title: Reasons and circumstances for the late notification of Acute Flaccid Paralysis (AFP) cases in health facilities in Luanda.
abstract: BACKGROUND
  As the polio eradication effort enters the end game stage, surveillance for Acute Flaccid Paralysis in children becomes a pivotal tool. Thus given the gaps in AFP surveillance as identified in the cases of late notification, this study was designed to explore the reasons and circumstances responsible for late notification of AFP and collection of inadequate stools (more than 14 days of onset of paralysis until collection of the 2nd stool specimen) of AFP cases in health facilities equipped to manage AFP cases.
  
  
  METHODS
  Eleven AFP cases with inadequate stools were reported from January 2 to July 8, 2012 - Epidemiological Weeks 1-27. The families of these cases were interviewed with an in-depth interview guide. The staff of the seven health units, where they later reported, was also enlisted for the study which used in-depth interview guide in eliciting information from them.
  
  
  RESULTS
  Ignorance and wrong perception of the etiology of the cases as well as dissatisfaction with the health units as the major reasons for late reporting of AFP cases. The first port of call is usually alternative health care system such as traditional healers and spiritualists because the people hold the belief that the problem is spiritually induced. The few, who make it to health units, are faced with ill equipped rural health workers who wait for the arrival of more qualified staff, who may take days to do so.
  
  
  CONCLUSIONS
  An understanding of the health seeking behavior of the population is germane to effective AFP surveillance. There is thus a need to tailor AFP surveillance to the health seeking behavior of the populations and expand it to community structures.
authors.affiliation: World Health Organization, Angola.
authors.forename: Arciolanda
authors.initials: A
authors.lastname: Macama
authors.affiliation: World Health Organization Regional Office for Africa.
authors.forename: Joseph
authors.initials: J
authors.lastname: Okeibunor
authors.affiliation: World Health Organization, Angola.
authors.forename: Silvia
authors.initials: S
authors.lastname: Grando
authors.affiliation: World Health Organization, Angola.
authors.forename: Karim
authors.initials: K
authors.lastname: Djibaoui
authors.affiliation: World Health Organization, Angola.
authors.forename: Robert Koudounoaga
authors.initials: RK
authors.lastname: Yameogo
authors.affiliation: Ministry of Health, Angola.
authors.forename: Alda
authors.initials: A
authors.lastname: Morais
authors.affiliation: World Health Organization Regional Office for Africa.
authors.forename: Alex Ntale
authors.initials: AN
authors.lastname: Gasasira
authors.affiliation: World Health Organization Regional Office for Africa.
authors.forename: Salla
authors.initials: S
authors.lastname: Mbaye
authors.affiliation: World Health Organization Regional Office for Africa.
authors.forename: Richard
authors.initials: R
authors.lastname: Mihigo
authors.affiliation: World Health Organization Regional Office for Africa.
authors.forename: Deo
authors.initials: D
authors.lastname: Nshimirimana
mesh_terms: D000810:Angola / Q000453:epidemiology; D002648:Child; D018563:Disease Notification / Q000706:statistics & numerical data*; D062665:Epidemiological Monitoring; D006268:Health Facilities; D006801:Humans; D007407:Interviews as Topic; D009123:Muscle Hypotonia; D010243:Paralysis / Q000453:epidemiology*; D013997:Time Factors
keywords: Angola; Luanda; Polio; acute flaccid paralysis; late notification; surveillance