Evaluation of the Acute Flaccid Paralysis Surveillance System in Health Region 8

Abstract

This surveillance system evaluation aimed to study the acute flaccid paralysis (AFP) surveillance process, assess both the quantitative and qualitative aspects of the system, and provide recommendations for AFP-related operations. It was a descriptive cross-sectional study that collected data from eight hospitals in four provinces within Health Region 8. Medical record reviews were conducted for patients under 15 years old diagnosed with relevant conditions (37 diseases) over the past two years (2023-2024), and for general diseases over the past year (2024). Interviews were also conducted with stakeholders at the hospital, provincial, and regional levels. The study found that hospitals had AFP surveillance guidelines in place and operated through multi-sectoral collaboration. Physicians and nurses served as the frontline in detecting and reporting cases to epidemiologists. A review of 2,605 medical records revealed a male-to-female ratio of 1.21:1, with a median age of 7 years (minimum 1 month, maximum 14 years). The 10-14 age group was the largest, accounting for 31.74%. Eleven cases met the AFP case definition, but only one case was reported, resulting in a low reporting sensitivity (9.09%), especially in large hospitals where report completeness was lower. The positive predictive value, representativeness, timeliness, and overall data quality were satisfactory. Stool samples were collected twice per patient, and case investigations and reports were conducted in a timely manner. However, follow-up on patient symptoms was incomplete, and active case finding was lacking. Interviews with stakeholders indicated recognition of the importance and benefits of the surveillance system. However, there was a lack of shared understanding and review of the surveillance guidelines within the organizations. Physicians and nurses often did not suspect AFP, resulting in underreporting and failure to meet surveillance standards. It is recommended that hospitals review and reinforce the knowledge and understanding of AFP definitions and surveillance guidelines among relevant personnel and implement active case finding measures to enhance case detection opportunities. Provincial and regional authorities should monitor, support, and expedite follow-up while seeking measures to strengthen the AFP surveillance system to ensure compliance with established standards.