MAIDUGURI, 14 June 2010 (IRIN) - Campaigns to distribute Vitamin A supplements to reduce high rates of child mortality and morbidity in northern Nigeria have had the unexpected side-effect of encouraging heavily stigmatized polio immunizations in the region.

Helen Keller International (HKI) started administering Vitamin A to children under five in northern Nigerian states in 2001 to reduce child mortality and protect children against river blindness, which is endemic in some states, including Borno.

Vitamin A can reduce under-five deaths by 30 percent, according to the UN World Health Organization (WHO), and reduce malaria infection rates in children by one-third.

As a result, the treatment tends to be welcomed by parents. Realizing this, health officials and international NGOs started to use Vitamin A to entice parents into accepting the polio vaccine. In 2007, Nigeria's National Council on Health integrated polio vaccines with the government's bi-annual Immunization Plus Days, when inoculations against measles, yellow fever, worms and Vitamin A were also administered.

"The inclusion of Vitamin A as a component of the integrated immunization campaign has helped in polio vaccine acceptance and is helping in the polio eradication drive," Susan Ojomo, UNICEF child survival and development manager in charge of 10 northern states, told IRIN.

Nigeria hopes to eradicate poliomyelitis by 2015 but resistance to the vaccine among some religious groups and traditional leaders in northern states had hampered the fight and led the infection to spread to the country's once polio-free neighbours.

"Now almost every household brings its under-fives for polio immunization once it is accompanied by a Vitamin A supplement," local government immunization officer Mamman Isa told IRIN from the town of Biu, 200km south of Maiduguri.

Political commitment

These efforts have made a difference, said Oliver Rosenbauer, spokesman for the WHO Polio Eradication Initiative, but deeper engagement from state authorities and individual religious leaders has also increased acceptance. "We have always had strong political commitment at the national level, but this was inconsistent at the district and local level until last year," he told IRIN.

In 2009, state governors signed up to the "Abuja Commitment to Eradicate Polio" They engaged civil society leaders to ensure vaccinators were carefully selected and well-trained; polio campaigns were well-organized and had the right amount of vaccines. "This has had a real trickle-down effect," he said.

At the same time, the Sultan of Sokoto state in the north formed the Traditional Northern Leaders' Forum to try to engage religious and traditional leaders in the fight.

"Resistance was never the only reason there is polio in Nigeria. Before, vaccinators didn't have maps; they didn't have the right number of vaccines; they weren't kept cold enough; and communities weren't engaged in immunizations – to get those fixed, you need this kind of local level leadership," said Rosenbauer.

The number of polio cases has plummeted by 99 percent – from 289 to three – in June 2010 versus June 2009, says WHO.

Polio campaigners must also ensure they achieve 100 percent coverage, warns Rosenbauer. Some 85 out of 700 local government areas in the north are still considered "high or very high-risk", he says; and in some areas 20 percent of children are still being missed. "The [targeting] trend is better, but needs to be built on. If we take our foot off the accelerator - this is an endemic-prone disease and it will come roaring back in no time."