2011 Polio Communication Summary Report

8/3/2019 2011 Polio Communication Summary Report

1/9

S U M M A R Y R E P O R T

POLIO COMMUNICATION

NIGERIA

ADDRESSINGCOMMUNICATIONCHALLENGES 2011

UNICEFNigeria/2011/Morgan


2/9

F A C T S A N D F I G U R E SAs of November 25, 2011, Nigeria has recorded 43 cases of wildpoliovirus (WPV) in eight States compared to 14 cases in sevenStates for the same period in 2010. Four (4) States of NorthEastern part of Nigeria recorded 28 WPV cases. Kano has so far14 WPV cases followed by Kebbi (8), Jigawa (6), Borno (5),Sokoto (5) and Yobe (3), whereas Katsina and Zamfaraexperienced one case each.

Total number of circulating vaccine derived poliovirus (cVDPV2)is 25 in six States compared to 25 cases in eight States for the

same period in 2010. Jigawa has the highest number of cVDPVcases (11) followed by Kano (9), Borno (2) and one in Katsina,Zamfara and Yobe States.

In 2011, Nigeria conducted eight national and sub-national IPDsin January, February, March, May, June, July, September andNovember. There will be another Special Immunization PlusDays in 12 high-risk States in December. In line with the 21

st

Expert Review Committee (ERC) recommendations, Nigeria alsoconducted mop-up campaigns in the polio-affected States. Theproportion of missed children during these campaigns hasfluctuated.

In January Immunization Plus Days, the percentage of missedchildren was 6% while in September it rose to 6.5% in thenorthern high-risk States. Non-compliance as a reason formissed children also showed a similar wavy trend.

In January round, non-compliance as a reason for missedchildren was 27% and it finally reached 28% in SeptemberImmunization Plus Days.

Fig 1: Trend of missed children (MC) and non-compliance (NC)in 2011 IPDs.

UNICEF Nigeria /2011/Morgan


3/9

Nigeria continues to experience a surge of polio cases,following a dramatic reduction of cases in 2010. Thecountry remains the only polio-endemic country inAfrica. Significant progress has been achieved inNigeria, with the number of cases collapsing by morethan 95% in 2010. However, as of end of November,Nigeria recorded 43 cases of wild poliovirus comparedto 14 cases in the same time period in 2010.

In the first nine months of 2011, Nigeria has alreadyreported more cases than in the whole of 2010. The

States of Borno, Kano, Jigawa and Kebbi account for85% of all cases nationally. Continued communityresistance to the programme is profoundly impactingprogress. Caregiver refusals, or non-compliance, toimmunize their children still make up a significantproportion of the total number of children missed duringcampaigns, and refusals are on the rise in some high-risk States.

This upsurge of polio cases is also due to highernumber of under-immunized population groups andpockets of non-compliance in a few northern States.Routine immunization coverage remains below 80%

nationally, with sub-optimal performance by northernStates.

Over the past months, Nigeria conducted a series ofnational and sub-national Immunisation Plus Days(IPDs) as well as mop-up campaigns in the polio-affected States. During mopping-up, vaccine isdelivered house-to-house to children to ensure that allchildren are vaccinated. However, the proportion ofmissed children has shown a slightly increasing trend.Child absent was found as the main reason for missedchildren. According to Independent Monitoring data,one quarter of all missed children are missed due to

refusal, with 68% of missed children due to childabsent.

The biggest challenges facing the Nigerian programmeare to find ways to overcome the operationalchallenges, as well as the increasing numbers ofmissed children due to resistance. Experts opine thatthe eradication of polio from Nigeria in 2012 is feasibleif all children under five years of age receive two dropsof the oral polio vaccine during Immunization Plus Dayscampaigns and during routine immunization sessions atthe health facility irrespective of their previousimmunization status.

Nigeria has made a lot of progress in reducing thenumber of polio cases in the country. More than everbefore, the Federal Government, State Governments,Traditional and Religious Leaders and other Partnersare committed to stopping polio completely in Nigeriaby end of 2012. In September 2011, the FederalGovernment and the Nigeria Governors Forum signeda re-confirmation of the Abuja Commitments, pledgingto reach at least 90 percent of children with poliovaccine with the goal of wiping out polio from thecountry and improve routine immunization.

To achieve the target of Polio eradication requiresmultiple high quality rounds of Immunization Plus DaysCampaigns that reach more than 90% of children underfive in all villages.

UNICEFNigeria/2011/Morgan


4/9

According to independent monitoring data, the level of priorawareness of caregivers about polio campaigns is 98% in allrounds of 2011. According to the September 2011 IPDindependent monitoring data, 45% of the caregivers wereinformed about IPDs by town announcers followed by radio/TV(23%) and traditional/religious leaders (19%). IPD data alsorevealed that about 75-80% of the decision to immunize thechild was taken either by the father or the mother.

Consequently, community dialogues involving men andcompound meetings with women have been intensified so that

caregivers high awareness level can be effectively turned into apositive decision about polio immunization by caregivers.

Nationally, the level of awareness about polio immunization hasincreased from 65% (2009 KAP) to 75% (2010 KAP) with a widevariation among States (25% in Kano to 94% in Bauchi). Themilestone target is to bring the awareness level to 85% by theend of 2011. Effort is underway to increase awareness throughcommunity dialogues, compound and town hall meetings, Majigifilmshows, the use of IEC materials and mass media.

Sustained high awareness of polio immunizationP R O G R E S S



5/9

Reduced proportion of non-complianceCommunication activities to address non-compliance haveproduced promising results. The proportion of missed childrendue to non-compliance has declined in comparison to 2010. In2010 non-compliance as a reason for missed children rangesfrom 47% (2010 January IPD) to 35% (2010 November IPD) inhigh risk States where as it came down to 27% in January2011 and 28% in September 2011 IPDs. However, thenumber of non-compliant wards varies greatly from round toround and is difficult to predict.

Involvement of community in PEIUNICEF piloted few community-based communicationinitiatives in three northern States. Neighbor to Neighbor (N2N)in Sokoto, Dattawa & Abokai (Respected elderly women andyouth) in Zamfara and Household Adoption Strategy in KebbiStates showed encouraging results by reducing missedchildren and non-compliance through active communityparticipation.

The 22nd

Expert Review Committee meeting recommendedscale-up of participatory and community-based communicationinitiatives. UNICEF is now rapidly scaling up community-based communication initiatives in three priority States.

The main objective is to reduce the percentage of missedchildren during IPDs through targeted interventions togenerate demand for and acceptance of Oral Polio Vaccine inKano, Sokoto and Kebbi States. This project is funded by theBill and Melinda Gates Foundation.

Decreased immunity gapThe proportion of zero doses NP-AFP cases at national levelfell from 3% in 2010 to 2% in 2011. As of 18 November 2011,Borno has more than 12% zero dose children followed byKano (7%), and Katsina (5%). Three high-risk States namelyGombe, Jigawa and Yobe have 0% zero dose children.

Nationally, 22% children among NP-AFP cases received 3 doses which was68% in 2010. However, four States Borno (61%), Kano (63%),Yobe (64) and Sokoto (68%) have lower coverage.

Implementation of intensifiedward communication strategyIntensified Ward Communication Strategy was implementedvigorously in 2011 as recommended by 21

stERC and was

found to be effective. While 86 wards were identified as veryhigh risk in January IPDs, only 59 remained high risk inSeptember round. This indicates that evidence-basedcommunication planning at ward and LGA level has producedpromising results. However, States like Borno, Kano, Jigawaand Yobe still have high number of LGAs with persistent non-compliance (>300 households).

As Nigeria approaches the last phase of polio eradication, datadriven communication activities and interventions whichempower communities to take action will be of high importanceto reduce missed children and non-compliance.

The objective of the intensified ward communication strategy isto reduce the percentage of missed children due to non-compliance of more than10%in the targeted wards throughintensified communication activities.

Selection of the high-risk wards is based on the following

criteria:

with more than 20% missed children and more than 30%non-compliance

with more than 50% missed children, presence of WPV or cVDPV in the last six months



6/9

ADDRESSINGCHALLENGES

s 10.00 a.m. at the health facility of Dawakin Tofa, one of the villages in Kano State with several polio cases thisar. Outside of the health facility, a group of women health educators, community mobilisers and vaccinators -

e preparing to start a house-to-house polio immunization mop-up activity to reach every last child. Among thisoup, Ms. Hafsat, vaccinator, and her team were assigned to cover a remote village of Yansalmo, where blocksistance to polio immunization by the community is still persisting.

Why is the polio vaccine given round after round when there is no health care nor clean water in our village?here are so many other diseases like malaria, cholera and meningitis that kill our children; drugs are eithernavailable and we cannot afford to buy them,a representative of the village asked when the team arrived.

Kano State, continued community resistance to the polio eradication programme is profoundly impactingogress. Caregiver refusals, or non-compliance, to immunize their children still make up a significant proportionthe total number of children missed during campaigns, and refusals are on the rise in some high-risk areas.

ccording to the latest data analysis, non-compliance accounts for more than four (4) out of ten (10) of missedildren in Kano State and in ten (10) Local Government Areas (LGAs), non-compliance accounts for fifty percent

0%) of missed children.

is difficult to convince families under these circumstances, especially when they are facing multipleeprivations. But, through compound meetings and community dialogues, we were finally able to convincelagers to accept the oral polio vaccine. We have been successful in turning around their resistance bycreasing their threat perception of polio,Ms. Hafsat said.

o address the issue of resistance to polio immunization, local government and polio eradication partnersganize regular community dialogues with the support of traditional leaders. In fact, according to the latest dataalysis, almost eight out of ten of resolved non-compliance cases were due to traditional leaders interventions.

NICEF also initiated an interpersonal communication training to strengthen the capacity of health educators,pervisors and ward focal persons to convince communities to be immunized against polio. By the end of thear, all these actors - in the States of Kano, Kebbi, Zamfara and Sokoto which account for the majority of all

ases nationally- will be trained. Piloted in Kano State, these training sessions will be followed by a cascadeaining aiming to target all actors at community levels.

edia professionals have joined communication efforts to raise awareness around polio issues in some high risksates. Through the Journalists against Polio networks, radio programs with appropriate messages and health-ated FAQs are periodically on air for mass awareness.Journalists are playing and have to play an importantle in communication for social and behavior change. This is why we decided to join our forces and support polioadication initiative in Nigeria,said Sani Zango, chairman of the Journalists against Polio network in Kano State

With all the challenges we are facing, we justhave to do more to eradicate this disease, and the most importantntribution is to strengthen the health system to improve Routine Immunization coverageMs. Hafsat concluded.

everal pilot projects which have engaged and empowered community volunteers in the efforts to reduce missedildren and non-compliance have also shown encouraging results in Nigeria. With the support of Bill and Melindaates Foundation, UNICEF is planning to scale up these volunteer community mobilizer initiatives in three priorityates as recommended by the 22

ndExpert Review Committee.

his project will contribute to reducing the percentage of missed children during IPDs through targetedterventions to generate demand for and acceptance of Oral Polio Vaccine in Kano, Sokoto and Kebbi States.ver 900 settlement level volunteer mobilizers will be recruited, trained and deployed in these settlements wherefusals have been a persistent problem,says Tommi Laulajainen, UNICEF Chief of Polio Communication.

geria continues to experience a surge of polio cases, following a dramatic reduction of cases in 2010. As ofovember 25, Nigeria recorded 43 cases of wild poliovirus compared to 14 cases in the same time period in 2010.the first nine months of 2011, Nigeria has already reported more cases than in the whole of 2010. This upsurgepolio cases is also due to higher number of under-immunized population groups and pockets of non-compliancea few northern States. Routine immunization coverage remains below 80% nationally, with sub-optimal

erformance by northern States. The country remains the only polio-endemic country in Africa.

national and state level raise awareness and advocacy campaign Polio-Free Torch campaign - was recentlyunched in the country to reinforce advocacy efforts and to mobilize wide support from a variety of stakeholdersall levels for the last lap of the polio eradication efforts in the country.


7/9

C H A L L E N G E SLack of commitment of healthworkersIn principle, health workers need to be in the forefront andspearheading the polio eradication effort in Nigeria. However,the contribution of the health workers in communication activityhas been found very minimal and that may indicate lack ofcommitment from them. In 2011, the contribution of healthworkers as a source of information and influencer has beenfound below 5% in all rounds. Interpersonal Communication(IPC) skills training as part of the IPDs training packages wasfound to be ineffective. Knowledge of health workers aboutpolio, the vaccine efficacy and safety is poor. Health workers

also hardly make efforts to resolve non-compliance and trackchild absence.

Considering the importance of involving health workers in amore effective manner, UNICEF has started IPC Skills trainingin high-risk States. Training of trainers on IPC Skills hasalready been completed in Kano and Sokoto and byDecember, in two other States.

2011 national election andsecurity situationWith the 2011 national and state level elections, thegovernment at different levels gave its priority and focus on theelection campaigns for a certain period. Likewise, the massmedia was also preoccupied for extended period of time byelection coverage.

Tracking of the implementation of Abuja commitments(Governors and LGA Chairmen involvement in IPDs) shows adownward trend with the new faces of leaders at national,State and LGA levels. However, it is expected that the on-

going advocacy efforts and Polio-Free Torch campaign willincrease the commitment level of Governors and LGAchairmen in the high risk States.

The August 26, 2011 bomb attack at the UN House in Abujawas also a big blow to the normal functioning of UNICEF andother partners like WHO. Several staff of UNICEF and WHOdied in that incident and many were injured. The situation wasvery stressful and still there are threats of more bomb blasts.However, UNICEF was able to rapidly recover from thisincident with renewed commitment to polio eradication inNigeria.

States like Borno, Bauchi, Yobe, Kaduna and Plateau also

have faced repeated outbursts of violence in 2011. Sectariancarnage erupted a number of times this year in Plateau,Kaduna and Bauchi while abduction, bombing and killingshave become common in Borno.



8/9

POLIO-FREE TORCH

AWARENESS

AND ADVOCACY

CAMPAIGN

The Federal Government of Nigeria with the support of the Polio EradicationInitiative partners launched a new communication campaign on September 24

th,

2011, entitled Polio Free Torch Campaign.

Supported by the Nigerian Olympic Committee (NOC) and a number of Nigerian

Olympians, this campaign is designed to overcome resistance to polio immunisationand to mobilize wide support from a variety of stakeholders at national and Statelevels for the last lap of the polio eradication efforts in Nigeria.

The Polio- free Torch will serve as a reminder to all Nigerians that a healthyNigerian child can grow up to be an Olympian and win laurels for the country,saidthe Vice-President of the Federal Republic of Nigeria, Namadi Sambo, on behalf ofthe President, Goodluck Jonathan.

As the world heads for the London 2012 Olympic Games, the Polio Free Torchillustrates the determination of the Nigerian Polio Eradication Initiative to make theyear 2012 the last year that Nigeria witnesses a case of Polio.

The campaign kickoff at the federal level has already initiated a series of State levellaunches in the Northern States which are still considered at very high risk from thewild polio virus. Olympic Icons in each State carried the Polio Free Torch during apublic Polio Rally to sensitize the public and engage their support.

In Niger State, the Governor commits to release funds for polio eradicationprogrammes in the state until the end of the year. He also instructed all localgovernment chairmen to rise up to the task of eradicating polio from the State. InKano, one of the highest risks States in the country, the torch campaign serves as asymbol of renewing the commitments of all the main stakeholders.

The State tour joined by Nigerian Olympians featured lighting of the torch by theGovernor to symbolize the States commitment to eradicate polio by the London2012 Olympics. Governors decorate a number of key influencers as Polio

Ambassadorswith the Polio free lapels.

We are racing against time with the global goal of eradicating polio from the worldby 2012. UNICEF believes that partnerships and collaborative relationships with allstakeholders at all levels are critical to deliver results for children and to ensure thatnot a single Nigerian child will be victimized by this crippling disease,said Dr.Suomi Sakai, UNICEF Representative in Nigeria.

Private sector companies have also expressed their interest to support this specialadvocacy campaign. Flash IT Solutions is among the corporate companiesresponding to the call for support issued by PEI partners, by designing and hostingfree of charge a dedicated website for the campaign. The telecommunicationcompany, Visafone, also supported the campaign by financing print advertisementin the newspapers.

This is a war. Not

a war on killing

people, but a war

for the survival ofpeople

His Royal Highness,The Emir of Kano State, Nigeria


9/9

House-to-house mop-up at the villageof Kashirmo in Kano State

Hafsat, the vaccinator, uses her interpersonal skills to engagewith a nervous mother clutching her child close to her. Sheexplains about prevention of childhood diseases and theimportance of Routine Immunization to the mother who drawscloser, listens and looks carefully at the picture of the child withpolio.

Hafsat shares more pictures and information on vaccine-preventable diseases and a quick lesson on health hygiene andsanitation and care of her baby. The mothers face istransformed with a smile as she vaccinates her child with oralpolio vaccine. Hafsat is confident that this mother hasunderstood the importance of giving her child the oral poliovaccine drops. Before she steps out of the household, sheexplains where and when to take her child to the health facilityfor Routine Immunization.

Tommi Mika LaulajainenChief of Communication (Polio)+234 706 401 [email protected] Nigeria Country Officewww.poliofreenigeria.comFacebook page: Polio Free Nigeria

COMMUNITY MOBILIZERS NETWORK

TARGETED

NTERVENTIONS

TO GENERATE

DEMAND FORAND ACCEPTANCE OF

ORAL POLIO VACCINE

everal pilot projects which have engaged and empowered community

lunteers in the efforts to reduce missed children and non-complianceave shown encouraging results in Nigeria. In October 2011, 22nd

xpert Review Committee recommendations clearly emphasize theeed to strengthen community empowerment through up scalingmmunity based innovative approaches following intensified wardmmunication strategy (IWCS). Some community based innovativerategies were piloted at High Risk settlements at various poliodemic States. Case studies were submitted with before and after theervention data analysis, and some very positive trends of reductionnon-compliance and missed children were noticed.

volunteer mobilizersith the support of Bill and Melinda Gates Foundation, UNICEF is

arting to scale up these volunteer community mobilizer initiatives inree priority States as recommended by the 22

ndExpert Review

ommittee. This project will contribute to reducing the percentage ofssed children during Immunization Plus Days through targetederventions to generate demand for and acceptance of Oral Polio

accine in Kano, Sokoto and Kebbi States. All high risks LGAs, Wardsd Settlements will be identified. Over 900 settlement level volunteerobilizers will be recruited, trained and deployed in these settlementshere refusals have been a persistent problem: 557 settlements inano, 200 in Kebbi and 200 in Sokoto. Through this extensive Socialobilization efforts and increased House-to-House behavior changemmunication, Polio Eradication Initiative aims to achieve the goal ofmunizing missed children and making Nigeria Polio Free.

Neighbour to Neighbourcommunication approach to reducenon complianceMakwabci to Makwabci (Neighbour to Neighbour) aims toreduce non compliance and child absent in high risksettlements. Neighbour to Neighbour is a community-basedapproach delivered by volunteers and strengthens communityownership and action for addressing local health issues withspecial focus on Routine Immunization and polio eradication.Volunteers serve as champions for their neighbours, familiesand friends. The purpose of volunteers is to conduct informal

conversations with their neighbours in community settings.Volunteer training was designed to provide key facts aboutaims of this project, polio updates/risk, Routine Immunization,Wild Polio Virus, Polio Eradication Initiative, Oral PolioVaccine, sanitation and hygiene. Volunteers conduct individualconversations with their neighbours. Reasons given forholding individual conversations were to encourage openconversations, as people are more likely to query rumours andvocalise doubts on a one-to-one basis, expectations of groupsinclude pluses.

FOR MORE INFORMATION, PLEASE CONTACT

mailto:[email protected]:[email protected]://www.poliofreenigeria.com/http://www.poliofreenigeria.com/http://www.poliofreenigeria.com/mailto:[email protected]

Documents

2011 Polio Communication Summary Report