In the Journals

Two strategies emerge to eradicate polio from Nigeria

Researchers from WHO discovered that engaging youth groups and tracking vaccination teams with smartphones were two effective strategies to deliver oral polio virus vaccine to affected communities in Nigeria.

Since the World Health Assembly launched the Global Polio Eradication Initiative in 1988, the global population has experienced a 99% reduction in confirmed cases of wild poliovirus, according to the researchers. However, Nigeria — along with Afghanistan and Pakistan — remains an endemic reservoir of the disease.

Engaging youth groups

Systematic engagement of youth groups allowed polio vaccination teams to treat children who are typically missed in vaccine-refusing communities, according to data published in the Journal of Infectious Diseases.

“The presence of the youths gave a sense of security to vaccination teams, making it easier to reach chronically missed children.” Audu Musa, of the WHO Country Representative Office in Abuja, Nigeria, and colleagues wrote. “We also found that youth engagement reduced harassment to vaccination team members.”

Musa and colleagues selected youths from groups in polio-affected communities. These groups included youth associations, motorcycle riders, local vigilante groups and motor park touts. Some youths were known to have been linked with polio vaccine resistance and team harassment. For 1 day, the researchers taught the youths about polio eradication in Nigeria through lectures, discussion and role-playing. For 7 to 8 days, the youths accompanied the vaccination teams into hostile communities. Participants carried and distributed vaccination supplies, controlled the crowds, and occasionally provided entertainment for the community. Data were collected for 8 months during the period from July 2013 to March 2015.

The researchers found that the proportion of missed children decreased from 7% to 2% in Igabi and from 5% to 1% in Zaria after youth groups became involved. They found that the noncompliant households decreased from 4,126 to 778 in Igabi and from 489 to 81 in Zaria. In addition, they found that team harassment per round of immunization decreased from more than 10 to less than five incidents.

“Engagement of youth groups has great future in polio interruption,” Musa and colleagues wrote. “It promises to be a veritable innovation in reaching chronically missed children in oral polio vaccine-refusing communities in Nigeria and other polio-endemic countries.”

Tracking vaccination teams with smartphones

In a second study published in the Journal of Infectious Diseases, researchers found that tracking polio vaccination teams with GPS-enabled Android smartphones led to improved vaccination coverage.

“Routine tracking of vaccination teams during polio campaigns … provided significant feedback on settlements reached … and enabled supervisors to evaluate performance and missed settlements to be revisited in real time,” Kebba Touray, of the WHO Country Representative Office in Abuja, Nigeria, and colleagues wrote. “In addition, monitoring vaccination teams’ movement through tracking made vaccinators accountable throughout campaigns.”

In 2012, Touray and colleagues gave GPS-enabled Android phones to each vaccination team in 10 Nigerian states at high risk for polio transmission. The researchers created maps of these states that showed the location of health facilities, schools and markets. At the end of each day, phone data were uploaded onto a tracking system, showing how much area the vaccinators covered. Data were collected from October 2012 to June 2015.

Touray and colleagues found that all states improved coverage over time. They found that the number of settlements that had been consistently missed during the previous three campaigns decreased significantly for nine states and decreased slightly for one state. In Bauchi, for example, the number of chronically missed children was reduced from 1,884 to 219.

“The use of GPS … is highly valuable in improving population immunity,” Touray and colleagues wrote. “GPS technology, if used effectively alongside other interventions, could contribute immensely to the interruption of polio in Nigeria.” – by Will Offit

Disclosures: The researchers report no relevant financial disclosures.

Researchers from WHO discovered that engaging youth groups and tracking vaccination teams with smartphones were two effective strategies to deliver oral polio virus vaccine to affected communities in Nigeria.

Since the World Health Assembly launched the Global Polio Eradication Initiative in 1988, the global population has experienced a 99% reduction in confirmed cases of wild poliovirus, according to the researchers. However, Nigeria — along with Afghanistan and Pakistan — remains an endemic reservoir of the disease.

Engaging youth groups

Systematic engagement of youth groups allowed polio vaccination teams to treat children who are typically missed in vaccine-refusing communities, according to data published in the Journal of Infectious Diseases.

“The presence of the youths gave a sense of security to vaccination teams, making it easier to reach chronically missed children.” Audu Musa, of the WHO Country Representative Office in Abuja, Nigeria, and colleagues wrote. “We also found that youth engagement reduced harassment to vaccination team members.”

Musa and colleagues selected youths from groups in polio-affected communities. These groups included youth associations, motorcycle riders, local vigilante groups and motor park touts. Some youths were known to have been linked with polio vaccine resistance and team harassment. For 1 day, the researchers taught the youths about polio eradication in Nigeria through lectures, discussion and role-playing. For 7 to 8 days, the youths accompanied the vaccination teams into hostile communities. Participants carried and distributed vaccination supplies, controlled the crowds, and occasionally provided entertainment for the community. Data were collected for 8 months during the period from July 2013 to March 2015.

The researchers found that the proportion of missed children decreased from 7% to 2% in Igabi and from 5% to 1% in Zaria after youth groups became involved. They found that the noncompliant households decreased from 4,126 to 778 in Igabi and from 489 to 81 in Zaria. In addition, they found that team harassment per round of immunization decreased from more than 10 to less than five incidents.

“Engagement of youth groups has great future in polio interruption,” Musa and colleagues wrote. “It promises to be a veritable innovation in reaching chronically missed children in oral polio vaccine-refusing communities in Nigeria and other polio-endemic countries.”

Tracking vaccination teams with smartphones

In a second study published in the Journal of Infectious Diseases, researchers found that tracking polio vaccination teams with GPS-enabled Android smartphones led to improved vaccination coverage.

“Routine tracking of vaccination teams during polio campaigns … provided significant feedback on settlements reached … and enabled supervisors to evaluate performance and missed settlements to be revisited in real time,” Kebba Touray, of the WHO Country Representative Office in Abuja, Nigeria, and colleagues wrote. “In addition, monitoring vaccination teams’ movement through tracking made vaccinators accountable throughout campaigns.”

In 2012, Touray and colleagues gave GPS-enabled Android phones to each vaccination team in 10 Nigerian states at high risk for polio transmission. The researchers created maps of these states that showed the location of health facilities, schools and markets. At the end of each day, phone data were uploaded onto a tracking system, showing how much area the vaccinators covered. Data were collected from October 2012 to June 2015.

Touray and colleagues found that all states improved coverage over time. They found that the number of settlements that had been consistently missed during the previous three campaigns decreased significantly for nine states and decreased slightly for one state. In Bauchi, for example, the number of chronically missed children was reduced from 1,884 to 219.

“The use of GPS … is highly valuable in improving population immunity,” Touray and colleagues wrote. “GPS technology, if used effectively alongside other interventions, could contribute immensely to the interruption of polio in Nigeria.” – by Will Offit

Disclosures: The researchers report no relevant financial disclosures.