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Stop Transmission of Polio (STOP) Katsina State, Nigeria. 21 June 2011 Richard Niska, MD, MPH CAPT, USPHS CDC STOP-33 Consultant. Goals of this presentation. To describe efforts of the Stop Transmission of Polio (STOP) program
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Stop Transmission of Polio (STOP)Katsina State, Nigeria 21 June 2011 Richard Niska, MD, MPH CAPT, USPHS CDC STOP-33 Consultant
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
Objectives At the end of this session, participants will be able to describe activities, issues and recommendations in Nigeria concerning: • Routine immunization • Acute flaccid paralysis surveillance • Polio eradication
Nigeriahttp://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
Katsinahttp://en.wikipedia.org/wiki/Katsina_State • Population (2010): • 3.9 million • Main ethnic group: • Hausa-Fulani • Predominant religion: • Muslim • Languages: • English • Hausa • Fulani
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
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
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)
Major Issues Identified:Routine Immunization • High-risk sharps disposal practices • Incomplete burning of medical waste
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.
Summary of Activities:AFP surveillance • Verified or followed up on 11 AFP cases in Batsari and Safana LGAs
Summary of Activities:AFP surveillance • Ruled out paralysis in several more cases
Major Issues Identified:AFP Surveillance • Excellent non-polio surveillance efforts • Surveillance rates exceed WHO standards for polio-endemic countries. • Good stool collection performance
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.
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
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 head’s wife
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
Practices improving performance(Social mobilization) • Availability of pluses • Mosquito bed nets for pregnant women • Candy for kids
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
Barriers to better performance(Team factors) • Interpersonal communication (IPC) skills of teams • Male recorders (can’t enter households) • Training male supervisors in role-plays • But not female vaccinators in back of room
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
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)
Way forward!(Social mobilization) • Engagement of traditional leaders • Advance mobilization of husbands • Resolve non-compliance before it happens • Town criers
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
Way forward!(Training) • Improved training quality • Less use of lectures • More practical demonstrations • Involve female vaccinators in role-plays
Way forward!(Training) • Incorporate ethical teaching • To address false reporting of non-compliance, house-marking, etc. • To reassure population that religious leaders support immunization
Way forward!(Operational) • Plan for high workloads to prevent hurried work • Separate morning and afternoon shifts with different teams • Revisit strategy