Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
In this AEFI surveillance system, there is parallel different reporting systems. These two have no interoperability, usability and used different tools for data management.
For addressing this issue, I will start the re-designing of surveillance system reporting flow. To initiate I will do advocacy meeting with M&E team and Disease Surveillance Unit for the health staff’s awareness of the need for change, targeting to raise their desire to use acceptability interoperable data and data collecting tools (single one). Then, after getting consensus to use single management system, I will prepare the electronic data reporting system for AEFI cases from health facility to common server as immediate reporting. For zero reporting cases, there will be defined specific date (every Tuesday) to report to server. For stability strengthening, I will recruit new staff for surveillance data reporting, prepare the report formats as simple and flexible ones. After this, the AEFI surveillance training will be given to all RI providers, LIO, RIO, DSNO and M&E Officers, emphasizing the importance of data to report and giving constructive feedbacks and required logistics supplies to surveillance site.
2.) Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.
In this case, under-reporting and incomplete data decrease the sensitivity of system. So, I will initiate the direct electronic reporting system to central server (KoBo application can be used freely). All LIO, RIO, DSNO and M&E Officer will be grouped as surveillance team and monitor the reported data as their assigned duty. The reporting format will be prepared to collect the most required data (date, health facility name, village/ward, age, received vaccine, symptoms). After confirmation of the case, the case investigation process will be proceeded by surveillance team to reported health facility.
Expected trade-offs:
(1) Required training to use KoBo application and create KoBo server
(2) Responsiveness from the surveillance team will be faster and start investigation or feedback to health facility
(3) Knowledge and perceptions of RI providers to collect AEFI data will be raised due to proper training.
(4) Their workload can reduce compared to previous system.
(5) Data security and privacy must be applied for the system.
Indicators
(1) Timeliness and completeness of surveillance data on weekly basis
(2) Random data quality assessment reports between primary data source and electronic system reporting
(3) Feedbacks evaluation from RI providers for using electronic reporting system
3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
– If yes, what trigger would you use to revert to the prior definition?
– If no, why should this change not be implemented?
Yes, AEFI case definition should be temporarily broadened to get many positive case as much as. Because we have no adequate capacity in giving information about vaccine safety, no reported AEFI data means that the system is not competent to provide vaccine safety consideration.
To revert the prior definition, I will request for ad-hoc NEC meeting, reporting the system’s pitfalls to consider vaccine safety and modify the AEFI case definition for new vaccine to AEFI National Expert Committee (NEC).