We conducted a cross-sectional survey was conducted from 19th September-31st October 2016 (as part of the phase 1b of the GAP III on laboratory containment of the poliovirus) using structured Laboratory survey and inventory (LSI) questionnaires uploaded onto the SPSS software package in 560 biomedical facilities classified either as high risk or medium risk facilities across the six geopolitical zones in Nigeria. Those not captured in the phase 1a and those initially retaining poliovirus or poliovirus potentially infectious materials in phase 1a were also surveyed.
The laboratory/biomedical facility survey was conducted in such a way that most activities occurred at the biomedical facilities/ laboratory. Coordination of activities therein was done at different levels but final coordination was done at the National level. It involved different activities that were monitored using a standardized questionnaire. Key activities conducted were: establishment of laboratory/biomedical facility list, survey of such facilities classified as high risk and those initially retaining poliovirus or poliovirus potentially infectious materials, destruction of unwanted poliovirus type 2 infectious/potentially infectious materials and validation which was done by WHO staff, six Zonal consultants (ZCs) (representing the six geopolitical zones in the country), the National Coordinator (NC) and members of the National Task Force (NTF).
Generation of laboratory/biomedical facility list
The National laboratory list generated in the phase 1a exercise was the major source from which selected laboratories were picked for the phase 1b containment activity. The list included facilities with any capacity to handle biological materials, including diagnostics, research, teaching and industrial production.
Biomedical facilities to be surveyed in phase 1b were selected based on those classified in phase 1a activity as outlined: high risk laboratories, those initially with inventory of infectious materials, veterinary institutions, teaching Hospitals/Federal Medical Centres, research institutions, medium risk laboratories, low risk laboratories, new facilities to be found in the field and cold stores. Information on new facilities was obtained from professional group meetings, Disease Surveillance and Notification Officers (DSNOs), National and State Chapters of the Association of Medical Laboratory Scientists in Nigeria (AMLSN) and Guild of Medical Laboratory Directors in Nigeria.
The NC was responsible for maintaining and updating the generated list as the containment activities progressed.
The laboratory scientist completed the LSI survey questionnaires at the laboratory/biomedical facility. Immediate retrieval and validation of the completed survey form was done. Endorsed facility visitation/evidence of destruction forms were deposited in the laboratory/biomedical facility to provide evidence that such facility have been surveyed by the ZCs and WHO staff.
Laboratories/biomedical facilities with poliovirus or poliovirus potentially infectious materialscompleted the inventory form of the LSI and were immediately validated by the ZCs and WHO staff.Delisting of endorsed laboratory/biomedical facility followed this. Note that validation of laboratories surveyed for poliovirus potentially infectious materials in the country was done solely by the six ZCs covering the six geopolitical zones under the supervision of the NC.
Completeness of response
Almost all the laboratories/biomedical facilities initially surveyed responded to the questionnaires. Follow-up attempts using telephone calls, text messages and physically going back to the laboratories to remind them of completion of the questionnaires were carried out by the ZCs and WHO staff.
Quality of survey
The completed LSI forms were retrieved and crosschecked by the ZCs and WHO staffs to make sure all variables were completed and validation was carried out. The retrieved validated forms were submitted weekly in WHO state offices of the survey.
The completed survey forms were double-checked by WHO state coordinators for correctness before filing in the state offices. The NC analysed data from the survey weekly.
Also, laboratories that initially declined during the phase 1a and 1b activities were surveyed again while survey forms yet to be retrieved from laboratories were collected and submitted timely and accordingly.
The NC also randomly selected laboratories/biomedical facilities in all six zones and physically validated the information provided in the completed LSI forms. The NC prioritized validation of survey information to the high-risk laboratories, those with inventory of poliovirus or poliovirus potentially infectious materials.
Thoroughness of inventory process
Laboratories/biomedical facilities identified to keep poliovirus potentially infectious materials were given an inventory questionnaire for completion by the head of the laboratory. Thereafter, the ZC physically validated the completed inventory forms at the laboratories/biomedical facilities.
To further support the inclusion of such facilities in the national inventory list, the NTF members during their supervisory visitation to states physically validated the completed inventory of the laboratory. Finally, the NC internally and physically validated some of the laboratory information with completed Inventory and fully established their inclusion in the national Inventory list for the phase 1b activities.
A follow-up by means of reminder through phone calls, SMS and personally returning to the laboratories was done by the ZC, WHO staff and NC to enhance high response of 100% to the inventory questionnaire by all laboratories identified in the survey as holding poliovirus or poliovirus potentially infectious materials.
Internal validation for destruction of poliovirus infectious and potentially infectious materials
An internal validation team consisting of a member of NTF, WHO, NC and Director, National Polio Reference Laboratory, visited and provided guidelines instructing the laboratories/biomedical facilities with inventory to destroy. The instructions were fully followed by heads of the laboratories.
The NC updates the national inventory list when identified laboratories are guided to destroy all poliovirus or poliovirus potentially infectious materials. In most instances the NC, with WHO staff or NTF member(s) and Director, WHO National Poliovirus Reference laboratory visits the identified laboratory, gives guidelines, and monitors the destruction process using the best standard practice. Such identified laboratory is then de-listed from the national inventory list.
Laboratories on the inventory that claimed to have destroyed all poliovirus potentially infectious materials were made to provide a validated signed copy of the inventory form to support their claim.
Laboratory report books indicating dates and methods of destruction of the poliovirus potentially infectious materials were provided to support such claim.
In the case of destruction of such poliovirus potentially infectious materials and, evidence of a functioning dirty autoclave must be seen by the NC and NTF members on supervisory visitation to establish appropriate implementation of best standard practice approach.
Software (SPSS version 20) was used for data entry and analysis. The NC carried out data entry and also prepared weekly national data analysis, which was shared with WHO, NCC, National Primary Health Care Development Agency (NPHCDA), ZC and NTF.