January 02, 2008	Wednesday	Zilhaj 22, 1428

KARACHI, Jan 1: In terms of the eradication of polio, for Sindh it is a matter of so near and yet so far. The province was close to controlling the virus in 2005 when there were only five cases.

In 2007, however, 11 confirmed polio cases were reported from five different districts, including Karachi. Although the provincial government and the international health organisations working in Pakistan for the eradication of polio have been claiming since 2005 that “the coming year will be a polio free year,” this hope has not so far materialised.

In the last week of October 2007, there were eight confirmed polio cases in Sindh. The number increased to 11 in a mere month or so, said Dr Farhat Jafri, the focal person for polio eradication at the Expanded Programme on Immunisation (EPI), Sindh. Explaining the situation, the doctor told Dawn that cases had been detected at the Kambar district, which experienced an influx of people from across the provincial border in the wake of the flood.

On Feb 17 last year, the project director of the EPI Sindh, Dr Salma Kauser Ali, said that only two confirmed and one contact polio cases had been detected in the province during the first two months of 2007. Keeping this number and the overall performance and targets achieved in Sindh, she had said, polio appeared to be on the verge of eradication.

Compared to 40 polio cases in 2006, Pakistan recorded a total of 24 cases in 2007. The percentage of the cases in Sindh in terms of the total number reported in the country increased from 30 per cent recorded in 2006 (when Sindh reported 12 cases), to 46 per cent in 2007.

Interestingly enough, relatively low numbers of cases were reported from the provinces that are considered the sources of the transmission of the virus to Sindh. During 2007, four cases were recorded in the NWFP, two in FATA and seven in Balochistan.

Asked about this, Dr Jafri said that the higher number of polio cases recorded in Sindh could be because the provincial surveillance system had improved and because it was possible to verify cases in comparison to Balochistan and the NWFP.

Challenges mounting up

Experts believe that the challenges in Sindh are mounting up. To ensure the interruption of the transmission of the virus, the province will have to carry out targeted vaccination campaigns and possible outbreak response campaigns in addition to national immunisation and special immunisation days, they told Dawn.

The chairman of the Expert Review Committee on Polio in Sindh, Prof Iqbal Memon, said that the province had come a long way in controlling polio since 1994 and should not be discouraged. “Our progress may be slow but we should not give up and we must continue to pursue our goals,” he said. “Sindh is now nearer to achieving a polio-free status than ever before.”

According to Dr Memon, who is a specialist in paediatrics, steps needs to be taken to increase the rate of routine vaccination, as, according to him, the overall 40 to 50 per cent coverage of the children less than one year was not satisfactory.

Furthermore, he suggested, in order to ensure an increase in routine immunisation, it should be made compulsory for parents to produce vaccination cards while enrolling their children in primary schools.

“In certain inaccessible areas such as parts of Jacobabad, Dadu, Larkana, Ghotki, Shikarpur and even Karachi, polio teams are hindered in their operation by physical constraints or social taboos,” he pointed out. “Media, political and social figures can play an important role in raising awareness amongst communities and countering misconceptions about the quality and side-effects of polio vaccines administered to children under five years of age during various national and special immunisation campaigns.”

Dr Memon told Dawn that amongst the misconceptions was that the vaccine affected human fertility and said that irrespective of their financial status, parents ought to wholeheartedly accept the vaccinators who came to their very doors.

According to another EPI Sindh official, Pakistan was one of four countries — the others being India, Afghanistan and Nigeria — which were close to eradicating polio. He told Dawn that in many cases, polio is reported to have originated in other countries such as Afghanistan, and then have been transmitted to Pakistan. He added that EPI workers were finding it difficult to reach remote areas of the province bordering Balochistan.

The EPI official suggested a review of the current communication strategy and the development of province/district specific plans with the involvement of local partners to check the spread of the virus.

During 2007, five polio cases were reported in Kambar, two in Karachi and Jacobabad each, and one case each in Khairpur and Thatta.