Background A voluntary procedure for reporting adverse drug reactions (ADRs) was formally put in place in 1989. However,only a small proportion of ADR reports are actually forwarded to the national monitoring center. To identify the reasons for underreporting,the authors investigated the awareness and attitudes of healthcare professionals (doctors,nurses,and administrators) toward the ADR system in China. In addition,the authors sought to formulate approaches to improve the current ADR reporting system.Methods Structured interviews were carried out in 16 hospitals selected from 27 municipal hospitals in Wuhan,Hubei Province,China. A questionnaire survey of a stratified random sample of approximately 15% of healthcare professionals in each selected hospital was conducted during February to March 2003.Results The response rate of this survey was 85%. One thousand six hundred and fifty-three questionnaires were used in the final analysis. Only 2.7% of the healthcare professionals had a correct understanding to the definition of ADR. Eighty-nine point two percent of the healthcare professionals had encountered ADRs. Ninety-four percent of them were aware of the need to report these to the ADR monitoring center. However,only 28.5% of doctors,22.8% of nurses,and 29.7% of administrators actually submitted a report. For the most part,they reported ADRs to the hospital pharmacy (66.0%),to other departments in the hospital (72.5%),and to the pharmaceutical industry (23.0%),rather than to the national monitoring center (2.9%) or regional monitoring center (9.5%). Severe or rare ADRs and ADRs to new products were generally perceived to be significant enough to report. Sixty-two point one percent of the healthcare professionals had encountered ADRs,yet not reported them to anybody. The major reasons for not reporting included no knowledge of the reporting procedure (71.4%),unavailability of the reporting center mailing address (67.9%),unavailability of the ADR report form (60.4%),lack of knowledge of the existence of a national ADR reporting system (52.2%),and belief that the ADR in question was already well known (44.1%). Conclusions Healthcare professionals in Wuhan,China have little basic knowledge of ADR and of the voluntary reporting system. The main reasons for underreporting were lack of basic knowledge about ADRs and the voluntary reporting procedure. Education and training of healthcare professionals is needed to improve the current ADR reporting system. Background A voluntary procedure for reporting adverse drug reactions (ADRs) was formally put in place in 1989. However, only a small proportion of ADR reports are actually forwarded to the national monitoring center. To identify the reasons for underreporting, the authors investigated the awareness In addition, the authors sought to formulate approaches to improve the current ADR reporting system. Structured interviews were conducted in 16 hospitals selected from 27 municipal hospitals in Wuhan, Hubei Province, China. A questionnaire survey of a stratified random sample of approximately 15% of healthcare professionals in each selected hospital was conducted during February to March 2003. Results The response rate of this survey was 85%. One thousand six hundred and fifty-three questionnaires were used in the final analysis. Only 2.7% of the healthcare professionals had a co rrect understanding to the definition of ADR. Eighty-nine point two percent of the healthcare professionals had encountered encountered adRs. Ninety-four percent of them were aware of the need to report these to the ADR monitoring center. However, only 28.5% of doctors, For the most part, they reported ADRs to the hospital pharmacy (66.0%), to other departments in the hospital (72.5%), and to the pharmaceutical industry (23.0 % than, rather than to the national monitoring center (2.9%) or regional monitoring center (9.5%). Severe or rare ADRs and ADRs to new products were generally perceived to be significant enough to report. Sixty-two point one percent of the healthcare professionals had encountered ADRs, yet not reported them to anybody. The major reasons for not reporting included no knowledge of the reporting procedure (71.4%), unavailability of the reporting center mailing address (67.9%), unavailability of the ADR report form 60.4%), lack of knowledge of the existence of a national ADR reporting system (52.2%), and believes that the ADR in question was already well known (44.1%). Conclusions Healthcare professionals in Wuhan, China have little basic knowledge of ADR and of the voluntary reporting system. The main reasons for underreporting were lack of basic knowledge about ADRs and the voluntary reporting procedure. Education and training of healthcare professionals is needed to improve the current ADR reporting system.