Increased sensitization of health workers leading to detection of unintended cases of acute flaccid paralysis: A case of a “Konzo” outbreak in Western Zambia

Abstract

The threat of high profile diseases causing outbreaks has drawn attention to public health surveillance systems, much needed for the timely detection of outbreaks. A disease characterized by weakness of the lower limbs in Luatembo rural health facility was reported to the province in 2013. Through the Acute Flaccid Paralysis surveillance (AFP) program the Western Province in Zambia recorded an increase in the numbers of people affected with spastic paraparesis. The disease affected clusters of families, especially women and children. The disease was found to be in specific geographic areas, with the initial cases being identified in Mongu district followed by Luampa and Senanga districts. Surveillance for a particular disease condition may sometimes lead to detection of a related or unrelated condition. This study aims to assess the sensitivity of the Acute Flaccid Paralysis surveillance program surveillance program to detect other diseases of public health importance using the suspected 'Konzo' outbreak in Western Province as a case study.Through the surveillance system and medical records review, patients with spastic paraparesis were identified and brought for clinical examination to selected health facilities. A team of specialists comprising of an infectious disease specialist and neurologist, supported by physiotherapists, epidemiologist,surveillance officers and laboratory scientists comprehensively investigated the cases. To improve the diagnosis a detailed case investigation form and checklist were used to capture clinical data and socio demographic information. Laboratory investigations included routine urine microscopy and full blood count. Further analysis included viral analysis for enteroviruses , cytomegalovirus among others, copper levels and thiocyanate levels. Preliminary laboratory results indicated no viral infections. Thiocyanate and copper levels are yet to be analysed. As a result of the increased sensitization of health workers and communities, more cases were reported in other parts of Western Province, namely Luampa and Senanga districts. All the cases were detected through active surveillance for AFP. This study indicates a potential role for integrating AFP surveillance with other notifiable diseases within the integrated disease surveillance and response for early notification of unusual events in the community and community involvement to foster health seeking behaviors. In conclusion,this paper reflects on the role of AFP surveillance in integrated disease surveillance and response that resulted in the detection of an uncommon spastic paralysis 'Konzo' disease in Mongu, Western Province.