JMIR Publications

ABSTRACT

Background:

Nigeria was declared polio-free in 2020, yet recent outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) have re-exposed vulnerabilities in its disease surveillance infrastructure. Figures from the April 2025 National Immunization Plus Days (NIPDs) provide compelling evidence of systemic weaknesses, including limited geographic reach, overstated performance indicators, and operational bottlenecks

Objective:

This report aims to critically assess Nigeria’s AFP surveillance system performance during the April 2025 NIPDs and provide actionable policy recommendations for closing gaps in disease detection and campaign quality.

Methods:

The analysis used programmatic data from April 2025 NIPDs, specifically focusing on three key figures namely geo-evidence showing only 71% of settlements were reached, LQAS coverage results indicating 88% of LGAs met the ≥90% threshold and field-level documentation of execution challenges, including delays and weak supervision. The findings were analyzed against national AFP surveillance indicators: NP-AFP rate (11.9), Stool Adequacy (99%), and NPENT (12.1%).

Results:

Despite high national averages, field data revealed alarming disparities. Surveillance coverage remains geographically inconsistent, with nearly 30% of settlements untracked. Reported LQAS performance may not reflect true household-level coverage. Operational issues, especially supervision and feedback systems, continue to hinder field effectiveness. Virus detection has also declined, with only 9 states reporting, down from 15 previously.

Conclusions:

Nigeria’s surveillance system, while strong at the center, remains operationally weak in critical peripheries. Surveillance success on paper may obscure deficiencies in field validation, community engagement, and timely outbreak response. Without urgent reforms, these gaps risk reversing the country’s polio-free status and weakening broader epidemic preparedness. To close the identified surveillance gaps, Nigeria must pursue a strategic mix of policy interventions and operational reforms. Independent surveillance audits should be conducted in low-performing LGAs to validate AFP case detection accuracy and geographic reach, using geo-tagged verification tools. The expansion of mobile-enabled community informant networks comprising local leaders, religious figures, teachers, and birth attendants will play a vital role in strengthening early case identification and grassroots surveillance. Additionally, the establishment of accountability metrics and performance-linked incentives is essential to reward prompt detection and discourage under-reporting. Strengthening LQAS implementation will also require external validation, community transparency, and random spot checks to ensure that reported figures reflect true field performance. Finally, systemic execution challenges such as poor supervision, logistical delays, and data flow inefficiencies must be addressed through operational redesign, supervisor retraining, and digital infrastructure upgrades. The health impact of ineffective surveillance is not abstract, it translates into vulnerable children, unchecked virus transmission, and increased risk of public health emergencies. Strengthening surveillance is both a technical and moral imperative, vital to preserving public trust and national health security.