Evaluation of community-based surveillance for acute flaccid paralysis cases in a security-compromised setting, Tillabéri Health Region, Niger, 2021

Introduction: Community-based surveillance (CBS) is based on community engagement in disease and public health event surveillance. Enhancing the CBS project has been implemented since 2020 through a Community Relays’ network in a security-compromised setting of Tillabéri Health Region in Niger to ensure progress towards poliomyelitis eradication. The study aimed at describing the CBS system and assessing its usefulness, simplicity, sensitivity, acceptability, timeliness, representativeness and determining its positive predictive value. Methods: This was a descriptive cross-sectional study that included all alerts and acute flaccid paralysis (AFP) cases reported, as well as the selected surveillance system personnel from January 2017 to December 2021. Data were collected via desk reviews and individual face-to-face interviews to describe the CBS’ organisation and operation and assess its usefulness and attributes using the US Center for Disease Control and Prevention, Atlanta, 2001 guidelines. Usefulness were assessed by the Non Polio Acute Flaccid Paralysis Rate (NPAFP-R) before and during CBS, simplicity: no constraint in cases investigation, sensitivity: NPAFP-R≥3.0 cases/100,000 under 15 children in CBS districts, acceptability: ≥80.0% Community Relays reporting alerts associated with ≥80.0% priority sites adequately visited, ≥80.0% cases notified within 7 days after paralysis onset and ≥80.0% adequate cases, timeliness: ≥80.0% AFP cases notified within 7 days after paralysis onset investigated within 48 hours and received at National lab in good condition within 72 hours, representativeness: expected NPAFP-R with both sex and associated with the expected age groups within AFP cases in the CBS districts, Positive Predictive Value: percentage of Poliomyelitis cases among cases notified. Results are presented in proportions. Results: Community Relays report to the health system through a free fleet mobile phone network involving all CBS stakeholders from the operational to the central level. The overall NPAFP-R rose from 1.3 to 18.0 cases/100,000 under 15 in CBS districts. AFP cases should be notified within 7 days after paralysis onset, investigated within 48 hours, and specimens should be collected 14 days after paralysis onset. The proportion of AFP cases notified within 7 days was 42.1% (8/19) and 65.1% (69/106) in 2020 and 2021 respectively. The NPAFP-R (Number of AFP cases/100,000 under 15) was 15.0 in Abala, Ayorou: 66.0, Gothèye: 13.0 and Kollo: 16.0. M/F sex ratio: 0.96. Age (years) distribution of cases was <1: 13.1% (15/114), 1-4: 84.3% (96/114), and 5-14: 2.6% (3/114). The overall Positive Predictive Value was 1.4% (2/141). Conclusion: The enhanced CBS in Tillabéri Region was useful, sensitive, representative, complex, neither reactive nor acceptable. Its timeliness and acceptability could be improved if Community Relays were established and introduced to their respective communities.