Write an essay on Poliomyelitis in Pakistan?
The current assignment deals with the serious issue of poliomyelitis in context of Pakistan. Although Polio is eradicated from most of the countries across world, Pakistan still faces the risk of Polio infection. The study highlights the major reasons for this and points out the factors contributing to the barriers to eradicate the disease. These include religious beliefs, illiteracy, economical constraints, etc. This research presents a deep insight into the prospective symptoms, treatments and prevailing programs in Pakistan for eradicating Polio from the country. The study concludes with the note that the country of Pakistan need to focus highly on the incorporation of educative sessions in the polio eradicating programs. This assignment also presents an intervention program based on the NPSP program through analysis of the social, behavioral and cultural aspect of the country.
This research paper will spread light on the poliomyelitis infection that spread over in Pakistan and also the statistical data of the polio cases in Pakistan. It also gives a detail description about the polio virus and the vaccines that can prevent the poliomyelitis disease. It will also highlight the conflicts that occur during administration of a vaccine. In the last section, I have proposed an intervention programme for eradication polio, which when implemented on other countries have proved very successful. Lastly, I will also highlight some of the limitation of the proposed intervention
Today Polio has almost been eradicated from worldwide, but few countries remain endemic like Afghanistan, Pakistan, and Nigeria. Pakistan has the highest percentage of cases of poliomyelitis in the world, 23%. Though Immunization of polio campaign has started in a country since 1974, but the efforts of eradication has been started from 1993. Around 60 rounds of vaccination have been carried out till 2007 in the country but still it remains endemic. Cases of polio in Pakistan were 37% in 2011 though only 7cases of polio has been reported in 2015. The number of new cases though has been lesser down but still poliomyelitis has still not got completely eradicated from Pakistan. The reason may be the challenges that remain in Pakistan. The constant conflict in polio sanctuaries restrict the coverage of territories by the vaccination team and generate displacement of the population which contributes to spreading of polio virus and bring about a condition of poverty.
According to nation surveillance reports since 1999, the rate of non-polio below the age of 15years has exceeded to 2% per 100000. Polio eradication has become a priority program for Pakistan. The program started with a hope of eradication but faced a lot of limitation due to violence and protest against the workers of polio. From 58 cases of polio in 2012, it increased to 91 in 2013. Government of Pakistan has declared a national emergency to interrupt transmission of polio and to achieve the goal of eradication.
NEAP programme was established in Pakistan to eradicate polio in Pakistan. This programme relied on the strong political leadership and provincial administration also the agency and district administrator. The main goal of this programme was to stop the transmission of polio virus. A total 58 Wild polio virus cases were reported in 2012 which increased by 58 wild polio virus in 2013 that is more than 68% of the complete cases of polio in Pakistan. The reason of the increasing number of cases was because of the vaccination ban that occurred in the south and North Waziristan and also due to the aloofness from conflict in Khyber agency. On the basis of religious ground, the parents refused to participate in the programme and get their children vaccinated
Recently government in 2015 issued arrest warrants for 1,200 guardians and parent who refused administration of vaccination for their children. Reports state that 512 people who were arrested were freed as they agreed for not opposing vaccination. New cases were of poliomyelitis has dropped by70% because of the increasing vaccination as previously northwest Pakistan was under the militants who were opposing for vaccination administration but Zarb-e-Ab which by Pakistani forces secured these areas and theses campaign were against Taliban militants. So they could administer the vaccine to the children in those areas. Though the issue of polio has recently been dropped because of continuous support of eradication programme by the government but still it is not completely eradication in this paper I would like to discuss an intervention for poliomyelitis.
Despite the progress of the polio sanctuaries situation remain fragile because of some reason like the outbreak at Khyber Pakhtunkhwa, continuous poliovirus transmission in FATA block, isolation of cVDPD-2 in Quetta block etc.
The limitation of this programme was that it did not spread education programme. Educating programme is important because many people are unaware of the details of polio they should be made aware of all the pros and cons about the vaccination, religious myths that were present among the people were not resolved. And lastly it will require more support from the government as the financial limitation becomes a barrier in an implementation of new techniques.
Poliomyelitis is an infectious disease caused by polio virus. It affects the central nervous system that sometimes results in paralysis. Infantile paralysis is the greatest incidence of polio disease that occurs in children between the ages of 10. In 1840, an orthopedist Jacob von Hein from Germany has first descried this disease. Poliovirus is enteroviruses that are spread from one individual to another following pharyngeal secretions and excretion in feces, chiefly via mouth route or via hand to hand. Poliovirus receptor is expressed only on the cells of humans being and a few subhuman primate species there are no known extra human reservoirs. This virus replicates in the gastrointestinal tract and can cause viremia. It then invades the CNS and also destroys the motor neurons that cause flaccid paralysis and sometimes sensory loss permanently. It is a preventable disease it can be prevented by vaccination of live attenuated oral polio virus.
The virus usually enters the body through the alimentary tract and spreads long nerve cells to affect various parts of central nervous system. The period of incubation is 4-35days. Fatigue, nausea, fever, vomiting, pain diarrhea, spasm of the neck are the common symptoms. As nerve cell once destroyed do not regenerate, and it plays a crucial role in control movement of muscle and this cause paralysis permanent. The nerve cell that controls the respiration if once destroyed then the patient is kept alive with the help of iron lung.
Immunizations can prevent polio, polio vaccines are given for a number of times and almost it protects child life always. Five different polio vaccines have been armored by the Global Polio eradication initiation to stop polio transmission. The vaccines are as follows oral polio vaccine (OVP), Inactive polio vaccine (IPV), monovalent polio oral vaccine (mOPV3 and mOVP1), and bivalent polio oral vaccine.
On the basis of the religious ground many conflicts arises, many people restrict the administration of the polio virus the greatest obstacle, even lack of health infrastructure limits the distribution of the vaccine. Another big challenge that arises is maintaining the potency of the live attenuated vaccine due to hot temperature. The oral polio vaccine is to be maintained at 2 to 8 degree Celsius for successful vaccination. The crucial problem in Pakistan is the barrier of insecurity among people, inadequate resource for health facilities, managing resources of human, political pressure, conflicts among the people living in Pakistan as well as influenced from other countries, other than this the major problem lies in the technical issues. These all create barriers for safe polio vaccine administration by the programme that are held to eradicate poliomyelitis
As there are so many social, environmental issues which restrict the eradication of polio from Pakistan. I would like to implement a programme NPSP i.e. National polio surveillance project will help in controlling and eradicating the problem of polio in Pakistan. This programme is funded and established by the Government of India and WHO. As India is a neighboring country of Pakistan and has a similar environment, and atmospheric condition implementation of this programme in India has resulted in complete eradication of the infectious disease poliomyelitis. The basic problem that occurs in Pakistan is restricting the team of vaccination to administer the vaccine to the children.
Educating programme if implemented then it may resolve the matter of this concern as, less knowledge creates difficulties. Education programme must give a detailed information about the consequences of polio vaccine if not given to the children, it may lead to flaccid paralysis, stiffness etc. the common difficulty that creates a barrier is the knowledge of total doses. The people are sometimes unaware of the multiple doses that are required for appropriate vaccination, due to lack of knowledge as well as the poor immunity of the children leads to polio even after receiving doses of polio vaccine. As building the immunity of the body is important to fight against the polio virus thus proper nutrition chart must be implemented for the children as well as their family member to guide them through diet. Some cookery classes service are to be given so that the people could participate and get detail information on healthy diet chart as dietary health habit will increase the immunity of the children to fight against the polio disease. As malnutrition, underweight are the two factors which decrease the immune system of the body so it is important to focus on this problem and give them appropriate support so that multiple doses of polio vaccine can eradicate the virus from the body.
The people must know that OPV is a safe vaccine. It can be also given to newborns and sick children. Some people also have misconception like OPV causes infertility so doctors are to be appointed so that they could resolve this myth as from a long time scientist are testing this polio vaccine but cannot get any link between these two issues.
Religious conflicts are the major problem among people, so if religious people from various Islamic institution and muftis can support vaccination and OPV this practice may influence people and the religious barrier can be removed. So it is important that campaigns in which religious people participate and educate the population this will help in controlling the barrier of religion. Even all the hajjis are required to be vaccinated against the polio virus. People like Imams, cleric’s madrasa teachers, physicians, etc will work together in this project to urge the parent for immunizing their children, and will also reduce the person who refuses to get their children vaccinated
Another major problem is an economy. So a team of people is to be appointed who will monitor accurately and analyze the requirement of capital resources required for the programme so that they can give the complete budget to the government and convince the government to spend an amount to eradicate this process. And this team will maintain a proper documentation of the amount of money invested and also about the amount required for maintaining the laboratories that prepare the vaccine. This team will also handle convincing other countries and arranging meeting so that the government could collaborate with the other country, and joint ventures are formed which will increase the resource as well as capital. So national as well as international collaboration is very important in increasing the capital.
Government’s support plays the most crucial role in eradicating the polio disease from Pakistan. As investing, more capital will not create a crisis and all the people can get the multiple vaccine free as people due to financial crisis sometimes become a barrier. So it is important that this polio doses must be made free. And even two days in a month should be allocated for polio vaccination delivery.
People will be appointed who will cover all the areas of Pakistan and place campaign in which free vaccination against polio virus is to be given. Attendance barrier problem will also be resolved as some people have issues regarding transportation. So this small campaign that will cover almost all the areas will enable the people to access this camp and get their children vaccinated.
Health workers are appointed for sampling from environment sewage in areas which are remote, or are unhygienic will help the government in tracking out the complete spread area of the virus. Areas with increasing risk will then be targeted, and more support could be given to eradicate poliomyelitis. Health workers will target the mobile families that are the people who are travelling by bus or motorbikes train etc. This will help them to immunize children who stay in remote areas. As well it will interrupt transmission of the disease from one country or place to another.
An approach to ensure the good quality of polio is the main goal of this program. The people must get high quality of vaccine which will increase the efficacy of the eradication process. The vaccines are to be created in such a way so that it can also immunize children from other diseases like diarrhea; chicken pox etc. and this will also built capacity to eradicate vital disease like measles, etc. This will ensure that the children are immunized from other preventable diseases also.
Lastly, this programme will require a team of people that will monitor the whole process as monitoring the whole process is very beneficial as the lagging problem will get resolved. Teams will note all the issues from each and every individual and get detail information that will help them to check their mistakes if any. So monitoring the whole process throughout the process is very crucial. Post-polio vaccination programme are implemented, as it will help in maintaining the polio vaccine multiple dose records. So continuously health works keep a track is all doses of polio been given to the children or not.
NPSP has been implemented in India, and it has proved a very effective as well as the successful programme. Along with polio, it has also been effective in eradicating other preventable diseases that include Japanese encephalitis; measles, etc. 100% eradication has been achieved by India for eradicating this disease.
The main challenges that will be faced in the implementation of this programme are of the documentation. If documentation is not done correctly it creates the huge problem it may misguide and mislead of proper delivering of a vaccine may occur.
Another challenge is it needs a good amount of investment and thus need foreign collaboration as alone the government of Pakistan cannot meet the target amount. If these two challenges are overcome, then this project may bring huge success.
This research paper addresses the major health problem that is poliomyelitis in Pakistan. It is a preventable disease. Most of the countries are successful in eradicating this disease but Pakistan still is not completely successful in eradicating this disease. It is important that people should not oppose in administrating polio vaccine as it is a preventable disease and people could be immunized with the help of vaccine. And this issue of eradication of poliovirus can be 100% successful. This paper highlighted the importance of eradication of polio. I have proposed an intervention programme that includes an analysis on the basis of social, culture, behavior. This proposal was based on NPSP programme guidelines. This programme was implemented in India and eradicated polio 100% so this guideline, if implemented to Pakistan, may also result in the successful eradication of polio. This programme was based on the analysis of social, behavioral, cultural, environmental factors contribute. And also it gives importance to the role of international and national collaboration and also the funders.
Reference
Abimbola, S., Malik, A. U., and Mansoor, G. F. (2013). The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria. PLoS Med, 10(10), e1001529.
Addy D. Poliomyelitis in Pakistan and Afghanistan. Archives of Disease in Childhood. 2012; 97(12):1096-1096.doi:10.1136/archdischild-2012-303240.
Alexander J, Zubair M, Khan M, Abid N, Durry E. Progress and Peril: Poliomyelitis Eradication Efforts in Pakistan, 1994-2013. Journal of Infectious Diseases. 2014; 210(suppl 1):S152-S161. doi:10.1093/infdis/jiu450.
Bass, S., and Dalal-Clayton, B. (2012). Sustainable development strategies: a resource book. Routledge.
CDC. Progress toward poliomyelitis eradication — People’s Republic of China, 1990-1996. MMWR 1996; 45:1076-9.
Estívariz, C. F., Pallansch, M. A., Anand, A., Wassilak, S. G., Sutter, R. W., Wenger, J. D., and Orenstein, W. A. (2013). Poliovirus vaccination options for achieving eradication and securing the endgame. Current opinion in virology,3(3), 309-315.
Fetene, N. W., and Sherani, A. (2013). Determinant Factors for Implementing Polio Eradication Activities under Security Compromised Settings of Pakistan.J Trop Dis, 2(127), 2.
Grassly, N. C. (2013). The final stages of the global eradication of poliomyelitis.Philosophical Transactions of the Royal Society of London B: Biological Sciences, 368(1623), 20120140.
Hussain, S. S., and Sabri, P. S. U. (2014). National Environmental Policy Development for Sustainable Economic Growth in Developing Countries: A Case Study of Pakistan. International Journal of Social Quality, 4(1), 78-94.
Impfgegner vs. Regierung Poliomyelitis in Pakistan. Flug u Reisemed. 2015; 22(02):58-58.doi:10.1055/s-0035-1550293.
Khan A, Gebreselassie H, Asturias E et al. Corrigendum to “No evidence for prolonged excretion of polioviruses in persons with residual paralytic poliomyelitis in Ethiopia, Pakistan and Guatemala” [Biologicals 34 (2006) 113-116]. Biologicals. 2007; 35(1):73. doi:10.1016/j.biologicals.2007.01.001.
Khan A, Gebreselassie H, Asturias E et al. No evidence for prolonged excretion of polioviruses in persons with residual paralytic poliomyelitis in Ethiopia, Pakistan and Guatemala. Biologicals. 2006; 34(2):113-116. doi:10.1016/j.biologicals.2006.03.004.
Lowther, S. A., Roesel, S., O’Connor, P., Landaverde, M., Oblapenko, G., Deshevoi, S., and Wassilak, S. (2013). World Health Organization regional assessments of the risks of poliovirus outbreaks. Risk Analysis, 33(4), 664-679.
Moturi, E. K., Porter, K. A., Wassilak, S. G., Tangermann, R. H., Diop, O. M., Burns, C. C., and Jafari, H. (2014). Progress toward polio eradication—worldwide, 2013–2014. MMWR, 63(21), 468-472.
O’Reilly K, Durry E, ul Islam O et al. The effect of mass immunisation campaigns and new oral poliovirus vaccines on the incidence of poliomyelitis in Pakistan and Afghanistan, 2001-“11: a retrospective analysis. The Lancet. 2012; 380(9840):491-498.doi: 10.1016/s0140-6736(12)60648-5.
Polio Eradication.Org. Polio Global Eradication Initiative: Pakistan. Polio Eradication.Org. https://www.polioeradication.org/infectedcountries/pakistan.aspx.Accessed August 2, 2015.
Poliomyelitis vaccine inactivated. Reactions Weekly. 2004; &NA ;( 1017):13.doi: 10.2165/00128415-200410170-00044.
Russell W. Poliomyelitis. London: E. Arnold; 1956.
Thibaut, H. J., De Palma, A. M., and Neyts, J. (2012). Combating enterovirus replication: state-of-the-art on antiviral research. Biochemical pharmacology,83(2), 185-192.
World Health Organization. (2013). Poliomyelitis, Fact sheet no. 114. World Health Organization, Geneva.
World Health Organization. (2014). Poliomyelitis; 2014.
Lowther, S. A., Roesel, S., O’Connor, P., Landaverde, M., Oblapenko, G., Deshevoi, S., and Wassilak, S. (2013). World Health Organization regional assessments of the risks of poliovirus outbreaks. Risk Analysis, 33(4), 664-679
Poliomyelitis vaccine inactivated. Reactions Weekly. 2004; &NA ;( 1017):13.doi: 10.2165/00128415-200410170-00044.
Moturi, E. K., Porter, K. A., Wassilak, S. G., Tangermann, R. H., Diop, O. M., Burns, C. C., and Jafari, H. (2014). Progress toward polio eradication—worldwide, 2013–2014. MMWR, 63(21), 468-472.
Addy D. Poliomyelitis in Pakistan and Afghanistan. Archives of Disease in Childhood. 2012; 97(12):1096-1096.doi:10.1136/archdischild-2012-303240.
Fetene, N. W., and Sherani, A. (2013). Determinant Factors for Implementing Polio Eradication Activities under Security Compromised Settings of Pakistan.J Trop Dis, 2(127), 2.
Impfgegner vs. Regierung Poliomyelitis in Pakistan. Flug u Reisemed. 2015; 22(02):58-58.doi:10.1055/s-0035-1550293.
Alexander J, Zubair M, Khan M, Abid N, Durry E. Progress and Peril: Poliomyelitis Eradication Efforts in Pakistan, 1994-2013. Journal of Infectious Diseases. 2014; 210(suppl 1):S152-S161. doi:10.1093/infdis/jiu450.
Hussain, S. S., and Sabri, P. S. U. (2014). National Environmental Policy Development for Sustainable Economic Growth in Developing Countries: A Case Study of Pakistan. International Journal of Social Quality, 4(1), 78-94.
Bass, S., and Dalal-Clayton, B. (2012). Sustainable development strategies: a resource book. Routledge.
World Health Organization. (2014). Poliomyelitis; 2014
Khan A, Gebreselassie H, Asturias E et al. No evidence for prolonged excretion of polioviruses in persons with residual paralytic poliomyelitis in Ethiopia, Pakistan and Guatemala. Biologicals. 2006; 34(2):113-116. doi:10.1016/j.biologicals.2006.03.004.
World Health Organization. (2013). Poliomyelitis, Fact sheet no. 114. World Health Organization, Geneva.
Thibaut, H. J., De Palma, A. M., and Neyts, J. (2012). Combating enterovirus replication: state-of-the-art on antiviral research. Biochemical pharmacology,83(2), 185-192.
Moturi, E. K., Porter, K. A., Wassilak, S. G., Tangermann, R. H., Diop, O. M., Burns, C. C., and Jafari, H. (2014). Progress toward polio eradication—worldwide, 2013–2014. MMWR, 63(21), 468-472.
Estívariz, C. F., Pallansch, M. A., Anand, A., Wassilak, S. G., Sutter, R. W., Wenger, J. D., and Orenstein, W. A. (2013). Poliovirus vaccination options for achieving eradication and securing the endgame. Current opinion in virology,3(3), 309-315.
Russell W. Poliomyelitis. London: E. Arnold; 1956.
Grassly, N. C. (2013). The final stages of the global eradication of poliomyelitis.Philosophical Transactions of the Royal Society of London B: Biological Sciences, 368(1623), 20120140.
Estívariz, C. F., Pallansch, M. A., Anand, A., Wassilak, S. G., Sutter, R. W., Wenger, J. D., and Orenstein, W. A. (2013). Poliovirus vaccination options for achieving eradication and securing the endgame. Current opinion in virology,3(3), 309-315.
Abimbola, S., Malik, A. U., and Mansoor, G. F. (2013). The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria. PLoS Med, 10(10), e1001529.
Moturi, E. K., Porter, K. A., Wassilak, S. G., Tangermann, R. H., Diop, O. M., Burns, C. C., and Jafari, H. (2014). Progress toward polio eradication—worldwide, 2013–2014. MMWR, 63(21), 468-472.
Estívariz, C. F., Pallansch, M. A., Anand, A., Wassilak, S. G., Sutter, R. W., Wenger, J. D., and Orenstein, W. A. (2013). Poliovirus vaccination options for achieving eradication and securing the endgame. Current opinion in virology,3(3), 309-315.
World Health Organization. (2013). Poliomyelitis, Fact sheet no. 114. World Health Organization, Geneva.
Fetene, N. W., and Sherani, A. (2013). Determinant Factors for Implementing Polio Eradication Activities under Security Compromised Settings of Pakistan.J Trop Dis, 2(127), 2.
World Health Organization. (2013). Poliomyelitis, Fact sheet no. 114. World Health Organization, Geneva.
Bass, S., and Dalal-Clayton, B. (2012). Sustainable development strategies: a resource book. Routledge
Estívariz, C. F., Pallansch, M. A., Anand, A., Wassilak, S. G., Sutter, R. W., Wenger, J. D., and Orenstein, W. A. (2013). Poliovirus vaccination options for achieving eradication and securing the endgame. Current opinion in virology,3(3), 309-315.
Polio Eradication.Org. Polio Global Eradication Initiative: Pakistan. Polio Eradication.Org. https://www.polioeradication.org/infectedcountries/pakistan.aspx.Accessed August 2, 2015.
Grassly, N. C. (2013). The final stages of the global eradication of poliomyelitis.Philosophical Transactions of the Royal Society of London B: Biological Sciences, 368(1623), 20120140.
CDC. Progress toward poliomyelitis eradication — People’s Republic of China, 1990-1996. MMWR 1996; 45:1076-9.
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