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Leishmaniasis is a disease caused by what is known as “protozoan parasites”. Protozoa are microscopic, one-celled organisms that are able to multiply in humans, causing serious infections. Leishmansis is transmitted to humans by the bite of infected female sandflies.
The worst form of the disease is called Visceral Leishmaniasis (VL), and it is endemic in more than 80 countries. People usually suffer from irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia.
This disease affects some of the poorest people on earth. It is associated with malnutrition, population displacement, poor housing, a weak immune system and lack of financial resources. The most cases are found on the Indian subcontinent and in East Africa, where an estimated 200, 000 – 400, 000 new cases occur each year. Some 90% of all new cases are reported from Brazil, Ethiopia, India, Somalia, South Sudan and Sudan. Left untreated, VL will kill a person within two years of the onset of the disease in more than 95% of all cases. Source: Neglected tropical diseases, WHO, 2017 ©
Diagnosis and treatment of VL is not easy. In endemic countries, only few health facilities have well-trained health workers and the equipment to perform proper diagnosis and case management. To be able to accurately map the distribution of VL cases and calculate incidence and population at risk, several factors come into play:
Identifying health facilities where the resources will be targeted (training, equipment, drugs, diagnostic tests),
Allocating cases to the probable place of infection (or at least place of residence), and not to the place where the person is being treated.
In view of the country’s difficult context, Somalia is doing very well in terms of VL surveillance. Since 2013, the Ministry of Health, with the support of the WHO and SOS Somalia, have trained health workers from three health facilities in VL diagnosis, case management, and data collection.
Individual data was collected for each VL case in an Excel spreadsheet and shared with the central level of the Ministry of Health. Basic descriptive analysis of the data was performed. However, the following limitations affected the quality of the data:
No central database to store, clean and compile the data.
No standardization of the locations where cases were detected.
No skills at the Ministry of Health to map the cases at village level.
In 2016, the WHO Global Leishmaniasis programme developed a generic “VL patient form” using DHIS2 Tracker, and a generic “VL patient register” using DHIS2 Event Capture. The objectives are to support the Somali MoH in using these generic modules to strengthen VL surveillance and control in Somalia.
The WHO team developed an “Excel importer” app, based on an existing DHIS2 app from HISP Vietnam. VL event data from 2013 to 2015 was imported, and data was then available for analysis of Neglected Tropical Diseases (NTDs) surveillance and control.
A DHIS2 dashboard was implemented for Somalia, with main indicators, and a map representing VL cases from villages of residence as a proxy of the village of infection.
In February 2017, 24 health workers in Entebbe, Somalia received training on how to enter data in the WHO-VL modules. The training, performed by WHO and in collaboration with HISP Uganda, lasted for 5-days. Health workers learned about areas such as identifying the minimum data to be collected for each VL patient; DHIS2 tools and features for surveillance (individual and aggregated data entry, data validation, data analysis and working with dashboards); and practical sessions for data entry in Tracker Capture. At the end of the training, participants were expected to know how to:
Connect to the platform,
Enter individual and aggregated data,
Validate their data using the data validation tools,
Analyze the data through the interpretation of dashboards showing indicators required by the Leishmaniasis Programme.
Since this training, data entry is collected centrally in Mogadishu. This is a first phase, which aims at testing the usability of the Tracker “VL patient form”. The second phase is to invite the peripheral level to Mogadishu on a monthly basis to enter data in the “VL patient form”. The third phase is to test the possibility of entering data at the peripheral level.
Although initially three phases were planned for the VL control program in Somalia, due to logistic constraints, the peripheral level is continuing with the Excel solution, and the central level is tasked with uploading the data to DHIS2. The deployment of the “VL patient form” or the “VL register” is planned for a later stage, after further analysis of the technical requirements at the peripheral level.
This intermediary solution represents a substantive improvement for the Somali VL control programme. Indeed, it will enable better data quality, centralization of all the data in a single database, safeguarding of the data, easy sharing with main partners, improved data usage and improved feedback to the peripheral level.