JMIR Publications

ABSTRACT

Background:

To detect early outbreaks; installation and actualization of disease surveillance system is prerequisite. Prompt response is possible when robust surveillance system is in place. Dengue fever is one of the many diseases endemic in Pakistan with potential fatality.

Objective:

This study aimed to document the current dengue surveillance system, gauge its performance and provide recommendations to the stakeholders for its actualization and strengthening.

Methods:

A cross sectional study was conducted to document the outcomes in 2020. The evaluation was guided by updated Centre of Disease Control public health surveillance system guidelines for the year 2019. A structured questionnaire was designed and piloted to estimate simplicity, flexibility, acceptability and stability. Total sample size was 45 surveillance staff at provincial and district level involved in dengue surveillance. Dengue fever provincial data was analyzed to evaluate completeness, data quality, predictive positive value, sensitivity and representativeness. Field visits to districts were carried out to assess data flow and timeliness.

Results:

Reporting rate ranged from 12/100,000 in 2017 to 21/100,000 in 2019, with a total number of 7641 reported cases in the province. The mean time of reporting cases was one day; ranging from zero to two days. Dengue surveillance system simplicity was 90% regarding structure and dataflow. Stability of the system was at 84% due to data backup. The system flexibility was 81% allowing addition and modification of variables. The average completeness of selected variables was 65%. About 59% of the staff interviewed considered the system acceptable. Data quality was suboptimal at 48%. The system is mainly representative of secondary and tertiary health care hospitals which was 40%, particularly inpatients. The system predictive positive value of dengue fever was 15% and sensitivity was 14% which were below par. The dengue surveillance system can detect dengue outbreaks early.

Conclusions:

An immediate, collaborative, multisectoral and transdisciplinary plan is needed to enhance reporting from all health facilities. Adequate government funding to improve data quality and ensuring monitoring mechanism at all levels for prompt functionality of the surveillance system.