Evaluation of the Influenza Sentinel Surveillance System in Madagascar, 2009-2014/evaluation Du Systeme De Surveillance Sentinelle De la Grippe a Madagascar, 2009-2014/evaluacion del Sistema De Vigilancia Centinela De la Gripe En Madagascar, 2009-2014

By Rakotoarisoa, Alain; Randrianasolo, Laurence et al. | Bulletin of the World Health Organization, May 2017 | Go to article overview

Evaluation of the Influenza Sentinel Surveillance System in Madagascar, 2009-2014/evaluation Du Systeme De Surveillance Sentinelle De la Grippe a Madagascar, 2009-2014/evaluacion del Sistema De Vigilancia Centinela De la Gripe En Madagascar, 2009-2014


Rakotoarisoa, Alain, Randrianasolo, Laurence, Tempia, Stefano, Guillebaud, Julia, Razanajatovo, Norosoa, Randriamampionona, Lea, Piola, Patrice, Halm, Ariane, Heraud, Jean-Michel, Bulletin of the World Health Organization


Introduction

The World Health Organization (WHO) recommends that, from no more than two years after implementation, influenza surveillance systems should be periodically and comprehensively evaluated. (1) Such evaluations may enable shortfalls to be identified, performance to be improved and data reliability to be assessed. Although several influenza surveillance systems have been established in Africa, (2,3) data on the performance of influenza surveillance in Africa are scarce.

Local setting

Madagascar is a low-income country with a health system that faces numerous challenges--including problems in the timely detection of disease outbreaks and the mounting of effective responses to such outbreaks. Although there has been an influenza surveillance system in Madagascar since 1972, in 2007 this system covered only six primary health centres--all located in the capital city of Antananarivo. Between 2002 and 2006, each of the six health centres collected up to five specimens weekly from patients presenting with influenza-like illness (ILI). Staff from the national influenza centre in Antananarivo collected these specimens twice a week. Only one centre reported weekly aggregated data on the numbers of ILI cases recorded among all consultations. The pre-2007 system could monitor influenza activity only in the capital city. Thus, for influenza pandemic preparedness and to satisfy the 2005 International Health Regulations, (4) it became important to implement influenza surveillance throughout Madagascar.

Approach

In 2007, in collaboration with the Malagasy Ministry of Public Health, the Institut Pasteur de Madagascar initiated a countrywide system for the prospective syndromic and virological surveillance of fever. (3,5) The system was designed to enable the daily collection of data on ILI, the daily reporting of the data to staff at the Institut Pasteur de Madagascar--via a short message service-based system--and the collection of samples to be tested for influenza virus. The main aim of the syndromic surveillance, which was integrated in the general practice of the clinicians at the sentinel sites, was the prompt detection of any influenza-related unusual event, outbreak or seasonal epidemic, especially in areas where laboratory-confirmed diagnoses were difficult to obtain.

To check that the reliable data needed for effective public health interventions were being generated, we evaluated the influenza surveillance component of the fever surveillance system between January 2009 and December 2014. During the study period, influenza surveillance--nested within the fever surveillance--was implemented in 34 public or private health-care facilities spread across Madagascar (available from the corresponding author). Each day, trained staff at each of these sentinel sites were supposed to report, via text messages to the Institut Pasteur de Madagascar, the age-stratified numbers of outpatients who had presented with fever, i.e. a temperature of at least 38[degrees]C (Fig. 1). For each person with fever that gave verbal informed consent, a standardized paper-based case report form should have been used to record demographic characteristics, clinical symptoms and date of illness onset. Case report forms should have been sent to the Institut Pasteur de Madagascar weekly, by express courier. All the data sent were entered into a central electronic database. If incomplete or inconsistent data were detected, queries were sent to the corresponding sentinel sites. Each day, a time-trend analysis of the syndromic surveillance data was implemented so that any peaks in ILI incidence--above a pre-established threshold--could be detected rapidly. Clinicians at the sentinel sites identified cases of ILI, among the fever cases, using standard WHO case definitions. (6,7) Daily, weekly and monthly reports were generated at the Institut Pasteur de Madagascar and shared with the sentinel sites and other key stakeholders. …

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Evaluation of the Influenza Sentinel Surveillance System in Madagascar, 2009-2014/evaluation Du Systeme De Surveillance Sentinelle De la Grippe a Madagascar, 2009-2014/evaluacion del Sistema De Vigilancia Centinela De la Gripe En Madagascar, 2009-2014
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