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Umeh GC, Shuaib F, Musa A, Tegegne SG, Braka F, Mkanda P, Banda R, Adamu U, Nomhwange TI, Arenyeka E, Omoleke SA, Johnson TM, Craig K, Idris I, Iyal H, Sambo IG, Nsubuga P. Acute flaccid paralysis (AFP) surveillance intensification for polio certification in Kaduna state, Nigeria: lessons learnt, 2015-2016. BMC Public Health 2018; 18:1310. [PMID: 30541509 PMCID: PMC6291918 DOI: 10.1186/s12889-018-6186-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Nigeria has made remarkable progress in its current efforts to interrupt wild poliovirus transmission despite the re-emergence of wild poliovirus in 2016. The gains made in Nigeria have been achieved through concerted efforts by governments at all levels, traditional leaders, health workers, caregivers, and development partners. The efforts have involved an elaborate plan, coordination, and effective implementation of routine immunization services, supplemental immunization activities, and acute flaccid paralysis (AFP) surveillance. Methods We conducted the following activities to strengthen AFP surveillance in Kaduna state: a monetary reward for all AFP cases reported by health workers or community informants and verified as “true” AFP by a World Health Organization (WHO) cluster coordinator; training and sensitization of surveillance officers, clinicians, and community informants; recruitment of more personnel and expansion of the surveillance network; and the involvement of special populations (nomadic, hard-to-reach, and border communities) and caregivers in stool sample collection. The paired t test was used to evaluate the impact of the different initiatives implemented in Kaduna state to intensify AFP surveillance in 2016. Results There was increased annualized non-polio AFP rate (ANPAFPR) in 21 out of 23 Local Government Areas (LGAs) of Kaduna state 6 months after implementation of different initiatives to intensify AFP surveillance. The AFP reported by the special population increased in 15 out of 23 LGAs. Statistical analyses of mean scores of ANPAFPR before and after the interventions using the paired t test revealed a significant difference in mean scores: mean = 19.7 (standard deviation (SD) = 16.1) per 100,000 < 15 years old in July–December 2015, compared with 38.0 (SD = 21.6) per 100,000 < 15 years old in January–June 2016 (p < 0.05). Likewise, analysis of silent wards using the paired t test showed a significant difference in mean scores: mean = 4.0 (SD = 2.1) in July–December 2015 compared with 2.4 (SD = 1.8) in January–June 2016 (p < 0.05). Conclusion The different initiatives implemented in 23 LGAs of Kaduna state to intensify AFP surveillance may be responsible for the significant improvement in the AFP surveillance performance indicators in 2016.
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Affiliation(s)
- Gregory C Umeh
- World Health Organization, Country Representative Office, Abuja, Nigeria.
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Audu Musa
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Sisay G Tegegne
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Pascal Mkanda
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Richard Banda
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Terna I Nomhwange
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Eyiotoyo Arenyeka
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Semeeh A Omoleke
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ticha M Johnson
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Kehinde Craig
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ibrahim Idris
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Hadiza Iyal
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ishaku G Sambo
- World Health Organization, Country Representative Office, Abuja, Nigeria
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Musa AI, Shuaib F, Braka F, Mkanda P, Banda R, Korir C, Tegegne SG, Abdullahi S, Umeh GC, Nomhwange TI, Iyal HA, Ishaku S, Adamu U, Damisa E, Bagana M, Gugong V, Balarabe H, Nsubuga P, Vaz RG. Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013-2015. BMC Public Health 2018; 18:1303. [PMID: 30541497 PMCID: PMC6291911 DOI: 10.1186/s12889-018-6180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria. METHODS Special interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions. RESULTS The number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention. Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage > 90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with > 4 doses of oral polio vaccine increased from 2 to 8% before to 93-98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016. CONCLUSION Scaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Usman Adamu
- National Primary Health Care Agency, Abuja, Nigeria
| | | | | | | | | | | | - Rui G. Vaz
- World Health Organization, Abuja, Nigeria
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Nomhwange TI, Shuaib F, Braka F, Godwin S, Kariko U, Gregory U, Tegegne SG, Okposen B, Onoka C. Routine immunization community surveys as a tool for guiding program implementation in Kaduna state, Nigeria 2015-2016. BMC Public Health 2018; 18:1313. [PMID: 30541515 PMCID: PMC6291913 DOI: 10.1186/s12889-018-6197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Routine childhood immunization remains an important strategy for achieving polio eradication and maintaining a polio-free world. To address gaps in reported administrative coverage data, community surveys were conducted to verify coverage, and guide strategic interventions for improved coverage. Methods We reviewed the conduct of community surveys by World Health Organization (WHO) field volunteers deployed as part of the surge capacity to Kaduna state and the use of survey results between July 2015 and June 2016. Monthly and quarterly collation and use of these data to guide the deployment of various interventions aimed at strengthening routine immunization in the state. Results Over 97,000 children aged 0–11 months were surveyed by 138 field volunteers across 237 of the 255 wards in Kaduna state. Fully or appropriately immunized children increased from 67% in the fourth quarter of 2015 to 76% by the end of the second quarter of 2016. Within the period reviewed, the number of local government areas with < 80% coverage reduced from eight to zero. Conclusions The routine conduct of community surveys by volunteers to inform interventions has shown an improvement in the vaccination status of children 0–11 months in Kaduna state and remains a useful tool in addressing administrative data quality issues.
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Affiliation(s)
| | | | - Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
| | - Sambo Godwin
- World Health Organization, Kaduna Field Office, Kaduna, Nigeria
| | - Usman Kariko
- Kaduna State Primary Healthcare Development Agency, Kaduna, Nigeria
| | - Umeh Gregory
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | - Chima Onoka
- National Primary Health Care Agency, Abuja, Nigeria
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Umeh GC, Madubu DM, Korir C, Loveday N, Ishaku S, Iyal H, Omoleke SA, I Nomhwange T, Aliyu A, Musa A, Dankoli R, Mi Ningi A, Braka F, Dogo PM, Soba H, Iliyasu N. Micro-planning for immunization in Kaduna State, Nigeria: Lessons learnt, 2017. Vaccine 2018; 36:7361-7368. [PMID: 30366806 PMCID: PMC6238078 DOI: 10.1016/j.vaccine.2018.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/24/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The OPV 3 coverage for Kaduna State, 12-23 months old children was 34.4%. The low OPV 3 coverage, due mainly to weak demand for routine antigens and the need to rapidly boost population immunity against the disabling Wild Polio Virus (WPV), led the Global Polio Eradication Initiatives (GPEI) to increase supplemental OPV campaigns in Kaduna State, despite the huge cost and great burden on personnel. The OPV campaigns, especially in high risk (low vaccine uptake, <80% OPV 3 coverage and high vaccines refusal rate) states of northern Nigeria with poliovirus transmission has resulted in overestimated denominators or target population, as the highest ever vaccinated is used to set OPV campaign targets. METHODS We utilized a cross-sectional study that assessed the impacts and possible solutions to the challenges of overestimated denominators in immunization services planning, delivery and performance evaluation in Kaduna State, Nigeria. We used both descriptive and quantitative approaches. We enumerated households and obtained the target populations for routine immunization (<1 year), polio campaign (<5 years) and acute flaccid paralysis surveillance (<15 years). RESULTS We found a significant difference in mean scores between the micro-planning and supplemental vaccination data on a number of <5 years (M = 102967, SD = 62405, micro-planning compared to M = 157716, SD = 72212, supplemental vaccination, p < 0.05). We also found a significant difference in mean scores between the micro-planning and projected census data on a number of <1 year (M = 26128, SD = 16828, micro-planning compared to M = 14154, SD = 4894, census, p < 0.05). CONCLUSION Periodic household-based micro-planning, aided with the use of technology for validation remains a useful tool in addressing gaps in immunization planning, delivery and performance evaluation in developing countries, such as Nigeria with overestimated denominators.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul M Dogo
- Kaduna State Ministry of Health, Kaduna, Nigeria
| | - Haliru Soba
- Emergency Operations Centre (sEOC), Kaduna, Nigeria
| | - Neyu Iliyasu
- Kaduna State Primary Health Care Agency, Kaduna, Nigeria
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Abstract
Over-diagnosis of malaria has previously been described, especially in East Africa. Abuja is the capital of the most populous country in Africa. Over-prescription of artemisinin-based combination therapy (ACT) antimalarials in Nigeria on the scale reported from other countries will result in substantial unnecessary use of this class of drug. In a study of 1000 children seen in the outpatient paediatric clinics of four district hospitals in Abuja, 669 had history of fever, of whom 616 (92%) were diagnosed with malaria. Only 24 (3.8%) where confirmed by positive malaria slides. Of 82 malaria tests requested, 32 (40%) were not available when clinicians wrote their prescriptions. Of 256 children prescribed an ACT, 11 (4.4%) were test negative, eight (3.1%) test positive, in 11 (4.3%) the test was not available and the test was not requested for 219 (86%). The proportion of available negative slides for patients treated with an antimalarial was 23/26 (88%), which was similar to the 22/24 (91%) treated with an antimalarial who were test positive. Testing for malaria made almost no impact on ACT prescription or on all other antimalarials and antibiotics. Based on these findings there is high possibility of massive over prescription of antimalarials.
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Affiliation(s)
- Terna I Nomhwange
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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