The Quality of Poliomyelitis Linked Acute Flaccid Paralysis Surveillance Systems in Zambian Districts Bordering Angola and the Democratic Republic of Congo

Objective: To evaluate the quality of poliomyelitis linked Acute Flaccid Paralysis (AFP) surveillance system in Zambian districts bordering Angola and the Democratic Republic of Congo.Design: A concurrent mixed method design was used to collect data in 7 of 9 provinces; cross sectional surveys, a retrospective descriptive analysis on secondary AFP surveillance data and routine immunization trivalent Oral Polio Vaccine (tOPV) coverage data collected between 2000 and 2009. A case study on community based AFP surveillance was conducted utilizing focus group discussions.Results: Sixteen out of twenty-five districts did not attain 90% target for OPV 3 immunization in the period under review (2000 to 2009).All provinces attained the 80% target of the stool adequacy indicator while the Nonpolio AFP rate indicator of 2/100,000 children aged <15 years was not attained. Levels of knowledge on all aspects of AFP surveillance were generally low regardless of administrative level (province, district & health facility) duration of service, work department, profession and geographical location.Knowledge levels were lowest (P value=<.0001) at health facility level (8.4%). Only 31.8% heath workers were trained across all levels. Logistics for AFP surveillance were not adequate at health facility level. There was inadequate staffing and supervision for AFP surveillance, especially at health facility level. Focus group discussions revealed that communities were not involved and not sensitized in AFP surveillance.Conclusions: There is suboptimal AFP surveillance quality in districts bordering Angola and DRC. The gaps identified need to be addressed, or could result in failure to detect imported wild polio viruses from neighbouring countries or from any part the world. This would lead to sustained transmission of the polio virus and resurgence of poliomyelitis, given the fluctuatingt OPV 3 immunization coverage