Gender Dimensions of Acute Flaccid Paralysis Surveillance in Nigeria

Abstract

Background: After nearly two years without reporting any case of Wild Poliovirus (WPV), Nigeria has of recent (2016) witnessed a setback in its struggle to eradicate polio. Four cases of Acute Flaccid Paralysis (AFP) from three Local Government Areas (LGAs) of the security challenged state of Borno were confirmed as WPV cases with the latest case having a date of onset of paralysis on 21 st August, 2016. A case of circulating Vaccine Derived Poliovirus type 2 (cVDPV2) from a healthy contact of one of the WPV cases was confirmed. In addition, cVDPV2 was confirmed in a sample from one of the seven environmental sample collection sites in Borno. Another case of cVDPV2 with date of onset of paralysis on 28 th October 2016 was confirmed in Sokoto state. Gender inequities and inequalities are a major cause of inequity in health. Gender equality in health means that women and men have equal chances of realizing their full rights and potential to be healthy, and contribute to health development. It is therefore important to mainstream gender dimension in the engagement of women through improving their employability in the disease surveillance sector of public health. Objectives: The objective of this study is to determine whether there is gender disparity among boys and girls in the incidence of reported AFP cases in Nigeria during the reporting period (2007-2016); and also to identify any gender bias among male and females in the number of AFP surveillance workforce. Methods: We conducted a retrospective review of reported AFP cases in Nigeria between 2007 and 2016 from the AFP database at the World Health Organization Country Office. We conducted gender analysis of the datato identify any inequities and subjected any observed difference to a statistical test of significance. We also conducted literature search on gender dimensions of AFP surveillance. Results: The AFP detection rate in Nigeria has consistently increased from 2007 to 2016, with the highest number of AFP cases reported being 17,867 in 2016. Of the total AFP cases reported, 81.5% and 18.5% were under and over five years of age respectively. The proportion of male and female AFP cases that were under five years was 81% and 82% respectively. There was a consistent decline in the proportion of OPV zero dose AFP cases with the least (0.3%) 2016. There was increase in the proportion of 3+ OPV doses with the highest (91%) also in 2016. In the year 2016, there were more male (29) state epidemiologists than females (8), more male (23) state DSNOs than females (14), more male (609) LGA DSNOs the females (218) and more male (543) LGA assistant DSNOs than females (274). The number of health facility surveillance focal persons however is almost equal in both sexes (2814 males Vs 2879 females). Conclusion: There was no gender disparity among boys and girls in the incidence of reported AFP cases and in their status of OPV immunization. Gender disparity however exists at the disadvantage of females with regards to the number of key personnel involved in the conduct of surveillance activities. Mainstreaming gender sues in the health human resource policy and planning in states and LGAs to enable engagement of more women in the disease surveillance sector of public health is crucial.