Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: experience from a vaccine trial.
BACKGROUND
In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described.


METHODS
The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was formed to provide support for disease surveillance. Children who had a reported history of fever for more than three days were enrolled for a diagnosis.


RESULTS
Between May 2003 and April 2004, 5540 children younger than 16 years with fever for three days or more were enrolled in the study. Of the children, 1312 (24%) were seen first by private practitioners; the remainder presented directly to study centres. In total, 5329 blood samples were obtained for microbiology. The annual incidence of Salmonella typhi diagnosed by blood culture was 407 (95% confidence interval (95% CI), 368-448) per 100 000/year and for Salmonella paratyphi A was 198 (95% CI, 171-227) per 100 000/year. Without the contribution of private practitioners, the rates would have been 240 per 100 000/year (95% CI, 211-271) for S. typhi and 114 (95% CI, 94-136) per 100 000/year for S. paratyphi A.


CONCLUSIONS
The private sector plays a major health-care role in Pakistan. Our experience from a surveillance and burden estimation study in Pakistan indicates that this objective is possible to achieve but requires considerable effort and confidence building. Nonetheless, it is essential to include private health care providers when attempting to accurately estimate the burden of disease in such settings.
Khan
Mohammad Imran
MI
Department of Paediatrics, Aga Khan University, Karachi, Pakistan.
Sahito
Shah Muhammad
SM
Khan
Mohammad Javed
MJ
Wassan
Shafi Mohammad
SM
Shaikh
Abdul Wahab
AW
Maheshwari
Ashok Kumar
AK
Acosta
Camilo J
CJ
Galindo
Claudia M
CM
Ochiai
Rion Leon
RL
Rasool
Shahid
S
Peerwani
Sheeraz
S
Puri
Mahesh K
MK
Ali
Mohammad
M
Zafar
Afia
A
Hassan
Rumina
R
von Seidlein
Lorenz
L
Clemens
John D
JD
Nizami
Shaikh Qamaruddin
SQ
Bhutta
Zulfiqar A
ZA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003299:Cooperative Behavior; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010154:Pakistan; D017149:Private Sector; D012485:Salmonella typhi / Q000276:immunology; D018571:Sentinel Surveillance; D014612:Vaccines
D014612:Vaccines