Evaluation of the surveillance system for acute flaccid paralysis in Vachira Phuket Hospital, 2023–2024

Abstract

Background: Acute Flaccid Paralysis (AFP) is a condition characterized by sudden, primarily caused by poliovirus. The World Health Organization (WHO) mandates that surveillance systems detect at least two cases per 100,000 children under 15 years old. In 2023, Vachira Phuket Hospital identified two AFP cases (2.64 per 100,000) and reported them through the 506 Disease Surveillance System (R.506). In 2024, cases were reported via the Digital Disease Surveillance (DDS) system. However, the hospital has never conducted an evaluation of its AFP surveillance system. This study aimed to examine the reporting process, quantitative characteristics, and quality of the AFP surveillance system at Vachira Phuket Hospital in 2023 under the 506 surveillance system and in 2024 under the DDS system.

Methods: A mixed-methods descriptive study was conducted to evaluate the surveillance system using both quantitative and qualitative approaches. Data was collected retrospectively from medical records between January 1 and December 31, 2023 (506 surveillance system), and between January 1 and December 31, 2024 (DDS system). Case identification was performed using primary and secondary ICD-10 codes and Chief Complaint (CC) records from patient visits.

Results: The quantitative assessment revealed that the reporting sensitivity was 22.22% in 2023 and decreased to 16.66% in 2024, while the positive predictive value remained at 100% for both years. In 2023, data representation was inconsistent in terms of gender, age, location at the time of illness, and the month of hospital admission. In 2024, comparisons could not be made due to the use of Syndromic Surveillance. Regarding timeliness, the average reporting time was 0 days in 2023 but increased to 1.5 days in 2024. Data quality assessment in 2023 showed that gender and age data were 100% complete and accurate. However, in 2024, a direct comparison was not possible due to the shift to Syndromic Surveillance. The qualitative analysis indicated a lack of clear reporting guidelines, with hospital staff demonstrating limited knowledge of AFP and its reporting procedures, affecting the overall effectiveness of the surveillance system.

Recommendations: The DDS system should adopt individual case reporting to facilitate easier data retrieval and analysis. Clear AFP reporting guidelines should be established within the hospital to ensure timely case reporting. Training programs should be conducted on notifiable diseases and reporting systems, especially for conditions that can be reported based on early symptoms. The surveillance system should prioritize case identification based on chief complaints rather than relying solely on ICD-10 coding.