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Polio Eradication in Egypt: What Triggered the Change?
Presentation to the Executive Board
of the International Union for Health Promotion
and Education (IUHPE)
Cairo, Egypt - June 4, 2008
By: Farag Elkamel, PhD
Senior Communication Adviser, Unicef
Dean, Faculty of Mass Communication,
Ahram Canadian University
1
2
3
This is a hieroglyph of the 18th dynasty,
dating between 1580 – 1350 B.C
Scientists discovered the first vaccine against
poliovirus in 1955. The vaccine was in the form
of an injection until 1961, when an oral route of
administration was discovered.
In 1988, when the Global Polio Eradication
Initiative began, polio paralyzed more than
1000 children worldwide every day.
Since the global eradication effort began in
Egypt, Polio cases kept declining.
4
Even though reported polio cases were
decreasing,
by 2002 Egypt was unfortunately
one of only a handful of countries
in the world
where polio still existed
5
Number of Confirmed Cases of
Poliomyelitis in Egypt: 1996-2002
• 1996 100
• 1997 14
• 1998 35
• 1999 9
• 2000 4
• 2001 5
• 2002 7
6
The remaining wild polio virus
in Egypt was circulating in
the environment in densely
populated and slum areas,
where it was more difficult
to reach and vaccinate all
children.
There was some panic
because of an upward
trend (4 cases in 2000, 5 in 2001, and 7 in 2002)
7
New Strategic Directions
After 2002
8
• An assessment of the May 2003 campaign was
carried out by Dr. Farag Elkamel who was
contracted by Unicef, Egypt as their Senior
Communication Adviser.
• Based on a study he designed a new strategy for
Communication and Social Mobilization was
among his recommendations to Unicef and the
government for future polio campaigns in Egypt.
• Dr. Elkamel developed the new strategy and
provided technical assistance to Unicef and the
government to ensure its implementation
between 2003 and 2006.
9
1. The assessment utilized a field study that was
sponsored by Unicef, Egypt and was designed,
directed, and analyzed by Dr. Farag Elkamel
after the first of three rounds of National
Immunization Days (NIDs) which took place in
May 2003.
2. The study used a condensed cluster sample of
204 participants was distributed as follow: 1. Cairo (52)
2. Giza (53)
3. Zagazig (50)
4. Assiut (49
10
MAIN FINDINGS
11
1. STATE OF IMMUNIZATION
• In the 204 homes visited, there were 289
children who were five years old or less
• All but 11 children were immunized during
the 2003 campaign. They were:
8 in Cairo
2 in Giza
1 in Zagazig
12
1.A. REASONS FOR MISSING
IMMUNIZATION
Of all the children in the sample, 11 weren't
immunized for the following reasons:
4 weren't immunized because they were at their
school or nursery,
3 were not immunized because their parents
were not at home even though the children were
there, and
2 weren't immunized because of fear of infection
1 wasn’t immunized due to travel of the family
during the campaign
1 unknown reason
13
2. INFORMATION SOURCES
Parents found out about the 2003 campaign from the
following sources:
• TV: 88%
• Outdoor signs and balloons: 22%
• Megaphones: 19%
• Other family members: 19%
• Radio: 16%
• Newspapers: 9%
• Mosque or Church sermons: 5%,
• Schools/nurseries: 2.5%.
14
3. THE SCHOOL NETWORK
In 47% of the households visited there were
other siblings who were enrolled in school. Only
29% of the parents of these siblings said that
their children were told at school about the
campaign.
15
4. OTHER UNDER-USED CHANNELS
When asked to exclude radio and television and think of the
most effective community mobilization channels,
respondents specified the following:
– Outdoors 21.6
– Megaphones 20.6
– Mosque sermon and megaphone 19.1
16
5. POSITIVE INDICATORS
Attitudes and Intentions towards immunization are overwhelmingly positive:
Only five persons (2.5%) of the total sample expressed a negative intention towards future immunization
Only six persons (3%) believe that immunization has health hazards.
17
6. THE MAIN COMMUNICATION
OBSTACLE: MISINFORMATION
There is a relatively large minority of
parents who are misinformed. For
example, 14% of parents in the sample
stated that a child should not be
immunized if he/she was sick, which is
contrary to the basic polio campaign
message.
18
Summary of Main Obstacles
Identified by Research
• Lack of adequate public information on certain
important immunization facts
• Too many children are missed by the NIDs,
specially in slum areas
• Poor community awareness and social
mobilization because MOHP lacks expertise
19
CONCLUSIONS & RECOMMENDATIONS
20
CONCLUSION & RECOMMENDATION-1
REVISE CAMPAIGN STRATEGY:
CHANNELS
The Communication campaign should be
revised and divided into two main
components: A national Campaign that
covers the country and a community
mobilization one that has a more targeted
focus.
21
CONCLUSION & RECOMMENDATION-1A
The national component of the
communication campaign should mainly
utilize TV and radio,
since they virtually reach everyone, with
much less expenditures on other means
because of their comparatively limited reach
and the limited campaign budget
22
CONCLUSION & ECOMMENDATION-1B
The community mobilization campaign should
focus on harder to reach areas as well as all
areas where the last cases of polio were
reported
This campaign should focus on 5 community
outreach channels: 1. The megaphone
2. Schools & Nurseries
3. Outdoors/businesses/NGOs, etc.
4. Megaphones: street and mosques
5. Mosque & Church sermons
23
CONCLUSION & RECOMMENDATION-2:
REVISE MESSAGE STRATEGY
Campaign messages should focus on:
a. Correcting existing misinformation
b. Offering needed knowledge and practical
advice to make sure that a child gets
immunized
c. Appealing to parents’ sense of responsibility
d. less emphasis on attitude-change messages,
since attitudes are already very positive
24
CONCLUSION & RECOMMENDATION 3:
STRENGTHENING MOHP COMMUNITY
MOBILIZATION CAPABILITIES
Developing Planning tools for Organizing community awareness campaigns
Building MOHP capacities for planning and implementing community social mobilization activities (training, TOT, manuals)
Institutionalizing community social mobilization within the MOHP micro planning process
25
Tools and Activities for Enhancing the
MOHP Capacities
Four Training Programs:
1. Communication Skills
2. Vaccination and Registration Skills
3. Supervision and Training Skills
4. Community Mobilization Skills
Activities:
1. Training Curricula
2. TOT
3. Training plans
4. Audio-Visuals
5. Evaluation & Monitoring system & tools
Trainees:
• 2550 close supervisors in 51 workshops
• 775 administrative supervisors in 24 workshops
• More than 6000 volunteers (vaccinators) 26
Community mobilization used local channels of communication to
reach families in target areas, including mosques, churches,
schools, megaphones, health centers and local businesses.
27
How Community Mobilization
Made a Difference?
• Tackling the issue of missed children with targeted reach and messages
• Combating rumors in local communities
• Penetrating slums and hard-to-reach areas
28
IMPACT OF REVISED STRATEGY
Mass media (mainly TV)
combined with community mobilization
(2003-2005)
29
Attitude Towards Immunization Remained
Very Highly Positive
97.3 99.2
20
40
60
80
100
Important to receive routine & NID doses
2002 2005
30
Significant Information Gains
Due to Revised Approach & Message Strategy
94.5
73 77.1
45.6
64
98.5 90 98 91.1
96.6
0
20
40
60
80
100
120
Take routine
+ NID
Vaccine has
no side effect
Max age 5 y Min. age is
one day
No harm of
extra doses
2002 2005
31
THE EFFECT
32
Confirmed Cases of Polio
started to decline by the end of 2003,
and completely disappeared
in 2005
33
Number of Confirmed Cases of
Poliomyelitis in Egypt: 2003-2008
(as of 15 May 2008)
• 2003 1
• 2004 1
• 2005 0
• 2006 0
• 2007 0
• 2008 0
34
THE OUTCOME
35
Egypt was declared polio free by the Egyptian MOHP on August 29,
2005, and by UNICEF/WHO on February 1, 2006.
36