F G Benson1, A Musekiwa2, L Blumberg3, L C Rispel4. 1. National Department of Health, Private Bag X828, Pretoria, 0001, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa. Electronic address: frewbenson@gmail.com. 2. Division of Global Health Protection, United States Centers for Disease Control and Prevention (CDC), Pretoria, South Africa. Electronic address: ydm4@cdc.gov. 3. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa; National Institute of Communicable Diseases, Sandringham, Johannesburg, South Africa. Electronic address: lucilleb@nicd.ac.za. 4. Centre for Health Policy and DST/NRF SARChI Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa. Electronic address: Laetitia.Rispel@wits.ac.za.
Abstract
OBJECTIVE: The aim of this study was to compare laboratory surveillance with the notifiable diseases surveillance system (NDSS) in South Africa. METHODS: Data on three tracer notifiable diseases - measles, meningococcal meningitis, and typhoid - were compared to assess data quality, stability, representativeness, sensitivity and positive predictive value (PPV), using the Wilcoxon and Chi-square tests, at the 5% significance level. RESULTS: For all three diseases, fewer cases were notified than confirmed in the laboratory. Completeness for the laboratory system was higher for measles (63% vs. 47%, p<0.001) and meningococcal meningitis (63% vs. 57%, p<0.001), but not for typhoid (60% vs. 63%, p=0.082). Stability was higher for the laboratory (all 100%) compared to notified measles (24%, p<0.001), meningococcal meningitis (74%, p<0.001), and typhoid (36%, p<0.001). Representativeness was also higher for the laboratory (all 100%) than for notified measles (67%, p=0.058), meningococcal meningitis (56%, p=0.023), and typhoid (44%, p=0.009). The sensitivity of the NDSS was 50%, 98%, and 93%, and the PPV was 20%, 57%, and 81% for measles, meningococcal meningitis, and typhoid, respectively. CONCLUSIONS: Compared to laboratory surveillance, the NDSS performed poorly on most system attributes. Revitalization of the NDSS in South Africa is recommended to address the completeness, stability, and representativeness of the system.
OBJECTIVE: The aim of this study was to compare laboratory surveillance with the notifiable diseases surveillance system (NDSS) in South Africa. METHODS: Data on three tracer notifiable diseases - measles, meningococcal meningitis, and typhoid - were compared to assess data quality, stability, representativeness, sensitivity and positive predictive value (PPV), using the Wilcoxon and Chi-square tests, at the 5% significance level. RESULTS: For all three diseases, fewer cases were notified than confirmed in the laboratory. Completeness for the laboratory system was higher for measles (63% vs. 47%, p<0.001) and meningococcal meningitis (63% vs. 57%, p<0.001), but not for typhoid (60% vs. 63%, p=0.082). Stability was higher for the laboratory (all 100%) compared to notified measles (24%, p<0.001), meningococcal meningitis (74%, p<0.001), and typhoid (36%, p<0.001). Representativeness was also higher for the laboratory (all 100%) than for notified measles (67%, p=0.058), meningococcal meningitis (56%, p=0.023), and typhoid (44%, p=0.009). The sensitivity of the NDSS was 50%, 98%, and 93%, and the PPV was 20%, 57%, and 81% for measles, meningococcal meningitis, and typhoid, respectively. CONCLUSIONS: Compared to laboratory surveillance, the NDSS performed poorly on most system attributes. Revitalization of the NDSS in South Africa is recommended to address the completeness, stability, and representativeness of the system.
Authors: Brenda Anna Kwambana-Adams; Adam L Cohen; Lee Hampton; Aquino Albino Nhantumbo; Robert S Heyderman; Martin Antonio; Andre Bita; Jason Mathiu Mwenda Journal: J Infect Dis Date: 2021-09-01 Impact factor: 5.226