Omoleke and de Kiev’s evaluation revealed that the AEFI surveillance system in Kebbi State had major weaknesses affecting sensitivity and representativeness. From a public health perspective, I think the most serious design limitation is under-reporting due to passive surveillance and limited stakeholder participation. Many healthcare workers may not recognize or report all AEFI cases, especially from peripheral or private facilities.
To address this within six weeks, I would introduce targeted active case finding in a few sentinel sites combined with short refresher trainings and supervision visits. This would quickly raise awareness, improve reporting completeness, and provide data to benchmark sensitivity.
1. Key design limitation and short-term action
Limitation: Reliance on passive reporting → high risk of missed AEFI cases.
Action: Conduct a six-week rapid active surveillance at selected high-volume sites and cross-check facility records against AEFI reports.
Rationale: This can estimate under-reporting and improve representativeness without redesigning the whole system.
2. Low-cost intervention to increase sensitivity
Using CDC surveillance attributes, one low-cost intervention could be:
Intervention: Implement a simple WhatsApp-based AEFI notification group for frontline health workers.
Expected trade-offs:
↑ Sensitivity and timeliness
↓ Data completeness and risk of unverified reports (false positives)
Indicators to track impact:
Number of AEFI reports submitted per month (baseline vs post-intervention)
Proportion of reports verified within 72 hours
Number of facilities actively contributing reports
This approach builds on simplicity and communication—two attributes already identified as partial strengths.
3. Broadening case definition for new vaccine
In my view, temporarily broadening the case definition makes sense at the start of a new vaccine introduction because early detection of unexpected signals is crucial.
Yes: It should be broadened initially to capture any unusual reactions.
Trigger to revert: After about two to three months or once the background AEFI rate stabilizes and no new safety signals emerge, the definition can revert to the standard one to avoid overburdening the system.
If the system capacity is already low, over-reporting could create false alarms—but early vigilance outweighs that short-term burden.