In June 2023, Dr. Pius Mutuku and his team were alerted of three patients whose lab samples had tested positive for polio from the Hagadera Refugee camp in Garissa County, Kenya. The samples indicated the presence of a non-wild variant of poliovirus, known as circulating vaccine-derived poliovirus (cVDPV), and linked to cases in neighboring Somalia.
This was alarming as it revealed an outbreak of polio in the area and posed a major challenge to the government’s goal of eliminating polio from the country. Kenya had achieved a milestone when it was declared free of wild polio in 2014, and it has had no cases of wild or cVDPV over the last decade.
The response to the new cases was swift and decisive. Within a few days, Dr Mutuku was appointed to lead a clinical assessment team from Nairobi to the refugee camp in Garissa.
“When we received the results from the Kenya Medical Research Institute (KEMRI) indicating that three of the samples sent were positive for polio, we noted that this was already above the action threshold and meant we needed to mobilize our teams to do a risk assessment and start field investigations,” he points out.
Dr Mutuku was the lead clinician sent from the Kenya Ministry of Health (MoH) to carry out the field investigations. He is a resident doctor within the MoH’s Public Health Emergency Operation Center (PHEOC) pursuing a master’s degree in Field Epidemiology at the University of Nairobi. He has worked as a doctor for 20 years with ten spent in the field of infectious disease control.
Once the team arrived at the site, they examined the vulnerabilities of the camp that led to the polio outbreak. Their findings were sobering: the camp’s vulnerability stemmed primarily from its refugee population, many of whom hailed from parts of Somalia where polio vaccination programs were scarce. Dr. Mutuku and his team quickly initiated clinical evaluations for each affected child, which ensured affected children received timely physiotherapy and follow-up checks. The evaluation reports were sent to MoH headquarters, which swiftly recommended mass vaccination targeting every child in the refugee camps.
Not ‘Individual Glory’ but Community Collaboration
Central to this response is a collaborative network, uniting community members, health volunteers, surveillance officers and institutions like KEMRI (the national reference laboratory). Dr. Mutuku observes, “Eradication of polio is a team effort. It’s not about individual glory; it begins at the community level, weaving in everyone, all the way to the labs.”
During the recent polio outbreak in Hagadera camp, the key differentiator that led to the quick response was the effective partnership between the Global Polio Eradication Initiative (GPEI) members, including the Bill & Melinda Gates Foundation, WHO and the core group partners project (CGPP), in fortifying the polio surveillance system. The system prioritizes community engagement, with community members trained to recognize symptoms of acute flaccid paralysis (AFP) and relay this information through a tiered system from local health volunteers up to the KEMRI.
To support this system and the MoH’s goal of completely eliminating polio, VillageReach partnered with the MoH to evaluate the polio lab specimen referral system in 2022. The goal of the assessment was to strengthen polio sample transportation from health facilities and the county level to the national KEMRI polio lab while ensuring that the quality of the lab samples is not compromised en route.
Addressing Gaps Through People-Centered Solutions
The results from the nationwide assessment revealed that Kenya’s polio sample transport process was commendable, with the vast majority of samples reaching the KEMRI lab on time (within 72 hours after being collected) and arriving in good condition. The MoH was already collaborating well with a private transport company, G4S for the movement of the samples countrywide. However, a few challenges of accessibility were identified especially in under-reached areas.
Refresher trainings were also needed, so the MoH initiated targeted sample transport training in collaboration with VillageReach. Drawing on internal resources and additional support from WHO, the MoH and KEMRI enhanced the training curriculum, building the capacity of county staff and procuring cooler boxes and supplies for transportation. The training targeted 47 county disease surveillance coordinators (CDSCs) and 47 county laboratory managers (CLM) nationwide.
Ms. Joan Hassan, Technical Lab Coordinator, KEMRI, training county disease surveillance coordinators and clinicians (Photo credit: Ms. Joan Hassan)
The Importance of Disease Surveillance Coordinators
An important part of the surveillance system are the CDSCs, who recently (May 2023) benefitted from the trainings focusing on sample collection, packaging and shipment, supported by VillageReach.
One of the trainees was the Garissa County Disease Surveillance Coordinator, Mr. Ali Amin. He attributes his improved response during the recent outbreak to this training, emphasizing its role in enhancing his skills.
“During the new outbreak in Hagadera, Dadaab camp, we were able to apply our training on environmental surveillance. The support we have received has yielded results and helped us with the right skills to collect samples,” he says.
On his part, Mr. Hilary Limo, the Public Health Emergency Operation Center Manager at the national MoH, underscores that the partnership with VillageReach paved the way for improved collaboration with private transporters and introducing digital innovations like the Tec4med devices, which are real-time GPS trackers helping to ensure the timely and temperature-controlled delivery of samples.
“VillageReach helped us enhance our collaboration with the private transporters. Now, when they see our sample carriers, they know that this is a ‘golden stool’ which must be handled with care. They flag this out quickly and make sure the sample has been transported to KEMRI as quickly as possible,” Mr. Limo points out.
In the future, the MoH aims to leverage its primary health care (PHC) network of providers to maintain its polio-free status. The ministry also plans to train senior policymakers at the county level on how to respond to disease outbreaks.
The alliance between the Kenya MoH, VillageReach and other partners underlines the power of unity and the indomitable spirit of professionals like Dr. Mutuku. Most importantly, it showcases what we can accomplish when dedication, expertise and collaboration unite in the battle against infectious diseases.
For more information about the Polio Lab Sample Transport program in Kenya, contact Mr. Hilary Limo, Kenya Ministry of Health (kimelilimo@gmail.com) or Mr. Dauda Majanbu (Dauda.Majanbu@villagereach.org)