Date: June 16, 2025

Written by: Timilehin Oladosu

Dengue Fever (DF) is a high-burden disease that disproportionately affects countries in the tropics and subtropics, many of which have limited healthcare resources (1). In Nigeria, DF is endemic in almost all states nationwide and could be the leading cause of unclassified febrile illnesses (1). Dengue Fever has a mixed distribution among urban and rural areas, though it was previously predominantly reported in urban areas (1). A seroprevalence study conducted in Osun State, southwest Nigeria, reveals the IgG prevalence of DF is 77%, while Oyo State has a seroprevalence of 44.2% (2). In Nigeria, Dengue Virus (DENV), Yellow Fever Virus (YFV), and other arboviruses have a high potential to cause serious public health impact due to the high density of competent disease vectors, pockets of unvaccinated and susceptible populations from low YF vaccination coverage, and the unavailability of vaccines for DF and other arboviral infections (2). 

Enzyme-linked Immunosorbent Assay (ELISA) has been the most frequently used diagnostic method for the detection of Dengue Fever (3). Other limitations include epidemiological gaps that slow the detection of cases, the non-availability of routine testing for DF, and inadequate engagement of local healthcare providers in disease surveillance and management (4). Integrated vector management and control strategies, prompt case detection, and management are the primary strategies for preventing and controlling dengue virus transmission (2). However, DF surveillance has been suboptimal at all tiers of the health system (primary, secondary, and tertiary). The most accessible form of health system (primary healthcare) is not well-equipped to diagnose or manage DF outbreaks. The Integrated Disease Surveillance and Response (IDSR) system is responsible for weekly and monthly notification of DF and other neglected tropical diseases. The health system’s poor reporting system and low disease notification due to suboptimal surveillance also has an impact on DF data and response.

Animasaun et al. (2025) indicated the use of a One Health approach in tackling the spread and outbreak of DF (2). While this is commendable, it is only truly effective when paired with a robust monitoring and evaluation (M&E) framework. Surveillance efforts must be data-driven and harmonized across human, animal, and environmental health sectors. The current data gaps prevent stakeholders from making informed decisions or predicting outbreak trends. It’s time for a paradigm shift in disease reporting, especially for Neglected Tropical Diseases (NTDs) such as DF.

A well-designed monitoring and evaluation system will strengthen surveillance and improve data reporting to inform decision-making. This system would define clear indicators such as timely case reporting rates, vector control coverage, and laboratory turnaround times, and identify diverse data sources, from health facility registers to community-based surveillance. Crucially, it would establish continuous feedback mechanisms to ensure data insights directly inform operational adjustments and policy decisions. The One Health initiative is a multisectoral approach that relies heavily on a pool of stakeholders’ harmony, but the majority of these stakeholders are affected by a data dearth for DF. An integrated M&E system is pivotal here, providing a common language and set of data-driven targets that align efforts across human, animal, and environmental health sectors. These foster shared accountability and facilitates truly collaborative decision-making, moving beyond siloed operations.

With the inclusion of M&E systems in the design of strategies to combat DF and other arboviruses, we are one step closer to eradicating DF and other NTDs. Incorporating M&E systems into DF surveillance strategies will strengthen data collection, improve reporting accuracy, and enhance accountability. Beyond vertical strengthening of disease tracking, a strong M&E system will empower One Health collaborations and improve Nigeria’s readiness for emerging public health threats. However, implementing such a system is not without its challenges. Overcoming barriers like securing dedicated funding, ensuring adequate human resources with M&E expertise, strengthening infrastructure for data transmission, and enhancing data literacy among frontline healthcare providers will be essential for sustained success. By learning from other low-resource countries where integrated M&E has already boosted disease surveillance, we understand that this strategy is not only achievable but also vital for Nigeria’s public health delivery. 

References

1. Nasir, I. A., Agbede, O. O., Dangana, A., Baba, M. & Haruna, A. S. (2017). Dengue virus non-structural Protein-1 expression and associated risk factors among febrile Patients attending University of Abuja Teaching Hospital, Nigeria. Virus Research, 230, 7-12. https://doi.org/10.1016/j.virusres.2016.12.011 
2. Animasaun, O. S., Shaibu, J. O., Akomolafe, B. K., Animasaun, O. P., Niyang, P. A. M., Olugbade, O. T. & Audu, R. A. (2025). Enhancing surveillance for dengue fever in Oyo State, Nigeria–a one health approach. One Health Outlook, 7(1), 5. https://doi.org/10.1186/s42522-024-00121-9 
3. Adesola, R. O., Ajibade, F. A., Idris, I., Scott, G. Y., & Agaie, M. I. (2024). Addressing the Dengue fever challenges in Nigeria: A narrative review and recommendations for control. Le Infezioni in Medicina, 32(2), 157. https://doi.org/10.53854/liim-3202-5 
4. Adesina, O.A. and Adeniji, J.A., 2016. Incidence of dengue virus infections in febrile episodes in Ile-Ife, Nigeria. African Journal of Infectious Diseases, 10(1), pp.21-24.