Disease Surveillance Investments and Administration: Limits to Information Value in Pakistan Polio Eradication

AbstractIn Pakistan, annual poliovirus investment decisions drive quantities of supplemental immunization campaigns districts receive. In this article, we assess whether increased spending on poliovirus surveillance is associated with greater likelihood of correctly identifying districts at high risk of polio with assignment of an elevated “risk ranking.” We reviewed programmatic documents from Pakistan for the period from 2012–2017, recording whether districts had been classified as “high risk” or “low risk” in each year. Through document review, we developed a decision tree to describe the ranking decisions. Then, inte grating data from the World Health Organization and Global Polio Eradication Initiative, we constructed a Bayesian decision network reflecting investments in polio surveillance and immunization campaigns, surveillance metrics, disease incidence, immunization rates, and occurrence of polio cases. We test these factors for statistical association with the outcome of interest—a change in risk rank between the beginning and the end of the one‐year time period. We simulate different spending scenarios and predict their impact on district risk ranking in future time periods. We find that per dis trict spending increases are associated with increased identification of cases of acute flaccid paralysis (AFP). However, the low specificity of AFP investment and the largely invariant ranking of district risk means that even large increases in surveillan...
Source: Risk Analysis - Category: International Medicine & Public Health Authors: Tags: Original Research Article Source Type: research