10th September, 2012
By Bilkis Bakare
Poliomyelitis, Polio or infantile paralysis is a term derived from the Greek word ‘Polios’ meaning grey referring to the grey matter in the spinal cord and ‘itis’a suffix which denotes inflammation. It is an acute infection caused by the Polio virus. The virus was first isolated in 1909 by Karl Landsteiner and Erwin Popper. It is spread from person to person through the faecal – oral route that is through contamination of food and drink. It often spread in areas with poor sanitation. The virus is shed in faeces of infected individuals and viral replication occurs in the alimentary canal, where it is capable of surviving the acidic condition.
The virus spread throughout the body via the lymphatic system and because it can replicate quickly, it overwhelms the host organs before an immune response can be mounted. It mainly affects young children, ages 0-5 years. Many infected victims have no symptoms, but do excrete the virus in their faeces, hence transmitting infection to others, with initial symptoms including fever, fatigue [tiredness], headache and vomiting. Other symptoms are stiffness in the neck and pain in the limbs. 95% of cases are asymptomatic i.e. not manifesting the symptoms while the remaining 5% manifest the symptoms causing permanent paralysis. Till date, the only source of prevention for the disease is the administration of the polio vaccine.
In the quest to eradicate polio worldwide, the World Health Assembly in 1988 launched the Global Polio Eradication Initiative [GPEI], championed by the World Health Organisation [WHO], Rotary International, US Centre for Disease Control and Prevention and United Nations Children Fund [UNICEF]. It was launched then to arrest the polio endemic as more than 350,000 children from over 250 countries were left paralysed annually from the disease. Since then, it has been monitoring and rendering financial assistance to countries plagued by the disease.
WHO has identified Nigeria as the country with the highest figure in poliomyelitis cases, contributing 90% of the polio burden in Africa and nearly 60% of the world polio burden alongside Pakistan and Afghanistan after India in January became the latest country to become polio free, going a full year without registering a new case. Similarly, the country is also recognized as the only one with all three types of polio virus viz: Type 1, Type 2[circulating vaccine derived] and type 3.
Currently, two third of reported cases in the country are from the northern states of Borno, Kano, Sokoto and Zamfara. Other states include Jigawa, Kaduna, Katsina, Yobe, Bauchi and Niger. No thanks to current security challenges, religious beliefs, no care giver [parent and guardian] consent due to the controversy on whether the administration of the vaccine on children causes infertility among the females and apathy to too many rounds of doses of the polio vaccine .All these factors combine are working against the total eradication of the disease in these states.
Therefore, in order to nip the spread of the disease in the bud, administrators and stakeholders in the health sector of each state, especially the states with the highest polio burden, are leaving no stone unturned in their effort to eradicate the disease. For instance, in Borno state, Governor Kassim Shettima has declared that henceforth, one of the criteria for measuring the performance of any Local Government chairman is his achievement in vigorously fighting to eradicate polio. In Karkarku village, Sandamu Local Government of Katsina State, a two year old girl was recently confirmed to have been infected with the polio virus. This discovery brought to bear the reality of the existence of the disease which hitherto residents were nonchalant about.
Consequently, Governor Ibrahim Shehu Shema threatened to sack any Local Government chairman in whose domain fresh cases are reported. Similarly, the Emir of Daura, Alhaji Farouk Umar Farouk, vowed to sack any traditional ruler whose domain the administration of polio vaccine is rejected.
Also, in the last six months, four children from three Local Government areas of Zamfara state have been left paralysed while the Sokoto state Governor, Alhaji Aliyu Wamakko, has declared that the state has the highest cases of polio in the country. Also, in Delta State, eight persons were discovered to have the disease, a situation described as shocking by the Deputy Governor because the state had been polio free since 2008.
In order to arrest the polio spread in Nigeria, President Goodluck Jonathan set up a Presidential Task Force on polio eradication in March this year with the Minister of State for Health, Dr. Muhammed Alli Pate, as the chairman. The Task Force has the mandate of meeting regularly to evaluate progress towards fully implementing the national polio emergency action plan. Similarly, the World Bank Board has approved a sum of 15.2 billion naira credit for the country’s polio eradication support project which will help achieve 80% polio immunization across all states in the country.
Bill and Melinda Gates Foundation, brainchild of billionaire Bill Gates has rendered assistance to the country in the past in the area of polio eradication. Likewise, the Japanese Government recently offered about 1.24 billion naira grant to the Nigerian Government to help combat the disease. Also, UNICEF has increased its domestic funding for polio eradication in the country from $17m to $30m per year after President Jonathan declared polio eradication as a national emergency. Traditional and religious leaders in the affected states, mostly in the northern part of the country, have also been incorporated to help sensitize their subjects about the importance of the polio vaccine.
To avoid making past mistakes, Minister of Health, Prof. Onyebuchi Chukwu affirmed that GPS devices to track movements of migrants in high risk areas are being employed and also working with neighbouring countries to ensure there is no cross border transmission of the disease. Individuals involved in the eradication campaign are now being made to account for any lapses noticed in the immunization programme. To guarantee the availability of quality, safe and affordable vaccine in the country, the Federal Government has renewed its joint venture with May and Baker for the production of vaccines to bridge supply gap for routine immunizations.
In order to achieve total eradication of polio, primary health care system across the country must be strengthened at the Local Government level. Without this, the routine immunization programme required to maintain community immunity at a high level after being certified as polio free may not be able to maintain such tempo, resulting in the re- emergence of wild polio. Good water supply must, also, be available to the people. Likewise, the culture of proper disposal of faecal matters by the people especially in highly populated areas must be improved upon.
In all, high quality immunization campaigns and sensitive disease surveillance are more important than ever in the total eradication of polio. The reorientation and sensitization of the people on the danger of polio must be taken more seriously. Children are the joy and future of the world. Let’s join hands to wage war against polio to ensure a better future for our children.
•Bakare is of the Features Unit, Ministry of Information and Strategy, Alausa, Ikeja