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Background: Nomadic populations have a considerably higher risk of contracting a number of diseases but, despite the magnitude of the public health risks involved, they are mostly underserved with few health policies or plans to target them. Nomadic population movements are shown to be a niche for the transmission of diseases, including poliomyelitis. The nomadic routes traverse the northern states of Nigeria to other countries in the Lake Chad subregion. As part of the February 2016 polio supplemental immunization activity (SIA) plans in Bauchi state, a review of nomadic routes and populations identified a nomadic population who originated from outside the international borders of Nigeria. This study describes the engagement process for a transboundary nomadic population and the interventions provided to improve population immunity among them while traversing through Nigeria. Methods: This was an intervention study which involved a cross-sectional mixed-method (quantitative and qualitative) survey. Information was collected on the nomadic pastoralists entry and exit points, resting points, and health-seeking behavior using key informant interviews and semistructured questionnaire. Transit vaccination teams targeted the groups with oral polio vaccines (OPVs) and other routine antigens along identified routes during the months of February to April 2016. Mobile health teams provided immunization and other child and maternal health survival interventions. Results: A total of 2015 children aged under 5 years were vaccinated with OPV, of which 264 (13.1%) were zero-dose during the February 2016 SIAs while, in the March immunization plus days (IPDs), 1864 were immunized of which 211 (11.0%) were zero-dose. A total of 296 children aged under 1 year old were given the first dose of pentavalent vaccine (penta 1), while 119 received the third dose (penta 3), giving a dropout rate of 59.8%. Conclusions: Nomadic pastoralists move across international borders and there is a need for transboundary policies among the countries in the Lake Chad region to improve population immunity and disease surveillance through a holistic approach using the One-health concept.
As part of the process for conducting SIAs in Nigeria, the micro-planning process is followed to identify areas, characterize the population, and quantify and identify resource requirements. This process was conducted as itemized below. In preparation for the exercise in February2016, the entry and exit routes, resting/watering points, and grazing areas of nomadic populations were reviewed in Bauchi state and the affected local government areas, wards, and potential camps were identified. This is part of the analysis for identifying potential areas and high-risk populations for polio transmission and developing strategies to target them. We made contact with the leadership of the nomads, mobilized them, and identified focal persons among them for easier contact and planning of immunization activities to target them. Furthermore, indigenous community leaders in the settlements closest to where they were found were also used as an entry point. They were sensitized and very receptive once it was explained to them the benefit of immunization and other health interventions that their eligible children and women would have. Rapid collection of information from the nomads was exigent, and a key informant interview was used to rapidly appraise their pattern of movement and their health needs. We collected information on the routes (dynamics of movement), knowledge, attitude, and health-seeking behavior of the nomadic and migrant population. A total of 120 key informant interviews were conducted (two per ward) using a semistructured instrument with questions asked according to thematic areas of health-seeking behavior, pattern of movement, healthcare access, and utilization of the nomads and their herd. The information collected was analyzed and used to develop plans for implementation of the vaccination exercise. Transit vaccination teams were trained to administer oral polio vaccines (OPVs) depending on the size of the nomadic population and the routes identified during the micro-planning process. At least 2–5 teams per ward were deployed and accompanied by local interpreters. Senior supervisors from the LGAs and supported by partners were deployed for the exercise that lasted for 3–4 days during the days of each round of February and March 2016 SIAs. Furthermore, routine immunization antigens and treatment of minor ailments were offered in some LGAs. In addition, and in between the SIA campaigns, mobile health teams targeted them to provide immunization and other child and maternal health survival interventions in the form of vitamin A supplements, deworming tablets, treatment of minor ailments, and health promotion. We collected information on the pastoralist transit and resting points during the course of their movement. Polio, routine immunization, and treatment coverage data were collected and percentages derived from them. The transit and resting points of the pastoralists were also transposed onto the regional map. This project was not intended as research work, but instead as an intervention to improve vaccination uptake among nomads and, as such, ethical clearance was not required. However, the government of Bauchi state granted permission for the intervention.
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