Evaluation of Notifiable Diseases Surveillance System in Western Area, Sierra Leone, 2014

Abstract

Background: In Africa, infectious diseases continue to be a major health problem because many of the national surveillance systems have scarce resources at their disposal and struggle to ensure timely detection or an effective response to disease outbreaks. To address this issue, in 1998 the World Health Organization Regional Office for Africa approved the Integrated Disease Surveillance and Response (IDSR) strategy for strengthening infectious disease surveillance and response capacity among its 46 Member States and requested that Member States conduct assessments of their IDSR systems , the findings of which would act as a baseline for reform plans. This study describes the structure, inputs, process and outputs of the notifiable diseases surveillance system in Western Area of Sierra Leone, assesses the knowledge on and practices of disease notification among primary health care providers in the Western Area. Assessing peripheral health units (health facilities) on reporting practices and underreporting of notifiable diseases using cholera as a case study Methods: An evaluation of the surveillance system was done. The study reviewed documents of the disease surveillance system in the Western Area district; reviewed notification data made to the district disease surveillance office by reporting sites. Semi structured questionnaires were used in interviews with communicable diseases coordinators and structured questionnaires were administered by telephone to a random sample of public general practitioners and reporting site staff. Results: The research showed that the notification system in the Western Area District of Sierra Leone is deemed useful by the communicable disease coordinators as it can detect disease outbreaks. However data quality, as indicated by the incompleteness of the "Onset date" of illness reporting on notification, varied between; 33% (n=2) to 81% (n=13). Compliance with disease notification was reported by twelve (12) (75%) of the public general practitioners and the mean score for knowledge on notification status of medical condition was 52%. A total of 258 staff were reported to be present at the sites surveyed; 206 (80%) of them are paid by the government and 52 (20%) of them are not paid by the government. The reporting sites that complied with disease notification were 24 (80%) and the mean score for their knowledge on notification status was 60%. The study revealed that 10 (32%) of all reporting sites have been trained in the Integrated Diseases Surveillance and Response and 12 (38%) reported unavailability of disease manual at sites and all sites lacked trained personnel in data management. In addition 14 (45%) of the sites reported that the surveillance phones given to them for weekly notification reports had developed a fault. Sites asking for monetary incentives due to work load burden were 14 (45%). The unavailability of the notifiable diseases manual was recorded in 12 (38.7%) of the sites surveyed and the remaining 19 (61.2%) had charts on the wall that they could use to assess case definitions but are interested in acquiring the notifiable diseases manual. The shortage of reporting forms within the last six (6) months was reported by 93.5% of the reporting sites especially the tally sheets. Conclusion: The notifiable diseases system is useful and can detect diseases. There are however, many challenges within the system which makes it inefficient at all levels. Even though both the public general practitioners and the site staff self-reported high compliance with notification they cited constraints of high work load and lack of motivation. The knowledge of the notifiable medical condition was lower for the general practitioners than the reporting site staff. The system could perform better with constant refreshers training being implemented at all the levels. The data collected, could also be much better and more meaningful if the system has specialised trained personnel within to analyse the data which in turn could yield more useful results for planning and policy. Keywords: Evaluation, Notifiable Diseases, Surveillance, Western Area, Sierra Leone