COMPLETENESS OF MALARIA CASE NOTIFICATION AND SURVEILLANCE INFRASTRUCTURE AT HEALTH FACILITIES IN AKINYELE AND IBADAN NORTH LOCAL GOVERNMENT AREAS, OYO STATE, NIGERIA

Abstract

Integrated Disease Surveillance and Response policy was adopted in 2002 to strengthen disease notification and surveillance in Nigeria. An efficient surveillance system for malaria constitutes an essential activity for planning evidence-based control measures and monitoring these interventions. However, there is paucity of reports on the completeness of malaria case notification and the adequacy of the surveillance system currently in place thus this study was designed to compare available surveillance infrastructure, and estimate the completeness of malaria case-notification from public Health Facilities (HFs) in two Local Government Areas (LGA) of lbadan. A comparative cross-sectional study design was employed. Stratified random sampling technique was used to select two of the 11 LGAs in Ibadan metropolis-Akinyele (AKY) and Ibadan North (IBN). All public HFs and surveillance units in these LGAs were visited. An interviewer administered questionnaire containing variables on socio-demographics and a 10point knowledge scale on malaria case notification was used to obtain data from all surveillance focal persons present in these HFs; 102 in AKY and 63 in IBN respectively. A facility checklist was used to collect data on available surveillance infrastructure. Malaria surveillance registers from January to June 2008 at the HFs and LGA surveillance units were reviewed and relevant information extracted for comparison using a proforma. The Lincoln-Peterson capture-recapture technique was used to estimate total number of malaria cases expected for each LGA within this period. Reporting completeness was calculated as a proportion of total number of malaria cases reported to the LGA by HFs to number estimated by the capture-recapture method. Data were analyzed using descriptive statistics, t-test, Fisher's exact and Chi-square tests. Mean age of the focal persons was 39.8±0.7years and majority was female (64.6%). Average years of work experience were 11.6±0.6years in IBN and 12.3±0.8years in AKY. Respondents who had ever attended training on malaria surveillance were, 4.0% (AKY) and 17.0% (IBN) (p<0.05). Mean knowledge score was 6.2± l.6 (AKY) and 6.4± 1.6 (IBN). Eight percent (AKY) and none (IBN) of the focal persons reported receiving feedback from the LGA (p<0.05). Proportions of HFs that complied with stipulated reporting intervals were 100.0% (AKY) and 42.0% (IBN). Available surveillance infrastructure were; Case registers 55.0% vs 56.5%, reporting forms 21.0% vs. 23.0%, computers 3.0% vs 9.0% (p<0.05), calculators 27.0% vs 32.0% and laboratory equipments 37.0% vs. 52.0% (p<0.05) AKY and IBN respectively. Of the expected 22080 malaria cases, 19531 malaria cases were recorded at the health facilities, the overall completeness of reporting malaria cases from HFs to LG A was 87.1% (95% Cl: 70.9-71.8%) and 17.7% (95% CI: 27.6-27.9%) AKY and lBN LGAs respectively (p<0.05). Under-reporting of malaria cases in Ibadan North, an urban LGA was higher than in Akinyele a rural LGA. In addition, surveillance infrastructure was inadequate in both local government areas. Training and provision of reporting infrastructure is needed to address under-reporting of malaria cases in both local government areas.