Flodgren G M, Bezuidenhoudt J E, Alkanhal N, Brinkwirth S, Lee A C K
Norwegian Institute of Public Health, Norway.
National Institute for Communicable Diseases, South Africa.
Public Health. 2024 May;230:105-112. doi: 10.1016/j.puhe.2024.02.018. Epub 2024 Mar 23.
The objective of this study was to examine the conceptualisation and operationalisation of Integrated Disease Surveillance (IDS) systems globally and the evidence for their effectiveness. Furthermore, to determine whether the recommendations made by Morgan et al. are supported by the evidence and what the evidence is to inform country development of IDS.
The study incorporated a scoping review.
This review summarised evidence meeting the following inclusion criteria: Participants: any health sector; Concept: IDS; and Context: global. We searched Medline, Embase, and Epistemonikos for English publications between 1998 and 2022. Standard review methods were applied. A bespoke conceptual framework guided the narrative analysis. This scoping review is part of a research programme with three key elements, with the other studies being a survey of the International Association of National Public Health Institutes members on the current status of their disease surveillance systems and a deeper analysis and case studies of the surveillance systems in seven countries, to highlight the opportunities and challenges of integration.
Eight reviews and five primary studies, which were assessed as being of low quality, were included, mostly examining IDS in Africa, the human sector, and communicable diseases. None reported on the effects on disease control or on the evolution of IDS during the COVID-19 pandemic. Descriptions of IDS and of integration varied. Prerequisites of effective IDS systems mostly related to the adequacy of core functions and resourcing requirements. Laws or regulations supporting system integration and data sharing were not addressed. The provision of core functions and resourcing requirements were described as inadequate, financing as non-sustainable, and governance as poor. Enablers included active data sharing, close cooperation between agencies, clear reporting channels, integration of vertical programs, increased staff training, and adopting mobile reporting. Whilst the conceptual framework for IDS and Morgan et al.'s proposed principles were to some extent reflected in the highlighted priorities for IDS in the literature, the evidence base remains weak.
Available evidence is fragmented, incomplete, and of poor quality. The review found a lack of robust evaluation studies on the impact of IDS on disease control. Whilst a lack of evidence does not imply a lack of benefit or effect, it should signal the need to evaluate the process and impact of integration in the future development of surveillance systems. A common IDS definition and articulation of the parts that constitute an IDS system are needed. Further robust impact evaluations, as well as country reviews and evaluations of their IDS systems, are required to improve the evidence base.
本研究的目的是考察全球综合疾病监测（IDS）系统的概念化和实施情况及其有效性证据。此外，确定摩根等人提出的建议是否有证据支持，以及哪些证据可为各国IDS的发展提供参考。
本研究采用了范围综述。
本综述总结了符合以下纳入标准的证据：参与者：任何卫生部门；概念：IDS；背景：全球。我们在Medline、Embase和Epistemonikos数据库中检索了1998年至2022年期间的英文出版物。应用了标准的综述方法。一个定制的概念框架指导了叙述性分析。本次范围综述是一个研究项目的一部分，该项目有三个关键要素，其他研究包括对国际国家公共卫生研究所协会成员进行的关于其疾病监测系统现状的调查，以及对七个国家监测系统的深入分析和案例研究，以突出整合的机遇和挑战。
纳入了八项综述和五项质量被评估为较低的原始研究，大多考察了非洲、人类部门和传染病方面的IDS。没有一项研究报告IDS在新冠疫情期间对疾病控制的影响或其演变情况。对IDS及其整合的描述各不相同。有效IDS系统的先决条件大多与核心功能的充分性和资源需求有关。未涉及支持系统整合和数据共享的法律法规。核心功能的提供和资源需求被描述为不足，资金不可持续，治理不佳。促成因素包括积极的数据共享、机构间的密切合作、明确的报告渠道、垂直项目的整合、增加人员培训以及采用移动报告。虽然IDS的概念框架和摩根等人提出的原则在文献中突出的IDS优先事项中在一定程度上有所体现，但证据基础仍然薄弱。
现有证据零散、不完整且质量较差。综述发现缺乏关于IDS对疾病控制影响的有力评估研究。虽然缺乏证据并不意味着没有益处或效果，但这应表明在监测系统未来发展中需要评估整合的过程和影响。需要一个共同的IDS定义以及对构成IDS系统各部分的明确阐述。需要进一步进行有力的影响评估，以及各国对其IDS系统的审查和评估，以改善证据基础。
