Factors Influencing The Low Reporting Rates Of Measles, Yellow Fever And Acute Flaccid Paralysis In New Juaben North Municipal
Date
2022-05
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Publisher
University Of Ghana
Abstract
Introduction: Weaknesses in national public health surveillance and response systems in many African countries led to the adoption of the Integrated Disease Surveillance and Response (IDSR) strategy by countries in the WHO African Region (WHO-AFRO) for implementing comprehensive public health surveillance and response systems for priority diseases, conditions and events at all levels of health systems. IDSR aims at integrating surveillance functions at all levels. Over the period 2018 to 2020, the New Juaben Municipality has recorded less than expected numbers of suspected or confirmed acute flaccid paralysis, measles or yellow fever and the numbers keep declining. Such phenomena are characteristic of inadequate surveillance and may constitute a missed opportunity in disease surveillance for effective control strategies.
Objective: The main objective of the study was to assess the factors contributing to the low reporting of Measles, Yellow fever and AFP in New Juaben North Municipal.
Methods: A descriptive cross-sectional study was conducted on health workers in New Juaben North Municipality’s IDSR performance using quantitative methods with interviews (key-informant interviews and quantitative questionnaires) in April, 2022. Data analysis was done using SPSS with level of reporting as the outcome. Factors associated with reporting were assessed using bivariate and multivariate logistic regression models. Significance was assessed at 5% level.
Results: A total of 233 health workers took part in the quantitative study whilst nine respondents participated in the key informant interviews. More than half of the respondents were nurses, 127 (54.5%); the respondents predominantly held certificate (43.8%) and diploma (41.6%) level qualifications. One-hundred and eighty-five (79.4%) of the health workers ever heard about IDSR but only 74 (31.8%) had training on it. Less than four out of every ten - 38.2% (89/233) - of the health workers ever reported any of the priority IDSR diseases and more than half 131 (56.2%) never conducted any data analysis on the three notifiable diseases considered in this study. The overall rate of reporting of IDSR priority diseases was low/poor as only 29.2% of health facilities reported at least two suspected cases of the surveillance diseases. Age group (p=0.004), educational qualification (p=0.034), professional category of health workers (p=0.005), number of years in employment with the GHS (p=0.001) and number of years in current health facility (p<0.001) were the demographic characteristics of respondents which were strongly statistically associated with reporting of IDSR. Having standard case definitions of AFP, measles and yellow fever (χ2=56.059, p<0.001), having case-based forms for AFP, measles and yellow fever (χ2=65.005, p<0.001), evidence of data analysis of notifiable diseases (χ2=71.162, p<0.001), having a surveillance focal person (χ2=45.671, p<0.001) and supervision from district or higher levels (χ2=49.378, p<0.001) were health system factors associated with reporting of IDSR. Having training on IDSR was the only independent predictor of reporting of the three priority IDSR diseases [OR=11.28; 95%CI=4.560-27.907; p<0.001). Lack of/irregular training, lack of funding or motivation and no feedback on reported diseases were some of the challenges of IDSR in the municipality.
Conclusion: There exists a disconnection between the awareness/knowledge of IDSR and level of reporting IDSR-priority diseases with high knowledge but low reporting rates in the New Juabeng Municipality. Health worker stability in terms of experience and length of stay in the district as well as availability of appropriate inputs to guide accountability were associated with reporting rates. Training of health workers on IDSR to be followed by regular supervision and provision of adequate resources to health facilities may hold the key to improving reporting of priority events in the municipality.
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Keywords
Measles, Yellow Fever, Acute Flaccid Paralysis, New Juaben North Municipal