Performance of the Severe Acute Respiratory Infection (SARI) Surveillance System: A Case Study of Chey Chumneas Hospital, Kandal Province, Cambodia, 2022

Abstract

Cambodia’s Severe Acute Respiratory Infection (SARI) surveillance system was established in 2012. The system monitors SARI cases, detects outbreaks, and identifies influenza trends. However, the system has not undergone evaluation since its inception. This evaluation aimed to assess surveillance attributes at Chey Chumneas Hospital, Kandal Province. A mixed-methods approach was utilized, following US-CDC guidelines. Medical records in 2022 were reviewed to assess sensitivity and positive predictive value (PPV). Case reporting forms were reviewed to determine completeness. The timeliness of weekly reports in the system and the release of laboratory results were evaluated. Semi-structured interviews with key stakeholders were used to assess qualitative attributes. Between 2018 and 2022, 576 SARI cases were reported. The sensitivity in detecting true SARI cases among admitted patients was 33%, and the PPV was 73%. In 2022, 54% (28/52 weeks) of weekly reports were submitted on time, and 59% (52/88) of SARI cases had laboratory results released within 24 hours. Of 88 case reporting forms, 91% of socio-demographic and date of onset variables were complete, and three SARI symptom variables had a completion of 95%. The system was positive in terms of usefulness, simplicity, acceptability, and flexibility, but stability was relatively weak due to dependence on external funding. The system was useful in estimating morbidity and mortality and monitoring influenza trends. Although its performance was good, gaps in sensitivity, timeliness, and stability remained. Targeted training, supervision for the hospital SARI focal point, and sustained financial support are needed to improve the surveillance system’s performance.