Factors Associated with Detection and Reporting of Suspected Yellow Fever Cases in the Greater Accra Region

Abstract

Introduction: Yellow fever is a viral haemorrhagic fever transmitted primarily by the Aedes aegyptii mosquito and is characterized mainly by fever and jaundice. It is endemic in Africa and South America. the possibility of eradicating yellow fever is quite remote but a drastic of disease burden can be attained through vaccination of populations living in or visiting places considered to be high-risk areas in endemic countries. The WHO surveillance case definition for a suspected case of yellow fever is any case presenting with acute onset of fever, with jaundice appearing within 14 days of onset of the first symptoms. WHO recommended strategy for controlling yellow fever is through detection, reporting, preventing and controlling outbreaks and vaccination with the 170 yellow fever vaccine. A number of factors affect the detection and reporting of suspected cases but these can be improved through heightened surveillance. Objective: The main objective of this study was to assess the factors associated with detection and reporting of suspected yellow fever cases in the Greater Accra Region and how to possibly improve on the rate of reporting of suspected cases. Methods: The study is a cross sectional survey of clinicians who are directly involved in attending to patients and district disease control/surveillance officers in the Greater Accra region. Clinicians were selected from government, quasi-government and private facilities. Disease control officers were selected from the 21 operational districts in the Greater Accra Region. A structured anonymous questionnaire (Appendix I) was administered to all participants in the stud}, Data entry and analysis were done using Epi Info and STATA 14 respectively. Results In all, 371 clinicians and 18 disease control officers were interviewed. Out of the 371 clinicians inter viewed, 87.6% had detected fever with jaundice cases in their consulting rooms within the la,[ 12 months but only 10.8% had reported any suspected yellow fever case. Investigation of fever with jaundice cases as well as reporting of suspected cases had significant influence on the detection of yellow fever as well as case notification (p<0.00 I). Clinicians who had identified I to 3 fever with jaundice cases were US (C/ 1.07-1.23, p<0.001) times more likely to detect yellow fever as compared to those who identified no case. However, after adjusting for the sending of notification forms, the association between identification of fever with jaundice and detection of yellow fever was no longer significant (p=0.092). The unadjusted odds of detecting yellow fever cases among those who did not send notification forms were 82.0% lower than those who sent notification forms (OR=0.18, 95% C/=0.09-0.38). After controlling for the identification of fever with jaundice, the association between sending of notification forms and detection of yellow fever was no longer significant (p=0.0865). Additional factors found to be associated with reporting of suspected yellow fever cases were sensitization (AOR 15.02, C/=3.88 - 58.14. ,,<0.001). availability of reporting tools (AOR 7.41, C/=2.76- 19.89, p<O.OOI) and number of fever with jaundices recorded (AOR 0.05, C/=0.04-0.19, p<O.OOJ). Conclusion and Recommendations Although clinicians in the Greater Accra Region see a lot of fever with jaundice cases in their consulting rooms, which is the surveillance case definition for a suspected yellow fever case, this does not translate to the number of suspected cases reported. Only one-tenth of cases that fit the suspected yellow fever case definition seen get reported and investigated and the main reasons for non-reporting are that clinicians do not suspect yellow fever cases (53.2%) or are unaware of the reporting system (25.2%). It is recommended that District Health Directorates should further sensitize clinicians on the application of the surveillance case definition for yellow fever and the need to report all such and Public Health Units in facilities and districts should make case notification forms readily available and accessible in all consulting rooms and wards.