The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents
Authors: Schubert Grit , Achi Vincent , Ahuka Steve , Belarbi Essia , Bourhaima Ouattara , Eckmanns Tim , Johnstone Siobhan , Kabore Firmin , Kra Ouffoue , Mendes Adriano , Ouedraogo Abdoul-Salam , Poda Armel , Some Arsène Satouro , Tomczyk Sara , Couacy-Hymann Emmanuel , Kayembe Jean-Marie , Meda Nicolas , Muyembe Tamfum Jean-Jacques , Ouangraoua Soumeya , Page Nicola , Venter Marietjie , Leendertz Fabian H. , Akoua-Koffi Chantal ,   the ANDEMIA consortium, Kouadio Vincent Assé , Aka-Tano Aude , Diarrassouba Adoulaye , Anoh Etilé , Traoré Adjaratou , Sounan Fidèle Touré , Karidioula Safiatou , Kizito Gabriel Mbunsu , Izizag Benilde Bepouka , Mpwekela Nicole , Kabengele Benoit , Alama Nicole , Tshiani Olivier , Lusamaki Eddy Kinganda , Muyembe Baby , Mitongo Naomie , Manienga John , Lionzo Franck , Mbandu Alliance , Makiala Sheila , Sin Muna Abu , Gröschner Karin , Köhler Susanne , Niendorf Sandra , Nowak Kathrin , Pitzinger Paul , Sachse Andreas , Vietor Ann Christin , Thomas Juno , Walaza Sibongile , de Gouvea Linda , von Mollendorf Claire , Quan Vanessa , Keddy Karen , Smith Anthony , Ramalwa Ntsieni , Avenant Theunis , du Plessis Nicolette , Menu Kgothatso , Pretorius Marthi , McIntyre Caitlyn , Bonnet Elise , Jeal Rebecca 
Published: June 2021

Abstract
Background
In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa.

Methods
ANDEMIA includes 12 urban and rural health care facilities in four African countries (Côte d’Ivoire, Burkina Faso, Democratic Republic of the Congo and Republic of South Africa). It was piloted in 2018 in Côte d’Ivoire and the initial phase will run from 2019 to 2021. Case definitions for ARI, GI and AFDUC were established, as well as syndrome-specific sampling algorithms including the collection of blood, naso- and oropharyngeal swabs and stool. Samples are tested using comprehensive diagnostic protocols, ranging from classic bacteriology and antimicrobial resistance screening to multiplex real-time polymerase chain reaction (PCR) systems and High Throughput Sequencing. In March 2020, PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and analysis of full genomic information was included in the study. Standardised questionnaires collect relevant clinical, demographic, socio-economic and behavioural data for epidemiologic analyses. Controls are enrolled over a 12-month period for a nested case-control study. Data will be assessed descriptively and aetiologies will be evaluated using a latent class analysis among cases. Among cases and controls, an integrated analytic approach using logistic regression and Bayesian estimation will be employed to improve the assessment of aetiology and associated risk factors.

Discussion
ANDEMIA aims to expand our understanding of ARI, GI and AFDUC aetiologies in sub-Saharan Africa using a comprehensive laboratory diagnostics strategy. It will foster early detection of emerging threats and continued monitoring of important common pathogens. The network collaboration will be strengthened and site diagnostic capacities will be reinforced to improve quality management and patient care.