An evaluation of the surveillance system for dengue virus infections in Maldives.

Background: Dengue is endemic in Maldives. The largest epidemic to date was in 2011. This study evaluates the surveillance system for dengue during 2011, identifies gaps and suggests ways to improve.

Methods: This evaluation of the national surveillance system for dengue was done in September to October 2012, using an evaluation tool based on United States Centers for Disease Control and Prevention (US CDC) guidelines, staff involved in surveillance of different levels, and doctors expected to notify, were interviewed, and surveillance data from the Health Protection Agency (HPA) were compared by use of an independent database of the country's national referral hospital in Malé, Indira Gandhi Memorial Hospital (IGMH), to assess sensitivity and timeliness.

Results: National surveillance is conducted by HPA, which collects information daily from a network of health facilities. Standard case definitions were published, butthey were not easily accessible to clinicians. The quality of data was acceptable. Information is disseminated as annual communicable disease reports to health facilities and uploaded onto the official website. The timeliness of reporting was good (median 2 days). However, the usefulness for early warning of outbreaks was limited, owing to central and peripheral resource limitations. Data were useful for planning. Sensitivity was 0.54. Acceptability by clinicians was poor, owing to the lack of feedback reaching them. The reporting rate was high from the paediatric ward in IGMH (85%), where the responsibility of notifying was also assigned to ward in-charge and support staff, but it was extremely low from the medical ward (1.7%), where only doctors were given the responsibility.

Conclusion: This evaluation shows the performance of the dengue surveillance system was good overall. However, clinicians need more regular feedback. The performance could be improved significantly by written protocols, legislature and assigning the responsibility of surveillance in hospitals to ward managers in addition to doctors.