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ISDS 2012 Conference Abstracts

Evaluation of Cholera and Other Diarrheal Disease
Surveillance System, Niger State, Nigeria-2012
Adebobola T. Bashorun*1, Anthony Ahumibe1, Saliman Olugbon1, Patrick Nguku1 and
Kabir Sabitu2

1Nigeria Field Epidemiology and Laboratory Training Program, FCT, Nigeria; 2Ahmadu Bello University, Zaria, Nigeria

Objective
To determine how the cholera and other diarrheal disease surveil-

lance system in Niger state is meeting its surveillance objectives, to
evaluate its performance and attributes and to describe its operation
to make recommendations for improvement.

Introduction
Cholera causes frequent outbreaks in Nigeria, resulting in mortal-

ity. In 2010 and 2011, 41,936 cases (case fatality rate [CFR]-4.1%)
and 23,366 cases (CFR-3.2%) were reported (1). Reported cases in
Nigeria by week 26, 2012 was 309 (CFR-1.29%) involving 20 Local
Government Areas in 6 States. In Nigeria, there are currently eleven
(11) States including Niger state at high risk for cholera/bloodless di-
arrhea outbreaks.

In 2011, Niger state had 2472 cholera cases (CFR-2%) and 45,111
other diarrhea diseases cases, recorded in more than half of state Pur-
pose of surveillance system is to ensure early detection of cholera
and other diarrheal cases and to monitor trends towards evidence-
based decision for management, prevention and control.

Methods
We conducted evaluation in July, 2012. We used CDC guideline on

surveillance system evaluation (2001) as guide to assess operation,
performance and attributes (2). We conducted key informant/in-depth
interviews with stakeholders. We examined cholera action plans for
preparedness and response, conducted laboratory assessment, ex-
tracted and analyzed cholera surveillance (2005-2012) for frequen-
cies/proportions using Microsoft Excel. Thematic analysis was done
for qualitative data. We shared findings with stakeholders at all lev-
els.

Results
Surveillance system was setup for early detection and monitoring

towards evidence-based decision. State government funds system.
Case definition used is highly sensitive and is any patient aged 5 years
or more who develops acute watery diarrhea, with/without vomiting.
Though simple case definition, laboratory confirmation makes sur-
veillance complex. A passive system, active during outbreaks; has
formal and informal sources of information and part of Integrated
Disease Surveillance and Response (IDSR) system and flow(fig.1). It
takes 24-48 hours between outbreaks onset, confirmation and re-
sponse.

Line list showed undefined/poorly labeled outcomes. Of 2472
cases in 2011 1320 (49%) were found in line list. 2011 monthly data
completeness was 75%. So far in 2012, 5(0.02%) of all diarrhea cases
were cholera. System captures only age as sociodemographics.

Of 11 suspected cholera cases tested during 2011 epidemic, 7 con-
firmed as cholera (PPV-63%). Of 3 rumours of cholera outbreaks
(January 2011-July 2012), one (PPV-33%) was true. Acceptability of
system is high among all stakeholders interviewed. Timeliness of
monthly reporting was 68.7% (Table 1). 

Laboratory can isolate Vibro cholerae isolation but has no Cary
Blair transport medium and cholera rapid test kits.

Conclusions
Evaluation revealed that surveillance system is meeting its objec-

tives by early detection and response to cholera outbreaks. System is
simple, stable, flexible, sensitive with poor data quality, low PPV, fair
laboratory capacity and moderate timeliness. We recommended elec-
tronic and internet-based reporting for timeliness and data quality im-
provement; and provision of laboratory consumables.

Table 1. Summary of performance attributes of cholera surveillance system,
Niger state, 2012.

Keywords
Surveillance; Evaluation; Cholera; Nigeria

Acknowledgments

Niger State Ministry of Health

References

1. Federal Ministry of Health, Nigeria Weekly Epidemiology Reports,
NCDC/Federal Ministry of Health – Nigeria Volume 1 No 1-52. 2011

2. Centers for Disease Control and Prevention. Updated guidelines for
evaluating public health surveillance systems: recommendations from
the guidelines working group. MMWR 2001;50 (No. RR-13)

*Adebobola T. Bashorun
E-mail: bashogee@yahoo.com

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e146, 2013