An assessment of the operationality and factors influencing the effectiveness of rabies surveillance in Gombe State, Nigeria

Rabies remains a burden in Africa, disproportionately affecting the most vulnerable despite the availability of effective vaccines. Nigeria, the most populous African country, needs rapid disease control actions and commitments to achieve the goal of eliminating dog-mediated rabies by 2030. Surveillance is an essential element of effective disease control strategies. This study examined the current state of operationality of the rabies surveillance system for early case detection and management in Gombe state, Nigeria, through a One Health lens. It further examined the barriers impeding the effectiveness of the surveillance based on the perception of surveillance workers. Qualitative and quantitative methods were used to assess the structure of the system and its functioning. Data on dog bite and rabid cases obtained from the veterinary services in Gombe state were analysed descriptively. A total of 13 key informants were interviewed using a semi-structured interview guide. Qualitative data were analysed using thematic analysis to explore in depth the factors that influenced the operationality of the system. A total of 157 potential human exposures to rabies were identified in this study, out of which two people reportedly died at the health facility after showing symptoms highly suggestive of rabies. In terms of rabies surveillance and control, cross-sectoral collaboration was found between the human health and veterinary sectors for risk assessment of potential rabies exposures and its management. Some identified factors affecting the operations of the surveillance were inadequate funding, lack of infrastructure, lack of feedback from higher authorities and insufficient knowledge of rabies prevention and management. To improve the capacity for case detection and management within the state, the appropriate authorities may focus on increasing awareness about the disease to the populace to increase the number of cases identified by the system, employ more workers and strengthen the surveillance capability of existing workers.

Mapping guide for surveillance system activities I will show you a map that I have created in Microsoft PowerPoint.The information I used to produce this overview map included the National Rabies Elimination Guideline and the Nigerian One Health Strategic Plan.The map illustrates the rabies reporting channels and information flows of the system.I will ask you a few questions in relation to this map.
1. Is this map an accurate representation of the rabies surveillance system as you know it?Why? 2. Is there anything that is wrongly displayed on this map?Could you describe it?3. Is there any missing information on the map?If yes, please can you kindly explain them.4. Based on your knowledge, can you explain the responsibility of your unit as displayed in the map? 5. What data is generated from your unit with regards rabies surveillance?6.What is done with the data once they are generated?(sent immediately to the next unit or analysed).7. Based on your knowledge, who else do you most closely collaborate with and what is their role?8. Can you describe integration mechanisms with your unit and other parts of the system?
Integration can be any form of collaboration, sharing, exchange, or coordination in the surveillance system and can refer to data collection, data analysis, use of the information, decision made on the information, governance, budget, or similar.I would be particularly interested in any integration points or mechanisms between human surveillance and animal surveillance?9. Can you describe areas of inter-operation between human surveillance and animal surveillance?Inter-operation means the ability of the system or components to work with another without any special effort.For example, sharing of a common database between the health and veterinary sector.

Surveillance system evaluation
Different guidelines have been developed for evaluating attributes of the surveillance system attributes.The questions for this interview guide were adapted from existing guidelines such as the CDC, RiskSurv/SurvTools, and SERVAL guidelines.
The questions below refer to the overall surveillance system as shown in the map.If you would like to comment on particular aspects of the system, please specify them.

Simplicity:
This refers to the ease of operations and data flow within the surveillance system.
1. On a scale from 1 to 5 where 1 is simple and 5 is complicated, how would you score the simplicity of the surveillance system spanning both humans and animals?(Is the disease reporting and data management process easy and clear to you?) What is your reason for giving this score?2. Are there any the objectives of the rabies surveillance system?If yes, what are the objectives?3. Do you have a case definition for rabies (humans/animals) in your surveillance system?Is it written?4. How easy is it for you to understand the case definition? 5.In your view, on a scale of 1 to 5, where 1 means extremely simple and 5 stands for complication.How easily does information flow through the surveillance system within one sector?What is your reason for giving this score?6.On a scale of 1 to 5, where 1 means extremely simple and 5 stands for complication.How easily does information flow between Health and veterinary services?What is your reason for giving this score?

Acceptability:
This refers to the willingness of people to actively participate in the surveillance system activities.
1. On a scale of 1 to 5, where 1 means not active and 5 means extremely active.How actively do owners of dogs with suspected rabies or their families or communities report cases to the health or veterinary service?What is your reason for giving this score?2. On a scale of 1 to 5, where 1 means not engaged while 5 means extremely engaged.How engaged are Doctors/Veterinarians/surveillance officers involved in the active identification of suspected and confirmed rabies cases in humans/animals?What is your reason for giving this score?3. On a scale of 1 to 5, where 1 means not engaged while 5 means extremely engaged.How engaged are Doctors/Veterinarians/surveillance officers in the active identification of suspected and confirmed humans/animals rabies cases?What is your reason for giving this score?4. In your view, are there certain groups that you would like to be more active in the surveillance system?Which ones and why? 5. What are the challenges affecting the willingness/motivation of workers within the surveillance system to actively participate in the system? 6.On a scale of 1 to 5, where 1 means zero acceptance and 5 means high acceptability.What is the acceptability of the surveillance information are the veterinary and health sector about