Under reporting of measles in Hlaingtharya Township, Yangon Region

Abstract

Background: According to the reports from Yangon regional public health department from 2014 to 2018, the percentage of reported cases from the Yangon (East) district was increased from 2014 to 2018, decreased in Yangon (North) district and not much changed in Yangon West and South districts. Among the confirmed measles cases, 4 out of 5 cases had no vaccination or unknown vaccination status. Although there was increasing reporting of measles and rubella cases during five years, only one year (2017) reached the targeted reporting rate for discarded non-measles and non-rubella cases and there were also sporadic outbreaks in Yangon Region although MR coverage is 80% or more. This study aimed to evaluate the measles surveillance system in the Hlaingtharya township because Hlaingtharya is one of the highest reporting townships with the sporadic outbreaks in the Yangon Region. Methods & Materials: A cross-sectional study was done by reviewing the reports at Rural Health Center, Urban Health Center and Township Public Health Department and Medical records at Hlaingtharya Township Hospital to detect quantitative attributes and under-reporting rates. An in-depth interview with basic health staff who were involved in Measles surveillance was done for qualitative attributes. Results: This evaluation showed that the measles surveillance system in Hlaingtharya township was still ineffective in assessing suspected measles cases; sensitivity was 27%, positive predictive value was 91%, and the under-reporting rate was 73%. In concerning timeliness, 75% of cases had been investigated within 48 h of symptom onset, 44% had been taken blood sample within 48 h of symptom onset, but 100% of cases had been reported weekly according to the predefined schedule. According to an in-dept interview, although all basic health staff knew the case definition and reporting pathway, most of them do not know the goals of the measles surveillance system and they do not report the suspected measles cases. Conclusion: The supportive functions for surveillance systems such as refresher training for BHS on operating measles surveillance system, supporting reporting forms to all BHS, providing MoHS guideline on Measles surveillance booklet, and financial support for field visits are needed to be strengthened.