- Scope of the problem
Poliomyelitis which is also referred to as polio or infantile paralysis is an infectious disease that mostly affects children. It is caused by poliovirus. It affects the nervous system resulting in paralysis and in some instances death within a couple of hours. Polio mostly affects children who are under the age of 5 years but it can affect individuals of any age. In poor countries, polio is transmitted via the faecal oral route while in rich countries it is transmitted via the oral- oral route. The symptoms of polio are often evident in less than 1% of the infected individuals. Polio is particularly endemic in third world countries.
Reports indicate the polio still remains a serious health problem in Nigeria. In 2012, there was a sharp decline in the number of cases of 467 to 171 which represented a 63% decline. Nigeria stood out from the rest of the countries since there was an increase in the number of polio cases that were reported in 2012. In 2011, there were 62 cases of wild polio virus while in 2012 there were 97 cases which represented a 36% increase in the polio cases. There are two other countries that are known to have endemic to polio: Afghanistan and Pakistan. Within the period between 2011 and 2012, Afghanistan recorded a 37.5% decline while Pakistan recorded a 62.7% decline in the cases of wild polio virus that were recorded. India which also featured among the countries that are endemic to polio has successfully eliminated the polio virus in spite the fact that it has a large population living in the rural areas.
According to the Global Polio Initiative, Nigeria is one of the countries where the wild polio virus is deeply entrenched. The three serotypes of polio virus which are wild polio virus 1, wild type virus 2 and circulating vaccine derived polio type 2 are still transmitted in Nigeria. The northern regions of the country are the main sites of transmission to the rest of the country and the rest of the country. The poor are the ones who bear the brunt of the polio virus in Nigeria given that the virus results in disability. There is little provision for individuals with disabilities making the lives of those who are affected extremely difficult.
In the year 2012, 61 children were paralyzed as a result of contracting the polio virus in Nigeria while in 2011 24 children were paralyzed as a result of the disease. 95% of the incidences of polio virus were reported in eight states that are located in northern Nigeria. Notable among the states that reported polio cases in Nigeria was Katsina. 40% of the cases of polio that were reported in 2012 were in that state. The state also has a low turn-out during immunization with reports indicating that at least one third of the children in the state are under immunized. The situation in Nigeria has led to it being ranked as the country with the gravest risk of polio eradication along with Pakistan.
- Global polio trends
The Global Polio Eradication Initiative aimed at eradicating polio by the year 2000 but incidences of polio are still being reported in various parts of the world. The initiative which was launched in 1988 has led to the decline in polio cases by 99%. Over the years, there have been fluctuations in the number of polio cases that have been reported. The least number of cases which was 483 of reported in 2001. In 2006, there was a record high number of cases which was 1997 cases. In 2008, the number of cases recorded reduced to 1,600. Nigeria has managed to record a decline of 95% in the incidences of polio but there are still incidences that have been reported in the recent past. For instance, in 2009 there 388 cases that were reported in 27 states. This number declined to 21 in 2010. 2011 saw that number quadruple while in 2012 there was a 63% decline from the previous year. All the three types of polio are still being transmitted in Nigeria with the northern parts as the source of transmission to the rest of the countries.
- The population of Nigeria
Nigeria is country in West Africa that is made up of 36 states and a population of 155 million people. It is bordered by Chad and Cameroon to the east, Benin to the west and Niger to the North. The capital city of Nigeria is Abuja. The population is diverse: some parts of the country are predominantly Muslim while others are predominantly Christian. There is also a small portion of the citizens that still practices their traditional beliefs. The northern region comprises of two major ethnic groups: Hausa and Fulani. The main religion that is practiced in the northern region is Islam. The southern region of Nigeria is predominantly Christian. The distinct dominance of one religion in the regions of the country can be attributed to the segregation during the colonial times.
During the colonial times, the two regions were governed separately. Rivalry between the northern and southern parts dates back to the colonial times and is still prevalent. The country has a federalized government system which is hierarchical. The local government authorities answer to the federal government which is in turn under the state governments. The capacity and the priority of each level varies hence challenges often arise in terms of the allocation of funds, prioritization and accountability.
The northern region of the country is isolated from the rest of the country. Its inhabitants often harbour suspicion for anything that is foreign particularly that which is promoted by the Western governments. Given that the region’s inhabitants are mostly Muslims, the local imams have great influence over the inhabitants of the northern region. It is this influence that fuelled the boycott of polio vaccination in 2003 after the imams alleged that immunization was a ploy by the Western governments to eliminate the Muslim population by causing sterility and spreading HIV.
- Comparison between Congo and Nigeria
Both countries have experienced polio outbreaks in the recent past. The polio outbreak in Nigeria was in northern Nigeria; a rural area where the majority of the population is highly impoverished. The polio outbreak in the Republic of Congo took place in Pointe Noire; an urban centre which is the second largest city in the republic. Northern Nigeria has been neglected by successive government hence there is little commercial development that has taken place over the years. On the other hand, Pointe Noire is the hub of commercial activities in Congo. The climate of Pointe Noire is hot and humid while that of northern Nigeria varies. There are four types of climate experienced in northern Nigeria: humid sub equatorial, hot wet tropical which is experienced in the middle belt, moderate sub temperate which is experienced in the mountains and high plateaus and hot tropical experienced in the far north.
- Rural response to polio eradication in Nigeria
In response to the polio outbreaks in rural parts of Nigeria, there are several measures that have put in place in order to curb future incidents. To begin with, there have been renewed efforts to sensitize the community about the polio virus. The sensitization campaigns involve the local administrative leaders and the religious leaders. The sensitization campaigns are carried out on selected days and are aimed at getting parents to be more receptive towards the immunization program. As part of the efforts to encourage dialogue in communities about polio, the local film industry has produced local dramas known as majigi. These films are screened at local Quranic schools so as to educate the children, the women and local health workers about the devastating effects of the disease.
In addition to this, there has been a renewed zeal towards immunization of all children under the age of 5 years. This has particularly been emphasized because Nigeria is currently the only nation in the world where the three types of polio virus are still being transmitted. Samples drawn from the environment in Kano which is located in northern Nigeria were found to be positive for wild type polio virus type 1. This indicates the severity of the risk of transmission of polio in Nigeria. In order to increase coverage by the immunization program, local health workers are often sent to remote rural parts of Nigeria in order to carry out immunization. The immunization programme is an initiative of the Global Polio Eradication Initiative which is a partnership of various international donor organizations which include: USAID, World Health Organization Program, Rotary International, UNICEF and US Center for Disease Control and Prevention. The initiative works hand in hand with the Nigeria government in addition to other governments in neighbouring countries such as Chad, Benin and Cameroon.
The immunization program in northern Nigeria also targeted nomadic communities who live in the northern part of the country. This was geared towards ensuring that no child was left out during the immunization programme. The federal government in conjunction with the Global Polio Eradication Initiative worked hard to increase the capacity of the staff. Staffs drawn from the nomadic communities were trained on how to vaccinate the children. Mobile vaccination units were also set up to keep with the nomadic community.
The administration in the affected region has not been left behind in the fight against polio. In some states such as Kano where polio has been endemic in the recent past, the state administration has put in place measures to coerce parents into taking their children for immunization. Parents who refuse to take the children for immunization have been threatened with imprisonment or heavy fines. According to state officials in Kano, the prosecution of such parents would be under the laws that prohibit parents from barring their children from accessing health care.
- Critical issues in relation to polio eradication in rural Nigeria
Efforts made by the Global Polio eradication initiative have led to the drastic reduction of polio around the globe by a whopping 99%. This is as a result of the aggressive campaigns that have been undertaken to educate communities and immunize children under the age of 5 years. However, in spite the gains that have been made as a result of the initiative, Nigeria still lags behind with new cases of polio still being reported in northern states of the country. For instance, reports indicate that there were 171 new cases of polio that were reported in Nigeria in 2012 in spite the aggressive efforts made by the Global Initiative to eliminate the disease by 2012. There are several factors that have contributed to the recurrence and persistence of new polio infections in Nigeria particularly in the rural settings as shall be outlined below:
The local government authorities are charged with the responsibility of providing health care services; a task that they are ill equipped to carry out. Unlike the national Expanded Program on Immunization in the 1980s which successfully increase the immunization rate, the local government authorities’ local government authorities have in the past failed to enhance the success rate of the polio immunization programmes. In the past, the local government authorities have failed to adequately allocate resources to purchase vaccines leading to deficits. This has greatly impacted the rural areas where the majority of the population is poor hence cannot afford to pay for the vaccination at private hospitals.
Secondly, the Global Polio eradication initiative was launched in Nigeria in 1996. At that time, the country was experience deep seated economic and political crises having undergone 10 military coups by that time. The rule of General Sani Abacha was marked by incompetence, the ruin of state run health facilities, neglect of certain regions of the nation, suppression of the civil society and deterioration of the general standards of living. While the country has made strides towards becoming politically stable since that time, the health sector still bears the brunt of the years of misrule and corruption. This is evident in the run down facilities that are found in rural parts of Nigeria making it difficult for the population in such regions to access immunization. The infrastructure is also poorly developed in rural areas therefore making it difficult to reach some parts of rural Nigeria even in this day and age.
- Structural inequalities and geographical factors
In spite the fact that Nigeria has experienced political and economic upheavals in the past, there were significant gains that were made in eradicating polio over the years. However, the drop in the cases of polio was particularly noted in the south. This is because of the focus of both public and private investors on the south leading to the development of proper health facilities and infrastructure in the south. As a result, the south had better health facilities, qualified personnel and better logistic support as compared to the north. The per capita investment in health in the north is half of what is invested in health in the south. The local government authorities and the households bear the brunt of the burden of healthcare in north while in the south; the private and the public sector bear the burden of health care to a large extent. The ascension of Olusegun Obasanjo to power in 1999 and his leadership further shifted the focus of development to the south given that he represented the southern elite. Polio cases are almost unheard of in the south as a result of the availability of the amenities. The north on the other hand has poor health amenities and lacks the technical support hence leading to repeated incidences of polio epidemics.
The local government authorities are often regarded as a weak link in the efforts to eradicate polio in rural parts of Nigeria. They are a constituent of a larger system that is inept, are not accountable and have poor and inadequate feedback systems. In the local government authorities (both rural and urban), these weaknesses have manifested in various ways: to begin with, the commitment of the local government authorities toward the eradication of polio in some rural areas is wavering. As a result of the unwavering commitment, there is often breakdown in the management of logistics such as provision of supplies and diversion of resources. There have been accusations of unqualified personnel being deployed to conduct vaccination activities in remote rural areas. Reports indicate that some of the personnel deployed are middle schoolers or untrained family members of the officials at the local government authorities.
The northern states of Nigeria where polio is endemic have particularly bore the brunt of the years of misrule. Successive leaders have failed to recognize the importance of investing in other sectors apart from the oil sector therefore leading to the collapse of agricultural and manufacturing industries which are critical in the growth of a robust economy. The decline of the growth of the economy as a result of the poor leadership over the years led to impoverishment of the northern region of the country. This fostered hostility and suspicion towards the government; a factor that would later contribute to the vaccine boycott in 2003.
The rumor was backed by the Supreme Council of Muslims in Nigeria, and a prominent Muslim group known as Jama’ atul Nasril Islam; which called for the testing of the efficacy of the polio vaccines. These two groups which are largely influential openly declared that they had strong reasons to believe that indeed the polio vaccines contained anti fertility agents, cancer causing agents and could ultimately lead to infertility. Politicians especially in Kano also added their voice to the rumor hence leading to the suspension of the vaccination altogether in some places such as Kano.
The rumor was further compounded by news about a drug trial that was carried out by Pfizer Limited in which the efficacy of antibiotic trovaflaxin was being compared with another anti meningitis drug. During the clinical trials, 11 children died. The trials were carried out in Kano, a rural area in northern Nigeria in 1996. The deaths that occurred as a result of the clinical trials sparked great controversy and sowed seeds of doubt in the minds of the rural populace in northern Nigeria. In the mean time, the south continued with their aggressive polio vaccination programme therefore leading to a drastic reduction in cases of polio. The boycott in 2003 was subsequently linked to the reports of polio cases in 20 countries which accounted for 80% of the cases of paralysis that were reported around the globe. This surge in the cases of polio was costly; it cost the international community about $ 500 million.
The northern region is also the epicentre of activities of Boko Haram that promotes anti western and antiestablishment ideologies. Boko Haram has been attacking government institutions in most parts of the northern Nigeria therefore making it difficult for health workers especially those who go into the rural areas shun such areas. The group’s terror attacks go beyond the remote rural areas in northern Nigeria and spill over to urban areas. The National Program on Immunization suffered a major loss in the recent past after its offices in the state capital of Maiduguri were bombed by Boko Haram. The programmes meant to eradicate of polio in Nigeria therefore have to contend with this problem.
In spite of the political changes that have taken place in Nigeria over the years, the northern region still remains highly volatile and the frustrations continue to pile up. The elections that were held in 2011 which marked the beginning of the tenure of Jonathan Goodluck were marked with tension and further enhanced the division between the north and the south. In the same year, a community in northern Jigawa state threatened to boycott polio vaccination unless the government completed the construction of health clinic that they had been started 15 years earlier. There were protests in the northern region of the country as a result of feelings harboured by the residents that it was the “north’s turn” to be at the helm of leadership. The wave of violence led to the death of 800 people hence raising concerns about the security in the northern region. This further hampered the efforts to do door to door vaccination campaigns that were being carried out in remote rural parts of northern Nigeria.
In spite of the boycott, sensitization efforts, public endorsement of immunization by local leaders and involvement of communities have led to better outlooks towards immunization. As a result, more children are being immunized in northern Nigeria.
- Conclusion
In conclusion, the eradication of polio in rural parts of Nigeria still remains a priority. The collaborative efforts of the government, local political and religious leaders and the Global Polio Initiative need to continue in order to eradicate polio from Nigeria.
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