Using Creative Approaches in the Fight against Polio: Community Informants in Northern Nigeria
The Nigeria Polio Program has achieved significant progress in recent years. To date, Nigeria has gone 2 years without detection of any new cases of wild poliovirus. While the absence of new cases is promising, Nigeria remains a polio-endemic country and it is critical to strengthen all efforts to reach every child with vaccination across the country, including the country’s northern border region that is particularly insecure and inaccessible.
Insurgency-related conflicts in Northern Nigeria has caused significant damage to the health system, making it impossible to deliver basic healthcare services, including vaccinations, in many areas. Moreover, the areas under insurgents’ control remain completely inaccessible to outreach vaccination and disease surveillance teams.
CDC has worked tirelessly to support the timely detection and investigation of potential cases of polio through the Acute Flaccid Paralysis (AFP) surveillance system in all areas in Nigeria. For the areas that health teams cannot access, CDC developed an innovative approach involving local community informants to conduct basic surveillance activities such as detecting, reporting and investigating AFP cases.
Working with Key Community Informants
Health teams face incredible challenges to work in Northern Nigeria, due the active presence of insurgents and the lack of effective government control. One such area is the Local Government Areas (LGA) located close to the shores of Lake Chad in the Nigeria-Chad border, where most of the people reside in Internally Displaced Person (IDP) camps. In 2010, this area reported a wild poliovirus (WPV) case, but no AFP cases had been reported in the recent years. Since this area was epidemiologically silent, CDC concentrated efforts to strengthen the surveillance system.
Given that surveillance officers cannot access certain areas in Northern Nigeria, CDC started working with key community informants from LGA. Local informants would be most likely able to overcome barriers to conducting AFP surveillance in those communities. CDC and partners identified and trained 15 community leaders as informants. These informants had good contacts and easy access to the settlements located in inaccessible areas. Besides the training, CDC provided mobile phones capable of capturing geo-coordinates of the areas visited while searching for AFP cases. Surveillance informants typically visit areas where the community congregates, such as markets, asking about any children who may have developed paralysis, which may lead to an AFP investigation and report.
Four of the five cases reported by these community informants had been from hard to reach settlements. The last AFP case reported was from an LGA on the border. The case, a two-year-old female child, was healthy and walking for months, until she developed fever and suddenly could not move her left arm and left leg. The informant reported the case to the Assistant Disease Surveillance Notification Officer and National STOP (N-STOP) Local Government Area focal person. Following that, the AFP surveillance notification form was completed and the case investigated.
As of August 2018, this innovative community surveillance system has detected four suspected AFP cases from the LGA located in the Nigeria-Chad border. This successful system has been implemented in all areas where CDC cannot directly conduct surveillance activities and investigations. CDC will continue to work with our partners and community informants to ensure that all AFP cases are detected The identification of AFP cases in inaccessible areas in Nigeria is key to polio eradication.