Evaluation of surveillance performance and determinants for priority vaccine-preventable diseases in Niger State, Nigeria: A CDC 2001 Guideline-based multilevel analysis

Vaccine-preventable diseases (VPDs) remain important causes of morbidity and mortality in sub-Saharan Africa, and evidence on subnational surveillance performance in Nigeria remains limited. We conducted a cross-sectional analytic evaluation of surveillance systems for measles, diphtheria, acute flaccid paralysis (AFP), and cerebrospinal meningitis (CSM) in Niger State, Nigeria. Data were collected from 415 clinicians, community resource persons, and surveillance focal persons across 12 purposively selected Local Government Areas using structured questionnaires adapted from CDC surveillance evaluation guidelines and aligned with IDSR guidance. Surveillance performance was assessed using sensitivity, data quality, and stability. Analyses included descriptive statistics, bivariate tests, and multivariable regression models. Reported suspected case detection was higher for measles and AFP than for CSM and diphtheria, with detection reported by 94.2% and 93.0% of respondents for measles and AFP, respectively, compared with 84.3% for CSM and 81.4% for diphtheria. Transport availability without delays was consistently associated with lower odds of surveillance failure across disease-specific models, including measles sample collection (aOR = 0.12, 95% CI: 0.05–0.28) and case confirmation (aOR = 0.07, 95% CI: 0.02–0.21), diphtheria sample collection (aOR = 0.18, 95% CI: 0.06–0.49) and confirmation (aOR = 0.22, 95% CI: 0.08–0.58), and CSM sample collection (aOR = 0.18, 95% CI: 0.06–0.54) and confirmation (aOR = 0.21, 95% CI: 0.07–0.61). Active guideline use was associated with AFP sample collection (aOR = 4.12, 95% CI: 1.72–9.87). Only 66.5% of respondents reported fully accurate submitted forms, and financial support was associated with lower odds of instability (aOR = 0.74, 95% CI: 0.56–0.97). Strengthening transport, infrastructure, financing, and data quality systems may improve VPD surveillance performance and outbreak preparedness in similar settings.