BACKGROUND
Rotavirus kills over 185,000 children under 5 every year and responsible for over one-third of all child diarrheal deaths worldwide. The Rotavirus Surveillance System (RVSS) in Yemen was launched in 2007 in five sentinel sites to monitor the impact of vaccine on rotavirus morbidity and mortality.
OBJECTIVE
This study aimed to determine the level of usefulness of the RVSS, assess its performance, and identify the strengths and weaknesses of the surveillance system implementation.
METHODS
The Centers for Disease Control and Prevention (CDC) updated guidelines on evaluation of a public health surveillance system was used to evaluate RVSS. In this assessment, qualitative indicators of usefulness and other attributes of the system including flexibility, stability, simplicity and acceptability were assessed through in-depth interviews with the stakeholders at central level and semi-structured questionnaires with sentinel sites coordinators. Furthermore, indicators for quantitative attributes including sensitivity, Positive Predictive Value (PPV), completeness and timeliness were assessed through reviewing results of laboratory samples and a random sample of case report forms. Scores for the indicators were expressed as following: poor: <60%, average: 60 - <80%, and good: ≥ 80%.
RESULTS
The overall usefulness score percent of the RVSS was 73%, which indicates an average rank. The RVSS was rated as good on flexibility (score percent = 91%) and stability (score percent = 81%) attributes and was rated as an average on simplicity (score percent = 77%) and acceptability (score percent = 76%) attributes. Regarding the quantitative attributes, the system was rated as poor for sensitivity (score percent = 91%), average for PPV (score percent = 73%) and good for completeness and timeliness (score percent = 100%).
CONCLUSIONS
The overall RVSS performance was an average. Although the system attributes demonstrated a good flexibility, stability, data quality and timeliness, some attributes still need enhancements. The system was rated “average” on the usefulness, simplicity, and acceptability and poor for the sensitivity. To ensure sustainability, there is a need for planning gradual replacement of donor’s fund with government’s funds. Gradual scaling up of the RVSS through increasing the number of sites and governorates, and enhancement of the sensitivity of the RVSS are strongly recommended.