DISEASE REPORTING BY PRIMARY HEALTH CARE WORKERS IN CROSS RIVER STATE: A RURAL-URBAN COMPARATIVE STUDY

Abstract

Background: This study assessed knowledge, attitude and practices of disease reporting and identified factors associated with the use of IDSR system forms by health workers to report diseases in the urban and rural local government areas (LGAs) of Cross River State.
Methods: A comparative cross-sectional study design was used to assess disease reporting by 308 health workers; 152 rural and 156 urban workers. Multistage sampling was used to recruit health workers from 44 health facilities. Information was obtained from respondents using interviewer administered questionnaires. Data on respondents’ knowledge of notifiable disease reporting, attitudes and practices were collected. Qualitative information was elicited by a focus group discussion. Data were summarized using proportions, and Chi-square tests were used to explore associations between categorical variables. Predictors of disease reporting with use of IDSR forms were determined using binary logistic regression. Level of statistical significance was set at p < 0.05.
Results: The mean age for all the workers was 37 ± 8years, while the mean age of rural and urban workers were 38 ± 9 years and 37 ± 8years respectively. Females constituted (85.3%) of the urban and (78.9%) rural workers. A significantly higher proportion of the urban health workers (52.6%) had first degree or postgraduate qualification compared to (26.3%) of rural workers (P < 0.001).
Overall, the knowledge of workers on disease notification was high (78.3%). The distribution was similar in urban (74.0%) and the rural (82.7%) LGAs, but the depth of knowledge of the workers on the number of diseases for immediate notification on the priority list was better in rural compared to the urban LGAs.
The attitude of the workers to disease reporting was good as the overall median range attitude score was 78(10-92).More than three – quarter (86.2%) of the urban facilities had
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Case investigation sheets for reporting notifiable diseases compared to (57.8%) of the rural facilities (p < 0.001).
On logistic regression analysis,“years of practice” and “knowledge” were significantly associated with use of IDSR forms. Health workers who had 20 or more years’ experience in practice were less likely to report disease using IDSR forms compared to those who were 0-9 years old in practice. (OR=0.30, 95% CI = 0.10; 0.85, P=0.024). Health workers with good knowledge of reporting compared to those with poor knowledge of reporting notifiable diseases had fivefold odds of reporting notifiable diseases(OR= 4.6, 95% CI=1.01; 21.0, (P=0.049).
Conclusion
The knowledge of IDSR strategy was high among workers but their depth of knowledge on the notifiable disease items was low in urban LGAs. Disease reporting was significantly better in urban health facilities compared to rural health facilities. Improvement in disease notification will require regular training of the concerned health-care workers.

DISEASE REPORTING BY PRIMARY HEALTH CARE WORKERS IN CROSS RIVER STATE: A RURAL-URBAN COMPARATIVE STUDY