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NEW THIS TUESDAY: POLIO FIELD CENSUS AND VACCINATION OF UNDERSERVED POPULATIONS – NORTHERN NIGERIA, 2012-2013

Saturday, 24th of August 2013

Editorial Note below; full text is at  
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6233a3.htm?s_cid=mm6233a3_w

The findings described in this report demonstrate that many remote nomadic, scattered, and border settlements have been missed by polio vaccination teams during SIAs in northern Nigeria, including a substantial number of settlements that have never been accessed. These settlements are home to thousands of children aged <5 years who are susceptible to WPV infection. By bringing these settlements to the attention of local health officials, the children are often vaccinated during the field census and also can be included in the local plans for future SIAs. Although outreach to these settlements is often logistically difficult because of terrain, security, and distance from centrally located health facilities, the successful penetration by N-STOP teams shows that remote settlements can be reached. The 211 undocumented AFP cases detected during the field census exercises further validate the importance of this outreach strategy. Planning is under way to enhance AFP surveillance in underserved communities. The community engagement strategy and operational procedures used during this field census have been incorporated into the national polio eradication guidelines for the vaccination of children residing in hard-to-reach settlements, which is a key priority of the 2013 National Polio Eradication Emergency Plan for Nigeria.

In addition to outreach to underserved communities, N-STOP provides operational research capabilities to address evolving polio eradication challenges. For example, N-STOP officers recently supported studies to evaluate 1) why some families refuse polio vaccination, 2) why some children are missed during SIAs, and 3) whether a new polio vaccination team-training package is effective and has gained acceptance. N-STOP officers also have played important roles in enhancing routine infant immunization services by serving as focal points dedicated to improving immunization capacity and in investigations of outbreaks of polio and measles by focusing on assessments of underserved communities.

The findings in this report are subject to at least two limitations. First, comprehensive assessment of the field census was limited by the difficulty of estimating the total population of children aged <5 years within the settlements enumerated, which further prevented a complete count of those children who have never been administered polio vaccine. Thus, the proportion of children aged <5 years with no history of polio vaccination relative to the total number of vaccine-eligible children within each settlement cannot be calculated with certainty. Second, the scattered nature of these settlements prevents conclusive completeness of the field census. Even with active searches for settlements by N-STOP teams that included enumerators and local guides, isolated settlements might have been missed. Use of satellite imagery to attempt to locate all possible settlements before conducting a field census is being considered.

N-STOP represents a successful partnership between FELTP, international health organizations, and the public health community in Nigeria. Through the program, public health capabilities in Nigeria have been greatly enhanced. N-STOP will continue to respond to emerging issues related to the Nigeria polio eradication program. In addition, N-STOP will continue to provide field work and leadership opportunities for public health professionals. After polio is eradicated, N-STOP can serve as both a model and an important source of public health leadership in Nigeria.