Abstract
BackgroundPublic health agencies require valid, timely and complete health information for early detection of outbreaks. Towards the end of the Ebola Virus Disease (EVD) outbreak in 2015, the Ministry of Health and Sanitation (MoHS), Sierra Leone revitalized the Integrated Disease Surveillance and Response System (IDSR). Data quality assessments were conducted to monitor accuracy of IDSR data.MethodsStarting 2016, data quality assessments (DQA) were conducted in randomly selected health facilities. Structured electronic checklist was used to interview district health management teams (DHMT) and health facility staff. We used malaria data, to assess data accuracy, as malaria was endemic in Sierra Leone. Verification factors (VF) calculated as the ratio of confirmed malaria cases recorded in health facility registers to the number of malaria cases in the national health information database, were used to assess data accuracy. Allowing a 5% margin of error, VF < 95% were considered over reporting while VF > 105 was underreporting. Differences in the proportion of accurate reports at baseline and subsequent assessments were compared using Z-test for two proportions.ResultsBetween 2016 and 2018, four DQA were conducted in 444 health facilities where 1729 IDSR reports were reviewed. Registers and IDSR technical guidelines were available in health facilities and health care workers were conversant with reporting requirements. Overall data accuracy improved from over- reporting of 4.7% (VF 95.3%) in 2016 to under-reporting of 0.2% (VF 100.2%) in 2018. Compared to 2016, proportion of accurate IDSR reports increased by 14.8% (95% CI 7.2, 22.3%) in May 2017 and 19.5% (95% CI 12.5–26.5%) by 2018. Over reporting was more common in private clinics and not- for profit facilities while under-reporting was more common in lower level government health facilities. Leading reasons for data discrepancies included counting errors in 358 (80.6%) health facilities and missing source documents in 47 (10.6%) health facilities.ConclusionThis is the first attempt to institutionalize routine monitoring of IDSR data quality in Sierra Leone. Regular data quality assessments may have contributed to improved data accuracy over time. Data compilation errors accounted for most discrepancies and should be minimized to improve accuracy of IDSR data.
Highlights
Public health agencies require valid, timely and complete health information for early detection of outbreaks
Four data quality assessments were conducted in 444 health facilities of which 390 (87.8%) were lower level facilities (CHC, Community Health Posts (CHP), Maternal Child Health Posts (MCHP)) (Table 1), 47 (10.6%) were secondary and two (0.4%) were tertiary level hospitals
We reviewed 1729 weekly Integrated Disease Surveillance and Response System (IDSR) reports that is, 299 in the first assessment, 377 in the second assessment, 501 in the third assessment and 552 in the fourth assessment
Summary
Public health agencies require valid, timely and complete health information for early detection of outbreaks. Public health surveillance data is used to monitor disease trends, detect outbreaks and trigger response activities. It guides allocation of resources, evaluation of public health interventions, policies and strategies [1]. The revised International Health Regulations (2005), require state parties to build public health capacity to detect, report, and respond to public health threats [3, 4]. This can only be achieved through robust public health surveillance systems that generate high quality data. Demand for high quality data has led to an increase in the number of data quality assessments worldwide [6]
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