Rahman Kazi Mizanur, Samarawickrema Indira V M, Harley David, Olsen Anna, Butler Colin D, Sumon Shariful Amin, Biswas Subrata Kumar, Luby Stephen P, Sleigh Adrian C
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Population and Social Health Research Program, Griffith Health Institute, Gold Coast Campus, Griffith University, Gold Coast, Queensland, Australia.
National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
PLoS Negl Trop Dis. 2015 Apr 10;9(4):e0003531. doi: 10.1371/journal.pntd.0003531. eCollection 2015 Apr.
Elimination of kala-azar is planned for South Asia requiring good surveillance along with other strategies. We assessed surveillance in Gaffargaon upazila (a subdistrict of 13 unions) of Mymensingh district, Bangladesh highly endemic for kala-azar.
In 4703 randomly sampled households, within nine randomly sampled villages, drawn from three randomly sampled unions, we actively searched for kala-azar cases that had occurred between January 2010 and December 2011. We then searched for medical records of these cases in the patient registers of Gaffargaon upazila health complex (UHC). We investigated factors associated with the medical recording by interviewing the cases and their families. We also did a general observation of UHC recording systems and interviewed health staff responsible for the monthly reports of kala-azar cases.
Our active case finding detected 58 cases, but 29 were not recorded in the Gaffargaon UHC. Thus, only 50% (95% CI: 37%-63%) of kala-azar cases were reported via the government passive surveillance system. Interviews with health staff based in the study UHC revealed the heavy reporting burden for multiple diseases, variation in staff experience, high demands on the staff time and considerable complexity in the recording system. After adjusting for kala-azar treatment drug, recording was found more likely for those aged 18 years or more, males, receiving supply and administration of drug at the UHC, and more recent treatment.
Fifty percent of kala-azar cases occurring in one highly endemic area of Bangladesh were recorded in registers that were the source for monthly reports to the national surveillance system. Recording was influenced by patient, treatment, staff and system factors. Our findings have policy implications for the national surveillance system. Future studies involving larger samples and including interviews with health authorities at more central level and surveillance experts at the national level will generate more precise and representative evidence on the performance of kala-azar surveillance in Bangladesh.
南亚地区计划消除黑热病，这需要良好的监测以及其他策略。我们评估了孟加拉国迈门辛希区加富尔冈乡（一个下辖13个联合村的分区）的监测情况，该地区黑热病高度流行。
在从三个随机抽取的联合村中随机抽取的九个村庄内的4703户随机抽样家庭中，我们积极搜寻2010年1月至2011年12月期间发生的黑热病病例。然后，我们在加富尔冈乡卫生中心（UHC）的患者登记册中查找这些病例的医疗记录。我们通过访谈病例及其家属来调查与医疗记录相关的因素。我们还对UHC的记录系统进行了总体观察，并采访了负责黑热病病例月度报告的卫生工作人员。
我们的主动病例发现检测到58例病例，但加富尔冈UHC未记录其中29例。因此，只有50%（95%置信区间：37%-63%）的黑热病病例通过政府被动监测系统报告。对研究UHC的卫生工作人员的访谈显示，多种疾病的报告负担沉重，工作人员经验存在差异，对工作人员时间要求高，记录系统相当复杂。在对黑热病治疗药物进行调整后，发现18岁及以上者、男性、在UHC接受药物供应和管理以及近期接受治疗者更有可能被记录。
在孟加拉国一个黑热病高度流行地区发生的50%的黑热病病例记录在登记册中，这些登记册是向国家监测系统进行月度报告的来源。记录受到患者、治疗、工作人员和系统因素的影响。我们的研究结果对国家监测系统具有政策意义。未来涉及更大样本并包括对更高级别卫生当局和国家层面监测专家进行访谈的研究将产生关于孟加拉国黑热病监测绩效的更精确和有代表性的证据。
