Stop Transmission of Polio (STOP) Katsina State, Nigeria 21
June 2011 Richard Niska, MD, MPH CAPT, USPHS CDC STOP-33
Consultant
Slide 2
Goals of this presentation To describe efforts of the Stop
Transmission of Polio (STOP) program Focus on 2 local government
areas (LGA) in the state of Katsina, Nigeria Collaborative effort
among: World Health Organization (WHO) Centers for Disease Control
and Prevention (CDC) Rotary International
Slide 3
Objectives At the end of this session, participants will be
able to describe activities, issues and recommendations in Nigeria
concerning: 1.Routine immunization 2.Acute flaccid paralysis
surveillance 3.Polio eradication
Slide 4
Nigeria http://www.state.gov/r/pa/ei/bgn/2836.htm
http://www.state.gov/r/pa/ei/bgn/2836.htm Population (2010): 152
million 250 ethnic groups, largest are: Hausa-Fulani Igbo Yoruba
Religions: Muslim Christian indigenous Languages: English
(official) Hausa Fulani others Life expectancy (2010): 47
years
Slide 5
Katsina http://en.wikipedia.org/wiki/Katsina_State
http://en.wikipedia.org/wiki/Katsina_State Population (2010): 3.9
million Main ethnic group: Hausa-Fulani Predominant religion:
Muslim Languages: English Hausa Fulani
Slide 6
Background STOP participants serve as consultants for:
Monitoring routine immunization programs: WHO Expanded Program of
Immunizations (EPI) Ongoing surveillance: Acute flaccid paralysis
Polio eradication: Preparation for supplemental oral polio vaccine
campaigns Program assessment, supervision and training
Slide 7
Summary of Activities: Routine immunizations (RI) Monitoring of
4 health centers in Batsari & Safana local government areas
(LGA) Debriefing of local and LGA staff Training topics
identified
Slide 8
Major Issues Identified: Routine Immunization Low volume (0-13
immunization candidates per half day) Effective organization of
work space Unsafe clinical practices (used medical equipment left
out)
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Major Issues Identified: Routine Immunization High-risk sharps
disposal practices Incomplete burning of medical waste
Slide 10
Recommendations: Routine Immunization Increase outreach efforts
to encourage full immunization schedule in time allotted. Use bed
nets as incentives for completion of DPT-3 during RI rather than
just giving them out during IPD. Encourage organized immunization
station setup in training sessions. Add burial after burning to
sharps (and other medical waste) disposal procedure.
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Summary of Activities: AFP surveillance Verified or followed up
on 11 AFP cases in Batsari and Safana LGAs
Slide 12
Summary of Activities: AFP surveillance Ruled out paralysis in
several more cases
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Major Issues Identified: AFP Surveillance Excellent non-polio
surveillance efforts Surveillance rates exceed WHO standards for
polio-endemic countries. Good stool collection performance
Slide 14
Recommendations: AFP Surveillance Continuous training of LGA
health personnel in correct assessment of AFP Reinforce correct
injection techniques (i.e. not in buttocks) to prevention injection
neuropathies.
Slide 15
Summary of Activities: Polio Eradication Met with traditional
leaders at district and village levels to encourage involvement
Conducted training sessions for campaign #2 to reflect observations
in campaign #1 Extensive field work during campaigns in remote
villages and nomadic settlements
Slide 16
Performance by Batsari LGA wards in March IPD round
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Performance by Safana LGA wards in March IPD round
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Practices improving performance (Social mobilization)
Participation in flag- off by traditional leaders and wives
Location chosen by high risk status General health messages
reinforced to mothers by district heads wife
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Practices improving performance (Social mobilization) Active
participation of task force members in supervision and resolving
noncompliance Plan was to resolve non-compliances the next day But
many were actually resolved the same day
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Practices improving performance (Social mobilization)
Availability of pluses Mosquito bed nets for pregnant women Candy
for kids
Slide 21
Practices improving performance (Operational) Finding new
settlements (Fulani) Immediate mop-ups on day 5 for: Wards not
reaching 90% coverage Settlements not reached in any ward
Slide 22
Barriers to improved performance
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Barriers to better performance (Team factors) Interpersonal
communication (IPC) skills of teams Male recorders (cant enter
households) Training male supervisors in role-plays But not female
vaccinators in back of room
Slide 24
Barriers to better performance (Timing) Fatigue and hardship
for vaccinators Households and communities not visited Vaccination
teams finishing just after noon Husbands not present till late
afternoon Children absent from home
Slide 25
Barriers to better performance (Documentation) Not recording
noncompliant households Not recording absent children Not marking
households appropriately Not tallying as vaccinations are done Not
reporting acute flaccid paralysis (AFP)
Slide 26
Noncompliance or child absent? Noncompliance or child
absent?
Slide 27
Way forward! (Social mobilization) Engagement of traditional
leaders Advance mobilization of husbands Resolve non- compliance
before it happens Town criers
Slide 28
Way forward! (Training) Selection of high quality team and
supervisors Local trusted people Recorders should be able to read
Better supervisor training Use IPC training guide and WHO
procedures Use women trainers to train vaccinators
Slide 29
Way forward! (Training) Improved training quality Less use of
lectures More practical demonstrations Involve female vaccinators
in role-plays
Slide 30
Way forward! (Training) Incorporate ethical teaching To address
false reporting of non- compliance, house- marking, etc. To
reassure population that religious leaders support
immunization
Slide 31
Way forward! (Operational) Plan for high workloads to prevent
hurried work Separate morning and afternoon shifts with different
teams Revisit strategy