Assessing the performance of the integrated disease surveillance and response systems: a systematic review of global evidence.

OBJECTIVES: Public health surveillance systems are critical for detecting and responding to health threats. This review aims to analyze international literature on the performance of these systems in terms of core, support, and attributes of surveillance system. STUDY DESIGN: Systematic review. METHODS: Following the preregistered protocol (PROSPERO: CRD42022366051), a systematic search was conducted on PubMed/MEDLINE, CINHAL, CABI, Web of Science, and Google Scholar for articles evaluating Public Health Surveillance System performance from inception to July 21, 2023. Various study designs were included, and quality assessment was performed. Thematic analysis categorized findings into key surveillance system functions. RESULTS: Nine studies from different countries assessed core and supportive functions, as well as surveillance attributes. Performance varied among countries, with some excelling overall and others showing poor performance in specific areas. Many countries' surveillance systems had inadequate performance in key measures in terms of the core and supportive functions, as well as the attributes of the surveillance system. CONCLUSION: This review shows significant variations in the performance of public health surveillance systems across countries. Further research is needed to understand underperformance reasons and inform global policymaking for strengthening surveillance systems.

Inpatient or outpatient initiation of insulin therapy. Experience and cost effective analysis in a suboptimal clinical setting.

In diabetic day-care centres insulin therapy is started on an outpatient basis. However, in areas where such centres are non-existent, diabetics are admitted to hospital for initiation of insulin therapy. As an alternative to this practice, insulin was initiated in 53 outpatients in a suboptimal clinical setting to find out if it is safe, feasible, acceptable and cost-effective. Fifty-one diabetics, admitted for initiation of insulin, served as controls. No significant difference was found in the mean blood glucose before and after treatment, insulin requirement and response to treatment in both groups. Cost analysis showed that outpatient treatment was cheaper than inpatient treatment at third class and indicated a saving of US $273.00 per patient; these costs were much higher for those admitted to expensive classes. None of the outpatients had hypoglycaemia or ketoacidosis during the study period. Thus, outpatient insulin therapy is safe, feasible, acceptable and cost effective; it could be adopted even in places with suboptimal clinical setting.