EFFECT OF EDUCATION ON KNOWLEDGE OF ACUTE FLACCID PARALYSIS REPORTING AMONG PRIVATE MEDICAL DOCTORS IN ONDO STATE, NIGERIA

Abstract

Acute Flaccid Paralysis (AFP) surveillance system in Nigeria remains largely dependent on reporting from public health facilities while other potential reporting sources such as private medical facilities are neglected. An understanding of the knowledge and practice gaps on AFP surveillance among private medical doctors is essential to the design of programmes to enhance their involvement. This study therefore investigated the effect of education on knowledge of acute flaccid paralysis reporting among private medical doctors in Ondo State. This study was conducted in two stages. Stage one was a cross sectional survey, which involved the use of a semi-structured questionnaire. Eighty-two private medical practitioners who consented out of the 112 available were interviewed. The questionnaire, which contained WHO surveillance criteria, was used to obtain baseline information. Stage two was a pre and post test design, where respondents were divided into four groups based on their specific locations. A one-day training was conducted on AFP surveillance and reporting, using WHO reference standard, with a ten point knowledge scale. Good knowledge score was categorised as a score >5. Data were analysed using descriptive statistics and student t-test at 5% level of significance. The mean age of respondents was 43.0 + 6.3years and they were predominantly male (82.9%). Majority (73.8%) of respondents were MBBS graduates while 20.0% had fellowship as additional qualification. Only 25.6% of respondents had ever reported AFP cases. Identified constraints to reporting included inadequate logistics support (90.2%), poor supervision by local government area officers (100.0%), lack of involvement of private medical doctors in surveillance trainings and activities (85.4%), and lack of request for feedback from government agency (91.5%). However, there was a general willingness to report if provided with the necessary logistics (100.0%). After the training, knowledge improved significantly from pre-test score of 6.97 + 0.09 to post-test value of 9.8 + 0.01. At pre-test only 15.9% had the correct knowledge of AFP case definition compared to 95.0% at post-test. The proportion of respondents who had ever seen an AFP form improved from 37.8% to 97.5% post intervention. Respondents who knew local government as the appropriate notification authority increased from 73.2% to 91.7% post intervention. Knowledge of stool as the specimen to be collected in AFP cases increased from 86.6% at pre-test to 96.3%. Also, respondents with knowledge of ice packs as the storage and transportation requirement for specimens increased from 70.7% at baseline to 98.8%. Education through training improved knowledge of acute flaccid paralysis reporting among private medical doctors. Therefore, training and provision of necessary logistic support may translate into improvement of acute flaccid paralysis reporting cases among private medical doctors.