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Evaluation of influenza surveillance systems in sub-Saharan Africa: a systematic review protocol
  1. Evanson Zondani Sambala1,2,
  2. Duduzile Edith Ndwandwe1,
  3. Loveness M Imaan2,3,
  4. Charles S Wiysonge1,4,5
  1. 1 Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, Western Cape, South Africa
  2. 2 Malawi Public Health Forum, Lilongwe, Malawi
  3. 3 Social Work Department, Catholic University of Malawi, Blantyre, Malawi
  4. 4 Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  5. 5 Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Evanson Zondani Sambala; evanson.sambala{at}


Introduction Influenza infrastructure systems are crucial for maintaining surveillance operations, and for mitigating and responding to the disease. The role of surveillance is to isolate and identify as rapidly as possible any new influenza strains and collate this information for the preparedness for, and response to, an impending influenza activity in humans. However, sources of surveillance information, particularly in Africa, are meagre. This systematic review will critically evaluate the existing influenza surveillance systems in sub-Saharan Africa.

Method and analysis We will build multiple electronic database search strategies for use in PubMed, Scopus, African Journal Online, Web of Science and Google scholar to identify as many studies as possible. The medical subject heading and keywords will include a wide range of synonyms, both in index terms and free-text words. Database search will be followed by hand searching of reference lists of all relevant studies. We will include eligible full-text studies published from 2002 in order to coincide with the establishment of the integrated disease surveillance and response system in Africa by WHO. We will examine the influenza surveillance performance systems using the US Centers for Disease Control and Prevention guidelines on evaluating public health surveillance systems. Our outcome measures will include surveillance system attributes such as timeliness, sensitivity, specificity, acceptability, representativeness, simplicity and usefulness. We will conduct a narrative synthesis of all studies.

Ethics and dissemination This study does not require ethics approval because it uses publicly available data. Our findings will be published in a peer review journal and disseminated to policy makers.

PROSPERO registration number CRD42018103042.

  • influenza infrastructure systems
  • surveillance systems
  • burden of influenza
  • Sub Saharan Africa
  • influenza preparedness

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  • Patient consent for publication Not required.

  • Contributors EZS, DEN, LMI and CSW contributed to the conceptualisation of the review. EZS wrote the manuscript draft. EZS and LMI developed the search strategy. All authors revised and edited the manuscript draft and search strategy. All authors approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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