18 November 2003

Nigeria: Poliomyelitis: Childhood Killer Disease On the Prowl Again

Lagos — Concerned by the re-emergence of polio,, one of the child killer diseases in some African countres, especially Nigeria UNICEF and other agencies recently organised a workshop in Benin City, Edo State, to enlighten the public on the dangers of the disease and to remind journalists that they have a greater role to play in information dissemination on the disease. Bennett Oghifo, who was at the forum, writes

It takes only two drops of a little regarded vaccine to liberate a child from a life confined to a wheel chair or from eternal use of crutches or worse still, living on 'skates'.

Polio has no cure, which makes it the worst enemy of children from age zero to five years. The effect of poliomyelitis, a water borne wild virus that attacks the limbs of children, is usually deadly and irreversible, but the good news is that it is preventable. But if left unchecked, parents only need to notice weakness of their child's limbs to recognise the inevitable and unless their reaction is swift, none of the affected limbs would recover.

Immunisation is the right of every child and so parents should do all in their capacity to give children their rights, because it is their responsibility as duty bearers to immunise them. Their generation would hold parents accountable because duty bearers are accountable to right owners, said Mrs. Caroline Akosile, assistant programme officer social mobilisation, UNICEF, at a workshop organised by the UN boday in collaboration with SSOMTEC, who was represented by Mrs. Ronke Osho of the Lagos State Ministry of Information for the training of media and non governmental organisations on routine immunization and national immunization days in Benin City recently.

The killer diseases are those scientifically identified six childhood diseases that take their toil on infants below the age of five years, who because of their young physiological make up have bodies not strong enough to fight diseases and so require the help of vaccines. These diseases are: Tuberculosis, Poliomyelitis, Diphtheria. Whooping cough (Pertusis), and Tetanus

Scientifically, it has been proved that these diseases are either caused by bacteria or virus as against age long held myth by Africans that diseases and death are caused by evil or unexplainable forces, observed Mr. Abayomi Silas who discussed Vaccine Preventable Diseases, Route of Transmission and Immunization Messages.

Parents want healthy children and, fired by a growing awareness of the potency of the vaccine, they have been set in search of the lifesaver wherever it could be found. But the sad story is that most health facilities always come up short and out of stock, a phenomenon insiders ascribed to a situation where real use of fund is not equal to intended use.

Another aspect is the Federal Government's lack of total commitment to Polio eradication as measured by low funding, only a third of the amount currently spent on the disease's eradication, leaving UNICEF, a foreign agency to foot the remaining two-third. The situation is this bizarre.

The vaccine, which is procured by UNICEF from credible sources, is supposed to be administered free to every child born in Nigeria. but the reality is that there is a thriving unscrupulous trade in these vaccines, which naturally excludes the very poor target groups whose children fall prey to the virus.

The world is on its last lap of polio eradication, but Nigeria has failed in its efforts to eradicate the disease since 2000, a date set by it to eradicate polio. There is a likelihood that the nation would be isolated if it fails to do so in 2004, a new date slated again as the golden year of achieving this goal. When this is done successfully. then the nation would receive its certification by the year 2005.

Statistics show that Nigeria, Niger, Democratic Republic of Congo. Pakistan, Afghanistan and India are the world's reservoirs of poliomyelitis. According to the last report from World Health Organisation (WHO), surveillance Department, as at the end of August 2003, Nigeria has 189 confirmed wild polio viruses.

"It is sad that the virus has reared its ugly head in Lagos State again. Two wild polio viruses were confirmed in Ojoo Local Government Area of Lagos State in June this year, bringing us back to the dark ages in B-Field office of UNICEF. What have we done wrong? Or what are supposed to be done that we are not doing?" Mrs. Akosile asked .

Regardless of the problem of vaccine scarcity, there is need to create more awareness and indeed change the behaviour of Nigerians towards immunization to enable them allow their children to be immunised and taking them for immunization as and when due.

The last wild polio virus was reported in Ikorodu LGA, Lagos, in 2001 and the present polio infections, UNICEF believes, were importation. But if the children were fully immunised, as they should, then there would not have been infections.

There are three strategies used to prevent polio: -These are: Routine immunization, Acute Flaccid Paralysis (AFP) surveillance and Supplemental immunization activities or what is called house to house immunization or national immunisation days.

UNICEF has done so much in the area of creating awareness for the programme through advocacy visits to political and traditional rulers, training of town criers, setting up and training of village development committees and reactivation of local government social mobilisation committees.

"The effectiveness of electronic media messages in the eradication of polio/RI and communicating and developing specific messages for PEI/RI-Towards eradication of polio," were special areas discussed by Mrs. Dupe Oladeinde, a communications expert.

Efforts by the Federal Government toward the successful eradication of poliomyelitis and other childhood killers diseases has been the adoption, since 1985, of specific days in the year when children below five years are given a dose (two drops) of oral polio vaccine (OPV) free of change. This development has not only created awareness among child-bearing women, but has helped creating a platform to discuss issues affecting children from where child related National Policies are formulated in collaboration with all stakeholders-the government, health bodies and non-governmental organisations (NGO). Besides, the development has also helped in preventing polio virus from circulating among children.

But then came this new outbreak of the dreaded virus detected to be spreading from Nigeria to neighbouring countries, putting l5 million children at risk.

The new outbreak, which requires a massive immunisation campaign across five countries in west and central Africa was described by experts as a grave public health threat.

The campaign, organised at a cost of more than US$10 million, is in response to reports that a dozen children have been paralysed as "Polio continues to spread within Nigeria to areas which were polio free and also to neighbouring countries. Polio and other infectious diseases know no national boundaries. We face a grave public health threat, and our goal of a polio-free world is in jeopardy," he said.

Senior epidemiologists from the Global Polio Eradication Initiative convened a high-level meeting with the Nigerian Minister of Health at the end of September, at which the minister gave his assurance and commitment to eradicate polio in Nigeria by 2004.

To successfully meet this goal, strong political support must be established or strengthened at the sub national level. Political and community leaders must be engaged to facilitate the logistical organisation of immunization campaigns, and ensure all children are reached during the activities, said the experts.

"Nigeria is the most populous nation in the region, and in many ways it has been a good neighbour, contributing to peacekeeping in West Africa," said Carol Bellamy, UNICEF's executive director. "Now, it has another crucial role to play in the region, and that is stamping out polio once and for all. We need all Nigerians, particularly community leaders, to step up and do their part to end polio."

Dr Bruce Aylward, Global Co-ordinator Polio Eradication Initiative, WHO said that the situation in Nigeria had become the last major challenge on the road to global eradication.

"Because of the tremendous progress made in 2002, the polio eradication tactics and resources were shifted in 2003 to focus on just those few remaining countries which remained endemic. But the situation in Nigeria is now forcing us to go back to countries, which had already eliminated polio. We simply cannot afford to see these isolated viruses again paralysing children in areas, which had previously been polio-free. That is why this massive campaign is critical," he said.

Epidemiologists attribute the marked increase in cases in Nigeria, around the state of Kano, to insufficient coverage during both polio immunization campaigns and routine services. Monitored data have highlighted that in at least one state, as few as 16 per cent of children have been sufficiently immunised against polio. A difficult environment has severely compromised the quality of polio campaigns and helped spread rumours about the safety of the oral polio vaccine.

Despite the apparent setback, epidemiologists are convinced that polio can be eradicated from Nigeria. "Polio eradication is feasible in Nigeria," said Dr Walter Orenstein. Director National Immunization Programme US Centre for Disease Control and Prevention (CDC 3

"Much of the country was already polio-free for over two years. including Lagos. The challenge now is to increase the quality of polio campaigns in the key endemic areas of Nigeria, and reach all children during activities", he added.

Recently volunteers and health workers in Benin, Burkina Faso, Ghana, Niger and Togo were expected to reach every child with polio vaccine in just three days. Similar campaigns are planned in Chad and Cameroon for mid-November because of a further case recently reported.

Rotary International has made ending polio its main philanthropic goal since 1985. "At Rotary, we are dedicated to wiping out this terrible disease, having committed over US$500 million to the effort," said Jonathan Majiyagbe, President of Rotary International. "Today. I call on the international community to urgently provide the necessary funds as quickly as possible for the sake of the children across western Africa", he added.

Further resources are required for this unforeseen campaign. The Nigeria outbreak is only one global risk to the goal of a polio-free world, as globally the initiative continues to face a funding gap of US$2l0 million for activities through 2005, said UNICEF.

The Global Polio Eradication Initiative is spearheaded by WHO. Rotary International, the US Centers for Disease Control and Prevention and UNICEF. The polio virus is now circulating in only seven countries, down from over 125 when the Global Polio Eradication Initiative was launched in 1988. The seven countries with indigenous wild polio virus are Nigeria, India, Pakistan, Egypt, Afghanistan, Niger and Somalia. Additionally, in 2003, polio viruses from endemic countries have been imported into Burkina Faso. Ghana, Lebanon, Niger and Togo.

The polio eradication coalition includes governments of countries affected by polio; private foundations (United Nations Foundation, Bill & Melinda Gates Foundation); development banks (the World Bank); donor governments (Australia, Austria. Belgium, Canada, Denmark, Finland, Germany, Ireland, Italy. Japan. Luxembourg, the Netherlands, New Zealand, Norway, the United Kingdom and the United States of America).

The European Commission, humanitarian and non governmental organisations (the International Red Cross and Red Crescent societies) and corporate partners (Aventis Pasteur, De Beers). Volunteers in developing countries also play a key role: 20 million have participated in mass immunization campaigns.

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