143th APHA Annual Conference

Chicago, Illinois“AFP Surveillance status and

community awareness in pastoralist and semi-pastoralist communities of

Ethiopia conducted on 2012”Kibrom Abraham, BSc, MPH

Kibrom Abraham Filimona Bisrat, Mesganaw Fantahun,

Authors

Outline Introduction Objective Methods Result Conclusion Recommendation References

Country profile

Projected population = 90.14 million

(Census 2007)

Growth Rate= 2.6

Estimated live births = 3.36

Estimated surviving infants at 1 year

= 3.16

Under-5 yrs =14.59

Child Mortality Rate: 67/1000 ,

MDG4 achieved,2012

Population Density

Organizational profile

CORE Group is an association of 54 US based PVOs/NGOs working on child survival in 160 countries across the world

CORE has various initiatives & working groups one of them is Polio Eradication

Currently CGPP is being implemented in five countries (India, Ethiopia Angola, Nigeria and South Sudan)

Consortium of Christian Relief and Development Associations (CCRDA) is the biggest network of Civil Society Organizations(360 members), operating the past 38 years in Ethiopia.

Background

The global effort to eradicate polio have identified high quality surveillances of acute flaccid paralysis(AFP) as essential component of the eradication strategy.

Polio eradication initiative in Ethiopia was started in 1996 based on the guide line provided by WHO.

Difficult tertian, migratory population and weak infrastructure in pastoralist communities of Ethiopia remains the major challenges to the surveillances system.

ObjectivesGeneral objective: To assess AFP surveillances status and

enhance better AFP case detection in CGPP implementation areas

Specific objectives: To determine KAP of mothers/care takers towards polio

and AFP surveillances To examine the system of identification and follow up of

AFP case surveillances from Woreda to health facility and community level

To identify mechanism to support the AFP surveillances system at community and HF level.

Methods

Study design: facility and community based cross-sectional study design, FGD with community and religious leaders

Study area: purposively selected 9 district of CGPP Ethiopia implementation areas in Gambela, Somali, Afar, Oromia and Benishangul Regional stats.

Distance, cultural representation and health services performances used as selection criteria.

Method .…… Study population: WHOs and HC AFP surveillances

focal person, WHO surveillances focal person, Mother/care givers , community members and religious leaders

11 HC(1or2 randomly selected per district) 600 mother/care givers was selected using pps

technique, 30 clusters distributed among 9 selected Woredas

Sampling: 18,282(eligables)/30 = 609 ≈(600/30) 20 samples per cluster

FGD conducted among 6-8 individuals from community/religious leaders in the study area

Method….. Data collection: questioner developed in

English and translated to local language. Pretested and administered by trained interviewer

Data analysis: quantitative data entered and analyzed using SPSS version 17. FGD records translated to English and transcribed for analysis using open cod computer program

Ethical considerations: permission obtained from RHBs and woreda and kebele administrative authorities. Informed consent was obtained from study participants

Results Interview with HC AFP focal person:

Provide IE

C

Report AFP

Coordinate co

mmunity base

d activities

Identification of A

FP at t

he OPD

Particip

ate in SIAs

Other a

dditional task

s and re

sponsib

ilities

0

2

4

6

8

10

1211 11

2 21

11

Figure 1: Task of Health center AFP focal persons in pastoralist and semi-pastoralist CGPP implementation areas, 2012

NO

of A

FP F

ocal

Per

son

in th

e su

rvey

ed H

ealt

h Ce

nter

Result….Summery of activities by HC/District AFP focal person:

Category Training RM Supervision Reported AFP case last 1year

Having additional task

Zero reporting

IIP/MLM IDSR CC CBS SS Feed back

HC AFP focal person

2 1 2 2 4 8 5 3 yes 7

District AFP focal person

4 3 6 6 yes 7

Table1. status of activities by HC/District AFP focal person

Result…..Interview with WHO surveillances focal persons

Table 2: AFP indicators in CORE Group Ethiopia Polio Project Implementation Areas in 2011, as reported by WHO, Surveillance Officers from Various Regions.

Activities Somali/

Shinelle Zone

International

border

woredas (all)

Benishan

gul-

Gumuz/

Assosa

Zone

Oromiya/

Borena

Zone

Gambella/

Nuer,

Mejenger

and Anuak

zones

NP AFP rate 2.6 < 2 6.0 - Low*

Stool

adequacy

> 80 <60 100 93 Low*

Case

detection

rate

6 Low 2 2.5 Low*

Rates not specified, but considered low

Result…Interview with Mothers

Knowledge/Actions Frequency Percent

Heard about AFP (n=600)YesNo

344256

57.342.7

Source of AFP information*HEWsCVSFPsOther health workersMass mediaCommunity members (neighbors, friends…)Model families

21911858492827

36.529.79.78.24.74.5

Signs and symptoms of AFP cited by respondents*LimpingStops walkingFever Flaccid paralysisOthers (diarrhea, cough, rash, blindness..

18915614614520

31.526.024.324.23.3

Actions to be taken if a person is suspected to have AFPTake to health facilityTake to traditional healer or wizardInform community volunteer surveillance focal person Others (apply home remedies e.g. fluids, massage, recite prayers, take child for vaccination, isolate child.)

415803218

69.213.35.33.0

Table 3: Knowledge and Attitudes Towards AFP of six hundred Women who Delivered a Child in 2011 in Pastoralist and Semi-pastoralist Areas of CORE Group Polio Project Implementation Districts of Ethiopia

Result…FGD with community and religious leaders:

Polio known by d/f names indicated by Sign and symptom such as ‘’death of legs’’

Miss conception about polio transmission e.g. respiratory rout, physical contact, mov’t of communities

Polio can be prevented by vaccination of children‘s

Summary of findings

Shortage of trained HR to perform routine disease surveillances activities

Inadequate number of AFP case identified and reported e.g Teltelle, Gambella border woredas

Multi-tasked of HC/district surveillance person.

lack of awareness, and traditional health seeking behaviors

Conclusion

There is need to continue the effort of strengthen awareness of communities, capacity building and monitoring, involving community members at each steps, and giving emphasis to hard to reach and border communities.

Recommendations Strengthen awareness of communities

through targeted IEC intervention on causes, transmission, prevention of polio and identification of AFP case.

Training and strengthening of supportive supervision

Establish or strengthen forums to involve stakeholders

Identify /develop mechanisms for identification of AFP case, reporting, collection of specimens and transportation especially to silent, border and hard to reach areas.

References Global polio eradication initiative quality of surveillance, Available at

www.polioeradication.org/survellance.aspx,2010

GPEI – Polio Eradication And Endgame Strategic Plan, quality of surveillance, available at

www.polioeradication.org/portas/0/document/Resources/s..,2013

World Health Organization. Protocol for the assessment of national communicable Disease

Surveillance and Response Systems. 2001.

Global polio eradication initiative, available at

www.polioeradication.org/polioandprevention.aspx,2010 accessed Sept 2012.

Hovi T. Surveillance for polioviruses. Biologicals. 2006 Jun;34(2):123-6

Federal Ministry of Health (Ethiopia). Integrated Diseases Surveillance and Response (IDSR)

strategy. Addis, 1999.

World health organization. WHO country surveillance of poliomyelitis, Available at

WWW.who.int/immunization_monitoring/....surveillance /country/Ethiopia/…/index.html.

accessed November 17, 2012

Letts reach them !!!!! End Polio!!

Thank you