To be certified "polio free", a country must demonstrate absence of poliovirus transmission under an Acute Flaccid Paralysis (AFP) surveillance system that is sensitive and timely as measured against a set of criteria set by WHO. Over the last 4 years, Government of Bangladesh has developed an extensive AFP surveillance system that meets all WHO indicators except one, that is, the timeliness of notification. At least 80% of the AFP cases need to be "notified/detected" by the system within 10 days of on-set to allow two-stool specimen collection within 14 days of onset. Therefore, we conducted a study on the health care seeking behavior of families of children with AFP to understand causes of delay. Most recent 50 urban and 50 rural AFP cases during 1999-2000 were sampled. Data were collected from the case investigation forms and in-depth interviews of caregivers, decision makers, community leaders and health care providers. Factors contributing to immediate or delayed notification to a hospital were analyzed.
The study indicates that there were no major taboos, religious factors or superstitions inhibiting AFP notification. Invariably, families contacted health care providers (medical practitioners or traditional healers) without delay. Factors contributing to delayed notification included: lack of knowledge of health care providers, contacting multiple service providers, distance to hospitals, potential loss of income/cost, low confidence/perceived harassment in government hospitals and wait and see attitude.
The study discusses several approaches to improving the timeliness of AFP notification: financial incentives, orientation training and locally relevant publicity campaigns.
Learning Objectives: Understand reasons for delayed notification of Acute Flaccid Paralysis(AFP) cases and learn alternative approaches to improve timeliness of notification and hence improve the quality of AFP surevillance.
Keywords: Surveillance, Disease Data
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.