Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria

BACKGROUND

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance.

OBJECTIVE

We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received.

METHODS

A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior.

RESULTS

Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications.

CONCLUSIONS

Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region

Background

The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998.

Objectives

This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation.

Methods

A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019.

Results

The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare.

Conclusions and implications of findings

These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.

A Pilot Study: Factors Influencing Compliance With Tetanus-Diphtheria Vaccine in Katsina State, Northwestern Nigeria

Background

Tetanus-diphtheria vaccine (Td+) coverage has been steadily declining in Katsina State, Nigeria. The pilot study was guided by The Andersen and Newman Framework of Health Services Utilization. The goal of the pilot study was to identify the Td+ vaccination coverage and identify any association between maternal residence, educational status, occupational status, access to routine immunization services, availability of routine immunization services, perceived need for Td+, perceived severity of maternal and neonatal tetanus (MNT), and compliance with Td+ in Katsina State.

Methods

A cross-sectional survey of 309 randomly selected women in Charanchi district of Katsina State, Nigeria, was conducted. Data were collected using structured questionnaire and analyzed using logistic regression model.

Findings

The Td+ coverage was low at 23%. Bivariate analysis showed that age, maternal residence, educational status, availability of Td+, perception of Td+, and perception of MNT significantly affected compliance with Td+ (P < .05, P < .05, P < .05, P < .001, P < .001, P < .001, respectively). Multiple logistic regression findings were inconclusive.

Conclusion

Effective strategies to improve compliance were awareness creation on Td+ immunization schedule, risk factors associated with MNT, vaccine availability, and safety. Additionally, improving access to routine immunization services, especially in underserved communities, and effective use of Td+ coverage data were used as strategies.

Implications

The pilot study suggests that the design can be used to realize more conclusive and generalizable multivariate findings in future studies.