Effectiveness of infectious disease surveillance and response: Finding the missing link in cholera contact tracing - insights from Lusaka’s Response Teams, Zambia

Cholera continues to pose a major public health challenge globally, especially across Sub-Saharan Africa and South Asia. Zambia has long grappled with recurring cholera outbreaks, which have worsened over the years. To evaluate the effectiveness of current cholera response systems, we used mixed-methods using parallel convergent design. We used a questionnaire, focus group discussions, and non-participatory observations during field visits to collect data from 32 contact tracing team members. Our results showed that team member involvement was moderately and significantly positively correlated with cases found during contact tracing (r = 0.521, p = 0.002), indicating that comprehensive contact tracing is crucial for identifying cholera cases. However, we also found potential weaknesses in the contact tracing process, including low rates of household re-visitations and limited cases (symptomatic or asymptomatic) found during contact tracing. The study's findings suggest that optimizing contact tracing protocols and improving team effectiveness could help maximize the impact of outbreak response efforts.