Exploring the Performance, Challenges, and Digitalization Opportunities in Measles and Rubella Laboratory Surveillance in Nigeria: A Qualitative Study

Measles and rubella remain important vaccine-preventable diseases in Nigeria, with persistent transmission and variable surveillance performance across regions. This study examines the performance, challenges, and digitalization opportunities of measles and rubella surveillance in Nigeria. This study adopted a qualitative research design to explore the performance, challenges, and opportunities within the measles and rubella laboratory surveillance system in Nigeria. Data were collected through in-depth key informant interviews with 40 purposively selected laboratory personnel across eight national laboratories. Participants included heads of laboratories and officers responsible for data management, surveillance, quality assurance, and logistics. Interviews were transcribed and analysed using thematic analysis in QDA Miner to identify key themes related to laboratory performance, operational challenges, data quality, and digitalization opportunities. Findings indicated improving testing capacity but inconsistent turnaround times due to reagent stockouts, staffing gaps, and funding constraints. Six of nine respondents reported improving testing capacity, while five observed fluctuations in turnaround time linked to intermittent reagent shortages. Results further showed that the COVID-19 pandemic temporarily disrupted operations by diverting resources and reducing sample volumes. Data incompleteness was mainly attributed to inadequate training and poor documentation, despite the widespread use of validation mechanisms such as external quality assessments and data harmonization. Approximately seven of nine respondents identified reagent stockouts as the most significant operational challenge, while six highlighted unreliable internet connectivity as a major barrier to digitalization. Most laboratories used basic digital tools, with strong support for real-time electronic reporting despite challenges such as poor internet connectivity and limited training. Measles and rubella laboratory surveillance systems demonstrate improving capacity and functional quality assurance practices; however, sustained performance is constrained by supply chain instability, workforce limitations, and weak funding structures. Strengthening logistics systems, investing in human resources, and expanding tailored digital infrastructure are critical to achieving resilient, timely surveillance.