Abstract
Eradication of poliomyelitis remains a public health priority due to the paralytic effects of the virus on children and impact on global health system. However, existing gaps in surveillance can hinder eradication. Improved timeliness of identification and reporting of acute flaccid paralysis (AFP) cases with further confirmation of Wild Poliovirus (WPV) in stool samples, can help Nigeria achieve the performance indicators of non-polio AFP rate of ≥ 2/100,000 population aged < 15 years and ≥80% stool sample collection adequacy. To ascertain the awareness of AFP case definition and detection by health care workers and to evaluate the impact of SMS-based reporting on the AFP surveillance system the study was conducted from November 2013 to July 2014. In Sokoto state, 112 health facilities (focal sites) were operational and participated in this study. All AFP focal points for the 112 facilities were included in the study. In addition to AFP focal points, two clinicians per facility where possible, were included in the study. The study focused exclusively on reports from focal sites. The methodology was a one group pretest-posttest design conducted in 3 phases. 1) Pre-intervention Knowledge, Attitude and Practices (KAP) survey, 2) SMS implementation and 3) Post-intervention KAP. Results were analysed using the independent sample t-test to assess the increase in knowledge, attitudes, or practice scores pre- and post- training. The study showed improved knowledge gap of health care workers on AFP surveillance between pre and post intervention. It shows that this approach of improved surveillance will be effective in countries in hard to reach, access compromised or countries/place without sufficient surveillance staff.
Highlights
Poliomyelitis remains endemic in three countries – Afghanistan, Pakistan, and Nigeria
Polio cases are detected through surveillance for acute flaccid paralysis (AFP) which entails rigorous, timely AFP identification and reporting, and confirmation of Wild Poliovirus (WPV) in stool samples[2]
Identification of AFP caused by polio is significant because, for every child affected by paralytic poliomyelitis, approximately 200-1,000 children may be infected with WPV without paralysis
Summary
Poliomyelitis remains endemic in three countries – Afghanistan, Pakistan, and Nigeria. In July 2016, continued WPV circulation was detected in Borno, a northern state with ongoing conflict[1]. Polio cases are detected through surveillance for acute flaccid paralysis (AFP) which entails rigorous, timely AFP identification and reporting, and confirmation of WPV in stool samples[2]. The two major AFP surveillance performance indicators are 1) non-polio AFP rate of ≥ 2/100,000 population aged < 15 years old and 2) ≥80% stool sample collection adequacy. The Global Polio Eradication Initiative (GPEI) utilizes environmental surveillance, in which sewage samples are collected and analysed to provide supplementary information, in urban populations where AFP surveillance is absent or questionable, persistent virus circulation is suspected, or there is a high risk of virus re-introduction. In Nigeria, environmental samples are currently collected at 43 sites in 10 states and the Federal Capital Territory[2]
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