Participatory Disease Surveillance for the Early Detection of Cholera-Like Diarrheal Disease Outbreaks in Rural Villages in Malawi: Prospective Cohort Study

Abstract

Background: Cholera outbreaks are complex and influenced by environmental factors, socio-economic conditions, and population dynamics, leading to limitations in traditional surveillance methods. In Malawi, cholera is considered an endemic disease. Its epidemiological profile is characterized by seasonal patterns, often coinciding with the rainy season when contamination of water sources is more likely. However, the current outbreak has extended to the dry season, having deaths reported in all 29 districts since March 2022, and it has been considered the worst outbreak of the 10 past years. Objective:The study aims to evaluate the feasibility and outcomes of participatory surveillance using Interactive Voice Response technology for early detection of cholera-like diarrheal disease outbreaks in Malawi. Methods:The longitudinal cohort study followed up for 24 weeks, including 740 households in rural settings in Malawi. The survey tool was designed to have 10 symptom questions collected every week. The proxies' rationale was related to exanthematic, ictero-hemorragica for endemic diseases or events, diarrhea and respiratory/targeting acute diseases or events and Diarrhea and respiratory/targeting seasonal diseases or events. This present work will focus only on the CLDD as a proxy for gastroenteritis and cholera. The definition of CLDD utilized in this study was the following: reports that informed Diarrhea AND Fever OR Vomiting/Nausea. Results:During the period of the study, our data comprises 16,280 observations, achieving an average of 35% of weekly participation rate. Maganga TA showed the highest average of completed calls, 144.83 (SD = 10.587), while Ndindi TA showed an average of completed calls of 123.66 (SD = 13.176). Participation rates were slightly higher at the beginning of the study and presented a discrete decay over time, thanks to the sensitization activities rolled out at the CBCCs level. On the attack rates for CLDD, the study found close rates between Maganga TA and Ndindi TA, showing 16% and 15%, respectively.Conclusions: Participatory surveillance has proven to be of high value for the early detection of epidemics, and IVR technology is a promising approach for disease surveillance in rural villages in Africa, where access to healthcare and traditional disease surveillance methods may be limited. The study highlights the feasibility and potential of IVR technology for timely and comprehensive reporting of disease incidence, symptoms, and behaviors in resource-limited settings.