Completeness of reporting and case ascertainment for neonatal tetanus in rural Pakistan

Abstract

Objectives: The objectives of this study were to assess the case ascertainment and completeness of neonatal tetanus (NT) reporting and to estimate the incidence of NT in Dadu District, Pakistan.

Methods: We conducted active surveillance and hospital record reviews for suspected NT cases. We compared the cases of NT reported to the routine surveillance system with the cases identified through the hospital record reviews for 1993 through 2003. The two-source capture-recapture method was used to evaluate case ascertainment in the routine surveillance system and to estimate the incidence of cases of NT.

Results: Active surveillance and hospital record reviews identified 134 cases in addition to 274 cases in the routine surveillance system. The two-source capture-recapture method indicated that there would have been 463 cases during this period (95% confidence interval (CI)=418-508), representing an average annual incidence of 0.62 per 1000 live-births. The overall completeness of routine reporting was 59.2%. The proportions of cases reported were 68.1% for government hospitals and 53.8% for private reporting sites.

Conclusions: Reporting of NT cases is incomplete. Active promotion of private sector participation, community involvement, and strengthening of the government sector as a way of improving NT reporting and surveillance is strongly suggested.