The Drum Beat 383 - Communication for Polio Eradication

This issue of the Drum Beat is part of an ongoing series that highlights current means of addressing and assessing global polio eradication efforts through communication. The strategic thinking and evaluation summaries included below were posted over the past two months in the Communication Initiative website's Immunisation, Vaccines and Polio section in response to recent meetings held in India and Zimbabwe.

These meetings convened with the shared objectives of reviewing in-country progress on polio eradication and to make recommendations on accelerated strategies to ensure interruption of wild poliovirus transmission (WPV). Epidemiological data were presented in order to illustrate polio eradication progress, and specific communication strategies and challenges were discussed. Please click here for summaries of and links to the full presentations from the Annual Meeting of the Technical Advisory Group (TAG) on Communication for Polio Eradication, held in Harare, Zimbabwe, November 8-10 2006. For summaries and presentations related to the India Expert Advisory Group (IEAG) meeting, held in New Delhi, India, on December 11-12 2006, click here. A past issue of The Drum Beat detailing the previous year's TAG meeting, held in Yaoundé, Cameroon, June 22-24 2005, may also be viewed by clicking here.

We welcome information about your polio-related activities, materials, thinking pieces, and evaluations. Send details to Deborah Heimann at dheimann@comminit.com To join The Communication Initiative's online polio discussion forum please contact Chris Morry at cmorry@comminit.com

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Please see The CI's Polio Theme Site providing a specific focus on the information related to polio on The CI website.

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Presentations from the Technical Advisory Group (TAG) Meeting in 2006 in Harare, Zimbabwe

This meeting was hosted by the World Health Organization (WHO) African Regional Office (AFRO) in Zimbabwe, and began with a series of presentations that outlined accelerated disease control and communication efforts in child and routine immunisation throughout the African region. Country-specific presentations followed, led by communication practitioners in 5 African countries - Angola, Democratic Republic of Congo, Ethiopia, Niger, and Nigeria - which have experienced ongoing cases of wild polio virus (WPV) from 2005 to 2006. Click here for access to summaries of presentations from this meeting.

Please note: Some of the presentations at this conference were given in French. Whenever possible, we have included translations of the full presentations for your convenience.

S'il vous plaît noter: Certaines présentations étaient offertes en français à cette conférence. Les traductions des présentations complètes et des sommaires sont mises à votre disposition pour votre convenance lorsqu'elles sont disponible.

1.Overall Review and Insights into African Polio Communication Efforts in Context of Overall Immunisation and Child Health Trends and Programmes

This presentation provided a general review of overall immunisation and child health to date and gives some insights into African polio communication efforts. Special attention is given to initiatives for improving communication support in Nigeria, which remains the only polio endemic country in Africa. Major activities and achievements throughout Africa are discussed, and the creation of a set of global standards to guide country level communication support is put forth. Communication challenges remain, and centre on a lack of training and resources. Several suggestions, focused on capacity building and skills training, strengthening communication between partners and providing immediate response to outbreak situations, were detailed.

Click here for a summary.

Click here for the full presentation [PDF].

Contact Grace Kagondu, WHO/AFRO kagondug@whoafr.org

2.Overview of Accelerated Disease Control in the African Region

A large part of the polio eradication (PE) effort involves routine and supplementary immunisation activities. Researchers therefore often find it helpful to look at immunisation models for other vaccine-preventable diseases in the region of interest in order to identify key strategies or shortcomings, and in some cases to initiate multi-intervention campaigns. This presentation gave an overview of measles, maternal and neonatal tetanus (MNT) and yellow fever (YF) control in the African region. It also discussed the integration of child survival interventions through supplementary immunisation activities (SIAs) and related challenges and issues. A detailed look at the epidemiology of these diseases was presented, with the goal of overcoming the major social mobilisation and communication challenges to SIAs.

Click here for a summary.

Click here for the full presentation [PDF].

Contact Grace Kagondu, WHO/AFRO kagondug@whoafr.org

3.Routine Immunisation Performance in the Africa Region

This presentation gave an overview of the WHO/AFRO routine immunisation priorities for 2006. It also reviewed main achievements with regards to third dose diptheria, pertussis and tetanus vaccine (DPT3) coverage in the African region between 2005-2006, as well as upcoming challenges to immunisation performance. A series of slides in this presentation illustrated the 2005-2006 performance statistics for DPT3 coverage for 4 main African regions. Globally, the future challenge for DPT3 coverage consists of 28.2 million unreached infants. WHO/AFRO has identified 8.71 million infants in sub-Saharan Africa who are an important part of this demographic, and who represent an area for future focus.

Click here for a summary.

Click here for the full presentation [PDF].

Contact Grace Kagondu, WHO/AFRO kagondug@whoafr.org

4.Update on Status of Polio Eradication

This presentation gave an overview of WPV transmission, Acute Flaccid Paralysis (AFP) and laboratory surveillance in 12 African countries and addressed related immunisation challenges. Transmission trends and infection statistics throughout the African region are discussed, and progress is compared to the WHO's annual goal of 2/100,000 operational non-polio AFP cases in children 15 years of age or younger. Issues for the communication TAG were also presented at community, national and donor/partner levels.

Click here for a summary.

Click here for the full presentation [PDF].

Contact Grace Kagondu, WHO/AFRO kagondug@whoafr.org

5.Angola's Response to the Circulation of Wild Poliovirus

This presentation was developed in partnership with the Angolan Ministry of Health, and gives an overview of the spread of WPV in Angola in the context of the current socio-political status of the country. It provides a comprehensive list of coverage responses, activities and objectives since the introduction of WPV into the country in 2005. Outlined here are country objectives for October 2006 to December 2007, pertinent management activities, and supplementary immunisation activity goals. The presentation concludes with an extensive discussion on advocacy, communication strategies and future immunisation challenges currently facing Angola.

Click here for a summary in English.

Click here for the full presentation in English [PDF].

Click here for a summary en Français.

Contact Maria Filomena Wilson Manuel, Ministry Of Health filomenawilson@hotmail.com

6.Communication for Polio Eradication in Democratic Republic of Congo (DRC)

This presentation provided an overview of the epidemiological history of poliovirus in DRC, as well as country-specific communication strategies, challenges and threats. Currently, the largest potential risk to attainment of the DRC polio eradication goal is seen as the weak financing of communication activities. The presenters stressed that DRC would like to share immunisation experiences with other countries, in terms of social marketing for vaccination and in maintaining motivation of community relays. Originally presented in French, this slideshow is also available in English on the Communication Initiative's website.

Click here for a summary in English.

Click here for the full presentation in English [PDF].

Click here for a summary en Français.

Click here for the full presentation en Français [PDF].

Contact Maria Filomena Wilson Manuel, Ministry Of Health filomenawilson@hotmail.com

7.Communication for EPI/PEI Ethiopia

This presentation gave an overview of the spread of WPV, routine immunisation and DPT coverage in Ethiopia. It also discussed current risks to surveillance and communication, and outlined several communication strategies for the polio eradication initiative (PEI) and expanded programme on immunisation (EPI). The presentation concluded with a discussion of Ethiopia's 2006-2007 social mobilisation (SocMob) plan, and addressed some key communication challenges facing immunisation coverage, particularly in the instance of cross-border communities.

Click here for a summary in English.

Click here for the full presentation in English [PDF].

Click here for a summary en Français.

Contact Nehemie Mbakuliyemo, WHO mbakuliyemon@et.afro.who.int

8.Communication for Polio Eradication in Niger

From 2005 to March 2006, 20 cases of WPV were reported in Niger (10 cases in 2005, and 10 cases in 2006). During that same period, the country has conducted 8 rounds of polio SIAs. The communication environment of Niger is characterised by significant mobility of the population, persistence of residual refusal cases, and active involvement of Islamic Women Associations in the sensitisation of parents. This presentation stressed the importance of developing communication strategies to address high-risk zones and rendering functional communication structures at the community level. Originally presented in French, this slideshow is also available in English on the Communication Initiative's website.

Click here for a summary in English.

Click here for the full presentation in English [PDF].

Click here for a summary en Français.

Click here for the full presentation en Français [PDF].

Contact Abdoul Hakim Mokthar, Ministry of Health mokhakim@hotmail.com

9.Nigeria Country Presentation

This presentation offered an extensive discussion of communication results through to September 2006 in Nigeria, with a focus on community and local mobilisation and media involvement. These strategies were illustrated by an extensive analysis of February 2006 data collected in Kano state. Overview of the communication environment and strategic components that are currently employed in Nigeria's polio eradication initiative are discussed, which included increased involvement of community-based organisations (CBOs), traditional and mass media and community dialogue for empowerment and ownership.

Click here for a summary in English.

Click here for the full presentation in English [PDF].

Click here for a summary en Français.

Contact Brandao Co, United Nations Children's Fund (UNICEF) Nigeria bco@unicef.org

10.TAG Panel Report: Communication for Polio Eradication and Expanded Routine Coverage

The mandate of the TAG peer review panel is to listen to country presentations, ask questions and provide constructive recommendations. This presentation covered the main issues identified during the 2-day meeting and outlined recommendations for polio eradication efforts in Democratic Republic of Congo, Nigeria, Angola, Niger and Ethiopia. In addition to reviewing major challenges identified in each country's platform and providing country-specific recommendations, the TAG Panel outlined 6 major challenges pertinent to all countries. These included the need for relevant indicators and measurement of communication impact, and improvement in training of vaccinators in their communication roles, among others.

Click here for a summary.

Click here for the full presentation [PDF].

Contact Grace Kagondu, WHO/AFRO kagondug@whoafr.org

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Presentations from India Expert Advisory Group (IEAG) Meeting in 2006 in New Delhi, India

This was the sixteenth meeting of the IEAG, which convened to review polio eradication progress in India within a global context, and to make recommendations on the strategies presented. Participating organisations included the World Health Organization (WHO), Rotary International, the United States Centres for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF). Click here for access to summaries of presentations from this meeting.

11.Global Polio Eradication - The Final Four

This presentation gave an overview of the recent epidemiological history of polio on a global scale, with a focus on the 4 polio endemic countries - India, Nigeria, Pakistan and Afghanistan. Despite a drastic global decrease in the number of confirmed polio cases since 1988, these countries saw an increase in the number of cases between 2005 and 2006 due to missed children. Tools and strategies developed to deal with this threat over this 12-month period were discussed, and were found to have a positive impact on transmission interruption across all countries. The approach for 2007 is also outlined, with an emphasis on stopping transmission in these countries, protecting polio-free areas and responding to outbreaks as they occur, and reducing the polio importation risk.

Click here for a summary.

Contact Bruce Aylward, WHO aylwardb@who.int

12.Polio Eradication in India

According to this presentation, vaccination in the western Uttar Pradesh region is presenting more of a challenge in Muslim rather than Hindu communities. Due to significant improvement in the quality of SIAs, the expectations for the status of polio in India by February 2007 is that transmission will continue only in key core areas, including western Uttar Pradesh and selected districts of Bihar. In conclusion, strategies for more rapid and effective protection of younger children were discussed.

Click here for a summary.

Contact Michael Galway, UNICEF, c/o Gitanjali Chaturvedi, gchaturvedi@unicef.org

13.Bihar Polio Eradication Initiative - An Overview

Presented by the Government of Bihar's State Health Society, this slideshow provided an overview of the epidemiological status of polio in Bihar, India for 2006. This included the severity of paralysis in the current 48 polio cases in this state. The State Health Society emphasised the definite improvement in operational quality and the maintenance of coverage and quality at this high level by the government over the previous year. Despite these efforts, the presenters urge that increases in the number of WPV cases in 2006 necessitate a review of the state programme as soon as possible. In addition, polio eradication initiatives taken by the Government of Bihar over the last year are detailed.

Click here for a summary.

Contact State Health Society, Bihar info@shsbihar.org

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DISSCUSION: Use of Clinical Pictures in HIV/AIDS Education

A discussion of the article "Pictures As A Health Promotion Strategy In Addressing HIV/AIDS In Developing Countries," written for SafAIDS by Dr Edwin Mapara, and focused on issues related to methodologies, format, and process of using pictures.

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14.Status of Polio Eradication - Uttar Pradesh

Uttar Pradesh reported a total of 481 polio cases in 2006. This presentation illustrates those cases by age, oral polio vaccine doses (OPV) and religious community. The government of Uttar Pradesh has made significant efforts to strengthen the health infrastructure and continues its strong commitment to the programme, participating in periodic review at the highest levels of the state and enhanced monitoring efforts. Routine immunisation (RI) achievements in Uttar Pradesh in the areas of RI monitoring, reported coverage, and immunisation week coverage were summarised. Overall, full immunisation coverage increased from 33.8% to 43.9% from 2005 to 2006. Uttar Pradesh is currently experiencing its lowest number of missed houses reached, with continued strong political and administrative support to counter the last few remaining pockets of polio left.

Click here for a summary.

Contact Mr. A.K. Mishra, Health and Family Welfare Department

15.Community Perceptions About the Polio Eradication Programme: Focus Group Discussion in Western Uttar Pradesh

In November 2006, Jamia Millia Islamia was commissioned by UNICEF to assess community perceptions towards the Intensified Pulse Polio Immunisation (IPPI). Among other goals, this study sought to probe community support if the space between the rounds was to be compressed. The study sought answers to key questions surrounding community perceptions and receptiveness toward the polio eradication effort in Uttar Pradesh. Data were collected from a series of 16 focus discussion groups in 4 locations throughout Uttar Pradesh. This paper details the results of those efforts, and was presented as part of the IEAG meeting. It was concluded that intensive partnership with the media to challenge rumours and misconceptions is necessary, and that the programme must engage the media at all levels. Furthermore, additional needs of the community must be addressed in subsequent immunisation rounds, regardless of whether rounds are intensified.

Click here for a summary.

Contact Dr. Gitanjali Chaturvedi, UNICEF gchaturvedi@unicef.org

16.Sixteenth Meeting of the India Expert Advisory Group for Polio Eradication - Conclusions and Recommendations

The goal of this paper was to review progress on polio eradication since the last full meeting of the IEAG held 7 months earlier, and to make recommendations on accelerated strategies to ensure the interruption of wild poliovirus (WPV) transmission in India. According to the IEAG, as of December 2006, a total of 583 cases of WPV (with onset in 2006) were confirmed in India. Of these, the vast majority of cases were concentrated in 2 highly affected states - 481 cases in Uttar Pradesh and 48 in Bihar. The IEAG provided a detailed description of transmission trends, with specific focus on genetic evidence behind the viral spread, for each of these states. Recognising that population immunity against WPV will be very high by the end of 2006 due to improvements in SIA quality, the use of monovalent OPV, and recent outbreaks, the IEAG concentrated on optimising the use of polio vaccines to create adequate immunity to stop WPV1 transmission in the low season of 2007. They also provided specific objectives within 5 key areas.

Click here for a summary.

Click here for the full presentation [PDF].

Contact Michael Galway, UNICEF, c/o Gitanjali Chaturvedi, gchaturvedi@unicef.org

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This issue of The Drum Beat was written by Kiyuri Nacker, Coordinator, Routine Immunisation and Polio Communication Initiative, The Communication Initiative.

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