Joining hands to ensure polio transmission remains at zero in Ethiopia

AWBARE, Somali region– Ermias Amare and Salah Kedir, health workers in Ethiopia’s Somali region, zip through the arid plains kicking up a trail of dust as they ride their motorcycle to the next settlement where they will be administering polio vaccines to children under the age of 5 years.

It is campaign time in Ethiopia’s Somali region, and the two health workers are on a mission that is critical for the well-being of Ethiopia’s children.

Ermias and Salah are taking part in the National Immunisation Days (NIDs) campaign, vaccinating children against polio with the oral polio vaccine (OPV) in the Somali region. Vaccination against polio is essential to prevention of this crippling, disabling and potentially fatal disease which, is easily contracted from person to person, and especially dangerous to individuals and populations when there is not sufficient immunity, or protection, against the virus. The consequences of polio disease are devastating, for a child, for a family, and for a community.

Salah Kedir, clinical nurse (left), fills out vaccination records outside the hut of Sophia Abdi in Dudejirma sub-district, Rer Hassen Settlement,Tulugulid District, Fafan Zone. Three year old Sehardid Ali Hassen (standing) and his baby brother Umer Keyir Ali Hassen, one years old, have been vaccinatied by clinical nurse Ermias Amare (right), during the Polio NIDs campaign in Somali Region, 9 February 2015. THe half-tick mark on the hut's opening flap indicates that not all the children who live their under the age of five have been vaccinated.Sophia's eldest daughter (five years old) is out wtending the families goats, and the vaccination team makes an appointment to return the next day to vaccinate her as well. ©UNICEF Ethiopia/2015/Getachew
Salah Kedir, clinical nurse (left), fills out vaccination records outside the hut of Sophia Abdi in Dudejirma sub-district, Rer Hassen Settlement,Tulugulid District, Fafan Zone. Three year old Sehardid Ali Hassen (standing) and his baby brother Umer Keyir Ali Hassen, one years old, have been vaccinatied by clinical nurse Ermias Amare (right), during the Polio NIDs campaign in Somali Region ©UNICEF Ethiopia/2015/Getachew

Most of the children in the village visited by Ermias and Salah have their finger marked with ink, indicating that they have already been vaccinated during this present campaign.

In August 2013, the Dollo zone of Somali region, in the southeastern corner of Ethiopia bordering Somalia, was hit by a polio outbreak. Tragically 10 children were paralysed as a result of wild poliovirus (WPV) infection. Since the beginning of the polio outbreak, 15 National and Sub-national Immunisation Days (NIDs/SNIDs), have been conducted to date to respond to the outbreak. The total number of WPV cases reported since the start of the outbreak remains at 10 – the last case confirmed 18 months ago. Maintaining the momentum of response efforts has been be critical to ensure no more polio cases are seen in Ethiopia.

Social Mobilisation  

Communication and social mobilisation efforts have been instrumental in the interruption of the WPV transmission in the Somali region. In Lafaisa kebele (sub-district) of Awbare (woreda) district, a town crier mobilizes the community through a megaphone to alert parents that children under the age of 5 years will be receiving polio vaccinations during the campaign.

Nearby, a village Sheikh, trained by the Somali Regional Health Bureau (SRHB) in partnership with UNICEF and the Islamic Affairs Supreme Council, gathers mothers and children for a discussion about the campaign where he explains the benefits of immunisation and urges them to have their children vaccinated. Among the strategies deployed by the SRHB and UNICEF to meet the need for information was to engage religious leaders to council the pastoralist communities, particularly women, about the importance of vaccinating their children, for every round. The eminent position that religious and clan leaders hold in pastoral Somali communities and their ability to mobilize the population, has become a key factor in the success of immunisation activities.

Town crier in Lafaisa subdistrict, Awbare District, using a megaphone to alert parents that children five years and younger will be receiving polio vaccinations during the Polio NIDs Campaign in Somali Region, 9 February 2015. ©UNICEF Ethiopia/2015/Getachew
Town crier in Lafaisa subdistrict, Awbare District, using a megaphone to alert parents that children five years and younger will be receiving polio vaccinations during the Polio NIDs Campaign in Somali Region, 9 February 2015. ©UNICEF Ethiopia/2015/Getachew

“In the past when we informed communities about upcoming campaigns, because they didn’t have an understanding about it, some would refuse to bring their children forward,” said Ermias. “There were many challenges. They would refuse to have their children vaccinated. But today, we vaccinated an infant who was born today. In the past, that would be unheard of.  Now, if they have a child out at their farm when we come for the vaccinations, they will tell us we missed one and to come back the next day.”

Cross Border Vaccination

The success of the polio eradication efforts hinges on successful cross-border collaboration between neighbouring countries, such as Somalia and Kenya. Immunisation activities in Ethiopia’s Somali region are therefore held in coordination with health institutions across the borders. Border vaccination points have been set up, and all children under 15 years of age crossing the border receive polio vaccination.

“All the children under 15 years of age who cross the border from Ethiopia to Somaliland or the other way are vaccinated,” said Nemo Alele, head of the Awbare Health Center, located near the border with Somaliland. “This is a border area and we explain to the mothers very carefully what harm can happen if there is transmission of the disease. We have good relations with our counterparts in Somaliland and have discussions on a monthly basis.

There is a similar vaccination centre on the other side of the border where they are doing similar work, and we are both committed that no child should cross without being vaccinated.” Sophia Ege Bulale lives with her three month old grandson Hamad Mukhtar Dayib, in Lafaissa kebele. Sophia has been caring for her grandson ever since her daughter-in-law left Hamad with her son, who lives in Hargeisa in Somaliland, to raise on his own. “I travel back and forth between Lafaissa and Hargeisa with Hamad,” said Sophia. “We didn’t have these vaccinations when I was young and I have seen children who grew up disabled as a result of polio. I am therefore happy that vaccinators come to our house to make sure that my grandson will be protected, whether he is here or in Hargeisa.”

Campaign Support

Clinical nurses Ermias Amare (front) and Salah Kedir, traveling on motorcycle between pastoral settlements in Tulugulid District, Fafan Zone, Somali Region, to provide polio vaccinations for children five years and younger during the Polio NIDs Campaign, 9 February 2015 ©UNICEF Ethiopia/2015/Getachew
Clinical nurses Ermias Amare (front) and Salah Kedir, traveling on motorcycle between pastoral settlements in Tulugulid District, Fafan Zone, Somali Region, to provide polio vaccinations for children five years and younger during the Polio NIDs Campaign, 9 February 2015 ©UNICEF Ethiopia/2015/Getachew

In February, the polio NID aimed to reach nearly 14 million children under the age of 5 years with OPV. According to the national administrative coverage, 99.7 per cent of children were reached with the polio vaccine nation-wide; and over 98 per cent in the Somali region. This is a remarkable achievement, particularly within the context of the highly mobile pastoralist communities of Somali region.

Mobile health and nutrition teams (MHNTs) have helped to reach communities with polio and routine vaccination.  In the Somali region, 24 MHNTs operate to reach pastoralist and remote populations. The teams work 5-6 days a week in selected operational sites on a fixed schedule, and with the support of local social mobilizers who continuously inform the target community of the arrival of health teams. They reach over 1,000 clients per month, of whom, over 40 per cent are children under the age of 5 years.

Reaching all targeted children with the polio vaccine is neither an easy nor simple task. More than 90 million doses of the OPV were provided for all polio outbreak response campaigns to date. Much effort has been exerted by all stake holders to bring the polio vaccine from the manufacturer, to the vaccination teams, to the mouths of children, in a timely, safe and good condition to help protect every child against polio.

It is through the leadership of the Federal Ministry of Health and the generous support of polio donors such as the European Union, the Bill and Melinda Gates Foundation and Rotary International, and others that more children have been reached with the polio vaccine, and that interruption of the outbreak has been possible. In partnership, alongside health workers like Ermias and Salah, together, we can ensure polio transmission remains at zero in Ethiopia.

Drop by drop closer to polio-free Ethiopia

Polio vaccination a response of a recent polio outbreak in the Horn of Africa
Polio vaccination a response of a recent polio outbreak in the Horn of Africa ©UNICEF Ethiopia/2013/Sewunet

 

Jigjiga/Wardher, 9 February 2015: A pledge of commitment for a polio-free Ethiopia was made on 8 February 2015 in Jigjiga and Warher to launch the polio national immunization days (NIDs) in Somali Regional State. Ethiopia has been polio free since 5 January 2014, but the risk of polio cases in Horn of Africa prevails. The campaign running until 11 February 2015 aims to reach over one million children under the age of five in the region.

“Despite the progress, Ethiopia is in a fragile position and the risks for outbreaks remain. We invite all stakeholders to make the goal of a polio-free Africa in 2015 a reality,” said Dr Pierre M’Pele-Kilebou, WHO Representative to Ethiopia at the launch event in Jigjiga.

The pledge signatories – the State Ministers of Health, the Vice President of the Somali Regional State, the Head of the Somali Regional Health Bureau, Doollo Zonal Administration, religious and clan leaders, WHO, UNICEF, Rotary International and Ethiopian Pharmaceuticals Fund and Supply Agency among others, – pledged to do their part to ensure that all children are provided with an equal chance for health and success in life through immunization.

The State Ministers of Health are supervising the work of almost 3000 vaccination teams in Somali Region. H.E. Dr Amir Amin, State Minister of Health, said at the launch in Wardher, the epicentre of the Ethiopian polio outbreak, that the Government, partners, communities and families need to share responsibility to ensure immunization of children and “to save children from sickness, disability and death.”  H.E. Dr Kebede Worku, State Minister of Health, stressed in Jigjiga that parents should get their children vaccinated even if they had been vaccinated in the previous round. 

“Ethiopia is working to find hard-to-reach communities and settlements, to bring vaccination to those areas. So, when polio eradication is achieved, we will end polio everywhere for everyone and leave a legacy of healthy families and communities, rooted in equality for all,” – Ms Anupama Rao Singh, Country Representative a.i. to UNICEF Ethiopia.

The national polio campaigns conducted in all regions of Ethiopia between 6 to 9 February 2015 reached over 13 million children under 5 years of age. Since August 2013, when the outbreak began, 12 rounds of polio immunization campaigns have been conducted in addition to vaccination of children along Ethiopia’s border with Somalia. A total of 10 polio cases are recorded in Ethiopia during the outbreak. Working closely with national and regional authorities, WHO and UNICEF established an Operations base in Wardher, Doollo Zone, in August 2014 to bring together the needed expertise to support polio interventions in the zone and kick polio permanently out of Ethiopia.