14 July 2012

Nigeria: Polio Staging Big Return

Damaturu, Abuja, Maiduguri, Katsina — Nigeria is one of the four countries - the rest are India, Pakistan, and Afghanistan - where polio transmission remains a worrying concern.

Indeed, the United Nations Children's Fund said in June this year that Nigeria has so far recorded 45 cases of wild polio virus this year.

The cases occurred in 10 northern states of the country according to a news note by the UNICEF, signed by Fatratra Lalaina Andriamasinoro. The affected states are Niger (1); Jigawa (2); Kaduna (8); Kano (8); Katsina (7); Sokoto (5); Zamfara (4); Borno (6); Yobe (3) and Bauchi (2).

"Nigeria contributes 90 per cent to the polio burden in Africa and more than 50 per cent of this year's cases worldwide are from Nigeria," the agency added, but said the number has reduced compared to 25 cases in six states for the same period in 2011.

The UNICEF said: "In key infected states like Borno, Kano, Sokoto and Yobe more than one in three children received less than four doses of oral polio vaccine. Polio-free states like Kaduna and Niger were re-infected in 2012."

"While the proportion of missed children has shown a slightly decreasing trend in the last three rounds (7.2 per cent in February, 7.4 per cent in March and 7.2 per cent in May), hundreds of thousands of children continue to be missed during polio immunization campaigns in Nigeria.

"According to the latest UNICEF Social Data Analysis, Kano has the highest percentage of missed children (8.9 per cent), followed by Kebbi (8.4 per cent) and Sokoto (8.1 per cent). In all northern high risk states, caregivers' refusals to vaccinate their children account for 24 per cent of the total number of missed children during the May Immunization Plus Days."

UNICEF, however, acknowledged that Nigeria's funding of polio eradication has increased from $17m to $30m per year.

The statement added: "In 2012, the President of Nigeria declared polio eradication as a national emergency, and Nigeria has committed additional funds to the program from its own treasury. "Domestic funding to polio eradication increased from $17m to $30m per year. Nevertheless, the Global Polio Eradication Initiative is currently facing its largest funding gap worldwide since its inception, with a total shortfall of $1 billion out of the $2.23 billion budget."

Where lies the problem?

The war to eradicate polio from Nigeria and the rest of the world is being fought both at local and international levels.

US billionaire Bill Gates, through the Bill and Melinda Gates Foundation, has visited Nigeria in the past to help eradicate the disease. Recently, the Japanese government offered a US$ 7.85 million (about N1.24 billion) grant to the Nigeria government to help it combat. The UNICEF said domestic funding of polio eradication in Nigeria has increased from $17m to $30m per year, after President Goodluck Jonathan declared polio eradication as a national emergency.

Traditional and religious leaders have also been incorporated, especially in northern Nigeria, to help cover the designated children (0-5 years). However, in spite of these efforts the disease is staging a comeback rather than abating.

According to the Independent Monitoring Board under the auspices of the Global Polio Eradication Initiative in another report stated that over 1.8million children had never been immunized in Nigeria.

According to the report, more than 2.7 million African children who had never received a single dose of polio vaccine are in danger of infection.

It reads in part, "Nigeria holds two-third of this population while it is the only country in the world to have three kinds of polio virus."

But according to the GPEI, the main reasons for non-compliance in high risk states are given as "no felt need" (25%), "no reason" (24%), "no care giver consent" (15%), "religious belief" (10%), and "too many rounds" (7%).

'We don't trust vaccines'

In Borno State, Governor Kashim Shettima said vigorous fight against the polio will henceforth be one of the criteria for measuring the success or otherwise of all the local government areas of the state.

The governor, who spoke recently at the flag-off of polio immunization plus days, said "Polio is confined to northern Nigeria owing largely to the misconception about the oral polio vaccines."

Weekly Trust reports that the misconception is evident in the attitude of many parents who vehemently reject entireties to avail their children for immunization.

"We strongly believe that the oral vaccines will make our children, especially girls completely impotent," Kanna Bukar, a 38-year-old housewife in Maiduguri, said.

"There are many diseases killing our children, such as malaria, diarrhoea and even hunger...why can't they (immunization officers) give us free drugs and food to cure such diseases," Kanna, who was seen at the Mala Kachalla Hospital in Maiduguri, said.

Often times, parents whisk away their children to far flung villages and left them under the custody of their grandparents to avoid the watchful eyes of immunization officers.

"Even if Borno State takes appropriate measures to tame the spread of polio, the effort will be in futility if there is no commensurate effort from authorities in the other side (countries), Dr. Jamila Shehu, a medical practitioner said.

Commissioner for Health in the state, Dr. Salma Anas Kolo noted that though Borno remains a High Risk State, the incumbent administration was doing its best.

She said Mobbar, Konduga, Maiduguri Metropolitan Council, Jere and Monguno local government areas are the "worst performing among the 11 LGAs that are lagging behind in the fight against poliomyelitis."

However, some local government officials in Borno State are now vaccinating their biological children at village squares to prove that the vaccines are not harmful.

In Katsina, fresh cases were recorded within six months in Sandamu, Ingawa, Batsari, Mani and Mai'adua Local Government Areas in Katsina State, according to the Executive Director of the National Primary Helathcare Development Agency, Dr. Ado Muhammad.

Speaking at the flagging-off of immunization in Ingawa last week, he said the FG has also recruited 2,000 midwives and 1,500 other health workers for the ongoing crusade of eradicating polio in the country.

Following the recent development, however, Katsina State government has conducted a mop up immunization in the affected areas. It was flagged-off in Karkarku, a village where a girl was said to have been infected by the disease.

Worried by the sad development, Katsina State Governor Ibrahim Shehu Shema threatened to sack any local government chairmen in whose domain fresh case of polio is recorded and or rejection of vaccination was observed.

Similarly, the Emir of Daura, Alhaji Farouk Umar Farouk has during a flag-off of a mop up immunization in Karkarku village, Sandamu local government area, vowed to sack any traditional ruler who allowed rejection of polio vaccination to occur in his area.

The father of the infected girl, Malam Yusuf Salihu, refused to speak to Weekly Trust on how his daughter fell victim of polio. But one of the residents Adamu Muhammad said "with the discovery of a polio case in this village, we now believe that it is real and that was why when the mop up of polio immunization was flagged-up in this village we all presented our children for the immunization."

In Yobe State, Dr. Hauwa Larai Goni Fika, Director, Primary Health Care confirmed that three new cases of Wild polio virus (WPV) were reported in Damaturu, Gulani and Karasuwa Local Governments Areas.

FG admits mistake

Minister of Health, Prof. Christian Onyebuchukwu Chukwu yesterday admitted that certain mistakes were made in the implementation of the polio eradication strategies which led to the upsurge in some states.

He was quick to add that the country has learnt from its mistakes, pointing out that the observed mistakes had now been corrected.

Speaking when the World President of Rotary International Rotarian Sakuji Tanaka paid him a courtesy visit, Chukwu said some innovations had been adopted to address the mistakes of the past.

Some of the new strategies, he said, included the use of GPS devices to track the movement of migrants in areas at risk, while everyone involved in the campaign is now held accountable for any lapses.

He also said that Nigeria is working with neighbouring countries to ensure there is no cross-border transmission of the disease.

The minister noted that polio cases are localized in only ten states, warning however that there could be problem if immunization is not continued in all states. Minister of State for Health, Dr Muhammed Ali Pate, who is also the Chairman of Presidential Task Force on Polio, asked governors of the remaining polio-affected states to hold accountable their LG chairmen when they do not reach 90 per cent coverage of polio immunization in the campaigns.

Executive Director NPHCDA Dr. Ado Muhammed said all affected states are presently receiving more attention and increased surveillance to stem further transmission of the virus.

Warning to countries

The World Health Organization (WHO) said "all polio-free countries are advised to maintain high levels of immunity against polioviruses at all times through strong routine vaccination programs, adding supplementary immunization activity when necessary."

Stanley A. Plotkin, MD, who developed the rubella vaccine in worldwide use today and who has worked on poliovirus vaccine, also stresses the importance of maintaining high levels of immunity--even in countries like the United States, which has not seen a case of naturally-occurring polio since 1979.

"As long as poliovirus circulates somewhere in the world it can be introduced anywhere people are not vaccinated," Dr. Plotkin says. "Therefore high individual and population vaccination coverage is necessary."

Ruby Leo, Judd Leonard Okafor, Hamza Idris, Yusha'u a Ibrahim, Kabir Hamisu Matazu

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