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Volume 26, Number 11—November 2020
Synopsis

Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019

Benido ImpoumaComments to Author , Maroussia Roelens, George Sie Williams, Antoine Flahault, Claudia Torres Codeço, Fleury Moussana, Bridget Farham, Esther L. Hamblion, Franck Mboussou, and Olivia Keiser
Author affiliations: World Health Organization Regional Office for Africa, Brazzaville, Congo (B. Impouma, G. Williams, F. Moussana, B. Farham, E.L. Hamblion, F. Mboussou); Institute of Global Health, University of Geneva, Switzerland (M. Roelens, A. Flahault, O. Keiser); Fundacao Oswaldo Cruz Ringgold Standard Institution, Rio de Janeiro, Brazil (C.T. Codeço)

Main Article

Table 3

Results of multivariable Cox proportional hazard regression analysis of substantiated outbreaks by predictor variables, WHO African Region, 2017–2019*

Categories Total no.† Time to detection (15) Time to notification (15) Time to end (15)
Income (16)
Low 156 Referent Referent Referent
Middle and high 140 1.01 (0.68–1.52) 1.11 (0.71–1.73) 1.07 (0.78–1.73)
Significance
p = 0.5147
 p = 0.6289
 p = 0.1513
WHO subregion (10)
Eastern and Southern 133 Referent Referent Referent
Western 102 1.02 (0.52–1.46) 0.84 (0.47–1.50) 0.94 (0.56–1.54)
Central 61 0.81 (0.49–1.38) 1.13 (0.65–1.97) 0.55 (0.33–0.90)
Significance
p = 0.0427
 p = 0.6784
 p = 0.0608
Outbreak start date‡ (15)
2017 103 Referent Referent Referent
2018 101 1.68 (1.16–2.34) 0.46 (0.31–0.70) 1.57 (1.08–2.27)
2019 87 2.59 (1.71–3.94) 0.40 (0.25–0.64) 0.94 (0.63–1.43)
Significance
p = 0.0000
 p = 0.0000
 p = 0.0182
No. refugees from elsewhere (13)
Low‡ 199 Referent Referent Referent
High‡ 97 1.61 (0.96–2.70) 0.82 (0.45–1.48) 0.80 (0.48–1.33)
Significance
p = 0.2017
 p = 0.8066
 p = 0.0236
IDP, % population (13)
Low‡ 212 Referent Referent Referent
High‡ 84 1.01 (0.64–2.70) 1.38 (0.85–2.23) 0.70 (0.47–1.04)
Significance
p = 0.8446
 p = 0.2843
 p = 0.0163
Disease category (13)
Food/waterborne 74 Referent Referent Referent
Vectorborne 48 0.59 (0.34–1.03) 1.18 (0.63–2.22) 0.89 (0.54–1.45)
Viral hemorrhagic fever 56 0.40 (0.25–0.66) 1.57 (0.89–2.77) 1.20 (0.75–1.91)
Vaccine-preventable 85 0.46 (0.29–0.73) 1.19 (0.69–2.05) 0.53 (0.34–0.83)
Other 33 0.44 (0.34–1.05) 0.91 (0.47–1.78) 1.45 (0.85–2.46)
Significance
p = 0.0023
 p = 0.4704
 p = 0.0014
Current health expenditure, % GDP (13)
Low§ 162 Referent Referent Referent
High§ 134 1.11 (0.75–1.65) 0.93 (0.58–1.49) 1.02 (0.69–1.51)
Significance
p = 0.5415
 p = 0.7700
 p = 0.9354
Population density (13)
Low§ 201 Referent Referent Referent
High§ 95 1.10 (0.74–1.61) 0.98 (0.64–1.49) 0.96 (0.67–1.38)
Significance p = 0.6555 p = 0.9258 p = 0.8251

*GDP, gross domestic product; IDP, internally displaced persons; IQR, interquartile range.
†Numbers, based on records of total outbreaks meeting selection criteria (total for each modality = 296). 
‡Five dates missing in initial dataset. 
§Low indicates < median, high indicates > median of in-country value for variable compared with that value for all countries in the African region.

Main Article

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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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