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Intro: Understanding sex-related differences and gendered roles in outbreak dynamics is critical to deliver an effective response. Despite existing recommendations and minimum requirements, collection, analysis, and use of sex-disaggregated data and gendered data, including operational analytics, is seldom included in outbreak response. Methods: A systematic literature review was conducted to examine the extent to which sex-disaggregated data and gendered data for outbreak analytics and responses are collected, analyzed, and utilized in low-and middle-income countries (LMIC). Five databases were searched for peer-reviewed literature examining sex- and gender-specific outcomes for communicable disease outbreaks, published in English between January 1, 2012, and April 12, 2022. Results were independently screened, and all articles meeting the inclusion criteria were included in the review. Findings: A total of 77 out of 15,601 screened articles were included in the analysis. Literature describes sex- and gender-related differences in outbreak susceptibility, risk of exposure, symptoms, and severity of illness, healthcare seeking behavior, and access to treatment and support services. Findings varied by disease, setting, and population. Gaps in the analysis and use of sex disaggregated data and gendered data in outbreak response were identified. The analysis showed that identified sex and gender-related differences were not systematically utilized to address sex and gender-related barriers to health, implement sex and gender specific prevention messaging, and adapt disease detection and treatment across all aspects of outbreak response. Conclusion: While sex data is often collected during outbreaks in LMIC, few publications disaggregated outcomes by sex or discussed gendered roles in outbreak dynamics, and even fewer examined the implications of the differential outcomes that were observed. Mounting evidence calls for an approach to outbreak prevention, detection, response, and recovery that includes sex and gender specificities. Systematic and context specific guidance for the collection, analysis, and utilization of sex-disaggregated data and gendered data is urgently needed.

BackgroundDespite the comprehensive World Health Organization (WHO)/United Nations Children's Fund (UNICEF) measles mortality-reduction strategy and the Measles Initiative, a partnership of international organizations supporting measles mortality reduction in Africa, certain high-burden countries continue to face recurrent epidemics. To our knowledge, few recent studies have documented measles mortality in sub-Saharan Africa. The objective of our study was to investigate measles mortality in three recent epidemics in Niamey (Niger), N'Djamena (Chad), and Adamawa State (Nigeria).Methods and findingsWe conducted three exhaustive household retrospective mortality surveys in one neighbourhood of each of the three affected areas: Boukoki, Niamey, Niger (April 2004, n = 26,795); Moursal, N'Djamena, Chad (June 2005, n = 21,812); and Dong District, Adamawa State, Nigeria (April 2005, n = 16,249), where n is the total surveyed population in each of the respective areas. Study populations included all persons resident for at least 2 wk prior to the study, a duration encompassing the measles incubation period. Heads of households provided information on measles cases, clinical outcomes up to 30 d after rash onset, and health-seeking behaviour during the epidemic. Measles cases and deaths were ascertained using standard WHO surveillance-case definitions. Our main outcome measures were measles attack rates (ARs) and case fatality ratios (CFRs) by age group, and descriptions of measles complications and health-seeking behaviour. Measles ARs were the highest in children under 5 y old (under 5 y): 17.1% in Boukoki, 17.2% in Moursal, and 24.3% in Dong District. CFRs in under 5-y-olds were 4.6%, 4.0%, and 10.8% in Boukoki, Moursal, and Dong District, respectively. In all sites, more than half of measles cases in children aged under 5 y experienced acute respiratory infection and/or diarrhoea in the 30 d following rash onset. Of measles cases, it was reported that 85.7% (979/1,142) of patients visited a health-care facility within 30 d after rash onset in Boukoki, 73.5% (519/706) in Moursal, and 52.8% (603/1,142) in Dong District.ConclusionsChildren in these countries still face unacceptably high mortality from a completely preventable disease. While the successes of measles mortality-reduction strategies and progress observed in measles control in other countries of the region are laudable and evident, they should not overshadow the need for intensive efforts in countries that have just begun implementation of the WHO/UNICEF comprehensive strategy.