Immunization Plus Days: Polio Eradication Initiative in Kaduna, Northern Nigeria. Nonso Njokanma September 19, 2006

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1 Immunization Plus Days: Polio Eradication Initiative in Kaduna, Northern Nigeria Nonso Njokanma September 19, 2006 Outline Epidemiology of Wild Polio Virus (WPV) History of Global Polio Eradication Immunization Plus Days (IPDs) Results of IPDs Conclusions 1

2 Epidemiology of WPV Virus Types Types I, II and III (I and III found in Nigeria ) Oral-fecal transmission Incidence 10% of infected cases are clinical Risk factors Children U3, immune deficiency In absence of immunity, paralysis of 0.5% Natural Immunity is virus specific WHO Eradication Goal The goal of global eradication is defined as: no new cases of clinical poliomyelitis associated with wild poliovirus and no wild poliovirus found worldwide, despite intensive zero surveillance efforts. 2

3 Current Status of Eradication Since 1988, the global incidence of polio has decreased by more than 99%, and three World Health Organization (WHO) regions (Americas, Western Pacific, and European) have been certified as polio-free. Goal was to eradicate polio in Nigeria by Polio Eradication in Nigeria WPV cases last year By June 266 cases in 18 states 93% of cases from 10 states in the North 2006 By June , Nigeria had 531 WPV cases in 15 states 11 high risk states account for 98% of all cases in Nigeria in 2006; 6 states account for 85% Data compiled: WHO Abuja EPI 3

4 Status of WPV in Nigeria Nigeria accounts for 82% of the global WPV cases in 2006 Nigeria accounts for 95% of the cases in Africa Nigeria is the only country in Africa that is still actively transmitting wild poliovirus in 2006 Distribution of WPV Cases in Nigeria WPV Type I WPV Type III 4

5 AFP Surveillance Epidemiology Distribution of zero OPV doses status of non-polio AFP cases, Nigeria 2005 Sokoto Zamfara Katsina Kano Yobe Borno Kebbi Bauchi Kaduna Gombe Niger Oyo Kwara Kogi FCT Nasarawa Plateau Taraba Adam awa Ekiti Ogun Lagos Osun Ondo Benue Edo Enugu Anambra Ebonyi Cross River Imo Abia Delta Akwa Ibom Rivers Bayelsa Zero dose greater than 20 percent Zero dose percent Data source: AFP Surveillance database 160 Nigeria: Comparison of Monthly WPV Cases, WPV Cases * ** Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec NB:- * There are 7 AFP cases pending ITD result in April. **As of 7 June 2006, there are 282 AFP cases pending laboratory investigation (ITD + Primary) as compared to 99 AFP cases pending laboratory investigation the same period in Data from: WHP Abuja EPI 5

assist in the planning, training and implementation of a targeted immunization campaign

6 Distribution of OPV 0 dose children among NPAFP cases (6-59 months) Nigeria Jan Dec 2005 Jan-June 2006 Key >= 20% 10-19% < 10% Source: WHO Abuja EPI Program Objectives To assist in the planning, training and implementation of a targeted immunization campaign to eradicate polio, through Immunization Plus Days (IPDs) program in Kaduna State, Nigeria. 6

7 Planning Immunization Plus Days State Operations Plan Microplan State level Ward level Training Logistics & Cold Chain Vaccine, Antigen & Other Supplies Data Management Social Mobilization Training Personnel State level LGA level NPI Mgr, STF, Rotary Ward level Ward Focal Person, Health Workers 7

8 Logistics and Resources Cold Chain Requirements Vaccine, Antigens and Others Transportation Social Mobilization State level LGA level Ward and District levels Community Dialogues 8

9 Social Mobilization Strengths Community based Drew positively from 1 st round Limitations Late implementation Highly biased attendance Community Dialogue Session 9

10 Support for Social Mobilization Socio-cultural beliefs Anti-conception strategies History of Polio and Politics Immunization Safety Ensuring Safety Monitoring Injection Safety Waste Disposal 10

11 Data Management Daily IPDs Call-in Data SMS FORMAT FOR DAILY IPDS CALL-IN DATA LGA NAME...DY LGFO (Y/N) WFO.WR.VPR.. CI: OPV.. ZD DPT.MSL VU:OPV.DPT.MSL. H-H: CI OPV: VU: NC: ChI ChR.HI HR Supervision Support of Pre-Implementation Activities Checklist for Verification of Preparations Verification by LGA, SACI, WHO, MoH Daily Review Meetings COMPASS, WHO, UNICEF, NPI? Biohazard Management Social Mobilization Activities Implementation Phase LGA level review meetings 11

Vaccination Post Each fixed and temporary

12 Vaccination Post Each fixed and temporary post had the following 2 Recorders Rec 1 -screens child and issues immunization card Rec 2 collects child history and 2 Vaccinators- Vacc 1 administers OPV and assists Vacc 2 Vacc 2- administers injectables 1 Team Supervisor Photo 12

13 Limitations OPV administration Use of Kick-Polio embossed carriers (SM) Cold Chain Lack of adequate freezing facilities in cold store and health facilities Health Worker Training Inconsistent administration across posts Results Comparison of Dose by Vaccination Sites in Kaduna LGAs 60 Proportion of Dose Relative to Children Immunized (%) Zero Dose Other Dose 0 Fixed Post House School Other Vaccination Site 13

14 Zero Dose Children Immunized in Kaduna State Zero Dose Children Immunized in Kaduna State 30% 25% Percentage of Target Population (%) 20% 15% 10% 5% May June 0% Birnin Gwari Chikun Giwa Igabi Ikara Jaba Jema'a Kachia Kaduna North kaduna South Kagarko Kaura Kauru Kuban Kudan Lere Makarfi Sabon Gari Sanga Soba Zaria LGA Administrative Data June All Coverage(%) LGA Target Pop ZD OtherDose Birnin Gwari 30, Chikun 55, Giwa 47, Igabi 81, Jaba 31, Jema'a 39, Kachia 45, Kaduna North 118, kaduna South 115, Kagarko 26, Kajuru 23, Kaura 18, Kauru 39, Kuban 53, Kudan 55, Lere 66, Makarfi 31, Sabon Gari 53, Sanga 25, Soba 46, Zaria 52, Total 1,058,

15 End Process Evaluation KADUNA STATE END PROCESS EVALUATION June Coverage(%) LGA Children Seen Marked finger Birnin Gwari Chikun Giwa Igabi Jaba Jema'a Kachia Kaduna North kaduna South Kagarko Kajuru Kaura Kauru Kuban Kudan Lere Makarfi Sabon Gari Sanga Soba Zaria % Missed 12.9% 4.4% 26.8% 34.4% 0.0% 0.0% 4.1% 14.5% 14.3% 0.0% 0.0% 1.2% 4.9% 6.0% 11.3% 12.3% 11.7% 12.2% 29.1% 25.4% 31.3% Total % Estimating Coverage in Local Government Areas in Kaduna State Zero Dose OtherDose Target Coverage (%) LGA June May June May June May Birnin Gwari , Chikun , Giwa , Igabi , Ikara , Jaba , Jema'a , Kachia , Kaduna North , kaduna South , Kagarko , Kaura , Kauru , Kuban , Kudan , Lere , Makarfi , Sabon Gari , Sanga , Soba , Zaria , Total **Z K t f d K j LGA l d d f th l i d t i l t d t 15

Social Mobilization Results Source of Campaign Information Of Children Seen (%) Town Crier 8.3% Media 7.2% Traditional Institution 9.1% Neighbor/friend 1.

16 Social Mobilization Results Source of Campaign Information Of Children Seen (%) Town Crier 8.3% Media 7.2% Traditional Institution 9.1% Neighbor/friend 1.8% Other 0.7% Total 27.1% Polio Vaccination- then & now New York, Circa 1955 Picture by Ernie Sisto Abuja, August 2006 Family Health Clinic Area II, Session I, Garki 16

17 Lessons Learned Low response rate on surveys Conduct over weekend Data management is crucial Going down to the sewage Questions??? Comments?? Acknowledgments (i) World Health Organization Nigeria (ii) Kaduna Local Government Area Staff (iii) Abuja Family Health Clinic (iv) UWMSoMPH 17

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NIGERIA ROUTINE IMMUNIZATION IN NIGERIA. 31% of children who received the 1st dose of pentavalent vaccine did not get all 3 doses

NIGERIA ROUTINE IMMUNIZATION IN NIGERIA. 31% of children who received the 1st dose of pentavalent vaccine did not get all 3 doses MICS/NICS 206/7 NIGERIA 206 207 PROGRESS TOWARD GVAP GOALS Penta3 coverage 00% goal 90% goal States with 80% penta3 coverage NATIONAL IMMUNIZATION COVERAGE SURVEY (NICS): National Brief ROUTINE IMMUNIZATION