‫ﺑﺴﻢ اﻟﻠﻪ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ‬

University Of Kassala
Faculty Of Medicine and Health Sciences
Department of Community

Assessment of second Outbreak of Poliomyelitis disease in children

under five years old in Kassala state ,Sudan2020.

prepared by:‐
Zahir Osman
Remaz Mouhamed
Alryan Almakey
Rouida Salh
Ryan AbdAllah
Randa Hatim
Ryan Hussein
Roaa Alamin
Ryan Magd Aldein
Ryan Jabir

Supervise by :‐
Dr. Rabab Mohamed Haj Hamed Ahmed
1.1.Introduction:‐

Poliomyelitis is human enterovirus disease with serotype 1, 2 or 3.Most of

people infected have no symptoms .Paralytic poliomyelitis is rare outcome and
occurs when polio virus enter the central nervous system.1 Some viruses -as
old as our existence - have been present since the rise and fall of great empires,
poliomyelitis is one of it. The oldest records of its existence data back to 2nd
B.C. In 20th century occurred the massive polio epidemic in history which
killed the half a million a year, before discovery of vaccine in 1995.2
Pattern of polio depend upon the degree of the socioeconomic development
and health care services of a country . According to WHO 3 epidemiological
patterns have now been delineated: countries with no immunization ,countries
with partial immunization and countries with almost total immunization
coverage.3Moreover the number of countries with epidemic polio reduced from
125 to just 3 countries in 2017(Nigeria, Afghanistan, Pakistan).1

There are two types of vaccination to prevent person to person transmission :

first , injected polio vaccine "Salk" which given to children of age 2, 4, 6 and 18
months and 4 - 6 years old .Also for adult who travel to countries where the risk
getting polio is high. second, oral polio vaccine (OPV)"Sabin" the child receive
the vaccine as drop in mouth .It vaccine of choice to control polio.4
several WHO Regions have been certified polio-free, including the Americas
(in1994)the Western Pacific Region (in 2000), the Euro- peen Region (in 2002),
and the South-East Asia Region, which includes the Indian subcontinent and
Indonesia (in 2014).5
Sudan initiated poliomyelitis eradication activities at 1994 in its northern part
and followed through in 1998 in the southern part. As a result, there was
significant progress in implementing poliomyelitis eradication strategies, with
no cases reported from May 2001 until April 2004.a case of wild poliomyelitis
was detected in Sudan in May 2004 and it was found to be imported from
Nigeria through Chad. This initiated an outbreak that spread to give a total of
128 cases were reported in 2004 and 27 additional cases in 2005.6
On 9 August 2020, the Federal Ministry of Health, Sudan notified WHO
of the detection of a circulating vaccine-derived poliovirus type 2
(cVDPV2) in the country.the virus is genetically-linked with Chad.Two
Acute Flaccid Paralysis (AFP) cases were notified. The first case, a child
of 48 months, had onset of paralysis on 7 March 2020 and was from
Sulbi city of Kas locality in South Darfur state.The second case, a child
of 36 months, had onset of paralysis on 1 April 2020 and was from Shari
city of AI Gedarif locality in Gedarif state in the east, close to the border
with Eritrea and Ethiopia. Both children received the their last bOPV (
type 1 " 3) dose in 2019.Cases in the following states – Red Sea, West
Darfur, East Darfur, White Nile, River Nile and Gezira have been
reported. Hence, between 9 August and 26 August 2020, there have
been a total of 13 cVDPV2 cases reported.7And in kassala state there
are cases too.One in west kassala (Maloyia) and others in kassala
locality in (Alsalam 16 & AlKahtmia Algadima).

Detection and control of emerging infectious diseases in there

sudden outbreak are major challenges due to multiple risk factors
known to enhance emergence and transmission of infectious
 diseases.

1.2.Justification:‐

we choose this topic to know the causes of this sudden outbreak of

poliomyelitis after 15 years free of case of polio in Sudan. poliomyelitis disease

is important especially among children because it cause paralysis and affect

their daily activity.Ignorance of this new outbreak well make this viral disease

an endemic agin , especially among under - immunized population . And in

Sudan and especially in kassal state the low economic status means almost all
population have low immunity particullary the children . So studying this

outbreak help to identify either it wild polioviruse breakout like what happened

in 2004 - 2005 or it vaccine- derived poliovirus to make the proper prevention

and control methods againest this disease among children . detection of serotype

of viruses if it vaccine derived poliovirus give an idea of suitable vaccine also

to improve the effectiveness of vaccine.

2. Objectives:

2.1.General Objectives:‐
To study the second outbreak of poliomyelitis disease in Kassala state .Sudan
2020 ‐ 2021.

2.2.Specific Objectives:‐

1.To identify the role of vaccine in the outbreak in Kassala state ,Sudan 2020 -
2021.

2. To determine the socioeconomic and cultural factor that enhance this

outbreak in Kassala state ,Sudan 2020 - 2021.

3. To explain the existing association between Kassala mothers’ level of

education, and the odds of getting their children vaccinated against polio.

4. To explain the percentage of each reason that Kassala mothers living either in
rural or urban areas provided for not getting their children vaccinated

.Materials &Methods:-
3.1.study area:

Kassala state is one of the 18 states of Sudan. It is located in eastern part of the
country and has an estimated population of approximately 1,800,000.8 Kassala
city is the capital of the state. Kassala State together with the Red Sea and
Gedaref states share a number of characteristics historically, ethnically, socially
and politically. Kassala State has a total population of about 1.5 million people.
One fifth of this population concentrated in Kassala Town and the annual
growth rate of the entire population stands at around 2.5%. The average
household size in the state is 6.2 persons with a significant number of female-
headed households in rural areas as urban economic migration increases. With a
total area of 55,374 km2, Kassala State lies between latitude 34º 12' E and 36º
57' E, and between longitude 14o 12' N and 17o 12' N. The state shares an
international border with Eritrea to the East, and nationally, it borders Red Sea
State and River Nile State to the North, Gezira State to the West and Gedaref
State to the South. The state is composed of eleven localities (mahaliyas) of
which nine are primarily rural in composition while the two localities of Kassala
Town and New Halfa are urban centers.9
3.2.study design:

Across-sectional(quantitative and qualtitative)study will be conducted

during November 2020 to Jaunary2021 among children under five

years old in Kassala State Sudan.

3.4.Study population:

The study population will be selected of children under five years old of

Kassala state,(west kassala (Maloyia) & kassala locality especialy ALsalam 16

& ALKhatmia AlGadeema), Sudan.

3.3.sample size determination:

The sample size will be calculated using the following formula;

..................................................................

3.5.methodology:

A self-designed questionnaire containing quantitative and

qualtitative questions will be developed and asked to the mothers of
the children. The demographics, mean knowledge, attitude, and
practice of the participants will be investigated.
3.6.Ethical Consideration:

Permission to carry out the study will be taken from the health research ethics
committee, ministry of health, Kassala state and Kassala university committee
board.
3.7.data analysis:

Statistical analyses will be performed using SPSS, version 22.

Knowledge, attitude, and practice scores will teste for normality of
distribution using a one-sample Kolmogorov Smirnov test.
Measurement data will expressed as mean ±SD and categorical
data will have expressed as frequency and percentage. Parametric
tests (t and ANOVA) will use for comparison between different
subgroups of the participant's pre-intervention. Comparisons of KAP
scores among the mothers with respect to gender, religion, and
age-category are done using independent samples t-test and one-
way analysis of variance (ANOVA), as appropriate. The statistical
significance level of the test will be expresses as α=0.05.
4.Time table:

20Oct - 2Nov- 7Nov- 25Nov -10

Activities 1Nov 6Nov 25Nov Jan

proposal writing
proposal approve

Ethical clearance
Inform local
authorities
data collection
data analysis
thesis writing

submission

5.Budget:‐
Items Break down Cost /SDG

Preparation of the 100 paper × 20 2000

questionnaire

Data collection & 1500 1500

transportation
Data processing & analysis 5000 5000

Report writing & print out 60papers ×80 4800

Others 1200 1200
Total 14500 SDG
6.Referance:‐
1‐World Health Organization Surveillance Vaccine Preventable 18 polio R2 ,last
update september 5,2018.

2- Ochmann S, Roser M. Polio. Our World in Data.( 2017) Oct 10. Published
online at Our WorldInData.org

3‐Dr.Rasha Salma .PhD community medicine ,paper sheet in epidemiology of

polio.

4- Wu Z, McGoogan JM. Characteristics of and important lessons from the

coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report
of 72 314 cases from the Chinese Center for Disease Control and Prevention.
Jama. (2020) Apr 7;323(13):1239-42.
5‐ World Health Organization. Polio Global Eradication Ini‐ tiative. Annual
report 2015. Geneva: WHO; 2016.
6‐The Pan African Medical Journal. 2019/ Imported outbreak of poliomyelitis in
Sudan 2004‐2005.
7‐Torresi J, McGuinness S, Leder K, O’Brien D, Ruff T, Starr M, Gibney K.
Immunisation. InManual of Travel Medicine 2019 (pp. 19‐169). Springer,
Singapore.
8‐Mahgoub F. Current status of agriculture and future challenges in Sudan.
Nordiska Afrikainstitutet; 2014.
9‐Hamad OE, El‐Battahani A. Sudan and the Nile basin. Aquatic Sciences. 2005
Mar 1;67(1):28‐41.