Polio Eradication in Nigeria and India: A Systematic Review of Challenges and Successes

Abstract

Background: The global eradication of polio is considered an emergency and an unaccomplished task until completely eliminated. Vaccinating children against the polio virus confers immunity on them and breaks the transmission of the polio virus. Afghanistan, Nigeria and Pakistan remain the only three countries in the world that have not eliminated polio. The aims of this paper were to: (1) to identify the factors that impact the failure to eliminate polio from Nigeria and (2) determine the factors that led to the successful elimination of polio from India. Methods: A systematic literature review was carried out to meet the above research objectives. Four electronic databases were searched (Cochrane Library, Medline, PubMed and Google Scholar) and articles that fulfilled the inclusion and exclusion criteria were selected and critically appraised. Results: In all, 98 articles were retrieved. After selection based on our selection criteria, fourteen studies were identified and included in the study. These were 5 systematic reviews: 3 cross-sectional studies, 3 mixed methods studies, 2 case-control studies and one quantitative (survey) study. In all, seven themes were identified from the review of the articles. Four themes were identified from the factors associated with the failure to eliminate polio from Nigeria: (1) Failure of the oral polio vaccine (OPV); (2) Institutional and geographical failures in vaccine programs; (3) Program and campaign management limitations; and (4) Vaccine refusal. Similarly, three themes were identified from the factors that contributed to the elimination of polio from India: (1) Replacement of the trivalent OPV with the monovalent and bivalent OPVs; (2) Implementation of intensive social mobilization strategies; and (3) Effective program micro planning and campaign management. Conclusion and Implications for Translation: Based on the findings from the literature review, we highlight areas where Nigeria can learn from India in its quest to eliminate polio. These factors can form the basis for future theoretical and policy reforms in the fight against polio not only in Nigeria but in countries where it remains endemic. Further research should compare the success of polio eradication in other countries.