Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru): a prospective evaluation

Moises A Huaman,Jose A Quispe,Carmen C Mundaca,Miguel F Fernandez,David L Blazes,Roger V Araujo-Castillo,Joan M Neyra,Giselle Soto

doi:10.1186/1472-6947-9-16

Moises A Huaman, Jose A Quispe + Show 6 more

Open Access

https://doi.org/10.1186/1472-6947-9-16

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Abstract

BackgroundA timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy.Methods40 Alerta reporting units (18 clinics and 22 ships) were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively.ResultsTimeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p < 0.001) and from 46.9% to 77.3% on ships (+30.4 [95% CI, +16.9 to +43.8]; p < 0.001). Visit and control groups did not show significant changes in timeliness. Error rates decreased in the visit group from 7.1% to 2% in clinics (-5.1 [95% CI, -8.7 to -1.4]; p = 0.007), but only from 7.3% to 6.7% on ships (-0.6 [95% CI, -2.4 to +1.1]; p = 0.445). Phone and control groups did not show significant improvement in data quality.ConclusionRegular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.

Highlights

A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics
Systems focused on emerging infectious disease surveillance are of special public health importance due to the potential for outbreaks that might lead to regional or even pandemic expansion if they are not rapidly controlled [2]
No baseline differences were found between the intervention groups in terms of number of reporting personnel, reporting tools available and time operating Alerta. When we compared these characteristics according to the type of unit, there were differences in the number of reporting personnel (p = 0.007), reporting tools available (p = 0.052) and time operating the Alerta system (p = 0.005)

Summary

Introduction

A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. Surveillance systems provide essential data for the development and enhancement of disease prevention and control programs. They allow establishment of disease baselines, assessment of responses to public health measures and generation of hypotheses [1]. Systems focused on emerging infectious disease surveillance are of special public health importance due to the potential for outbreaks that might lead to regional or even pandemic expansion if they are not rapidly controlled [2]. The situation is often more difficult in developing settings due to lack of trained personnel and lack of resources to ensure proper functioning of the system

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