Why Polio Continues To Thrive In Nigeria

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Polio in Nigeria
Polio in Nigeria

Achieving a polio-free country this year would remain elusive if the setbacks to the realisation of this dream are not addressed, writes WINIFRED OGBEBO.

As Nigeria reaches the deadline for polio eradication this year, there are rising concerns whether it will be able to meet the challenge. However, these fears are not unfounded given the present status of the polio eradication report card.

Speaking at the National Consultative Stakeholders’ Conference on Polio Eradication in Nigeria organized by the National Primary Health Care Development Agency (NPHCDA), last week in Abuja, the minister of state for Health, Dr Muhammad Ali Pate expressed worry over the number of cases Nigeria is contending with, saying that Nigeria has 60 out of 600 cases of polio cases worldwide.

India once recognized as world’s epicentre of polio recently celebrated a major achievement of recording one polio case thus leaving Nigeria, Afghanistan and Pakistan in the category of polio-endemic nations.

Two years ago, the Expert Review Committee (ERC) on Polio Eradication and Routine Immunisation warned that though new cases of polio were at an all-time low in Nigeria, “the disease was still circulating in the country” and “could come roaring back.” And that is exactly what has happened.

Nigeria continues to experience a surge of polio cases, following a dramatic reduction in 2010. The country remains the only polio-endemic country in Africa. Significant progress has been achieved, with the number of cases collapsing by more than 95% in 2010. However, by the end of November 2011, Nigeria recorded 43 cases of wild poliovirus compared to 14 cases in the same time period in 2010.

Last year, Nigeria conducted eight national and sub-national IPDs in January, February, March, May, June, July, September and November. There was another Special Immunization Plus Days in 12 high-risk States in December in line with the 21st Expert Review Committee (ERC) recommendations, and Nigeria also conducted mop-up campaigns in the polio-affected s tates. The proportion of missed children during these campaigns has fluctuated. In January Immunization Plus Days, the percentage of missed children was 6% ,while in September it rose to 6.5% in the northern high-risk states. Non-compliance as a reason for missed children also showed a similar wavy trend.

According to a report by the Global Polio Eradication Initiative (GPEI) last week,  transmission of the virus has largely been in the northern part of the country since November last year, with all three serotypes (WPV1, WPV3 and circulating vaccine-derived polio virus type 2-  (WPV2).

Also, the GPEI confirmed five new cases of paralysis caused by the WPV in the past week  (four WPV1s and one WPV3), bringing the total number of cases for Nigeria in 2011 to 57. The most recent case had onset of paralysis on December 2, 2011 (WPV) from Borno State.
The executive secretary of the National Primary Health Care Development Agency (NPHCDA), Dr Ado Mohammed, disclosed in an interactive session with the media  that there were 109 high risk polio local government areas and the epicentres are Kano, Jigawa, Katsina, Zamfara, Yobe, Borno, and Kebbi. Of all        wa and Kebbi account for a significant proportion.

According to Kano State Immunisation Officer, Alhaji Abdulrahman Yakubu,  Kano State has 16 cases in six LGAs, namely; Kumbotso, Dawakin, Tofa, Dawakin Kudu, Nasarawa, but Kumbotso has the largest number of cases.

  Similarly, the United Nations Children Education Fund (UNICEF), Communication  Specialist, Polio Communication, Lalaina Fatratra Andriamasinoro, noted with dismay that continued community resistance to polio immunization is profoundly impacting progress.

The fact remains that most of the communities are holding government to ransom by deliberately refusing to immunize their children.

  A fact readily attested to by this reporter who went on a monitoring exercise at Dawakin Tofa Local Government Area of Kano State last year.

The people had bluntly refused to allow their children and wards to be given the two drops of the oral polio vaccine by the vaccinators whom they chased away on flimsy excuses.
The Danmajen Kano, District Head of the LGA, Alhaji Labahani Ibrahim who was livid, disclosed that the settlement had requested for a borehole, which was dug for them, yet they still refused to release their children for immunisation.

Also, the public relations officer of the LGA, Salisu Babangida, revealed that the people were always against government policies.

    He  explained that during the voters’ registration exercise, they had also refused to turn out and that it took the intervention of the district heads before they did and even when they responded, they refused to allow their wives to register.
He said an indigene residing in Lagos, who came home and asked his wife to register was almost lynched by the community.

“Nobody knows their problem; one cannot lay a finger on it. They demanded for insecticide treated nets (ITN) and the head of the Department of Health in the LGA obliged, but they rejected them.

“Several discussions have taken place on this issue, yet the problem still persists. Once a policy comes from the government, they are always against it,” Babangida lamented.

  The community’s junior secondary school coordinator, Garba Ali Shariff , while attributing the problem to illiteracy and the lack of education, pointed to the community’s mosque, saying, “The mosque and primary school you see here were built by a philanthropist, but the people refuse to use  the Mosque, saying that the man is of the Izalla sect. It was only after much talk and effort that a few of them started using it.”

“That is one of our headaches,” says the north west Coordinator, NPHCDA, Dr Abdullahi Bulama Garba. “These excuses they are giving are not acceptable. One cannot say, one cannot take care of one’s child because ordinarily if they are sick, you must take them to the hospital. Then why are they denying these children? Is it because these children are innocent, they cannot speak?

Many at times, these parents denying their children immunization are members of the opposition. If you find out, it’s either they have a grudge with their chairman or elected House member. You know the cliché that when two elephants fight it’s the ground that suffers. This is most unfortunate and one we cannot accept. In health, we have not started using force like in other countries but I don’t know because if this persists, something has to give because the world cannot continue watching as the country remains the only one battling the virus after investing so much. It’s so embarrassing”
But there are demands by these communities that are genuine.  For example, many LGAs like Dawakin Tofa’s health care facilities are nothing to write home about.
A staff of the World Health Organisation (WHO) said that to eradicate polio, it must be ensured that villages/communities get some health services, drugs and improved hygiene. She observed that safe water and safe sanitation both contribute to good health, which must be promoted by the government.

She said, “During the rainy season, WPV is bound to spread more because it’s the peak of transmission.”
Andriamasinoro also noted that caregiver refusals or non-compliance to immunize their children still make up a significant proportion of the total number of children missed during campaigns, and refusals are on the rise in some high-risk states of the country.  The challenges related to social mobilization and communication issues have become complex at this end stage of polio eradication programme.

Dr Garba attributed the upsurge to several factors like immunization fatigue, logistics and especially, the poor commitment from the local government.

He noted that most of the states and local government officials do not come out to supervise and make sure that their children are at immunization points, leaving the work for them and the vaccinators.  “The vaccinators are not directly under us so we cannot punish them even if they misbehave. We don’t pay them salary so the worst we can do is to sack them and by then the damage has already been done. So what we are saying is that those that are directly supervising them on their routine services should pay more attention. That is one big gap we are having and that is why w e have these setbacks.”

  The NPHCDA Boss said the country witnessed election transition which diverted the attention of political leaders making the campaign suffer setback last year.

   In the words of the director, Disease Control and Immunisation, NPHCDA, Dr Emmanuel Adebayo Abanida, people are still suspicious of the polio vaccine, especially given the fact that it is free.

He said another reason attributed for the non-compliance is that it does not kill like small pox.

“People believe since it is free it means something must be wrong with it and again our health system lacks capability.

Added to this is the state of insecurity being witnessed in the country. According to Pate, “The security challenge is an important challenge now to the eradication efforts which cannot be ignored”.

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