Polio in Uganda

Polio, also known as poliomyelitis is caused by a virus. In about 0.2% of cases there is muscle weakness and inability to move. Many people with muscle weakness make a full recovery. 2-5% of children and 15-30% of adults with muscle weakness die. 25% of people infected have only minor symptoms and in more than 70% of cases there are no symptoms. Many years after recovery post polio syndrome (PPS) may slowly develop resulting in a further gradual weakening of muscles (see Wikipedia). The mechanism of PPS is poorly understood.

Polio is preventable. Various vaccines were developed in the 1950's. In 1988 there were an estimated 350,000 cases of polio worldwide when the GPEI (Global Polio Eradication Initiative) was started. By 2014 polio cases had declined by 99% to 223 (see Surviving Polio in a Post Polio World).

A young mum with Polio

I can find no data on the numbers of people disabled by polio in Uganda or in sub Saharan Africa. Most information focuses on the eradication of polio. This report, Surviving Polio in a Post Polio World, provides illuminating reading:

...insufficient attention has been paid to those who do contract the disease (polio) and their subsequent health and rehabilitation, as well as social, financial and psychological needs throughout their lifetime.
Today, the largest, youngest populations of polio survivors live in developing countries (Rekand et al., 2003). However, little research has been conducted to assess their current situation. In developed countries, polio survivors tend to be older and middle to upper class, as the majority of infections occurred before a vaccine was available (Oshinsky, 2010). In contrast, due to the later introduction of wide-spread vaccination, survivors in developing countries are often younger, many still children or of prime working age (Halder, 2008 and Gonzalez et al., 2010). Furthermore, polio occurs disproportionately amongst the poorest, most marginalized populations; those least likely to have received vaccine protection (Pinto and Sahu, 2001, Yeo and Moore, 2003 and Halder, 2008). This younger cohort presents different needs and challenges to healthcare and rehabilitation, as well as education, social integration and economic self-sufficiency, than their older counterparts in resource-abundant environments.
In developing countries, what little research exists concerning polio survivors has focused on individuals immediately disabled after the initial polio infection. In most countries, the numbers disabled by polio far outstrips the medical and rehabilitative services available (Parnes et al., 2009). Moreover, available services tend to be expensive, limited in scope and/or available only in urban medical centers or specialized facilities that can accommodate only small numbers of patients (Boyce, 2000 and Halder, 2008; Parnes et al., 2009, Groce et al., 2013). There are limited options for education, employment, social integration or civic participation.
Even less is known about individuals who survive polio without residual disability but who subsequently find themselves with PPS. There is little research or understanding of how PPS manifests itself in individuals who did not suffer from residual paralysis after acute infection or how the condition of persons disabled by polio deteriorates over time with the onset of additional PPS complications in developing world settings. Specifically, how PPS-related health issues might be compounded by factors found among poor populations in developing countries: lack of access to rehabilitation or assistive devices (wheelchairs, crutches), poor nutrition, hard labor or exposure to diseases such as malaria or HIV which might further compromise the health of millions of polio survivors. Nor has there been much attention to low-cost, low-tech interventions to address these needs. Furthermore, chronic underreporting on prevalence of polio survivors and competition for resources and attention from individuals with other diseases and social problems has led to the significant lack of attention towards this population (Zhang, 1991,Andrus et al., 1997 and Nathanson and Kew, 2010). Nor has there been discussion on the potential impact that their needs will have on local medical and rehabilitation systems as PPS begins to appear among aging populations in coming decades.
Evidence from the few existing developing countries studies also finds that disability from polio has profound social and economic consequences. Halder, studying women disabled by polio in India found they were disproportionately under-educated and unemployed, with only 32% working, despite unfilled government quotas for women with disabilities (Halder, 2008). Similarly, in a Chinese study 85% of disabled polio survivors over age 15 were either unemployed or underemployed and their marriage rates were markedly lower than for non-disabled individuals (Dai and Zhang, 1996a and Dai and Zhang, 1996b). A paired-sibling study in Lebanon noted significant differences in employment, social class, income and marital status between individuals disabled by polio and non-affected sex-matched siblings (Shaar and McCarthy, 1992). A recent Nigerian study reported adolescent disabled polio survivors scored significantly lower than age- and sex-matched peers on quality of life measurements, particularly concerning productivity, community participation and emotional/physical health (Adegoke et al., 2012).

The report, Surviving Polio in a Post Polio World, summarizes the lack of knowledge for polio survivors in countries like Uganda: 

Without question, the largest knowledge gap concerns survivors disabled by polio in developing countries. While the number of individuals disabled by polio will begin to disappear in the next few decades in developed world, such individuals will continue to be a major concern in much of the developing world for at least another generation (Gonzalez et al., 2010). And as the population of younger polio survivors reaches middle and old age, a new wave of individuals with PPS will begin to make additional demands on developing countries' health systems.

This article from The Monitor, Uganda: 4.7 Million Children to Get Polio Vaccine, describes the continuing initiative to eradicate polio in Uganda:

Kampala — Beginning Saturday, the Ministry of Health will immunise children below five years against the polio virus using the oral polio vaccine.
According to the Permanent Secretary, Dr Asuman Lukwago, the vaccination campaign will start from January 23 to January 25 in 57 high-risk districts.
"During the exercise, all children under five years whether previously immunised or not, will be given oral polio vaccine (OPV) drops in the mouth," Dr Lukwago told journalists yesterday at the Uganda Media Centre. "The vaccination teams will comprise one health worker and one local council (Local Council One) official or VHT member and we shall use this opportunity to educate parents and guardians on identifying and investigating any unreported cases of suspected cases of polio," Dr Lukwago added.
Mr Andrew Bakainaga, the WHO adviser on immunisation, said the campaign is part of the strategies set to eradicate polio from the country by 2018.
"The targets include border districts, those with poor performance in routine immunisation and the districts hosting refugees," Mr Bakainaga said. The house-to-house polio vaccination campaign is targeting 4.7 million children and is estimated to cost Shs9.9 billion. It is funded by WHO, UNICEF and the Uganda government.
Mr Bakainaga said the selected districts have high cross-border movements of populations due to insecurity in neighbouring countries that could re-establish circulation of wild polio virus in Uganda.
"The campaign also involves the identification of acute flaccid paralysis (AFP) cases," said Mr Bakainaga. He said AFP is characterised by weakness or paralysis and reduced muscle tone without other obvious causes.
Target districts: The targeted 57 high risk districts are: Adjuman, Arua, Buliisa, Busia, Gulu, Isingiro, Kabarole, Kanungu, Kiboga, Kitgum, Kyankwanzi, Agago, Amuru, Bundibugyo, Butaleja, Hoima, Kampala, Kabale, Kasese, Kiryandongo, Koboko, Kyegegwa, Lamwo, Apac, Buikwe, Bugiri, Buvuma, Iganga, Jinja, Kamwenge, Kibaale, Kisoro, Kole, Luweero, Mayuge, Masindi, Lira, Kyenjojo, Maracha, Moyo, Mubende, Yumbe and Zombo. Immunisation dates are January 23,24 and 25.

A summary of polio cases 2015/2016 Polio this week as of 3 August 2016, show that Pakistan and Afghanistan are the only countries that have wild polio cases, totaling 127. In Ukraine, Nigeria, Myanmar, Madagascar, Lao PDR, Guinea, Pakistan and Afghanistan there were 47 cases of polio from vaccines.

In conclusion, polio eradication is taking priority over the concerns of PWDs with polio. There is little doubt that the impact of being disabled by polio has profoundly detrimental socioeconomic consequences. The lack of information about the numbers of people affected by polio is indicative of institutionalized discrimination against polio survivors. This lack of adequate research and information about post-polio survivors is an example of further discrimination against a group of people who are already marginalized and stigmatized.

For more information about polio contact the website of Post-Polio Health International or Post-Polio Health International on Facebook. For information about eradication of polio contact the Global Polio Eradication Inintiative.