Evaluation of the Existing Diarrhoea Surveillance System in Children Under 5 in District Peshawar, NWFP Pakistan

Abstract

Background: Diarrhoea globally causes an estimated 3.3 million deaths per year with a median infant mortality of 8.37 deaths per 1000 live births. In Pakistan it is responsible for 43.3% of all post-neonatal deaths. In North Western Frontier Province (NWFP) its prevalence in children under 5 is 15% &16% in rural & urban areas respectively. Objectives: To assess the performance of the existing diarrhoea surveillance system to identify strengths and weakness to make recommendation for improvement. Methods: CDC Guidelines for Evaluating Public Health Surveillance Systems were followed. A questionnaire was developed, pretested & used for collecting data from identified stakeholders. A scoring system was evolved to compare the three existing surveillance system as poor, average, and good. Results: Existing surveillance systems are a) Health Management Information system (HMIS), b) National Programme for Family Planning & Primary Health Care (FP & PHC), c) Active surveillance (to PH section) during Monsoon. Active surveillance during monsoon is found to be better than the other two arrangements as it is simple, having good quality of data, acceptability & representative-ness with an average flexibility, sensitivity, positive predictive value (PPV) & timeliness. NP for FP & PHC was ranked second owing to its good score in simplicity, data quality & timeliness with an average sensitivity & stability. According to flexibility, data quality, PPV, representativeness & timeliness HMIS was labelled as the weakest. Conclusion: HMIS although labelled as the weakest remains themain information system for the country. Review & modifications of the existing system including adding information from secondary & tertiary level health care facilities, vertical programs’ MIS e.g. NP for FP & PHC will improve the HMIS substantially.