title: Forewarning of poliovirus outbreaks in the Horn of Africa: an assessment of acute flaccid paralysis surveillance and routine immunization systems in Kenya.
abstract: BACKGROUND
  Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process.
  
  
  METHODS
  Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance.
  
  
  RESULTS
  Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level.
  
  
  CONCLUSIONS
  Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Allison Taylor
authors.initials: AT
authors.lastname: Walker
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Samir
authors.initials: S
authors.lastname: Sodha
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Wick C
authors.initials: WC
authors.lastname: Warren
authors.affiliation: World Health Organization, Kenya Country Office.
authors.forename: Kibet
authors.initials: K
authors.lastname: Sergon
authors.affiliation: World Health Organization, Kenya Country Office.
authors.forename: Shem
authors.initials: S
authors.lastname: Kiptoon
authors.affiliation: World Health Organization, Kenya Country Office.
authors.forename: John
authors.initials: J
authors.lastname: Ogange
authors.affiliation: World Health Organization, Kenya Country Office.
authors.forename: Abdi Hassan
authors.initials: AH
authors.lastname: Ahmeda
authors.affiliation: World Health Organization, Inter-country Support Team, East and Central Africa.
authors.forename: Messeret
authors.initials: M
authors.lastname: Eshetu
authors.affiliation: UNICEF Regional Office, Eastern and Southern Africa.
authors.forename: Melissa
authors.initials: M
authors.lastname: Corkum
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Satish
authors.initials: S
authors.lastname: Pillai
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Heather
authors.initials: H
authors.lastname: Scobie
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Rennatus
authors.initials: R
authors.lastname: Mdodo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Tack
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cara
authors.initials: C
authors.lastname: Halldin
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kristie
authors.initials: K
authors.lastname: Appelgren
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Kretsinger
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Bensyl
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Ian
authors.initials: I
authors.lastname: Njeru
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Titus
authors.initials: T
authors.lastname: Kolongei
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Juliet
authors.initials: J
authors.lastname: Muigai
authors.affiliation: Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Amina
authors.initials: A
authors.lastname: Ismail
authors.affiliation: World Health Organization, Inter-country Support Team, East and Central Africa.
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Okiror
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010243:Paralysis / Q000453:epidemiology* / Q000517:prevention & control*; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control*; D023321:Poliovirus Vaccines / Q000008:administration & dosage* / Q000600:supply & distribution; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D023321:Poliovirus Vaccines
keywords: decentralization; polio; program review; routine immunization; surveillance