Evaluation of the COVID-19 Surveillance System in Harare City, Zimbabwe 2020

  • Vaccine preventable diseases
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Background:
Surveillance is key for controlling the COVID-19 pandemic. Of the 90 confirmed cases reported in Harare City between 1-4 December 2020, 80 (89%) had been detected in previous months. Of these, only 10% were reported within 10 days of laboratory confirmation and could be contact traced. We assessed the performance of the laboratory based COVID-19 surveillance system in Harare City.

Methods:
We conducted a descriptive cross-sectional study at Harare City COVID-19 facilities using the updated CDC guidelines for evaluation of public health surveillance system. We reviewed the line-list and 200 laboratory and case-investigation forms. We interviewed 56 health workers and 6 key informants to collect data on reasons for late reporting. We then evaluated the following system attributes: representativeness, stability, data quality and timeliness.

Results:
Three of forty-three public health facilities in the city and three private laboratories were participating in COVID-19 surveillance. The system was mainly paper-based. Of 200 case-investigation forms, 58% did not have addresses, 16% no age and 7% no sex documented. Late reporting of confirmed cases resulted in 84%, 96% and 80% of cases not being contact traced in October, November and December respectively. Reasons for late reporting were late turn around time of laboratory results 40/56 (71%) and poor knowledge of the reporting system 38/56 (68%). Of the three public health facilities, none had communication and internet services, 1 had dedicated transport for COVID-19 activities and 2 had case investigation forms.

Conclusions:
The COVID-19 surveillance system in Harare City was not timely and data quality was poor thereby affecting contact tracing. Decentralisation of services is necessary to make the system more representative of the city population. Continuous provision of resources such as transport and means of communication is needed to ensure systems' stability. Use of integrated electronic systems may improve data quality and ultimately contact tracing.

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