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Compliance with epidemic-prone diseases surveillance and response guidelines among health officers at surveillance units in South-West Nigeria Magbagbeola David Dairo, Daniel Ola Afolayan, Joshua Odunayo Akinyemi Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. Abstract Introduction: Although compliance with surveillance guidelines is crucial to epidemic diseases control, determinants of use of these guidelines in Nigeria are poorly documented. We assess health workers compliance and factors associated with the surveil- lance and response guidelines for epidemic-prone diseases in South-West Nigeria. Methods: In a cross-sectional study, 199 disease surveillance and notification officers in Oyo state were interviewed using a questionnaire on knowledge of disease surveillance and performance of surveillance activities. Data were analysed using de- scriptive statistics, chi-square and multiple logistic regression at P= 0.05. Results: Most surveillance units submitted disease outbreaks reports (81.48% at the health facility and 100% at the local govern- ment level). Timeliness and completeness of weekly reporting were 94% and 95% respectively. a quarter (25.9%) adhered to na- tional case definitions guidelines. About 85.7% did laboratory case confirmation while 2.6% did facility level data analysis. Pre- dictors for six months reporting activity include attending a training on surveillance and reporting (OR=7.92; CI=1.65–37.92), fund adequacy (OR=27.81; CI=7.68–100.60) and knowledge of surveillance dataflow (OR=4.80; CI=1.64–14.10). Conclusion: In addition to provision of adequate financial and laboratory resources, surveillance activities would benefit from continuous training on surveillance data flow. Keywords: Epidemic-prone diseases, case definitions guidelines, surveillance and response. DOI: https://dx.doi.org/10.4314/ahs.v18i2.28 Cite as: Dairo MD, Afolayan DO, Akinyemi JO. Compliance with epidemic-prone diseases surveillance and response guidelines among health officers at surveillance units in South-West Nigeria. Afri Health Sci. 2018;18(2): 428-436. https://dx.doi.org/10.4314/ahs.v18i2.28 Introduction unit).3 The guideline specifies the core activities of infec- The prevention, control and reduction of mortality from tious disease surveillance and response system to include: epidemics are dependent on an effective disease surveil- detection, confirmation and registration of cases of dis- lance system.1,2 The National Technical Guideline for In- eases; disease reporting; data analysis and interpretation; tegrated Disease Surveillance and Response (IDSR) seeks feedback; epidemic preparedness and responses to out- to ensure the performance of core surveillance activities breaks.3,4 It also specifies that health authorities should at all surveillance units (health facilities, local government provide support for the surveillance and response system health departments, states and national epidemiology such as standard guidelines, reporting forms, training, funding, supervision, logistic resources.3 Epidemic-prone diseases (EPD) in Nigeria include chol- Corresponding author: era, cerebrospinal meningitis, diarrhoea with blood (shi- Magbagbeola David Dairo, gella), measles, yellow fever, viral hemorrhagic fevers Department of Epidemiology (such as lassa fever) and highly pathogenic avian influen- and Medical Statistics, za.3 These diseases keep occurring and cause the highest University of Ibadan, Ibadan, Oyo State case fatality rate in Nigeria.5 Nigeria has been faced with Telephone: (+234) 8035664708 repeated out-breaks of these epidemic-prone diseases Email: [email protected] in recent years.6-10 Meanwhile, the surveillance of these African © 2018 Dairo et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons At- Health Sciences tribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 428 African Health Sciences Vol 18 Issue 2, June, 2018 diseases has been recognized to be weak in Nigeria.1,10-14 randomly selected by balloting from the sample frame of This study aims to assess compliance with the surveil- local governments in each of the three senatorial districts lance and response guidelines for epidemic-prone diseas- (North, Central and South) in Oyo state. After the bal- es in South-West Nigeria. loting the following local government areas were select- ed; Kajola, Ogbomosho south, and Surulere Local gov- Methods ernment areas were chosen from Oyo North Senatorial Study design: A cross sectional descriptive study of the district; Afijio, Akinyele, and Egbeda Local government surveillance workers for epidemic prone diseases (EPD) areas from Oyo Central Senatorial district while Ibadan at surveillance units was conducted. North, Ibadan SouthEast and Ibarapa East Local gov- Study population: ernments areas were selected from Oyo South Senatorial The study population was the disease surveillance and district. notification officers throughout Oyo State. This popula- In the third stage, seven wards each were randomly se- tion includes the state epidemiologist at the state Ministry lected by balloting from the list of the health wards in of Health. At the local government level the population each of the local government areas. In the fourth stage, included disease surveillance and notification officers. At three health facilities were randomly selected by ballot- the health facility level, the population of disease sur- ing from each of the wards. Only the consenting health veillance officers included the health workers (focal per- workers who are assigned the duty of reporting diseases sons) who were assigned the responsibility of reporting occurrence in the health facilities were interviewed. This on the disease patterns and out-breaks that occurred at study interviewed a total of 199 officers at various lev- the health facility and reporting of out-breaks of diseases els of surveillance activities in the state as follows. Thus within the catchment areas of their health facility. the respondents interviewed are drawn from the units of surveillance as follows; the State epidemiology unit (n=1) Sample size determination represented by the State epidemiologist, the local gove The minimum sample size for the study was derived using rnment health departments (n=9) represented by the dis- the formula for a simple descriptive cross-sectional study ease surveillance and notification officers (DSNO) and as follows: at the health facilities (n=189) represented by the focal n=z2 pq/d2 persons. where n = calculated sample size, z = standard normal deviate at 95% confidence Data collection instrument interval=1.96, Data was obtained by the use of questionnaires, check- p = proportion of Disease Surveillance and Notification lists, and records review of the monthly and weekly re- Officers that regularly report surveillance data to the state porting surveillance data from surveillance units at the epidemiology unit=0.858,1 Oyo state Ministry of Health and the local government q = 1 - p, and d = 5% precision of the estimate health department. of the sample size. The questionnaires were derived from the review of the After substitution of the relevant figures a sample size of literature on the subject matter and sought information n=188 surveillance officers was obtained. A projected on socio-demographics of the respondents, knowledge non-response rate of 5% was then included to derive a on disease surveillance by the officers at the surveillance minimum sample size of 198 surveillance officers. units. The questionnaire was self administered since all the participants in the study could read and write in En- Sampling procedure glish. A four stage sampling was used for selecting the respon- Meanwhile, a checklist was used to obtain information on dents. In the first stage, Oyo state was randomly selected performance of core surveillance activities and support by simple balloting from the list of the six states in South- functions. The checklist was used to review the health West Nigeria. The states in South-West Nigeria are Ekiti, facility out-patient register, log books and copies of lab- Lagos, Ogun, Osun, Ondo and Oyo states. oratory reports at health facilities, copies of completed In the second stage, three local government areas were IDSR forms, tables or charts showing analysis of EPD, African Health Sciences Vol 18 Issue 2, June, 2018 429 and also to ascertain the availability of standard case defi- terial supplies for out-break response at the State epide- nition poster and logistic resources at the surveillance miology unit and local government health departments. units. Data were analysed using descriptive statistics, chi-square and multiple logistic regression at P= 0.05 on SPSS ver- Timelines and completeness of weekly reports in the se- sion20. lected local government areas for the year were obtained from the Epidemiology Unit of the Ministry of Health, Ethical approval Oyo state. Timeliness of reporting was defined as the Ethical approval for the study was obtained from the Oyo submission of surveillance reports on or before the stip- State Ethical Review Committee. The confidentiality of ulated time for submission which is specified by the epi- the respondents was assured. The respondents were in- demiology unit of the state.

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