Analysis of the MoH Weekly Epidemiological Surveillance April to June 2016 data revealed; that weekly surveillance reporting rates increased slightly over the quarter and the Central Region is still pulling the national average below the minimum target of 80%. There was a lot of variation in MMR and PMR across districts. Kisoro district reported one of the highest cholera attack rates, yet it did not report an outbreak. The North-Eastern districts were the most more affected by Dysentery. Abim had an unusually high MMR justifies an investigation. It was noted that HMIS data still has major quality issues. Several districts reported unreasonably high numbers of cases or deaths while denominator data in the DHIS2 system is incorrect.
Introduction: On a weekly basis, the Ministry of Health Di- vision of Health Information (MoH-DHI) analyses and disseminates weekly epidemiological data so as to monitor for changes in disease/event trends. This ensures early detection of possible dis- ease outbreaks, prompt investigation and response. It also monitors the effect of public health interventions. Several priority dis- eases and events were selected to be monitored on a weekly basis through the mobile phone-based weekly surveillance data collect-
-ion system commonly known as mTRAC. These reportable dis- ease/events are the priority under the Integrated Disease Surveil- lance and Response (IDSR) framework [1, 2]
Methods: We abstracted national weekly Health Management Information System (HMIS) surveillance data for the period April-June 2016 as compiled in the District Health Information System (DHIS2) database [3]. This data is collected through the health facility weekly surveillance report known as HMIS report
Results. Weekly Epidemiological Surveillance (HMIS 033b) Reporting Rates. Much as the national reporting rate has been slightly increased from 70% to 75% though this is still below the target of 80%. Northern Region has consistently had the best reporting rates while Kampala re- mains way below the other Regions. Over the quarter, Buliisa, Maracha and Moyo districts maintained 100% reporting rates. Central Districts of Kampala and Wakiso had the lowest reporting rates (Fig 1).
Maternal and Perinatal Mortality Rates: Districts in the North and Eastern Uganda reported the he highest Maternal Mortality Rates (MMR). Abim District reported the highest MMR (267/100,000). The Perinatal Mortality Rates (PMR) were concentrated in West Nile reported, Western and South Western Districts (Figure 2). Mubende had the highest PMR (3.3/1000).
Attack Rates of Selected Priority IDSR Diseases: Typhoid had high attack rates in several districts as can be seen in Figure 3. Oyam and SSembabule had the highest attack rates. The highest dysentery attack rates were concentrated in North Eastern Uganda. The highest attack rate was in Bukwo. Kalangala was the only District with a high AR in the rest of Uganda. Several districts reported Cholera cases during this quarter.
The highest cholera ARs were in Kisoro and Namutumba. The highest measles attack rates were in Namutumba, Nakaseke and Lyantonde (Fig 3)
Yellow Fever: Some districts reported yellow fever cases through HMIS though these cases were not investigated. Yellow fever surveil- lance requires case based reporting with laboratory verification of eve- ry suspected yellow fever case.
However as expected, the highest attack rates were in Masaka Sub Region and Rukungiri where yellow fever outbreaks were confirmed in this reporting period. Kabale District had the highest Case Fatality Rate (CFR) for Malaria. Buvuma District had the highest Typhoid CFR while Nakasongola had the highest Cholera CFR (Table 1).
Region and Rukungiri where yellow fever outbreaks were confirmed in this reporting period. Kabale District had the highest Case Fatality Rate (CFR) for Malaria. Buvuma District had the highest Typhoid CFR while Nakasongola had the highest Cholera CFR (Table 1)
Discussion and Conclusions. Although the weekly surveil- lance reporting rates have slightly increased over the quarter, Central Region is still pulling the National average below the minimum target of 80%. This has been mainly attributed to the many private facilities in Kampala which do not prioritise HMIS reporting because it does not generate revenue for them yet it requires time and personnel. Northern Uganda has always per- formed better than the other regions in HMIS reporting and this trend is likely to continue.
Most of the District reporting highest numbers of maternal deaths were from Northern Uganda. This could be due to the good reporting rates although several other factors could explain it. The CFR for malaria were highest in Northern Uganda Districts. This is likely due to the ongoing malaria outbreak in the region.
Just like most surveillance data, HMIS data still has major issues in quality and its ease to analyse. Several districts reported ab- normal numbers of cases or deaths. Another weakness is that the population data in the system is incorrect and thus could not be used to calculate incidence rates, mortality rates and attack rates. These indicators would have provided stronger epidemiological evidence.
Recommendations/Public Health Actions:
HMIS reporting from private facilities must be improved by providing them with tangible benefits when they report. An example could be recogni- tion of the best reporting private facilities in each Region and District.
There is an urgent need to incorporate accurate and up to date population data to enable the calculation of stronger epidemiological statistics.
References:
WHO, Integrated disease surveillance and response in the African Region: a guide for establishing
community based surveillance. 2014.
Kasolo, F., et al., IDSR as a platform for implementing IHR in African countries. Biosecurity and
bioterrorism: biodefense strategy, practice, and science, 2013. 11(3): p. 163-169.
MOH. District Health Information System (DHIS2) dashboard. 2016; Available from:
http://hmis2.health.go.ug/dhis-web-commons/security/login.action.