Abstract
BackgroundEffective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya.MethodsA mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically.ResultsSurveillance core and support functions in relation to PC-NTDs were assessed in comparison to an indicator performance target of 80%. Optimal performance reported on specimen handling (84%; 100%), reports submission (100%; 100%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Facilities achieved the threshold on reports submission (84%), reporting deadlines (88%) and feedback (80%). However, low performance reported on case definitions availability (60%), case registers (19%), functional laboratories (52%) and data analysis (58%). Having well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), PC-NTDs provision in reporting forms (3.20, 95% CI: 1.44, 7.10) and surveillance training (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of functional surveillance systems. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision.ConclusionThere was evidence of low-performing surveillance functions regarding PC-NTDs especially at the peripheral surveillance levels. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.
Highlights
Effective surveillance and response systems are vital to achievement of disease control and elimination goals
Strengthened health information systems are a product of quality data generated through effective and well-functioning disease surveillance and response systems
Findings from the current study indicate that a great deal of effort is required to achieve effective surveillance and response to PC-neglected tropical diseases (NTDs)
Summary
Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Public health surveillance is a key component of HIS involving the continuous collection, analysis and interpretation of health data resulting in the timely dissemination of information to enable effective public health action [4]. In September 1998, an Integrated Disease Surveillance (IDS) strategy, which was later renamed Integrated Disease Surveillance and Response (IDSR) system, was adopted by member states of the World Health Organization Regional Office for Africa (WHO-AFRO). This strategy aimed to ensure that action oriented, integrated and district-focused public health surveillance systems are in place [6,7,8]. On the other hand, sustained core function performance necessitates support from adequate standards and guidelines, supervision, training and resources [9]
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