Evaluation of measles surveillance system in Enugu State, South - East Nigeria, 2010 - 2015

Introduction : measles remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. The disease is endemic in Nigeria. In 2005, measles case-based surveillance was introduced in Nigeria. Hence, between January and March 2017, we evaluated Enugu State Measles Surveillance System in order to describe the various attributes of the system, determine whether the system is meeting its set public health objectives, identify gaps in the surveillance system and recommend appropriate measures for improvement. Methods : we analyzed the Measles case-based surveillance data between 2010 and 2015. Primary data were collected from relevant State officers using standardized questionnaires. We evaluated the performance of the surveillance system using CDC updated guidelines 2001, to determine the relevance, effectiveness and impact of the system in the light of its set objectives. We used Epi-info 7.2 and microsoft excel for analysis. Results : twelve percent of the 1180 reported cases tested positive for Measles IgM with 0.7% case fatality rate. 58% of the confirmed cases occurred in children less than 5 years old and 80% of them were rural dwellers. The highest reported cases of 20% and 26% occurred in 2011 and 2015 respectively. The highest annualized incidence of confirmed cases per 10,000 population was 13.5 in 2011 and the lowest was 1.2 in 2015. The State was able to meet the target for most of the performance indicators. However, less than 15% of blood specimens collected from suspected cases arrived laboratory timely except for the 50% in 2010. The system was rated useful, simple, flexible, acceptable but more training is required. 18% of the data was missing and the system was donor driven. The Predictive Value Positive was less than 25% across the years under review. Few private health facilities were involved. Conclusion : the system was useful, simple, flexible, acceptable, and meets its objectives. However, the system was unstable with suboptimal data quality and timeliness of arrival of samples to laboratory and representativeness needs further improvement. Training of operators and sensitization of private facilities is crucial.