Limited Diagnostic Capacity Leads to Misdiagnosis of Acute Fever – US CDC

Challenges in Diagnosing Acute Febrile Illness in Nigeria

The United States Centers for Disease Control and Prevention (CDC) has raised concerns about the limited laboratory diagnostic capacity for Acute Febrile Illness (AFI) in Nigeria. This issue is leading to misdiagnosis or underdiagnosis of diseases, which in turn results in inappropriate treatment and management of patients. The U.S. CDC highlighted this during a media roundtable in Abuja, emphasizing its support for AFI surveillance in the country, in partnership with the Nigeria Centre for Disease Control and Prevention (NCDC) and other stakeholders.

Experts have pointed out that addressing gaps such as weak policies, limited testing facilities, and poor diagnostic capacity is crucial for improving AFI surveillance in Nigeria. According to Oladipupo Ipadeola, a Senior Public Health Specialist for Epidemiology and Surveillance at the U.S. CDC Nigeria, AFI is an illness characterized by the rapid onset of fever, often accompanied by other symptoms. It can be caused by various pathogens, including bacteria, viruses, protozoa, and fungi, and is more common in children and young adults but can affect all age groups.

Ipadeola noted that AFI presents with overlapping symptoms, making it challenging to manage without adequate diagnostic tools. He emphasized that AFI surveillance is vital for early identification of infectious disease outbreaks, understanding their epidemiology, and implementing effective control measures. He explained that AFI surveillance involves the systematic monitoring and investigation of cases of acute fever that occur suddenly and typically have a short duration.

In Nigeria, limited laboratory diagnostic capacity for AFI is contributing to misdiagnosis or underdiagnosis of diseases, which leads to inappropriate treatment and management of patients. Addressing these gaps, such as the lack of clear policy, limited geographical spread of testing facilities, and poor diagnostic capacity, is essential. A good understanding of AFI cases allows ministries of health and public health institutions to strengthen surveillance and laboratory capacity.

Despite these challenges, the Federal Government has shown commitment to addressing AFIs through several strategies and initiatives. These include surveillance and monitoring to improve early detection and response, public health education campaigns, malaria control programs, vaccination initiatives, strengthening healthcare infrastructure, and collaborating with partners to enhance AFI activities.

The U.S. CDC, in collaboration with the NCDC and other partners, has established sentinel surveillance sites across Nigeria’s six geopolitical zones. These sites test over 11,000 samples for priority diseases such as malaria, dengue, yellow fever, Lassa fever, and COVID-19. The agency has also enhanced laboratory capacity by upgrading equipment, introducing multiplex PCR testing, and training staff in selected laboratories.

AFI surveillance is a key component of the U.S. CDC’s work to advance global health security. It helps identify disease patterns, co-infections, and strengthens diagnostic capacity in Nigeria. Since August 2024, coordination of the program has been handed over to the NCDC, while the U.S. CDC continues to provide technical support, rapid diagnostic kits, and laboratory reagents to improve testing at sentinel sites.

Farah Husain, Programme Director at the Division of Global Health Protection, U.S. CDC Nigeria, emphasized the importance of strengthening surveillance for AFI in Nigeria. She explained that a robust surveillance system will help identify the causes, burden, and spread of such diseases, enabling better and faster responses to outbreaks. Today’s engagement is part of a broader effort by the U.S. CDC in collaboration with the NCDC to establish a sustainable AFI surveillance system in Nigeria.

Fatima Saleh, Director of Surveillance at the NCDC, stressed the need to strengthen surveillance systems, improve response capacity, and scale up outreach efforts. She emphasized the importance of strong advocacy across all levels of government to ensure evidence-based action, wider inclusion, and sustained support for protecting the health of Nigerians.