The implementation of Integrated Disease Surveillance and Response in Uganda: a review of progress and challenges between 2001 and 2007
The implementation of Integrated Disease Surveillance and Response in Uganda: a review of progress and challenges between 2001 and 2007
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DOI：
10.1093/heapol/czs022
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发表时间：
2013-01-01
影响因子：
3.2
通讯作者：
Talisuna, Ambrose
中科院分区：
文献类型：
--
作者：
Lukwago, Luswa;Nanyunja, Miriam;Talisuna, Ambrose
方法采用世界卫生组织（WHO）和美国疾病控制和预防中心（CDC）-亚特兰大推荐的监测框架，对2001 - 2007年国家一级IDSR核心指标的绩效进行评估。为了确定IDSR在地区和卫生设施一级的性能超过5年的时间，我们比较了2004年的监测调查的评估结果与2000年的基线评估结果。结果2000- 2007年，国家层面对IDSR的资助情况有所改善，主要表现在：（1）地区层面的报告情况有所改善（2001年为49%; 2007年为85%）;（2）各区向中央一级报告的及时性先增后减;（3）地方层面的分析数据增加（从10%增加到47%，分析至少一种目标疾病，P < 0.01）。在实施IDSR期间，两种目标优先疾病（霍乱和脑膜炎球菌性脑膜炎）的病死率有所下降（霍乱：从7%降至2%;脑膜炎：从16%降至4%），这很可能是由于改进了疫情应对措施。实施前后的比较表明，政府和发展伙伴为IDSR提供的资金有所增加。然而，从2000/01年度政府预算到2007/08年度，资助减少了十倍。疾病监测活动的人均投入从1996-99年的0.0046美元增加到2000- 07年的0.0215美元。然而，政府预算支持的减少可能会侵蚀这些成果。政府和其他利益攸关方必须作出新的努力，以维持和扩大通过实施《国际减灾战略》取得的进展。
Methods We used a monitoring framework recommended by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC)-Atlanta to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. To determine the performance of IDSR at district and health facility levels over a 5-year period, we compared the evaluation results of a 2004 surveillance survey with findings from a baseline assessment in 2000. We also examined national-level funding for IDSR implementation during 2000-07.Results Our findings show improvements in the performance of IDSR, including: (1) improved reporting at the district level (49% in 2001; 85% in 2007); (2) an increase and then decrease in timeliness of reporting from districts to central level; and (3) an increase in analysed data at the local level (from 10% to 47% analysing at least one target disease, P < 0.01). The case fatality rate (CFR) for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. A comparison before and after implementation showed increased funding for IDSR from government and development partners. However, funding support decreased ten-fold from the government budget of 2000/01 through to 2007/08. Per capita input for disease surveillance activities increased from US$0.0046 in 1996-99 to US$0.0215 in 2000-07.Conclusion Implementation of IDSR was associated with improved surveillance and response efforts. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.