IRIN Focus on the vaccination of nomadic children

Two-year-old Mahamane received her first ever vaccination as a wave of intense heat swept over the tiny village of Tagdom that lies on the fringes of the Sahara desert, near Agadez in northern Niger. A team of mobile nurses found Mahamane and her two sisters - five and three years old- as their nomadic family were searching for pasture and water for their livestock. She received the polio, the Bacillus Calmette-Guerin (BCG), measles and yellow fever vaccines at one go. "She had never been vaccinated," Girma Ladjo, Mahamane's father told IRIN. "I heard of vaccinations but I had never bothered to have my children vaccinated," he added. The nurses said Mahamane received the vaccines at a "go" because she was over age. It was also impossible to tell when Ladjo, who was moving with his two wives and the children would meet vaccinators again. Like all people from Niger's nomadic northern tribes, Ladgo is constantly on the move looking for pasture and water. Asked where the family was going next, he said: "Ahead". One vaccine, the Diptheria/Tetenus/Pertussis (DTP), was not administered because the children were on the move. The nurses said it would be difficult to trace them for subsequent doses. Mahamane was lucky. According to UNICEF, very few of Niger's children have been vaccinated against preventable diseases. In 2002, only 22 percent of those under one year old were vaccinated. Vaccination is priority According to UNICEF, nearly 30 percent of Niger's children die before the age of five, many from preventable diseases. With 265 deaths out of 1,000 children, the country has the world's second highest mortality rate for this age group. "We decided to focus on preventive actions, development and protection issues," the UNICEF representative in Niger, Adjibade Aboudou Karimou told IRIN. "Immunisation is our priority because it has a direct impact on children." UNICEF's efforts have began bearing fruit. In August, the national vaccination coverage of children upto 11 months old, rose to 50 percent. UNICEF however said it had experienced resistance to polio vaccination in the southern districts of Maradi and Zinder, which border the Hausa States of Nigeria. "We faced some resistance in these areas because of religious or cultural beliefs," Karimou said. "Many people there do not believe that immunisation is a way of protecting children from deadly diseases. They suspect that there is a hidden agenda aimed at reducing their population." UNICEF has faced similar problem in neighbouring Nigeria where local people said that polio vaccines were laced with birth control drugs that would interfere with the children's fertility. "Others argue that it is God who gives life and takes it. Traditional leaders, for example, say vaccination is not effective. They say protection from illnesses is God's prerogative," Karimou said. Villagers have shut doors on the faces of vaccinators. In some cases parents have come to meet vaccinators after hiding their children indoors. When asked where the children are, they claim that they have no babies. To try and change attitudes, UNICEF is using radio, the most widely used medium of communication in this landlocked country to raise awareness. It also using television and traditional chiefs. Every year National Immunisation Days are held to reach thousands of children. This year, the NIDS are planned in October and December, starting with the "hard-to-reach children" among the nomads living in remote northern Niger's areas such as Agadez. "Agadez is about 800 km from Niger's border with Libya. In between there are people and they have to be reached," an official in Agadez told IRIN. "The challenge is both geographical and financial," he added. Because of the peculiar challenges in northern Niger, vaccinating a child costs one-and-a-half times more than it does in southern Niger. "Polio vaccination for example, costs US $60-70 per child," the official said. "Due to the vastness of the north and lack of defined roads in the desert, we have also had cases of mobile vaccination teams losing their way into Mali or southern Algeria." Cultural practises Karimou told IRIN that matters were made worse by cultural practices that contribute to under nourishment of children. "There are cultures that recommend that men eat first. In such cases, the men take the best of the meal," he said. "UNICEF is assisting to improve the nutritional status of families, particularly children and providing Vitamin A supplements." One strategy UNICEF is using is to help women to start income generating activities through planting of vegetables, cereals and other crops with high nutritional value. "This extra income means that the women can buy other types of food to feed the family," Karimou said. Creative strategies The challenges of health care delivery in Niger have led UNICEF to come up with creative strategies. It is for example using the few existing health centres to cater for populations living five kilometres away, an outreach strategy for those living 5-15 km away and mobile teams for those beyond 15 km of a health centre. The last strategy assumes that cars, cold chains, vaccines and trained manpower are available. It also compels UNICEF to ensure the communities participate in the programmes, a health official working on this strategy told IRIN. Since 2000, UNICEF has also successfully used the "Cure Salee" or "salt cure" festival, an annual ceremony held by the nomadic tribes in September, as a one-stop opportunity to vaccinate nomadic children who gather in the remote northern town of In Gall for the celebrations. More creative options are being looked at. UNICEF is writing a booklet on planning in nomadic areas that shows when and where nomads move, where they settle and where they go to the market. UNICEF is also discussing with local leaders who have suggested the use of camels and donkeys to carry vaccinators to distant villages. Health care is a major concern for President Mamadou Tandja's government. Niger is ranked the second poorest country in the world on the UNDP human development index. Only 48 percent of its 11 million people have access to health care - mostly those who live less than 10 km from a health facility.