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Contribution of Community Informants to Sensitivity of Acute Flaccid Paralysis Surveillance in Nigeria (2011-2017)

Abdullahi Walla Hamisu, G.C. Onyemelukwe, Sume Etapelong Gerald, Isiaka Ayodeji Hassan, Braka Fiona1,Richard Banda, Ajiboye Oyetunji, Alemu W, Faisal Shuaib, Nigeria

Background: Nigeria, a country of about 200 million people is one of the three remaining polio-endemic countries in the world. The last case of Wild Poliovirus (WPV) had onset of paralysis on 21st August 2016. Surveillance for cases of Acute Flaccid Paralysis (AFP) is one of the four strategies designed to eradicate polio. Polio is only one out of the many causes of AFP. AFP is thus a complex clinical syndrome with a broad array of potential etiologies. AFP surveillance in Nigeria is sensitive and an average of 12,000 AFP cases have been reported annually in the last five years. The Nigeria disease surveillance system is both health facility and community based. Information from community informants is combined with facility-based disease surveillance and response mechanisms to strengthen and expand the coverage of the national system. Community informants are people that own or manage places in the non-formal health sector where parents with AFP cases may most likely seek assistance or consult. Examples of these are Patent Medicine Vendors (PMVs), traditional healers, spiritual healers, bone setters etc. This system of AFP reporting by informants is complementary to health facility -based surveillance system and has been shown to have more potential for improving surveillance quality in terms of timeliness, simplicity and representativeness. In addition, community involvement in disease surveillance is justified especially in developing and other resource poor settings where access to orthodox health centres is poor and self-medication and patronage of non-orthodox practitioners is rife. Systematic inclusion of more informants into AFP surveillance network is advocated and is crucial towards improving AFP case detection. Objectives: The objective of this paper is to highlight the contribution of community informants to the sensitivity of AFP surveillance in Nigeria during the period between 2011 to 2017. Methods: We conducted a retrospective review of enlisted community informants and reported AFP cases in Nigeria between 2011 to 2017 from the AFP database at the World Health Organization Country Office. We segregated the reported AFP cases by source of reporting including those reported by informants. The proportion of AFP cases reported by informants during the reporting period was calculated. Results: The number of AFP cases reported in the country increased from 6108 in 2011 to 16261 in 2017. The number of community informants increased from 22252 in 2011 to 53514 in 2017.The number of community informants in the northern and southern zones was 32690(61%) and 20824(39%) respectively. The proportion of AFP cases reported by community informants increased from 7% in 2011 to 18% in 2017.The number of AFP cases reported by informants from the northern and southern zones in 2017 was 1613(10%) and 1323(8%) respectively. Conclusion: There was significant increase in reporting of AFP cases by community informants from 2011 to 2017 in Nigeria. Considering the size of the country, the number of informants was generally inadequate. There is variation in the number and performance of informants in the different geopolitical zones of the country with more informants located in the northern zones of the country and relatively more AFP cases reported by informants from the southern zones. Systematic inclusion of more informants into AFP surveillance network is advocated and is crucial towards improving AFP case detection.

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