Evaluation of measles and acute flaccid paralysis surveillance systems in Southern Province, Zambia, 2022 - 2024

Abstract

<jats:p>Abstract Background: The Vaccine-Preventable Disease (VPD) surveillance system in Zambia integrates routine immunization monitoring with disease surveillance to guide control measures. In 2022, Zambia recorded 422 measles cases and 37 deaths, with Southern Province recording the highest case fatality rate (11.2%), suggesting possible weaknesses in surveillance performance and outbreak response systems. This evaluation assessed the measles and acute flaccid paralysis (AFP) surveillance systems in Southern province of Zambia from 2022 to 2024. Methods: We conducted a cross-sectional surveillance system evaluation following the Centers for Disease Control and Prevention (CDC) guidelines. We purposively selected three districts and three facilities from each district, based on measles and AFP case burden and vaccination coverage. We collected data on system’s simplicity, usefulness, and acceptability from 27 participants using structured questionnaires. We also collected data from the electronic Integrated Disease Surveillance and Response (eIDSR) system and World Health Organization databases to assess, data completeness, timeliness, and accuracy. Results were summarized using frequencies and percentages. Results: The measles and AFP surveillance systems comprised both passive and active surveillance operating across community, health facility, district, and provincial levels. The systems demonstrated high levels of simplicity (mean score: 84.6%), usefulness (90.5%), and acceptability (90.8%). However, surveillance performance was limited by suboptimal data quality, with mean completeness of 66.7%, timeliness of 51.1%, and data accuracy of 50%. We also identified key operational challenges of inadequate specimen transportation and insufficient program funding. Conclusion: The measles and AFP surveillance systems in Southern Province are functional, simple, acceptable, and well-integrated into routine services. However, significant gaps in data quality limit their effectiveness for early outbreak detection and timely public health response. Strengthening data management, specimen transport, and sustainable program financing will be critical to improving surveillance performance and accelerating progress toward vaccine-preventable disease control and elimination targets. Keywords: Acute Flaccid Paralysis (AFP), measles, surveillance systems, vaccine-preventable disease, Zambia.</jats:p>