Evaluation of communicable disease statistics according to the SPOindex of provinces in Turkey

The aim of this study is to evaluate the differences of notification among provinces in Turkey according to the State Planning Organization(SPO) developmental level of provinces.
            Methods: Numbers of cases and morbidity data for communicable diseases was obtained from Ministry of Health 2006 General Directorate of Primary Health Care Statistical Yearbook. A prelimininary analysis was done comparing communicable disease statistics with population size of provinces. An index developed by SPO for ministry of health in 2005 classifying provinces to six categories of health services status and NUTS classification of provinces was used for comparisons. For some analysis, the index had to be re-grouped into three categories by combining adjacent two categories. Chi-square, Kruskal-Wallis and Student’s t tests were used for statistical analysis.
            Results: When six regions were compared, brucellosis, typhoid fever and hepatitis A morbidity increased significantly with worsening index. Higher morbidity for Hepatitis C was found in 3-4.regions, for rabies related bites in 2.and 6.regions and for syphilis in 3.and 5.regions.
            When presence of disease in provinces was analysed according to the index regions, there was significantly higher morbidity for pertussis, syphilis and eccinoccosus, with diseases present in 75%, 83% and 46% of provinces in 1-2.regions. Difference was not found for other comparable diseases. According to NUTS regions, typhoid fever was highest in east expectedly, then in west unexpectedly and least in middle Turkey. Eccinococcus was unexpectedly found highest in west.
            Conclusion: There is inconsistency in notifications according to types of diseases and developmental region. Laboratory resources should be evaluated according to developmental regions when analysing communicable disease statistics due to the mandatory notification of only confirmed cases.