Table 4 Description of the SMS-reinforced IDSR strategy. Table describing characteristics of the reinforced IDSR strategy in southern Madagascar including objectives, indicators, data source, collection, transfer and use

PH importance of diseases/ syndromes under surveillance

Diseases under surveillance constitute the biggest part of basic healthcare consultations such as Acute Respiratory Infections (ARI), malaria, diarrhoea

Available interventions

23/35 of the diseases and syndromes under surveillance have a defined response foreseen in the national health action plan

IDSR objectives

Follow the trend of endemic and/or epidemic diseases and syndromes

Detect cases of highly epidemic diseases or diseases subject to elimination or eradication programmes as well as unexpected events in a timely manner

Provide IHR data to the WHO

Performance indicators used

Weekly number of cases and deaths by disease, syndrome or event, and by HS

Proportional morbidity: Number of consultations by disease, syndrome or event/ Number of total consultations

Completeness: Number of reports received/Number of expected surveillance reports

Timeliness: Number of reports received within 48 h after the week in question/Number of expected surveillance reports

Information collected

Number of cases and deaths for three groups of diseases/syndromes/ events

 • Endemic and potential epidemic diseases: Acute Respiratory Infections (ARI), diarrhoeal diseases, malnutrition, malaria, tuberculosis, Human Immunodeficiency Virus (HIV), Sexually Transmitted Infections (STI), maternal deaths

 • Highly epidemic diseases: cholera, bacterial dysentery, meningitis, plague, yellow fever, viral haemorrhagic fever, chikungunya, dengue-like syndrome (DLS), rabies, foodborne outbreaks, severe acute respiratory syndrome (SARS), avian influenza, Rift Valley fever, chickenpox, West Nile virus

 • Diseases subject to eradication or elimination programmes: poliomyelitis & acute flaccid paralysis (AFP), leprosy, measles, neonatal tetanus, filariasis, malaria

Data source

HS patient consultation register

Data collection, entry and transfer

Compilation of weekly number of total consultations, and cases and deaths per disease/ syndrome or event (including zero reporting) before sending them per SMS to the DHO. At the DHO, the surveillance focal point enters the data into an Excel spreadsheet.

Database set-up

One observation (line) per week and per district

Data analysis and thresholds

Weekly analyses based on defined thresholds, for example:

 • Disease for which one case = epidemic, such as meningitis, acute flaccid paralysis, neonatal tetanus, measles, SARI, avian influenza, cholera, plague, haemorrhagic fever, human rabies

 • Malaria: doubling of cases over three consecutive weeks

 • Brutal increase in comparison with other diseases/ syndromes

 • Completeness and timeliness of data transfer

Communication

No routine communication of analysis results to stakeholders (2016)

Use of data and analyses results

Weekly monitoring of performance indicators (completeness, timeliness), investigation of and response to potential identified or notified signals