An evaluation of acute respiratory infection surveillance systems in Gilgit-Baltistan Pakistan

Background: Acute Respiratory Infections (ARIs) are leading cause of death among children and cause 2.1 million deaths worldwide. In Pakistan, around 11.74 million ARIs cases are reported annually. Gilgit Baltistan (G-B) has higher ARIs incidence and mortality among children under 5. Study aims to evaluate the strengths and weaknesses of ARI surveillance systems in GB. Methodology: Evaluation was conducted during April 2011 using CDC's updated guidelines on evaluating the public health surveillance system, 2001. Two existing surveillance systems: Health Management Information System (HMIS) and Lady Health Workers Management Information System (LHWs-MIS) were identified. Literature, documents and reports were reviewed. Stake holders were interviewed. Sensitivity was calculated using estimates of Pakistan Health & Demographic Survey (PDHS) 2006-07. Results: HMIS was simple, but inflexible in accommodating additional information. Data quality was poor due to incomplete forms; data took 30 days to reach provincial HMIS cell. Sensitivity of system was 94% but lacked Predictive Value Positive (PVP) due to absence of laboratory confirmation. System was operational in public sector and covered 95% population in 95% districts. System was stable with timely and secure data collection and management. LHWs-MIS, was simple and lacked flexibility. Data quality was good and stable with adequate collection, management and provision of data. Form completion was around 90%. However, had moderate representativeness covering about 65% districts. Data were transmitted within 30 days while the Sensitivity was 84%. Conclusion: LHW/MIS has better quality data and timeliness, while HMIS has better coverage. Both systems have different objectives and have problems in flexibility along with an absence of lab component. To cater for the robustness of the surveillance system, new information system with latest and appropriate technology is required.