Article Info
Year: 2007
Month: July
Issue: 3
Reference: Dahlan A., Al-Rabeah A., Nooh R., .Saudi Epidemiology Bulletin. 2007;14(3):.
The surveillance of infectious diseases has recently assumed greater importance on account of emerging and re-emerging infectious diseases. Our study attempts to evaluate the knowledge, attitude and practices of Ministry of Health (MOH) physicians throughout the entire 18 health regions of the Kingdom towards the surveillance system. The study included all MOH physicians working in notifying disease in both governmental Primary Health Care Centers (PHCCs) and hospitals in July 2006 as a cross sectional study, using a self-administered questionnaire.
A multistage stratified random cluster sampling technique was used to identify participants. The study sample involved 3399 physicians from all health regions; the response rate was 85%.
Regarding physicians' attitude towards the surveillance system, 83% agreed that the case definition was clear, 77.2% agreed that the operating surveillance system was good, 76.5% agreed that the notifiable diseases were sufficient, 46.4% agreed that some diseases should be added, 58.2% didn't agree that some diseases should be removed, 98.4% agreed that MOH should arrange for training courses in surveillance, and 93.9% agreed that they would like to attend such courses.
Regarding practices, the majority (95%) had not attended any surveillance training and 48% stated that they did not have a clear manual about surveillance system. 76.6% reported facing difficulties in notifying the communicable diseases that they diagnosed, ranging from always to rarely. 79.2% reported receiving feedback from the health directorate or regional district ranging from always to rarely.
The most common reasons for perceived difficulties in notifying communicable diseases were that patients were not cooperative in providing information (44.8%), the health inspector was not always present (37.2%), insufficient time for recording information due to high patient load (28.6%), too much information to record (22.2%), patient not knowing his address (21.9%), busy or unoperating communication system (15.8%), and other reasons (10.3%).
The most common perceived difficulties in conducting control measures were uncooperative patient contacts (50%), no communication system with patient (30.2%), transportation difficulties (27.7%), unclear control measures of diagnosed disease (26.6%), unknown patient address (24.5%), non-cooperation of non-governmental hospitals (14.3%), not knowing the control measures of diagnosed disease (13.3%), information required to fill unclear (12.7%), and other reasons (5.1 %).
Physicians stated that they received feedback in the form of either letters (41.4%), reports 939 (37%), journals and/or bulletins (26.4%), Symposia & periodic meetings (9.5%), and other forms eg. by phone, through the health inspector (4.2%). Feedback was received by mail (42.7%), hand (31.5%), Fax (29%), or others (8.4%).
Regarding knowledge of the surveillance system, poor knowledge (<80% correct answers) was found among 59% of respondents. Also, most (85.7%) scored poor knowledge in the notifiable diseases.
Factors influencing physicians' knowledge of the definition and components of surveillance system and their knowledge about notification time for communicable diseases are presented in Table 1.
Editorial note:
Surveillance is the ongoing systematic collection, analysis and interpretation of health data in the process of describing and monitoring a health event.[1] The information is used for planning, implementing and evaluating public health intervention programs. Worldwide, notifiable disease surveillance often suffers from incomplete reporting.[2]
In this study, many physicians had poor knowledge about the definition and components of the surveillance system and about the time for disease notification, which is similar to many studies worldwide. A study in Nigeria evaluating doctors' knowledge of disease notification in governmental hospitals reported that 88% had poor knowledge of disease notification.[3] In Canada, 79.5% of Emergency Physicians had poor knowledge about notifiable disease reporting.[4] A study conducted in Jeddah that assessed the reporting and recording system of communicable diseases found that the reporting rate was 74%.[5]
There was significantly better knowledge of the definition and components of the surveillance system among males, older physicians, those working 5 years and above in MOH, lower qualifications (i.e. GPs), non-Saudis, working at PHCCs, and those who had previously attended training courses on surveillance. Knowledge of the notification times was significantly better among males, those working 5 years and above, physicians with lower qualifications, non-Saudis, those working in PHCCs, and those who had previously attended training courses.
Knowledge of physicians of the correct timing of notification is crucial. It is also mandatory for physicians to be aware of the control measures of each disease. In our study, physician's good knowledge constituted only 14.3% in identifying the time for reporting of the 36 notifiable diseases, which is only slightly higher than the Nigerian study (11.9%).[3]
Only 12.2% of physicians in our study always received feedback. Studies in various countries have concluded that the low attitude of physicians with notification systems is partly caused by insufficient feedback. In Germany a study showed that out of 1,320 respondents, 59.3% stated not to have received any feedback on infectious disease surveillance.[ 6] Feedback demonstrating that preventive action is taken as a result of notification may be effective in improving notification practices.
Lack of training (95%) and lack of clear written manuals (48%), may explain the poor knowledge of physicians in our study and advocate for arrangement of periodic training courses for physicians. Clear written manuals should also be supplied, including clear control measures of each disease. Easy reporting forms should be made available, with a condensed and feasible list of notifiable diseases. The feedback system should be evaluated to improve reporting rate. Better communication between curative and preventive health sectors would improve attitudes of doctors regarding notification.
References
- Jajosky RA, Groseclose S. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health 2004, 4:29
- Doyle TJ, Glynn MK, Groseclose SL. Completeness of notifiable disease reporting in the United States: An analytical literature review. Am J Epidemiol 2002; 155(9):866-74.
- Ofili AN, Ugwu EN, Ziregbe A, Richards R, Salami S. Knowledge of disease notification among doctors in government hospitals in Benin City, Edo State, Nigeria. Public Health 2003; 117(3):214-7.
- Friedman S M, Sommersall LA, Gardam M, Arenovich T. Suboptimal Reporting of Notifiable Diseases In Canadian Emergency Departments: A Survey of Emergency Physician Knowledge, Practices, and Perceived Barriers, Canadian Communicable Disease Report 2006; 32(17): 1.
- Bakarman MA, Al-Raddadi RM. Assessment of reporting and recording system of communicable diseases in Jeddah Region. SMJ 2000; 21 (8):751-754.
- Krause G, Ropers G, Strak K. Notifiable Disease Surveillance and Practicing Physicians. Emerging Infectious Diseases. 2005; ll(3):442-5.
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Table 1: Effect of physicians' characteristics on their knowledge of the surveillance system and the notifiable diseases.
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|||||||||||
|
Physicians' characteristics
|
Surveillance system
|
Notifiable diseases
|
|||||||||
|
Good
Knowledge
|
Poor
Knowledge
|
P-Value
|
Good
Knowledge
|
Poor
Knowledge
|
P-Value
|
||||||
|
No.
|
%
|
No.
|
%
|
No.
|
%
|
No.
|
%
|
||||
|
Gender
|
Male
|
1091
|
42.2
|
1494
|
57.8
|
0.006
|
398
|
15.5
|
2173
|
84.5
|
0.006
|
|
Female
|
264
|
36.6
|
458
|
63.4
|
82
|
11.4
|
638
|
88.6
|
|||
|
Age (Years)
|
> 40
|
665
|
44.1
|
842
|
55.9
|
0.002
|
241
|
16.1
|
1258
|
83.9
|
0.161
|
|
<40
|
577
|
38.7
|
915
|
61.3
|
212
|
14.2
|
1277
|
85.8
|
|||
|
Experience
(Years)
|
> 5
|
726
|
44.3
|
912
|
55.7
|
0.001
|
290
|
17.8
|
1339
|
82.2
|
<0.001
|
|
<5
|
491
|
38.3
|
790
|
61.7
|
152
|
11.9
|
1124
|
88.1
|
|||
|
Degree
|
GP
|
1113
|
43.0
|
1477
|
57.0
|
<0.001
|
423
|
16.4
|
2156
|
83.6
|
<0.001
|
|
Specialist/ Consultant
|
247
|
33.4
|
493
|
66.6
|
56
|
7.6
|
683
|
92.4
|
|||
|
Nationality
|
Non-Saudi
|
1278
|
41.9
|
1771
|
58.1
|
<0.001
|
463
|
15.2
|
2577
|
84.8
|
<0.001
|
|
Saudi
|
87
|
30.5
|
198
|
69.5
|
16
|
5.7
|
266
|
94.3
|
|||
|
Workplace
|
PHCC
|
957
|
44.7
|
1184
|
55.3
|
<0.001
|
384
|
18.0
|
1744
|
82.0
|
<0.001
|
|
Hospital
|
395
|
33.8
|
774
|
66.2
|
91
|
7.6
|
1103
|
92.4
|
|||
|
Training
course
|
Yes
|
89
|
52.0
|
82
|
48.0
|
0.002
|
53
|
31.2
|
117
|
68.8
|
<0.001
|
|
No
|
1265
|
40.2
|
1879
|
59.8
|
424
|
13.4
|
2737
|
86.6
|
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