A comparative analysis of two national tuberculosis reporting systems and their impact on tuberculosis case notification in Uganda

Background: Before 2018, the use of parallel tuberculosis (TB) reporting systems was resource intensive with duplication of efforts and hence the need to select one that contributed to better TB case notification at the National TB and Leprosy Program (NLTP) in Uganda. We sought to analyse the difference in reporting rates between the two systems in order to improve NTLP TB case notification rates, logistics management, and planning for better health service delivery initiatives. Methods: We conducted a comparative study to assess TB case notification between the web-based DHIS2 and the district TB supervisor-led health management information system between January 2016 to December 2017. We used Poisson regression analysis to assess the statistical differences in reporting rates between the two reporting systems. Results: The association between TB case notification and the type of reporting system was statistically significant (Prob > chi2 = 0.0000). The Incident Rate Ratio (IRR) for the web-enabled DHIS2 system versus the district TB supervisor-led health management information system was 1.106625. Conclusion: The web-based integrated DHIS2 system was more effective in reporting missing TB cases. It presents an opportunity for better planning and allocation of resources for improved service delivery in a low-income setting.

Maximizing HIV Partner Notification Opportunities for Index Patients and their Sexual Partners in Malawi

Background. HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment; care; and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However; partner notification strategies must be feasible in the healthcare setting and acceptable to the population. Methods.We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study; newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive; contract; and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners; after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group; a healthcare provider notified partners directly. Results.Although most index participants and partners expressed a preference for passive notification; they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing; including the opportunity to change behaviour. Conclusions. Provider-assisted partner notification is not preferred; but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged

Effectiveness of Data Collection and Information Transmission Process for Disease Notification in Anambra State; Nigeria

Background: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria; thus; its inability to promptly detect and control epidemics.Objective: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state.Materials and Methods: The study was of cross-sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review.Results: One hundred (43.9) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms; 25 and 16.2 reported it was irregular and usually out of stock; respectively. Most facilities (81.5) were the least correct; while out-patient register (88.9) was the most correct. Only 10.0 of health facilities submitted completed forms 5 days after completion; 88.9 of them submitted completed IDSR002 forms within 2 days of completion; while the remainder was submitted 4 days later.Conclusion: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training-retraining of health personnel on DSN; improved funding; provision of logistics; improved supervision; and feedback of information

Awareness and Knowledge of Disease Surveillance and Notification by Health-Care Workers and Availability of Facility Records in Anambra State; Nigeria

Background: Disease surveillance and notification (DSN) is part of the Health Management Information System (HMIS) which comprises databases; personnel; and materials that are organized to collect data which are utilized for informed decision making. The knowledge about DSN is very important for the reporting of notifiable diseases. Objective: The aim of this study is to examine the awareness and knowledge of health-care workers about DSN; and availability of facility records in Anambra State; Nigeria. Materials and Methods: The study was a descriptive cross-sectional one in which relevant data were collected from health-care workers selected by a multistage sampling technique. Qualitative information was also elicited by key informant interviews; whereas an observational checklist; preceded by a desk review was used to examine the availability of facility records. Results: Although 89.8 of the health-care workers were aware of the DSN system; only 33.3; 31.1; and 33.7 of them knew the specific uses of forms IDSR 001; IDSR 002; and IDSR 003 (IDSR: Integrated Diseases Surveillance and Response); respectively. Knowledge of use of the various forms at the facility and local government area (LGA) levels were generally low; although the observational checklist revealed that IDSR 001 and IDSR 002 forms were predominantly found in primary health-care facilities. HMIS forms were less likely to be available in secondary health-care facilities (?[2]=7.67; P=0.005). Conclusions: Regular training and retraining of concerned health-care workers on DSN at the LGA level is recommended. This should run concurrently with adequate and regular provision of IDSR forms; copies of the standard case definitions; and other necessary logistics to the health-care facilities by the local and state governments

Surnotification du paludisme : l'exemple des consultations dans les centres de sante de Lobito; Angola

Dans la region holo et hyperendemiques du paludisme; une definition simple de l'acces palustre ne peut pas se fonder sur les donnees cliniques ni sur la densite parasitaire sanguine; quand on la connait ; D'autres variables doivent etre prises en compte; en fonction de l'epidemiologie de chaque region. Dans une region de transmission moyenne; hypo ou mesoendemique; la parasitologie reste importante pour confirmer un diagnostic. Les auteurs ont fait l'experience pendant cinq ans dans une surnotification du paludisme du fait d'un taux excessif d'examens paracliniques rendus positifs. Ils concluent que cet etat de fait n'est pas bon; ni pour la prise en charge de l'acces palustre simple ou d'autres pathologies infectieuses; ni pour les releves epidemiologiques. Le rapport 2008 sur le paludisme de l'OMS avait deja note ce fait en soulignant que de nombreuses statistiques du centre de sante en zone endemique se fondaient sur des donnees cliniques; ce qui entrainait une surestimation de la situation endemique. Beaucoup d'elements sont a prendre en consideration dans cette situation; qui pourrait etre corrigee par une revalorisation du diagnostic parasitologique surtout dans les zones isolees et la creation d'un reseau de diagnostic; capable de renforcer la prise en charge des cas au niveau individuel et le recueil epidemiologique au niveau global