Abstract:
Background: Effective surveillance is critical for the early detection and control of Mpox outbreaks. In Zambia, the performance of the Mpox surveillance system has not been systematically assessed since its implementation under the Integrated Disease Surveillance and Response framework. We evaluated the Mpox surveillance system in Central Province to determine its performance and identify gaps that could affect timely detection and response.
Methods: We conducted a cross-sectional study using the United States Centers for Disease Control and Prevention updated guidelines for public health surveillance system evaluation. We collected data from provincial, district, and health facility surveillance personnel using a semi-structured questionnaire and reviewed Mpox surveillance linelist, laboratory records, and electronic Integrated Disease Surveillance and Response (eIDSR) dataset. We assessed surveillance system attributes using predefined indicators. We derived attribute scores by averaging indicator proportions within each attribute and classified performance using predetermined thresholds. We summarized referral and laboratory turnaround times using medians and interquartile ranges.
Results: A total of 74 surveillance personnel completed the questionnaire. Analysis of provincial line list identified 102 suspected Mpox cases, of which 41 were laboratory confirmed, yielding a positive predictive value of 40.2%. The surveillance system was representative and demonstrated high acceptability (85.8%) and completeness (96.4%). Simplicity (79.3%), timeliness (66.2%), usefulness (64.9%), and stability (60.4%) were rated as moderate, while data quality was poor (56.8%). Review of surveillance records showed that 88.7% of specimens were referred to the laboratory within 48 hours of collection, with a median referral delay of 0 days (IQR: 0–1) day. However, only 9.1% of laboratory results were reported within 72 hours, with a median laboratory turnaround time of 6 days (IQR: 4–12.5) days. Inconsistencies were observed across surveillance datasets, including differences in reported case counts and absence of a unique identifier for linking laboratory to surveillance records. Qualitative responses identified training and knowledge gaps (33/74, 44.6%), and shortages of personnel (16/74, 21.6%) as key barriers to effective surveillance implementation.
Conclusion: The Mpox surveillance system in Central Province, Zambia was useful, acceptable, and capable of monitoring Mpox occurrence across the province. However, weaknesses in data quality, record linkage, delayed laboratory turnaround time, training and workforce capacity may limit its effectiveness in supporting timely public health action. Strengthening data management systems, laboratory processes, and surveillance workforce capacity could improve overall system performance.
Biography:
Azibadighi Walter is an Africa Epidemic Service (AES) Fellow with the Africa Center for Disease Control and Prevention, currently attached to the Zambia National Public Health Institute. She holds a Master of Public Health in Epidemiology and Biostatistics from the University of Ibadan, Nigeria, and previously served as an EDCTP-supported Epidemiology and Biostatistics Fellow. She is currently pursuing a PhD in Public Health at the University of Port Harcourt, Nigeria. Her interests include infectious disease epidemiology and health systems strengthening, with a focus on generating evidence to inform public health policy and practice in Africa.
