Demand Creation for Polio Vaccine in Persistently Poor-Performing Communities of Northern Nigeria: 2013-2014

Introduction. Poliomyelitis remains a global threat despite availability of oral polio vaccine (OPV), proven to reduce the burden of the paralyzing disease. In Nigeria, children continue to miss the opportunity to be fully vaccinated, owing to factors such as unmet health needs and low uptake in security-compromised and underserved communities. We describe the implementation and evaluation of several activities to create demand for polio vaccination in persistently poor-performing local government areas (LGAs).

Methods. We assessed the impact of various polio-related interventions, to measure the contribution of demand creation activities in 77 LGAs at very high risk for polio, located across 10 states in northern Nigeria. Interventions included provision of commodities along with the polio vaccine.

Results. There was an increasing trend in the number of children reached by different demand creation interventions. A total of 4 819 847 children were vaccinated at health camps alone. There was a reduction in the number of wards in which >10% of children were missed by supplementary immunization activities due to noncompliance with vaccination recommendations, a rise in the proportion of children who received ≥4 OPV doses, and a decrease in the proportion of children who were underimmunized or unimmunized.

Conclusions. Demand creation interventions increased the uptake of polio vaccines in persistently poor-performing high-risk communities in northern Nigeria during September 2013–November 2014.

Contributions of different mosquito species to the transmission of lymphatic filariasis in central Nigeria: implications for monitoring infection by PCR in mosquito pools

Background

Members of the Anopheles gambiae complex are important vectors of lymphatic filariasis (LF) in sub-Saharan Africa, but little is known about the relative contributions of all mosquitoes to lymphatic filariasis transmission in this area.

Methods

Over a 28 month period, mosquitoes were collected from 13 villages in Plateau and Nasarawa states in central Nigeria and dissected to determine W. bancrofti infection status. Wings and legs from a subset of the mosquitoes visually identified as A. gambiae s.l. were identified by PCR as either A. gambiae s.s. or A. arabiensis.

Results

A. gambiae s.s peaked in abundance during the rainy season while A. arabiensis predominated during drier parts of the year. Both species were found equally likely to be infected with the developing stages (L₁-L₃) of W. bancrofti (9.2% and 11.1%, respectively). Fewer A. funestus (1.1%, p < 0.001) were infected than A. gambiae s.l.

Conclusion

Understanding the relative contributions of morphologically indistinguishable species to LF transmission is essential if PCR is to be performed on mosquito pools. In the study area, the use of mosquito pools composed of A. gambiae sibling species would not be problematic, as both A. gambiae s.s. and A. arabiensis contribute equally to LF transmission.

Successful integration of insecticide-treated bed net distribution with mass drug administration in Central Nigeria

In Africa anopheline mosquitoes transmit malaria and lymphatic filariasis (LF); insecticide-treated bed nets significantly reduce transmission of both. Insecticide-treated bed net provision to children under 5 (U5) and pregnant women (PW) is a major goal of malaria control initiatives, but use in Africa remains low because of cost and logistics. We therefore integrated insecticide-treated bed net distribution with the 2004 LF/onchocerciasis mass drug administration (MDA) program in Central Nigeria. Community volunteers distributed 38,600 insecticide-treated bed nets, while simultaneously treating 150,800 persons with ivermectin/albendazole (compared with 135,600 in 2003). This was subsequently assessed with a 30-cluster survey. Among surveyed households containing U5/PW, 80% (95% CI, 72-87%) owned > or = 1 insecticide-treated bed net, a 9-fold increase from 2003. This first linkage of insecticide-treated bed net distribution with mass drug administration resulted in substantial improvement in insecticide-treated bed net ownership and usage, without adversely affecting mass drug administration coverage. Such integration allowed two programs to share resources while realizing mutual benefit, and is one model for rapidly improving insecticide-treated bed net coverage objectives.