Abstract
BackgroundA sentinel hospital-based severe acute respiratory infection (SARI) surveillance system was established in Indonesia in 2013. Deciding on the number, geographic location and hospitals to be selected as sentinel sites was a challenge. Based on the recently published WHO guideline for influenza surveillance (2012), this study presents the process for hospital sentinel site selection.MethodsFrom the 2,165 hospitals in Indonesia, the first step was to shortlist to hospitals that had previously participated in respiratory disease surveillance systems and had acceptable surveillance performance history. The second step involved categorizing the shortlist according to five regions in Indonesia to maximize geographic representativeness. A checklist was developed based on the WHO recommended attributes for sentinel site selection including stability, feasibility, representativeness and the availability of data to enable disease burden estimation. Eight hospitals, a maximum of two per geographic region, were visited for checklist administration. Checklist findings from the eight hospitals were analyzed and sentinel sites selected in the third step.ResultsSix hospitals could be selected based on resources available to ensure system stability over a three-year period. For feasibility, all eight hospitals visited had mechanisms for specimen shipment and the capacity to report surveillance data, but two had limited motivation for system participation. For representativeness, the eight hospitals were geographically dispersed around Indonesia, and all could capture cases in all age and socio-economic groups. All eight hospitals had prerequisite population data to enable disease burden estimation. The two hospitals with low motivation were excluded and the remaining six were selected as sentinel sites.ConclusionsThe multi-step process enabled sentinel site selection based on the WHO recommended attributes that emphasize right-sizing the surveillance system to ensure its stability and maximizing its geographic representativeness. This experience may guide other countries interested in adopting WHO’s influenza surveillance standards for sentinel site selection.
Highlights
A sentinel hospital-based severe acute respiratory infection (SARI) surveillance system was established in Indonesia in 2013
We limited selection to public hospitals that had previously participated in the sentinel pneumonia or SARI surveillance systems
Timeliness and completeness data for the 50 hospitals were extracted from the Ministry of Health (MOH) surveillance system databases
Summary
Step one: creation of a hospital shortlist Indonesia has 2,165 public and private hospitals [11]. We limited selection to public hospitals that had previously participated in the sentinel pneumonia or SARI surveillance systems We ranked these 50 hospitals in terms of two performance indicators, timeliness and completeness of data reporting to national level. The WHO guideline recommended calculating the funds needed to cover general costs of surveillance operations for the long term We operationalized this by calculating the yearly costs of one sentinel site and determining the number of sites that could be established using funds available from MOH and donors for the three years. We developed a sentinel site selection checklist to address the other attributes and criteria This included five questions to assess representativeness, such as the type of hospital (general versus specialty), accessibility of wards for influenza surveillance and the demographics of the population served by the hospital (Table 2). We requested data on total patient admissions not respiratory patient admissions since hospitals may vary in their disease coding and recording systems
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