Polio returns with menace in Kano

Maimuna, the daughter of Umma, contracted the wild polio virus that causes paralysis seven months ago. Her mother recalls that she fell ill during the last planting season, and Maimuna has since succumbed to the disease and is not using her legs again. Even as her age mates play around her home, she was being […]

Maimuna, the daughter of Umma, contracted the wild polio virus that causes paralysis seven months ago. Her mother recalls that she fell ill during the last planting season, and Maimuna has since succumbed to the disease and is not using her legs again. Even as her age mates play around her home, she was being cuddled by her grandmother.

 

Maimuna’s mother believes strongly that her child’s ailment has got nothing to do with the polio virus. Rather, she thinks it is caused by the jinn. Although state health officials and the ward head of ‘Yanhamar have separately faulted the claim, Umma insisted that her daughter was vaccinated against the polio virus more than twice before she became infected. She blames her daughter’s state on spiritual attack because “her right foot was first affected, but after sometime, the infection moved to her left knee.”

But it was a different case with Adamu, the second victim. His mother Binta recalled that the boy contracted the disease about three months ago. “He never received polio vaccine before the incident, because we I never allowed it administered on him,” she said.

Binta further explained that after her son was diagnosed with polio, she shifted grounds and allowed doses upon doses of the vaccine to be administered on him and his younger siblings. “Even other women in the household accepted it wholeheartedly and forced their children to take it. We all came to accept that polio is real,” she said. Their earlier misgivings were caused by a suspicion that the vaccine was harmful and could cause infertility.

Maimuna and Adamu are among seven other children in Kumbotso Local Government Area and among the 13 fresh cases of polio recorded in Kano State this year – the highest in the whole country.

The ward head of ‘Yanhamar, Malam Yakubu Haruna, said it was a herculean task getting some families to accept the vaccine in the village, adding that other parents turned away vaccinators as Adamu’s mother did. “We had to embark on vigorous sensitization campaign, assuring people that the vaccine is not harmful and that taking it is in the best interest of their children,” he said. “Those who stood their ground, we used the police to arrest them.”

In recognition of the ward head’s effort in the fight against the disease, the state government decorated him with the Polio Free medal recently. He said Maimuna and Adamu have been visited by the minister of health, who donated N10,000 to each of them as contribution for their treatment.

Poor primary healthcare system

Aside from superstitious beliefs and safety fears, Weekly Trust gathered that deep-seated anger towards government among members of the community was partly responsible for most of the rejection or non-compliance cases. For instance, the only dispensary at the village has been under lock and key for years, with no medical personnel attending to the health needs of the community. The building itself is dilapidated, while bats have taken over its roofs, emitting foul stench.

All attempts to get local or state government to put the structure to use for the benefit of the community have proved abortive, residents said. Consequently, people in the village always go to another dispensary located far away in another village for medical attention. The seeming unconcern about their health needs nonetheless, government keeps posting vaccinators with the objective of eradicating polio, whom the residents consistently. They said their rejection was in a bid to subvert the initiative so that by government failing in the cause, they will appear to exact a payback for the suffered neglect.

Another finding made by Weekly Trust showed that local government health officials saddled with the burden of identifying new case areas face problems of logistics, as neither motorcycles nor bicycles were made available to most of them for visiting far away villages and communities.

Therefore, in most cases, the officers rely on medical personnel attached to such villages for information. But where there is no hospital presence, as in the case of ‘Yanhamar, they scrounge such information from traditional healers or patent medicines stores owners, yielding a series of delays before a case gets to the knowledge of higher authorities.

“You can imagine the damage that a single delay can cause when you consider the fact that one infected child has the capacity of infected 200 children,” a health officials laments.

The increase in new polio infections in the state is giving authorities serious concern, especially as it is coming on the heels of renewed commitment by the Federal Government and international agencies to wipe out the disease from Nigeria. Earlier in the week, the Federal Government and American billionaire Bill Gates, among others, announced new financial commitments towards the polio campaign.

Destroying the vaccines

Weekly Trust investigations revealed that many cases of missed children were recorded on account of negative attitude of some of the vaccinators, often with the approval of their superiors. A civil servant, who does not want her name mentioned, disclosed to Weekly Trust that while she was hired as supervisor for the polio eradication campaign between 2006 and 2007, the facilitator overseeing the catchment area reprimanded her for retuning three unused bottles of the polio vaccine.

“I was given 10 bottles for my team of four and directed to cover a ward in Dakata area. At the end of the day, we were still having about nine unused bottles because people rejected the vaccine. In fact, even the ward head there did not give us access to his children. So on our way back to the group’s meeting point, the girls under me advised that we destroyed the remaining bottles, otherwise we will be queried,” she said.

“Knowing that they were participating in the exercise before me, I agreed but insisted only six were to be destroyed,” she said. “So we returned three bottles, but to my chagrin, as we were setting out for exercise the next day, the facilitator called me and swore that ‘if you return any unused vaccine today, to God you will be forced drink it’.”

With the warning, she said, she never returned a single vaccine for the remaining three days that the campaign lasted. “We hardly vaccinate 10 children in a day. What we do with the nine bottles was to destroy some and give some to the locals who take it as hard drug or rub it, claiming it cures eczema,” she said.

Furthermore, she said, they will mark houses and fingers of children to make it look that the entire neighbourhood is covered. “We will also fill in the Tally Sheet accordingly.”

Weekly Trust learnt that issue of vaccine destruction by the vaccinators started long ago and has continued to this day. Another ex-supervisor, Sa’ad Muhammad, now working with a federal establishment, told our correspondent how back in 2001, while on school vacation, his facilitators would order staff to empty the vaccines in the gutter. “They would be directed to discharge so and so quantity, before we sit and do the paperwork,” he said.

A lady who craved for anonymity also stated that she was sacked from the vaccination campaign job three months ago because she refused to destroy unused vaccines as ordered by her superiors.

Reacting to issues of vaccine destruction by polio officials, the Kano State Immunisation Officer (SIO) Abdurrahman Yakubu said: “All those are allegations, but sometimes we see those cases. For everything you do, you get some people who don’t go with you. Some of the personnel are not doing the job for the sake of the child; they are only interested in the money.”

While explaining that most of such cases are common among hired staff, Yakubu said “we have followed some teams, we saw such kinds of episodes and had to drop the teams.”  His office is moving to address the problem by emphasizing on “supportive supervision,” he said. “Because you only get what you inspect, you never get what you expect.”

On his part, the state Commissioner of Health, Dr. Abubakar Labaran Yusuf, said he was not aware the vaccines were being wasted, but promised to investigate.

The alarming figures

The campaign to eradicate poliomyelitis globally started in 1988, following a resolution by the World Health Assembly (WHA) to get rid of the wild polio virus as smallpox was completely wiped out from the face of the earth in 1980.

The resolution was adopted and Polio Eradication Initiative (EPI) was given birth to at a time when 350, 000 polio cases were reported annually, in addition to the virus being responsible for 1,000 paralysis per day among children, with 125 polio endemic countries.

Statistics provided by immunization officials in Kano, showed that from 1988 to 2003, the number of fresh polio cases dropped to 748 with only 6 remaining endemic countries. But three years after, 1763 cases were reported. More so, 16 countries recorded infections.  Importantly however, the number of endemic countries further decreased by two, leaving the four countries referred to this day as the global PAIN (Pakistan, Afghanistan, India and Nigeria) of polio eradication.

But Kano State alone has seen a steady rise in reported cases from 84 in 2003 to 184 in 2004 and 212 and 357 cases in 2005 and 2006 respectively. The trend then took a dive in 2007 to 59 cases and then hit the ceiling again by reaching 273 the following year (2008). It dropped to 102 in 2009 and hit a record low of 1 reported case in 2010 before it resumed fresh rise to the current 13 cases this year.

Recurring cases of the virus are largely due to non-compliance and missed children, explained Kano SIO Yakubu. “Non-compliance can arise in a situation where parents site problems of lack of infrastructure, absence of hospitals, schools, or job for their wards to argue that government is not aware or unconcern about their existence and for that they reject the vaccine,” he said.

According to him, such justifications are classified as “felt needs.” “Some say it causes infertility or it is a strategy of the West for reducing population or promoting birth control,” he added. Children are missed, according to him, when they are not captured probably due to reasons of absence to school, farm, embarking on trip etc.

Giving the breakdown of the new cases, the immunization officer said apart from Kumbotso which has 7 cases, Dawakin Tofa reported 2 cases, while Dawakin Kudu, Nassarawa, Gezawa and Bichi recorded 1 case each and concluded that the virus might have spread to the remaining affected areas from Kumbotso.

At national level, other states following Kano (with 13), are Kebbi, 8; Borno, 5; Jigawa, 5; Sokoto, 2; and Zamfara, one case.

According to the official table, 55% of the children not vaccinated (missed children) in the month of July, 2011 were absent, 37% due to “non-compliance” and 8% were missed because the houses were “not visited.” For the same month, only 4% rejected the vaccine on “religious” ground as against 22% who simply stated that they did not need it and 17% who claimed “no caregiver consent.”

In Kumbotso Local Government Area alone, Weekly Trust gathered that 32 cases were recorded recently, but only seven were confirmed polio. However, while our correspondent was waiting on Wednesday at the local government’s hospital for a guide to show him round the houses of some victims, another fresh case was being suspected to have occurred in a village called Dambare. Similarly, another case was also said to have been discovered about two hours after at Samegu village, both in the same local government area.

Health officials however told our correspondent that specimen stools of the two cases will have to be sent to either Maiduguri or Ibadan for laboratory confirmation through the state office of the WHO.

The people were once bitten

The ugly experience of people in the state is still being cited as one of the potent factors militating against the polio campaign in Kano.  In 1996, the American drugmaker Pfizer conducted “unauthorized” clinical trials of a meningitis vaccine, Trovan, on children in the state resulting in deaths and permanent disabilities. Pfizer has since denied the charges, but agreed to an out of court settlement lately to end a $8.5billion lawsuit instituted by the Kano State government.

Second, investigation by WHO showed that 69 children were paralyzed by the polio virus after contracting the disease through exposure to the live virus contained in the oral vaccine drop.

For these two traumatic experiences, parents became more paranoid to the polio vaccine and refused to take their children for routine immunization at hospitals and in some cases turned away vaccinators on eradication campaigns.

Above the two incidences however, another stage that was said to have dealt an even more serious blow to acceptability of the vaccine and the PEI was when the state government rejected the polio vaccine in 2003, based on “safety” reasons.

The rejection, apart from triggering new infections in the state, experts said, spread the virus to other countries, thereby sparking cases of re-infections and fuelled a drawback in the campaign with 84 cases reported that year against 9 recorded two years earlier. The cases further jumped to 184 in 2004 and to 357 in 2006. “That problem of the state itself refusing the vaccination really contributed,” said health commissioner Yusuf.

Although the state government had since made a U-turn and accepted the vaccine, most cases of rejections today are still being attributed to this incident.

State confident on 2013

Against the backdrop of the fresh polio cases in Kano, the state health commissioner was asked if the state is losing or winning the war against the scourge: “I will say we are winning, because initially when we started we were having hundreds of cases of polio in Kano. The surge we saw recently was due to some lapses which government is trying to tackle,” Yusuf said.

He said the errors that gave rise to the 13 fresh cases in the state this year have been identified and are being tackled effectively. “Most of the lapses were to do with (lack of) storage systems, which we have now provided to the local government,” he said. But he admitted that rejection by “adamant” parents is one of the serious drawbacks threatening the 2013 target, stressing however that, the state government has met with all stakeholders and discussed methodologies on how to go about it. “I’m sure level of non-compliance will reduce at the end this round, because we have taken drastic measures against any father who refused to allow his child to be vaccinated,” he said.

For his part, Yakubu, the SIO, believes that at the rate which government is going, the target of achieving total eradication in the country by the year 2013 is achievable.

“The government is doing a lot with the involvement of traditional rulers, religious leaders and all stakeholders. I think we will finish the job in small time,” he said.

“I see Kano wiping out polio by 2013 with the tempo we are in now. The government is fully committed and if the health workers will tighten up their belts and do the right thing and the parents will stop rejecting vaccination, we will finish the job,” he added.

A refrain of the Polio Eradication Initiative (PEI) warns that: “Until every child is protected…every child is at risk.” The slogan sounds more like a wakeup call to Kano State, which has the highest number of reported cases in the country, to work towards ensuring the safety of the Nigerian child by arresting the spread of the disease. It remains to be seen whether the government could truly tackle the spread and wipe out the disease in two years’ time.