Birth control row hits polio eradication in Nigeria  

I came across this interesting piece of article in a Daily Trust Newspaper as written by Judd-Leonard Okafor:
When President Good luck Jonathan made his famous pronouncement about needing to control Nigeria’s exploding population through birth control, he didn’t anticipate how it would impact efforts to kick polio out of the country.
Weeks after his announcement, ongoing campaign to break transmission of polio this year has taken the first blow.
Polio eradication has historically faced tough resistance among residents mostly in the north of the country where people often feared that the vaccine came with a side effect: to render young girl children infertile in a bid to control population.
It showed up in Nasarawa A, a ward in Chanchaga council area of Niger. This time, residents cited the president’s comments when they refused vaccines meant for their children.
The ward, one of 11 sandwiched in the council area, has not been known for stiff resistance in recent past. Despite the comments, it recorded only a handful of non-compliant households (where parents refused the vaccine) on the first of four days of massive vaccination planned this July.
That’s because officials saw the problem coming, said a field supervisor.
In days before the immunisation took off, said a local World Health Organisation staff, officials sat with religious leaders and explained that the president’s comment was not final—and birth control couldn’t become legislation without going through the national assembly.
“We told them they have representation in the Senate and House of Representatives who will speak for them,” said the official. Similar assurance was broadcast on Radio Kaduna, he noted, and people listened.
Broken covers
Mixing a shaky polio eradication programme with murky politics of birth control is calling for trouble. Already, some northern states not on the list of high-risk areas in the north have seen record new cases of polio.
Immunisation still needs stronger political will to see it through. Officials meeting for to review the day’s work in the chambers at Chanchaga council secretariat believe they see the will in the local government politicians who sit in on the review.
It was always the case, they explain. Before they simply met under a tree in an open space, quoted figures from the field and dispersed. Now a lot has changed, the local WHO official said.
But pockets of resistance remain, and with them newer problems. Vaccine carries in use since mass immunisation rounds started years ago have worn out.
In May, field workers in Birnin-Kebbi swaddled the worn-out lids of vaccine carriers in polythene bags and foam, and vigorous complaints prompted release of 10 new carriers for the council area.
Field workers in Minna sought new improvisation: thermos food flask of nearly same capacity as the vaccine carriers. They stuff the plastic flasks with ice boxes to keep the vaccine within optimally cool for the four, five hours it takes to administer all the vaccine doses they carry in a day’s work.
But that depends on parents accepting the vaccines. Vaccination teams combing through households in Chanchaga and Bosso still come up against households who don’t “give us any response,” complained one field worker.
“He [the head of the household] didn’t even answer us. Zamu koma anjima tare da shi.” He meant the team would go back later together with him—him being the ward focal person, local facilitators who accompany field teams.
Such focal persons are becoming crucial to breaking through resistance.
Needed links
Officials reviewing Saturday’s work prepared to visit churches during service the following Sunday, but the absence of representatives from Christian Association of Nigeria and Rotary left plans in the air.
“We need them to liaise with churches so that we have things easier,” admitted a top official in Minna, amidst worry over low coverage.
While some are not getting the right coverage, other residents in Soje find fault with the rounds. A field vaccinator who worked there on Saturday reported cases of noncompliance. “They are complaining that their children have received vaccines and why are we coming around to [vaccinate] them again.”
Another WHO supervisor said noncompliance among Fulani dwellers of Soje was “critical”.  She recorded 15 households who refused, telling her “they don’t go to hospital, they don’t take vaccines [or injections]—it is not part of them.”
Many of the cases go unreported and undocumented, she suspects, and blames it on field vaccinators being indifferent, concluding—even before being told—that the households have no children under age five.
In general, concern about noncompliance isn’t shocking anymore. It’s the biggest entrenched front in polio eradication, but “we are more concerned where ward focal persons are around and nothing is done,” observed one official.
It is the task of focal persons, after the day’s work, to revisit noncompliant homes in hope of turning their no to yes.
A bigger picture
Focusing on statistics alone can paint the wrong picture in polio eradication.
On the first day of vaccination this month, field workers reported figures far above or below the numbers they targeted. In one ward, only one newborn was vaccinated for the first time (known as zero dose).
There are as much children growing out of the age-five bracket as there are children growing into it.
Newborns and migration also swell the group. So less number of children under five immunised can sometimes be cancelled out by more newborns.
When children move out of one location, they shrink the numbers there and swell numbers of new neighbourhoods their families enter. This way, immunising fewer children than targeted may not necessarily be underachievement, explains a WHO official. What’s important is to get the right children—those who need the vaccine.
Witchcraft plus
Vaccinators are sure they will continue to get the children—despite the absent of incentives.
So-called pluses—sweets given to children, soap and salt given to their mothers—are used to entice households to take the vaccine. That’s the “plus” in the programme’s name—Immunisation Plus Days.
Pluses were pulled from Niger’s immunisation programme last year, according to one official, in the wake of rumours about secret cults and witchcraft.
The rumour was that children could be initiated through petty offerings of sweets and biscuits. Even teachers who sold such items to children at schools stopped.
“Imagine your child wakes up in the morning and tells you they went to a [night] meeting with their teacher,” explained one official. The mental picture was chilling.
However, the numbers of children receiving vaccines in Niger are comfortably high, compared with states seeing more noncompliance despite using pluses.
It has managed to overcome bickering over incentives. Now it must face ideologies that could scuttle the efforts. Such is the impact of statements regarding birth control.
One at a time, officials still hope to bring those refusing on grounds of the pronouncement to see reason.
The day team couldn’t finish what it started. By evening, another team including the ward focal persons will visit homes of sceptics. If that fails, another revisit is scheduled next day.

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