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Table 3 Findings from the evaluation of the influenza like-illness surveillance system in Tunisia, 2012–2015

From: Evaluation of the influenza-like illness surveillance system in Tunisia, 2012–2015

Attributes and definitions Indicators Scores a Mean score
Data quality and completeness
 The completeness and validity of the data recorded in the public health surveillance system
• Proportion of ILI surveillance staff that identified correctly the ILI case definition 2 2.7
• Proportion of ILI surveillance staff that identified correctly the sampling criteria 2
• Proportion of collected variables included in the WHO recommended minimum data collection for influenza sentinel surveillanceb 2
• Quality and proficiency of NIC laboratory detection of of influenza using RT-PCR 5
Representativeness
 Describes the occurrence of a health-related event over time and its distribution in the population by place and person
• Geographical coverage d 4 4.5
• Inclusion of all age groups d 5
Timeliness
 Reflects the speed between steps in a public health surveillance system
• Proportion of NIC staff estimating that more than 80% of results of tested samples were obtained within 7days from the date of reception 5 3.4
• Proportion of ILI surveillance staff estimating that more than 80% of aggregated data were sent within 7 days from ILI sites to regional directorates 3
• Proportion of ILI surveillance staff estimating that more than 80% of aggregated data were sent within 1 month from ILI sites to regional directorates 3
• Proportion of regional directorates surveillance staff estimating that more than 80% of aggregated data were sent within 7 days to DSSB 3
• Proportion of regional directorates surveillance staff estimating that more than 80% of aggregated data were sent within 1 month to DSSB 3
Simplicity
 Refers to both structure and ease of operation of a public health surveillance system
• Perception of surveillance staff on the ease of accomplishing these surveillance activities: 2 2.5
▪ Data collection for the sampling form 3
▪ Data collection for the shipment form 3
▪ specimen collection 2
• Mean of time devoted to weekly surveillance activities c
Acceptability
 The willingness of persons and organizations to participate in the surveillance system
• Proportion of surveillance staff that was satisfied with the following:   3.0
▪ Virological surveillance report 2
▪ Influenza bulletin 2
▪ Communication 3
• The proportion of surveillance staff that reported that the surveillance system was good:  
▪ ILI surveillance staff 3
▪ NIC surveillance staff 4
▪ Regional directorate 4
Flexibility
 The ability of a surveillance system to changing information needs or operating conditions with little additional time, personnel, or allocated funds
• The 2014 decrease in the number of ILI sites performing surveillance d 3 4.0
• The adoption of new ILI forms d 4
• Inclusion of other pathogens surveyed with influenza surveillance system d 5
Stability
 The reliability and availability of the public health surveillance system
• Proportion of ILI surveillance staff that report using:   2.7
▪ SOP for sampling 3
▪ SOP for shipment 3
▪ Influenza Surveillance Guide 2
• Proportion of ILI surveillance staff that report being trained on:  
▪ Epidemiological surveillance 2
▪ Influenza surveillance activities 2
▪ Influenza-specific response activities 2
▪ The practice of nasopharyngeal specimens 2
• Proportion of ILI surveillance staff that reported that depletion of stock never occurred for:  
▪ Data collection forms 4
▪ Sampling material 3
▪ Protective equipment 3
Utility
 Does the system provide information that is useful for public health authorities and communities
• Proportion of ILI surveillance staff that reported that the influenza surveillance system:   3.6
▪ was important 4
▪ provided useful data 4
• Proportion of ILI surveillance staff that reported that they regularly receive the following reports:  
▪ Virological surveillance report 2
▪ Monthly Influenza bulletin 2
▪ Annual Influenza report 3
• Identification and sharing of circulating seasonal influenza strainsd 5
• Contribution of influenza viruses to WHO CC for vaccine strain selection:  
▪ participation with WHO CC for vaccine selection 5
▪ number of shipments 4
▪ adherence to recommended timing of shipment 3
• Outbreaks detected over pre-established threshold during the evaluation period d 4
Overall total    3.3
  1. ILI: influenza like-illness, WHO: World Health Organization, NIC: National Influenza Center, DSSB: Primary Health Care Directorate, SOP: Standard operating procedures, WHO CC: WHO Collaborating Centers on influenza
  2. a: a scale from 1 to 5 was used to provide a score for each indicator with a percentage value as follows: [0–20%[score 1 (very poor performance); [20–40%[score 2 (poor performance); [40–60%[score 3 (moderate performance); [60–80%[score 4 (good performance); [80–100%[score 5 (very good performance)
  3. b: The Tunisian surveillance system lacks data, within the list of the recommended WHO minimum data, on body temperature at presentation, date of symptom onset, date of specimen collection, seasonal influenza vaccination status, antiviral treatment and underlying medical conditions
  4. c: a scale from 1 to 5 was used to provide a score for the mean of time devoted to weekly surveillance activities with a percentage value as follows: [1–5%[score 5 (very good performance); [5–10%[score 4 (good performance); [10–15%[score 3 (moderate performance); [15–20%[score 2 (poor performance); [20–25%[score 1 (very poor performance)
  5. d: These indicators were scored from 1 to 5 but these scores were based on the consensus opinions of surveillance experts: virologist, public health specialist and epidemiologists as follows: score 1 (very poor performance); score 2 (poor performance); score 3 (moderate performance); score 4 (good performance) and score 5 (very good performance)