Evaluation of Dengue Surveillance System, Sirindhorn Khon Kaen Hospital, 2019–2023

Abstract

Background: In 2023, the hospital information system of Sirindhorn Khon Kaen Hospital showed a total number of 38 dengue viral infection cases, whereas the 506 system was underreported with only 21 cases. In order to determine the disease reporting steps, the quantitative and qualitative attributes of the surveillance system, and the recommendations for improving the Dengue surveillance system, we then conduct the evaluation of the Dengue surveillance system.

Methods: We performed cross-sectional study among patients who sought care at Sirindhorn hospital during 2019–2022 and were diagnosed as dengue viral infection as well as related disease. We collected the medical records by systematic random samplings and stratified by selected ICD-10 codes. Both case definitions (from the Division of Epidemiology) and physicians’ diagnoses were used. The code numbers 26, 27, and 66 of the 506 report were reviewed. We also interviewed health care personnel and reviewed the steps of the disease report of the 506 system.

Results: The 506 report data of Sirindhorn hospital were collected and sent by the epidemiologist. The cases were notified by nurses at the point of care. The ICD-10 codes were entered by physicians and medical statisticians at OPD and IPD, respectively. The sensitivity by case definition and by physicians’ diagnosis were 52.09% and 50.75%, respectively. The sensitivity by case in season, out of season, IPD, and OPD were 48.40%, 61.27%, 50.67%, and 53.04%, respectively. The positive predictive value by case definition and by physicians’ diagnosis were 60.70% and 78.16%, respectively. The positive predictive value by case in season, out of season, IPD, and OPD were 61.36%, 58.81%, 57.05%, and 66.84%, respectively. All variables showed 100% completeness and 85.86-98.97% accuracy. The report was 100% timely every year except 2019 (1.91%). Age/Age group were variables that represented the surveillance system. All healthcare personnel accepted the surveillance system and concluded that the reporting system was simple. Their working steps could be changed according to the new guidelines/case definitions that had been launched. The substitution among staff was commonly found. The information from the surveillance system was used by various health care personnel.

Recommendations: We recommend epidemiologists communicate how to notify the dengue cases to all related healthcare personnel, assign the right person who is responsible for the notification of dengue cases, monitor both cases and non-cases of dengue in order to correct the data when physicians’ diagnosis has been changed at IPD and re-send the 506 reports, and make a business continuity plan according to the outbreak of dengue in order to improve disease surveillance reports.