Impact of engaging security personnel on access and polio immunization outcomes in security-inaccessible areas in Borno state, Nigeria

Loveday Nkwogu,Yared G Yehualashet,Fiona Braka,Charles Korir,Alemu Wondimagegnehu,Richard Banda,Mahmud Saidu,Pascal Mkanda,Rui G Vaz,Aliyu Shettima,Samuel Bawa,Usman Adamu,Hyelni Mshelia,Sisay G Tegegne,Faisal Shuaib,Peter Nsubuga,Sule Mele

doi:10.1186/s12889-018-6188-9

Abstract

BackgroundNigeria was polio free for almost 2 years but, with the recent liberation of areas under the captivity of insurgents, there has been a resurgence of polio cases. For several years, these inaccessible areas did not have access to vaccination due to activities of Bokoharam, resulting in a concentration of a cohort of unvaccinated children that served as a polio sanctuary. This article describes the processes of engagement of security personnel to access security-compromised areas and the impact on immunization outcomes.MethodsWe assessed routine program data from January 2016 to July 2016 in security-inaccessible areas and we evaluated the effectiveness of engaging security personnel to improve access to settlements in security-compromised Local Government Areas (LGAs) of Borno state. We thereafter evaluated the effects of this engagement on postcampaign evaluation indicators.ResultsFrom 15 LGAs accessible to vaccination teams in January 2016, there was a 47% increase in July 2016. The number of wards increased from 131 in January to 162 in July 2016, while the settlement numbers increased from 6050 in January to 6548 in July 2016. The average percentage of missed children decreased from 8% in January to 3% in July 2016, while the number of LGAs with ≥ 80% coverage increased from 85% in January to 100% in July 2016.ConclusionThe engagement of security personnel in immunization activities led to an improved access and improvement in postcampaign evaluation indicators in security-compromised areas of a Nigerian state. This approach promises to be an impactful innovation in reaching settlements in security-compromised areas.

Highlights

Nigeria was polio free for almost 2 years but, with the recent liberation of areas under the captivity of insurgents, there has been a resurgence of polio cases
Description of the organizational structure of the state and security personnel engaged in the delivery of immunization services in Borno state Civilian joint task force The civilian joint task force (CJTF) is a community-initiated security network that is supporting the Nigerian military in the war against insurgents in Borno state
Process of engagement of the CJTF and operations During the outbreak response to the Circulating vaccine-derived poliovirus (cVPDV) from an environmental sample taken on March 23 2016, we discovered that Maiduguri Metropolitan Council (MMC), Jere Local Government Area (LGA), and some wards in Mafa and Konduga LGAs had many eligible children outside households that could be reached using directly observed polio vaccination (DOPV), but the challenge was dealing with the huge crowds associated with DOPV in an environment that was prone to attacks by insurgents

Summary

Introduction

Nigeria was polio free for almost 2 years but, with the recent liberation of areas under the captivity of insurgents, there has been a resurgence of polio cases. The monovalent and bivalent virus strains induce higher levels of immunity than the trivalent vaccine; they can only elicit a response for the specific type of virus. This means that monovalent OPV1, OPV2, and OPV3 can only elicit a response for WPV1, WPV2, and WPV3, respectively [4]. The increased risk for outbreaks of cVDPV2 necessitated a strategic path to eventual cessation of OPV and the polio eradication end-game strategic plan of 2013–2018, which provided comprehensive, long-term strategies to deliver a polio-free world by 2018 [13, 14]

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