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

Abstract

Background Control of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers’ perceptions in relation to PC-NTDs endemic in Kenya. Methods A cross-sectional health facility survey was used to purposively sample respondents involved in disease surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions on surveillance system attributes on a five-point likert scale. Frequency distributions for each point in the likert scale were analysed to determine health workers’ overall perceptions. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson’s chi-square and Fisher’s exact tests examined associations between categorical variables. Thematic analysis was performed for questionnaire open-ended responses. Results Most (88%) respondents worked in public health facilities with 71% stationed in second-tier facilities. Regarding PC-NTDs, respondents perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality data (25%). Facility locality, facility type, respondents’ education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p = 0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p < 0.001) and completeness (p < 0.001) thresholds compared to lower-level facilities. Conclusion Health personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system considering PC-NTDs. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers’ perceptions and improve surveillance system overall performance with regard to PC-NTDs.

Development and validation of a framework to improve neglected tropical diseases surveillance and response at the sub-national level in Kenya

“…Phase II: Primary data surveys on surveillance core, support and attribute functions concerning PC-NTDs [28,29] The first phase described surveillance system assessment studies previously conducted in the African region, which identified broad recommendations to improve the existing surveillance systems; however, these recommendations were inclined to notifiable diseases considered of national priority in African countries. Therefore, based on the premise that diseases targeted for control or elimination were to be accorded priority commensurate to notifiable diseases, the second phase entailed conducting health worker surveys involving primary data collection to assess performance of surveillance core, support and attribute functions concerning PC-NTDs endemic in Kenya.…”

“…Therefore, the main recommendations based on a high degree of groundedness encompassed provision of surveillance guidelines for supervision, properly constituted supervisory teams, regular supervision from higher levels, frequent provision of PC-NTDs updates, regular sensitisation and involvement of all health workers in surveillance activities, enhanced training on PC-NTDs surveillance, improved human resource capacity, provision of surveillance reporting and analysis tools, availing equipment and training materials, provision of adequate funding to facilitate surveillance activities and provision of reliable transportation. [29] The subsequent study aimed to evaluate surveillance system attributes based on health workers' perceptions concerning PC-NTDs endemic in Kenya. Health workers perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality surveillance data (25%).…”

“…Phase II: Primary data surveys on surveillance core, support and attribute functions concerning PC-NTDs [28,29] The aim of this phase was to conduct two empirical studies in NTDs endemic regions in Kenya.…”

“…Modified WHO generic questionnaires, observation checklists and interview schedules were used for data collection. The second study aimed to evaluate surveillance system attributes based on health facility workers' perceptions concerning PC-NTDs [29]. The study sites were similar to those selected in the first survey.…”

“…Phase III: Feasibility of implementing recommendations to improve PC-NTDs surveillance and response [32] The first and second phase provided a plethora of recommendations on improving the existing surveillance systems considering broad perspectives within the African context and further actions peculiar to improving PC-NTDs surveillance and response within an endemic setting [27][28][29].…”