Improvement of the Surveillance Protocols After Experiencing a Pseudo-Epidemic After 2018 Central Sulawesi Earthquake in Indonesia

Objective
Following a disaster, a pseudo-epidemic can occur due to redundant and duplicated data caused by infrastructure and information system disruptions. This study aims to investigate whether there have been improvements the post-disaster surveillance system in the comparison of diarrhea incidents between Central Sulawesi, Indonesia, and Cianjur, West Java, Indonesia.

Methods
We conducted an analysis of the epidemic-prone disease diarrhea before and during disasters, comparing the data with secondary data from the Early Warning Alert and Response System (EWARS) and the District Health Information System V.02 (DHIS-2).

Results
In central Sulawesi in 2018 and Cianjur in 2022, we observed an upsurge in diarrhea cases in the first week after the disaster. Although diarrhea cases increased after the disaster, they remained within acceptable outbreak criteria. Multiplication and redundant data were detected in the DHIS-2 system in Central Sulawesi, likely leading to erroneous overreporting. Changes in surveillance officers and their personal experiences during the disaster contributed to data inconsistencies. As compared to Central Sulawesi, the DHIS-2 reporting form in Cianjur was simplified as an individual form to enhance efficiency and accuracy.

Conclusions
Enhancing valid assessment and conducting thorough investigations are essential to improve surveillance protocols for epidemic-prone diseases following disasters.