Evaluation of Event Based Surveillance System of Crimean Congo Haemorrhagic Fever in Balochistan Pakistan, 2017

Abstract

Background:  Crimean Congo Haemorrhagic Fever (CCHF) is an acute viral zoonotic disease that is endemic in Pakistan. Poverty, limited awareness and lack of biosafety practices make it a potential occupational health risk.  A poor surveillance system makes it more difficult to monitor the disease burden.  

Purpose:  An evaluation was carried out to identify the strengths and weaknesses of the event-based CCHF surveillance system in Balochistan, Pakistan, and to propose recommendations for improvement.

Methods:  A descriptive evaluation study was conducted at an isolation ward of a public hospital from November 2017 to February 2018 in Balochistan Province. Event-based CCHF surveillance system was evaluated by using updated CDC guidelines for Evaluating Public Health Surveillance Systems. Data were collected through review of records and interaction with stakeholders. Using a semi-structured questionnaire, surveillance system attributes were assessed according to the guidelines in the study tool.

Findings: The system was simple, but had no standardised case definition. It was found to be flexible as new health-related events could be easily incorporated. Data quality was moderate; 80% (75/94) of the reports were completely filled. The system had good timeliness but lacked involvement of the private sector. Acceptability was good with involvement of different government stakeholders. Sensitivity was poor while positive predictive value was 27.5%.

Conclusion: Event based surveillance for CCHF can be improved by involvement of private practitioners and laboratories in the surveillance system to improve representativeness. The timeliness could be improved by adopting an online reporting mechanism. Feedback, support and supervision should be ensured for data quality assurance. Periodic refresher trainings of the staff could be organized.