Performance of the Severe Acute Respiratory Illness Sentinel Surveillance System in Yemen: Mixed Methods Evaluation Study.

BACKGROUND: The national severe acute respiratory illness (SARI) surveillance system in Yemen was established in 2010 to monitor SARI occurrence in humans and provide a foundation for detecting SARI outbreaks. OBJECTIVE: To ensure that the objectives of national surveillance are being met, this study aimed to examine the level of usefulness and the performance of the SARI surveillance system in Yemen. METHODS: The updated Centers for Disease Control and Prevention guidelines were used for the purposes of our evaluation. Related documents and reports were reviewed. Data were collected from 4 central-level managers and stakeholders and from 10 focal points at 4 sentinel sites by using a semistructured questionnaire. For each attribute, percent scores were calculated and ranked as follows: very poor (≤20%), poor (20%-40%), average (40%-60%), good (60%-80%), and excellent (>80%). RESULTS: As rated by the evaluators, the SARI surveillance system achieved its objectives. The system's flexibility (percent score: 86%) and acceptability (percent score: 82%) were rated as "excellent," and simplicity (percent score: 74%) and stability (percent score: 75%) were rated as "good." The percent score for timeliness was 23% in 2018, which indicated poor timeliness. The overall data quality percent score of the SARI system was 98.5%. Despite its many strengths, the SARI system has some weaknesses. For example, it depends on irregular external financial support. CONCLUSIONS: The SARI surveillance system was useful in estimating morbidity and mortality, monitoring the trends of the disease, and promoting research for informing prevention and control measures. The overall performance of the SARI surveillance system was good. We recommend expanding the system by promoting private health facilities' (eg, private hospitals and private health centers) engagement in SARI surveillance, establishing an electronic database at central and peripheral sites, and providing the National Central Public Health Laboratory with the reagents needed for disease confirmation.

Performance of the Neonatal Tetanus Surveillance System (NTSS) in Sana'a, Yemen: Evaluation Study.

BACKGROUND: The Neonatal Tetanus Surveillance System (NTSS) in Yemen was established in 2009 to identify high-risk areas, determine trends, and evaluate elimination activities. Since its launch, the NTSS had never been evaluated. OBJECTIVE: This study aimed to assess the performance of NTSS and determine its strengths and weaknesses to recommend improvements. METHODS: The US Centers for Disease Control and Prevention (CDC) guidelines were used for evaluating the NTSS. Stakeholders at the central, district, and facility levels were interviewed to rate the attributes of the NTSS. The percentage scores for attributes were ranked as poor (<60%), average (≥60% to <80%) and good (≥80%). RESULTS: The overall usefulness score percentage was 38%, which indicates a poor performance. The performance of the NTSS was rated as average on flexibility (score percent: 68%) and acceptability (score percent: 64%) attributes and poor on stability (score percentage: 33%), simplicity (score percentage: 57%), and representativeness (score percentage: 39%) attributes. About 65% of investigation forms were completed within 48 hours of notification date. Data quality was poor, as 41% of the core variables were missing. CONCLUSIONS: The overall performance of the NTSS was poor. Most of the system attributes require improvement, including stability, simplicity, quality of data, and completeness of investigation. To improve the performance of NTSS, the following are recommended: capacity building of staff (focal points), strengthening NTSS through technical support and government funding to ensure its sustainability, establishing electronic investigation forms for improving the system data quality, and expansion of NTSS coverage to include all private health care facilities.

Evaluation of Two Malaria Surveillance Systems in Yemen Using Updated CDC Guidelines: Lessons Learned and Future Perspectives.

Yemen is classified as high malaria endemic area with two-thirds of population at risk. Currently, the National Malaria Control Program (NMCP) uses two malaria surveillance systems: the Integrated Malaria Surveillance System (IMSS) and the Early Disease Electronic Warning System (eDEWS). This study aimed to assess and compare the usefulness and attributes of the two malaria surveillance systems. The systems were evaluated according to the US Centers for Disease Control and Prevention (CDC) updated guidelines. Data were collected from 10 stakeholders through interviews and from 10 districts' coordinators and 20 health facilities' focal points using semistructured questionnaire. The score of the system attributes were interpreted as very poor, poor, average, good, and excellent according to the mean percent score. Both systems were found to be useful. The IMSS overall performance score was poor where flexibility was average and simplicity, acceptability, representativeness, and stability were poor. For eDEWS, the overall performance score was good where data quality, acceptability, and flexibility were excellent; simplicity was good; representativeness was average; and stability was poor. In conclusion, although the IMSS was found to be useful for assessing the burden of malaria, response to outbreak, and future planning, the overall performance was poor. While the eDEWS overall level of performance was good, it was found to be useful only for outbreak detection. Therefore, both surveillance systems need to be integrated for the advantages of both systems to be maintained.