Zulfikar Ahmed and his wife, Ayesha begum from Moradabad district of north Indian state of Uttar Pradesh (UP) had contracted polio when they were young. In 2009 out of 1,606 children that were affected by polio globally.
By Angela Walker
MORADABAD, India, 24 October 2010 – Baby boy Zulfikar Ahmed became seriously ill during the communal riots in the Indian state of Uttar Pradesh.
“It was a very dangerous time,” his mother Munni says. “He was three-months-old and he had a sudden, very high fever. He had severe loose motions.
“I cleaned him with cold water, but I realized that his legs could not stand. They were very soft,” she recalls, her eyes welling with tears as she recalls that time 30 years ago. “After the curfew lifted after six days, I took him to the doctor and the doctor said, ‘He has polio.’”
Her husband, who earned only a few rupees a day pulling a rickshaw, saved what he could for Zulfikar’s treatment, often sacrificing the money the family would have used to pay for food. But despite medication, therapy and an eventual operation, nothing could help heal their son.
“I didn’t know immunisation could save my child,” she says sadly.
Immunisation is one of the simplest, most cost-effective, health interventions. UNICEF, with funds from the IKEA Social Initiative, is working to implement a 10-Point Child Friendly Agenda, which includes immunisation as a key priority, in the mohallas, or slums, of Moradabad.
“It’s a great example of human-rights based, integrated programming,” said Nupur Pande, Project Officer in the UNICEF office of Uttar Pradesh. UP is India’s most populous state with 183 million inhabitants. An estimated 30 per cent of the population lives below the poverty line.
“We are not developing any new structures, but we are building the capacity of service providers, like health care workers, and empowering people in the slums to demand for better services,” she says. “We are bridging the gap, but it’s a slow process.”
Today, Munni, has become a volunteer “change agent” in her immediate community. She and four other women work together to map the families in their neighbourhood, identifying babies that need to be immunised, mothers who need prenatal care and children who should be in school.
“Generally the families that are left are the most resistant. They need a lot of convincing.”
They don’t understand the reason why their child gets fever or may not be aware of vaccines or know the long-term, positive benefits,” says Pande. “Volunteers go into their communities and identify families with small children, hold regular discussions to educate them and connect them to the government services available.”
Ayesha Parveen, Zulfikar’s wife who herself contracted polio when she was two-years-old, is now six months pregnant with her own child. Munni makes sure she receives her folic acid supplements and other prenatal healthcare services.
“We are able to teach our children so they will have healthy families,” she explains. “If this awareness existed when I was raising my children, then this wouldn’t have happened to my son.”
Ayesha, shakes her head sadly as her mother-in-law speaks, drawing her white veil more closely around her downturned head.
“What we have suffered, they should not suffer,” she whispers softly.
Moradabad has some of the worst immunisation rates in the country at 14.39 per cent and often inadequate health services. Children are exposed to poor hygiene and sanitation facilities in the slum areas. Dry latrines, where human excreta is removed manually in baskets, are still used by 60 to 70 per cent of the city. Poor hygiene increases the risk of transmission of polio.
“It is critical for every child under five years of age to take Oral Polio Vaccine (OPV) each time it is offered,” said Lieven Desomer, chief of UNICEF India’s Polio Prevention Programme. “We want all families to ensure their children are protected.”
Routine immunization coverage is critical for children to have adequate immunity against polio and other childhood diseases. According to DLHS data in 2007-2008, only 30.3 per cent of children under-five years of age were fully immunized in UP.
There are only four countries in the world that remain polio endemic: India, Pakistan, Afghanistan and Nigeria. The four endemic countries account for approximately 93 per cent of all cases globally. India accounts for 34 per cent of global cases.
In 2009, 1,606 children were affected by polio globally, of which 741 of these children were in India. Of those cases, 719 were children from either UP or Bihar. The virus in India is now limited to only 107 blocks in UP and Bihar.
In India, the Polio Partnership is led by the Government of India, with support from WHO National Polio Surveillance Project (NPSP), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF as well as significant contributions by the Bill and Melinda Gates Foundation. The partners work with health workers, civil society groups and communities at all levels to make sure every child under 5-years-old gets immunized each time oral polio vaccine (OPV) is offered.
During each vaccination campaign, more than 98 per cent of children under-five years of age in Uttar Pradesh and Bihar are immunised. Nearly 2.3 million vaccinators under the direction of 155,000 supervisors visit 209 million houses for each National Immunisation Day.
To reach people on the move, mobile and transit vaccination teams immunise children at railway stations, inside running trains, at bus stands, market areas, brick kilns and construction sites. Around five million children are immunized by transit and mobile teams during every round in UP, Bihar and Mumbai alone.
But despite these massive efforts, some families still resist having their children vaccinated. Even though there is over 98 per cent coverage, there are still some pockets of high risk areas where families refuse OPV due to misconceptions the vaccine will cause sterility or impotence.
“We need to take the time and effort to explain to these families the value of vaccinating their children so they can understand the benefits while dispelling the myths surrounding immunisation,” said Adele Khudr, Chief of the UNICEF UP office. “Trained community volunteers will know the families they need to reach out to and will be accepted by their neighbours as one of their own.”
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