Evaluation of the Cerebrospinal Meningitis Surveillance System: Lessons from the 2025 outbreak in Sokoto state, Nigeria
1
1 Africa Epidemic Services, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
2
2 Epidemiology Unit, Sokoto State Ministry of Health, Sokoto, Nigeria
3
3 Department of Planning, Research, and Statistics, Nigeria Center for Disease Control and Prevention, Abuja, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A3428
ABSTRACT
BACKGROUND:
Cerebrospinal meningitis (CSM) is endemic in Nigeria, with seasonal outbreaks in northern states causing substantial morbidity and mortality. Sokoto State reported 845 suspected cases and 72 deaths during the February to May 2025 outbreak. Effective surveillance during outbreaks is essential for timely action and reducing preventable outcomes. We evaluated the Sokoto State CSM surveillance system to determine its performance.
METHODS:
We conducted a retrospective evaluation of the surveillance system from February to September 2025 using the CDC guidelines for evaluating public health surveillance systems. We assessed reporting timeliness, data quality, and sensitivity through a review of line lists, laboratory reports, and case investigation forms (CIF). System attributes: simplicity, acceptability, representativeness, usefulness, and coverage were evaluated through structured interviews with 160 purposively selected surveillance officers across all 23 Local Government Areas (LGAs), and key informant interviews with five state level stakeholders. Quantitative data were analyzed descriptively in R, and qualitative findings summarized thematically.
RESULTS:
Of 845 suspected cases, 80% were reported from LGA to state level within 24 hours of facility notification, 37% had complete CIFs, and 98% had consistent demographic and clinical information across reporting tools. Among the suspected cases, only 113 (13.3%) had specimens collected for laboratory confirmation. Most surveillance officers reported high motivation (93%), ease of using reporting tools (96%), and routine use of surveillance data for response planning (90%), although only 70% achieved full coverage of their assigned areas. Interviews showed insecurity in multiple communities and a substantial workforce turnover that resulted in many newly deployed and undertrained surveillance officers.
CONCLUSIONS:
The surveillance system demonstrated good timeliness, accuracy, and operational usefulness but sub optimal coverage, low completeness, and minimal specimen collection. Structured training for new officers and improving operational access to insecure communities is essential for maintaining robust surveillance systems in endemic settings.
Cerebrospinal meningitis (CSM) is endemic in Nigeria, with seasonal outbreaks in northern states causing substantial morbidity and mortality. Sokoto State reported 845 suspected cases and 72 deaths during the February to May 2025 outbreak. Effective surveillance during outbreaks is essential for timely action and reducing preventable outcomes. We evaluated the Sokoto State CSM surveillance system to determine its performance.
METHODS:
We conducted a retrospective evaluation of the surveillance system from February to September 2025 using the CDC guidelines for evaluating public health surveillance systems. We assessed reporting timeliness, data quality, and sensitivity through a review of line lists, laboratory reports, and case investigation forms (CIF). System attributes: simplicity, acceptability, representativeness, usefulness, and coverage were evaluated through structured interviews with 160 purposively selected surveillance officers across all 23 Local Government Areas (LGAs), and key informant interviews with five state level stakeholders. Quantitative data were analyzed descriptively in R, and qualitative findings summarized thematically.
RESULTS:
Of 845 suspected cases, 80% were reported from LGA to state level within 24 hours of facility notification, 37% had complete CIFs, and 98% had consistent demographic and clinical information across reporting tools. Among the suspected cases, only 113 (13.3%) had specimens collected for laboratory confirmation. Most surveillance officers reported high motivation (93%), ease of using reporting tools (96%), and routine use of surveillance data for response planning (90%), although only 70% achieved full coverage of their assigned areas. Interviews showed insecurity in multiple communities and a substantial workforce turnover that resulted in many newly deployed and undertrained surveillance officers.
CONCLUSIONS:
The surveillance system demonstrated good timeliness, accuracy, and operational usefulness but sub optimal coverage, low completeness, and minimal specimen collection. Structured training for new officers and improving operational access to insecure communities is essential for maintaining robust surveillance systems in endemic settings.
| eISSN: | 2654-1459 |
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