Poor Diagnostic Capacity Driving Misdiagnosis Of Acute Fever In Nigeria – US CDC

The United States Centre for Disease Control and Prevention (US CDC) has raised concerns that limited laboratory diagnostic capacity in Nigeria was leading to the misdiagnosis and underdiagnosis of Acute Febrile Illnesses (AFIs), resulting in inappropriate treatment and poor patient outcomes.

The warning came during a media roundtable in Abuja on Wednesday, where the US CDC, in collaboration with the Nigeria Centre for Disease Control and Prevention (NCDC) and other partners, highlighted efforts to strengthen AFI surveillance across the country.

Acute Febrile Illness is defined as an illness marked by the rapid onset of fever, with or without additional symptoms. According to Oladipupo Ipadeola, Senior Public Health Specialist for Epidemiology and Surveillance at the US CDC Nigeria, AFI can be caused by bacteria, viruses, protozoa, or fungi, and while it is most prevalent in children and young adults, it can affect all age groups.

“AFI surveillance refers to the systematic monitoring and investigation of cases of acute fever that occur suddenly and typically have a short duration,” Ipadeola explained.

“In Nigeria, limited laboratory diagnostic capacity for AFI is leading to misdiagnosis or underdiagnosis of diseases, and inappropriate treatment and management of patients. Addressing AFI surveillance gaps, such as a lack of clear policy, limited geographical spread of testing facilities, and poor diagnostic capacity, is essential.”

He added that AFI presents with overlapping symptoms, which makes diagnosis difficult without adequate testing. Strengthening surveillance, he noted, is crucial for early identification of outbreaks, understanding disease epidemiology, and implementing timely control measures.

Ipadeola commended the Federal Government for steps taken so far, including surveillance and monitoring systems, malaria control programmes, vaccination campaigns, and partnerships aimed at improving AFI activities. He disclosed that the US CDC, working with NCDC, has set up sentinel surveillance sites across Nigeria’s six geopolitical zones. These sites have tested over 11,000 samples for priority diseases such as malaria, dengue, yellow fever, Lassa fever, and COVID-19.

The agency has also supported diagnostic improvements by upgrading laboratory equipment, introducing multiplex PCR testing, and training personnel in selected facilities. Since August 2024, coordination of the programme has been handed over to the NCDC, with the US CDC continuing to provide technical support, rapid diagnostic kits, and reagents.

In her opening remarks, Farah Husain, Programme Director at the Division of Global Health Protection, US CDC Nigeria, underscored the urgency of strengthening AFI surveillance.

“Today’s engagement is a broader effort by the U.S. CDC in collaboration with the NCDC to establish a sustainable AFI surveillance system in Nigeria,” she said.

“The overall intent of this system is to help improve early detection, enhance laboratory capacity, strengthen data, and ultimately help us respond better and faster to outbreaks.”

Also speaking, the NCDC’s Director of Surveillance, Fatima Saleh, stressed the need for stronger advocacy and collaboration at all levels of government to ensure evidence-based interventions.
“We must strengthen surveillance systems, improve response capacity, and scale up outreach efforts,” she said. “This requires sustained support, wider inclusion, and the political will to protect the health of Nigerians.”

Experts at the event agreed that tackling gaps in diagnostic capacity, policy frameworks, and testing infrastructure is critical to improving Nigeria’s AFI response and, by extension, the nation’s broader disease surveillance and health security.