# Evaluation of acute flaccid paralysis surveillance system in Kebbi State, Nigeria between 2013-2018

## TL;DR

This study evaluated the effectiveness of a system for tracking paralysis cases in Nigeria to help prevent polio, finding it mostly effective but with some areas needing improvement.

## Contribution

The study provides a detailed evaluation of AFP surveillance in Kebbi State, Nigeria, identifying strengths and operational gaps.

## Key findings

- The AFP surveillance system in Kebbi State met WHO standards for performance indicators like stool adequacy and timeliness.
- Donor dependency and lack of 60-day follow-up data were identified as key operational gaps.
- Surveillance officers understood case definitions and were willing to sustain the system.

## Abstract

since 1988, polio incidence has declined by over 99% globally, from more than 350,000 annual cases in over 125 endemic countries to transmission now limited to Pakistan and Afghanistan. Africa has not reported wild poliovirus since 2016. An effective Acute Flaccid Paralysis (AFP) surveillance system is crucial for detecting and interrupting polio transmission. This evaluation assessed the Acute Flaccid Paralysis (AFP) surveillance system in Kebbi State, Nigeria, to identify operational gaps.

using updated Center for Disease Control and Prevention (CDC) guidelines and the World Health Organization (WHO) performance standards, the study reviewed AFP surveillance data from 2013-2018, conducted stakeholder interviews using adapted questionnaires and key informant interviews, and analyzed data using means, frequencies, and proportions.

among the 49 respondents, 98% reported that case definitions and investigation forms were easy to use, while 97% found data tools adaptable to changes. All surveillance officers understood AFP case definitions and expressed willingness to sustain the system. Key performance indicators, including non-polio AFP rates (24.6-55.2), stool adequacy (95-99.7%), timeliness, and reporting completeness all consistently met WHO standards.

the evaluation concluded that the AFP surveillance system in Kebbi State, Nigeria, is useful, simple, flexible, acceptable, sensitive, representative, timely, and stable, although donor dependency remains a concern. A significant gap was the lack of data on 60-day follow-ups and laboratory feedback. Addressing these issues is important to further strengthen the system.