1Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia.
2Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Am J Trop Med Hyg. 2020 Jul;103(1):120-131. doi: 10.4269/ajtmh.19-0719. Epub 2020 May 7.
The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis "Dengue surveillance stands and falls by the rigor of the health system." The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.
近几十年来，登革热的发病率和地理分布有所增加。由于病例经常漏报和分类错误，实际疾病负担未知。一个功能完善的诊断、治疗和报告病例的系统至关重要，因为疾病统计数据是旨在控制疾病的决策的基础。本研究旨在探索印度尼西亚爪哇登革热流行地区日惹的基于医院的疾病监测系统。对来自四家医院的 16 名受访者（包括五名全科医生、三名内科医生、四名儿科医生和四名与登革热诊断和报告管理相关的行政人员）进行了半结构化访谈。使用内容分析对数据进行分析。分析产生了一个主题，“登革热监测取决于卫生系统的严格程度”。该主题及其下属类别和子类描述了一个监测系统，在最佳情况下运行良好，并且很可能产生可靠的登革热病例数据。然而，不同医院的法规和指南之间缺乏同步，监管机构和医疗服务提供者之间存在一些摩擦。工作人员的知识似乎存在差异，许多临床和财务决策都是任意做出的，这最终可能导致医疗服务提供的不平等。总之，所研究的登革热监测系统可以进一步改进，特别是通过确保所有法规和建议的程序都标准化，并为所有工作人员提供定期更新登革热相关事项（临床和监管）的最佳机会。
