Evaluation of the schistosomiasis surveillance system - Alagoas State, Brazil, from 2004 to 2008.

Abstract Text: Introduction: Schistosoma mansoni (SM) is endemic in Brazil and Alagoas state has the largest transmission area, 70% of its territory. An assessment was conducted to evaluate the SM surveillance system in Alagoas during 2004 to 2008.

Methods: Using the 2001 CDC Updated Guidelines for Evaluating Public Health Surveillance Systems we described the system, evaluated its attributes and utility using two surveillance databases, questionnaires administered to key respondents and interviews with confirmed cases from a non-endemic city, Major Isidoro.

Results: In the endemic area surveillance is based on active case finding through coproscopic surveys, registered in SM database, named SISPCE. In non-endemic areas it is passive, the data is recorded in the national information system for reportable diseases (SINAN). The completeness of SISPCE was >90% and inconsistencies were <20%. SINAN completeness ranged from 36 to 86% and inconsistencies from 20 to 92%. The acceptability of the population invited to respond to the surveys was <26%. In the study period, 19 non-endemic cities notified autochthonous cases of SM, however only one field investigation was conducted. The 140 cases of death due to SM recorded in the Mortality Information System were not detected by SINAN. Among confirmed cases from Major Isidoro, 67% reported no contact with water sources outside Major Isidoro, suggesting expansion of the transmission area.

Conclusions: The system was considered complex with good quality data in SISPCE, but poor quality in SINAN. The acceptability and the timeliness of investigation were low. The stated objective of preventing expansion of transmission may not have been met. We recommend improving data quality of SINAN and further investigation of the possible expansion of SM transmission in Alagoas.

Keywords: Schistosomiasis, surveillance, evaluation, Brazil

Word count: 268 For more information, email the presenter at: gilmara.nascimento@saude.gov.br

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Author Information: Authors: Gilmara L. Nascimento1, M. Menezes2, W. Araujo1, J. L?cia3, 1. Brazilian Field Epidemiology Training Program (EPISUS), Center for Strategic Information and Response in Health Surveillance (CIEVS), Department of Epidemiolog

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