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BMC Public Health. 2012; 12: 229.
Published online Mar 22, 2012. doi:  10.1186/1471-2458-12-229
PMCID: PMC3331818
Support for children identified with acute flaccid paralysis under the global polio eradication programme in Uttar Pradesh, India: a qualitative study
Rie R Yotsu,corresponding author1 Katharine Abba,2 Helen Smith,2 and Abhijit Das3
1Department of Dermatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo 162-8655, Japan
2International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
3Centre for Health and Social Justice, Avenue 21, G Block, Saket, New Delhi 110017, India
corresponding authorCorresponding author.
Rie R Yotsu: yotsurie/at/hotmail.com; Katharine Abba: kathabba/at/blueyonder.co.uk; Helen Smith: cjdhel/at/liverpool.ac.uk; Abhijit Das: abhijitdas/at/chsj.org
Received October 30, 2011; Accepted March 22, 2012.
Abstract
Background
Cases of polio in India declined after the implementation of the polio eradication programme especially in these recent years. The programme includes surveillance of acute flaccid paralysis (AFP) to detect and diagnose cases of polio at early stage. Under this surveillance, over 40,000 cases of AFP are reported annually since 2007 regardless of the number of actual polio cases. Yet, not much is known about these children. We conducted a qualitative research to explore care and support for children with AFP after their diagnosis.
Methods
The research was conducted in a district of western Uttar Pradesh classified as high-risk area for polio. In-depth interviews with parents of children with polio (17), with non-polio AFP (9), healthcare providers (40), and key informants from community including international and government officers, religious leaders, community leaders, journalists, and academics (21) were performed.
Results
Minimal medicine and attention were provided at government hospitals. Therefore, most parents preferred private-practice doctors for their children with AFP. Many were visited at homes to have stool samples collected by authorities. Some were visited repetitively following the sample collection, but had difficulty in understanding the reasons for these visits that pertained no treatment. Financial burden was a common concern among all families. Many parents expressed resentment for their children's disease, notably have been affected despite receiving multiple doses of polio vaccine. Both parents and healthcare providers lacked information and knowledge, furthermore poverty minimised the access to available healthcare services. Medicines, education, and transportation means were identified as foremost needs for children with AFP and residual paralysis.
Conclusions
Despite the high number of children diagnosed with AFP as part of the global polio eradication programme, we found they were not provided with sufficient medical support following their diagnosis. Improvement in the quality and sufficiency of the healthcare system together with integration of AFP surveillance with other services in these underprivileged areas may serve as a key solution.
Keywords: Acute flaccid paralysis, AFP Surveillance, Healthcare, India, Poliomyelitis, Pulse Polio Programme, Residual paralysis
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