THE KENYA 1999 POLIO ERADICATION CAMPAIGN The 1999 NIDs report is currently being prepared by a team of the Inter-Agencies Coordinating Committee under the leadership of KEPI. We will be able to share it with you in a couple of weeks. Below is a summary of findings from the 1999 NIDS campaign: 1. BACKGROUND: The Kenya NIDS has, over the past three years, been organized and supported by an active committee of donors and the Ministry of Health known as the Inter-Agencies Coordinating Committee (ICC). The ICC is composed of the Ministry of Health (Chair), WHO, UNICEF, DFID, USAID, DANIDA, JICA and the Rotary Club. Each of the organizations on the committee provides some financial, material or technical support for NIDS. All decisions regarding key NIDS activities are discussed and agreed to at meetings of this committee. In so doing there has developed a strong partnership among these organizations leading to effective support to the Kenya Expanded Program of Immunizations (KEPI). During 1998 and 1999, for example, a decision was made to have USAID funds for Kenya to WHO go to another African country. This was because DFID had provided adequate funding for operational costs through WHO. USAID remained an active member of the ICC and supported the surveillance component through UNICEF. 2. THE 1999 NIDS CAMPAIGN: The 1999 campaign was different from the 1998 campaign in that it included measles and Vitamin A supplementation. In order to have a successful campaign it was necessary to plan information campaigns well in advance and to reach as large a population as possible. Teams were organized at the district level, through the assistance of the district Health Management Teams and the District Administration officials. Churches and NGOs at the community level were asked to assist in the campaigns. The 1999 campaign continued to be adversely affected in the Central Province which also posted the lowest percentages. The reasons range from perceived low value of NIDs in an environment of high routine coverage of OPV that ranges from 95%- 100% to adverse rumors that the oral polio vaccine is laced with HIV or family planning chemicals. On this basis the 1998 NIDS had met with a strong anti- polio vaccination campaign by the Catholic and other opinion leaders in Central Province. In 1999, the Ministry of Health officials met with the Catholic Church officials and allowed the Church to take samples of the vaccines for testing by their own experts. Although the Church did concede that the polio vaccine was not harmful the statistics for Central Province were still low (55%) in 1999. How there is a better understanding amongst the opinion leaders on the need for NIDs.
Vitamin A was included during the second round of NIDS in 1999. Measles vaccination was also carried out in selected urban centers and low coverage districts. Of the 650,000 children aged between 9 months and 5 years that were targeted for measles, 80% were immunized. The campaign achieved 77 % coverage for the 6 months – 5-year age group for vitamin A compared to 83.5% for OPV. 3. ISSUES/PROBLEMS Most of the issues in the 1999 campaign were logistical and administrative. OPV donations were provided in a situation of global vaccine shortage, and were delivered at the last minute. An emergency distribution plan had been put in place where routine vaccines from regional stores were redistribution to distant rural areas. These were later replenished when the NIDS donations finally arrived. Although there is some improvement, stool specimens are still not being collected in good time. In 1999 only 38.8% of the children with AFP had their stool specimen collected within two weeks. In addition, the Ministry of Health did not effectively follow up cases of AFP to confirm whether the paralysis has persisted beyond 60 days. Only 30% of the AFP cases were followed up in 1999. A key constraint was said to be inadequate transport for surveillance officers. 4. PRELIMINARY RESULTS An overall coverage of about 85% in 1999 shows a slight improvement from the 1998 NIDS that averaged 80%. This is partly attributable to better social mobilization and the inclusion of measles and vitamin A in 1999. The table below shows the results of the 1999 NIDS and the non-polio AFP rate by province.
Population (0-59 months)
No. Ist Round
% Ist Round
No. 2nd Round
% 2nd Round
Nov, 99 detection rate. Non polio AFP/100,000 children less than 15 years.
Western Nairobi Nyanza Rift Valley Coast North Eastern Eastern Central Kenya overall
672,902 227,000 920,888 1,343,723 418,830 75,717 893,976 557,852 5,110,888
668,851 243,697 867,624 1,238,492 347,238 49,949 644,139 318.094 4,378,084
99.4 107.4 94.2 92.2 82.9 66.0 72.1 57.0 85.7
697,505 228,932 831,977 1,190,202 350,289 55,705 651,410 292,202 4,298,222
103.7 100.9 90.3 88.6 83.6 73.6 72.9 52.4 84.1
3.2 0.6 1.7 1.7 1.8 3.4
5. SURVEILLANCE: As already mentioned above, there were some missed opportunities to improve surveillance indicators due to failure to follow up cases of AFP. UNICEF, through USAID support has compiled the following data on AFP surveillance
**Number of cases where no follow up done in 60 days 166 234 1.67 185 (79.1%) 74(31.6%) 67(28.6%) * Target: to reach a Non –polio AFP rate of more than 1.0 per 100,000 children aged under 15 years of age. * * To find that an AFP case has no residual paralysis at the 60 Day follow-up examination is the only way to discard that case in the absence of two stool samples having been taken before 14 days. The Non-Polio AFP rate can therefore be improved upon by ensuring that all cases where the correct stool samples were not taken are followed up at 60 days, and - if no residual paralysis is present - discarded. AFP cases expected Overall AFP cases found *Annualized detection rate No. and % of any stool specimens Two stool specimens in <14days
The CDC STOP (Stop Transmission of Polio) teams greatly contributed to improvement in the surveillance system. A team of 4 officers from CDC Atlanta worked in four of the eight provinces for three months. The teams recommended the provision of transport to surveillance officers at the district level. UNICEF will be working on this during FY2000. The team also recommended that health workers be provided more intense information on AFP to improve awareness. 6. OBSERVATIONS: Intense social mobilization and planning needs to be done to improve the coverage rate. Districts with special problems such as Central province and North Eastern need revamped social mobilization strategies for FY 2000. There is a need to strengthen transport and communication capability among surveillance officers to improve the surveillance system. The Interagency Coordinating Committee (ICC) has approved a comprehensive external EPI review to commence in February 2000. Opportunity should be taken to include quantitative and qualitative aspects of NIDS, its impact on routine immunization and the quality of surveillance.