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Afghanistan: Meet Anis, The Tailor Who Became A Polio Eradicator | GPEI.

[28/01/2020]

In Kandahar, women polio workers open doors of hope.

24-year-old Anis manages a team of 56 community outreach workers in Kandahar. ©UNICEF/Afghanistan24-year-old Anis manages a team of 56 community outreach workers in Kandahar. ©UNICEF/Afghanistan

Amidst the extreme heat of Kandahar City in southern Afghanistan, Anis Faizy, a 24 year-old polio outreach worker, moves with confidence between houses. Her aim is to talk to families that refuse to vaccinate their children against polio. Her energy is endless and she tops that with a smile and a warm way of talking with women and men.

For someone her age, Anis has an impressive range of skills. Initially a tailor, now she works as a skilled midwife with passion for her community. She is also a District Communications Officer for the polio programme, leading a team of 56 community outreach workers in her neighbourhood.

“I want to help my people – polio is a danger to every child, and we should eradicate it”, says Anis.

When Anis started her job her father told her “You do what is best for you”, but neighbours in her socially conservative community were not impressed. She was told by others that she “could be killed while working in the community, it is unsafe for women, and women must stay at home.”

But social barriers didn’t deter Anis, who has now been working to eradicate polio in Kandahar for over three years.

Anis recalls, “I faced tough refusal families who denied their children the polio vaccine. A woman refused to vaccinate her younger sister. After one year, the sister died of measles as she hadn’t been vaccinated against it. Now, the same woman has a baby girl and she frequently takes her baby to the health centre for vaccination. Sadly, she learnt her lesson the hard way”.

Over the years, Anis progressed from the lower ranks of social mobiliser to become a supervisor. In September 2019, she applied for the position of District Communication Officer within the Immunization Communication Network supported by UNICEF.

In Kandahar, a male dominant community, women friends wondered if she would be able to supervise male teams. Undeterred, Anis won the job competition. The interview panel commended her achievements, including reducing the number of vaccine-hesitant families in her area, and her ability to drive others to promote vaccines effectively. Reflecting on her work now, Anis emphasizes, “I don’t have a problem working with men. We help each other.”

Anis leaves her house at 6:30am during immunization campaigns, just as the sun breaks over Kandahar. She checks the outreach plans with her teams before they disperse around the town. Through the day, she makes supervisory visits to her teams and obtains updates on vaccine uptake issues. When she receives reports on absent and missing children, she converses with families in order to encourage them to vaccinate their children.

To eradicate polio from Afghanistan, Anis thinks there is a lot more to do. She says, “we need better health and sanitation services, more women to access homes and better relationships with the local authorities to ensure families accept vaccine.”

“I will continue to work hard, for every child to be able to walk, attend school and grow healthy. It is the whole community cause for generations to come.”

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Correspondence: Why is polio still here? A perspective from Pakistan | The Lancet Global Health.

[Open Access] [Published: February 2020] [Pre-print online version]

Rana Jawad Asghar writes:

Poliomyelitis has been eradicated in all countries except Afghanistan and Pakistan. Why have we, as Pakistani government workers, public health officials, and community members been unable to eradicate polio in Pakistan? There is no doubt that our field immunisation staff and the security personnel protecting them have faced unprecedented attacks in a difficult, and in some cases, deadly, working environment. But with the security situation now much improved, the question of why we are witnessing one of the largest polio surges since 2014 remains unanswered. Pakistan had 91 cases of polio as of Nov 26, 2019. Not only have we had a major outbreak in Khyber Pakhtunkhwa, but all other provinces in Pakistan have also reported multiple cases. In 2018 we had 12 cases, and in 2017 we had only eight cases. Multiple explanations have been put forward from national elections, transition of government, underlying issues of community distrust of vaccinations, to negligence of key staff.

In its 2019 report, the field mission of the Technical Advisory Group on Polio Eradication, stated that the “Pakistan program is on a failing trajectory, putting the rest of the global program at risk”. In 2018, the independent monitoring board of the Global Polio Eradication Initiative reported that it felt the situation in Pakistan has not improved since the gains achieved in 2017 and that the programme in Pakistan is stalling. It also highlighted one of the key issues, which is crucial in the success or failure of the programme but is not openly talked about; the polio eradication programme is considered a foreign programme in some areas of Pakistan as local leaders are not seen leading it. In their absence, foreign technical staff are the ones seen by communities. Further, when one ventures beyond the streets and inside the polio programme offices, they find international technical staff developing strategies and supervising implementation.

Polio emergency control centre coordinators are usually the only governmental staff at the centres. Other technical leaders come from different donor agencies. A coordinator could be leading, but major strategic direction still comes from the headquarters of lead technical agencies, in different countries, though with some local input. There should be a good balance of local and international technical leaders in a working environment as complex as Pakistan, especially in a situation in which the programme gains have reversed in a major way. Local experts understand local issues and can come up with local solutions. For example, when the International Stop Transmission of Polio programme experts were unable to work because of security reasons in some of the most high-risk areas for polio transmission in Pakistan, a new programme was developed, National Stop the Transmission of Polio by the Pakistan Field Epidemiology and Laboratory Training Program. Although the names are similar, they are different in their design and implementation. Finding local public health officials from high-risk areas and providing them with epidemiological training resulted in both local acceptance and the technological skills to succeed in areas like North and South Waziristan. To achieve success, we need real partnerships in which local input is used to shape the work plan and strategies in a meaningful way. In its 2018 report, the independent monitoring board for polio eradication recognised a heavy top down approach and inflexibility in accepting local feedback and encouraged polio leadership staff to accept local feedback for strategy development.

What we need in Pakistan is to accept that polio eradication is not solely the domain of international agencies, the government of Pakistan should also take ownership. Real ownership comes with local funding, local strategy development, and political leadership at the forefront. The dengue virus outbreak in Pakistan in 2011 is one example in which the government did not ask donors to come forward but designed and implemented its own dengue control programme, which has shown its effectiveness over the years.

International experts can advise on global strategy alignment but the local action plans should originate locally to be successful. Pictures of leaders administering polio drops is not ownership of the programme. One polio case identified by a surveillance system might mean 1000–3000 polio infections in the community. This is the extent of the problem that Pakistani children are facing. It is time that we not only call the rise of polio a national emergency (we declared it sometime back), but also really mean it.
I declare no competing interests.

For References see source article.


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Afghanistan launches polio vaccination targeting 9.1 mn kids | Telangana Today.

[27th Jan 2020 2:21 pm]

Kabul: The Afghan Public Health Ministry on Monday launched a nationwide polio vaccination campaign targeting 9.1 million children under the age of five.

The five-day campaign started in 30 of the country’s 34 provinces, reports Xinhua news agency.

Due to harsh weather, the anti-polio drive will not be conducted in Bamyan, Daykundi, Ghor and Badghis provinces.

The drive was launched as 29 polio cases were detected in Afghanistan last year.

The ongoing insurgency and conflicts have been hindering the efforts to stamp out the infectious disease in the mountainous country as 1.2 million children from areas inaccessible to vaccination teams will miss the ongoing vaccine drive.

Afghanistan and the neighbouring Pakistan are the only two countries in the world where polio cases are reported every year, according to the statement.


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UNICEF-WHO Philippines: Polio Outbreak Situation Report #14 (27 January 2019) | World Health Organization, UN Children's Fund via ReliefWeb.

[27 Jan 2020]

Published on 27 Jan 2020

Highlights.

  • Two new human cases confirmed with cVDPV2: 1 st from Quezon City in National Capital Region (NCR). Other case is from Sultan Kudarat in Maguindanao, Bangsamoro Autonomous Region in Muslim Mindanao (BARMM)

  • Currently, 13 cases with cVDPV2, one case with cVDPV1; one case with VDPV1; and one case with immunodeficiency-related VDPV type 2 (iVDPV2).

  • Limited polio outbreak immunization in areas affected with VDPV1 conducted in Zamboanga and Isabela (Region IX),
    Lambayong (Region XII), and Basilan,
    Sulu and Tawi-Tawi (BARMM) vaccinated 705,089 children under 10 (95.33%) on 6-15 January 2020.

  • Third round of the Sabayang Patak Kontra Polio started on 20 January in Mindanao, targeting 3.1 million children under 5 with monovalent Oral Polio Vaccine against poliovirus type 2 (mOPV2) until 2 February. In the first 6 days of the campaign, 2,788,632children under 5 were vaccinated (89.87%)

  • 11.2 million doses of bivalent Oral Polio Vaccine (bOPV) to be procured for the Mindanao VDPV1 outbreak response rounds to replace borrowed routine immunization stocks

  • Global Polio Eradication Initiative (GPEI) Technical Advisory Group recommended sending 323,000 doses of mOPV2 vaccine for 2 rounds in NCR targeting 1.4 million children under 5

  • Poliovirus Outbreak Response Assessment (OBRA) mission confirmed for 8-14 February.

  • Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.

  • Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

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Australia: Polio survivors to discuss management of late effects as new symptoms emerge | Central Western Daily.

[JANUARY 27 2020 - 11:30AM]

Information on the Late Effects of Polio including self-management strategies and how to work with health professionals will be discussed at a free information session for polio survivors next month.

Polio Australia will conduct the session for polio survivors, along with their families and carers, at 10.30am on On Tuesday, February 4, at the Orange Senior Citizens' Centre in Kite Street.

Although polio is considered a thing of the past in Australia, there are still people, whether born here or overseas, who may now be experiencing new symptoms as they get older.

Many remember the trauma of months or even years of isolation in hospitals, immobilisation in complicated braces, and even the iron lung.

Some went on to make a full or partial recovery and polio was just a distant childhood memory.

Among them was Orange resident Michael Hutchinson of Orange who was 18 months old when he contracted the virus and has no memory of the initial illness but went to hospital in Sydney, for several months at time, to have corrective surgeries on his legs every few years throughout his childhood.

Mr Hutchinson made a good recovery and lived a normal life with work, marriage, and children until about 15 to 20 years ago when new symptoms started to emerge.

"Each year after that it depleted a little bit further," Mr Hutchinson said.

He said the new symptoms included an increase in leg weakness so he now relies on crutches to get around and finds it more difficult to do his usual daily activities.

The changes, which are are due to a collection of symptoms commonly known as the Late Effects of Polio can include new or increasing muscle weakness, reduced endurance and fatigue, difficulty with breathing and sleep, chronic pain and speech and swallowing problems.

Polio Australia's president and a polio survivor Gillian Thomas said with little knowledge of post-polio issues in the medical community, polio survivors often have to do their own learning and become self-advocates, addressing issues such as avoiding overuse of muscles and taking precautions with anaesthesia.

"For many ageing polio survivors, the re-emergence of symptoms, known as the Late Effects of Polio, can be quite debilitating," she said.

"Polio Australia's community information sessions provide historical context, as well as facilitating a discussion around how people can best manage their current condition."

Anyone who has been affected by polio, along with their families or carers can to attend the information session.


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Philippines: Ozamiz City Health intensifies 2nd round polio vaccination | Philippine Information Agency.

[January 26, 2020] Shaine Mae R. Nagtalon writes:

OZAMIZ CITY, Misamis Occidental, Jan 21 (PIA) -- The Ozamiz City Health Office conducts the second round of anti-polio mass vaccination or the Sabayang Patak Kontra Polio campaign in the 51 barangays of Ozamiz on January 20-February 4, 2020.

The campaign aims to ensure that all children aged five years old and below will be immunized and protected against the poliovirus.

City Health Officer Dr. Holly Tago encouraged parents and households not to resist the oral vaccination for their children to protect them from the debilitating effects of polio.

She assured the parents that the vaccines have no side effects on children.

She added that proper hygiene must also be practiced by defecating in toilets, proper handwashing, making sure water is safe for drinking, and preparing and cooking food thoroughly.

Polio is a highly contagious disease caused by a virus that invades the nervous system. It can lead to paralysis and death. Children below five years old and below are most vulnerable to the disease.

“The signs and symptoms of polio include headache, fever, stiff neck, vomiting, fatigue, and sudden onset of floppy legs," Tago said.

Health workers will go on house-to-house vaccination while others will be in health centers, malls, terminals, and other strategic areas.

During the vaccination, each child will be given two drops of monovalent oral polio vaccine (mOPV) Type 2. As proof of administration, the child’s pinky finger will be marked with indelible ink. (SMRN/PIA MISAMIS OCCIDENTAL)


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