Assessment of reporting sites for acute flaccid paralysis surveillance in Ethiopia: implications for planning of active case search visits.

Eshetu Wassie,Ayesheshem Ademe,Berhane Beyene,Fiona Braka,Kathleen Gallagher,Daddi Jima,Abyot Bekele Woyessa

doi:10.11604/pamj.supp.2017.27.2.10731

Abstract

IntroductionThe World Health Organization acute flaccid paralysis (AFP) surveillance standards recommend documentation of the role of each potentially reporting site for evidence -based planning and tailoring support for active surveillance visits. This study assessed the contribution of various sites as source and quality of AFP cases reported over a five -year period in Ethiopia.MethodsWe conducted a retrospective analysis of AFP surveillance data collected from 2010-2014 in Ethiopia. Analyses were done using EPI-INFO version 7 for calculating frequencies and proportions, and testing possible associations between reporting sites and key dependent variables.ResultsOf the 5,274 AFP cases reported, hospitals and health centers reported 4627 (88%) of the cases. Hospitals in Addis Ababa (53%) and health posts in Benishangul Gumuz (48%) regions have contributed majority of the cases reported. Only 3% of cases were reported by private clinics nationally. The stool adequacy rate for health posts (81%) was lower than the overall national rate of 88% .Cases from health posts are more likely to be reported after 14 days of onset of paralysis, and 62% less likely to be investigated within two days of notification(OR: 1.82, 95% CI OR : 1.41-2.36, p-value <0.0001). Greater proportion (2.4%) of cases reported from health posts were either compatible, VDPV or WPV compared to cases reported by health centers (1.14%) or hospitals (1.4%).ConclusionThough majority of the cases were reported by health centers followed by hospitals ,our findings suggest that all potentially reporting sites should be exhaustively identified, prioritized and regularly supported for quality case detection, investigation and reporting.

Highlights

In 2015 Ethiopia had an estimated population of 90 million living in nine Regional States and two City Administrations [1,2].The pyramidal age structure of the population has remained predominately young with 44.9% under the age of 15 years [2,3]
Greater proportion (2.4%) of cases reported from health posts were either compatible, vaccine-derived polio virus (VDPV) or wild polio virus (WPV) compared to cases reported by health centers (1.14%) or hospitals (1.4%)
Cases reported by health posts were more likely to be investigated and reported after 14 days of paralysis than other sites (OR: 1.82, 95% CI: 1.41-2.36, p-value:

Summary

Introduction

In 2015 Ethiopia had an estimated population of 90 million living in nine Regional States and two City Administrations [1,2].The pyramidal age structure of the population has remained predominately young with 44.9% under the age of 15 years [2,3]. To reach the vast and predominantly rural population, Ethiopia has designed a unique flagship Health Extension Program (HEP), which delivers cost-effective basic health services to all Ethiopians, mainly women and children [4]. This innovative approach is defined by the core principle of community ownership that empowers communities to manage health problems specific to their communities, enabling them to determine their own health [5,6]. The survey revealed that there were 202 functional hospitals; ongoing construction of an additional 123 hospitals was reported from seven regions [6]

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Discussion

Conclusion