Evaluation of the Acute Flaccid Paralysis Surveillance System From 2016 to 2020: A Retrospective Study
Bibliographic record
Abstract
Background Acute flaccid paralysis surveillance played a major role in the global eradication of polio. The World Health Organization adopted this method to monitor the progress toward poliomyelitis eradication. The Expanded Program of Immunization in Jordan has routinely collected acute flaccid paralysis data since 1999, which then attained a polio-free certification. Yet, because of wars in neighboring countries such as Syria and Iraq, there is a risk of polio outbreaks occurring. Objective This study aims to evaluate the acute flaccid paralysis surveillance system in Jordan from 2016 to 2020 and identify areas for improvement. Methods This was a retrospective descriptive study that used data from the acute flaccid paralysis surveillance system in Jordan between January 2016 and December 2020. The World Health Organization standard indicators were used to evaluate the performance of the surveillance system. Results A total of 483 cases of nonpolio acute flaccid paralysis were reported. Most of them (n=478, 99%) were younger than 15 years, and among those, 55.6% were younger than 5 years, and 58% were male. At the national level, the surveillance achieved all the World Health Organization indicators throughout the evaluating period, except for two indicators: the proportion of stool specimens from which nonpolio enterovirus was isolated in 2016 and 2017, and the nonpolio acute flaccid paralysis detection rate per 100,000 of the population younger than 15 years in 2020. At a subnational level (governorates level), the proportion of stool specimens from which nonpolio enterovirus was isolated, as an indicator, was not achieved most of the time. This was frequently observed in each of all evaluation years of 2016 to 2020. Moreover, most indicators were not achieved at the governorate level in 2020. Conclusions There are some gaps that need improvement in the acute flaccid paralysis surveillance system in Jordan, especially at the governorate level. The lower performance during 2020 could have been caused by the COVID-19 crisis and the lockdown during the pandemic. Similar challenges are possible in the future and proper preparation is required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".