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Analysis
The 117 call alert system in Sierra Leone: from rapid Ebola notification to routine death reporting
  1. Charles Alpren1,
  2. Mohamed F Jalloh2,
  3. Reinhard Kaiser1,
  4. Mariam Diop3,
  5. SAS Kargbo4,
  6. Evelyn Castle3,
  7. Foday Dafae4,
  8. Sara Hersey1,
  9. John T Redd2,
  10. Amara Jambai4
  1. 1Centers for Disease Control and Prevention, Freetown, Sierra Leone
  2. 2Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3eHealth Africa, Freetown, Sierra Leone
  4. 4Ministry of Health and Sanitation, Freetown, Sierra Leone
  1. Correspondence to Dr Charles Alpren; nra8{at}cdc.gov

Abstract

A toll-free, nationwide phone alert system was established for rapid notification and response during the 2014–2015 Ebola epidemic in Sierra Leone. The system remained in place after the end of the epidemic under a policy of mandatory reporting and Ebola testing for all deaths, and, from June 2016, testing only in case of suspected Ebola. We describe the design, implementation and changes in the system; analyse calling trends during and after the Ebola epidemic; and discuss strengths and limitations of the system and its potential role in efforts to improve death reporting in Sierra Leone. Numbers of calls to report deaths of any cause (death alerts) and persons suspected of having Ebola (live alerts) were analysed by province and district and compared with numbers of Ebola cases reported by the WHO. Nearly 350 000 complete, non-prank calls were made to 117 between September 2014 and December 2016. The maximum number of daily death and live alerts was 9344 (October 2014) and 3031 (December 2014), respectively. Call volumes decreased as Ebola incidence declined and continued to decrease in the post-Ebola period. A national social mobilisation strategy was especially targeted to influential religious leaders, traditional healers and women’s groups. The existing infrastructure and experience with the system offer an opportunity to consider long-term use as a death reporting tool for civil registration and mortality surveillance, including rapid detection and control of public health threats. A routine social mobilisation component should be considered to increase usage.

  • epidemiology
  • health systems
  • public health
  • viral haemorrhagic fevers
  • descriptive study

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2017-000392

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    Footnotes

    • Contributors All coauthors: contributed to the conceptualisation and design of the analysis plan. CA and MFJ led the data analysis with technical support from RK and JTR. All coauthors contributed to the interpretation of the results and preparation of the manuscript.

    • Funding Several authors are US government employees. This work was conducted as part of authors' normal duties and required no separate funding.

    • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

    • Competing interests None declared.

    • Ethics approval This analysis was reviewed and approved by Centers for Disease Control and Prevention, Center for Global Health Human Subjects Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.