Comparing laboratory surveillance with the notifiable diseases surveillance system in South Africa.

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.

Survey of the perceptions of key stakeholders on the attributes of the South African Notifiable Diseases Surveillance System.

BACKGROUND: An effective and efficient notifiable diseases surveillance system (NDSS) is essential for a rapid response to disease outbreaks, and the identification of priority diseases that may cause national, regional or public health emergencies of international concern (PHEICs). Regular assessments of country-based surveillance system are needed to enable countries to respond to outbreaks before they become PHEICs. As part of a broader evaluation of the NDSS in South Africa, the aim of the study was to determine the perceptions of key stakeholders on the national NDSS attributes of acceptability, flexibility, simplicity, timeliness and usefulness. METHODS: During 2015, we conducted a nationally representative cross-sectional survey of communicable diseases coordinators and surveillance officers, as well as members of NDSS committees. Individuals with less than 1 year experience of the NDSS were excluded. Consenting participants completed a self-administered questionnaire. The questionnaire elicited information on demographic information and perceptions of the NDSS attributes. Data were analysed using descriptive statistics and the unconditional logistic regression model. RESULTS: Most stakeholders interviewed (53 %, 60/114) were involved in disease control and response. The median number of years of experience with the NDSS was 11 years (inter-quartile range (IQR): 5 to 20 years). Regarding the NDSS attributes, 25 % of the stakeholders perceived the system to be acceptable, 51 % to be flexible, 45 % to be timely, 61 % to be useful, and 74 % to be simple. Health management stakeholders perceived the system to be more useful and timely compared to the other stakeholders. Those with more years of experience were less likely to perceive the NDSS system as acceptable (OR 0.91, 95 % CI: 0.84-1.00, p = 0.041); those in disease detection were less likely to perceive it as timely (OR 0.10, 95 % CI: 0.01-0.96, p = 0.046) and those participating in National Outbreak Response Team were less likely to perceive it as useful (OR 0.38, 95 % CI: 0.16-0.93, p = 0.034). CONCLUSION: The overall poor perceptions of key stakeholder on the system attributes are a cause for concern. The study findings should inform the revitalisation and reform of the NDSS in South Africa, done in consultation and partnership with the key stakeholders.

What will move malaria control to elimination in South Africa?

In this supplement, several authors have shared lessons from the past and identified factors that led to the significant reductions in malaria morbidity and mortality during the past half-century in South Africa. In addition, strategies for achieving malaria elimination have been proposed. Here, we highlight the gaps that have been identified and make proposals for taking South Africa from malaria control to elimination.