1.1 Study Setting
Mandura woreda is one of the 7th woreda’s of Metekel zone which is divided in to 20 kebele administrations (17 rural and 3 urban kebeles); The Woreda has 23 health posts, one health center, Non-Governmental Organization (NGO) medium clinic, four Private medium clinic and one prison clinic. The total population of Mandura is 55996(Male =28110 and Female =27886), from these about 1,719 are surviving infants, 9060 are under 5year children and 25,478 are under 15 years of age children. All 23 Health posts, 1 health center, 1 NGO medium clinic, 4 Private medium clinics and 1 Metekel prison clinic were reporting weekly measles surveillance reports.
1.2 The Design Used
To conduct measles surveillance system performance evaluation in Mandura woreda in 2018, the woreda Public Health Emergency Management (PHEM) and Health Management Information System (HMIS) reports were reviewed in addition to getting information through observational and in-depth interviews.
The performance of surveillance was evaluated according to United State (U.S) public health surveillance system guidelines
1.3 Measles Standard Case Definitions
Measles is one of nationally immediately notifiable diseases that all health facilities (private and public) in Mandura woreda are expected to report to the woreda officers using the aforementioned case definitions.
The Ethiopian national Public Health Emergency Management and measles guideline was used for the case definitions (6)
Clinicians (internist, general practitioners, nurses, health officers) reported suspected measles cases with blood serum samples using case-based reporting form to Ethiopian Public Health Institute for laboratory analysis.
1.3.1. Suspected cases at community level: A community member should report any person with rash and fever to a health worker.
1.3.2. Clinical Suspected measles case: Any person with an acute illness characterized by:
- generalized, maculopapular rash lasting ≥3 days;
- temperature ≥101°F or 38.3°C; and
- cough, coryza, or conjunctivitis
1.3.3. Epidemiological linked/Probable measles case: In the absence of a more likely diagnosis, an illness that meets the clinical description with:
- no epidemiologic linkage to a laboratory-confirmed measles case; and
- noncontributory or no measles laboratory testing.
1.3.4. Confirmed measles case: An acute febrile rash illness with:
- isolation of measles virus from a clinical specimen;
- a significant rise in measles immunoglobulin G/m antibody using any evaluated and validated method
1.4 Indicators Used
Some useful indicators (attributes) were used to evaluate measles surveillance system performance in Mandura woreda such as: -
- Acceptability,
- Simplicity,
- Flexibility,
- Completeness/Data quality,
- Sensitivity,
- Positive Predictive Value,
- Representativeness,
- Timeliness,
- Stability and Validity
1.5 Data Source
Different data sources such as; Mandura Woreda Measles surveillance database, annual reports, records and documents were used in addition to data gathered using in depth interview with standardized checklists and questionnaires.
1.6 Collection Procedure
Standardized questionnaire was adapted from the World health Organization (WHO) Guideline based on the objectives of the evaluation. Interview was made to the surveillance officers and focal persons in the selected office for this evaluation purpose. Therefore, data were obtained from two ways of routine reporting system. These are PHEM and HMIS reports that are weekly and monthly reports respectively. PHEM data has been collected at health facilities and reported to woreda health offices weekly every Monday and on wards to the next level every next day of receiving the data. The HMIS reporting form integrated measles disease. The HMIS data are also collected at health facilities. However, these data were reported to woreda health office by hard copy monthly every 28 days.