AFP Case Detection Along International Border Communities in Oyo State: Challenges, Opportunities and Threats

Bassey Enya Bassey,Angela Ugochukwu Okocha-Ejeko,Gerald Sume,Sisay Gashu Tegene,Fiona Braka,Olufunmilola Olawumi Kolude,Marion Mosunmola Osanoto,Rosemary Onyibe,Joy Ogechi Max-Ikechebelu,Ayomide Oluwaseyi Aibinuomo,Olayiwola Suliat Olanike,Leonard Idemudia Ugheighele

doi:10.11648/j.sjph.20210903.17

Abstract

A weak AFP surveillance system constitutes a major threat to Nigeria’s polio free certification status. This study investigates the factors that have affected AFP surveillance, case detection along the international border settlements of Oyo state, Nigeria. A cross-sectional survey was conducted between 26<sup>th</sup>-31<sup>th</sup> December 2018 using structured questionnaires uploaded onto Open Data Kit-collect (ODK) mobile software in 4 LGAs in Oyo state. Overall, 427 respondents (community members=420, community informants=7) participated in this study. On the average, 10% and 46% of the community members and informants could identify the various aspects of the AFP case definition. Majority of the community members weren’t aware of AFP surveillance neither were they aware of their AFP focal person/DSNO or where to report AFP cases. Barriers to case reporting include, irregular movements of commercial vehicles, swampy roads during rainy seasons, rocky roads during dry seasons; poor communication networks; and poor modes of transportation. The accessibility and difficulty of terrain along these international boarders has greatly hindered surveillance activities in their corresponding communities. If steps are taken to improve accessibility in such areas, we believe that AFP case detection and reporting would also improve.

Highlights

Four of the six World Health Organization regions have been certified as polio free nearly 3 decades after the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) in 1988. [1, 2] Nigeria, Afghanistan and Pakistan remain the only countries without a polio free certification.[3, 4]
To halt the transmission of polio in an area, the World Health Organization (WHO) recommends a four-part eradication strategy: routine immunization (RI) of infants less than 1 year old with at least three doses of oral polio virus vaccine (OPV), the administration of supplemental doses of OPV to all children under the age of 5 years during National Immunization Days to decrease the widespread circulation of the polio virus rapidly, localized ‘mopping up’ vaccination campaigns s and a highly sensitive AFP surveillance system. [5,6,7]
Variables Are community members aware/sensitized of AFP surveillance (n=428) Do community members know their AFP focal person or Disease surveillance and Notification Officers (DSNOs) (n=420) Do community members know where to report a suspected AFP case? (n=420) Do members of the community have contact numbers of focal person/DSNO? (n=420) Are the informants aware of AFP surveillance (n=7) Do the informants know that all cases of AFP must be reported (n=7) Must all cases of AFP be reported to the Disease surveillance and notification officer (DSNO) (n=7) When should seen AFP cases be reported (n=7) Have community informants received training on AFP surveillance in the last year (n=7)

Summary

Introduction

Four of the six World Health Organization regions have been certified as polio free nearly 3 decades after the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) in 1988. [1, 2] Nigeria, Afghanistan and Pakistan remain the only countries without a polio free certification.[3, 4] Nigeria was readmitted to the list of polio endemic countries following the August 2016 incident where four WPV1 was discovered in Borno state. [1] Though no new cases of WPV have been reported, Nigeria continues to implement prompt response strategies to ensure that the August 2016 scenario does not repeat itself.To halt the transmission of polio in an area, the WHO recommends a four-part eradication strategy: routine immunization (RI) of infants less than 1 year old with at least three doses of oral polio virus vaccine (OPV), the administration of supplemental doses of OPV to all children under the age of 5 years during National Immunization Days to decrease the widespread circulation of the polio virus rapidly, localized ‘mopping up’ vaccination campaigns s and a highly sensitive AFP surveillance system. [5,6,7]AFP surveillance remains the gold standard for polio eradication and it underpins the entire eradication initiative [8,9,10]. To halt the transmission of polio in an area, the WHO recommends a four-part eradication strategy: routine immunization (RI) of infants less than 1 year old with at least three doses of oral polio virus vaccine (OPV), the administration of supplemental doses of OPV to all children under the age of 5 years during National Immunization Days to decrease the widespread circulation of the polio virus rapidly, localized ‘mopping up’ vaccination campaigns s and a highly sensitive AFP surveillance system. For all AFP cases reported, adequate stool samples must be Science Journal of Public Health 2021; 9(3): 103-108 collected and transported to a World Health Organization (WHO) accredited laboratory via a reverse cold-chain transport system for polio enterovirus isolation. The Local Government Areas (LGAs) in the state, which share these boundaries, are Atisbo, Saki West, Iwajowa and Itesiwaju with a total population of 926,694 people

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