An evaluation of the surveillance system for dengue virus infections in Maldives.

Type Working Paper
Title An evaluation of the surveillance system for dengue virus infections in Maldives.
Publication (Day/Month/Year) 2014
Background: Dengue is endemic in Maldives. The largest epidemic to date was
in 2011. This study evaluates the surveillance system for dengue during 2011,
identifies gaps and suggests ways to improve.
Methods: This evaluation of the national surveillance system for dengue was done
in September to October 2012, using an evaluation tool based on United States
Centers for Disease Control and Prevention (US CDC) guidelines. Staff involved
in surveillance of different levels, and doctors expected to notify, were interviewed,
and surveillance data from the Health Protection Agency (HPA) were compared by
use of an independent database of the country’s national referral hospital in Malé,
Indira Gandhi Memorial Hospital (IGMH), to assess sensitivity and timeliness.
Results: National surveillance is conducted by HPA, which collects information
daily from a network of health facilities. Standard case definitions were published,
but they were not easily accessible to clinicians. The quality of data was acceptable.
Information is disseminated as annual communicable disease reports to health
facilities and uploaded onto the official website. The timeliness of reporting was
good (median 2 days). However, the usefulness for early warning of outbreaks
was limited, owing to central and peripheral resource limitations. Data were useful
for planning. Sensitivity was 0.54. Acceptability by clinicians was poor, owing to the
lack of feedback reaching them. The reporting rate was high from the paediatric
ward in IGMH (85%), where the responsibility of notifying was also assigned to
ward in-charge and support staff, but it was extremely low from the medical ward
(1.7%), where only doctors were given the responsibility.
Conclusion: This evaluation shows the performance of the dengue surveillance
system was good overall. However, clinicians need more regular feedback. The
performance could be improved significantly by written protocols, legislature
and assigning the responsibility of surveillance in hospitals to ward managers in
addition to doctors.

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