Any person with fever and maculopapular (non-vesicular) generalized rash and cough, coryza or conjunctivitis (red eyes) or any person in whom a clinician suspects measles in Mandura woreda were addressed under the existing Provider initiated (passive) population-based measles surveillance system.
Measles surveillance data is received from governmental health facilities, NGO health facilities missionary churches and private clinics. There was no shortage of reporting form in all health facilities and health office as we interview. The weekly reporting rates of the health facilities over the past 52 weeks of 2018 were >80% timeliness and completeness as show below by line graph for health posts, but it was 100% health centers 100% All the weekly surveillance reports were sent to the next level via report format and telephone.
However, reporting through telephone is limited in health posts where there were no telephone services. In case of such setups, the HEWs use their personal mobile phones for emergency, for which they were complaining for refund, the other limitations telephone is affecting report objectivity
Among the 10 visited health facility, all of them have standard case definition of measles and the understanding of the cases definitions by the health extensions, 75% were good understanding, as they explaining us while we interviewing them at the time of the field visit. Concerning weekly PHEM reports format was there.
In this evaluation some useful indicators (attributes) were used to evaluate measles surveillance system performance in Mandura woreda. These indicators are presented as follow
4.1. Simplicity: In Madura woreda measles Case definition was understood at local & Facility level but community measles case definitions were not well known due to different factors.
There was weekly report format at all health facility level. However, reporting is still paper-based at the health facility level and data reporting to the next level was by telephone calls and messages due to lack of computer & internet services that induces report subjectivity and report delay.
4.2. Flexibility: In Mandura woreda, measles surveillance system was performed with adaptable manner to any without no difficulty in district.
4.3. Completeness/Data Quality: As we reviewed the annual report records, most required information was clearly recorded manually using standardized formats and log books and there were complete and valid data at the observed sites. Moreover, we checked data completeness/quality by checking the recorded and reported data (simple case counts) comparing with woreda FHEM reports. and asking the clarity of the case definition as indirect measure of data quality.
4.4. Acceptability: As we reviewed the surveillance report records, the concerned organizations have awareness on it and have a willingness to participate in the surveillance system. This was assured by completeness of report forms and timeliness of data reporting processes. But the Woreda didn’t well engage for measles surveillance due to lack of multi-sectorial, health worker turns over, community cultural factor and poor geographical coverage as we interview & identified by programmers.
4.5. Sensitivity: In Mandura, proportion of reported suspected measles cases in the woreda is 2(100%) as expected but Proportion of serum/ dried blood specimens arriving at lab within 3 days of being taken. This may be due to geographical settings, poor medical care infrastructure, and population working behavior and far to get health facilities. Even though, 1(50%) blood specimen has been collected, the serological result feedback was not sent from the laboratory to the woreda.
4.6. Predictive Value Positive (PVP): We digit’s get cases result received from the national measles laboratory department for father conformation. As a result, we couldn’t measure the effect of PPV.
4.7. Representativeness: The health service coverage of Madura woreda is 96%. The routine surveillance covers all governmental and some private health facility, and all population under surveillance in the catchment area. But the data we obtained cannot accurately reflect the characteristics of measles under surveillance in related to time, place, and person due to poor quality health care service provision i.e. one health center 57 000 population, only geographical health coverages are covered by HP and HEWs. Therefore, the representativeness of the system in the woreda is likely to be low.
4.8. Timeliness: In Mandura Woreda reporting of measles cases to a public health agency and the time required for the identification of cases, outbreaks, or the effect of control and prevention measures including immediate control efforts, prevention of continued exposure and program planning was encouraging.
4.9. Stability: In Mandura Woreda, the surveillance system, the desired and actual amount of time required for the system to collect or receive data was stable.