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CA FETP 27 Sept 2012

Xiong , et al . A survey of core and support activities of communicable disease surveillance systems at operating-level CDCs in China . BMC Public Health 2010, 10:704. CA FETP 27 Sept 2012. Background. Communicable disease s urveillance in PRC:

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CA FETP 27 Sept 2012

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  1. Xiong, et al. A survey of core and support activities of communicable disease surveillance systems at operating-level CDCs in China. BMC Public Health2010, 10:704 CA FETP 27 Sept 2012

  2. Background Communicable disease surveillance in PRC: • Notifiable Disease Reporting System (NDRS): 2004 - internet-based real-time; developed indicators to monitor performance; involve all regional CDC & >80% public hospitals; covers 39 diseases; 2005 – Enhanced Infectious Diseases & Vector Surveillance Systems (25 diseases & 4 vectors; surveillance sites) 2. Disease-specific surveillance systems (DSSS)

  3. Administrative Levels: • Chinese Center for Disease Control & Prevention (CCDC) • Province-level CDC (N=31) • County-level CDC - monitor epidof com diseases, investigates outbreaks, and coordinates hospitals, HCs, clinics & labs.

  4. Problem: DSSS county managed, heavy workloads, multiple systems using different methods, terminologies & reporting forms. WHO recommended a structured approach to strengthen national communicable disease surveillance systems; must include evaluation of existing systems. Purpose: to describe how the existing surveillance systems worked at the province-level and county-level CDCs.

  5. Methods - Instruments Design questionnairesfollowing WHO assessment guidelines • Q for chief director of province-level CDC - 13 questions re priority CDs, goal of CDC, current situation NDRS & DSSS. • Q for NDRS directors at province-level - 24 questions re core & supp activities. • Q for DSSS directors at province-level CDCs - 25 questions re core & supp activities.

  6. Q for chief director of county-level CDC - 13 questions re priority CDs, goal of CDC, current situation NDRS & DSSS. • Q for NDRS directors at county-level CDCs - 23 questionsre core & supp activities. • Q for DSSS directorsat county-level CDCs - 25 questionsre core & supp activities.

  7. Pilot test Qs in 2 Prov CDC & 2 County CDC respondents were asked to answer two questions after finishing the Q: Has the questionnaire covered all the main areas of existing surveillance activities? Which item is the most time-consuming? Final adjustment of Q corresponding to the results of pilot study. Nationwide survey by mailing Q to all the province-level CDCs & selected county-level CDCs

  8. Method - Subjects • All 31 province-level CDCs in Mainland China • 14 from nearly 3000 county-level CDC were selected by a two-step framework: 1. the 31 province-level CDCs were divided into 3 groups – A (P75) the best reporting quality provinces, B (P75-P25) and C (P25); 2- 4 provinces were sampled from each group based on their socioeconomic status; 8 provinces were selected for further sampling.

  9. 2. the chief directors of the selected province- level CDCs were asked to nominate 1good performing and 1 weak performing county-level CDC; 14 county-level CDCs were chosen.

  10. Method – Statistical Analysis • Epidata 3.0 was used for data entry. • After data cleansing, the quality of returned Qs were evaluated; Q excluded if > 5 questions missing. • For each system the proportion of activities was calculated

  11. Results • 31 province-level and 14 county-level CDCs were investigated between May-October 2006. • All respondents were asked to describe core & supp activities performed in the previous year. • 91.9% of the province-level and 100% of the county-level CDCs returned the completed Q. • Proportions of invalid Qs: 6.9% province-level and 0.1% county-level CDCs.

  12. NDRS – Tabel 2 & 3 (28 Prov & 14 County Qs)  feedback (from decision makers to data providers), equipment & overtime pay insufficient in most CDCs. • DSSS - Tabel 4 & 5 (406 Prov & 85 County Qs)  A total of 47 diseases or syndromes were under surveillance at province level, and 20 at county level; clear targets & long-term assistance.

  13. Comments from CDC chief directors (%) re Achievement of Objectives & Functioning:

  14. Limitations • items about hospitals, health administrative departments and CCDC were excluded • Items about outbreak investigation, response to epidemics & epidemic preparedness were minimized • Recall bias • investigated 14 county-level CDCs

  15. Conclusion/Recommendation • Some activities need to be strengthened & more in-depth and comprehensive descriptions and evaluations are needed to improve the communicable disease surveillance systems in China.

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