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An evaluation of acute respiratory infection surveillance systems in Gilgit-Baltistan Pakistan
Zakir Hussain1, Jameel Ahmed Ansari2, Muhammad Salman3
1Department of Health, Gilgit-Baltistan, Pakistan.
Insights
Acute Respiratory Infections (ARIs) surveillance in Gilgit Baltistan needs improvement. The Health Management Information System (HMIS) offers broad coverage, while Lady Health Workers Management Information System (LHWs-MIS) provides better data quality and timeliness.
Area of Science:
- Public Health
- Epidemiology
- Health Systems Research
Background:
- Acute Respiratory Infections (ARIs) are a major cause of child mortality globally and in Pakistan.
- Gilgit Baltistan (G-B) experiences a high incidence and mortality rate of ARIs in children under five.
- Effective surveillance is crucial for managing ARI outbreaks and reducing child mortality.
Purpose of the Study:
- To evaluate the strengths and weaknesses of existing ARI surveillance systems in Gilgit Baltistan.
- To identify areas for improvement in data collection, quality, and timeliness.
- To inform the development of a more robust ARI surveillance system.
Main Methods:
- Evaluation utilized CDC's updated guidelines for public health surveillance systems (2001).
- Two systems were assessed: Health Management Information System (HMIS) and Lady Health Workers Management Information System (LHWs-MIS).
- Methods included literature review, document analysis, and stakeholder interviews; sensitivity was calculated using PDHS 2006-07 data.
Main Results:
- HMIS demonstrated high sensitivity (94%) and coverage (95% population/districts) but suffered from poor data quality and inflexibility.
- LHWs-MIS showed good data quality and timeliness but had moderate representativeness (65% districts) and lacked flexibility.
- Neither system included laboratory confirmation, impacting the Predictive Value Positive (PVP).
Conclusions:
- LHWs-MIS excels in data quality and timeliness, whereas HMIS offers superior population coverage.
- Both systems face challenges with flexibility and lack essential laboratory components for comprehensive surveillance.
- A new, technologically advanced information system is recommended to enhance the robustness of ARI surveillance in G-B.
Background:
Acute Respiratory Infections (ARIs) are leading cause of death among children and cause 2.1 million deaths worldwide. In Pakistan, around 11.74 million ARIs cases are reported annually. Gilgit Baltistan (G-B) has higher ARIs incidence and mortality among children under 5. Study aims to evaluate the strengths and weaknesses of ARI surveillance systems in GB.
Methodology:
Evaluation was conducted during April 2011 using CDC's updated guidelines on evaluating the public health surveillance system, 2001. Two existing surveillance systems: Health Management Information System (HMIS) and Lady Health Workers Management Information System (LHWs-MIS) were identified. Literature, documents and reports were reviewed. Stake holders were interviewed. Sensitivity was calculated using estimates of Pakistan Health & Demographic Survey (PDHS) 2006-07.
Results:
HMIS was simple, but inflexible in accommodating additional information. Data quality was poor due to incomplete forms; data took 30 days to reach provincial HMIS cell. Sensitivity of system was 94% but lacked Predictive Value Positive (PVP) due to absence of laboratory confirmation. System was operational in public sector and covered 95% population in 95% districts. System was stable with timely and secure data collection and management. LHWs-MIS, was simple and lacked flexibility. Data quality was good and stable with adequate collection, management and provision of data. Form completion was around 90%. However, had moderate representativeness covering about 65% districts. Data were transmitted within 30 days while the Sensitivity was 84%.
Conclusions:
LHW/MIS has better quality data and timeliness, while HMIS has better coverage. Both systems have different objectives and have problems in flexibility along with an absence of lab component. To cater for the robustness of the surveillance system, new information system with latest and appropriate technology is required.
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