Using a community-based surveillance program to rapidly screen internally displaced children for malnutrition and undervaccination in northwest Syria

BACKGROUND AND OBJECTIVES

The community-based surveillance (CBS) program was implemented in MSF-supported internally displaced person camps in Northwest Syria between 2022 and 2024. Information on disease surveillance and key health indicators in the community was collected systematically by trained community health workers (CHWs) and analysed in real time. In 2024, nutrition and vaccination modules were added to the program to rapidly screen, identify, and refer at-risk children aged 6–59 months and to generate population-level estimates.

METHODS/STUDY DESIGN

Bilingual English/Arabic screening modules were adapted from standardized surveys and integrated into the existing CBS questionnaire through the KoBo platform. Data were collected by 45 CHWs during routine household visits. The questionnaire was designed to allow real-time identification of acute malnutrition, zero-dose status, and missed vaccinations, and to recommend referrals to the nearest appropriate facility for further management. Programmatic data analysis was performed using standardized R scripts and Excel.

RESULTS/EXPECTED RESULTS

Nutrition screening was conducted from July to September 2024 and reached 4,410 children. Of these, 72 had moderate acute malnutrition and 24 had severe acute malnutrition. While all children were referred for treatment, receipt of care could not be fully ascertained due to inconsistent service availability and severe funding constraints affecting nutrition programs. Vaccination coverage screening was conducted from October to December 2024. Of the 5,146 children reached, 3% were zero-dose and 12% were undervaccinated. All identified children were referred, and 52% were confirmed to have received vaccinations. Activities were disrupted in November and December due to insecurity but resumed once the situation improved.

CONCLUSIONS/DISCUSSION

Existing community-based surveillance programs, particularly in displaced communities, provide a highly adaptable infrastructure for the rapid implementation of household surveys and screening programs. Digital survey methodologies, when feasible, offer greater flexibility, particularly for real-time diagnosis and referral. The system’s standardized tools and workflows enable replication of this approach in other settings. Although MSF may not directly provide certain services, regular service mapping of non-MSF facilities can support timely linkage to needed care.