<b>Mixed-methods assessment of systemic weaknesses and operational factors affecting the effectiveness of disease surveillance system for cholera control in Nasarawa State, Nigeria</b><b></b>

Abstract

Cholera remains a major public health concern in Nasarawa State despite existing surveillance policies. This study assessed the effectiveness of the disease surveillance system using a mixed-methods cross-sectional design involving 82 health personnel. Findings showed a relatively functional system, with high participation in the Integrated Disease Surveillance and Response (IDSR) framework (98.8%), timely reporting (95.1%), and good report completeness (87.8%). However, significant challenges persist, including inadequate funding, shortage of trained personnel, weak laboratory capacity, and poor epidemic response logistics. Only 56.1% of cases were laboratory-confirmed, and many facilities lacked functional labs. Digital reporting was extremely low (2.4%), indicating poor system modernization. Additional issues included weak feedback mechanisms, low staff motivation, poor community awareness, and logistical constraints such as specimen transport. Institutional weaknesses, including poor coordination and donor dependence, further limit effectiveness. Strengthening workforce capacity, infrastructure, funding, and digital systems is essential for improving cholera surveillance and response.