The role of nurses and midwives in polio eradication and measles control activities: a survey in Sudan and Zambia

Background  

Nurses and midwives are the key providers of nursing and midwifery services; in many countries, they form the major category of frontline workers who provide both preventive and curative services in the community. When the skills and experience of nursing and midwifery personnel are maximized, they can contribute significantly to positive health outcomes. We conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes.     

Use of m-Health in polio eradication and other immunization activities in developing countries

IntroductionReaching the children that are chronically missed by routine immunization services has been a key pillar of success in achieving progress toward polio eradication. The rapid advancement and accessibility of mobile technology (“mHealth”) in low and lower middle income countries provides an important opportunity to apply novel, innovative approaches to provide vaccine services. We sought to document the use and effectiveness of mHealth in immunization programs in low and lower middle income countries. We particularly focused on mHealth approaches used in polio eradication efforts by the Global Polio Eradication Initiative (GPEI) to leverage the knowledge and lessons learned that may be relevant for enhancing ongoing immunization services.MethodsIn June 2016, the electronic database PubMed was searched for peer reviewed studies that focused on efforts to improve immunization programs (both ongoing immunization services and supplemental immunization activities or campaigns) through mobile technology in low and lower middle income countries.ResultsThe search yielded 317 papers of which 25 met the inclusion criteria. One additional article was included from the hand searching process. mHealth was used for reminder and recall, monitoring and surveillance, vaccine acceptance, and campaign strategic planning. Mobile phones were the most common mobile device used. Of the 26 studies, 21 of 26 studies (80.8%) reported that mHealth improved immunization efforts.ConclusionmHealth interventions can effectively enhance immunization services in low and lower middle income countries. With the growing capacity and access to mobile technology, mHealth can be a powerful and sustainable tool for enhancing the reach and impact of vaccine programs.     

Costs and benefits of polio eradication: a long-run global perspective

Pre-vaccination polio incidence rates in USA and Italy were used to predict the cases that would have occurred in the world for the years 1970-2050 in the absence of immunization. Globally, polio program will cost about US dollars 67 billion if vaccination is discontinued after 2010. The medical care cost savings achieved will be more than US dollars 128 billions, implying that polio eradication activities actually pay for itself in the longer run. In addition to the cost savings, the program will prevent 855000 deaths, 4 million paralysis cases and 40 million disability adjusted life years (DALYs) over the years 1970-2050.     

Certification of polio eradication: process and lessons learned

Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, considerable progress has been made towards interrupting the transmission of wild poliovirus globally. A formal process for the certification of polio eradication was established on the basis of experience gained during smallpox eradication. Independent groups of experts were designated at the global, regional, and country levels to conduct the process. The main requirements for the global certification of the eradication of wild poliovirus are the absence of wild poliovirus, isolated from suspect polio cases, healthy individuals, or environmental samples, in all WHO regions for a period of at least three years in the presence of high-quality, certification-standard surveillance and the containment of all wild poliovirus stocks in laboratories. Three WHO regions--the Region of the Americas (1994), Western Pacific Region (2000), and European Region (2002)--have already been certified free of indigenous wild poliovirus. Eradication and certification activities are progressing well in the three endemic regions (African, Eastern Mediterranean, and South-East Asia). Several challenges remain for the certification of polio eradication: the need for even closer coordination of certification activities between WHO regions, the verification of laboratory containment, the development of an appropriate mechanism to verify the absence of circulating vaccine-derived polioviruses in the future, and the maintenance of polio-free status in certified regions until global certification.     

The global polio eradication initiative: lessons learned and prospects for success

Following the rapid progress towards interrupting indigenous wild poliovirus transmission in the Americas in the early 1980s, the Global Polio Eradication Initiative (GPEI) was launched with a resolution of the World Health Assembly (WHA) in 1988. The GPEI built on many lessons learned from smallpox eradication, including the large-scale deployment of technical assistance, implementing agendas of innovation and research and the use of professionally planned and guided advocacy. By the year 2000, the incidence of polio globally had decreased by 99% compared with the estimated >350,000 cases reported from 125 endemic countries in 1988. By 2002, three WHO Regions (the Americas, Western Pacific and European Regions) had been certified polio-free. By 2005, transmission of indigenous wild poliovirus (WPV) had been interrupted in all but 4 'endemic' countries: India, Nigeria, Pakistan and Afghanistan, where eradication efforts effectively stalled. WPV exported from northern Nigeria and northern India subsequently caused >50 outbreaks and paralysed >1500 children in previously polio-free countries across Asia and Africa. In each of the four remaining polio-endemic countries different challenges, or a combination of factors, prevented to build up sufficient levels of population immunity to stop transmission. Consequently, specific strategies were increasingly tailored to each setting. A new 2010-2012 GPEI Strategic Plan was developed which brought together several approaches to overcome the remaining hurdles to eradication, including the large-scale use of bivalent oral poliovaccine (bOPV) in supplementary immunization activities (SIAs). By the end of 2010, the impact of the new GPEI Strategic Plan 2010-2012 was apparent. Compared to 2009, the number of new polio cases in 2010 fell by 95% in both northern Nigeria and northern India, the world's largest remaining reservoirs of indigenous WPVs. By mid-2011, India had not reported a polio case for more than 5 months, and in Nigeria, endemic transmission appeared to be restricted to the north-east and north-west corners of the country. While polio cases due to WPV type 3 were still being detected in west and central Africa, the overall level of WPV3 transmission globally was at an all-time low. Uncontrolled WPV transmission appeared to be restricted to Chad and Pakistan, which increasingly represented the greatest risks to the GPEI. Although insufficient financing continued to be a major concern, political support for completing polio eradication in polio-infected countries was stronger than ever by mid-2011. While continued transmission in some areas, particularly in Pakistan and Chad, still had to be controlled as a matter of urgency, there were real opportunities to achieve new landmarks in polio eradication, especially in the key WPV reservoirs of India and Nigeria, setting the stage for polio to soon follow smallpox into the history books.     

Predictors of perceiving smoking cessation counselling as a midwife's role: a survey of Dutch midwives

BACKGROUND: Smoking during pregnancy can have many serious consequences. As the usual providers of pregnancy care in the Netherlands, midwives could serve as effective counsellors to pregnant women about cigarette smoking. The aim of the present study was to identify relevant factors that hamper or promote the provision of effective smoking cessation advice and counselling. METHODS: Questionnaires were mailed to midwives; 237 (64.4%) were returned. Questions were asked about advantages and disadvantages of giving smoking cessation advice, perceived health benefits for mother and child, smoking behaviour and normative beliefs of colleagues, self-efficacy and role definition of midwives with regard to giving smoking cessation advice. RESULTS: Midwives who have a more positive role definition regarding giving smoking cessation advice are more convinced of the advantages of giving advice, the advantages of quitting for their clients and perceive more support from their colleagues with regard to giving advice. CONCLUSION: In general, midwives were motivated to provide their clients with smoking cessation advice. They were less comfortable with guiding women through the cessation process. Therefore, effective materials and training should be developed to facilitate and stimulate midwives in their role as effective counsellors.     

A new paradigm for international disease control: lessons learned from polio eradication in Southeast Asia

OBJECTIVES: This study evaluated the impact of international coordination on polio eradication in Southeast Asia. METHODS: Active surveillance systems for acute flaccid paralysis were assessed. Analyses focused on surveillance proficiency and polio incidence. RESULTS: Ten countries coordinated activities. Importations occurred and were rapidly contained in China and Myanmar. Countries that have been free of indigenous polio transmission for at least 3 years include Sri Lanka, Indonesia, Myanmar, and Thailand. In the remaining endemic countries--India, Nepal, and Bangladesh--poliovirus transmission has been substantially reduced; however, these countries still harbor the world's largest polio reservoir. CONCLUSIONS: Unprecedented international coordination in Southeast Asia resulted in dramatic progress in polio eradication and serves as a paradigm for control of other infectious diseases such as malaria and tuberculosis.     

The relationships between coping styles and food intake in shiftworking nurses and midwives: a pilot study

Shiftworkers are more likely to suffer from gastrointestinal disease and Type 2 Diabetes than the general population, likely due to their altered dietary intakes. Previous research has suggested that coping strategies and health behaviours may be linked, however, questions remain regarding these relationships in shiftworking populations. The Standard Shiftwork Index and Food Frequency Questionnaire were completed by nurses/midwives working forward rotating shifts (N=27, female=24, age=38.4 ± 13.1 y). Greater engaged coping strategy usage was associated with lower total energy, fat, carbohydrate and sugar intake (ρs>−0.1). Greater disengaged coping strategy usage was associated with greater intake of these nutrients (ρs>0.1). Results suggest that engaged coping strategies may contribute to healthier dietary choices. A greater focus on coping styles, particularly during nursing education, may improve shiftworkers’ health.     

Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan

Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations.This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies – such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined – have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions.     

Role of environmental poliovirus surveillance in global polio eradication and beyond

Environmental poliovirus surveillance (ENV) means monitoring of poliovirus (PV) transmission in human populations by examining environmental specimens supposedly contaminated by human faeces. The rationale is based on the fact that PV-infected individuals, whether presenting with disease symptoms or not, shed large amounts of PV in the faeces for several weeks. As the morbidity:infection ratio of PV infection is very low, this fact contributes to the sensitivity of ENV which under optimal conditions can be better than that of the standard acute flaccid paralysis (AFP) surveillance. The World Health Organization has included ENV in the new Strategic Plan of the Global Polio Eradication Initiative for years 2010-2012 to be increasingly used in PV surveillance, supplementing AFP surveillance. In this paper we review the feasibility of using ENV to monitor wild PV and vaccine-derived PV circulation in human populations, based on global experiences in defined epidemiological situations.     

Prevention of measles in Sudan: a prospective study on vaccination, diagnosis and epidemiology

Despite the availability of safe and effective live attenuated vaccines, measles continues to be endemic in many developing countries. Control and elimination of measles will be especially difficult in East Africa, because of its limited infrastructure and political instability. We have studied diagnostic and epidemiological aspects of measles in suburban Khartoum, Sudan. Prospective studies were carried out in a cohort of clinically diagnosed measles cases and in a cohort of newborns, which were both followed up for 2 years. The studies intended to provide a rational basis for improvement of measles vaccination strategies, and strengthen measles research infrastructure in Khartoum.     

Smallpox and polio eradication in India: comparative histories and lessons for contemporary policy

This article argues that a detailed examination of factors contributing to the development of complex structures and strategies for smallpox eradication in South Asia in the 1970s can provide fruitful indications for the reformulation of the national chapters of the global polio eradication programme in this region. There is a magnificent archive in the WHO's Geneva offices, which details how smallpox eradication outbreaks were located and then contained in cities, small towns and remote rural areas in this region, by teams of international workers working closely with local officials. A systematic assessment of the global smallpox eradication efforts indicates parallels between the early stages of the global smallpox eradication programme and the present situation of the polio campaign; as we will see here, it can also provide useful indicators for future action in South Asia and beyond.     

Role of genetic factors in polio eradication: new challenge for policy makers

In 1988 the World Health Assembly passed resolution WHA 41.28, for global eradication of poliomyelitis by the year 2000 by providing immunization exclusively with oral polio vaccine (OPV). India happens to be the largest country in the world, where polio cases are occurring in large numbers. Despite increase in number of pulse polio immunization (PPI) rounds and introduction of monovalent oral polio vaccines mOPV1 and mOPV3, polio has not been eradicated from India. Global polio eradication cannot be achieved unless polio is eradicated from India because of the risk of exportation of wild poliovirus to other countries. India cannot become polio free unless Uttar Pradesh and Bihar become polio free. Because of genetic and some other factors, OPV cannot eradicate polio from Bihar and Uttar Pradesh. The present scenario strongly suggests that due to some host factors in recipients OPV cannot eradicate polio. Rather than extending the deadline for polio eradication again and again, it is time to prepare strategy for final push to polio.     

Working ‘off the record’: polio eradication and state immunity in Chad

The reappearance of polio in Chad generates anxieties about governance as well as public health. Since Chad was declared polio-free in 2003, at least 180 cases of paralytic polio have been linked to importations of wild poliovirus from Nigeria. In efforts to eradicate polio through house-to-house vaccination campaigns, international agencies have aggressively implicated political leaders, placing those authorities in a bind. On the one hand, governments are required to demonstrate compliance in the form of universal vaccination. On the other hand, the legitimacy of political leaders and of local authorities in particular depends upon their ability to show compassion for their populations and to be responsive to individual circumstances and concerns about the drops. This article looks at how the obligation of the African state to adopt global public health policy as its own becomes problematic when the goals and protocols of international agencies rely on the assumption that the state controls its population. Under pressure to render account to international agencies, state officials deploy high-level politicians to enforce vaccination mandates at critical moments, create administrative forms to record campaign progress that conceal difficulties in vaccinating children, and use statistics to portray the campaigns as success stories. Local authorities, who feel the bind most acutely, grant exceptions to the mandate of universal vaccination to certain subjects and work with local vaccinators and supervisors to keep cases of unvaccinated children ‘off the record’. These efforts allow the vaccination campaigns to be carried out without incident even as they work against the goal of polio eradication.