Path of Science: International Electronic Scientific Journal

The COVID-19 pandemic in Nigeria was associated with unprecedented challenges, including limited surveillance infrastructure, limited laboratory capacity, and a concurrent high burden of antimicrobial resistance. Patterns and community-based surveillance methods used during the pandemic have significant implications for future pandemic preparedness and antimicrobial stewardship.

This systematic review synthesised evidence on community-based COVID-19 surveillance systems, antimicrobial use patterns during the pandemic, factors influencing implementation to enhance surveillance effectiveness, and implications for pandemic preparedness and antimicrobial resistance control in Nigeria.

The researchers conducted a systematic review in accordance with the PRISMA 2020 guidelines. They searched electronic databases (PubMed, African Index Medicus, Web of Science, AJOL, and Google Scholar) from January 2020 to December 2023. They included studies conducted in Nigeria on community-based COVID-19 surveillance, antimicrobial use in managing COVID-19, implementation science, and health system capacity. They assessed study quality using the ROBINS-I tool and synthesised the data through narrative synthesis and thematic analysis.

The researchers included 28 studies involving 24 health facilities and 32 communities across six geopolitical regions in Nigeria. They introduced community-based surveillance systems at 71% of observable sites, with case detection rates ranging from 34% to 82% of known cases. Surveillance completeness, however, was not high: 41% had ≥90% completeness for key variables. The researchers found that antimicrobial use during COVID-19 was suboptimal: clinicians treated 78% of COVID-19 patients with antimicrobials despite the infection being viral, prescribed them for a mean duration of 8.3 days (compared with the typical 3–5 days), and used non-recommended antimicrobials in 64% of cases. They also observed that CHWs participated in 68% of surveillance systems, but programme managers provided inconsistent training and support. The researchers identified major obstacles, including insufficient funding (reported by 86% of sites), limited laboratory capacity (71%), inadequate surveillance infrastructure (79%), weak inter-facility communication (68%), and CHW dropouts (58%). They further reported health inequalities, with rural case detection rates 64% lower than those in urban areas. Finally, they found that antimicrobial resistance increased significantly between 2020 and 2023, with fluoroquinolone resistance in gram-negative organisms rising to 61% in 2023, up from 38% in 2019.

Community-based COVID-19 surveillance in Nigeria demonstrated potential but faced serious challenges in implementation and sustainability. Improper use of antimicrobials during the pandemic would likely have contributed to the increase in antimicrobial resistance. To prepare and sustain a Nigerian response to future pandemics, the nation needed: 1) A long-term investment in community-based surveillance infrastructure that will include CHW support; 2) Effective antimicrobial stewardship programs coupled with pandemic response; 3) Enhanced laboratory capacity at both community and facility levels; 4) Express focus on health equity in the design and implementation of surveillance systems; 5) Mechanisms of inter-facility data-sharing. Health systems can integrate surveillance and antimicrobial stewardship to achieve dual benefits: improving pandemic response and reducing antimicrobial resistance.

community-based surveillance; antimicrobial resistance; Nigeria; pandemic preparedness; health systems; implementation science

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