Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 12;23(1):2227.
doi: 10.1186/s12889-023-17141-1.

Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015-2021: a retrospective analysis

Barnabas Bessing  1 , Edward A Dagoe  2 , Deborah Tembo  3 , Alice Mwangombe  4 , Muzala K Kanyanga  3 , Fadinding Manneh  5 , Belem B Matapo  4 , Patricia M Bobo  6 , Musole Chipoya  7 , Victor A Eboh  8 , Princess L Kayeye  6 , Penelope K Masumbu  4 , Chilweza Muzongwe  6 , Nathan N Bakyaita  4 , Delayo Zomahoun  2   9 , Jude N Tuma  2   9
Affiliations

Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015-2021: a retrospective analysis

Barnabas Bessing et al. BMC Public Health. .

Abstract

Background: The resurgence of poliovirus infection in previously polio free regions and countries calls for renewed commitment to the global polio eradication efforts including strengthening of Acute Flaccid Paralysis (AFP) surveillance systems. Zambia is one of the countries substantially at risk for the importation of poliovirus infection from neighbouring countries including Malawi, Mozambique, and Democratic Republic of the Congo (DRC). This study describes a seven-year AFP surveillance, assesses the surveillance indicators, and highlights areas for improvement.

Methods: We conducted retrospective analysis of the routinely collected AFP surveillance data from January 2015 to December 2022. The AFP surveillance indicators performance was assessed using the World Health Organisation's recommended minimum AFP surveillance indicators performance.

Results: Cumulatively, a total of 1715 AFP cases were reported over the study period. More than half, 891 (52%) of reported cases were aged < 5 years with 917 (53.5%) of males. More than half, 1186 (69.2%) had fever at onset, 718 (41.9%) had asymmetric paralysis and 1164 (67.9%) had their paralysis progressed within 3 days of onset. The non-polio AFP rate ranges from 3.4 to 6.4 per 100,000 children < 15 years old and stool adequacy ranging from 70.9% to 90.2% indicating sensitive surveillance with late detection of cases. The percentage of cases with early stool collection, timely transportation was above the World Health Organisation (WHO) minimum of 80% but with declining proportion of stools arriving in the laboratory in optimal condition. Completeness of 60-days follow-up evaluation was suboptimal ranging from 0.9% to 28.2%.

Conclusion: The AFP surveillance system in Zambia is doing well. However, additional efforts are needed to improve early detection of cases; stool sample collection, transportation and monitoring to ensure arrival in good condition in the laboratory; and improve 60-days follow-up evaluation for evidenced-based classification of inadequate AFP cases and proper care.

Keywords: Acute Flaccid Paralysis; Indicators; Poliomyelitis; Surveillance; Zambia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of AFP surveillance system in Zambia. HW: Health Worker; SFP: Surveillance Focal Person; District Surveillance Officer; Provincial Surveillance Officer; World Health Organisation Surveillance Officer; MOH: Ministry of Health; ZNPHI: Zambia National Public Health Institute
Fig. 2
Fig. 2
Zambia annualized NPAFP rate from 2015–2021
Fig. 3
Fig. 3
Pattern of non-polio acute flaccid paralysis rates by districts in Zambia from 2015–2021
Fig. 4
Fig. 4
Pattern of stool adequacy rate performance of AFP cases in Zambia from 2015–2021
Fig. 5
Fig. 5
Pattern of stool adequacy rate performance of AFP cases by districts in Zambia from 2015–2021
Fig. 6
Fig. 6
Pattern of achievement of two core AFP surveillance indicators by districts in Zambia from 2015–2021
Fig. 7
Fig. 7
Pattern of % stool sample arriving in good condition in the WHO-accredited lab by districts in Zambia from 2015–2021
See this image and copyright information in PMC

References

    1. Zerriouh F, Khader Y, Qasem N, et al. Evaluation of the acute flaccid paralysis surveillance system in polio-Free Jordan, 2012–2016: retrospective secondary analysis. JMIR Public Health Surveill. 2019;5(3):e14217. doi: 10.2196/14217. - DOI - PMC - PubMed
    1. Raji IA, Abubakar AU, Ahmad A, et al. Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012–2019: a secondary data analysis. BMC Public Health. 2021;21(1):1–9. doi: 10.1186/s12889-021-11238-1. - DOI - PMC - PubMed
    1. Odoom JK, Ntim NAA, Sarkodie B, et al. Evaluation of AFP surveillance indicators in polio-free Ghana, 2009–2013. BMC Public Health. 2014;14(1):1–8. doi: 10.1186/1471-2458-14-687. - DOI - PMC - PubMed
    1. Jasem JA, Marof K, Nawar A, et al. An epidemiological analysis of acute flaccid paralysis and its surveillance system in Iraq, 1997–2011. BMC Infect Dis. 2014;14(1):1–9. doi: 10.1186/1471-2334-14-448. - DOI - PMC - PubMed
    1. Watkins RE, Martin PAJ, Kelly H, et al. An evaluation of the sensitivity of acute flaccid paralysis surveillance for poliovirus infection in Australia. BMC Infect Dis. 2009;9(1):1–13. doi: 10.1186/1471-2334-9-162. - DOI - PMC - PubMed

Publication types

Substances

Supplementary concepts