Expanding polio surveillance reach beyond vaccination reach in Borno State, Nigeria: The contribution of community informants from insecure areas engaged to conduct polio surveillance in security compromised areas, 2018-2019.

INTRODUCTION: Borno state in north-eastern Nigeria is the epicentre of the >10 years' insurgency activities that have affected the region since 2009, resulting in the destruction of health facilities, killing of health workers, massive population displacement and lack of access to populations to provide health services. This article demonstrates how the involvement of community informants from insecure areas (CIIA) to conduct polio surveillance in security-challenged settlements of Borno state contributed to the expansion of polio surveillance reach beyond polio vaccination reach. METHOD: In each of the 19 security compromised Local Government areas (LGAs) with community informants from insecure areas, Android phones enabled with Vaccination Tracking System (VTS) technology and Open Data Kit (ODK) mobile application were provided to capture geo-coordinates as evidence (geo evidence) for polio surveillance activity conducted. These geo evidence captured were uploaded and mapped to show insecure settlements reached with polio surveillance and those yet to be reached. RESULTS: A total of 3183 security compromised settlements were reached for polio surveillance between March 2018 and October 2019 with valid geo evidence, 542 of these security-compromised settlements had not been previously reached by any other intervention for polio surveillance or polio vaccination. CONCLUSION: The capturing of geo-coordinates as a proxy indicator of polio surveillance activity conducted by informants provided significant evidence of settlements reached for sustained polio surveillance even when a case of Acute Flaccid Paralysis (AFP) had not been reported from these settlements. Using the geo evidence captured by CIIA in insecure settlements, we have demonstrated the expansion of polio surveillance reach beyond polio vaccination reach in Borno state.

COVID-19 vaccine hesitancy amongst healthcare workers: An assessment of its magnitude and determinants during the initial phase of national vaccine deployment in Nigeria.

Background: While vaccination plays a critical role in the global response to the COVID-19 pandemic, vaccine rollout remains suboptimal in Nigeria and other Low- and Middle-income countries (LMICs). This study documents the level of hesitancy among health workers (HWs) during the initial COVID-19 vaccine deployment phase in Nigeria and assesses the magnitude and determinants of hesitancy across Nigeria. Methods: A cross sectional study across all States in Nigeria was conducted with over 10,000 HWs interviewed between March and April 2021. Data were cleaned and analyzed with proportions and confidence intervals of hesitancy documented and stratification by HW category. We compared the level of confidence/acceptance to be vaccinated across Nigeria and documented the sources of negative information amongst HWs who refused the vaccine. Findings: Among the 10 184 HWs interviewed, 9 369 [92% (95% CI= 91, 92)] were confident of the COVID-19 vaccines and were already vaccinated at the time of this survey. Compared to HWs who were less than 20 years old, those aged 50 - 59 years were significantly more confident of the COVID-19 vaccines and had been vaccinated (OR=3.8, 95% CI=2.3 - 6.4, p<0.001). Only 858 (8%) of the HWs interviewed reported being hesitant with 57% (479/858) having received negative information, with the commonest source of information from social media (43.4%.). Interpretation: A vast majority of HWs who were offered COVID-19 vaccines as part of the first phase of national vaccine roll out were vaccinated and reported being confident of the COVID-19 vaccines. The reported hesitancy was due mainly to safety issues, and negative information about vaccines from social media. The issues identified remain a significant risk to the success of subsequent phases of the vaccine rollout in Nigeria. Funding: None.

Electronic reporting of integrated disease surveillance and response: lessons learned from northeast, Nigeria, 2019.

BACKGROUND: Electronic reporting of integrated disease surveillance and response (eIDSR) was implemented in Adamawa and Yobe states, Northeastern Nigeria, as an innovative strategy to improve disease reporting. Its objectives were to improve the timeliness and completeness of IDSR reporting by health facilities, prompt identification of public health events, timely information sharing, and public health action. We evaluated the project to determine whether it met its set objectives. METHOD: We conducted a cross-sectional study to assess and document the lessons learned from the project. We reviewed the performance of the local government areas (LGAs) on timeliness and completeness of reporting, rumors identification, and reporting on the eIDSR and the traditional paper-based system using a checklist. Respondents were interviewed online on the relevance, efficiency, sustainability, project progress and effectiveness, the effectiveness of management, and potential impact and scalability of the strategy using structured questionnaires. Data were cleaned, analyzed, and presented as proportions using an MS Excel spreadsheet. Responses were also presented as direct quotes. RESULTS: The number of health facilities reporting IDSR increased from 103 to 228 (117%) before and after implementation of the eIDSR respectively. The timeliness of reporting was 43% in the LGA compared to 73% in health facilities implementing eIDSR. The completeness of IDSR reports in the last 6 months before the evaluation was ≥85%. Of the 201 rumors identified and verified, 161 (80%) were from the eIDSR pilot sites. The majority of the stakeholders interviewed believed that eIDSR met its predetermined objectives for public health surveillance. The benefits of eIDSR included timely reporting and response to alerts and disease outbreaks, improved timeliness, and completeness of reporting, and supportive supervision to the operational levels. The strategy helped stakeholders to appreciate their roles in public health surveillance. CONCLUSION: The eIDSR has increased the number of health facilities reporting IDSR, enabled early identification, reporting, and verification of alerts, improved timeliness and completeness of reports, and supportive supervision of staff at the operational levels. It was well accepted by the stakeholder as a system that made reporting easy with the potential to improve the public health surveillance system in Nigeria.