Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

Abstract

Background: Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. Methods: A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. Results: Detection of PC-NTDs was minimal at the peripheral level with limited (60%) use of standard case definitions. Case registration and confirmation capacities were suboptimal at the lower levels with 52% of facilities having functional laboratories. Presence of well-equipped laboratories (p = 0.007), provision for PC-NTDs in reporting forms (p = 0.004) and training of personnel on surveillance (p<0.001) were associated with higher odds of having a functional surveillance system. Lower levels lacked sufficient action thresholds and feedback was limited across all surveillance levels. Supervisory visits frequency at the community (73%) and facility (53%) levels were minimal. Challenges facing PC-NTDs surveillance activities implementation revealed through qualitative data included lack of surveillance guidelines and reporting tools, minimal data analysis, inconsistent feedback, limited supervisory activities, minimal training and low resource provision. Conclusions: Sufficient milestones have been achieved towards improving performance of surveillance functions in Kenya. However, challenges exist relating to PC-NTDs. Core functions including case detection, registration and confirmation, reporting, data analysis and feedback perform sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources are particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

Evaluation of health surveillance system attributes: the case of neglected tropical diseases in Kenya

“…There was a notable decline in monthly reporting timeliness and completeness rates of the surveyed health facilities in the 2017 surveillance period. Ultimately, health workers’ perceptions on the surveillance system attributes influenced the overall performance of other surveillance core and support functions [ 25 ]. Therefore, the study findings should inform efforts centered on improving PC-NTDs surveillance and response in Kenya by tackling concerns of surveillance system users based on their perceptions towards surveillance system attributes.…”

“…The three study regions comprised of 10 administrative counties prevalent of at least three or more PC-NTDs. Subsequently, 19 sub-counties that were most prevalent of the PC-NTDs were purposively sampled [ 25 ]. Health facilities that reported high-threshold levels of PC-NTD cases in the 2017 surveillance period according to data retrieved from the Kenyan Demographic Health Information System (DHIS2) were selected in each of the sub-counties [ 28 ].…”

“…Certainly, health workers’ perceptions on surveillance system attributes would provide a clear perspective on the overall performance of other surveillance functions. A preceding study conducted in Kenya assessed surveillance core and support functions relating to preventive chemotherapy targeted neglected tropical diseases (PC-NTDs) [ 25 ]. Thus, assessment of health care personnel perceptions regarding attributes of the existing surveillance system would be pertinent to obtaining crucial evidence for improving PC-NTDs surveillance and response at the sub-national level.…”

Feasibility of Implementing Recommendations to Improve Neglected Tropical Diseases Surveillance and Response in Kenya: A Modified Delphi Study

“…This survey approach involved an assessment of participants' opinions towards reaching group consensus. Utilisation of the Delphi process enabled practical assessment regarding the importance and feasibility of implementing generalised recommendations to improve surveillance systems derived from an initial systematic review of studies conducted in the African region and further disease-speci c recommendations derived from primary studies conducted in NTD endemic regions in Kenya [16][17][18]. By combining the opinions and perspectives of key stakeholders, the survey described consensus reached on the most feasible recommendations for implementation to improve surveillance and response to NTDs at the sub-national level in Kenya.…”

“…An initial systematic review of studies, which assessed surveillance systems in African countries postadoption of the revised IDSR guidelines between 2010 and 2019 was undertaken and the key ndings and recommendations ensuing from the assessment studies retrieved [16]. Furthermore, two studies involving primary data collection were conducted with the aim of assessing surveillance system core, support and attribute functions regarding PC-NTDs co-endemic in Kenya [17,18]. The PC-NTDs of focus included Lymphatic Filariasis, Schistosomiasis, Soil Transmitted Helminths and Trachoma.…”