Setting up a Hospital Based Diarrhoea Surveillance System in a Low- and Middle-Income Country: Lessons Learned

Abstract

Background: Acute diarrhoea is a major cause of morbidity and mortality among children in low-resource settings. Establishing effective surveillance systems is crucial for monitoring and responding to diarrhoeal outbreaks. Objective: This manuscript presents the lessons learned during the setup of a hospital-based diarrhoea surveillance system at Arthur Davison Children's Hospital in Ndola, Zambia. Specifically, the reasons for the delays in processing stool samples from collection to reporting of laboratory results were explored. Methods: The setup of the surveillance system involved several key steps, including stakeholder engagement, training of healthcare workers, development of data collection tools, and establishment of reporting mechanisms. The system aims to capture data on diarrhoea cases admitted to the hospital, including demographic information, clinical presentation and laboratory results. Results: Numerous obstacles were encountered during the implementation of the surveillance. There were three points of delay identified in the ADCH diarrhoea sample handling process from collection to processing: 1) Stool sample collection and packaging 2) Sample transfer from the clinical area to the laboratory 3) Handling and processing in the laboratory. Gaps identified in the three delays related to 1) Staff attitudes and perceptions 2) Health systems infrastructure 3) Operational issues 4) Data management. The following key elements are recommended for setting up a robust, locally owned diarrhoea surveillance system: Implementation of cross-cutting intervention across domains, and a human-centered approach targeted at behavioral change, creating local leadership and ownership of surveillance activities, systematic capacity building through ongoing training/orientation/local data sharing platforms for healthcare personnel, establishing reliable data collection and reporting procedures, addressing infrastructure limitations, and integrating the surveillance system into existing health information systems. Conclusion: We established a hospital-based diarrhoea surveillance system at ADCH in Ndola, Zambia. Several obstacles were identified and resolved, which provide valuable lessons for future implementing of diarrhoea surveillance systems in low resource settings. Successful implementation requires engaging of hospital and laboratory staff, adaptable and easy to use surveillance tools including entering sample information in an electronic laboratory information system and committed leadership.