Use of Dedicated Mobile Teams and Polio Volunteer Community Mobilizers to Increase Access to Zero-Dose Oral Poliovirus Vaccine and Routine Childhood Immunizations in Settlements at High Risk for Polio Transmission in Northern Nigeria

Abstract

BackgroundThe Polio Eradication Initiative in Nigeria, which started >20 years ago, faced many challenges, including initial denial, resistance from communities, and prolonged regional safety concerns. These challenges led into the structuring of the response including the development of the National Emergency Action Plan, improved partner coordination and government engagement, and the establishment of a Polio Emergency Operations Centre. Although monthly supplementary immunization activities (SIAs) continued, the targeting of settlements at high risk for polio transmission with routine immunization (RI) and other selected primary healthcare (PHC) services using dedicated mobile teams and volunteer community mobilizers (VCMs) became a key strategy for interrupting polio transmission in the high-risk areas. These efforts could have contributed to the wild poliovirus–free 2-year period between 24 July 2014 and 11 August 2016, when 2 cases of the virus were reported from Borno State, Northern Nigeria.MethodsA narrative analysis of polio-related program and other official documents was conducted to identify the relevant human resources and their role in the Polio Eradication Initiative and in RI. The data used in the article was obtained from United Nations Children's Fund (UNICEF) and World Health Organization project reports and a draft evaluation report of the dedicated mobile teams approach in Northern Nigeria.ResultsThe data from 6 of the states that commenced the provision of polio, RI, and other selected PHC services using the dedicated mobile teams approach in 2014 showed an overall increase in the percentage of children aged 12–23 months in the settlements at high risk for polio transmission with a RI card seen, from 23% to 56%, and an overall increase in fully immunized children aged 12–23 months, from 19% to 55%. The number of newborns given the first dose of oral poliovirus vaccine (OPV) according to the RI schedule and the number of children given zero-dose OPV with the assistance of the VCMs similarly increased between 2013 and 2015. In 2015, VCMs helped track 167 092 newborns and also linked 156 537 infants aged <1 year to RI services in the 6 states.ConclusionsThe analysis illustrates that polio personnel in Northern Nigeria are used in increasing access to zero-dose OPV, RI, and selected PHC services. The increase in the services generated represented the increasing role of the dedicated mobile teams and polio VCMs in strengthening RI.

Mobile outreach health services for mothers and children in conflict-affected and remote areas: a population-based study from Afghanistan

“…Three systematic reviews have reported important effects of MCH outreach delivery strategies on MCH service provision in non-emergency areas 24–26. Three additional studies have reported important impacts on MCH service delivery in conflict settings 8–10. In Myanmar, specialised maternal services in border camps increased ANC and PNC by 32%–50% 9.…”

“…Polio campaign camps in conflict-affected areas of Pakistan increased vaccination rates by 7%–9% 10. Regular visits from a MHT programme funded by the Polio programme in Nigeria increased coverage of children ‘fully immunised’ by 33%–36% 8…”

“…However, this type of ‘sustained standard package’ approach has not been evaluated. To our knowledge, there have been only three published outreach evaluations in conflict-affected and remote areas 8–10. One study evaluated specialised maternal services in remote Myanmar,9 one study evaluated a Polio campaign camp in Pakistan10 and one study examined regular visits from a focused MHT programme that was not part of the routine health system in Nigeria 8…”

Addressing the Challenges and Opportunities of the Polio Endgame: Lessons for the Future

“…Several of the articles in this supplement take stock of how GPEI resources support RI activities and contribute to strengthening RI services, with the specific aim of identifying services that may be at risk when polio resources diminish after eradication [80,81]. Deutsch et al and Ongwae et al describe how use of polio resources, social mobilization networks, and experience may also be valuable to broader health programs and RI activities [82,83]. Van den Ent et al identify several key factors behind the success of polio eradication programs in the 10 high-risk priority countries, including government leadership, evidence-based programing, community partnership, and strong accountability systems [84].…”

Transition Planning For After Polio Eradication

“…When Ebola virus was detected in Nigeria, the emergency operations center capability that had been put in place to manage the polio program was quickly repurposed to manage the Ebola outbreak, which was quickly terminated. GPEI-funded assets are also working to strengthen routine immunization in Nigeria [ 23 ]. The National Stop Transmission of Polio program, for example, was created in 2012 with the support of the Centers for Disease Control and Prevention and now involves >180 officers posted across the country.…”