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Disease Surveillance and Notification, Knowledge and Practice among Private

and Public Primary Health Care Workers in Enugu State, Nigeria: A Comparative
Study

Article · January 2016

DOI: 10.9734/BJMMR/2016/23249

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 British Journal of Medicine & Medical Research
13(3): 1-10, 2016, Article no.BJMMR.23249
ISSN: 2231-0614, NLM ID: 101570965

SCIENCEDOMAIN international
www.sciencedomain.org

Disease Surveillance and Notification, Knowledge

and Practice among Private and Public Primary
Health Care Workers in Enugu State, Nigeria: A
Comparative Study
Elias Chikee Aniwada1* and Christopher Ndukife Obionu1
1
Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus,
Nigeria.

Authors’ contributions

This work was carried out in collaboration between both authors. Author ECA conceptualized the
study, designed the study, did literature searches and statistical analysis with inputs from co- author
CNO. Author CNO in addition wrote the protocol. Author ECA wrote the initial draft of the manuscript.
Both authors read and approved the final manuscript.

Article Information

DOI: 10.9734/BJMMR/2016/23249
Editor(s):
(1) Patorn Piromchai, Department of Otorhinolaryngology, KhonKaen University, Thailand.
Reviewers:
(1) Fethi Ben Slama, National Institute of Public Health, Tunis, Tunisia.
(2) Triveni Krishnan, National Institute of Cholera and Enteric Diseases, Kolkata, India.
Complete Peer review History: http://sciencedomain.org/review-history/12901

nd
Received 22 November 2015
th
Accepted 18 December 2015
Original Research Article
Published 5th January 2016

ABSTRACT

Aims: The study was to compare knowledge, practice of Disease Surveillance and notification as
well as ascertain factors that influence it among Health care workers in public and private health
centres in Enugu state, Nigeria.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Selected public and private health facilities in Enugu state, Nigeria,
between January and March 2013.
Methodology: Health Care workers in selected public and private health facilities in southeast
Nigeria eligible for voluntary participation were selected and studied. The participants were
interviewed using a pretested, interviewer administered, semi-structured questionnaire. Data was
analyzed using Statistical Packages for Social Sciences (SPSS) version 18 and level of significance
was at p ≤ 0.05.
_____________________________________________________________________________________________________

*Corresponding author: E-mail: [email protected];

 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

Results: It was based on 160 HCWs (80 each from public and private). The mean age of HCWs
was 41.21±8.54 and 38.68±14.64 for public and private respectively. Females > Males in both
groups. Some of the factors associated with type of facility included; correct definition of IDSR
(AOR= 2.6, 95% CI: 1.4–5.1), correct knowledge of diseases reported (AOR= 4.1, 95% CI 2.1-8.0),
correct place to report to (AOR= 3.7, 95% CI 1.9–7.2), correct form for monthly reporting (AOR=
7.0, 95% CI 3.5–14.0), ever reported occurrence of disease (AOR= 8.5, 95% CI 4.0–18.2), reporting
in correct place (AOR= 11.5, 95% CI 1.8–73.6), current availability of forms at facility (AOR= 4.9,
95% CI 2.5–9.5), supervision or data collection visits (AOR= 8.8, 95% CI 4.3–18.1) and regularity of
the visits (AOR= 6.4, 95% CI 2.3–17.6).
Conclusion: Disease Surveillance and Notification needs to be improved on especially in areas of
manpower training and regular supply of forms for efficient Health Management Information System
and containment of most diseases ravaging the nation.

Keywords: Disease; surveillance; notification; knowledge; practice; public; private; Nigeria.

1. INTRODUCTION contact private health care providers and this

leads to cumulative effect of ineffective planning,
The emergence of new infectious diseases and implementation and monitoring of the programme
the resurgence of diseases previously controlled [9].
by vaccination and treatment are creating
unprecedented public health challenges. Recent The World Health Organization has been
disease outbreaks of Ebola viral hemorrhagic providing capacity building of surveillance
fever, Sudden Acute Respiratory Syndrome officers at the district (local government) and
(SARS), multidrug-resistant tuberculosis, West state level. Training has positively impacted on
Nile viral encephalitis, intentional anthrax, and disease notification as reported in an
H5N1 viral infections in humans have heightened interventional study conducted in Northern
concerns about global health security and global Nigeria in which percentage completeness of
economic stability [1-5]. reporting of notifiable disease increased form
2.3-52.0% and percentage of timely reports
In response to these concerns, government and increased from 0.0–42.9% post training [10].
global health leaders worked together to revise
the International Health Regulations in May These diseases for notification are categorized
2005. This provides both the legal framework as: epidemic-prone (eg Cholera, Measles),
and the requirements for all countries to be able targets for eradication/elimination (eg.
to detect and contain infections disease Poliomyelitis, Dracunculiasis), and other
outbreak. As of June 2007, all countries are diseases of public health importance (eg.
required to develop and maintain surveillance, Malaria, Tuberculosis, HIV/AIDs). The
reporting, verifications, and response prevalence of communicable diseases is varied
mechanisms at local, intermediate, and national though there are three most rated disease
levels. Any country with knowledge of a disease among them referred as the “big three” including
outbreak of international concern must report it to Malaria, Tuberculosis and HIV/AIDS. These are
the World Health Organization (WHO) within 24 the three most recognized diseases as they have
hours, regardless of where the emergency is high mortality rates and most international efforts
located [6,7]. to control infectious disease focus on these
diseases [11].
In Nigeria, the Federal Ministry of Health
recognizes the need for the implementation of an Malaria is the second leading cause of death
IDSR system, where personnel, materials and from infectious diseases in Africa, after
other resources could be used more effectively HIV/AIDS. There are an estimated 100 million
and efficiently [8]. Unfortunately this vision has malaria cases, accounting for 60% of outpatient
not been translated at the implementation level at visits and 30% of hospitalizations among children
both state and Local Government Area levels. It under five years with over 300,000 deaths per
has been observed that little or no training is year in Nigeria [12]. About 3.4 per cent of
received by health care workers in both public Nigerians are currently living with HIV/AIDS with
and private sectors and where there are training, 3.2 per cent in urban and 3.6 per cent in the rural
officials of the State Ministry of Health rarely areas and 2.9 per cent among young people

2
 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

aged 15-19 years [13]. Nigeria ranks 10th among 2.3 Sampling Technique
the 22 high-burden TB countries in the world.
There were an estimated 320,000 prevalent A multistage sampling technique was used. Four
cases of TB in 2010, equivalent to 199/100,000 out of seventeen LGAs in the state were
cases [14]. selected, Health facilities distribution in selected
LGAs were: Enugu East 93 private and 23 public,
As at 2009, Enugu state was running the Enugu South 65 private and 14 public, Nkanu
Essential Data Set (EDS) platform for her Health West 19 private and 18 public, Udi 21 private and
management information system (HMIS). This 31 public health facilities each for public and
dealt with data that were of interest only to the private were selected from the LGAs [16]. The
state alone, so no data were sent to the federal health workers were selected by choosing the
level. To bridge the gap created by the EDS Officer In Charge (OIC) of data/reporting and
system, the Partnership for Transformation of randomly selecting another health worker in each
Health Systems (PATHS) introduced the revised facility both for public and private. When not
version of NHMIS in the state and trained all feasible, the questionnaire is administered to
Monitoring & Evaluation officers in all the Local available health workers.
Government Areas (LGAs). This informed the
choice of the state for the study. 2.4 Sample Size

Despite all these on ground, coupled with The minimum sample size for the study was
established system, surveillance of disease determined using the formula for comparing two
breaks is down in Nigeria leading to avoidable proportions in a population less than ten
morbidity and mortality. While various reasons thousand [17].
and factors are proffered to be responsible, 2
studies have not yet documented the extant (Zα+Zᵦ) x (P1 (100-P1) + P2 (100-P2))
n=
reasons that may be responsible for the (P1-P2)2
breakdown in surveillance activities. This study The proportion of health workers that had the
attempts to assess and compare the surveillance knowledge and are practicing IDSR reporting
system in terms of the adequacy of DNS for were 11.4% (average of 11.9% and 10.8%)
timely collection of data and its associated [18,19] and 38.2% [20] for public and private
factors among public and private primary health respectively. Sample size calculated including
care workers of Enugu State, Nigeria. projected response failure rate of 10% gave a
sample size of 41 HCWs per group. We studied
2. METHODOLOGY 80 participants per group.

2.1 Setting 2.5 Study Participants

The study was carried out in selected Primary All cadre of health care workers; Doctors, nurses,
Health Care Centres in Enugu state. Enugu state midwives, laboratory technicians and scientist,
is located in the southeast geopolitical zone of Community Health Officers (CHO) and
Nigeria. There are seventeen LGAs in the state Community health extension workers (CHEWS)
with a total population of 4,881,500 people within of primary health facilities who met the inclusion
a total area of 7,618 sq. km [15]. The people are criteria and gave consent were studied.
of Igbo ethnicity and are predominantly
Christians. With the introduction of district health 2.6 Study Instrument
system in the state, the state is divided into
seven health districts for purpose of healthcare Pre-tested, semi-structured, interviewer
delivery. Each health district is made up of at administered questionnaire developed by
least two to three LGAs and has a range of researcher was used. Information obtained
public health facilities including a district hospital included; socio-demographic of participants, their
and primary health centres. knowledge of DSN, practice of DSN and factors
influencing practice of DSN.
2.2 Study Design
2.7 Data Analysis
This was a comparative Cross sectional
study using interviewer administered Data was analyzed using Statistical Packages for
questionnaire. Social Sciences (SPSS) version 18. Frequency

3
 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

and contingency tables was drawn to show the private mentioned correctly where to report
distribution of data. Chi square was used to test diseases, and 70.0% of public and 25.0% of
for associations between type of facility with private identified forms for monthly reporting.
socio-demographics, knowledge, practice and There were no significant association between
factors influencing IDSR. Binary logistic ever heard about IDSR (p = 0.191). There were
regression was done to determine predictors of significant association between definition of IDSR
IDSR. The level of statistical significance was at (p =0.003), knowledge of diseases reported
p value less or equal to 0.05. (p <0.001), where to report to (p <0.001), form for
immediate reporting (p <0.001), weekly
2.8 Ethical Consideration (p= 0.011) and monthly reporting (p <0.001).
Those that knew definition of IDSR were about
Ethical clearance was sought from the research 2.6 times (95% CI 1.365–5.090), correct
and ethical committee of University of Nigeria knowledge of diseases reported about 4.1 times
Teaching Hospital, Enugu. Clearance was also (95% CI 2.071-7.954), correct place to report to
sought from the LGAs Health Authority. about 3.7 times (95% CI 1.923–7.186), correct
Furthermore, written informed consent was form for immediate reporting about 3.2 times
obtained from the participants. The nature of the (95% CI 1566–6.549), correct form for weekly
study, its relevance and the level of their about 2.6 times (95% CI 1.236–5.577) and
participation were well explained to them. They monthly reporting about 7.0 times (95% CI 3.489
were also assured that all information as would –14.043) to be working in public facility than
be provided in the questionnaire will be treated private facility
confidentially and anonymously. Above all,
participation in the study was voluntary and Table 3 shows practice of Disease Surveillance
participants were assured that there would be no and Notification. Sixty eight (85.0%) public and
victimization of anyone who refused to participate 32(40.0%) private HCWs report diseases in their
or who decided to withdraw from the study after facility while 44(55.0%) public and 6(7.5%)
providing consent. private has dedicated HCWs for the reporting.
Forty eight (60.0%) public and 12(15.0%) private
3. RESULTS respondents has ever reported occurrence of
disease. Thirty eight (79.2%) public and
Table 1 shows the socio-demographic 4(33.3%) private HCWs of those that has ever
characteristics of respondents by type of facility. reported, report regularly. Seven (14.6%) and
The workers show similar ages in the two 4(33.3%) received feedback for public and
2
groups. (χ = 5.342, p = 0.430). Their mean age private respectively. There were significant
was 41.21±8.54 and 38.68±14.64 for public and association between facilities involved in
private respectively. Majority of the HCWs in reporting (p < 0.001), facilities that have ever
public facilities were females: 78 (97.5%) while in reported occurrence of disease (p <0.001),
private facilities it was roughly similar between appropriate authority to report to (p = 0.012),
2
the sexes male: female 46.3%: 53.8%. (χ = means of sending it to the authority (p = 0.016),
2.384, p = 0.123). Most of them were Community and regularity of sending forms to the authority
Health Extension Workers (CHEW)/Community (p = 0.002). There were no significant
Health Officers (CHO) for public (80.0%) while association between type of facility and
Midwives/Nurses for private (48.8%). Doctors ever received feedback (p = 0.133) as well as
were not involved in data in public while person responsible for reporting (p = 0.328).
13(16.3%) were involved in private (χ2 = 6.486; Public facilities were about 8.5 times (95% CI
p = 0.371). Years of practice showed that over 3.978–18.164) more likely to be reporting and
60% of workers in both groups have worked for about 8.5 times (95% CI 3.978–18.164) more
less than 20 years (χ2 = 6.146; p = 0.712). likely to have reported diseases than private
facilities. They are about 11.5 times (95% CI
Table 2 shows the knowledge of Disease 1.797–73.579) more likely to have reported in
Surveillance and Notification. It shows that correct place than private facilities. Public
67.5% of public and 57.5% of private have heard facilities were about 4.9 times (95% CI 1.257–
of IDSR, 50.0% of public and 27.5% private knew 18.774) to have used correct means of reporting
correct definition of IDSR; 57.5% of public and and about 7.6 times (95% CI 1.236–5.577) more
25.0% of private have correct knowledge of regular in reporting diseases than private
diseases reported, 60.0% of public and 28.8% of facilities.

4
 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

Table 1. Socio-demographic characteristics of respondents by type of facility

Socio-demographic characteristics Public Private test statistic p value

N =80 N =80 ᵡ2
(n %) (n %)
Age(years)
21-30 6(7.5) 31(38.8)
31-40 27(33.8) 17(21.3) 5.342 0.430
41-50 36(45.0) 16(20.0)
>50 11(13.8) 16(20.0)
Mean ± SD 41.21±8.54 38.68±14.64
Sex
Male 2(2.5) 37(46.3) 2.384 0.123
Female 78(97.5) 43(53.8)
Position
Doctor 0(0.0) 13(16.3)
Nurse 64(80.0) 39(48.8) 6.486 0.371
CHO/CHEW 10(12.5) 6(7.5)
Record officer/CLERK 6(7.5) 22(27.5)
Years of practice
1-10 22(27.5) 50(62.5)
11-20 31(38.8) 7(8.8)
21-30 16(20.0) 14(17.5) 6.146 0.712
>30 11(13.8) 9(11.3)

Table 2. Knowledge of disease surveillance and notification

Variable Public Private p value OR OR (95%CI)

N =80 N =80
n(%) n(%) Lower Upper
Ever heard about IDSR
Yes 54(67.5) 46(57.5) 0.191 1.725 0.899 3.310
No 26(32.5) 34(42.5)
Definition of IDSR
Correct 40(50.0) 22(27.5) 0.003 2.636 1.365 5.090
Incorrect 40(50.0) 58(72.5)
Knowledge of Diseases reported/notified
Correct 46(57.5) 20(25.0) 0.000 4.059 2.071 7.954
Incorrect 34(22.5) 60(75.0)
Where to report to
Correct 48(60.0) 23(28.8) 0.000 3.717 1.923 7.186
Incorrect 32(40.0)) 57(51.2)
For immediate/case based
Correct 34(22.5) 15(18.8) 0.001 3.203 1.566 6.549
Incorrect 46(57.5) 65(61.2)
For routine weekly reporting
Correct 27(33.8) 13(16.3) 0.011 2.626 1.236 5.577
Incorrect 53(46.2) 67(63.7)
For routine monthly reporting
Correct 56(70.0) 20(25.0) 0.000 7.000 3.489 14.043
Incorrect 24(30.0) 60(75.0)

Table 4 shows factors responsible for practice training/course in IDSR. The training/course took
Disease Surveillance and Notification. Very few place over five years ago. Fifty four (67.5%)
health workers 12(15.0%) and 7(8.8%) in public public and 9(11.3%) has regular supply of IDSR
and private centres respectively have attended forms. Fifty four (67.5%) and twenty four (30.0%)

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 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

Table 3. Practice of disease surveillance and notification

Variable Public Private p value OR OR (95%CI)

N =80 N =80
n(%) n(%) Lower Upper
Facilities involved in reporting
Yes 68(85.0) 32(40.0) 0.000 8.500 3.978 18.164
No 12(15.0) 48(60.0)
Person responsible for reporting* n=68 n =32
Doctors/Heads only 8(10) 8(10.0)
Dedicated health worker 44(55.0) 6(7.5) 0.328 0.136 0.037 0.500
Any health worker 16(20.0) 18(22.5) 1.125 .343 3.695
Ever reported occurrence of disease
Yes 48(60.0) 12(15.0) 0.000 8.500 3.978 18.164
No 32(40.0) 68(85.0)
If yes, what authority do you N=48 N=12
report to*
Correct 46(95.8) 8(66.7) 0.012 11.500 1.797 73.579
Incorrect 2(4.2) 4(33.3)
Means of sending filled IDSR form N=48 N=12
Correct 34(70.8) 4(33.3) 0.016 4.857 1.257 18.774
Incorrect 14(29.2) 8(66.7)
Regularity in reporting cases N=48 N=12
Yes 38(79.2) 4(33.3) 0.002 7.600 1.897 30.444
No 10(20.8) 8(66.7)
Reasons for not reporting N =32 N =68
diseases**
My facility not involved 10(31.3) 27(39.7)
Forms not supplied to us 18(56.3) 29(42.6) 0.543 NA NA NA
No training/incentives 4(12.5) 12(17.6)
Ever received feedback following N=48 N=12
reporting
Yes 7(14.6) 4(33.3) 0.133 0.341 0.081 1.446
No 41(85.4) 8(66.7)
*number that have reported occurrence of disease, **number that do not send report

has IDSR forms in stock as at time of study. 17.557) to be working in public facility than
Factor responsible for regular reporting was private facility.
supervision, public 34(89.5%) and private
2(50.0%). There were no significant association 4. DISCUSSION
between type of facility and ever attending
course or training on IDSR (p = 0.222) as well as Most of the healthcare workers were Community
last time they attended training (FT, p =0.965). Health Extension Workers (CHEW)/Community
All those that attended course had it over 5 years Health Officers (CHO) for public health workers
ago in both facilities. There is significant while Midwives or Nurses for private. Doctors
association between regularity in supply of forms were not involved in data in public while very few
(p = 0.020), current availability of forms at were involved in private health care centres. This
facilities (p < 0.001), supervision or data vast disparity in staff cadre between types of
collection visits (p < 0.001) and regularity of the facility is expected given the very different tasks
visits (p < 0.001) with type of facility. Those that they assume. A Situation Assessment of Human
do not have regular supply of forms were over 15 Resources the Public Health Sector in Nigeria
times, current availability of forms at facilities showed that CHOs/CHEWs are most frequently
about 4.9 times (95% CI 2.482–9.461), found in primary facilities [21]. Similarly study
supervision or data collection visits about 8.8 done among PHC workers in Igbo-Etiti, Enugu
times (95% CI 4.268–18.144) and regularity of state found 68% of PHC workers to be
the visits about 6.4 times (95% CI 2.315– CHEW/CHO [22].

6
 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

Table 4. Factors responsible for practice Disease Surveillance and Notification

Variable Public Private p value OR OR (95%CI)

N =80 N =80
n(%) n(%) Lower Upper
Ever attended course /training on IDSR
Yes 12(15.0) 7(8.8) 0.222 1.840 0.685 4.948
No 68(85.0) 73(91.3)
If yes, when was last training
>5years 12(15.0) 7(8.8) 0.96* NA NA NA
Regularity in supply of IDSR forms
Always 54(67.5) 9(11.3)
Occasionally 1`2q18(10.0) ``p>” 0.020 18.750 6.471 54.329
Usually out of stock 18(22.5) 47(58.8) 15.333 6.287 37.397
Current availability of IDSR forms in your HF
Yes 54(67.5) 24(30.0) 0.000 4.846 2.482 9.461
No 26(32.5) 56(70.0)
Anybody from the LGA come to ask for data/supervision
Yes 64(80.0) 25(31.3) 0.000 8.800 4.268 18.144
No 16(20.0) 55(68.8)
If yes, how often* N=64 N=25
At most monthly 48(75.0) 8(32.0) 0.000 6.375 2.315 17.557
Others 16(25.0) 17(68.0)
Factors responsible for regular
reporting# N=38 N=4
Supervision 34(89.5) 2(50.0) 0.091* NA NA NA
Motivation 4(10.5) 2(50.0)
Factors responsible for non
regular reporting ## N=10 N=8
Lack of forms 8(80.0) 3(37.5) 0.145* NA NA NA
No motivation 2(20.0) 5(62.5)
#number that has been reporting regularly ## number that do not report regularly
* Fisher’s test

Proportion of respondents that have ever heard types of Diseases Surveillance and Notification
of IDSR was impressive especially in public (DSN) forms. The study equally showed that
facilities. Knowledge of diseases reported, where awareness of how often the forms are to be sent
to report to, form for monthly reporting was to the next level was also low [19]. In similar
between 50 and 60 percent for public but less study of knowledge of disease notification among
than 30 percent for private. These findings were doctors in government hospitals in Benin City
not surprising as those in public facilities have Nigeria only 11.9% of surveyed doctors had a
higher chance of coming in contact with state good knowledge of disease notification [18].
Disease Surveillance and Notification as well as Likewise, study on the effect of training on the
attending functions where Integrated Disease reporting of notifiable diseases among health
Surveillance and Response (IDSR) and its likes workers in Yobe State, Northern Nigeria, only
will be mentioned or talked about. A study on fifty-five (38.2%) of the respondents were aware
awareness and knowledge of disease of the national disease surveillance system [20].
surveillance and notification by health-care
workers and availability of facility records in For immediate/ case based reporting (IDSR 001),
Anambra state showed that 9.8% of the health- thirty four (22.5%) public and fifteen (18.8%)
care workers were aware of the DSN system private; weekly (IDSR002) twenty seven (33.8%)
[23]. Another study on Health Management public and thirteen (16.3%) private; and routine
Information System in Private Clinics in Ilorin, monthly (IDSR 003), fifty six (70.0%) public and
Nigeria about two-thirds (67.6%) were aware of twenty (25.0%) private had correct knowledge of
the National Health Management Information form used in reporting. The findings contrasts
System (NHMIS); though very low proportion from findings on awareness and knowledge of
(10.8%) was able to correctly mention the two disease surveillance and notification by health-

7
 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

care in Anambra state which showed that only facilities. Reasons for not filling IDSR forms is
33.3, 31.1, and 33.7% of them knew the specific forms not available 56.3% and 42.6% followed by
uses of forms IDSR 001, IDSR 002, and IDSR their facilities not practicing disease notification
003 respectively [23]. Most facility visited in the 31.3% and 39.7% respectively for public and
study has IDSR 003 for monthly reporting with private health care workers. In a study in private
others IDSR 001 and IDSR 002 not available. clinics in Ilorin, Nigeria only 11 (29.7%) out of the
Some staff though have forms for monthly 37 health facilities had ever been supplied
reporting but do not know that it is identified as NHMIS forms, only 6 (16.22%) had any NHMIS
IDSR 003. Checklist from previous study forms during the interview and only 4 (36.4%)
revealed that IDSR 001 and IDSR 002 forms had made returns within the previous 6 months
were predominantly found in primary health-care of the study. Similarly, in a study in Yobe state,
facilities [24]. Likewise in that previous study fifty- more than 92% of the health facilities lack the
eight (65.9%) and 7 (8.0%) of the facilities had DSN 001 and 002 forms [25]. The findings from
up-to-date registers and DSN forms respectively this study were in line with findings in other
[24]. where visits to the peripheral facilities to receive
reports are done weekly and regularly by disease
Reporting of diseases has been carried out by surveillance officers [26]. However, in same
forty eight (60.0%) of public health respondents study the inadequacy of reporting forms and
and twelve (15.0%) private workers. Out of these stationeries as reported by 52.4% of the
workers that reported, a very high proportion respondents was significantly associated with
reports appropriately by both public and private non-reporting of outbreaks (p= 0.007). This has
centres especially the public health workers. The also been reported in previous studies which
most probable reason why public centre could reported lack of reporting forms as a reason for
afford using a dedicated worker is because their not reporting notifiable diseases [20,23].
employment is more permanent, has more
manpower and less pressure of work when Very few health workers in both public and
compared to private. A study in Yobe state, had private centres respectively have attended
a similar finding where thirty nine (70.9%) training/course in IDSR The ones that had
reported to have ever reported, while 16 (29.1%) training/course took place over five years ago.
have never reported any of the notifiable The finding is surprising as LGA DSNO has been
conditions [24]. trained, retrained and attend refreshers courses
but this was not stepped down to workers at
Very minimal number of respondents both in facility. Reports from study in Northern Nigeria,
public, seven (14.6%) and private, four (33.3%) supports the finding as only a small percentage
had ever received feedback. This poor feedback were found to have received training. However,
is neither encouraging to the workers nor healthy finding from study in southwest part of the
to effective monitoring and control of diseases in country Nigeria showed that 76.2% of DSN
the country. This implication is that this may officers had relevant training in disease
contribute to poor attitude to disease notification surveillance. The World Health Organization and
or reporting. Other similar studies in other parts other partner agencies have been providing
of the country had similar finding. Bawa and technical assistance to the nation most especially
Umar in their study in Yobe state found that only in capacity building of surveillance officers at the
12 (21.8%) of the respondents have ever district (local government) and state level but not
received feedback on the reports they forward to at facility level though the training is supposed to
higher authorities [20]. Study on Notifiable be stepped down to facility by respective DSNO
disease surveillance and practicing physicians, of [26].
the 1,320 respondents, 59.3% claimed not to
have received any feedback on infectious Factor identified to be responsible for regular
disease surveillance [25]. reporting among public health workers was
supervision and motivation however the main
While majority of public facilities has regular factor responsible for non-regular reporting was
supply of IDSR especially IDSR 003, the reverse lack of forms for public and no motivation for
happens in private as only very few has the private health workers. In public facilities, most
forms. This equally reflected same on finding on workers report because they believe that their
the forms availability at time of study. Visits by salaries and wages are tied to these reports. This
DSNO for supervision and data collection is fairly means that if they fail to return report they may
regular (at least monthly) especially at public not be paid at end of month. Workers who do not

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 Aniwada and Obionu; BJMMR, 13(3): 1-10, 2016; Article no.BJMMR.23249

comply are threatened with ceasing his or salary. SARS outbreak Challenged International
This is concurred by another study which and National Responses. Report No.
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