The Validity of Clinic-Based Nutrition Surveillance Data: A Study from Selected Sites in Northern Malawi

Many developing countries collect on the weight for age of children attending health facilities as one element of a nutrition surveillance system. This study compares the estimates of malnutrition from seven health clinics in northern Malawi with estimates derived from nearby community-level surveys. The results show that prevalence of underweight in clinics does not accurately reflect community prevalence. Clinic estimates often differ by two- to threefold from community estimates, and the direction of the bias is not constant across clinics, making these data an invalid basis for targeting programmes according to nutritional need. Similar results were reported in five other studies in the literature, indicating that the Malawi results are not unusual. It is suggested that, contrary to current practice, cross-sectional clinic-based data should be assumed invalid for targeting purposes unless proved otherwise in a given country. Trend data at regional and country levels require further validation.

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Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020060 ◽

2021 ◽

Vol 6 (2) ◽

pp. 60

Author(s):

Jyoti Acharya ◽

Maria Zolfo ◽

Wendemagegn Enbiale ◽

Khine Wut Yee Kyaw ◽

Meika Bhattachan ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Surveillance System ◽

Surveillance Data ◽

World Health ◽

Cross Sectional ◽

Antimicrobial Resistance Surveillance ◽

Data Collection Process ◽

Data Compilation ◽

Site Variation ◽

Health Organization

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.

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Evaluation of Measles Surveillance Systems in Ginnir District, Bale Zone, Southeast Ethiopia: A Concurrent Embedded Mixed Quantitative/Qualitative Study

10.21203/rs.3.rs-115297/v1 ◽

2020 ◽

Author(s):

Falaho Sani ◽

Mohammed Hasen ◽

Mohammed Seid ◽

Nuriya Umer

Keyword(s):

Public Health ◽

Qualitative Study ◽

Surveillance System ◽

Public Health Surveillance ◽

Health Surveillance ◽

Health Facilities ◽

Surveillance Data ◽

Surveillance Systems ◽

Southeast Ethiopia ◽

Bale Zone

Abstract Background: Public health surveillance systems should be evaluated periodically to ensure that the problems of public health importance are being monitored efficiently and effectively. Despite the widespread measles outbreak in Ginnir district of Bale zone in 2019, evaluation of measles surveillance system has not been conducted. Therefore, we evaluated the performance of measles surveillance system and its key attributes in Ginnir district, Southeast Ethiopia.Methods: We conducted a concurrent embedded mixed quantitative/qualitative study in August 2019 among 15 health facilities/study units in Ginnir district. Health facilities are selected using lottery method. The qualitative study involved purposively selected 15 key informants. Data were collected using semi-structured questionnaire adapted from Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems through face-to-face interview and record review. The quantitative findings were analyzed using Microsoft Excel 2016 and summarized by frequency and proportion. The qualitative findings were narrated and summarized based on thematic areas to supplement the quantitative findings.Results: The structure of surveillance data flow was from the community to the respective upper level. Emergency preparedness and response plan was available only at the district level. Completeness of weekly report was 95%, while timeliness was 87%. No regular analysis and interpretations of surveillance data, and the supportive supervision and feedback system was weak. The participation and willingness of surveillance stakeholders in implementation of the system was good. The surveillance system was found to be useful, easy to implement, representative and can accommodate and adapt to changing conditions. Report documentation and quality of data was poor at lower level health facilities. Stability of the system has been challenged by shortage of budget and logistics, staff turnover and lack of update trainings.Conclusions: The surveillance system was acceptable, useful, simple, flexible and representative. Data quality, timeliness and stability of the system were attributes that require improvement. The overall performance of measles surveillance system in the district was poor. Hence, regular analysis of data, preparation and dissemination of epidemiological bulletin, capacity building and regular supervision and feedback are recommended to enhance performance of the system.

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Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh

International Journal for Equity in Health ◽

10.1186/s12939-020-01265-6 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Shehrin Shaila Mahmood ◽

Sabrina Rasheed ◽

Asiful Haidar Chowdhury ◽

Aazia Hossain ◽

Mohammad Abdus Selim ◽

...

Keyword(s):

Developing Countries ◽

Health Service ◽

Service Delivery ◽

Healthcare Providers ◽

Health Service Delivery ◽

Health Facilities ◽

Community Level ◽

Community Clinics ◽

Rural Bangladesh ◽

Initial Outcome

Abstract Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare providers, and government personnel, document reviews and meeting observations were used in analysis. Results The study showed that participants were enthusiastic and willing to take part in the CSC intervention. They perceived CSC to be useful in raising awareness about health in the community and facilitating structured monitoring of CC services. The process facilitated building stronger community ownership, enhancing accountability and stakeholder engagement. The participants identified issues around service provision, set SMART (specific, measurable, attainable, relevant and time-bound) targets and indicators on supplies, operations, logistics, environment, and patient satisfaction through CSC. However, some systematic and operational challenges of implementation were identified including time and resource constraint, understanding and facilitation of CSC, provider-user conflict, political influence, and lack of central level monitoring. Conclusion The findings suggest that CSC is a feasible and acceptable tool to engage community and healthcare providers in monitoring and managing health facilities. For countries with health systems faced with challenges around accountability, quality and coverage, CSC has the potential to improve community level health-service delivery. The findings are intended to inform program implementers, donors and other stakeholders about context, mechanisms, outcomes and challenges of CSC implementation in Bangladesh and other developing countries. However, proper contextualization, institutional capacity building and policy integration will be critical in establishing effectiveness of CSC at scale.

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Evaluation of community-based disease surveillance systems for priority disease detection in Nairobi County Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20213763 ◽

2021 ◽

Vol 8 (10) ◽

pp. 4692

Author(s):

Annastacia Katuvee Muange ◽

John Kariuki ◽

James Mwitari

Keyword(s):

Community Involvement ◽

Surveillance System ◽

Disease Surveillance ◽

Cross Sectional Study ◽

Health Facilities ◽

Surveillance Systems ◽

Case Definitions ◽

Community Based ◽

Study Program ◽

Cross Sectional

Background: Community based disease surveillance (CBDS) may be defined as an active process of community involvement in identification, reporting, responding to and monitoring diseases and public health events of concern in the community. The scope of CBS is limited to systematic continuous collection of health data on events and diseases guided by simplified lay case definitions and reporting to health facilities for verification, investigation, collation, analysis and response as necessary.Methods: A cross sectional study design, interventions study program was adopted to determine the effectiveness of CBDS in detecting of priority diseases. Purposive and random sampling methods was employed to select the respondents.Results: The results of the study assisted the Ministry of health to understand the effectiveness of Community based surveillance in detection of priority diseases and hence strengthen the community-based surveillance initiative. From the findings, the integrated disease surveillance data for five years from 2014-2018 shows, more cases of priority diseases reported in health facilities linked to a community unit trained on CBDS. Cholera (9/5), Malaria (4757/2789), Neonatal tetanus (27/3) respectively.Conclusions: The study concluded that, use of community-based surveillance system, improves detection of the notifiable diseases in the community. The study revealed that there is a gap on training of community-based disease surveillance system and therefore there is need for continuous refresher trainings on CBDS to the CHVs and CHAs to accommodate also the newly recruited.

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Gender Difference in the Incidence of Malaria Diagnosed at Public Health Facilities in Uganda

10.21203/rs.3.rs-861110/v1 ◽

2021 ◽

Author(s):

Jaffer Okiring ◽

Adrienne Epstein ◽

Jane F. Namuganga ◽

Emmanuel V. Kamya ◽

Isaiah Nabende ◽

...

Keyword(s):

Public Health ◽

Gender Difference ◽

Poisson Regression ◽

Regression Models ◽

Health Facilities ◽

Surveillance Data ◽

Malaria Surveillance ◽

Cross Sectional ◽

Public Health Facilities ◽

The Cross

Abstract BackgroundRoutine malaria surveillance data in Africa primarily come from public health facilities reporting to national health management information systems. Although information on gender is routinely collected from patients presenting to these health facilities, stratification of malaria surveillance data by gender is rarely done. This study evaluated gender difference among patients diagnosed with laboratory confirmed malaria at public health facilities in Uganda.MethodsThis study utilized individual level patient data collected from January 2020 through April 2021 at 12 public health facilities in Uganda and cross-sectional surveys conducted in target areas around these facilities in April 2021. Associations between gender and the incidence of malaria and non-malarial visits captured at the health facilities from patients residing within the target areas were estimated using poisson regression models controlling for seasonality. Associations between gender and data on health seeking behaviour from the cross-sectional surveys were estimated using poisson regression models controlling for seasonality. ResultsOverall, incidence of malaria diagnosed per 1000 person years was 735 among females and 449 among males (IRR=1.72, 95% CI 1.68-1.77, p<0.001), with larger differences among those 15-39 years (IRR=2.46, 95% CI 2.34-2.58, p<0.001) and over 39 years (IRR=2.26, 95% CI 2.05-2.50, p<0.001) compared to those under 15 years (IRR=1.46, 95% CI 1.41-1.50, p<0.001). Female gender was also associated with a higher incidence of visits where malaria was not suspected (IRR=1.77, 95% CI 1.71-1.83, p<0.001), with a similar pattern across age strata. These associations were consistent across the 12 individual health centres. From the cross-sectional surveys, females were more likely than males to report fever in the past 2 weeks and seek care at the local health centre (7.5% vs 4.7%, p=0.001) with these associations significant for those 15-39 years (RR=2.49, 95% CI 1.17-5.31, p=0.018) and over 39 years (RR=2.56, 95% CI 1.00-6.54, p=0.049). ConclusionsFemales disproportionately contribute to the burden of malaria diagnosed at public health facilities in Uganda, especially once they reach childbearing age. Contributing factors included more frequent visits to these facilities independent of malaria and a higher reported risk of seeking care at these facilites for febrile illnesses.

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Delay in Making Decision to Seeking Care on Institutional Delivery and Associated Factors Among Mothers Who Gave Birth in South Gondar Zone Hospitals,2020. A Cross-sectional Study

10.21203/rs.3.rs-349973/v1 ◽

2021 ◽

Author(s):

Gebrehiwot Ayalew Tiruneh ◽

Dawit Tiruneh Arega ◽

Bekalu Getnet Kassa ◽

Keralem Anteneh Bishaw

Keyword(s):

Developing Countries ◽

Rural Area ◽

Associated Factors ◽

Institutional Delivery ◽

Statistical Significance ◽

Cross Sectional Study ◽

Health Facilities ◽

Sectional Study ◽

Cross Sectional ◽

South Gondar

Abstract Background: Delay to making decision to seeking care contributes to high maternal mortality and morbidity in developing countries. Major factor that contribute to maternal death in developing countries is decision-making to seek care. This study aimed at assessing the prevalence and associated factors of delay in making decision to seeking care on institutional delivery among mothers who gave birth in South Gondar zone hospitals, Ethiopia, 2020.Methods: An institution-based cross-sectional study design was conducted from September1-October30/2020 with 650 mothers were participated in this study using a systematic random sampling technique. Data were collected using a face-to-face interview with pretested semi-structured questionnaires Bi-variable and multi-variable analyses conducted and the Odds ratio with 95% CI was estimated to identify factors of delay to making decision to seeking care. The statistical significance was declared at p < 0.05.Results: Delay in making decision to seeking care on institutional delivery was found to be 36.3% (95%CI=32.6 to 40.1). The mean age of the respondents was 27.23 with a standard deviation of 5.67. Mothers who reside in rural area (AOR=3.14,95%, CI:2.40-4.01), uneducated mothers (AOR= 3.62, 95%, CI:2.45-5.52), unplanned of pregnancy (AOR: 2.01, 95% CI: 1.84-7.96), and no health facilities in Keble (AOR: 1.62, 95% CI: 1.43-6.32) were statistically associated with delay to making decision to seeking care.Conclusion: One in three delivered mothers had been delayed in making decision to seek care in South Gondar zone. Pregnant mothers living in the rural area, unplanned of pregnancy, uneducated mothers, no health facilities in Keble Therefore, strategies to identify determinants and reduced of delay in making decision to seek care.

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Assessment of Integrated Disease Surveillance Data Uptake in Community Health Systems within Nairobi County, Kenya

East African Health Research Journal ◽

10.24248/eahrj.v4i2.644 ◽

2020 ◽

Vol 4 (2) ◽

pp. 194-199

Author(s):

Athanasio Japheth Omondi ◽

Otieno George Ochienga ◽

Eliud Kayo ◽

Alison Yoos ◽

Muli Rafael Kavilo

Keyword(s):

Health Care ◽

Community Health ◽

Health Systems ◽

Health Care Workers ◽

Disease Surveillance ◽

Healthcare Workers ◽

Health Facilities ◽

Surveillance Data ◽

Community Level ◽

Care Workers

Background: Kenya has since independence struggled to restructure its health system to provide services to its entire population especially in outbreak responses. The last decade has seen the country witness disease outbreaks across the country i.e. Rift Valley fever in June 2018, and Chikungunya and Dengue fever in Mombasa in February 2018. This exposed the country’s lack of preparedness in handling outbreaks at grass root level. Outbreak incidences tend to prevail at community level before a public health action is established, with the situation becoming dire in the lower tier health facilities. Objective: The purpose of the study was to assess the uptake of Integrated Disease Surveillance Response (IDSR) health data and utilisation at community level health systems in the six sub counties within Nairobi County of Kenya. Methodology: The study used cross-sectional descriptive research design on a target population of 1840 community health workers. The study used Yamane formula to calculate the sample size of 371 respondents, selected using stratified sampling and simple random sampling methods. The logistic regression model was used to assess the benefits of Integrated Data Surveillance and Response data in health facilities across Nairobi County. Data was collected using questionnaires, analysis done using Statistical Packages for Social Sciences, and findings presented in form of tables and bar graphs. Results: The study had 315 questionnaires were duly filled and returned, representing 85% response rate. The findings showed that 268(85%) Healthcare Workers lacked training on using disease surveillance data; 236(75%) cited lack of tools for disease surveillance in facilities, while 173(55%)cited lack of timely IDSR data as hindrance to IDSR data uptake. The regression findings showed that training of healthcare workers on IDSR, installation of disease surveillance system tools, and timely collection and dissemination of surveillance data increases the likelihood of IDSR data uptake in community health facilities. Conclusion: The study concluded that IDSR system tools should be installed in community health facilities across the six sub counties in Nairobi County. Training should be emphasised to ensure all health care workers have the required skills to use the IDSR data. There is need to ensure IDSR data is collected and disseminated on time to make it available for interpretation and use by health care workers in their respective facilities.

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Evaluation of public health surveillance system performance in Dangila district, Northwest Ethiopia: a concurrent embedded mixed quantitative/qualitative facility-based cross-sectional study

BMC Public Health ◽

10.1186/s12889-019-7724-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Tefera Alemu ◽

Hordofa Gutema ◽

Seid Legesse ◽

Tadesse Nigussie ◽

Yirga Yenew ◽

...

Keyword(s):

Public Health ◽

System Performance ◽

Surveillance System ◽

Public Health Surveillance ◽

Cross Sectional Study ◽

Health Surveillance ◽

Health Facilities ◽

Sectional Study ◽

Cross Sectional ◽

Public Health Surveillance System

Abstract Background Evaluation of a surveillance system should be conducted on regular bases to ensure that the system is working as envisioned or not. Therefore, we evaluated Dangila district’s public health surveillance system performance in line with its objectives. Methods In August 2017, a concurrent embedded mixed quantitative/qualitative, facility-based cross-sectional study was conducted in Dangila district among 12 health facilities/sites. The qualitative part involved 12 purposively selected key stakeholders interview. A semi-structured questionnaire adapted from updated CDC guideline for evaluating public health surveillance system was used for data collection through face to face interview and record review. The major qualitative findings were narrated and summarized based on thematic areas to supplement the quantitative findings. The quantitative findings were analyzed using Microsoft Excel 2007. Results All necessary surveillance guidelines, registers and reporting formats were distributed adequately to health facilities. Only the district health office has Emergency Preparedness and Response Plan (EPRP), but not supported by the budget required to respond in case an emergency occurred. There were no regular data analysis and interpretations in terms of time, place and person. Weekly report completeness and timeliness were 100 and 94.6% respectively. The information collected was considered relevant by its users to detect outbreaks early with high acceptability. All stakeholders agreed that the system is simple, easy to understand, representative and can accommodate modifications. Written feedbacks were not obtained in all health facilities. The supervision checklist obtained in the district was not adequate to assess surveillance activities in detail. The calculated positive predictive value for malaria was 11%. Conclusions The surveillance system was simple, useful, flexible, acceptable and representative. Report completeness and timelines were above the national and international targets. However, the overall implementation of the system in the district was not satisfactory to achieve the intended objective of surveillance for public health action due to the lack of regular data analysis and feedback dissemination. To create a well-performing surveillance system, regular supervision and epidemiologically analyzed and interpreted feedback system is mandatory.

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Disease Surveillance System of Bangladesh: Combating Public Health Emergencies

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9815 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Mohammed Husain ◽

Mahmudur Rahman ◽

Asm Alamgir ◽

M. Salim Uzzaman ◽

Meerjady Sabrina Flora

Keyword(s):

Public Health ◽

Surveillance System ◽

Disease Surveillance ◽

Communicable Disease ◽

Control Unit ◽

Communicable Diseases ◽

Health Facilities ◽

Surveillance Data ◽

Public Health Emergencies ◽

Disease Surveillance System

Objectivea) To observe trends and patterns of diseases of public health importance and responseb) To predict, prevent, detect, control and minimize the harm caused by public health emergenciesc) To develop evidence for managing any future outbreaks, epidemic and pandemicIntroductionDisease surveillance is an integral part of public health system. It is an epidemiological method for monitoring disease patterns and trends. International Health Regulation (IHR) 2005 obligates WHO member countries to develop an effective disease surveillance system. Bangladesh is a signatory to IHR 2005. Institute of Epidemiology, Disease Control and Research (IEDCR <www.iedcr.gov.bd>) is the mandated institute for surveillance and outbreak response on behalf of Government of the People’s Republic of Bangladesh. The IEDCR has a good surveillance system including event-based surveillance system, which proved effective to manage public health emergencies. Routine disease profile is collected by Management Information System (MIS) of Directorate General of Health Services (DGHS). Expanded Program of Immunization (EPI) of DGHS collect surveillance data on EPI-related diseases. Disease Control unit, DGHS is responsible for implementing operational plan of disease surveillance system of IEDCR. The surveillance system maintain strategic collaboration with icddrr,b.MethodsThe IEDCR is conducting disease surveillance in several methods and following several systems. Surveillance data of priority communicable disease are collected by web based integrated disease surveillance. It is based on weekly data received from upazilla (sub-district) health complex on communicable disease marked as priority. They are: acute watery diarrhea, bloody dysentery, malaria, kala-azar, tuberculosis, leprosy, encephalitis, any unknown disease. Government health facilities at upazilla (sub-district) send the data using DHIS2. During outbreak, daily, even hourly reporting is sought from the concerned unit.Moreover, IEDCR conducts disease specific specialized surveillance systems. Data from community as well as from health facilities are collected for Influenza, nipah, dengue, HIV, cholera, cutaneous anthrax, non-communicable diseases, food borne illness. Data from health facilities are collected for antimicrobial resistance, rotavirus and intussusception, reproductive health, child health and mortality, post MDA-surveillance for lymphatic filariasis transmission, molecular xenomonitoring for detection of residual Wucheria bancrofti, dengue (virological), emerging zoonotic disease threats in high-risk interfaces, leptospirosis, acute meningo-encephalitis syndrome (AMES) focused on Japanese encephalitis and nipah, unintentional acute pesticide poisoning among young children. Data for event based surveillance are collected from usual surveillance system as well as from dedicated hotlines (24/7) of IEDCR, media monitoring, and any informal reporting.Case detection is done by syndromic surveillance, laboratory diagnosed surveillance, media surveillance, hotline, cell phone-based surveillance. Dissemination of surveillance is done by website of IEDCR, periodic bulletins, seminar, conference etc. Line listing are done by rapid response teams working in the surveillance sites. Demographic information and short address are listed in the list along with clinical and epidemiological information. Initial cases are confirmed by laboratory test, if required from collaborative laboratory at US CDC (Atlanta). When the epidemiological trend is clear, then subsequent cases are detected by symptoms and rapid tests locally available.ResultsIn 2017, 26 incidents of disease outbreak were investigated by National Rapid Response Team (NRRT) of IEDCR. In the same year, 12 cases of outbreak of unknown disease was investigated by NRRT of IEDCR at different health facilities. Joint surveillance with animal health is being planned for detection and managing zoonotic disease outbreaks, following One Health principles. Department of Livestock, Ministry of Environment and icddrb are partners of the joint surveillance based on One Health principles.Disease Control unit of DGHS, district and upazilla health managers utilizes the disease surveillance data for public health management. They analyze also the surveillance data at their respective level to serve their purpose.ConclusionsA robust surveillance is necessary for assessing the public health situation and prompt notification of public health emergency. The system was introduced at IEDCR mainly for malaria and diarrhea control during establishment of this institute. Eventually the system was developed for communicable disease, and recently for non-communicable diseases. It is effectively used for managing public health emergencies. Notification and detection of public health emergency is mostly possible due to media surveillance.Data for syndromic surveillance for priority communicable diseases is often not sent timely and data quality is often compromised. Tertiary hospitals are yet to participate in the web based integrated disease surveillance system for priority communicable diseases. But they are part of specialized disease surveillances. Data from specialized surveillance with laboratory support is of high quality.Evaluation of the system by conducting research is recommended to improve the system. Specificity and sensitivity of case detection system should also be tested periodically.ReferencesCash, Richard A, Halder, Shantana R, Husain, Mushtuq, Islam, Md Sirajul, Mallick, Fuad H, May, Maria A, Rahman, Mahmudur, Rahman, M Aminur. Reducing the health effect of natural hazards in Bangladesh. Lancet, The, 2013, Volume 382, Issue 9910IEDCR. At the frontline of public health. updated 2013. www.iedcr.gov.bdAo TT, Rahman M et al. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh. Emerging Infectious Diseases. Vol 22, No 4. 2016.<www.iedcr.gov.bd> accessed on 1 Oct 2018.

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Performance of COVID-19 Surveillance System as Timely Containment Strategy in Western Oromia, Ethiopia.

10.21203/rs.3.rs-123720/v1 ◽

2020 ◽

Author(s):

Afework Tamiru ◽

Bikila Regasa ◽

Tamirat Alemu ◽

Zenebu Begna

Keyword(s):

Surveillance System ◽

Local Community ◽

Health Workers ◽

Risk Group ◽

Group Testing ◽

Health Facilities ◽

Surveillance Data ◽

Response Strategy ◽

Health Extension Worker ◽

Case Detection

Abstract Background: Since its occurrence in late December, 2019, in Wuhan, China; COVID-19 is rapidly spreading across the world nations. Case detection and contact identification remains the key surveillance objectives for effective containment of the pandemic. This study was aimed at evaluating the performance of COVID-19 surveillance in Western Oromia towns, Ethiopia.Methods: CDC-update guideline for surveillance system evaluation and surveillance documents prepared by Ethiopian Public Health Institute were used as a benchmark. Qualitative interview of health workers and quantitative review of surveillance data were conducted. Semi structured questionnaire was used to interview 436 systematically selected local community to assess their awareness, perceived risk, health system utilization experience and current practices. We analyzed the data using descriptive approach by aligning the data from community, health facility and health authority along with suspect identification, case detection and reporting process of the surveillance system.Results: One hundred seventy-nine (41%) of the participants believe they have high risk of contracting COVID-19 and 127 (29%) of them reported they have been visited by health extension worker. One hundred ninety-seven (45.2%) reported that they are not using health facilities for routine services during this pandemic. Except one hospital, all health facilities (92%) were using updated case definition. From March to July 30, 2020, there were 150 contacts, 116 suspects and 634 risk group tested for COVID-19 of which cases were found only from risk group testing, 10/521 (2%) in Nekemte and none from Shambu. Surveillance data was not being analyzed at all level. Conclusion: In this study it is reasonable to conclude that community/risk group testing was more effective than suspect or contact testing. Surveillance data was not being used to identify group and/or area most exposed for guiding response strategy. Therefore, targeting risk group for testing can improve the effectiveness of COVID-19 surveillance in settings where mass testing is not feasible. Surveillance data analysis should be done to identify areas and groups at higher risk and investigate to avoid further crisis.

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