الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 198 |  |  |
| | | from | 198 | | |
Abstract
Surveillance of communicable diseases is the first and most important step in addressing public health challenges. Surveillance initiates awareness of the magnitude of public health problems, provides evidence for advocacy and action, facilitates accurate planning for service delivery, and allows for monitoring of the impact of interventions
Failure of vertical single disease control strategies to overcome the global burden of communicable diseases despite the monetary investments and the emergence of newer challenges to disease control prompted the WHO to develop and advocate an integrated approach to Disease Surveillance and Response (IDSR) in 1998
An intervention approach (one group pre-test post-test design) was developed and carried out to evaluate communicable disease surveillance after implementation of integrated disease surveillance and response strategy in Kassala state -Sudan with the following specific objectives
1. To assess the baseline performance of core activities and support functions at all levels of the surveillance system.
2. To evaluate the impact of the implementation of the IDSR strategy on the performance surveillance core activities and support functions.
All necessary guidelines, protocols, data collection forms, and electronic versions of forms are developed and all staff involved in the study were well trained to help and improve outcomes of the intervention.
Guided by the WHO questionnaire for the communicable disease evaluation, three different data collection tools were developed, tested in the field before administration to the study population, which includes an observation checklist, predesigned structured interview with key personnel, and document review.
Baseline data was collected from sampled units (60) health facilities surveillance unit, head of surveillance units of (4) localities and state are assessed before and after implementation of the integrated diseases surveillance and response activities for the six months.
The study revealed the following main results.
• The mean scores of cores, support and total indicators of health facilities in Kassala state was 17.72 ± 11.801, 30.30±13.869 and 21.10±10.461 for the core, support and total scores respectively in pre-intervention phase table (4-40).
• The medians scores of cores, support and total indicators of health facilities in Kassala state in pre-intervention phase was 15.16, 27.27 and 18.48 with no significant difference (Kruskal Wallis Test (Asymptotic sig.), 0.158, 0.177, 0.158) table (4-40).
• No significant difference for scores of hospitals and PHC was observed between health facilities for the different scores. (KWT Asymp. Sig. (0.695, 0.828 and 0.948) table (4-41).
• There was a significant difference between pre intervention and post intervention scores at all levels of services (median test = 0.000). The same pattern of significant difference was observed, regarding hospitals and PHC scores table (4-42) & (4-43).
Surveillance units at the health facility levels:
• In Kassala locality, there was a prominent significant improvement in the activities of core and supportive functions after intervention (mean ± standard deviation) (86.3 ± 8.8) compared to (24.8±11.4) in the preintervention phase with (P˂0.01) table (4-42).
• A similar result was observed in the other three localities. In rural Kassala (84.1 ± 11.9) rural Gerba (93.2 ± 2.1) and a half (92.7 ± 3.0) post-intervention compared to (22.6±14.3), (17.7±5.6) and (18.1±7.2) respectively in the preintervention phase with (P˂0.01) in all three localities table (4-42).
Surveillance units at head of locality levels:
• At head locality surveillance units’ level, similarly, the core and supportive surveillance functions in all four localities improved significantly at the intervention phase (100±0.0) against the preintervention value of (27.4 ±12.5) with (P˂0.01) table (4-42).
Surveillance units at head of state levels:
• The overall activities of core and supportive surveillance function at the head of a state unit increased from (47.3 ±24.4) at the preintervention to the (92.9 ±16.8) post-intervention phase. the difference in between was highly significant (P˂0.01) table (4-42).
surveillance units according to the types of health facilities:
• . All hospitals reached the core and supportive level of (20.3 ±8.4) pre-intervention and (92.5±5.4) post-intervention, the differences in between were highly significant (P˂0.01). likewise, in the PHCCs there was a salient improvement, in the core and supportive activities after intervention (88.4±8.7) against (21.2±10.8) in the preintervention the difference in between was significant (P˂0.01) table (4-43).
• The overall performance of all different types of health facilities (Hospitals and PHCCs) improved prominently after intervention (88.9±8.4) (21.1±10.5) with (P˂0.01) table (4-43).
6.2 . CONCLUSION
Based on the results of the current study the following can be concluded:
• The baseline data revealed a tendency of lower scores for core, support, and total indicators, with no significant differences across Kassala, Rural Kassala, Rural Gerba, and Halfa health facilities for the various scores. The same scenario emerged when it came to hospitals and PHC scores.
• The excellent performance of fundamental surveillance duties was dependent on higher-level supervision and a two-way information feedback strategy.
• Health facilities in Kassala state indicated that there were no observed disparities between health facilities for the different scores for hospitals and PHC. (KWT Sig. Asymp (0.695, 0.828 and 0.948).
• The execution of the (IDSR) in a well-controlled field setting generated a substantial change in post-intervention scores at all service levels (median test = 0.000). In terms of hospitals and PHC scores, the similar pattern of significant variations was seen.
• At all levels of surveillance health services, there was a substantial difference between pre and post intervention ratings; however, data management and analysis were lacking at the health facility level when compared to locality and state surveillance levels.
6.3 . RECOMMENDATIONS:
1. The Ministry of Health must guarantee that resources are obtained and made available to provide regular IDSR training to health care employees who are involved in IDSR implementation.
2. Make use of information technology, such as the District Health Information System (DHIS), to ensure that data is analyzed in a timely and full manner, allowing for appropriate and prompt responses.
3. Mentorship, regular, and scheduled supervisory support for IDSR implementers in the district should be provided by higher levels of authority in the Ministry of Health.
4. A financial allocation should be provided to particularly support IDSR activities and resource procurement for IDSR implementation at all levels of management in the health sector budgeting system.