End Polio Challenges In Pakistan

(Suhail Ahmed, Karachi)

In polio history early 20th century, polio was one of the most feared diseases in industrialized countries, paralyzing hundreds of thousands of children every year.
The introduction of effective vaccines in the 1950s and 1960s, however, polio was brought under control. During the 1970s, national immunization programmes, helping to control the disease in many developing countries.

Polio is a contagious viral illness that causes “nerve injury leading to difficulty breathing, paralysis and sometimes death”. Symptoms and signs for non-paralytic polio such as Headache, Fever, Fatigue and muscle weakness or tenderness etc. Some children can cause allergic reaction due to IPV usually occur within minutes to a few hours.

There are now only 3 countries where polio transmission have never stopped including Pakistan, Nigeria and Afghanistan.
IHR (2005), involving 196 countries across the globe, represents a binding international legal agreement including all the Member States of World Health Organization.
A polio-free world requires updated vaccination policies the plan has three goals, Eradication, Integration and Certification and Containment.

End polio programme in Pakistan is a public-private partnership led by The Government of Pakistan, and partners such as the World Health Organization (WHO), Bill & Melinda Gates Foundation (BMGF), the United Nations Children's Fund (UNICEF), Rotary International and the US Centers for Disease Control and Prevention (CDC).
Polio Eradication Programme has always been driven by strong Government commitment and leadership. The polio eradication always remains a top priority under each Government. The sustained programme operations are at every level Provincial Task Forces, Divisional Task Forces, and District Polio Control Rooms.
Rotary International more than one million Rotary members have volunteered their time and personal resources to polio eradication.
WHO coordinates the major strategic planning, and administration processes of the Global Polio Eradication Initiative (GPEI).
UNICEF supports for the implementation of National Immunization Days (NIDs) and Sub-National Immunization Days (SNIDs), and campaigns through the funding of more than 20,000 community-based vaccinators.
Bill and Melinda Gates Foundation contributes technical and financial resources to partners to accelerate efforts to eradicate polio.

For Polio Eradication Programme Surveillance is one of the main pillar. The programme is able to identify where the polio virus is circulating such as “testing stool samples of children suffering from acute flaccid paralysis and testing samples taken from sewage water across the country”.
In Pakistan, AFP surveillance began in 1997, but was focused attention in 2000. Acute flaccid paralysis (AFP) is sudden onset of weakness/ paralysis in any part of the body of a child less than 15 years of age.
Environmental Surveillance helps enhance the sensitivity of surveillance for polio-viruses. Currently there are 60 sampling sites for environmental detection in 40 towns and districts of the country.
Polio Cases across Pakistan’s Provinces was almost to end till 2018. Cases from 2015-2018 recorded are 54, 20, 8 and 12. This ratio has been increasing in 2019 recorded 111 cases throughout Pakistan. In 2019 there are Zero cases recorded in Gilgit-Baltistan, ICT and Azad Jammu & Kashmir. Whereas in Sindh 17, Punjab 6, Balochistan 9 and 79 in Khyber Pakhtunkhwa.
High risk areas in Pakistan are categorize in fours tiers. In first tier core reservoir districts contain 11 districts. In 2nd tier high-risk districts contain 30 districts. In tier 3rd vulnerable districts contain 32 districts. In 4th tier low risk districts contain 79 districts. In 2019 maximum num. of polio cases recorded in KPK Bannu district are 24 cases and 27 cases in Lakki Marwat.

Every Child Health Workers (CHW) has given their target to vaccine children. They vaccine children at home, roaming or school/Madrasa children. There may be Not Available (NA) children such as when visit at home, children has gone for visit to relatives or picnic with parents etc. or home may be Locked during their visit. Most cases arising in Pakistan is due to “Refusal” by parents such as their Misconception, our child is sick, we don’t want to vaccine/direct refusal, demands, or religious matter.

A media release on 18th December 2019 by end-polio in Pakistan, donor partners of the Lives and Livelihoods Fund (LLF) and Islamic Development Bank (IsDB) re-affirmed their commitment to support the Government of Pakistan in their fight against polio. For the eradication of polio and contributed over US$ 100 million to the Pakistan Polio Eradication Programme.

The financial assistance provided the LLF and the IsDB has enabled the programme to strengthen various areas of work, including vaccine procurement, surveillance, communications and social mobilization. Children should receive four doses of inactivated polio-virus vaccine (IPV) - first dose at age 2 months, the second at 4 months, a third at 6 to 18 months and the last at 4 to 6 years. We need awareness campaigns for backward areas people with limited thinking. Most of the people have misconception for polio eradication their children might have paralysis and sometimes death.

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