Revised Household-Based Microplanning in Polio Supplemental Immunization Activities in Kano State, Nigeria. 2013–2014

The 41st World Health Assembly in 1988 resolved to launch the Global Polio Eradication Initiative aimed at achieving a polio-free world by the year 2000 [1, 2]. Remarkable progress has been made, with a reduction from 350 000 cases in 125 countries in 1988 to 223 cases in 5 countries by the end of 2012 [3, 4]. In May 2012, the 65th World Health Assembly declared the completion of polio eradication a programmatic emergency for global public health [5–7]. At that time endemic wild poliovirus (WPV) transmission in 3 countries—Nigeria, Pakistan, and Afghanistan—constituted a risk factor for WPV reintroduction to polio-free countries and an obstacle to global polio eradication [8, 9]. Nigeria reported 122 cases of WPV in 2012, of which 28 (23%) were from Kano State in northern Nigeria [3, 10]. Kano State has traditionally been regarded as the epicenter of polio transmission in Nigeria and was the origin of the boycott of polio vaccination campaigns in 2003 [11]. Poliovirus of Nigerian and Kano State origin has been implicated as the source of reinfection to 25 polio-free countries since 2003 [6, 12]. The 2012 Nigeria National Polio Eradication Emergency Plan (NPEEP) included in its priorities the need to significantly reduce the numbers of chronically missed children by strengthening microplanning [13]. The Sixth Independent Monitoring Board of the Global Polio Eradication Initiative report in June 2012 identified poor microplanning as a major impediment to achieving the implementation of quality polio supplemental immunization activities (SIAs) [8]. Microplanning for polio SIAs is a process of estimation of the target populations and resource requirements for conduct of good-quality implementation in a specified location. The guidelines for microplanning for polio SIAs in Nigeria were revised to focus on the target number of households rather than the target number of children per vaccination team in August 2012. The revised guidelines were piloted in 87 very high-risk (VHR) local government areas (LGAs) in the 11 VHR states that were identified based on their risk categorization using the combined US Centers for Disease Control and Prevention–Global Goods Criteria [14]. The 24th Expert Review Committee on Polio Eradication in Nigeria in September 2012 recommended the expansion of implementation to all the LGAs in the 11 VHR states and the intensification of oversight of the 2012 NPEEP [13]. This resulted in the establishment of the National Emergency Operations Center (EOC) by the presidential task force and subsequent establishment of EOCs in 5 states. In August 2013, the Kano State EOC identified inflation of target population estimates with its consequent increase in requests for vaccines and high number of missed settlements as areas of serious concern in the available microplans; and with orientation, guidance and support from the country team organized a revised household-based microplanning exercise including microcensus (a process of estimating the numbers of households and eligible children in a given area by physical count, enumeration, and revalidation) was initiated. This process was aimed at collecting reliable demographic information on the target numbers of households and children in the communities. This article describes the process of implementing revised household-based microplanning intervention in Kano State between September 2013 and April 2014 and highlights the contributions of revised microplanning to improved outcomes of polio SIAs.