Abstract
BackgroundPoliomyelitis, often called polio is a viral paralytic disease caused by Polioviruses. Although all susceptible individuals are at risk of getting infected, only about 1% become paralyzed. During the 2013 Polio Outbreak in Garissa County in Kenya, 50% of the confirmed cases were from the nomadic population although it comprises of only less than 20% of the total population in the county. Following concerns from the Horn of Africa Polio Technical Advisory Group (TAG) regarding inadequate vaccine coverage of nomadic population, several strategies were put in place to improve coverage and Acute Flaccid Paralysis case reporting among nomads in the rest of the planned 2014 polio vaccination campaigns. We describe strategies initiated from April 2014 by the Ministry of Health and partners to reach children in nomadic settlement in the two sub-counties of Dadaab and Fafi of Garissa County.MethodsThe strategies involved improving the mapping and tracking of the nomadic population by establishing lists of nomadic settlements obtained from local clan leaders and government administrators, their <5-year-old populations and focal persons. Focal persons were used to mobilise residents in their respective settlements and guide vaccination teams during campaigns. Settlement leaders were sensitised to report cases of Acute Flaccid Paralysis. In remote hamlets, trained community health volunteers were used as vaccinators. In such places drugs for common illness were also provided during the campaigns. A tracking tool to monitor nomadic population movement and special tally sheets to capture data were created. Training of vaccination personnel and intense social mobilisation activities was done.Results and conclusionAbout 2,000 additional children, from both nomadic and non-nomadic areas were reached when the new initiatives were started. For the first time, an actual number of nomadic children accessed was documented. Suspected AFP cases continued to be reported from nomadic settlements, and the number of zero dose children among the nonpolio AFP cases dropped. With modification and improvement, these strategies may be used to take health services such as routine immunisation to nomadic communities and reduce their vulnerability to vaccine preventable disease outbreaks.
Highlights
A nomad is a member of a people or tribe who according to the changing seasons move from one place to another to meet the needs of their livestock
The settlements were put on a sketch map of the sub-County, for example (Figure 1) for Dadaab sub-County to aid both the teams micro-planning for upcoming supplementary immunization activities (SIAs) and those selected to reach nomadic settlements from the local health facility
We found that by using clan elders and other key informants in the nomadic communities, it was possible to establish a list of nomadic settlements and their location in the two sub-Counties
Summary
A nomad is a member of a people or tribe who according to the changing seasons move from one place to another to meet the needs of their livestock. Mobility is an important determinant of health worldwide, and nomadic populations in sub-Saharan Africa are no exception[3]. Given their lifestyle, there is inadequate systematic surveillance data on the health status of nomads. In most of sub-Saharan Africa, access to health care services by nomads is poor compared to settled populations, and there is no satisfactory strategy devised yet to deliver proper health care to remote populations. Following concerns from the Horn of Africa Polio Technical Advisory Group (TAG) regarding inadequate vaccine coverage of nomadic population, several strategies were put in place to improve coverage and Acute Flaccid Paralysis case reporting among nomads in the rest of the planned 2014 polio vaccination campaigns. We describe strategies initiated from April 2014 by the Ministry of Health and partners to reach children in nomadic settlement in the two sub-counties of Dadaab and Fafi of Garissa County
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