Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013–2015

Abstract

BackgroundThe Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria.MethodsSpecial interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions.ResultsThe number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention.Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage > 90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with > 4 doses of oral polio vaccine increased from 2 to 8% before to 93–98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016.ConclusionScaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation.

Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges

“… Intervention Frequency Note Reference Community engagement, sensitisation, and mobilisation Training community members to advocate for vaccination 8 Training volunteer community mobilisers, traditional and religious leaders (e.g., traditional barbers), schoolteachers, and other community leaders to advocate for vaccination successfully improved vaccination acceptance and uptake, particularly in traditional Muslim societies [95] . This included ‘baby tracking’ by volunteers to remind new mothers to vaccinate new-borns; and involving women and youth to help identify missed children [114] . [95] , [107] , [112] , [114] , [115] , [116] , [117] , [118] Engaging hard-to-reach communities 8 Engaging youth groups, leveraging existing structures, and using multi-pronged approaches to extend vaccination services, including screening tools for healthcare workers to identify vaccination needs and mobilising communities, increased coverage in hard-to-reach and security-challenged communities [90] , [92] , [95] , [113] , [119] , [120] , [121] , [122] Health education interventions for caregivers to increase vaccine awareness 4 Focused, short (5 min) health education sessions were more effective than longer (10–15 min), generic health promotion messages, and frequent vaccination messaging was preferred (i.e., not just during vaccination campaigns).…”

“…This included ‘baby tracking’ by volunteers to remind new mothers to vaccinate new-borns; and involving women and youth to help identify missed children [114] . [95] , [107] , [112] , [114] , [115] , [116] , [117] , [118] Engaging hard-to-reach communities 8 Engaging youth groups, leveraging existing structures, and using multi-pronged approaches to extend vaccination services, including screening tools for healthcare workers to identify vaccination needs and mobilising communities, increased coverage in hard-to-reach and security-challenged communities [90] , [92] , [95] , [113] , [119] , [120] , [121] , [122] Health education interventions for caregivers to increase vaccine awareness 4 Focused, short (5 min) health education sessions were more effective than longer (10–15 min), generic health promotion messages, and frequent vaccination messaging was preferred (i.e., not just during vaccination campaigns). Successful interventions included group health education for parents and pregnant women attending vaccination or antenatal clinics; and participatory learning on infant vaccination for older women.…”

“…Successful interventions included group health education for parents and pregnant women attending vaccination or antenatal clinics; and participatory learning on infant vaccination for older women. [68] , [95] , [107] , [114] Tailoring communication to preferred channels 3 Healthcare workers and media are the most common sources of information, with radio and town announcers preferred in rural settings and media preferred in urban and rural settings. Radio / television and home visits were preferred by Muslim women unable to leave their homes due to Purdah system.…”

“…Radio / television and home visits were preferred by Muslim women unable to leave their homes due to Purdah system. [95] , [107] , [114] Building awareness through media campaigns 3 This included media, sensitisation and enlightenment campaigns, statements from religious leaders, road shows, etc to increase vaccine awareness. [46] , [47] , [122] Engaging community liaisons 1 Engaging nomadic ‘Ardos’ a , who know migratory patterns of their communities, to act as a community liaison and provide dates and times of vaccination visits helped to engage nomadic communities.…”

“… [122] Healthcare worker training 1 Training of healthcare workers in interpersonal communication to increase successful interactions with caregivers; and home visits by healthcare workers helped to increase coverage. [114] Language support 1 Providing interpreters for native languages in PHC facilities enabled better communication around vaccination. [114] Sustaining vaccination coverage Vaccination reminders Reminders for follow-up appointments 5 Reminders (e.g., phone call or SMS texts) for appointments successfully increased return rates for appointments.…”