Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: Experience from a vaccine trial

Mohammad Imran Khan, Shah Muhammad Sahito, Mohammad Javed Khan, Shafi Mohammad Wassan, Abdul Wahab Shaikh, Ashok Kumar Maheshwari, Camilo J. Acosta, Claudia M. Galindo, Rion Leon Ochiai, Shahid Rasool, Sheeraz Peerwani, Mahesh K. Puri, Mohammad Ali, Afia Zafar, Rumina Hassan, Lorenz Von Seidlein, John D. Clemens, Shaikh Qamaruddin Nizami, Zulfiqar A. Bhutta

Research output: Contribution to journalArticle

Abstract

Introduction: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)72-77
Number of pages6
JournalBulletin of the World Health Organization
Volume84
Issue number1
DOIs
StatePublished - Jan 2006

Fingerprint

Health Care Sector
Pakistan
Private Sector
Vaccines
Salmonella paratyphi A
Confidence Intervals
Salmonella typhi
Health Personnel
Fever
Phlebotomy
Private Practice
Microbiology
Developing Countries
Delivery of Health Care
Incidence
Research

Keywords

  • Clinical trials
  • Epidemiologic surveillance
  • Pakistan (source: MeSH, NLM)
  • Private sector
  • Salmonella typhi
  • Vaccination

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan : Experience from a vaccine trial. / Khan, Mohammad Imran; Sahito, Shah Muhammad; Khan, Mohammad Javed; Wassan, Shafi Mohammad; Shaikh, Abdul Wahab; Maheshwari, Ashok Kumar; Acosta, Camilo J.; Galindo, Claudia M.; Ochiai, Rion Leon; Rasool, Shahid; Peerwani, Sheeraz; Puri, Mahesh K.; Ali, Mohammad; Zafar, Afia; Hassan, Rumina; Von Seidlein, Lorenz; Clemens, John D.; Nizami, Shaikh Qamaruddin; Bhutta, Zulfiqar A.

In: Bulletin of the World Health Organization, Vol. 84, No. 1, 01.2006, p. 72-77.

Research output: Contribution to journalArticle

Khan, MI, Sahito, SM, Khan, MJ, Wassan, SM, Shaikh, AW, Maheshwari, AK, Acosta, CJ, Galindo, CM, Ochiai, RL, Rasool, S, Peerwani, S, Puri, MK, Ali, M, Zafar, A, Hassan, R, Von Seidlein, L, Clemens, JD, Nizami, SQ & Bhutta, ZA 2006, 'Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: Experience from a vaccine trial', Bulletin of the World Health Organization, vol. 84, no. 1, pp. 72-77. https://doi.org/10.2471/BLT.05.023630
Khan, Mohammad Imran ; Sahito, Shah Muhammad ; Khan, Mohammad Javed ; Wassan, Shafi Mohammad ; Shaikh, Abdul Wahab ; Maheshwari, Ashok Kumar ; Acosta, Camilo J. ; Galindo, Claudia M. ; Ochiai, Rion Leon ; Rasool, Shahid ; Peerwani, Sheeraz ; Puri, Mahesh K. ; Ali, Mohammad ; Zafar, Afia ; Hassan, Rumina ; Von Seidlein, Lorenz ; Clemens, John D. ; Nizami, Shaikh Qamaruddin ; Bhutta, Zulfiqar A. / Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan : Experience from a vaccine trial. In: Bulletin of the World Health Organization. 2006 ; Vol. 84, No. 1. pp. 72-77.
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AU - Sahito, Shah Muhammad

AU - Khan, Mohammad Javed

AU - Wassan, Shafi Mohammad

AU - Shaikh, Abdul Wahab

AU - Maheshwari, Ashok Kumar

AU - Acosta, Camilo J.

AU - Galindo, Claudia M.

AU - Ochiai, Rion Leon

AU - Rasool, Shahid

AU - Peerwani, Sheeraz

AU - Puri, Mahesh K.

AU - Ali, Mohammad

AU - Zafar, Afia

AU - Hassan, Rumina

AU - Von Seidlein, Lorenz

AU - Clemens, John D.

AU - Nizami, Shaikh Qamaruddin

AU - Bhutta, Zulfiqar A.

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