Audit & Evaluation of the Acute Flaccid Paralysis Surveillance System in Khyber Pakhtunkhwa, Pakistan

Abstract

Objective: To evaluate acute flaccid paralysis (AFP) surveillance system in Khyber Pakhtunkhwa (KPK) – Pakistan.

Methods:  This descriptive cross-sectional study was conducted at directorate general health services office KPK, Peshawar from 10th November – 31st December, 2012.  AFP Surveillance System of KPK was evaluated by using a validated tool “CDC Updated Guidelines for Evaluating Public Health Surveillance System 2001”.  Review of surveillance documents/reports, records and interviews of stakeholders were carried out using semi-structured questionnaire. Specified surveillance system attributes were assessed objectively. Sensitivity and Positive Predictive Value (PPV) was calculated using WHO estimates for KPK. Data was analyzed and inferences were drawn according to guidelines in the study tool.

Results: System was found easy to operate so declared simple as collecting all necessary information. It was found flexible with ability to accommodate other diseases like Neonatal Tetanus & Measles. As active surveillance is done and private sector is involved, so it was a representative system. System is stable as ownership was found among all stakeholders at all levels. Average timeliness of different indicators like proportion of cases with two adequate stool specimens collected at least 24 hours apart and within 14 days after onset of paralysis, arriving at the laboratory in good condition was 84%. Case Sensitivity was 100% while PPV was 2.78%.  Overall system was ranked as good as per criteria.

Conclusion: AFP surveillance system though vertical, operating through partners, is well established and has an impact by identifying all AFP cases. It is a disease-based system and meeting its objectives effectively.