ReviewConflict and health2022
Evaluation of the electronic Early Warning and Response Network (EWARN) system in Somalia, 2017-2020.
Review in Conflict and health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Barriers and facilitators to the implementation of integrated disease surveillance and response (IDSR) in Africa: a systematic review using the consolidated framework for implementation research (CFIR).Frontiers in public health · 2026Pooled it
- Cholera in Lagos State, Nigeria: a One Health perspective on outbreaks and public health interventions.Frontiers in public health · 2026Pooled it
- Strengthening Ebola virus disease preparedness in Somalia: Lessons from the 2026 Eastern DRC outbreak for early warning and rapid response.Journal of virus eradication · 2026Article
- Article
- Trend of measles outbreak in Galmudug, Somalia: a retrospective study from 2023 to 2024.Frontiers in public health · 2026Article
- Core competency gaps among Somalia's disease surveillance workforce: a cross-sectional study.The Pan African medical journal · 2026Article
- Strengthening Clinical Epidemiology in Somalia: Challenges, Opportunities, and Future Directions.Clinical epidemiology · 2026Article
- Climate-informed surveillance for climate-sensitive infectious diseases in Somalia: early warning systems, policy gaps, and preparedness priorities.Frontiers in epidemiology · 2026Review
- The prolonged devastation of climate change on public health in Somalia: a silent crisis.Tropical medicine and health · 2025Review
- The future impact of zero-dose children in inaccessible conflict-affected areas of Somalia: aligned with the immunization agenda 2030.Tropical medicine and health · 2025Article
- Enhancing epidemic preparedness: a data-driven system for managing respiratory infections.BMC infectious diseases · 2025Article
- Community-based surveillance programme evaluation using the platform Nyss implemented by the Somali Red Crescent Society-a mixed methods approach.Conflict and health · 2024Article
- Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016-2023.Frontiers in public health · 2023Review
- The importance of community health workers as frontline responders during the COVID-19 pandemic, Somalia, 2020-2021.Frontiers in public health · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
backgroundIn 2008, Somalia introduced an electronic based Early Warning Alert and Response Network (EWARN) for real time detection and response to alerts of epidemic prone diseases in a country experiencing a complex humanitarian situation. EWARN was deactivated between 2008 to 2016 due to civil conflict and reactivated in 2017 during severe drought during a cholera outbreak. We present an assessment of the performance of the EWARN in Somalia from January 2017 to December 2020, reflections on the successes and failures, and provide future perspectives for enhancement of the EWARN to effectively support an Integrated Disease Surveillance and Response strategy.
methodsWe described geographical coverage of the EWARN, system attributes, which included; sensitivity, flexibility, timeliness, data quality (measured by completeness), and positive predictive value (PPV). We tested for trends of timeliness of submission of epidemiological reports across the years using the Cochran-Mantel-Haenszel stratified test of association.
resultsBy December 2020, all 6 states and the Banadir Administrative Region were implementing EWARN. In 2017, only 24.6% of the records were submitted on time, but by 2020, 96.8% of the reports were timely (p < 0.001). Completeness averaged < 60% in all the 4 years, with the worst-performing year being 2017. Overall, PPV was 14.1%. Over time, PPV improved from 7.1% in 2017 to 15.4% in 2019 but declined to 9.7% in 2020. Alert verification improved from 2.0% in 2017 to 52.6% by 2020, (p < 0.001). In 2020, EWARN was enhanced to facilitate COVID-19 reporting demonstrating its flexibility to accommodate the integration of reportable diseases.
conclusionsDuring the past 4 years of implementing EWARN in Somalia, the system has improved significantly in timeliness, disease alerts verification, and flexibility in responding to emerging disease outbreaks, and enhanced coverage. However, the system is not yet optimal due to incompleteness and lack of integration with other systems suggesting the need to build additional capacity for improved disease surveillance coverage, buttressed by system improvements to enhance data quality and integration.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.