Evaluation of Surviellance System
A full report on evaluation of: Measles surveillance in context of Disease Early Warning System (DEWS), Afghan Public Health Institute (APHI), Ministry of Public Health (MoPH) Afghanistan By Dr. Khwaja Mir Islam Saeed, Acting Director Public Health and Management Training Department, APHI, MoPH Third cohort Field Epidemiology and Laboratory Training Program (FELTP), National Institute of Health (NIH), Pakistan November-December 2009 Introduction
As a requirement of field epidemiology and laboratory training program (FELTP), fellows are asked to evaluate and surveillance system of their country using updated guidelines for evaluation of public health surveillance system which is develop by CDC- HHS. The evaluation of the surveillance will identify the shortcomings and will provide recommendations to improve the system and strengthen the effectiveness and efficiency of the system.
In order to apply the guidelines, Disease Early Warning System (DEWS) which is sentinel based surveillance system was selected for this purpose It should be mentioned that this document is focusing on measles surveillance in the context of DEWS. Background After establishment of new government and fall of Taliban regimen the efforts have been continuing to reinforce and expand the existing health system and just reconsider and refine the priorities of the health system.
The main health priorities have been summarized in two main documents of Ministry of Public Health which are Basic Package of Healthcare Services (BPHS) for primary healthcare services and Essential Package of Hospital Services which is mostly for secondary and tertiary care. Strengthening and rebuilding the health infrastructure is leaded to new policies and strategies to deal with health related events including communicable and vaccine preventable diseases equitably.
Generally vaccine preventable diseases in children including measles have been one of top priority in the country and scattered surveillance systems have been there in order to collect data for purpose of its control and prevention. Measles remains a major cause of childhood mortality throughout the world, especially one of the most severe health problems throughout Afghanistan. Being endemic it has been always present, during all the years and in all seasons in some parts of the country.
However, the high morbidity and mortality is preventable and mass immunization against measles has been one of the top priorities in order to prevent the disease. Measles is one of the most contagious human diseases. In 1980 before the use of measles vaccine was widespread, there were an estimated 2. 6 million deaths from measles worldwide (10). The estimation of the global burden of measles is challenging in the absence of reliable and comparable surveillance systems worldwide.
In 2000, it was estimated that there were a global incidence of 39. 9 million measles cases, 777,000 deaths, and 28 million disability-adjusted life years (8). Globally the number of measles’ death estimated to 750000 in 2000 which declined by 74% to an estimated 197000 deaths in 2007 and by 78%, from to 164,000 in 2008, but the reduction in measles mortality has been leveling off since 2007 (6). Measles was estimated to be the fifth leading cause of mortality worldwide for children aged
