Key Findings
Rabies cases in Africa are frequently underreported, with local data often either missing or inconsistently compiled due to complex, time-consuming processes. Previous attempts to address this issue have largely failed due to a lack of widespread adoption.
To tackle this, PARACON developed a new system built on the DHIS2 platform, which is already utilized by 40 African countries for reporting other diseases. The PARACON bulletin promotes data sharing at regional, national, and subnational levels, while also encouraging collaboration between the human and animal health sectors.
However, the success of rabies surveillance systems remains dependent on establishing basic surveillance infrastructure, which is currently inadequate in many African countries and has been highlighted as a critical area for improvement.
Summary
Rabies, a fully preventable disease, continues to pose a significant public health risk in many parts of Africa and Asia. Despite a global initiative to eliminate canine-mediated human rabies by 2030, achieving this goal is hindered by challenges in accurate data collection, reporting, and resource allocation. Accurate data is crucial for understanding the true burden of rabies and informing effective interventions.
This study, “Addressing the Disconnect between the Estimated, Reported, and True Rabies Data: The Development of a Regional African Rabies Bulletin”, outlines the data issues that impede rabies eradication efforts in Africa and the efforts by The Pan-African Rabies Control Network (PARACON) to tackle this.
Challenges and Current State
One of the primary barriers to rabies control is the disconnect between reported cases and the actual burden of the disease. In many African countries, rabies data collected at local levels is either not reported at the national level or is inconsistently aggregated, creating a gap between real-world figures and those officially recognized by health authorities. This is often driven by cumbersome processes, such as paper-based reporting systems.
As a result, rabies cases are grossly underreported, where the actual number of deaths may be 100 times higher than reported figures. This underreporting contributes to a false sense of security, reducing the priority placed on rabies control by governments and international organizations. As a result, rabies continues to be neglected compared to other, more visible health threats.
Previous Efforts to Improve Data Collection and Reporting
Africa faces significant challenges in improving rabies surveillance and reporting. While some countries have functional surveillance systems, many continue to rely on paper-based reporting methods, which are slow, cumbersome, and prone to errors. The lack of electronic data management systems in many countries further exacerbates the problem, leading to delays in reporting and poor data quality.
In response to these challenges, international organizations have developed several rabies-specific reporting systems. However, many of these systems have failed to take hold due to the underreporting issues present in national systems. For example, the World Health Organization (WHO) Rabnet system, which reported public health data on rabies, closed in 2011 due to a lack of submitted data. Similarly, the World Organization for Animal Health (OIE) World Animal Health Information System (WAHIS), which tracks veterinary data, is also limited by underreporting from national governments.
The Role of PARACON and the DHIS2 Platform
The Pan-African Rabies Control Network (PARACON) was established in 2014 to address the challenges of rabies surveillance and control in Africa. Managed by the Global Alliance for Rabies Control, PARACON aims to provide African countries with the tools and support needed to improve rabies reporting and data collection. To achieve this, PARACON has developed a rabies-specific bulletin using the District Health Information System 2 (DHIS2) platform, a web-based, open-access health information management system.
The DHIS2 platform is used by 40 countries throughout Africa for health surveillance and is adaptable for use in rabies reporting. By leveraging this system, PARACON aims to create a simple, efficient, and standardized method for collecting, managing, and analyzing rabies data. The platform allows for data to be automatically analyzed and shared with international authorities, reducing the burden on national governments while ensuring that data is readily available for intervention planning and advocacy.
Impact and Potential of the PARACON Bulletin
The implementation of a unified reporting system, as advocated by PARACON, has the potential to catalyze interest and rabies control initiatives across neighboring African countries. By evaluating shared data, nations can assess their progress and engage in a cooperative yet competitive effort to be the first to declare freedom from canine-mediated human rabies by 2030. Furthermore, the PARACON bulletin has been strategically designed not only to serve as a regional platform for collating national rabies data but also as a flexible framework that countries can adopt for their own national and subnational rabies surveillance systems. This dual functionality reinforces the bulletin’s importance in driving rabies elimination efforts on multiple governance levels.
The PARACON bulletin not only improves rabies surveillance but also fosters collaboration between human and animal health sectors. This cross-sectoral exchange is critical for tackling zoonotic diseases like rabies, where both human and animal health data are needed to develop comprehensive control strategies. The bulletin also provides valuable outputs for targeted interventions, such as identifying high-risk areas for rabies transmission, allowing for more focused and efficient control measures.
The PARACON bulletin represents a significant step forward in rabies control efforts in Africa. By encouraging countries to use standardized data indicators and adopt the DHIS2 platform, PARACON helps improve the quality of rabies data at the national, regional, and global levels. Initial feedback from countries involved in PARACON workshops has been positive, with participants reporting that the bulletin is easy to use and effective for rabies reporting.
Challenges and Future Directions
Despite the progress made by PARACON, challenges remain. The success of rabies surveillance systems depends on the foundation of basic surveillance, which is lacking in many African countries. Some countries lack the laboratory capacity to confirm rabies cases, and logistical constraints often prevent the timely submission of data. Additionally, the sustainability of surveillance systems is a concern, as many rely on donor funding, which may be discontinued.
Nevertheless, PARACON’s efforts to simplify and standardize rabies reporting provide a promising model for improving rabies surveillance in Africa. As more countries adopt the PARACON bulletin and improve their data collection systems, the true burden of rabies will become clearer. Additionally, the integration of regional bulletins into a global database can further enhance the impact of these efforts. By streamlining data reporting and management, we can reduce reporting burdens and convince stakeholders of the feasibility of rabies elimination. With these tools and international support, the 2030 target for rabies elimination will become attainable.
Miscellaneous
Data From Study:
–
Year of Publication:
2017
External Link:
Scott TP, Coetzer A, Fahrion AS and Nel LH (2017) Addressing the Disconnect between the Estimated, Reported, and True Rabies Data: The Development of a Regional African Rabies Bulletin. Front. Vet. Sci. 4:18. doi: 10.3389/fvets.2017.00018
https://doi.org/10.3389/fvets.2017.00018