Four thousand five hundred and thirteen cases (4513) of AFP were reported between January 2013 to December 2018, from all LGAs. Fakai and Ngaski LGAs reported 362 (8%) cases, while Bagudo reported 45 (1%). Non-polio AFP rate (NP-AFPR) for Ngaski and Fakai LGAs were 71.5/100,000 & 73.8/100,000 respectively, while Wasagu/Danko had NP-AFP rate of 20.1/100,000.
The data is also valid because the surveillance system aims to detect AFP cases and the system has been consistently and effectively reporting AFP cases throughout the review period. Ninety-seven percent of data fields used were complete.
Timeliness and completeness of reporting
In the years under review, the timeliness of monthly reporting was consistently above 90% (Fig 1)
All the respondents knew that polio is a disease caused by a virus. 47 (97.6%) responded that the AFP case definition is easy to understand. The majority of the respondents 45 (97%) felt the case investigation form CIF is easy to fill, however, 33 (70%) believed there is a need for regular training and retraining.
The AFP surveillance is well integrated into the integrated disease surveillance and response (IDSR) system. The AFP surveillance system uses the minimum data collection recommended by the WHO which are few. It can easily accommodate new specific variables as needed. Though 50% of the respondents feel that any change in the surveillance system process can be accommodated by the data collection forms.
The system was generally found to be acceptable by the surveillance officers. All of them were willing to continue to participate in the AFP surveillance in the state. Interview with some focal persons in some health care facilities showed that they are willing to continue with AFP surveillance despite their busy schedules. Community informants were always willing to participate in reporting of suspected cases. Nonetheless, some private health care facilities were not fully reporting.
However, despite their willingness to continue with the current system as it is, 62% of the respondents said they have made contributions or suggestions on areas where they think the system can be improved. Among the suggestions were, the surveillance officers should be supported especially with means of transportation to improve active case search, to increase the number of focal sites, or to completely change the reporting system to electronic format. The majority, 74% of the respondents said their suggestions were considered and some were even implemented (e.g. they were supported with motorcycles, android phones, and the number of focal sites were increased.
There are dedicated surveillance officers from the State Ministry of Health (i.e. The State Epidemiologist, State DSNO, and his Deputy), from the Local Government Authorities (LGAs) (i.e. LGA DSNOs and their Deputies), Health Facility surveillance focal persons, Community Informants, etc. The State is also supported by The WHO Cluster Consultants, WHO LGA facilitators, Field Volunteers, etc. therefore, the AFP surveillance system in Kebbi State is stable. However, the system is donor-driven. The WHO provides all the logistic support, laboratory reagents and consumables, sample collection bottles, and transportation of samples to the reference laboratories. Therefore, the system will be unstable the moment the donors withdraw their support.
The AFP surveillance system in the State is representative because the surveillance data analysed showed that the system is ongoing in all the LGAs in the State. Both males and females were represented in the data. Though there were more males (53%) than females (47%). It cuts across individuals from different ethnic backgrounds within the State, suspected cases cuts across individuals from different socioeconomic backgrounds, and all from both urban and rural settlements. The data is also obtained from both public and private health facilities.
The stool adequacy of ≥ 80 as prescribed by the WHO has been achieved throughout the review by the AFP surveillance system in the State.
The Because the minimum non-polio AFP rate (≥ 1/100,000/year of under 15) and stool adequacy rate (> 80% stool samples must be adequate) were consistently above the WHO minimum standard, as depicted in the figures 3 and 4 respectively, the system is, therefore, sensitive.
Timeliness of AFP surveillance in Kebbi State (2013-2018)
Timeliness of case investigation & stool arriving lab on time
All AFP cases should be investigated within 24-48 hours of reporting and two stool samples should be collected 24 hours apart, and each should be adequate. Furthermore, all collected stool samples should reach the WHO accredited laboratory in good condition and on time (48-72 hours of collection)
At least 80% of cases of AFP reported, must be investigated within 24-48 hours of notification, as prescribed by the WHO. This has been consistently achieved in all the period of review. The least percentage attained was 98% (2014)
The minimum cut off mark for stool samples arriving at the laboratoty on time (72 hours after collection), is also 80%. This has also been achieved consistently by the AFP surveillance system in Kebbi State.
The proportion of AFP cases investigated within 48 hours of notification as well as the proportion of stool samples arriving at the lab on time (i.e. 72 hours from of being sent to the lab), between January 2013 and December 2018. Both results were consistently above the WHO minimum standard of 80%. The minimum level obtained was 98% (for timeliness of case investigation), and 99% (for timeliness of sample arriving at the laboratory on time).
The stool sample must arrive at the laboratory in good condition; this simply means that the stool:
- Must arrive at the designated laboratory on time (48-72 hours of collection),
- the quantity of stool collected must be at least 8g, not desiccated, the container and Case investigation form well labelled, the container well sealed and at a good temperature of 2-80C (reverse cold chain).
Figures 5 and 6 above show the system met the minimum criteria set by the WHO, therefore, timely.