Usefulness, acceptability, representativeness and reactivity of community based surveillance in insecurity settings, tillaberi region - niger

Intro: Insecurity in Tillaberi region in Niger is a threat to the poliomyelitis eradication achievement due to weakened public health systems. Community- Based Surveillance (CBS) is implemented since June 2017 to strengthen Acute Flaccid Paralysis (AFP) surveillance but its performance is not yet assed. The purpose is to describe the CBS's usefulness, acceptability, representativeness and reactivity in Tillaberi region. Methods: This is a cross sectional study that included all AFP cases notified by surveillance system from January 2014 to July 2022. “CDC-Atlanta Guidelines 2003” were used to assess the studied attributes. We performed descriptive analysis using defined variables presented in proportions, median, interquartile range (IQR) and sex ratio. Usefulness: Non Polio AFP Rate (NPAFP-R) before CBS (2014) and during CBS (2022). Acceptability: percentage of stool samples collected within 14 days after paralysis onset and received to the laboratory in good condition. Representativeness: true AFP cases, AFP cases age group and their distribution in place and time. Reactivity: timeline between paralysis onset and the stool samples reception at the national laboratory. Findings: The NPAFP-R per 100,000 under 15 children ranged from 1.9 in 2014 to 26.1 in 2022. The percentage of AFP cases with two stool samples collected within 14 days after paralysis onset and received at the laboratory in good condition was 73.4%(122/166). True AFP cases represented 97.6%(166/170), belonged to under 15 age group, were from all CBS implementing districts and were notified every year of CBS implementation. Male to female sex ratio was 1.27(93/73). The median timeline between the paralysis onset and stool samples reception at the laboratory was 21 days, IQR (16-31). Conclusion: CBS was useful, representative, less acceptable and not reactive. Stakeholders capacity building, monitoring and appropriate means for samples transportation from the collection site to the national laboratory could improve its acceptability and reactivity.