Evaluation of surveillance system for measles – Morocco, 2017

  • Public health surveillance
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Background:
Measles is one of the leading causes of death among children under the age of five years in developing countries. The epidemiological surveillance has been strengthened in Morocco since 2010 to allow the disease elimination by 2020. The aim of this study was to describe measles national surveillance system, to analyze its data and evaluate its quality and timeliness during the periods 2010-2016.

Methods:
We conducted a descriptive study using measles surveillance data including all suspected measles reported between January 2010 and December 2016. We have established
indicators in accordance with the CDC, E-CDC Surveillance Systems Assessment Guideline
and the WHO Measles Elimination Guideline in order to describe and evaluate measles
surveillance system. Data quality was evaluated via the percentage of suspected measles for which all essential elements are available and the rate of discarded measles. The timeliness was examined through indicators such as the delay between onset of rash and notification and the rate of investigations initiated within 48 hours of notification.

Results:
The surveillance of measles in Morocco is exhaustive and individual. Between 2010 and 2016, 4891 suspected measles were reported, including 1040 (21%) lab confirmed. Annual incidence in suspected measles, per 100 000 populations, decreased from 3.65 in 2010 to 0.52 in 2016. Among the ten most relevant variables for measles surveillance, date of investigation is the least filled with 89% missing data. The average notification delay was three days with a minimum of zero days and a maximum of 90 days. The percentage of suspected measles investigated within 48 hours of declaration was only 68% while the target was 80%.

Conclusion:
According to these results and given the current context, our system does not meet all the objectives in phase of elimination. Some indicators are not meeting their targets, which imply that additional efforts will be needed to strengthen the surveillance system to achieve the disease elimination goal by 2020. In fact, professionals should be reminded of the obligation to report any suspect case of measles. Also, a computerized system for case notification should be set up.

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