Ethiopia towards polio eradication: insights from acute flaccid paralysis surveillance data analysis 2016 to 2023.

Introduction: Ethiopia remains at high risk of Circulating Vaccine-Derived Poliovirus (cVDPV2) and wild poliovirus (WPV) outbreaks due to high cross-border population movement and low population immunity. This study aims to analyze Acute Flaccid Paralysis (AFP) data from 2016 to 2023 to identify challenges in surveillance and capitalize on the lessons learned. Methods: we conducted a descriptive cross-sectional analysis of AFP surveillance data from January 2016 to December 2023. AFP is defined as the sudden onset of paralysis among children under 15 years of age, and the data were extracted from AFP case-based reports. Data were analyzed using Microsoft Excel, and QGIS 3.1.1 software was used to show the cVDPV2 hot spot areas. Results: the average annual AFP rate was 2.74 per 100,000 children under 15. Most cases (61.9%) were aged 0-5 years. Stool adequacy was 91%, and 72% were notified within seven days of onset. Investigation within two days occurred in 75% of cases. Vaccination coverage among cases was 72%. Sixty-four cases (0.6%) were cVDPV2 positive; 94.5% were discarded. Notification completeness was lowest in Tigray (55%), Afar (72%), and Oromia (76%). Benishangul-Gumuz, Oromia, Afar, Gambella, and Dire Dawa had suboptimal stool adequacy for more than 3 years. Conclusion: despite national progress in AFP surveillance, gaps persist in notification, investigation, and vaccination, especially in border and conflict-affected areas. We recommend digitalizing case management at district and facility levels, enhancing cross-border surveillance, strengthening community-based approaches, and improving routine immunization to meet WHO targets.