%0 Journal Article
%T Detection of infectious disease outbreaks in twenty-two fragile states, 2000-2010: a systematic review
%A Catherine Bruckner
%A Francesco Checchi
%J Conflict and Health
%D 2011
%I BioMed Central
%R 10.1186/1752-1505-5-13
%X We identified 61 reports concerning 38 outbreaks. Twenty of these were detected by existing surveillance systems, but 10 detections occurred following formal notifications by participating health facilities rather than data analysis. A further 15 outbreaks were detected by informal notifications, including rumours.There were long delays from onset to detection (median 29 days) and from detection to further events (investigation, confirmation, declaration, control). Existing surveillance systems yielded the shortest detection delays when linked to reduced barriers to health care and frequent analysis and reporting of incidence data.Epidemic surveillance and control appear to be insufficiently timely in fragile states, and need to be strengthened. Greater reliance on formal and informal notifications is warranted. Outbreak reports should be more standardised and enable monitoring of surveillance systems' effectiveness.The World Bank describes a fragile state as a country 'facing particularly severe development challenges such as weak institutional capacity, poor governance, political instability, and frequently ongoing violence or the legacy effects of past severe conflict' [1].In 2009, 29 countries were considered fragile, comprising a sixth of the world's population [2,3]. Fragile states generally feature poor health indicators, high malnutrition prevalence, scarcity of skilled health workers and worsening rates of extreme poverty [4-6]. Their populations are also highly vulnerable to infectious disease outbreaks, a reflection of inadequate government services and armed conflict-related phenomena such as forced displacement [7]. It has been suggested that most major epidemics worldwide occur in complex emergency and/or natural disaster settings [8].Detection and early containment of outbreaks in these settings is also challenging, as highlighted by the Global Polio Eradication Initiative's recent setbacks in several fragile states, where genetic analysis has demonst
%U http://www.conflictandhealth.com/content/5/1/13