Since 2014, ART clients in Ethiopia have been getting their CD4 status in 20 minutes

By Tesfaye Simerta

Ayele Feyisa Laboratory technical take sample of blood
Ayele Feyisa Laboratory technician takes sample blood at Chancho health centre, Oromia special zone surrounding Finfinne Sululta woreda, Ethiopia ©UNICEF Ethiopia/2014/Ayene

CHANCHO TOWN, OROMIA REGION, ETHIOPIA, 23 October 2014 – The Chancho Health Centre, 45kms north of Addis Ababa, is where Rediet* goes for her follow-ups, having discovered she was HIV positive back in 2013. Today, there are lots of people waiting alongside Rediet to utilise the laboratory services. Chancho is one of the health centres that the Ethiopian Government – supported by the Clinton Health Access Initiative (CHAI), UNITAID and UNICEF – is using to advance access to Point of Care Technologies (POCT). These provide results on the same day, in order to make HIV testing and treatment more effective, efficient and easier for both health care workers and patients.

Now, Rediet is a mother of a one-year-old baby girl and is still following up on her status regularly.

“Now I have stopped having to wait to hear my CD4 count status at the Fiche Hospital, far from here,” said Rediet, who used to have to travel to Fiche Town to get the test done. “When I went to Fiche, I was paying transport expenses for a round trip, but here it is accessible – about an hour and half walking distance from my home. Previously, when my blood sample was sent to Fiche Hospital, I was not able to know my CD4 count status for a month or more and could not receive treatment. Now that the machine has arrived in the Health Centre, I get my results just after 20 minutes of testing, receive my treatment here and then go home.”

According to Mr Asfaw Referra, Anti-Retroviral Treatment (ART) Focal Person at the Chancho Health Centre, there are now around 500 clients using the CD4 count of POCT, of which one in ten are children. “Clients are very happy about this machine, since they can discover their CD4 count status just after 20 minutes,” he told us. “There were clients whose CD4 counts had dropped as low as 93. As they start their ART treatment immediately after we know their CD4 count, however, we are very excited when these people show signs of improvement.”

In addition, before the POCT machine was introduced to the Chancho Health Centre, the number of clients allowed to give blood samples was restricted.

Aduna Lema is one of the many client in Chancho health center“The sample we used to take to Fiche hospital was restricted to between 10 and 15,” Abebe Gelme, Chancho Health Centre Laboratory Technician, informs us. As a result, Chancho Health Centre was forced to transport the samples every week. “Despite the large demand, we appointed only 10 to 15 clients to give their blood sample to our Health Centre up until 9 am every Friday morning, since the collected blood samples had to be taken to Fiche right away.”

Some clients coming from far away could not reach to the Health Centre before 9am and missed their chance. They were then appointed to come back again the following week. Often, they did not get the opportunity to have their blood samples taken and felt helpless.

“I know a client whose CD4 count was found to be eight,” Abebe told us. “Now, thanks to the POCT machine, I can have the data and tell the exact status of my client’s CD4 count with confidence.”

The POCT services are now becoming popular, both at the government level and at the grassroots level.

“The Oromia Regional Health Bureau is committed to working with partners,” Asfaw Endebu, Woreda Health Office Head, told us with great pride. “The woreda cabinet knows about the service provided at this Health Centre and we have recently started introducing it to the Health Workers and Health Extension Workers. We are informed about the availability of the machine, and that is why other HCs and HPOs refer cases to this centre.”

With the support of partners, 45 sites with high patient volume, like Chancho Health Centre, have received POCT machines at the initial stage. This ensures that women, like Rediet, and children in remote areas especially will not have to spend time and resources in order to discover their results. This will remove delays and enable more individuals to receive the treatment they need.

*Name changed to protect identity

From the Sheikh and Imam to the Nomad: Engaging a Network of Allies to End Polio in Ethiopia’s Somali Region

 

By Jasmine Pittenger, UNICEF consultant and writer

For many nomads in Ethiopia’s Somali Region, home is a hand-sewn tent.
For many nomads in Ethiopia’s Somali Region, home is a hand-sewn tent. To reach families that are constantly on the move, it is essential to tap into the nomads’ own communication networks. This house-marked tent shows children were reached with the polio vaccine during the campaign. Awbare woreda of the Somali Region, November 2014. © UNICEF Ethiopia/2014/Rozario.

The patches that make up the nomad’s tent say it all. Yellow, orange and red cloth is sewn together with broad stitches — even a pair of trousers is sewn into the mix. Yet the tent is greater than the sum of its parts. It protects a large family from scorching desert sun, from cold nights and rain.

When a polio outbreak struck the Horn of Africa in 2013, WHO and UNICEF with the help of the European Union had to find a way to reach every last child across Somalia, Kenya and Ethiopia. It was a daunting task to deliver multiple doses of OPV (Oral Polio Vaccine) into the mouths of some of the world’s hardest-to-reach children – from war-torn parts of Somalia to the diverse landscapes of Kenya and Ethiopia. Among the very hardest-to-reach are nomads in Ethiopia’s Somali region, which shares a porous 1,600 kilometer border with Somalia. Here, over 80 per cent of the 5 million people are nomadic, herding cattle, camels and goats across broad stretches of desert in search of water and pasture. For many families, home is a tent sewn together from patches of cloth and carried from one watering hole to another on the back of a camel.

To end the outbreak, it was crucial to deliver messages to families constantly on the move. Yet only 11 per cent of people here have access to newspapers or radio. How, then, do you inform families about polio’s risks and the need for children to take OPV? What is the patchwork that makes up this particular community? How do the nomads themselves pass on life-saving information, and receive it? And who is in a position to mobilize families?

One answer is with the Sheikhs and Imams. The Somali Regional Health Bureau and UNICEF reached out to the Somali Region’s IASC (Islamic Affairs Supreme Council). This part of Ethiopia is close to 100 per cent Muslim, and the IASC Sheikhs and religious leaders, are amongst the most respected and influential personalities amongst nomadic communities here. The communities have faith and belief in what they say, and seek out their teachings even as they’re on the move. Once the highest-level Sheikhs and Imams became engaged in warning parents about polio’s risks and the need for OPV, Islamic leaders at all levels got on board.

“We have partnered with UNICEF and WHO because we believe this is a noble cause that is completely in line with our religion, Islam,” says Sheikh Abdel Rahman Hassan Hussein, President of the IASC in Jigjiga, capital of the Somali region. “From the city to the most remote villages, you will find every person working in this project motivated and doing his/her best. They know they are doing something that almighty Allah will reward them for, at the last day. They know they are saving the lives of children and their future by protecting them from this disease, polio. We take every occasion to tell people about this – from Friday prayers to feasts.”

Another answer: children themselves. Messages about polio and OPV are also being taught in schools, including the religious schools or madrassas that many children attend.

School children
School children – like these, at a religious school near the border with Somalia – can be powerful advocates for polio eradication. Awbare woreda, Somali Region, 2014. © UNICEF Ethiopia/2015/Mohamed.

“How many drops of the polio vaccine must be taken, every time the vaccinators come, by each and every child in your home?” asks a teacher at a small IASC-run madrassa on the border with Somalia. “Two drops, two drops!” shout the school children. “How do you know when a child has been vaccinated?” “The finger! The mark on the pinkie finger!” Children clamor to show off where the ink-marks should go on their fingers. Children can be great transmitters of polio messages to their parents. Says 10-year-old schoolboy Hassan: “At home I tell my mother and father about the importance of immunisation to protect little ones under the age of five.”

Parents pay attention – especially when the messages their children bring home are backed up by their local Imams, clan leaders and female community mobilisers who work for polio eradication. In Lafa’isa kebele 04 in the Awbare woreda of the Somali Region, Mrs. Hibo Abdikarim Ibrahim, mother of one-and-a-half-year-old baby boy Mohamed-Amin Abdusalam Abdosh proudly shows his vaccination certificate:

Hibo Abdikarim Ibrahim proudly shows the vaccination certificate for her son
Hibo Abdikarim Ibrahim proudly shows the vaccination certificate for her son, Mohamed-Amin Abdusalam Abdosh, which is a record of his completed routine immunisation schedule. Lafa’isa kebele, Awbare woreda, Somali Region, November, 2014. © UNICEF Ethiopia/2014/Rozario.

“I am so happy my child is fully immunized now. Every National Immunisation Day I also immunize him to protect him from polio. I learned all of this from our lady community mobilizers and we heard the same message in the mosque.”

From Sheikh and Imam to female community mobiliser to clan leader from madrassa student to mother and baby – this is how a movement is built. Each forms a piece of the patchwork to protect children from polio. Just like each dose of polio vaccine, generously funded by the European Union, strengthens the immunity of the community.

Yet there is still much to be done. In the last campaign, 5 per cent of children reached were “zero dose” – they had never before received even a single dose of OPV. This is both hopeful, we are reaching children never reached before, and potentially troubling – are there further pockets of zero dose children we have not yet reached, who are entirely unprotected from polio? And while OPV and Routine Immunisation can go a long way toward protecting children from ten life-threatening, vaccine-preventable diseases, ongoing threats to child health and survival in Ethiopia’s Somali region, and across the Horn of Africa, are great.

Like the patches that make up the nomad’s tent, no single square of cloth is enough on its own. When we join together, from the Sheikh and Imam to the nomad to the international community, the whole is much greater than its parts. Together we can keep building a tent of protection to end polio and improve child health in the Horn of Africa – and to wipe the virus from the face of the earth for good. This can only be done with generous contributions from donors such as the European Union who have enabled the programme to reach the hardest to reach with life-saving polio vaccine.

In Ethiopia, Nationwide Polio Vaccination Campaign Reaches 13 Million Children

Sahro Ahmed vaccinates a child
Sahro Ahmed vaccinates a child in Warder, Somali region, Ethiopia. © UNICEF Ethiopia/2013/Sewunet

Somali Region, Ethiopia, 12 May, 2014 – Ethiopia kicked off a polio vaccination campaign on 3 October 2013, targeting 13 million children across the country following an emergency response that began in the Dollo Ado refugee camps in June 2013. In July 2013, Ethiopia Reports First Wild Poliovirus Case since 2008.

Ayan Yasin, a four-year-old girl, was one of the first confirmed polio cases in Ethiopia. Ayan lives with her father and mother, a typical pastoralist family, in their house, made of tin, wood and woven bed sheets in a remote secluded area three kilometres from Geladi Woreda in Ethiopia’s Somali Region. Living next to the Somalia border means that the family move frequently between Ethiopia and Somalia – making routine immunisation practices difficult.

When Ayan fell sick, her father took her to the nearest hospital in Somalia where he was told there was very little hope. After many visits to various health posts, Hergeisa Hospital finally confirmed she had Polio. “We call this illness the disease of the wind. We know that there is no cure for it, and that it can paralyse and even cause death. My daughter hasn’t died but it has disabled her forever,” says her father.

Close to 50,000 health workers and volunteers and 16,000 social mobilisers have been deployed all over the country as part of a campaign that includes remote and hard to access areas. With the support of the Crown Prince Court, Abu Dhabi, UAE, UNICEF has procured vaccines to support immunisation efforts particularly for children and the refugee population being hosted in the Somali Region. In total, 135,000 vials or 2.7 million doses of bivalent Oral Polio Vaccine (bOPV) were procured to immunise 2.43 million children with a polio vaccine – a critical input to immunisation activities in the Somali Region and Polio high-risk areas. The support from the Crown Prince Court has also helped to airlift the Polio vaccine to hard-to-reach zones of Afder, Gode and Dollo in the Somali Region.

Synchronised cross-border polio outbreak preparedness and response

Parents of Ayan Yasin Confirmed Wild Polio Virus (WPV-1) case in Degafur rural village
Parents of Ayan Yasin Confirmed Wild Polio Virus (WPV-1) case, lives in a border close to Somalia, in Degafur rural village, Somali region of Ethiopia. ©UNICEF Ethiopia/2013/Sewunet

Supplementary Immunisation Activities (SIAs) were conducted in Ethiopia, Somalia, Kenya, and Djibouti to accelerate progress towards ending Polio in the Horn of Africa. The synchronised SIAs were an outcome of the Horn of Africa Countries Cross-Border Polio Outbreak Preparedness and Response Meeting in Jigjiga, from 21 to 23 May 2014, where Ethiopia, Somalia, Kenya and Djibouti agreed to strengthen cross-border collaboration to eradicate polio from the Horn of Africa.

To reinforce support and strengthen Polio eradication efforts in the Somali Region, a high-level delegation consisting of Dr Kebede Worku, State Minister of Health, Mr Abdufatah Mohammed Hassen, Vice President of Ethiopia’s Somali Regional State and Head of the Somali Regional Health Bureau, Dr Pierre M’Pele-Kilebou, WHO Representative to Ethiopia, and Dr Willis Ogutu, Head of UNICEF programme in Somali Region, visited Warder in Dollo Zone, the epicentre of the wild polio virus outbreak in Ethiopia, on 14 June 2014. The delegation, together with the Warder Zonal Administration, launched the ninth round of Supplementary Immunisation Activities (SIAs) in the outbreak zone and formally inaugurated the Zonal Polio Outbreak Command Post, which had been established in April 2014 to improve coordination of response activities.

Sustained interventions to ensure long-term success

While the campaigns to vaccinate children against Polio in the Somali Region have been going well, ensuring long-term success in eliminating the disease will require sustained interventions.

Abdufatah Mohammud Hassen believes the best solution is to immunise every child and ramp up routine immunisation activities in the region. “The campaigns are just to stop the emergency but the main thing that we are doing is to reach every child by strengthening the routine EPI and ensuring that the health facilities have the capacity to respond to the demands of the public”

With the help of developing partners like the Crown Prince Court, Abu Dhabi, UAE, Rotary International European Commission of Humanitarian Department (ECHO) and Bill and Melinda Gates Foundation, UNICEF together with the Ministry of Health is continuing its efforts so that young children like Ayan Yasin living in the region are protected from the disabling symptoms of the Polio disease.