{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:30:19Z","timestamp":1791412219507,"version":"4.3.3"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T00:00:00Z","timestamp":1608681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Following an influx of an estimated 742,000 Rohingya refugees in Bangladesh, M\u00e9decins sans Fronti\u00e8res (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox\u2019s Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Suspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Between epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>The CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox\u2019s Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244214","type":"journal-article","created":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T19:18:33Z","timestamp":1608751113000},"page":"e0244214","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Evaluation of community based surveillance in the Rohingya refugee camps in Cox\u2019s Bazar, Bangladesh, 2019"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1168-8491","authenticated-orcid":true,"given":"Elburg","family":"Van Boetzelaer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samiur","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berhe","family":"Etsay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abu","family":"Faruque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2013-8405","authenticated-orcid":true,"given":"Annick","family":"Lenglet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kuehne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8845-3447","authenticated-orcid":true,"given":"Isidro","family":"Carrion-Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Keating","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martins","family":"Dada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorieke","family":"Vyncke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Sonne Kazungu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0047-149X","authenticated-orcid":true,"given":"Maria","family":"Verdecchia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,23]]},"reference":[{"key":"pone.0244214.ref001","volume-title":"Bangladesh Rohingya Emergency","author":"UNHCR","year":"2019"},{"key":"pone.0244214.ref002","unstructured":"UNHCR. Situation Refugee Response in Bangladesh. 2019. 2019."},{"issue":"8","key":"pone.0244214.ref003","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.3201\/eid2208.160205","article-title":"Assessment of community event-based surveillance for Ebola virus disease, Sierra Leone, 2015","volume":"22","author":"R Ratnayake","year":"2016","journal-title":"Emerg Infect Dis"},{"issue":"(6","key":"pone.0244214.ref004","article-title":"Event-based surveillance at health facility and community level in low-income and middle-income countries: A systematic review","volume":"4","author":"A Kuehne","year":"2019","journal-title":"BMJ Glob Heal"},{"key":"pone.0244214.ref005","unstructured":"MSF-OCA. Case Definitions and Epidemic Thresholds of Infectious Diseases with Epidemic Potential. 2018;"},{"issue":"11","key":"pone.0244214.ref006","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.3201\/eid2411.181237","article-title":"World health organization early warning, alert and response system in the Rohingya crisis, Bangladesh, 2017\u20132018","volume":"24","author":"B Karo","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"pone.0244214.ref007","unstructured":"Centers for Disease Control and Prevention (CDC). Updated guidelines for evaluating public health surveillance systems. 2001;"},{"issue":"1","key":"pone.0244214.ref008","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1505-6-11","article-title":"Implementation and utilisation of community-based mortality surveillance: a case study from Chad","volume":"6","author":"S Bowden","year":"2012","journal-title":"Confl Health"},{"key":"pone.0244214.ref009","first-page":"1","article-title":"Public health surveillance after the 2010 Haiti earthquake: The experience of M\u00e9decins Sans Fronti\u00e8res","author":"J Polonsky","year":"2013","journal-title":"PLoS Curr"},{"issue":"8","key":"pone.0244214.ref010","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.3201\/eid2208.160205","article-title":"Assessment of community event-based surveillance for Ebola virus disease, Sierra Leone, 2015","volume":"22","author":"R Ratnayake","year":"2016","journal-title":"Emerg Infect Dis"},{"key":"pone.0244214.ref011","article-title":"Community Event-Based Surveillance for Ebola Virus Disease in Sierra Leone: Implementation of a National-Level System During a Crisis","volume":"8","author":"E Stone","year":"2016","journal-title":"PLoS Curr"},{"key":"pone.0244214.ref012","unstructured":"MSF-OCA. Follow-up Health Survey in Kutulapong and Balukhali Refugee Settlements, Cox\u2019s Bazar, Bangladesh July 2018. 2018."},{"key":"pone.0244214.ref013","doi-asserted-by":"crossref","DOI":"10.1186\/1478-7954-10-18","article-title":"Sentinel site community surveillance of mortality and nutritional status in southwestern Central African Republic, 2010","volume":"10","author":"GM Caleo","year":"2012","journal-title":"Popul Health Metr"},{"issue":"1","key":"pone.0244214.ref014","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1742-7622-3-16","article-title":"Ethical issues in epidemiologic research and public health practice","volume":"3","author":"SS Coughlin","year":"2006","journal-title":"Emerg Themes Epidemiol"},{"issue":"S1","key":"pone.0244214.ref015","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1089\/hs.2018.0066","article-title":"Factors Influencing Community Event-based Surveillance: Lessons Learned from Pilot Implementation in Vietnam","volume":"16","author":"A Clara","year":"2018","journal-title":"Heal Secur"},{"issue":"9","key":"pone.0244214.ref016","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.3201\/eid2409.171851","article-title":"Event-based surveillance at community and healthcare facilities, Vietnam, 2016\u20132017.","volume":"24","author":"A Clara","year":"2018","journal-title":"Emerg Infect Dis"},{"issue":"4","key":"pone.0244214.ref017","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/j.1467-7717.2008.01085.x","article-title":"Cross-sectional survey methods to assess retrospectively mortality in humanitarian emergencies","volume":"33","author":"KL Cairns","year":"2009","journal-title":"Disasters"},{"issue":"3","key":"pone.0244214.ref018","first-page":"55","article-title":"Reproductive age mortality study (RAMOS) for capturing underreporting maternal mortality: Why is it important in the Rohingya refugee camps, Bangladesh?","volume":"3","author":"R. Paromita","year":"2019","journal-title":"Int J Perceptions Public Heal"},{"key":"pone.0244214.ref019","volume-title":"Eurosurveillance","author":"J Guerra","year":"2019"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0299167","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T00:00:00Z","timestamp":1707868800000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244214","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T19:19:08Z","timestamp":1608751148000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244214"}},"subtitle":[],"editor":[{"given":"Jennifer","family":"Yourkavitch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,23]]},"references-count":19,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0244214","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pone.0299167","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,23]]}}}