Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

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Abstract Background: Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. Methods: A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson’s Chi-square or Fisher’s exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. Results: Performance of surveillance core and support functions in relation to PC-NTDs was assessed in comparison to an indicator performance target of 80%. Optimal level of performance was achieved on specimen handling capacity (84%; 100%), reports submission (100%; 100%), meeting report deadlines (84%; 80%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Health facilities achieved the target threshold on reports submission (84%), meeting report deadlines (88%) and providing feedback (80%). Presence of well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), provision for PC-NTDs in reporting forms (3.20, 95% CI: 1.44, 7.10) and training of personnel on surveillance (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of a functional surveillance system. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision. Conclusion: There was evidence of low-performing surveillance functions regarding PC-NTDs in Kenya. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

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