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Paediatr Child Health. 1998 Jul-Aug; 3(4): 221.
PMCID: PMC2851336

On caring and counting

Surveillance is an integral part of our health care system. Surveillance data are used to quantify particular conditions to assess the effectiveness of existing control measures, or to rationalize new or altered ones. In short, surveillance provides a measure of reality and fuels progress towards a healthier society. Paediatricians are important contributors to a wide range of surveillance activities, one of which – the Canadian Paediatric Surveillance Program (CPSP) – is highlighted in this issue.

Disease surveillance takes a number of forms. Most familiar to physicians are the federal-provincial reporting systems for notifiable diseases, vaccine-associated adverse events and drug-related adverse reactions. These systems are passive in the sense that they rely on the goodwill of health professionals to initiate reports. Compliance is generally poor because the obligation to report is easily overlooked and the task of reporting is unremunerated.

The CPSP is an example of ‘stimulated passive’ surveillance, in which paediatricians are prompted monthly to report whether they have encountered certain rare childhood conditions. Replying yes or no takes only moments because it requires just a few tick marks on a postage-paid reply card. The few paediatricians who report seeing a target condition are contacted by the CPSP office for more detailed case information. In 1996, the first year of operation, the program achieved a 76% overall response rate. This is quite remarkable when one considers that all practising paediatricians – more than 2100 individuals – were contacted, not just those with membership in the Canadian Paediatric Society. The shortfall in reporting rates does not mean that 24% of paediatricians are curmudgeons but that some were miscast, others were on the move and some needed to be convinced of the value of participating. The best remedy for such doubts is regular reporting of the findings (as in this issue pages 240–245) and how they are used to benefit child health. Using such an approach, the British Paediatric Surveillance Unit, the model on which the CPSP is based, managed to achieve monthly response rates in excess of 90% after several years. I expect that the Canadian program will achieve this participation goal too.

The ultimate means of surveillance involve active case finding and description by persons dedicated to the task. This approach offers the most complete information but is accomplished at a greater cost. Canadian paediatricians have been at the forefront in this area too, with the CPS-affiliated projects such as the Childhood Injury Reporting and Prevention Program (CHIRPP) and Immunization Monitoring Program, Active (IMPACT). These projects depend on the voluntary cooperation of scores of subspecialists.

It is worth pointing out that CPSP, CHIRPP and IMPACT are unique in Canada, apart from certain disease registries. Why don’t other disciplines do likewise? One can invoke factors like workable numbers of general and specialty paediatricians and their strategic positioning to see serious illnesses in children but the ‘special ingredient’ in making such programs work is the extraordinary willingness of paediatricians to cooperate in the interests of children. Canadian paediatricians deserve kudos for their willingness to combine caring for children with counting selected conditions. Children will benefit as a result, and all who help can justifiably claim to have made a contribution to progress.


Articles from Paediatrics & Child Health are provided here courtesy of Oxford University Press