all core and supportive indicators. Rapid Response Teams were fully operational, all staff received training/refresher courses, supervision was regular, and laboratories and communication systems were fully functional. The intervention demonstrated that targeted investments in training, coordination, and infrastructure can substantially improve surveillance capacity, even under conflict and resource-limited conditions. Lessons Learned: Community engagement and grassroots health workers are critical for early detection and reporting. Strengthening surveillance systems through modest, targeted interventions is feasible and cost-effective, contributing to more resilient primary healthcare and outbreak preparedness. Integrated and well-supported surveillance systems can achieve rapid improvements in performance, even in fragile and conflict-affected settings. |
| Discussion/Conclusion | Discussion and Conclusion: The evaluation of the Neglected Tropical Diseases (NTDs) surveillance system in Gadarif State, Sudan, during 2024 under conflict conditions revealed critical insights for strengthening public health systems in fragile settings. Pre-intervention assessments highlighted gaps in training, supervision, and logistics, particularly at locality and state levels. Post-intervention results demonstrated that targeted interventions-focused on capacity-building, improved communication, and laboratory support-can achieve full compliance across core and supportive surveillance functions, even in resource-limited and conflict-affected contexts. Implications: The findings underscore the importance of integrating community-based surveillance networks with formal health systems. Grassroots health workers and volunteers play a key role in early detection and rapid reporting, which can bridge gaps in formal system capacity. Strengthening surveillance systems is a cost-effective approach to reducing disease burden, improving outbreak response, and enhancing overall health system resilience. Investments in training, coordination, and infrastructure are feasible even under conflict, providing a model for other regions facing similar challenges. Policy Impact: The study supports national policies on Integrated Disease Surveillance and Response (IDSR), emphasizing sustainable staff capacity-building, resource allocation, and inter-sectoral collaboration. Evidence from this study can inform government and donor strategies to prioritize surveillance strengthening and integrated NTD management. Scaling Options: The intervention model can be replicated in other conflict-affected states or regions with fragmented health systems. Integrating NTD surveillance with broader primary healthcare programs ensures sustainability and resource efficiency. Leveraging digital tools and community networks can enhance timeliness and completeness of reporting at scale. Link to Conference Theme: This research directly addresses themes of health system strengthening, outbreak preparedness, and resilience in fragile settings. It provides practical strategies for improving surveillance performance, policy alignment, and community engagement in low-resource and conflict-affected environments, which aligns with sub-themes on disease surveillance, public health resilience, and integrated healthcare interventions. |
| Presenters and Affiliations | Mohamed Talib 1. Senior Field Analyst - Voluntās - Kenya Nairobi team - Sudan 2. Head of Public Health & Community Medicine (Head of Medical Research Office)- Sudanese Medical Research Association (SMRA) 3. Partnership & Localization Manager - Action Against Hunger -P Mohamed Talib Africa CDC Mohamed Talib Africa CDC Mohamed Talib Africa CDC |
