Evaluation of the implementation of the EWARS Mobile epidemiological surveillance tool in Sudanese refugee camps in Eastern Chad: A retrospective and population-based surveillance study. Affiliations

Stephane Tewo¹Thierno Balde²Freddy M Banza²Idriss M Mahamat¹N’dri E E Kouame¹Djinguebey R Ngarhounoum¹John Otokoye Otshudiema²Castilla Echenique Jorge³Moussa Brahimi¹Djoumbarina Maina¹Evers Egmond¹Marcel Woung³Boris Pavlin³Kazuki Shimizu³Jacques L Tamuzi^4*Patrick D M C Katoto⁵Charles S Wiysonge⁶Philomena B Anya¹

• ¹World Health Organization (Chad), N'djamena, Chad
• ²World Health Organization (Senegal), Dakar, Senegal
• ³World Health Organization (Switzerland), Geneva, Geneva, Switzerland
• ⁴Stellenbosch University, Stellenbosch, South Africa
• ⁵Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
• ⁶World Health Organization - Regional Office for Africa, Brazzaville, Republic of Congo

The escalation of the conflict in Sudan has created a major humanitarian challenge for neighboring countries, especially in the Eastern regions of Chad. This humanitarian setting's health needs are unique in that they are more vulnerable to both outbreak-prone disease and a lack of essential services. To address these challenges, the World Health Organization (WHO) has supported implementing the Early Warning Alert and Response System (EWARS) Mobile. The purpose of this study was to evaluate the application of the EWARS Mobile epidemiological surveillance tool in Sudanese children's refugees in Eastern Chad.Methods: This was a retrospective and population-based surveillance study that provided an overview of the pattern of cases and deaths in time and space related to potential outbreaks.Results: In total, 1,645 alerts were reported among children in vulnerable provinces of Quaddai, Sila, and Wadi Fira. There were 41738 alerted cases and 236 deaths, for a 0.56% projected fatality rate. The EWARS Mobile system successfully reported alerted increases in cases of acute flaccid paralysis (AFP), acute jaundice syndrome (AJS), acute respiratory infection (ARI), acute watery diarrhea in children (AWD), measles, meningitis, diphtheria, neonatal tetanus (NT), dengue, dysentery, and atypical events in vulnerable children in time and space. Case reporting, alert recording, and weekly reporting were completed successfully at all levels (camps, district, zone, and province) (≥80% completion rate). In contrast, the timeliness of alert reporting, weekly reporting, and probable outbreaks did not perform well across levels (≥80% timeliness rate). Epidemic curves indicated multiple probable outbreak types, characterized by a point source (AJS and AWD under 5 years), common source (AWD in 5 years and above), propagated source (ARI and dysentery), and intermittent source (AFP, measles, meningitis, diphtheria, NT, and unusual events). The sensitivity and PPV were estimated at 81.0% (798.9% -83.1%) and 72.0% (68.0% -75.0%), respectively.The EWARS Mobile is a practical solution for Eastern Chad provinces to implement throughout the pre-epidemic and outbreak periods in vulnerable children in this severe humanitarian crisis. However, efforts should be made to improve timeliness indicators in all sub-national levels and incorporate alarm indicators.