Evaluation of Mpox surveillance system in Nigeria: A sub-national analysis

An effective sub-national disease surveillance system contributes significantly to early detection, prevention and control of reemerging diseases such as Mpox. Nigeria recorded its first recognized Mpox outbreak in 2017 highlighting the resurgence of the disease in West Africa thirty-nine years after the eradication of smallpox. Despite reporting cases since 2017, its Mpox surveillance system has never been evaluated. This study, therefore, evaluated the Mpox surveillance system in Bayelsa State, Nigeria focusing on its key attributes and challenges. A cross-sectional study adopting the US CDC’s 2001 updated guidelines for evaluating public health surveillance systems was conducted. Mpox surveillance dataset from 2017 to 2023 was analyzed, conducted key informant interviews, and administered questionnaires to all twenty-eight surveillance officers in Bayelsa State Nigeria. Data were analyzed with IBM SPSS version 20. The mean age of participants was 43± 8 years with (82.1%) persons having ≤ 15 years of work experience. Mpox surveillance data analysis revealed males (63.3%) and individuals less than 20 years old (39.2%) were predominantly affected with a positivity rate of 32.8% and 21.7% pending/inconclusive results. In assessing system attributes, 96.4% of respondents indicated flexibility, 92.6% confirmed clarity in Mpox case definitions, and all participants highlighted the system’s acceptability and usefulness in resource allocation and decision-making. However, under- reporting and inadequate laboratory capacity were identified as major gaps by all key informants influencing the quality of data. While the Mpox surveillance system in Bayelsa State Nigeria possesses some good attributes, it is challenged by the above-stated critical gaps. Strengthening laboratory testing capacity, training surveillance officers in data management and mobility support for field surveillance are recommended to enhance Mpox surveillance at sub-national levels.