Publication:

Evaluating an incentive based syndromic case reporting model using local health volunteers for predicting and preventing chikungunya epidemics in North Kerala, India

Background We attempted to explore the utility of incentive based syndromic surveillance for chikungunya, by identifying, training and utilizing female health volunteers and testing its adaptability in a low resource setting.

Methods A prospective evaluation of the syndromic reporting model was done in five selected urban and two rural units of Kozhikode district in North Kerala. Since large gaps were identified in the district health system reports of CKG for 2009 epidemic, an incentive based reporting and intervention model was developed which functioned independently from the official reporting systems by training health volunteers. For comparison baseline fever levels were generated using 5 year district health system data, calculating Z-scores. Statistical forecasting using time series analysis was done in both rural areas for the year 2011. Official  IDSP and health volunteer fever reports were compared to predicted fever counts for 2011.Timeliness and completeness of reporting units and completeness of case reporting was monitored by WHO inventory method.

Results The current reporting model detected higher fever counts compared to the official data. For every 100 fever counts by the LHVs only 15 fever counts were reported by the official health system. Timeliness and completeness of reporting units exceeded 70% and completeness of case reporting 75%.

Conclusions The present study reiterated the ability of syndromic surveillance in detecting and monitoring out breaks. Timeliness and completeness of reports goes to prove the effectiveness of incentive based reporting system at the regional level. Incentive based disease surveillance and reporting at grass root levels, is effective in detecting early outbreaks triggering a reactive community participation leading to prompt disease containment measures and is applicable in resource poor settings.