JMIR Publications

ABSTRACT

Background:

Background:

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny of private providers’ intentions, motives and obstacles to comply with infectious disease surveillance reporting (IDSR). Appreciation of how private providers’ attitudes shape their TB notification behaviors yields lessons for surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among institutions is an under-studied part of the “software” of surveillance.

Objective:

We aimed to assess self-reported knowledge, motivation, barriers, and case notification behavior to public health authorities in Lagos, Nigeria We sought to compare self-report against actual notifications received and cases found in facility records.

Methods:

A geographically representative, stratified sample of 278 private health care workers (HCWs) was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify TB treatment provided and facility case counts were abstracted. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior.

Results:

Noncompliance with legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were not comfortable notifying TB scored lower on the perceived benevolence sub-scale of trust. HCWs who affirmed ‘always’ notifying via IDSR monthly reported higher median trust in the state’s public disease control capacity. While self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, self-report did not tally with actual notifications.

Conclusions:

Providers perceive both risks and benefits to recording and reporting. In order to improve private providers’ public health behaviors, policymakers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. A renewed attention to the ‘software’ of health systems (e.g. norms, values, and relationships) is vital to address pandemic threats.