title: Strategies for Improving Polio Surveillance Performance in the Security-Challenged Nigerian States of Adamawa, Borno, and Yobe During 2009-2014.
abstract: BACKGROUND
  The security-challenged states of Adamawa, Borno, and Yobe bear most of the brunt of the Boko Haram insurgency in Nigeria. The security challenge has led to the killing of health workers, destruction of health facilities, and displacement of huge populations. To identify areas of polio transmission and promptly detect possible cases of importation in these states, polio surveillance must be very sensitive.
  
  
  METHODS
  We conducted a retrospective review of acute flaccid paralysis surveillance in the security-compromised states between 2009 and 2014, using the acute flaccid paralysis database at the World Health Organization Nigeria Country Office. We also reviewed the reports of surveillance activities conducted in these security-challenged states, to identify strategies that were implemented to improve polio surveillance.
  
  
  RESULTS
  Environmental surveillance was implemented in Borno in 2013 and in Yobe in 2014. All disease surveillance and notification officers in the 3 security-challenged states now receive annual training, and the number of community informants in these states has dramatically increased. Media-based messaging (via radio and television) is now used to sensitize the public to the importance of surveillance, and contact samples have been regularly collected in both states since 2014.
  
  
  CONCLUSIONS
  The strategies implemented in the security-challenged states improved the quality of polio surveillance during the review period.
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Abdullahi Walla
authors.initials: AW
authors.lastname: Hamisu
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Ticha Muluh
authors.initials: TM
authors.lastname: Johnson
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Kehinde
authors.initials: K
authors.lastname: Craig
authors.affiliation: World Health Organization, Regional Office for Africa, Brazzaville, Congo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Mkanda
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Richard
authors.initials: R
authors.lastname: Banda
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Sisay G
authors.initials: SG
authors.lastname: Tegegne
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Ajiboye
authors.initials: A
authors.lastname: Oyetunji
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Nuhu
authors.initials: N
authors.lastname: Ningi
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Said M
authors.initials: SM
authors.lastname: Mohammed
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Mohammed Isa
authors.initials: MI
authors.lastname: Adamu
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Khalid
authors.initials: K
authors.lastname: Abdulrahim
authors.affiliation: Global Public Health Solutions, Atlanta, Georgia.
authors.forename: Peter
authors.initials: P
authors.lastname: Nsubuga
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Rui G
authors.initials: RG
authors.lastname: Vaz
authors.affiliation: National Primary Health Care Development Agency, Abuja, Nigeria.
authors.forename: Ado J G
authors.initials: AJ
authors.lastname: Muhammed
mesh_terms: D049674:History, 21st Century; D006801:Humans; D009549:Nigeria / Q000453:epidemiology; D011051:Poliomyelitis / Q000453:epidemiology* / Q000266:history; D011159:Population Surveillance / Q000379:methods; D058996:Quality Improvement; D012189:Retrospective Studies
keywords: community informants; cross border importations; security challenge; surveillance performance