Major article
How do Iranian physicians report notifiable diseases? The first report from Iran

https://doi.org/10.1016/j.ajic.2008.09.014Get rights and content

Background

Epidemiologic surveillance through notifiable diseases is an essential component of a public health program. Surveillance systems relay mostly on physicians to report notifiable diseases The aim of this study was to identify physicians’ knowledge about reporting of notifiable diseases as well as their self-reported practices and perceptions regarding disease reporting barriers and ways to improve compliance.

Method

A validated, reliable self-administered questionnaire addressing knowledge of notifiable diseases, self-reported practices, reasons for noncompliance with reporting requirements, and suggestions to improve compliance with reporting was distributed to 400 general physicians (GPs) attending medical conferences in Shiraz, Iran between March and July 2006. Knowledge was quantified by evaluating the answers to 45 questions (with 1 point awarded for each correct answer). Associations between the independent variables and physician knowledge were modeled using analysis of covariance.

Result

The response rate was 75%. The overall mean score was 17.03 ± 7.45 (range, 4 to 31). Knowledge of the location of the posted notifiable diseases list was positively associated with score on knowledge questions (F = 4.431; P = .036). Fully 88% of the participants stated that they had never reported a notifiable disease. There was no significant association between the participants’ self-reported practices and knowledge question scores. The major barriers to reporting notifiable diseases were the extra time required for reporting and poor knowledge of the list of reportable diseases and reporting requirements. The most frequent suggestions for improving physicians’ compliance with disease reporting were to simplify the reporting process and to shift the responsibility for notification to another person, such as a secretary or a nurse.

Conclusion

Our findings suggest poor knowledge of disease notification requirements among GPs. Modifying physisicans’ knowledge and motivation, eliminating barriers to disease reporting, and promoting some facilitating factors could help reduce the underreporting of notifiable diseases.

Section snippets

Study design and participants

In this cross-sectional study, between March and July 2006, a self-administered questionnaire was distributed to 400 GPs working in Shiraz and attending conferences sponsored by the Office of Interuniversity Relations, International & Congress Affairs, Shiraz University of Medical Sciences.

Questionnaire

The questionnaire comprised 6 sections:

  • 1.

    Sociodemographic (age, sex, number of years since graduation), workplace (working in a governmental or in a private clinic/hospital)

  • 2.

    Knowledge of reporting methods

Results

A total of 301 participants returned the questionnaire, for a response rate of 75%. The respondents’ mean age was 32.09 ± 4.63 years (range, 26 to 67 years). The respondents were predominately male (69.1%); 25% of the respondents worked in a government hospital/clinic, 52.3% in a private setting, and 22.7% in both a government setting and a private setting (Table 1).

Discussion

The historical paradigm of public health surveillance systems includes both a case finding and diagnosis component and a disease reporting component.6 In Iran, the reporting of notifiable diseases is mandated by the Health Ministry, and a list of notifiable diseases and legal requirements for reporting (ie, commonly understood case reporting criteria [ie, case definitions], methods of reporting [eg, telephone, mail]), the data to include in the report, and the required time interval between

Conclusion and recommendations

The findings of this study suggest the benefit of improving physicians’ knowledge of and compliance with notifiable disease reporting through such simple methods as posting the list of notifiable dieases and reporting requirements in the workplace. Motivating physicians, removing barriers to notifiable disease reporting, and facilitating the reporting process should reduce the underreporting of notifiable diseases. Focusing educational programs in this area, and having other medical staff

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  • Conflict of interest: None to report.

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