March 24, 2008	Monday	Rabi-ul-Awwal 15, 1429

KARACHI, March 23: The fresh detection of a polio case in a 16-month old boy in Shikarpur district has upset the immunisation campaigners and others associated with the programme, said sources privy to the expanded immunisation programme.

The bigwigs at the helm of affairs of the polio-drop administration programme considered the detection of three polio cases during the first three months of the year a rebirth of the polio virus, which, according to them, had almost been eliminated in the province.

“Now, the concern is how the huge funding behind at least 72 rounds of oral polio drops since 1994 and the services of thousands of national vaccinators and polio workers under the supervision of national health officials and representatives of international donors and health agencies will be justified,” said a source.

According to a senior health official, despite a long journey and efforts including a good number of foreign trips in the name of study tours and interactions with other counterparts and important meetings, zero reporting of polio cases still remains a distant goal.

In 2005, a total of five polio cases were found in Sindh, while 12 cases were confirmed for 2006, including four at Karachi, two at Sukkur and one each at Naushehro Feroze, Umerkot, Ghotki, Jacobabad, Shikarpur and Sanghar.

Twelve cases were also discovered in 2007. The cases were discovered in Karachi (2), Khairpur (1), Thatta (1), Jacobabad (2), Ghotki (1) and Kambar (5).

Now, Hyderabad, Nawabshah and Shikarpur have also entered the list of high-risk districts in the province as they reported one polio case each during 2008 so far, while other districts outside Sindh are currently zero reporters.

At an Expanded Programme on Immunisation (EPI) review meeting held on Saturday (March 22) at Karachi, it was stressed that the high-risk population – specially the nomadic population – should be focused on more, while communication and advocacy activities should be intensified and enhancement of routine immunisation as a top priority be ensured.

Some of the participants were of the view that the report of fresh cases in Sindh was indicative of an improved surveillance system, while the number of cases from the NWFP, which was at a higher risk of transmission of the virus from Afghanistan, had been zero as the immunisation and surveillance teams were not getting time to conduct meaningful activities due to the militant uprising there.

The National Programme Manager of the EPI, Dr H.B. Memon, told Dawn that Sindh, after the detection of the Shikarpur case, was launching a three-day mopping up campaign in the whole of Shikarpur, Larkana and Kambar districts, while partial mopping up would be done in Sukkur, Jacobabad and Khairpur districts. He said that about 1,040,354 children up to the age of five years would be administered oral polio vaccines in 176 union councils during the campaign.

“Changes of executive district officers (health) from time to time also hampers the anti-polio drive as the newcomers had to reset the strategies and unify the field workers, which surely needed some time for a positive orientation,” Dr Memon said while commenting on the failures of the EPI initiative in Sindh.

Campaign review needed

However, a couple of others at the helm of affairs expressed the view that there was a need to review the whole vaccination exercise, particularly at a time when the province was so near to giving a final push against the dreaded polio virus.

“We need logistical support, budget for vaccination activities, transport to reach the non-accessible areas and enhancement in POL charges as well,” said an official coming from the interior of Sindh.

“The high risk months of August to November are still ahead,” said another insider, stressing that it was high time for the international health agencies and donor bodies as well to revisit their strategies in regard to monitoring and technical management and also assess the output of experts and related manpower deployed in the country.

Pleasure trips?

A depressed official went on to say that trips of personnel of the health department and immunisation projects under the garb of polio or measles campaigns should also be stopped forthwith, even to the capital or other provinces as these did not help in any way.

“The EDOs of health and other staffers are also called for meetings at one place almost every month, some time ahead of the polio campaigns or during the campaigns, which also hindered other health-related activities and caused a lack of concentration in campaigns and follow-up activities,” said a district health official, who suggested reducing such meetings and ceremonies.

Another official said that at a time when the vaccine coverage was being extended to 90 to 95 per cent of the deserving population of children in line with the international standard, an exercise to know the quality of vaccines and performance of cold-chains at various stages could also be undertaken.

However, there are quarters which believed that even the coverage rate of 95 per cent was also not a major achievement.

It was learnt through a source that national immunisation managers from Islamabad in July last year – when only four polio cases had been reported in Sindh and the progress was being appreciated – had pointed out to the EPI Sindh project director that there were still some key issues that needed to be addressed before the next polio campaign.

A communication from Islamabad, which was also forwarded to the special secretary (health) Sindh, DG health Sindh and WHO medical officers at Karachi and Sukkur, said the monitoring data compiled after the June 19-21, 2007, polio campaign and received from Kambar, Shikarpur, Jacobabad, Kashmore and Sukkur, had shown deterioration in the campaign’s quality.

A sub-optimal coverage of 94 per cent in children of less than five years at Shikarpur and Kashmore districts and 92 per cent at Sukkur district and a very high proportion of poorly covered areas in Kambar (11 per cent), Shikarpur (12pc), Jacobabad (17pc) and Kashmore (10pc) were reported.

Another key issue that needed to be addressed was the marking of the fingers of children after giving polio drops. An official source claimed that finger marking was very poor, i.e. about 64 per cent, in Jacobabad, Kashmore and Shikarpur during the June 2007 campaign.

Islamabad had also expressed concern over the inadequate announcements pertaining to drops administration from area mosques during the campaign in question. The rate was one per cent and six per cent in Shikarpur and Kashmore respectively.