A.A. Fatiregun1, A.O. Sangowawa2, A.A. Abubakar3
- Department of Epidemiology, Medical Statistics and Environmental Health, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.
- Institute of Child Health, College of Medicine, University of Ibadan, Nigeria.
- Disease Surveillance and Notification Unit, Ministry of Health, Osogbo
Background: Poor knowledge among Disease Surveillance and Notification Officers (DSNOs) as a result of high staff turnover has been identified as a major reason for sub-optimal surveillance performance in Osun State. Training aimed at strengthening the measles surveillance sub-system of the Integrated Disease Surveillance and Response (IDSR) was thus conducted for DSNOs in the state in May, 2006.
Objectives: The immediate impact of the training on participants’ knowledge and their role in the measles surveillance process was assessed as well as demographic factors associated with participants’ knowledge.
Methods: Participants were DSNOs from the 30 Local Government Areas of the State and the Ife East Area office. Training materials were received from the WHO country office and adapted for use. Assessment of training was conducted by statistical evaluation of the pre- and post-tests results.
Results: Thirty-one DSNOs with a mean age of 36.2 (± 3.5) years participated. There were 14 (45.2%) males and 17 (54.8%) females and they had been employed for an average of 13.7 (± 2.2) years. Mean pre- and post-test scores were 31 and 61, respectively, and showed a significant statistical difference (paired t-test = 12.665, p=0.000).
Conclusion: Training achieved its short-term objective. However, a correlation between knowledge and practice will be based on the subsequent surveillance performance.
Keywords: Assessment of training, measles case-based surveillance, disease surveillance and notification officers, Nigeria
Department of Epidemiology,
Medical Statistics and Environmental Health,
Faculty of Public Health,
College of Medicine,
University of Ibadan,
Disease surveillance is an approach to information gathering about the occurrence and spread of diseases that serves to improve or maintain the health of the population1. The information obtained is used to set priorities, plan, implement, and monitor interventions. It is also useful in mobilizing and allocating resources, as well as predicting or providing early detection and response to outbreaks. Attributes of an effective surveillance system include acceptability of the process, reliability of data, timeliness, and completeness of reporting2. In September 1998, the 48th World Health Organization regional committee for Africa met in Harare, Zimbabwe and the members adopted the Integrated Disease Surveillance and Response (IDSR) as a regional strategy to strengthen weak national surveillance systems and ensure an efficient response to priority communicable diseases for the Africa region3. Implementation of the IDSR commenced in Nigeria in the year 2000 and replaced the former Disease Surveillance and Notification System (DSN), which had been in operation in the country since 1990. Information about the 22 communicable diseases selected for reporting in the IDSR strategy are collected from health facilities and forwarded to the Local Government Areas (LGA). At the LGA, the completed forms from the health facilities are collated periodically as applicable and sent to the state level. The LGA are also expected to initiate investigation and response of suspected outbreaks and rumors, provide support for specimen transfer for laboratory confirmation, and monitor and supervise the health facilities. The Disease Surveillance and Notification Officers (DSNOs) under supervision of the Local Government Medical Officers of Health (MOH) perform this duty. Unfortunately, because of lack of territorial epidemiologists at the local government level, the DSNOs are mostly medical record officers with little or no training in disease surveillance and response. The Local Government Civil Service Commission is responsible for selection and appointment of health record officers as DSNOs.
The measles mortality reduction programme was adopted in Nigeria in 2005. The recommended strategies for achieving this goal include achieving routine immunization coverage of at least 90% in each LGA, ensuring that all children have a second opportunity for measles vaccination through supplemental immunization activities, and establishing case-based surveillance and improving management of measles cases, including the administration of supplemental vitamin A and adequate treatment of complications4. Measles case-based surveillance is an important strategy to detect cases and outbreaks of measles. It is also useful in monitoring the performance of the programme5. The DSNOs, under the supervision of the MOH, have an important role to play to ensure the success of the programme. These roles include sensitizing clinicians and health facility staff on the measles surveillance activities in the LGA, actively searching for measles cases, ensuring that samples are promptly collected from suspected measles cases, and transportation and delivery of the specimen at the zonal measles laboratory; monitoring surveillance indicators in the LGA, providing feedback to reporting facilities, focal persons, and communities, and also keeping them informed of likely outbreaks4. An Accelerated Measles Catch-up campaign was conducted in the northern part of the country in December 2005 and in the southern part of the country in 2006.
In order to enhance the capacity of DSNOs to perform their roles in disease surveillance, cascaded training on measles and acute flaccid paralysis (AFP) surveillance sub-systems of the IDSR were conducted from the National level to the LGA level between June and August 2005. However, in January 2006 four DSNOs were redeployed and six new ones were appointed which resulted in suboptimal performance in AFP surveillance . This necessitated the need to conduct formal training for the new surveillance officers and an opportunity to retrain the previous officers. The training which was aimed at strengthening AFP and measles surveillance in order to direct immunization activities was used to review the current epidemiology of polio and measles transmission, as well as the goals and current status of the global and national initiatives. The training enabled participants to understand and appreciate the surveillance process, indicators, and data management issues, as well as the role of officials at various levels, particularly DSNOs in both the AFP and measles surveillance subsystem. The training was assessed to document its immediate impact on the knowledge of participants about their role in the surveillance process. The results of the effect of the training on measles surveillance are reported here. The association between some socio-demographic factors and the changes in knowledge following the training were also assessed.