The Evaluation of Communicable Disease Data in the New Surveillance System According to Development Level of the Region

Objective: This study aims to compare communicable disease rates of provinces according to their SPI (State Planning Institute) socioeconomic development levels, to determine whether the occurrence of some of the diseases depend on the developmental level and to investigate the relationship between laboratory diagnostic facilities and developmental level and the occurrence of communicable diseases. Material and Methods: In this retrospective study, communicable disease morbidity rates of provinces according to the 2006 Basic Health Services Statistical Yearbook were used. Information about laboratory facilities in each province was obtained from the Ministry of Health's Standard Diagnosis, Surveillance and Laboratory Guidebook. The data on the socioeconomic developmental level of provinces relied on a scale developed by the SPI for the Ministry of Health, classifying the most developed provinces as the first and the least developed provinces as the sixth region. The provinces were classified according to their socioeconomic developmental level and the difference in communicable disease morbidity and laboratory diagnostic infrastructure were investigated. For some of the analyses, categories of the socioeconomic development scale were regrouped to form combinations of two or three consecutive categories. Chi-square and Kruskal-Wallis tests were used for analyses. Results: When occurrences of diseases were assessed according to regions, whooping cough (75%), syphilis (83%) and ecchinococcosis (46%) were notified significantly more in the first and second socioeconomic level provinces. Unexpectedly, diarrhoea or agents causing diarrhoea were more among the first five most frequent diseases in the first region. Similarly, leishmaniasis was among the 10 most common diseases only in the first and third regions. When both probable and confirmed cases were combined, thyphoid fever was among the first 10 most common diseases in the 1(st), 4(th), 5(th) and 6(th) regions whereas it was not among the first 10 most common diseases even in the least developed region when only confirmed cases were considered. The availability of laboratory facilities in provinces increases the notification rate of cases by 1.08-3.47 times. Conclusion: With worsening SPI developmental level, the morbidity of brucellosis, typhoid fever and hepatitis A increases significantly. For some other diseases, there are inconsistencies that are not expected according to the developmental level of provinces. Although it prevents the notification of untrue cases, the notification of confirmed cases leads to inadequacy in notification in provinces where laboratory facilities are limited. In consideration of this limitation, the number of diseases with probable case notification to the ministry should be increased and laboratory infrastructure should be improved.