Concurrent evaluation of acute flaccid paralysis surveillance in Kashmir: A mixed methods study

Background: Active acute flaccid paralysis (AFP) cases surveillance in children under 15 years is ongoing till reaching eradication of poliomyelitis in the globe. As there is always a high risk of importation of wild poliovirus (WPV) from the endemic countries, accurate surveillance for AFP cases to detect WPV circulation and to maintain our achievement is thoroughly essential. Objectives: To evaluate the performance of the AFP surveillance system in Kashmir Valley. To identify gaps, if any, in AFP surveillance. Materials and Methods: The Mixed Methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design using individual, face-to-face interviews with thirty-two (32) different stakeholders from the State, District, Medical Block, and PHC levels. To complement the qualitative study, a quantitative door-to-door survey was done in two Districts, Srinagar and Ganderbal, which consist of five and four Medical Blocks respectively. Results: The thematic qualitative analysis approach was used, and the analysis process resulted in five themes. 1. Stakeholders' description of AFP surveillance. 2. Perception and awareness, appraisal of AFP Surveillance among stakeholders 3. Barriers in reporting AFP cases 4. Forging stronger linkages, improved planning in the health system to address gaps in AFP surveillance. 5. Enhancement of activities for sensitive AFP surveillance. In door to door survey of households in different sub-centre areas, a total of n = 1304 families were visited in which maximum (n = 647) families had two