1. Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
The stability or resilience of the AEFI surveillance system of the Kebbi State most threatens the valid estimates of sensitivity and representativeness. According to the study, 88.7% of respondents reported that lack of resources interrupted the AEFI surveillance system. This may lead to high degree of underreporting of AEFI cases, affecting the sensitivity and representativeness of the system. This can be addressed by increasing the investment to the lacking resources (financial resources, human resources, and logistics such as data tools) in order for the AEFI system to be fully operational.
2. Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.
Since interviews and FGDs revealed that some health workers lacks positive attitude towards AEFI reporting and the community have low awareness about AEFI and its reporting, a low-cost intervention to increase the sensitivity of the system is by educating the health workers and the community about the importance of AEFI reporting and surveillance. The expected trade-offs are it will take some time to educate and convince everyone to report AEFI cases and will be added workload to the health worker tasked in educating others. Two indicators to detect the impact from the intervention are increased number of AEFI cases reported and increased participation of the community in AEFI reporting.
3.For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
Because it is a new vaccine, yes, the AEFI case definition should be temporarily broadened to maximize early signal detection. The trigger to revert to the prior definition is when high number of false positive cases were detected.