A rapid assessment of the implementation of integrated disease surveillance and response system in Northeast Nigeria, 2017

Abstract

Background Integrated disease surveillance and response (IDSR) is the strategy adopted for public health surveillance in Nigeria. IDSR has been operational in Nigeria since 2001 but the functionality varies from state to state. The outbreaks of cerebrospinal meningitis and cholera in 2017 indicated weakness in the functionality of the system. A rapid assessment of the IDSR was conducted in three northeastern states to identify and address gaps to strengthen the system. Method The survey was conducted at the state and local government areas using standard IDSR assessment tools which were adapted to the Nigerian context. Checklists were used to extract data from reports and records on resources and tools for implementation of IDSR. Questionnaires were used to interview respondents on their capacities to implement IDSR. Quantitative data were entered into an MS Excel spreadsheet, analysed and presented in proportions. Qualitative data were summarised and reported by thematic area. Results A total of 34 respondents participated in the rapid survey from six health facilities and six local government areas (LGAs). Of the 2598 health facilities in the three states, only 606 (23%) were involved in reporting IDSR. The standard case definitions were available in all state and LGA offices and health facilities visited. Only 41 (63%) and 31 (47.7%) of the LGAs in the three states had rapid response teams and epidemic preparedness and response committees respectively. The Disease Surveillance and Notification Officers (DSNOs) and clinicians’ knowledge were limited to only timeliness and completeness among over 10 core indicators for IDSR. Review of the facility registers revealed many missing variables; the commonly missed variables were patients’ age, sex, diagnosis and laboratory results. Conclusions The major gaps were poor documentation of patients’ data in the facility registers, inadequate reporting tools, limited participation of health facilities in IDSR and limited capacities of personnel to identify, report IDSR priority diseases, analyze and interpret IDSR data for decision making. Training of surveillance focal persons, provision of IDSR reporting tools and effective supportive supervisions will strengthen the system in the country.

Twenty years of integrated disease surveillance and response in Sub-Saharan Africa: challenges and opportunities for effective management of infectious disease epidemics

“…Improvements in IDSR system attributes such as completeness and timeliness of data reporting have been observed in Uganda, Malawi and Ghana [ 24 , 35 , 49 , 51 ]. By the end of 2017, 68% of the countries in the WHO Africa Region had achieved the timeliness and completeness threshold of at least 80% of the reporting facilities.…”

“…IDSR strategy strives for the concurrent integration route, but most countries have not achieved total integration. Implementation of the strategy is partially done [ 14 , 35 ], and there is more focus on technical aspects than organisational and human resource issues hence impair the performance of the systems [ 49 , 82 ]. Nevertheless, some countries such as Uganda have rectified those systemic challenges and reported improvement in the implementation [ 50 ].…”

Twenty Years of Integrated Disease Surveillance and Response in Sub-Saharan Africa: Challenges and Opportunities for Effective Management of Infectious Disease Epidemics

“…IDSR strategy strives for the convergent integration route but the majority of countries programmes have never achieved total integration. Implementation of the strategy is partially done [23,48] and there is more focus on technical aspects than organizational and workforce issues hence impairs the performance of the systems [61,93]. Nevertheless, some of the countries such as Uganda have taken the actions to rectify those systemic challenges and reported improvement in the implementation [62].…”

“…IDSR core functions Improvements in IDSR system attributes such as completeness and timeliness of data reporting after scaling up IDSR have been observed in some SSA countries including Uganda, Malawi and Ghana [37,48,61,63]. Recent statistics indicated that by end of 2017, about two-thirds (68%) of the countries in the WHO Africa Region had achieved the timeliness and completeness threshold of at least 80% of the reporting units [23].…”

Comparative Assessment of the Implementation of Integrated Disease Surveillance and Response in Public and Private Health Facilities in Jos North Local Government Area of Plateau State, Nigeria

“…[ 7 8 ] Implementation of IDSR has been especially limited in private health facilities, probably as a result of their low involvement in disease control efforts. [ 9 10 11 ] Other factors identified as responsible for the poor implementation of IDSR include low knowledge about IDSR, unavailability of reporting tools, and lack of feedback from local and state governments. [ 5 6 7 9 12 ]…”