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BACKGROUND: Dengue is endemic in Maldives. The largest epidemic to date was in 2011. This study evaluates the surveillance system for dengue during 2011, identifies gaps and suggests ways to improve. METHODS: This evaluation of the national surveillance system for dengue was done in September to October 2012, using an evaluation tool based on United States Centers for Disease Control and Prevention (US CDC) guidelines, staff involved in surveillance of different levels, and doctors expected to notify, were interviewed, and surveillance data from the Health Protection Agency (HPA) were compared by use of an independent database of the country's national referral hospital in Malé, Indira Gandhi Memorial Hospital (IGMH), to assess sensitivity and timeliness. RESULTS: National surveillance is conducted by HPA, which collects information daily from a network of health facilities. Standard case definitions were published, butthey were not easily accessible to clinicians. The quality of data was acceptable. Information is disseminated as annual communicable disease reports to health facilities and uploaded onto the official website. The timeliness of reporting was good (median 2 days). However, the usefulness for early warning of outbreaks was limited, owing to central and peripheral resource limitations. Data were useful for planning. Sensitivity was 0.54. Acceptability by clinicians was poor, owing to the lack of feedback reaching them. The reporting rate was high from the paediatric ward in IGMH (85%), where the responsibility of notifying was also assigned to ward in-charge and support staff, but it was extremely low from the medical ward (1.7%), where only doctors were given the responsibility. CONCLUSION: This evaluation shows the performance of the dengue surveillance system was good overall. However, clinicians need more regular feedback. The performance could be improved significantly by written protocols, legislature and assigning the responsibility of surveillance in hospitals to ward managers in addition to doctors.
RESUMO
OBJECTIVE: To identify the major risk factors for non-communicable diseases (NCDs) among the population of the capital city Male. METHODS: We undertook a cross-sectional survey among the 25-64-year-age group using a multi-stage sampling method with households as sampling unit. Information on behavioral, physiological, and biochemical risk factors was obtained through standardized methods as recommended by the STEPS survey guideline of the World Health Organization. Age-adjusted prevalence was calculated using the census figures for the year 2000. RESULTS: Among 2,028 individuals who participated in the survey, complete biochemical data were available for 1,506 subjects. The prevalence of NCD risk factors was high among both men and women in low education group: current smoking (39.9, 9.9%); overweight (BMI ≥ 23 kg/m(2)) (60.8, 65.5%); abdominal obesity (24.2, 54.1%); raised blood pressure (29.7, 32.9%); raised blood glucose (4.3, 4.7%); hypercholesterolemia (53.7, 54.9%). CONCLUSION: The significant burden posed by the NCD risk factors along with the gender and socioeconomic differentials point to the need for public health action. The Ministry of Health has already initiated a comprehensive response to this threat. The experience and lessons from this survey will be useful for developing a comprehensive and sustainable surveillance system in the country.