The evolution, facilitators, barriers, and additional activities of acute flaccid paralysis surveillance platform in polio eradication programme Bangladesh: a mixed-method study

Figures & data

Figure 1. Sequential exploratory-explanatory mixed-method for the current study.

Table 1. Overview of CFIR domains, indicating facilitators of and barriers for the Polio programme implementation in Bangladesh.

Domains	Characteristics of individuals within your organization	Organizational settings/Inner setting	Program/Intervention characteristics	Process of conducting the activities/implementation	External settings
Definitions	These include a low level of competence of coworkers within the respondent’s organization.	These include the environment and actions of the organization the respondent belongs to.	This includes medical products or technologies adopted by the organization and the actual strategy itself.	This includes strategies for how the program itself was conducted, including monitoring and evaluation activities.	External settings are any environment outside of the direct control of the project.
Determinants	● The person’s knowledge and beliefs about the activity ● Self-efficacy ● Individual stage of change ● Individual identification with organization	● Structural characteristics ● Networks and communications ● Culture: norms, values, basic assumptions of an organization led to challenges ● Implementation climate ● Readiness for implementation	● Intervention source ● Evidence strength and quality ● Relative advantage ● Adaptability to local context ● Trialability ● Complexity ● Design Quality and Packaging ● Cost	● Planning ● Engaging ● Executing ● Reflecting and evaluating	● Political environment ● Economic environment ● Social environment ● Technological environment ● Other environment

Table 2. Categories of the identified grey literature.

Category	Frequency n = 92	Percent
Language
Bangla	7	7.6
English	85	92.4
Type of document
Bulletin	13	14.1
Scientific journal	8	8.7
Report	5	5.4
Fact sheet	6	6.5
Newspaper	2	2.1
Power point presentation	4	4.3
Manual	4	4.3
Protocol	1	1
Other	49	53.3
Source/publisher of the literature
Government	61	66.3
GPEI core partners	40	43.5
Academic organization	8	8.7
Funding and implementing organization	31	33.7
Other	24	26

*Some of the literature has multiple source/publisher.

Table 3. Profile of the survey respondents.

Variables	Frequency n = 109	Percent
Years involved with polio eradication activities
<5 years	16	14.7
6–15 years	29	26.6
16–25 years	43	39.4
25+	21	19.3
Level in polio eradication activities
Global	18	10.1
National	46	25.8
District	66	37.1
Sub-district	48	27.0
Organization affiliation
WHO	29	17.4
Rotary International	2	1.2
UNICEF	7	4.2
Center for Disease Control, US	3	1.8
NGO Implementing Partners	7	4.2
Government	104	62.3
Academic/research institution	4	2.4
Other	11	6.6
Primary role in polio eradication activities
Resource mobilization	5	2
Partnership/alliance development	15	5.9
Strategy development and planning	29	11.4
Strengthening delivery systems	40	15.7
Vaccination	53	20.8
Surveillance	44	17.3
Community engagement	30	11.8
Monitoring & Evaluating	32	12.5
Others	7	2.7

*Many respondents served multiple roles in polio eradication activities.

Table 4. AFP surveillance performance indicators Bangladesh, 2002–2016.

Indicators	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
AFP rate	2.70	2.03	2.31	2.66	2.91	3.25	3.25	3.1	2.61	3.11	2.98	2.65	2.74	2.78	2.85
Non-polio AFP rate*	2.70	2.03	2.31	2.66	2.87	3.25	3.25	3.1	2.61	3.11	2.98	2.65	2.74	2.78	2.85
% adequate stool specimen collection*	89%	89%	90%	92%	93%	92%	92%	92%	94%	95%	96%	96%	98%	97%	99%
% Nonpolio enterovirus isolation	28.0	23.0	20.0	20.0	14.8	15.0	15.0	23.1	19.4	18.0	13.8	18.8	22.6	20.4	21
% timeliness of primary result reported	100	99	100	100	98	100	100	95	97	98	93	97	97	98	96

*Number of discarded AFP cases per 100,000 children <15 years of age.

*Percent with 2 specimens, 24 hours apart and <14 days of paralysis onset.

Source: EPI and VPD Surveillance Review and Post-Introduction Evaluation of Hib (Pentavalent) Vaccine (2012) and Polio Transition Plan Bangladesh.

Figure 2. Key events of the polio program, Bangladesh.

*NPL (National polio laboratory), SMO (Surveillance medical Officer), NPML (National Polio and Measles laboratory), ES (Environmental surveillance), SIMO (Surveillance immunization medical Officer).

Figure 3. Polio cases in Bangladesh, 1996–2015.

Figure 4. The structure and reporting system of the polio program in Bangladesh.

*DSFP (Disease Surveillance Focal Persons), CS (Civil Surgeon), CHO (Chief Health Officer), EPI HQ (Expanded Programme of Immunization Head Quarter), HSO (Hospital Medical Officer), LSO (Local Surveillance Officers) RMO Residential Medical Officer, SMO (Surveillance Medical Officer), SIMO (Surveillance Immunization Medical Officer), MODC Medical Officer for Disease Control, MOCS Medical Officer for Disease Surveillance, ZMO Zonal Medical Officer, AHO Airport Health Officer, HO (Health Officer).

Table 5. Contributing factors and challenges of AFP surveillance implementation (survey).

Variables	Frequency (N)	Percentage (n %)
Contributors of Surveillance
Process of conducting the activities/implementation	18	43.90
Program/Intervention characteristics	13	31.71
Organizational settings/Inner setting	7	17.07
Characteristics of individuals within your organization	3	7.32
External settings
Social environment	22	53.66
Technological environment	11	26.83
Political environment	7	17.07
Economic environment	1	2.44
Challenges of Surveillance
External settings (Social, technological, political, and economic environment)	16	38.10
Process of conducting the activities	14	33.33
Organizational settings	5	11.90
Polio eradication program characteristics	5	11.90
Characteristics of individuals within your organization	2	4.76

*The survey questionnaire has been subjected to multiple answers.

Data availability statement

Data and publications from this project will be Open Access and available via an online repository.