Assessment of the Quality of the Reverse Cold Chain Management in the Acute Flaccid Paralysis (AFP) Surveillance System for Polio Eradication; South-south Zone, Nigeria 2015

Background : The Global Polio Eradication Initiative (GPEI) uses the reverse cold chain system to measure the integrity and quality of stool specimen collected and transported to the laboratory. This paper aims to determine the quality of the reverse cold chain system during stool specimen collection and transportation to the polio laboratory. Methods : A cross-sectional survey was conducted between November-December 2015 using structured questionnaires uploaded on an open data kit-collect mobile software (ODK-collect) in 56 LGAs and 332 sites in Akwa Ibom, Bayelsa, Cross River, Delta, Edo and Rivers States. The information collected from all identified respondent covered knowledge on stool sample collection, packaging, storage and transportation. The data collected using the ODK-collect mobile software was submitted to WHO server in real-time. The EPIINFO software was used to run queries on the database and to obtain the specific data sets used in this study from the WHO server. Results : A total of 165 AFP cases were reported between November and December 2015. The mothers and the DSNOs collected 77% and 15% off the stool specimens respectively. Almost all cases (98.2%) had 2 stool specimens collected 24-48hours apart (98.1%) into dry, leak proof containers (98.2%). Between January-October 2015, 1955 AFP stool specimen were sent to the polio laboratory from the 6 states in the zone. Though 80.4% of the icepacks used were frozen, power shortages still affected the production of 55.3% of these icepacks. This was coupled with the long distances travelled by the DSNOs to their respective state capitals (WHO office) for travel clearance and specimen inspection. 63% of the stool specimens were placed in the Vehicle’s trunk during transport to the laboratory. Conclusions : This study identifies gaps in the reverse cold chain system; we recommend that the gaps observed in this survey be addressed systematically. This would enhance the reverse cold-chain system and the AFP surveillance system by extension as we proceed towards polio-free certification.