Data Innovation in Response to COVID-19 in Somalia: Application of a Syndromic Case Definition and Rapid Mortality Assessment Method

Background During the COVID-19 pandemic, the importance of reliable public health data has been highlighted, as well as the multiple challenges in collecting it, especially in low income and conflict-affected countries. Somalia reported its first confirmed case of COVID-19 on 16 March 2020 and has experienced fluctuating infection levels since then. Objectives To monitor the impact of COVID-19 on beneficiaries of a long-term cash transfer programme in Somalia and assess the utility of a syndromic score case definition and rapid mortality surveillance tool. Methods Five rounds of telephone interviews were conducted from June 2020 - April 2021 with 1,046-1,565 households participating in a cash transfer programme. The incidence of COVID-19 symptoms and all-cause mortality were recorded. Carers of the deceased were interviewed a second time using a rapid verbal autopsy questionnaire to determine symptoms preceding death. Data were recorded on mobile devices and analysed using COVID Rapid Mortality Surveillance (CRMS) software and R. Results The syndromic score case definition identified suspected symptomatic cases that were initially confined to urban areas but then spread widely throughout Somalia. During the first wave, the peak syndromic case rate (311 cases/million people/day) was 159 times higher than the average laboratory confirmed case rate reported by WHO for the same period. Suspected COVID-19 deaths peaked at 14.3 deaths/million people/day, several weeks after the syndromic case rate. Crude and under-five death rates did not cross the respective emergency humanitarian thresholds (1 and 2 deaths/10,000 people/day). Conclusion Use of telephone interviews to collect data on the evolution of COVID-19 outbreaks is a useful additional approach that can complement laboratory testing and mortality data from the health system. Further work to validate the syndromic score case definition and CRMS is justified.