Performance of the Severe Acute Respiratory Illness Sentinel Surveillance System in Yemen: Mixed Methods Evaluation Study (Preprint)

Abstract

BACKGROUND The national Severe Acute Respiratory Illness surveillance system in Yemen was established in 2010 to monitor SARI occurrence in humans and provide a foundation for detecting SARI outbreaks. OBJECTIVE To ensure that the objectives of the national surveillance are being met, this study aimed to determine the level of usefulness and assess the performance of the SARI surveillance system in Yemen. METHODS The updated Centers for Disease Control and Prevention (CDC) guidelines were used for the purpose of evaluation. Related documents and reports were reviewed. Data were collected from four central-level managers and stakeholders, and from ten focal points at four Sentinel sites using semi-structured questionnaire. For each attribute, the score percent was calculated and ranked as the following: very poor (≤ 20 %), poor (>20-≤ 40%), average (>40-≤ 60%), good (>60-≤80 %) and excellent (>80 %). RESULTS As rated by the evaluators, SARI surveillance system achieved its targets. The system attributes flexibility (percent score: 86%) and acceptability (percent score: 82%) were rated as excellent, and simplicity (percent score: 74%) and stability (percent score: 75%) were rated as good. The percent score of timeliness was 23% in 2018, indicating poor timeliness. The overall data quality percent score of SARI system was 98.5%. Despite its many strengths, the SARI system has some weakness in that it depends on irregular external financial support. CONCLUSIONS Overall, the SARI surveillance system was useful in estimating morbidity and mortality, monitoring the trend of disease, stimulating researches to inform prevention and control measures. SARI surveillance system was excellent in flexibility, acceptability and data quality. Its simplicity and stability were good; its timeliness was poor. It is recommended to expand the system and engage private sites in SARI surveillance, establish an electronic database at central and peripheral levels, and provide the lab with the reagents needed for confirmation.