Enhancing integrated disease surveillance and response system through data quality assessment: Lessons from Sierra Leone, November 2022

The Sierra Leone Ministry of Health in collaboration with the US Centers for Disease Control and Prevention, the African Field Epidemiology Network, and the World Health Organization assessed the quality of data generated by the Integrated Disease Surveillance and Response (IDSR) system. The assessment aim to determine the quality of the IDSR data in Sierra Leone through evaluating the accuracy of data compilation, data entry and transmission, and the overall precision of surveillance data at health facility and district levels. The assessment included 160 randomly selected health facilities in the 16 districts. Surveillance data stored electronically in the eIDSR platform were extracted and compared across the facility registers and IDSR summary forms. Data was collected from March 6 to March 18, 2023using an electronic checklist on the Open Data Kit (ODK) platform. The data reviewed covered the period from October 23 to November 26, 2022. Specific disease conditions/events targeted included Acute Flaccid Paralysis, Acute Viral Haemorrhagic Fever, suspected COVID-19, Dysentery, Tested Malaria, Positive Malaria, Maternal Death, and Measles. The assessment showed that 79% (127/160) of the facilities had IDSR case definition tools, with  a decreased accuracy reporting from 90% in May 2022 to 86% in November 2022 assessment.  However, the assessment revealed strengths: notably the availability of registers at all levels.  Majority, 74% (118/160) of the assessed facilities conduct data analysis and display results using  tables and graphs. The proportion of assessed facilities with weekly reporting forms decreased  to 94.4% from 98.1% in the May 2022 assessment, while case-based reporting forms increased  to 95.6% from 88.1%. Five diseases conditions/events (AFP, suspected COVID-19, Malaria tested & positive, Maternal death and Measles) exhibited data disparities between the number of cases  identified during register review and those reported in eIDSR. The assessment uncovered both strengths and challenges in facility reporting practices.  Therefore, we recommend the Ministry of Health implement targeted interventions such as  prioritising the conduct of routine DQA and supportive supervision, to strengthen weaker areas of the assessment and maintain progress in areas that shows improvement. It is critical to  strengthen the skills of the healthcare workers on data accuracy reporting, as well as to enhance  data quality feedback sharing from national to facility level to address data discrepancies for  better surveillance and response outcomes. Furthermore, replacing the faulty/lost tablets at facility level would improve the overall quality and dependability of surveillance data.