Polio is an incurable disease that can lead to life-long paralysis in unvaccinated children, and even one confirmed case means that the virus may be quietly spreading in communities. Over the last year, Mozambique and Malawi declared a national health emergency to contain polio quickly. Even the neighboring countries have been on high alert. Still, by February 2023, ministries of health mobilized, and now more than 33 million children in Southern Africa have been vaccinated against polio, with support from the Global Polio Eradication Initiative (GPEI).
Nowhere is safe until everywhere is safe
Going back to early 2022, a year and a half after Africa had been declared free of wild poliovirus, the virus resurfaced on the continent in Malawi when a child became paralyzed with a poliovirus strain from Pakistan. Then it was discovered in a child in Mozambique’s northern Tete province, across the border. Lab analysis has shown that all the Mozambican cases in the current outbreak have been genetically linked to the Pakistani strain.
As many health experts have anticipated, as long as the virus exists worldwide, it can spread again to other countries. Seven more children in Mozambique were confirmed to have wild polio in the following months. At the same time, Mozambique was making great efforts to contain two other outbreaks of vaccine-derived polio. These efforts included increased community surveillance, sensitizations, and six rounds of door-to-door vaccination campaigns throughout 2022, aiming to ‘catch children up’ on their routine vaccinations after two years of disruptions caused by COVID.
Implementing the Lab Sample Transport Program
Samples wait at the Tete Provincial Level Hospital Lab before they are transported to Maputo – Credit Kat Tillman
Since 2022, VillageReach has been implementing the Lab Sample Transport Program in 14 countries, focusing on improving the speed and quality of acute flaccid paralysis (AFP) and Environmental Surveillance (ES) sample transportation. Decreasing response times during the transport process can lead to faster detection of the poliovirus and notification of test results. The improvements can accelerate efforts to contain polio via immunizations and strengthen transport systems for other infectious diseases. It can also support the efforts of health workers like Rodrigues Banda and Domingos Abilio, who work with communities at risk of contracting this devastating illness in Mozambique.
One goal: Save lives
Rodriges Banda visits the Malangue community – Credit: Arsenio Manhice
At dawn, Rodrigues Banda always wakes up with one goal: ‘To save lives,’ especially the lives of children in the Changara communities in Tete province. Banda is responsible for the epidemiological surveillance services at the Changara health center. His focus for the past few months has been on stopping polio.
“Polio is a different disease because it has no cure. My efforts with my colleagues are to collect samples for testing so that we know if there are any polio cases in the district,” Banda said.
Jose was a boy who unknowingly was exposed to the virus. “This child lives with illness and amid poverty. As a health technician, my role has been to sensitize the family and the community about the need for hygienic care to prevent the spread of the disease,” Banda recalls. “Ernesto, Jose’s grandfather, says he is aware of the health condition of his grandson. And since he was diagnosed with polio, he has been fighting for cleanliness.”
The story of the boy Rangisse is similar to that of Jose. A Malangue, Tete province resident, Rangisse’s case was officially discovered in May 2022 when samples were taken during a polio vaccination campaign.
“Unfortunately, there is a high risk of contamination in the communities due to poor environmental sanitation. Many families do not have latrines.,” said Banda.
The six rounds of door-to-door vaccination campaigns throughout 2022 have been critical because vaccinating children is the best defense against polio.
Improving transport times
Domingos Abílio has been the Community Health Worker in the community of Malangue, in the Changara district, since 2011. On a typical day, he educates people during his health promotion activities.
“I had no idea what disease affected Rangisse, but I had already noticed something abnormal in him. I informed the health staff about the case long before the polio vaccination campaign,” said Domingos.
The way to the Malangue community is a winding road, rocky, and practically impassable during rainy days. Rangisse’s stool samples were transported by motorcycle to the Monsenhor Domingos Ferrão Type II rural health center in the Wiriyamo area. From Wiriyamo, the samples were transported to the Changara health center. Once there, the samples waited two days before continuing to Tete Provincial Hospital. From Tete Provincial Hospital, the samples were flown to the Faculty of Medicine of Eduardo Mondlane University in Maputo, in transit to the National Institute of Communicable Diseases (NICD) Laboratory in South Africa, where they were finally analyzed. It took approximately 30 days from collecting the specimens in the community to arriving at the South African laboratory. The test results returned 60 days later.
“VillageReach and its many partners are working to speed up the transportation of polio samples so that it is within 72 hours from the collection (in even the most remote communities) to arrive at the international lab.”
Polio labs are not everywhere, like for other infectious diseases (i.e., HIV and tuberculosis). In Mozambique, they are only abroad. VillageReach and its many partners are working to speed up the transportation of polio samples so that it is within 72 hours from the collection (in even the most remote communities) to arrive at the international lab. In Mozambique, there are early promising results after the introduction of an on-demand transport system via private transporters: Instead of waiting for samples to be picked up once or twice per week, health workers countrywide now have the option to call the toll-free Alo Vida health hotline which the Ministry of Health manages with support from VillageReach. Transport is requested immediately via Bollore Logistics from local transporters. The samples are picked up at the health center and delivered to the provincial health office within 24 hours (in the north/central regions) or to Maputo within 48 hours (in the southern areas. These efforts are then helping the Ministry of Health and WHO get the samples to the Johannesburg lab faster by air.
To prevent more polio cases, Domingos met with Rangisse’s family and others in the community to explain the precautions that needed to be taken.
“Now, there are already latrines here in the community. Families are already aware of polio and know what to do,” said Domingos.
The dream within reach
By implementing a transportation system that improves the speed and reliability of specimen processing in Mozambique, communities like those in Changara have a line of defense against polio alongside immunizing children and maintaining hygienic practices.
Reducing the time that samples take from the community to the national laboratory to a mere 72 hours will help short-circuit the spread of polio in all at-risk communities and make possible the dream of protecting children and eradicating polio.
For more information about the Mozambique Polio Lab Sample Transport Program, contact Aida Coelho at aida.coelho@villagereach.org.