Evaluating the timeliness of reporting in a First Nations communicable diseases program

Timely reporting of communicable diseases is necessary to enable a prompt response to mitigate and control outbreaks. This is especially true among First Nations communities due to a number of factors, including unique social determinants of health, which can contribute to rapid disease transmission.

To assess the timeliness of reporting for 12 notifiable communicable diseases in the Northern Inter-Tribal Health Authority, which includes 33 First Nations on-reserve communities in Northern Saskatchewan, Canada, and to assess whether there were differences in reporting times depending on degree of remoteness of community, season or year.

Data for four sexually transmitted infections (STIs) and eight other communicable diseases were abstracted from the integrated Public Health Information System (iPHIS) between 2008 and 2013 and compared against the targets set for reporting in the Saskatchewan Communicable Disease Control Manual. The reporting time was defined as the duration from client exposure or presentation at clinic to the case notification day at Saskatchewan's Ministry of Health. Communicable diseases were evaluated for proportion of cases reported within recommended time, and mean reporting time. Geographical and reporting data were also recorded to assess variations in reporting time among different northern communities and according to season or year.

A total of 9,767 records were identified for the 12 diseases; all had a 14-day recommended reporting time, with the exception of shigellosis, which had a three-day reporting time. Overall, 93.6% of the diseases were reported in the recommended reporting time, although there was variability among the diseases. All four of the STIs (chlamydia, gonococcal infections, HIV and syphilis) had over 90% of cases reported within the 14-day recommended time period. Other communicable diseases reporting times varied from a high of 93.4% for methicillin-resistant Staphylococcus aureus (MRSA), 91.7% for lab-confirmed influenza and 89.1% for streptococcal A-invasive disease to a low of 16.2% for shigellosis and 12.2% for pertussis. Salmonellosis and pneumococcal-invasive disease were intermediary with 77.4% and 72.2%, respectively. Mean reporting times indicated that eight of the 12 diseases (66.7%) had reporting times similar to or better than recommended times. There appeared to be a correlation between longer reporting periods and the more northern communities. There were no seasonal variations found but yearly-trend analysis demonstrated an anomalous year in 2011, in which all communicable diseases with the exception of STIs experienced a peak in reporting delays.

Overall, communicable disease reporting in this northern health authority program met recommended reporting times, although there were variations according to the disease, the area reporting and the year. Further research is needed to understand these variations in order to inform efforts to strengthen communicable disease surveillance among First Nations communities.