Evaluation of Acute Respiratory Infection Surveillance System in Balochistan-Pakistan 2017

Theoretical Background and research questions/hypothesis:

Acute Respiratory Infection (ARI) is leading cause of death among children, reportedly 2.1 million deaths worldwide. In Pakistan, 20-30% of total deaths among children under 5 years of age are caused by ARIs. District Health Information system (DHIS) Balochistan reports higher incidence of ARI among children under 5. Surveillance system doesn’t document its burden and etiology properly.

Methods:

Evaluation was conducted during September 2017 using Updated CDC guidelines for evaluating public health surveillance systems. Assessment of qualitative and quantitative system attributes was done. A semi structured questionnaire was used for interviews. Stakeholders were identified and engaged. Review of Literature, office records and reports was done.

Results:

DHIS is simple and easy to operate but inflexible in accommodating additional information like ARI outbreaks. Data quality assessed was poor, as less (45%) forms found completed. Timeliness is good as data takes 30 days to reach provincial DHIS cell from districts. Acceptability is good as government totally relies on DHIS data. Sensitivity calculated was 100 % but Predictive Value Positive (PVP) couldn’t be calculated due to non-available laboratory data. Representativeness is average as it is not covering whole province. System is operational in 30 districts, whereas data from Tertiary care hospitals is not included which is a major source. System is stable, secure and available when required but not integrated with other programs.

Conclusions:

DHIS is more or less meeting its objectives. System should cover all 30 districts with inclusion of tertiary care facilities, it will increase its representativeness. To increase percentage of completed reports training to all staff is required. Provision of laboratory services at district level will go a long way in strengthening the surveillance system.

Implications for research and/or practice:

To evaluate strengths and weaknesses of ARI surveillance system in Balochistan & to provide better evidence for its prevention and control