Assessment of Knowledge, Attitude and Practice of

Health Information Management Professionals towards Integrated

Disease Surveillance & Response (IDSR) in Abuja, Nigeria.
By
Victor Chibueze Ijeoma, PGDE
chibuezeijeoma@gmail.com
Department of Medical Records Management,
Wuse District Hospital, Abuja.
Formerly:
President, Students Union Government,
School of Health Information Management,
Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria.

Abstract
Successful implementation of Integrated Disease Surveillance and Response (IDSR)
programme no doubt, depends a lot on adequate awareness, knowledge, positive
attitude and best practices of all personnel involved in the system. In this study, a
sample of 50(fifty) Health Information Management (HIM) professionals were drawn
from a HIM population of 97 (ninety-seven) under the FCT HHSS, using proportional
allocation technique. Their knowledge, attitude and practice towards the IDSR
programme were assessed using the KAP survey. Findings show that HIM professionals
of FCT HHSS are adequately aware and also have very good knowledge of the IDSR
system in FCT, Abuja. They generally exhibit positive attitude towards the programme
but are however in general, not able to perform most of the core IDSR functions like
Trend Analysis. It is recommended that amongst others, for data collection and analyses
to be very effective, there should be training and retraining programs for the HIM
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professionals in the hospitals. This will hopefully improve their computational and
mathematical skills thus enabling them perform all core functions of the IDSR practices.
(Tags: Assessment; Health Information management; Integrated Disease Surveillance
& Response; Knowledge; Attitude; Practice; KAP Survey;

CHAPTER 1.0

INTRODUCTION

1.1 Background of the Study

There is an increasing recognition within the international aid community that
improving the health of a people across the world depends a lot upon adequate
awareness, knowledge, positive attitude, good practices and understanding of the
various aspects of the context in which public health programmes such as the Integrated
Disease Surveillance and Response, IDSR are implemented,(Chinomnso et al, 2012).
Such information is typically gathered through various types of cross-sectional surveys
on the personnel involved in the implementation of the various health programmes. The
most popular and widely used survey type is now the Knowledge, Attitude, and Practice
(KAP) survey, also called the knowledge, Attitude, Behaviour and Practice (KABP)
survey, (Green 2001, Hausmann-Muela et al. 2003, Manderson and Aaby 1992, Nichter
2008).
Communicable diseases are major causes of morbidity, mortality and disability in
Nigeria and indeed, the whole of Africa. Factors hampering their effective prevention
and control are diverse and multiple in their nature. In response to this challenge of
prevention and control of these severe outbreaks of largely preventable diseases in
African countries especially during the 1990s, the 46 Member States of the World
Health Organization (WHO) African Regional Office for Africa (WHO/AFRO) met in
Zimbabwe in 1998 to adopt what is now known as Integrated Disease Surveillance
and Response (IDSR) as a comprehensive regional framework for strengthening
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national public health surveillance and response systems in Africa. In 2006,

WHO/AFRO Member States recommended that the International Health Regulations
(IHR 2005) be implemented using the IDSR framework, especially for strengthening
core capacities for surveillance and response. Now identified as a primary strategy for
African countries to build the detection and response capabilities required under the
International Health Regulations, IDSR aims to improve the availability and use of
surveillance and laboratory data for control of priority infectious diseases that are the
leading cause of death, disability, and illness in the African region.
Surveillance according to the World Health Organization (WHO) is to watch over
with great attention, authority, and often with suspicion. Disease surveillance is defined
as the ongoing systematic collection, collation, analysis, and interpretation of healthcare data, essential to the planning, implementation, and evaluation of public health-care
practice, closely integrated with the timely dissemination of these data to those who
need to know, in order that action may be taken. Disease surveillance depends on
definition of case and recognition of illness, compilation of individual data, analysis,
and reporting. Disease notification is a process of reporting the occurrence of disease or
other health-related conditions to appropriate and designated authorities.
Notifiable diseases are diseases that, by statutory requirements, must be reported
to the public health-care authority in the pertinent jurisdiction when the diagnosis is
made. Such diseases are deemed to be of sufficient importance to public health care to
require that their occurrence be reported to authorities. The diseases that may become
epidemic are recorded weekly, in addition to the monthly report. They include: Cholera,
measles, cerebrospinal meningitis and yellow fever. Also included are the diseases
targeted for eradication and elimination such as poliomyelitis, dracunculiasis, neonatal
tetanus, leprosy lymphatic filariasis, and other diseases of public health importance like
pneumonia and diarrhoea in under-fives, bloody diarrhoea, HIV/AIDS, tuberculosis,
onchocerciasis, malaria, pertussis, hepatitis B, plague, and sexually transmitted
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infections (STIs).With the epidemiological transition, non-communicable diseases such

as diabetes mellitus and hypertension, tropical diseases like noma and buruli ulcer,
emerging infectious diseases such as human influenza of the H 5N1 subtype and severe
acute respiratory syndrome (SARS), and other diseases under the International Health
Regulation (IHR) are all targeted for control, eradication and complete elimination.
IDSR brings many surveillance activities together to try and make sure that priority
diseases can be controlled and prevented more effectively. The IDSR system requires
that all important communicable diseases within a health facility are reported together,
using the human and other resources already available within that facility. Collecting,
analyzing and reporting priority diseases in this way have several advantages:

It is cheap, since the same health personnel and reporting formats are used for
routine reports of health-related data.

It creates an opportunity to computerize all the available data at the central level.
It provides training and capacity building opportunities for health personnel
including Health Information Management professionals, to develop new skills.

It encourages community participation to detect and respond to disease

epidemics.
Public health surveillance for infectious disease is also a cornerstone of public

health decision making and practice. Surveillance provides crucial information for
monitoring the health of the public, identifying public health problems, and triggering
action to prevent further illness. Such information is vital to the nation's health, and its
analysis and dissemination frequently affect everyday life and clinical practice. Disease
surveillance equally provides data about the incidence of disease in the community
data that can help raise or lower the threshold of clinical suspicion for a particular
infectious disease, encouraging early detection and appropriate treatment and perhaps
avoiding unnecessary treatment, and treatment for the wrong disease. Public health
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surveillance data are readily available. Local and state health departments disseminate
data specific to their jurisdiction, often in periodic newsletters available to the public.
Thus, IDSR is a cost-effective surveillance system which addresses the major health
problems in Nigeria. Many other countries in sub-Saharan Africa such as Ghana and
The Gambia, have adopted a similar IDSR system, (Abubakar et al, 2013).
As noble as the IDSR system has come to be, there are some major concerns
which providers (facilities) have to contend with. For example, providers are
understandably concerned about the burden of reporting an increasing number of
infectious diseases to public health authorities. To avoid duplication of data entry and to
make efficient use of the National Hospital Management Information Systems,
providers have to work with relevant authorities to ensure direct reporting from their
laboratory data systems to public health agencies and to devise mechanisms for
obtaining inpatient and outpatient data for surveillance purposes directly from their
administrative data systems. Secondly is the issue of patient confidentiality. Healthcare
providers may be apprehensive about sharing computerized patient records for instance,
with outsiders. However, to do their job of protecting the health of the public, local
public health agencies routinely have access to sensitive personal information, such as
data on sexually transmitted disease contacts or sexual or other risk factors for disease.
The public health community thus should have an excellent history of safeguarding
patient confidentiality and using these data exclusively for public health purposes.
Without such information, public health officials cannot track persons at risk for disease
and thus prevent further spread of illness. Fear of loss of confidentiality has been used as
an argument against sharing electronic medical data for public health purposes.
However, electronic information systems can make medical data even more secure than
they are in paper-based medical records. It is important to reassure the public that health
facilities do protect the confidentiality of the data they gather, and must make the case
that these data are essential for preventing the occurrence and spread of disease. Both
managed care and public health organizations are concerned with population-based
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healthperhaps together they can show the public the value of medical records for both
clinical research and public health practice.
A third concern of the IDSR system is the health facilities concern for their own
confidentiality. Some facilities may fear that data will be used to measure their
performance and efficiency against that of other facilities, particularly with regard to
items not entirely under their control, such as disease incidence. It is important for
higher relevant authorities to reassure hospitals that public health surveillance is not a
regulatory function and that the purposes in conducting surveillance are to monitor the
public health and to identify opportunities for improving community health status.
Furthermore, data shared with public health organizations can be used only by public
health officials to identify problems or priorities and to take public health action. They
cannot be shared with secondary users except under conditions that guarantee
confidentiality.
Building of trusting partnerships helps facilitate timely and mutually beneficial
sharing of data between managed care organizations and public health agencies.
Underreporting has also been reported as a challenge to the IDSR system. Physicians
and other health care providers often do not report diseases to the local health
department. Some diseases that cause severe clinical illness (e.g., plague and rabies) are
probably reported accurately once they are diagnosed. However, persons with diseases
that are clinically mild and infrequently associated with serious consequences (e.g.,
salmonellosis) might not seek medical care from a health care provider. Even if these
diseases are diagnosed, they are less likely to be reported. Underreporting occurs
because, in general, few health care providers understand the importance of public
health surveillance, the role of the provider as a source of data, and the role of the health
department in response. Many providers do not know how or to whom to report
diseases. Some of this lack of understanding is due to the failure of public health

agencies to provide feedback on how data are used or to make data available to
providers or other potential users of the data.
In Nigeria, the disease surveillance system was actually introduced in 1988
following a major outbreak of yellow fever in 1986/87, which affected ten out of the
then nineteen States of the Federation. The magnitude of the outbreak was attributed to
weak or non-existent disease surveillance and notification system in most States. As a
result of this, a task force was established by the Federal Ministry of Health to review
disease surveillance and notification in the country. Between 1988 and 1989, a disease
surveillance and notification system for the country was developed. Forty diseases of
public health importance in the country were identified and designated for routine
(monthly) notification out of which ten epidemic prone diseases were selected for
immediate reporting. Standard reporting forms (DSN 001 for immediate reporting, and
DSN 002 for Monthly routine reporting) were also introduced. The methodology for
information flow between the various levels was also prescribed. In 1989, the National
Council on Health approved the adoption of Disease Surveillance and Notification
(DSN) in the country.
The Integrated Disease Surveillance system seeks to ensure that effective and
functional systems are available at each level of the healthcare system; from facilities to
Local Government areas (LGAs), states and at the national level. IDSR focuses on the
LGA level where information generated is used for timely action consequently leading
to reduction in morbidity, disability and mortality. Abubakar et al., 2013 state that a
country where IDSR is functional would use standard IDSR case definitions to identify
and report priority diseases; collect and use surveillance data to alert higher levels to
trigger local actions; investigate and confirm suspected outbreaks or public health events
using laboratory confirmations, when indicated; analyze and interpret data collected in
outbreak investigation and from routine monitoring of other priority diseases; use
information from the data analysis to implement an appropriate response; provide
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feedback within and across levels of healthcare system; and evaluate & improve the
performance of surveillance and response system.
The flow of information in the IDSR system in Nigeria is from the health facility
where diseases that have epidemic potentials, which are targeted for eradication and
elimination, are reported immediately to the focal persons in the health facility and to
the LGA. The LGAs receive data from the health facilities, collate and send to the next
level which is the State Ministry of Health (SMOH). At the LGA level, analysis and
feedback to the health facilities are usually carried out. The Epidemiology Unit of the
SMOH collates data from the LGAs and forwards them to the Epidemiology Division of
the Federal Ministry of Health (FMOH). At the SMOH, analysis and feedback to the
health facilities and the public are done as well as planning appropriate operations and
strategies for disease control. At the FMOH, data is collated and forwarded to the
Statistics Division, analysis and feedback are carried out, as well as planning for
appropriate intervention based upon the results of the analysis.
The goal of IDSR also seeks to improve the ability of Health Information
Management (HIM) professionals and other health workers to detect and respond to
diseases and conditions that cause high rates of death, illness and disability in the
communities thereby improving health and well being for the communities. The
National IDSR unit has developed a comprehensive database of the 21(twenty) priority
communicable diseases and provided data management guidelines for use at all levels.
Standard case definitions of priority diseases has been produced, and circulated to all
implementing health facilities, LGAs and States. Workshops have been conducted to
sensitize decision-makers on the use of data generated for decision-making and policy
formulation. Data is disseminated through a two-way feedback process, such as monthly
newsletter at all levels and the quarterly National Bulletin of Epidemiology (NBE) at the
Federal level. Surveillance officers which included HIM professionals, at all levels had
been trained in effective data management .IDSR is now an integral part of the overall
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National Health Management Information System, NHMIS. Data on disease

surveillance are fed into the NHMIS system for effective health planning,
implementation, monitoring and evaluation of programme, policy formulation, evidence
based decision making and research.
The roles and responsibilities of the Health Information Management
professionals in IDSR cannot be overemphasized. Their knowledge, attitude and
practice towards IDSR are very important for the efficient reporting of notifiable
diseases. However, the knowledge of reporting requirements and responsibilities among
the HIM professionals and even other health-care personnel has not been examined
adequately hence, the assessment of the Knowledge, Attitude and Practice of Health
Information Management professionals towards Integrated Disease Surveillance and
Reporting in Abuja, Nigeria.
1.2 Statement of the Problem
Integrated Disease Surveillance and Response (IDSR) is now a part of the National
Health Management Information System (HMIS) which comprises databases, personnel
including HIM professionals, and materials that are organized to collect data whose
information are then utilized for planning and informed decision making. However, one
of the challenges facing the smooth implementation of the IDSR programme is the issue
of Reporting which is often incomplete, and untimely, a problem traceable to the level
of Knowledge, Attitude and Practice of personnel towards the programme. The need to
ensure functional and effective integrated disease surveillance system thus justifies
assessment of the Knowledge, Attitude and Practice of Health Information Management
(HIM) professionals towards Integrated Disease Surveillance and Response.

1.3

Significance of the Study

At the end of this research, results obtained would be significant in the following ways:
1. It would bring to fore the level of knowledge, attitude as well as the standard of
practice of HIM professionals towards IDSR.
2. It would form a basis for additional training of HIM professionals thus enabling
them to contribute adequately in the smooth implementation of the IDSR system.
3. It would no doubt, become a reference material for the Human Resource
Management of the FCTA when considering deployment and training.
4. It would form a basis for further research in this subject matter.

1.4

Aims and Objectives of the Study

The following are the aims and objectives of this research work:
1. To determine the level of knowledge and awareness of HIM professionals
concerning the National Integrated Disease Surveillance and Response (IDSR).
2. To assess the attitude of HIM professionals towards the IDSR using the KAP
Survey technique.
3. To evaluate HIM professionals practical knowledge of the IDSR system in
Abuja, Nigeria.
4. To determine the availability of materials and tools in the FCT hospitals for the
IDSR system implementation.

1.5 Research Questions

The followings are the research questions:
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1. Are there available, IDSR forms and other relevant tools for the IDSR system in
FCTA Healthcare facilities?
2. Do HIM professionals know how to make effective use of these IDSR forms in
their facilities?

CHAPTER 2.0 LITERATURE REVIEW

2.1

Review of Literature Relevant to Knowledge, Attitude and Practice (KAP)

Survey
Knowledge, Attitude, and Practice (KAP) surveys are widely used to gather
information for training of personnel and planning public health programmes. However,
there is rarely any discussion about the usefulness of KAP surveys in providing
appropriate data for training, project planning, and decision making (Annika, 2009). The
KAP survey tradition was first born in the field of family planning and population
studies in the 1950s. KAP surveys were designed to measure the extent to which an
obvious hostility to the idea and organization of family planning existed among different
populations, and to provide information on the knowledge, attitudes, and practices in
family planning that could be used for programme purposes around the world (Cleland
1973, Ratcliffe 1976). In the 1960s and 1970s, KAP surveys began to be utilized for
understanding family planning perspectives in Africa (Schopper et al. 1993). Around the
same time, the amount of studies on community perspectives and human behaviour
grew rapidly in response to the needs of the primary health care approach adopted by
international aid organizations. Hence KAP surveys established their place among the
methodologies used to investigate health behaviour, and today they continue to be
widely used to gain information on health-seeking practices including towards disease
surveillance and response, (Hausmann-Muela et al. 2003, Manderson and Aaby 1992).
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The attractiveness of KAP surveys is attributable to characteristics such as an easy

design, quantifiable data, ease of interpretation and concise presentation of results,
generalisability of small sample results to a wider population, cross-cultural
comparability, speed of implementation, and the ease with which one can train
numerators (Bhattacharyya 1997, Stone and Campbell 1984). Nevertheless, over the
years some researchers have criticised KAP surveys for taking for granted that the data
provided offers accurate information about knowledge, attitudes, and practices that can
be used for training and programme planning purposes (Cleland 1973, Nichter 1993,
Pelto and Pelto 1997, and Yoder 1997,). A number of social scientists have also voiced
their concern over the applicability of KAP surveys (Cleland 1973, Caldwell et al. 1994,
Green 2001, Manderson and Aaby 1992, Nichter 1993, Ratcliffe 1976, Smith 1993). Yet
in the international health community and among trainers and health programme
planners, there is rarely any discussion about whether KAP surveys are an appropriate
methodology to explore health-seeking practices that can be used for training and
programme planning or not (Foster 1987). Lately there has not been much critical
discussion among social scientists regarding this issue either, (Annika, 2009).
In KAP surveys, the knowledge part is normally used only to assess the extent of
community knowledge about public health concepts related to national and international
public health programmes. Investigations of other types of knowledge, such as culturespecific knowledge of illness notions and explanatory models, or knowledge related to
health systems, e.g. access, referral, and quality as well as disease surveillance and
response, is highly neglected (Hausmann-Muela et al. 2003). Insufficient or lack of
investigation of the knowledge on these illness notions and explanatory models is
probably due to the fact that personnel and community knowledge are assumed to be
embodied in their knowledge of illness patterns and treatment practices. It is
contextualized, practice-based, and emergent in times of illness, and, therefore, very
difficult to detect using KAP surveys as pointed out by Nichter (1993).
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The narrow focus on knowledge can further be explained by the definition of

knowledge and the agreement on whose knowledge counts. Pelto and Pelto (1997) have
pointed out that public health professionals including Health Information Management
professionals usually share the view that knowledge and beliefs are contrasting terms.
They have an implicit assumption that knowledge is based on scientific facts and
universal truths (refers to "knowing" about biomedical information). In contrast, beliefs
refer to traditional ideas, which are erroneous from the biomedical perspective, and
which form obstacles to appropriate behaviour and treatment-seeking practices (Good
1994). This narrow definition of knowledge is also shared by international health
communities. While they have recognized the role and engagement of personnel and
communities in the management and prevention of diseases, such as communicable
diseases, malaria and acute respiratory infections (ARI), they still fail to recognize the
value of the knowledge that the communities possess (Nichter 1993). There is, however,
no specific reason why knowledge related to health systems are rarely investigated in
KAP surveys. Hence, it is appropriate to apply them on Health Information Management
professionals towards Integrated Disease Surveillance and response, (IDSR).
Measuring attitudes is the second part of a standard KAP survey questionnaire.
However, many KAP studies do not present results regarding attitudes, probably
because of the substantial risk of falsely generalizing the opinions and attitudes of a
particular group (Cleland 1973, Hausmann-Muela et al. 2003). In everyday English, the
term attitude is usually used to refer to a person's general feelings about an issue, object,
or person (Petty and Cacioppo 1981). However, the word attitude (from Latin word,
aptus) is defined within the framework of social psychology as a subjective or mental
preparation for action. It defines outward and visible postures and human beliefs.
Attitudes determine what each individual will see, hear, think and do. They are rooted in
experience and do not become automatic routine conduct. Attitude means the
individual's prevailing tendency to respond favorably or unfavorably to an object
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(person or group of people, institutions, events or programmes). Attitudes can be

positive (values) or negative (prejudice). Social psychologists distinguish and study
three components of the responses: (a) cognitive component: which is the knowledge
about an attitude object, whether accurate or not ;( b) affective component: feelings
towards the object and (c) conative or behavioral component, which is the action taken
towards the object, (Marcos, F.E., 1998).
Furthermore, attitudes are interlinked with the person's knowledge, beliefs,
emotions, and values, and they are either positive or negative. Pelto and Pelto (1994)
have also described causal attitudes or erroneous attitudes, which are considered
derivatives of beliefs and/or knowledge. The act of measuring attitudes via a survey has
been criticized for many reasons. When confronted with a survey question, people tend
to give answers which they believe to be correct or in general acceptable and
appreciated. Sensitive topics are particularly demanding. The survey interview context
may influence the answer; whether the interview is conducted at a hospital or in a
village, whether there are other people present, whether the survey aims at exposing
their weaknesses or lack of commitment to their jobs, etc. The question formulation can
also be manipulative towards a favourable answer. Sometimes, the respondents may be
uninformed about the issue and thus find it strange, but their attitudes are nonetheless
measured. Attitude can be proper or improper. Proper attitudes can improve practice
while improper attitudes can have a harmful effect. Measuring attitude is a part of a
standard KAP survey questionnaire. However, on occasion, the attitude scales
(numbers/verbal) may fail to reflect the respondents' answers (Cleland 1973, HausmannMuela et al. 2003, Pelto and Pelto 1994).
A third and integral part of KAP surveys is the investigation of health-related
practices. Practice has a direct impact on an individuals behavior and change in
practice can be obtained by carrying out more educational interventions for improving
personnels practice. Practice may be improved only after substantial changes in the
14

knowledge and attitude level. KAP surveys have been criticized for providing only
descriptive data which fails to explain why and when certain practices are chosen. In
other words, some surveys fail to explain the logic behind people's behaviour
(Hausmann-Muela et al. 2003, Nichter 1993, Pelto and Pelto 1994, Yoder 1997).
Another concern is that KAP survey data is often used to plan activities aimed at
changing behaviour, based on the false assumption that there is a direct relationship
between knowledge and behaviour. Several studies have, however, shown that
knowledge is only one factor influencing practices, and in order to change behaviour,
health programmes like the Integrated Disease Surveillance and Response need to
address multiple factors ranging from ergonometrical, socio-cultural to environmental,
economical, and structural factors, etc. (Balshem 1993, Farmer 1997, Launiala and
Honkasalo 2007).

2.2

Empirical Review of Literature Related to Integrated Disease

Surveillance and Response (IDSR)

Surveillance is the ongoing systematic collection, collation, analysis of data; and the
timely dissemination of the information to all those who need to know in order to take
action. Surveillance means to watch over. It is a watchful, vigilant approach to
information gathering that serves to improve or maintain the health of the population. A
functional disease surveillance system is essential for defining problems and taking
action. It was traditionally applied to acute communicable diseases beginning in 1950s
in the USA. Its scope has now expanded to include non infectious diseases, healthrelated events like environmental hazards, immunizations, distribution of biologicals,
health care delivery, etc. Historically, William Farr in Registrar Generals Office, in mid
1850s was the first to start collecting, collating, analyzing and disseminating vital
statistics data. In1878, the USA Congress authorized Public Health Services to report
15

occurrence of quarantinable diseases namely cholera, plaque and yellow fever. In 1893
same Congress directed weekly reporting from Municipal services. By 1903 effort
began towards the standardization of format for data collection by producing relevant
forms. In 1913, the US Government directed the Public Health Services, PHS to send
weekly telegraphic summaries. The National office of Vital Statistics (NOVS) was thus
created in the PHS office. Until 1950, weekly report was published in public health
reports but later became the Morbidity and Mortality Weekly Report and was then
transferred to the Centers for Disease Control, (CDC).
In recognition of the defect in the disease surveillance and notification situation
in the African continent, Nigeria and other member States in the WHO African Region
endorsed the Integrated Disease Surveillance and Response strategy at the 48 th Regional
Committee meeting held in Harare, Zimbabwe, in September, 1998. Nigeria has since
then embraced the new IDSR strategy and has also introduced it in all the States of the
Federation and Federal Capital Territory (FCT). The Public Health Division of the FCT
Health & Human Services Secretariat coordinates the IDSR programme in the FCT.
However, the implementation strategy started in June 2000, with an orientation
workshop held to sensitize national program managers of vertical programmes and
partners on IDSR strategy. This strategy integrates multiple surveillance systems, so that
personnel and other resources are utilized more efficiently and effectively. An integrated
approach means that data on all important diseases will be collected, analyzed,
interpreted and reported in the same way, by the same people who normally submit
routine report forms on health-related data. A functional disease surveillance system
equips health workers to set priorities, plan interventions, mobilize and allocate
resources and provide early detection and response to disease outbreaks. This requires
the effective coordination and synergy between personnel and IDSR activities. Among
the basic ingredients of the IDSR are an effective communication system, a clear case
definition and reporting system and a network of motivated personnel whose
16

knowledge, attitude and practice are geared towards the smooth implementation of the
IDSR strategy.
In January 2001, a steering committee on IDSR was inaugurated to steer the
implementation process. In June 2001 the steering Committee carried out an assessment
of the surveillance system with a view to obtaining baseline information on the existing
disease surveillance system in the country. Among their findings include the problem of
incomplete and untimely reporting which were largely traceable to the level of
knowledge, attitudinal pre-disposition and the quality of practices of personnel which
now includes the Health Information Management professionals. Based on this finding,
they recommended, amongst others, relevant trainings of personnel for IDSR. Many
years after this recommendation, it appears that much improvement has not been
witnessed in the area of Knowledge, Attitude and Practice (KAP) of personnel on IDSR
strategy. This can be noted when Chinomnso et al (2012) posit that in Nigeria, the
collection, collation, analysis, and interpretation of data in health-care facilities which of
course are the major responsibilities of the HIM professionals, are often unsatisfactory,
partly due to insufficient awareness among health-care personnel on the importance of
this process. This process refers to the channel of transmission of data. Here, the healthcare facility, which could be public or private, is the first level for the generation of
health-care facility-based data, and it also receives records from community-based
health-care workers serving within its catchment area. The health-care facility staff
collects the data at this level, fills, and sends the necessary IDSR forms on a weekly or
monthly basis or immediately depending on the condition of disease or health care.
These results are sent to the Local Government Primary Health Care Department
(Monitoring and Evaluation Unit), which collates data from various health-care facilities
in the locality and sends these to the State Ministry of Health (Epidemiology Unit).
These data are analyzed before transmission to the Federal Ministry of Health
(Epidemiology and Planning Research and Statistics Unit) for national collation,
17

analysis, records, and action.

No doubt, effective surveillance of disease begins from healthcare facilities and with
the health care personnel. The term health care personnel is defined broadly in some
jurisdictions and usually include physicians, nurses, Medical Records Officers, now
called Health Information Management professionals, physician assistants, community
health workers, nurse practitioners, infection control practitioners, chiropractors,
dentists, and others. Thus it is important for all HIM practitioners participating in the
strategy to have adequate knowledge of the guidelines in the logical completion of the
IDSR forms. Their Attitudes should be connected to this knowledge and they should
therefore attach great importance to the system. As a result of studying attitudes, the
emotional attitudes/evaluation of personnel towards their responsibilities is identified.
For instance, does she/he like specific programme and how much? How important
he/she thinks the specific programme is? What is her/his attitude towards specific action
or fact, etc. (ACT, 2002).
The role and responsibilities of the HIM professionals in the process of data
collection, collation, validation, analysis and transmission which of course defines their
practices in the IDSR system thus cannot be overemphasized. Data quality no doubt, is
an important component of the IDSR programme and the HIM professionals stand better
positions to ensure this. Data quality here can be regarded as a perception or an
assessment of data's fitness to serve its purpose in the DDSR context. They have the
responsibility of ensuring the various Aspects of data quality which include: Accuracy,
Completeness, Update status, Relevance, Consistency across data sources, Reliability,
Appropriate presentation and of course, Accessibility. They also carry out Data Quality
Assurance to ensure the compliance of the data with the IDSR format, (see Margret
Rouse, 2005). This is because the IDSR data quality is affected by the way the data is
entered, stored and managed. Hence, Data Quality Assurance (DQA) is necessary in
order to ensure quality. It is the process of verifying the reliability and effectiveness of
18

data. Maintaining data quality is a very crucial role of health information management in
the IDSR programme. This, among other functions requires thoroughly going through
the data periodically and scrubbing it. Typically this involves updating it, standardizing
it, and de-duplicating records to create a new single view of the data, even if it is stored
in multiple and disparate systems. By virtue of their training, HIM professionals are
able to support the smooth implementation of the IDSR strategy by facilitating the
availability of timely, relevant, and high-quality information through adequate and
efficient completion of the IDSR forms, (see Savel, 2012). They improve the efficiency
and effectiveness of IDSR systems through innovative data collection and analysis. This
crucial role demands the assessment of their knowledge, attitude and practice towards
IDSR.

19

CHAPTER 3.0 RESEARCH METHODOLOGY

3.1 Study Population
The study population includes all the ninety-seven (97) Health Information
Management professionals in the health care facilities of FCT, Abuja.
3.2 Research Design
The research design is essentially a Descriptive survey.
3.3 Sample Size and Sampling Techniques
A sample size of fifty (50) HIM professionals was drawn through
proportional allocation from each of the healthcare facilities; (see Table 3.1
below).
S/N

Name of Facility

No.

of

HIM Sample drawn

Percentage

(h)
Nyanya

professionals (Nh)
General 9

(nh)
4

sample drawn
8

Hospital
Maitama

District 10

10

Hospital
Asokoro

District 17

18

Hospital
Wuse

District 15

16

Hospital
Gwarinpa

District 9

Hospital
Kubwa

General 8

Hospital
Bwari

General 8

Hospital
Karchi

General 7

Hospital
Kuje

General 5

(%)

of

Hospital
20

10

Abaji

General 4

11

Hospital
Robochi

General 3

12

Hospital
Kwali

General 2

Total

Hospital
12

50

100

97

Table3. 1: Number of HIM Professionals drawn from each facility following Proportional Allocation.

Fig. 3.1: Chart showing the number of HIM Professionals drawn from each hospital by proportional allocation.

3.4 Instrument for Data Collection

Data were collected using Questionnaires and Reports of the FCTA Health &
Human Services Secretariat. Questionnaire is a document containing a set of
questions expected to be responded to, by the Respondents which will lead to data
collection in a research. The Questionnaire was preferred for this research due to
its flexibility, affordability and ease of administration. It was suitable because it
allowed the researcher to reach out to the sample within a limited time period. It
also ensured confidentiality; and thus it enabled the researcher to gather more
21

candid and objective data. The type made use of here is the self-administered,
structured Questionnaire. This is in cognizance of the level of the academic
qualification and work experience of the population under study.
The Report refers to FCTA Health & Human Services Secretariat Annual
report from which data and information relevant to the study were extracted. The
Reliability and Validity of this report rest completely outside the control of the
researcher, but within that of FCT HHSS. Where Interviews were needed, it only
served for clarification purpose and for follow-up. In fact, Borge et al (1993)
observe that Questionnaires are often used to collect basic descriptive information
from a large sample, while Interviews are used to follow-up Questionnaires. The
three (3) instruments adopted here: Questionnaires, Interview and the Reports,
were used in the study for the purpose of triangulation and confirming information
collected from various sources. The researcher had hoped that, by adopting these
methods, sampling errors due to bias might be adequately minimized.

3.5 Data Collection Techniques

A total of fifty structured questionnaires were prepared and administered
randomly to only HIM professionals in each of the twelve (12) hospitals in a
proportional allocation technique. They were all completed and returned within
same time schedule, representing 100% returns. All of them were equally usable as
there were no errors in any one of them. Multiple interviews were equally
conducted with some personnel in order to provide more in-depth information and
opportunities for possible follow-up.
3.6 Data Analysis

22

Methods of Descriptive Statistics were used to analyze the Data obtained

through the Questionnaires. The use of Descriptive Statistics was considered
appropriate for this research because it involved the Description, Tabulation,
Calculation, Analysis and Interpretation of the variables considered in this study.
Basic statistical techniques were used to analyze various items of the
Questionnaires and the Reports. These included: Average (means), Percentages,
Frequencies, and Totals. The choice of these techniques was informed because
they easily communicate results of research findings to majority of readers,
(Prabhakara, 2010).
3.7 Limitations of Study
The study was carried out only on HIM professionals currently on the
employment of the FCT Health & Human Services Secretariat and deployed to
each of the twelve (12) hospitals controlled and managed by the Hospitals
Management Board (HMB). It neither included non-HIM professionals working in
the HIM department nor other healthcare professionals in the hospitals who are
equally involved in the IDSR system. As a result, it may not be perfect for
complete generalization.
Secondly, there are limited regional and national literatures on the subject
matter. Hence, it was difficult to sufficiently compare results of this work with
those of previous works done in Nigeria and the sub-Saharan Africa.
CHAPTER 4.0 DATA PRESENTATION AND ANALYSIS
4. 1: Brief Introduction
In this chapter, a number of tables and charts would be used to present data
findings. Data collected would be analyzed according to the nature of Responses.
23

Once the coding were completed, the Responses and Results would be cumulated
and converted to Totals, Averages, and Percentages .The chapter would also dwell
on the discussion of the results of the analyses table by table after each analysis.
These discussions would enable the drawing of the final conclusion at the end of
the report.

4.2

Data Presentation, Analysis and Discussion of Results

4.2.1 Bio-Data Analysis of Respondents

s/n.

Name

of No.

Facility

of Respondent Male

Female

HIM

s (Male & Resp.

Resp.

Profession

Female)

(M.R.)

( F.R.)

% M.R % F.R

1
2

Nyanya GH
Maitama

als
9
10

4
5

1
2

3
3

25
40

75
60

DH
Asokoro

17

44

56

4
5

DH
Wuse DH
Gwarinpa

15
9

8
4

3
1

5
3

38
25

62
75

6
7
8
9
10
11
12
Total

DH
Kubwa GH
Bwari GH
Karchi GH
Kuje GH
Abaji GH
Robochi GH
Kwali GH
12

8
8
7
5
4
3
2
97

4
4
4
3
2
2
1
50

2
1
1
0
0
1
0
16
32%

2
3
3
3
2
1
1
34
64%

50
25
25
0
0
50
0

50
75
75
100
100
50
100

24

Table 4.1: Distribution of Respondents by Gender.

Table 4.1 above shows that, of the 4 Respondents in Nyanya General Hospital,
as high as 3 of them were female while 1 was a male officer constituting only 25%
of the respondents in the hospital. Also75% respondents in each of Gwarinpa,
Bwari and Karchi General Hospitals respectively, are all females. However, at
Maitama District Hospital, 60% of the respondents were female while 40% were
male. Interestingly, while all the respondents in Kuje and Abaji were all females,
there were equal male and female respondents in Kubwa and Robochi general
hospitals; and 38%Male and 62%Female Respondents at Wuse District Hospital.
In summary, 32% of the total 50 Respondents were female while 68% were male.
The researcher did not identify any possible implication of this composition on the
integrity of the data obtained from them.

4.2.2 Analysis of Data based on the years of working experience of

respondents.
S/N

Years in Service

n=50

n%

1-2yrs

14%

3-4yrs

11

22%

5-6yrs

23

46%

7-8yrs

16%

9 & Above

2%
25

Table4.2: Years of working experience of respondents.

Fig. 4.1: Years of working experience of the respondents in pie chart.

From Table 4.2 and Fig. 4.1, 14% 0f the respondents have worked in their
respective facility for a period of between 1 and 2 years while 23 of them,
representing 46% have worked for between 5-6years. 8 of them have worked for
between 7-8years while only 1 respondent have worked for more than 9years. The
above data suggest that a majority of the respondents have substantial level of
experience in their given responsibilities in the IDSR programme as HIM
professionals.

26

4.2.3 Analysis of Data based on the Availability of materials & resources at

the facilities.
Availability of materials for the IDSR Programme at the facility n=12

n%

level
1. IDRS Form 001

12

100

2. IDSR Form 002

12

100

3. IDSR Form 003

12

100

4. Outpatient Register

12

100

5. Inpatient Register

12

100

6. HMIS

12

100

7. Stationery

12

100

8. Calculator

12

100

9. Computers + Internet

42

10. Printers

12

100

11. Telephone

12. Constant power supply

42

Table 4.3: Availability of materials and Resources for IDSR Programme at the 12 Healthcare
facilities.

The above table lists the various forms and other tools which are often
provided for the smooth running of the IDSR system in the various healthcare
facilities. Table4.3 above shows that the 12 General or District hospitals all have
IDSR forms 001, 002 & 003. They all equally have Outpatient & Inpatient
registers as well as stationeries, calculators and printers, representing one hundred
percent of availability. This contrasts a little with results of Abubakar, et al, (2013)
27

who reported that sixty-two percent of health facilities in Kaduna State had
calculators available for Data management, while twenty-nine percent of them had
computers and printers.
However, only 5 of them respectively have Computers + Internet services
and constant power supply but all of them have the Hospital Management
Information System (HMIS) in booklet form, but all lack telephone network for the
IDSR programme. The implication of these is that the hospitals have almost all the
necessary materials and resources needed to contribute meaningfully to the smooth
running of the system.
4.2.4 Knowledge of the IDSR System by the HIM professionals
Knowledge of the IDSR system by the HIM professionals
Awareness of the IDSR system in your facility:
Yes
No

n=50 n%
48
2

96
4

Table 4.4: Number of HIM professionals who are aware of the existence of the IDSR system in
their facilities.

Fig.4.2: Bar showing the Awareness of HIM professionals of the existence of the IDSR system
in their respective facilities.
28

Table 4.4 and Fig.4.2show that as much as 48 of the 50 respondents affirm

that they were aware of the existence of the IDSR system in their respective
healthcare facilities, representing a whopping 96%, while only 2 of them claimed
they were not aware of such. They represent only 4% of the respondents. This is
assumed to be a good report in that it hopes to give results adequate enough for
local generalization of their awareness of the existence of the IDSR system at the
FCT secondary healthcare facilities.
4.2.5 Knowledge of the IDSR Forms
Knowledge of the IDSR Forms by HIM professionals
Knowledge of ID0SR 01 Forms for:

n=50* n%

i.

Immediate/Case-based Notification & 2 Diseases 42

84

ii.

correctly mentioned
Immediate/Case-based Notification & 1 Disease 46

92

correctly mentioned
Immediate/Case-based Notification only
2 diseases correctly mentioned only
1disease only correctly mentioned
Do not know
No response

46
22
6
2
4

iii.
iv.

v.
vi.
vii.

23
11
3
1
2

Table 4.5a: Knowledge of the use of the IDSR form 001. *there were multiple responses.

29

Fig. 4.5a: Knowledge of the use of the IDSR forms 001.

Table4.5a and Fig.4.5a above show the percentage and number of

respondent HIM professionals and the knowledge they have of the respective use
of the IDSR Form001 in their respective facilities. The diagrams, which show
multiple responses reveal that (42)82% of the (50)100% respondents have
knowledge of the form for immediate/Case-based Notification & 2 Diseases
correctly mentioned; (46)92% have knowledge of the form for immediate/Casebased Notification & 1 Disease correctly mentioned; (23)46% of them have its
knowledge for immediate/Case-based Notification only; and (11)22% and (3)6%
have knowledge of the form for 2 diseases correctly mentioned only and 1disease
only correctly mentioned respectively. While (1)2% of them accepted not to know
any use of Form001, (2)4% of the respondents provided no response on the subject
matter.
Knowledge of IDSR 002 Forms for:
i.
Weekly Notification of new cases of
ii.

n=50* n%
Epidemic-prone 42
84

diseases & 2 diseases correctly mentioned

Weekly Notification of new cases of Epidemic-prone 46

92

diseases & 1 disease correctly mentioned

30

iii.

Weekly Notification of new cases of

iv.
v.
vi.
vii.

diseases only
2 diseases correctly mentioned
1 disease correctly mentioned
Do not know
No response

Epidemic-prone 23

46

11
3
1
2

22
6
2
4

Table 4.5b: Knowledge of IDSR Form 002. *Multiple Responses

Table4.5b shows the knowledge of the respondents of the use of the IDSR
Form 002. This knowledge shows a similar pattern of their knowledge of Form001.
Knowledge of IDSR 003 Forms for :
n=50*
i.
Routine monthly disease notification & 2 diseases correctly 9
ii.

mentioned
Routine monthly disease notification & 1 disease correctly 11

mentioned
iii.
Routine monthly disease notification only
iv.
2 diseases correctly mentioned
v.
Only 1 disease correctly mentioned
vi.
Do not know
vii.
No response
Table 4.5c: Knowledge of IDSR Form 003. *Multiple Responses.

23
31
43
5
2

n%
18
22
46
62
86
10
4

Fig. 4.5b: Knowledge of the use of the IDSR forms 003

31

Table4.5c and Fig.4.5b above show the percentage and number of

respondent HIM professionals and the knowledge they have of the respective use
of the IDSR Form003 in their respective facilities. The diagram show that (9)18%
of the (50)100% respondents know the form for use in routine monthly disease
notification & 2 diseases correctly mentioned; (11)22% of them know the form to
be used for routine monthly disease notification & 1 disease correctly mentioned.
While (23)46% know it to be used for routine monthly disease notification only,
(31)62% can identify the form for use in 2 diseases correctly mentioned. However,
while (5)10% of the respondents do not know what Form003 is used for, (2)4% did
not respond to the subject matter.
4.2.6 Knowledge of the IDSR Records
The Disease Surveillance and Notification Records are used among other
things for disease prevention & control; to know trends in disease occurrence; for
Statistics & Planning; to detect & notify disease outbreaks; for Record or reference
purposes; to initiate & monitor intervention; for reporting to DSNO & other
authorities; for Health Education & Advocacy; to determine the prevalence of
diseases; for Research purposes; etc. This section would seek to determine the
knowledge of the sampled HIM professionals on the various uses of the IDSR
Records, (see Table4.6 and Fig.4.6).
Knowledge of HIM Professionals about the Uses of DSN n=50* n%
Records at Health Facility
i.
To know trends in disease occurrence
ii.
For disease prevention & control
iii. For Statistics & Planning
iv.
To detect & notify disease outbreaks
v.
For Record or reference purposes
vi.
For Research purposes

7
13
47
43
47
47

14
26
94
86
94
94
32

vii.
viii.
ix.
x.
xi.
xii.

To initiate & monitor interventions

For reporting to DSNO & other authorities
For Health Education & Advocacy
To determine the prevalence of diseases
Do not know any use of the Record
No Response

7
6
11
7
1
2

14
12
22
14
2
4

Table 4.6: Knowledge about the Use of IDSR Records at the facility level. *Multiple Responses.

Fig.4.6: Knowledge about the Use of IDSR Records at the facility level.

Table4.6 and Fig.4.6 show the number and percentage of the sampled HIM
professionals who are able to identify the various uses of the DSN Records. The
diagrams show that only (7)14% of them know that the DSN Records can be used
to know trends in disease occurrence, to initiate & monitor interventions and to
determine the prevalence of diseases, respectively; (13)26% of them know that the
records are used for disease prevention & control; but nearly all of them i.e.
(47)94% know that the records can be used for Statistics & Planning and same
number also know they can be used for Record or reference purposes and for
Research purposes, respectively. A majority of them (43)86% also know that the
33

records can be used to detect & notify disease outbreaks. However, only a very few
of them, (6)12% and (11)22% know that the records can be used for reporting to
DSNO & other authorities and for Health Education & Advocacy respectively. It is
worthwhile to equally note that only (1)2% of the respondents conceded not to
know what the records are used for while (2)4% people had no response to the
issue.
4.2.7 Assessment of the Attitudes of Respondents towards the IDSR

system.
This section would deal with the assessment of the attitudinal pre-disposition of
the respondent HIM professionals towards the IDSR system. Measuring attitudes is
a part of the standard KAP survey questionnaire administered to the respondents.
The section would analyze the personnels responses which would indicate their
prevailing tendencies to respond favorably or unfavorably to the IDSR system.

Attitudes of Respondents towards the IDSR

i.
Attach great importance to the IDSR System
ii.
IDSR is a programme to be embraced & encouraged
iii. Optimistic that IDSR would achieve its stated aims &
iv.

v.
vi.
vii.

objectives in Abuja.
Believe in the programme.
Do not believe in the programme
Indifference
No Response

n=50*
5
16
23

n%
10
32
46

43
1
4
2

86
2
8
4

Table4.7: Attitudes of Respondents towards the IDSR. *multiple responses.

Table4.7 and Fig.4.7 give great insight into the attitudes of the respondent
HIM professionals towards the Integrated Disease Surveillance and Response
34

(IDSR) programme. The diagrams show that only (5)10% of the respondents said
they attach great importance to the IDSR System; (16)32% feel that the IDSR is a
programme that should be embraced & encouraged; (23)46% of them are
optimistic that IDSR would achieve its stated aims & objectives in Abuja.

Fig.4.7: Attitudes of Respondents towards the IDSR.

While almost all the respondents i.e. (43)86% believe in the programme, only
(1)2% of them do not believe in the programme. However, (2)4% respondents did
not respond to the issue and (4)8% claimed indifferent to the programme.
4.2.8 Assessment of Practice of HIM professionals in core functions

of the IDSR programme

Some of the core surveillance functions of the IDSR system include the
ability of healthcare facilities to have Standard Case Definitions (SCDs); correct
case registration using the Inpatient and Outpatient registers; prompt case
confirmation/notification; correct data analyses which include ability to summarize
and present data in tables, perform trend analysis, correctly calculate Incidence &
Prevalence of Diseases etc; and ability to detect and respond to outbreaks; among

35

others. The respondents were assessed based on the practices which are relevant to
their roles and responsibilities in the IDSR programme, (see Table4.8 & Fig.4.8).
Some core surveillance Practice
i.
Ability to correctly complete Inpatient Register
ii.
Ability to correctly complete Outpatient Register
iii. Ability to summarize & present data in tables
iv.
Ability to perform Trend Analysis
v.
Ability to calculate Incidence & Prevalence of Diseases
vi.
Ability to compare present & previous data
vii. Not able to do any
viii. No Response.

n=50
48
48
23
7
23
7
0
2

n%
96
96
46
14
46
14
0
4

Table4.8: Assessment of Practice of HIM professionals in core functions of the IDSR.

Fig.4.8: Assessment of Practice of HIM professionals in core functions of the IDSR.

Table4.8 and Fig.4.8 show the practical abilities of the respondent HIM
professionals to perform some of the core functions in the IDSR system. The
diagrams show that almost of them i.e. (48)96% were able to correctly complete
36

both the Inpatient and Outpatient registers; but just (23)46% of them were able to
summarize & present data in tables and similar number were able to calculate
Incidence & Prevalence of Diseases; (7)14% could perform Trend Analysis and
same number said they were able to compare present & previous data. A more
cheery revelation was that none accepted not to be able to perform any one of the
core surveillance functions in their health facilities.

CHAPTER 5.0 SUMMARY, CONCLUSION AND RECOMMENDATIONS

37

5.1 Summary and Conclusion

Results obtained from the data analyses indicate that the Integrated Disease
Surveillance and Response (IDSR) system is in existence and functional in FCT,
Abuja. There is the availability of the necessary materials and tools, except
telephone whose absence may impede timely communication.
There is adequate awareness by the HIM professionals, of the existence of
the IDSR system in their respective hospitals. They can identify the various IDSR
Forms and they have adequate knowledge of what each is meant for. FCT HIM
professionals know the public health relevance and uses of the Surveillance
Records and are able to state many of them.
However, despite their strong believe in the IDSR system, they do not attach
great importance to it. They do not show sufficient strong or positive attitudinal
disposition to the IDSR system. This may not be unconnected with the work load
of the Medical Records department as a result of the limited number of qualified
HIM professionals in the FCT Health & Human Services Secretariat. They are only
97 in number and constitute only a paltry 4.2% of the total core health
professionals of the FCT HHSS.
In terms of their practical ability, they can substantially perform most of
the core surveillance practices required of HIM professional, although they lack
the skills to perform some equally important aspects of the job. This may perhaps,
be attributed to their insufficient level of computational and mathematical skills.

5.2 Recommendations
38

1. There should be regular awareness, information, education and

communication programs concerning the IDSR programme and its importance to
the public, for health-care facility workers particularly the HIM professionals at all
the FCT General or District hospitals and on a regular basis too. This will help
them appreciate the importance of the system and thus improve their general
attitude towards it.
2. For data collection and analyses to be effective, there should be training
and retraining programs for the HIM professionals in the hospitals. This will
hopefully improve their computational and mathematical skills thus enabling them
perform all core functions of the IDSR practices.
3. The staff strength of the HIM professionals in the FCT HHSS, should
urgently be increased to a level co-mensurate with the very crucial and important
services they render to the public. This will substantially reduce their work load to
a bearable minimum and enable them devote the necessary time to the IDSR
functions.
4. For the IDSR system to continue to be functional and effective there must
be constant collaboration among communities, health facilities; the public health
community and other agencies. This will definitely enhance opportunities for
disease prevention and control. A close collaboration is essential for effective
collection and dissemination of infectious disease surveillance data and for the
implementation of relevant actions. Both public health and private healthcare
organizations can benefit by sharing data and working together.

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39

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List of Tables
1. Table3. 1: Number of HIM Professionals drawn from each facility following Proportional
Allocation.

2.

Table 4.1: Distribution of Respondents by Gender.

3. Table4.2: Years of working experience of respondents.

4. Table 4.3: Availability of materials and Resources for IDSR Programme at the 12
Healthcare facilities.

5. Table 4.4: Number of HIM professionals who are aware of the existence of the IDSR
system in their facilities.

6. Fig. 4.5a: Knowledge of the use of the IDSR forms 001.

7. Table 4.5b: Knowledge of IDSR Form 002.

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8. Table 4.5c: Knowledge of IDSR Form 003.

9. Fig.4.6: Knowledge about the Use of IDSR Records at the facility level.
10. Fig.4.7: Attitudes of Respondents towards the IDSR.
11.

Table4.8: Assessment of Practice of HIM professionals in core functions of the

IDSR.

List of figures
1. Fig. 3.1: Chart showing the number of HIM Professionals drawn from each hospital by
proportional allocation.
2. Fig. 4.1: Years of working experience of the respondents in pie chart.
3. Fig.4.2: Bar showing the Awareness of HIM professionals of the existence of the IDSR
system in their respective facilities.
4. Fig. 4.5a: Knowledge of the use of the IDSR forms 001.
5. Fig. 4.5b: Knowledge of the use of the IDSR forms 003
6. Fig.4.6: Knowledge about the Use of IDSR Records at the facility level.
7. Fig.4.7: Attitudes of Respondents towards the IDSR.
8. Fig.4.8: Assessment of Practice of HIM professionals in core functions of the IDSR.

Appendix

QUESTIONNAIRE
Dear respondent,
44

This questionnaire is to collect data for a study in Knowledge, Attitude and Practice of
Health Information Management (HIM) professionals towards Integrated Disease Surveillance
and Response (IDSR) in Abuja, Nigeria: a case study of 12 Hospitals in FCT, Abuja, Nigeria.
Please answer the questions to enable me successfully complete the project. Every
information volunteered will be purely for academic purpose and shall be strictly confidential.
Thanks for your cooperation.
Section A: Bio-data of respondents.
Please write in or tick X on the appropriate box.
1. Age in years:
(a) <20 ( ), (b) 21-30 ( ), (c) 31-40 ( ), (d) 41-50 ( ), (e) > 51( ).
2. Gender: Male ( ) Female ( ).
3. Designation:
4. Number of years in service (in years):
(a) 1-2 ( ), (b) 3-4 ( ), (c) 5-6 ( ), (d) 7-8 ( ) (e) 9 & above ( ).

Section B: Availability of materials/tools for IDSR system.

Please tick which material/tool that is available in your facility for the IDSR programme.
Tick as much as are available.
S/N
1
2
3
4
5
6
7
8
9
10

Materials/Tools for IDSR programme

IDSR Form 001
IDSR Form 002
IDSR Form 003
Outpatient Register
Inpatient Register
HMIS
Stationeries
Calculators
Computers+ Internet
Printers

Available

Non-Available

45

11
12

Telephone
Constant power supply.

Section C: Knowledge of HIM professionals of the IDSR programme in the facility.

Please tick in the appropriate box, your best option.
A

I am aware of IDSR existence at this Yes

No

hospital.
B

I know Form 001 is used for the

No

following:
Yes
1. Immediate/case-based notification & 2
diseases correctly mentioned
2. Immediate/case-based notification & 1
disease correctly mentioned
3. Immediate/case-based notification
4. 2 diseases correctly mentioned only
5. Only 1 disease correctly mentioned
6. Do not know any of its use
C
I know Form 002 is used for the
following:
s
1. Weekly notification of new cases of

Ye

N
o

epidemic-prone diseases & 2 diseases

correctly mentioned.
2. Weekly notification of new cases of
epidemic-prone diseases & 1 disease
correctly mentioned.
3. Weekly notification of new cases of
epidemic-prone diseases only.
4. 2 diseases correctly mentioned.
5. Only1 disease correctly mentioned.
6. I do not know any of its use
D
I know Form 003 is used for the
following:
Yes
1. Routine monthly disease notification & 2

No

diseases correctly mentioned

2. Routine monthly disease notification & 1
46

disease correctly mentioned

3. Routine monthly disease notification.
4. 2 diseases correctly mentioned
5. 1 disease correctly mentioned
6. I do not know any of its use
E
In my facility, I know that the DSN
1.
2.
3.
4.
5.
6.
7.

Records are used for the following:

Yes
To know trends in disease occurrence
For disease prevention & control
For Statistics & Planning
To detect & notify disease outbreaks
For record or reference purpose
To initiate & monitor interventions
For reporting to DSNO & other

No

authorities
8. For health education & advocacy
9. For research purpose
10. To determine the prevalence of disease
11. I do not know any of its use
Section D: Attitude of HIM professionals towards the IDSR programme
Please tick as appropriate.
S/n Attitudes
Yes
1
I attach great importance to the IDSR
2

system
IDSR is a programme to be embraced &

encouraged
I am optimistic that IDSR would achieve

4.
5.

its stated aims & objectives in Abuja

I believe in the programme
I am indifferent to the programme

No

47

Section E: Assessment of Practice of HIM professionals in core functions of the IDSR

programme.
Please tick as appropriate. (Leave section blank if unable to perform any).
S/N Some core surveillance practices
Able to perform
1
Ability to correctly complete inpatient
2

register
Ability to correctly complete outpatient

register
Ability to summarize & present data in

4
5

tables & figures

Ability to perform Trend Analysis
Ability to calculate Incidence

Prevalence of diseases
Ability to compare present & previous

Un-able to perform

&

data

Thank you for participating in this project.

48