title: Application of WHO's guideline for the selection of sentinel sites for hospital-based influenza surveillance in Indonesia.
abstract: BACKGROUND
  A sentinel hospital-based severe acute respiratory infection (SARI) surveillance system was established in Indonesia in 2013. Deciding on the number, geographic location and hospitals to be selected as sentinel sites was a challenge. Based on the recently published WHO guideline for influenza surveillance (2012), this study presents the process for hospital sentinel site selection.
  
  
  METHODS
  From the 2,165 hospitals in Indonesia, the first step was to shortlist to hospitals that had previously participated in respiratory disease surveillance systems and had acceptable surveillance performance history. The second step involved categorizing the shortlist according to five regions in Indonesia to maximize geographic representativeness. A checklist was developed based on the WHO recommended attributes for sentinel site selection including stability, feasibility, representativeness and the availability of data to enable disease burden estimation. Eight hospitals, a maximum of two per geographic region, were visited for checklist administration. Checklist findings from the eight hospitals were analyzed and sentinel sites selected in the third step.
  
  
  RESULTS
  Six hospitals could be selected based on resources available to ensure system stability over a three-year period. For feasibility, all eight hospitals visited had mechanisms for specimen shipment and the capacity to report surveillance data, but two had limited motivation for system participation. For representativeness, the eight hospitals were geographically dispersed around Indonesia, and all could capture cases in all age and socio-economic groups. All eight hospitals had prerequisite population data to enable disease burden estimation. The two hospitals with low motivation were excluded and the remaining six were selected as sentinel sites.
  
  
  CONCLUSIONS
  The multi-step process enabled sentinel site selection based on the WHO recommended attributes that emphasize right-sizing the surveillance system to ensure its stability and maximizing its geographic representativeness. This experience may guide other countries interested in adopting WHO's influenza surveillance standards for sentinel site selection.
authors.affiliation: National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia. niketutsusi@yahoo.com.
authors.forename: Ni Ketut
authors.initials: NK
authors.lastname: Susilarini
authors.forename: Martahan
authors.initials: M
authors.lastname: Sitorus
authors.forename: Catharina Yekti
authors.initials: CY
authors.lastname: Praptaningsih
authors.forename: Ondri Dwi
authors.initials: OD
authors.lastname: Sampurno
authors.forename: Arie
authors.initials: A
authors.lastname: Bratasena
authors.forename: Ester
authors.initials: E
authors.lastname: Mulyadi
authors.forename: Roselinda
authors.initials: R
authors.lastname: Rusli
authors.forename: Ahmad
authors.initials: A
authors.lastname: Fandil
authors.forename: Amalya
authors.initials: A
authors.lastname: Mangiri
authors.forename: Hana
authors.initials: H
authors.lastname: Apsari
authors.forename: Edy
authors.initials: E
authors.lastname: Hariyanto
authors.forename: Gina
authors.initials: G
authors.lastname: Samaan
mesh_terms: D057189:Checklist; D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007251:Influenza, Human / Q000453:epidemiology*; D018571:Sentinel Surveillance; D014944:World Health Organization