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Infectious disease surveillance systems in developing countries: an evaluation of the systems' performance in an environment of HIV/AIDS and malaria.
Infectious diseases surveillance systems are important tools in the fight against HIV/AIDS and malaria. However, little is known about their current performance in developing countries, which are endemic for both diseases. To evaluate the performance of three in-country infectious diseases surveillance systems, namely the National Health Information System (NHIS), the Hospital Information System (HIS) and the Malaria Information System (MIS) in the Caribbean and Central Africa regions, to measure the potential impact of the HIV/AIDS and malaria epidemics. The systems are based on telephone interviews, blood tests and/or medical records, but they are not comparable. There is no gold standard for evaluation and comparison. Data from HIS, MIS and NHIS were collected at two sites for the periods July 1997-June 1998 (pre-HIV/AIDS/malaria period) and July 2000-June 2001 (after HIV/AIDS/malaria epidemic). Each country was asked to provide the same data for a reference period. Analysis of repeated cross-sections was used to evaluate the performance of the systems. Performance measures were sensitivity, specificity, positive predictive value, kappa and prevalence estimation (PE). The systems were not able to detect all cases, mainly because of weak identification criteria and lack of recording of diagnostic tests. The overall performance of the systems was poor, even in the pre-HIV/AIDS period. Performance of HIS was better than that of NHIS. MIS was least able to detect malaria cases. The systems were not able to capture all cases and their performance was poor even in the pre-HIV/AIDS period. Performance of HIS was better than that of NHIS. MIS was least able to detect malaria cases. Because of their low sensitivity and specificity, systems in countries affected by the HIV/AIDS and malaria epidemics cannot be used to measure the be359ba680
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