Abstract
.The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis “Dengue surveillance stands and falls by the rigor of the health system.” The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.
Highlights
The global burden of dengue fever (DF) is unknown, partly because of underreporting and misclassification of dengue cases,[1,2] with negative consequences for disease prevention and control
Our analysis resulted in 11 subcategories grouped into three major categories, which together form a theme named “Dengue surveillance stands and falls by the rigor of the health system.”
This theme represents a health system with weaknesses in three distinct areas, captured by the three categories: “Challenging disease diagnostics,” addressing the inherent challenges of diagnosing dengue correctly; “Mismatch in regulatory frameworks and interplay with regulatory bodies,” which describes challenges in dengue diagnostics and reporting imposed by regulations, regulatory frameworks, and interaction with regulatory bodies; and “Different prerequisites at different hospitals,” which signifies disparities caused by local management, attitudes, regulations, and variable quality of staff
Summary
The global burden of dengue fever (DF) is unknown, partly because of underreporting and misclassification of dengue cases,[1,2] with negative consequences for disease prevention and control. Based on official data from WHO member states, the number of dengue cases exceeded 3.34 millions in 2016, but the numbers are predicted to be closer to 390 million cases per year, of which 67–136 million manifest clinically.[3] The escalation of the spread of dengue is closely associated with population growth, urbanization, and shortcomings in environmental management.[4] there is increasing evidence that climate change is affecting the incidence rate and the spatial distribution of the disease, in addition to changing the timing and duration of disease outbreaks.[5,6]. Dengue has proven a challenge to categorize,[10] and new case classifications were launched by the WHO in 2009 to improve triage and case management. As dengue produces a broad spectrum of symptoms, recommendations are that diagnosis is confirmed by virus isolation and serotype identification, viral antigen ELISA tests, or non-structural protein 1 (NS1) antigen rapid test, access to diagnostic tools varies
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