Surveillance is the cornerstone of epidemiological services. To strengthen surveillance in Riyadh, we reviewed the surveillance system and data in the Riyadh Region. Infectious disease surveillance began in Saudi Arabia 60 years ago. Today, in Riyadh city, four reporting primary health care centers (RPHCCs) receive reports from hospitals and neighborhood primary health care centers (PHCCs) for evaluation. They in turn pass this data on to regional officials, who report to the Ministry of Health.
Methodology
We visited the four RPHCCs in Riyadh city. We reviewed reporting forms from all hospitals and PHCCs for Riyadh region for the years 1992 and 1993 by international weeks (IW). We reviewed the actions taken by the RPHCCs.
Results
We found several significant outbreaks in 1992, including: (1) mumps (IW 43-53): 298 cases from one governmental hospital; 74% in ages 5-14, 15% in ages 1-4; (2) hepatitis A (IW 40-43): 14 cases, 15% from pediatric hospital, 85% from one governmental hospital; (3) measles (IW 9-25): 1,605 cases in Riyadh city; 59% in ages 5-14, 13% in ages 1-4; (4) rubella (IW 20-26): 498 cases in Riyadh city; 71% in ages 5-14, 19% in 15-44. Several inconsistencies were found. One RPHCC reported only meningococcal meningitis and not other types of meningitis. No reports were found for wound infection and puerperal sepsis. For some diseases, such as shigellosis, only the type of organism, and not the serotype, was reported. Hepatitis B cases were diagnosed only by HBSAg, and there was no distinction made among acute cases, chronic cases and carriers. There were no accurate data for diarrhea surveillance. There is a delay in reporting from hospitals and PHCCs to the RPHCCs of three weeks. Doctors at the PHCCs lacked information about the importance of surveillance.
Conclusion
All data currently are recorded by hand; computers at the RPHCCs would facilitate identification of outbreaks. Outbreaks cannot be investigated because RPHCC epidemiologists do not have the authority to do so. The measles and rubella outbreaks occurred in children covered by the country's vaccination program; accordingly, complete surveillance would demand individual case investigations. Outbreaks may not be recognized in a timely manner because of a delay in reporting from hospitals and PHCCs. Feedback about outbreak investigations from regional health officials to the RPHCCs and from the RPHCCs to the PHCCs and hospitals is totally lacking but essential.