Abstract

Background: Nigeria, a country of about 200 million people is one of the three polio-endemic countries in the world. The last case of WPV and cVDPV2 had onset of paralysis on 21st August 2016 and 28th October 2016 respectively. Surveillance for cases of Acute Flaccid Paralysis (AFP) is one of the four strategies designed to eradicate polio. AFP surveillance is a syndromic reporting strategy in which all cases of sudden weakness/paralysis of the limbs of children less than 15 years of age or in anyone in whom a clinician suspects polio disease are reported and investigated rather than just reporting ‘suspected cases of poliomyelitis’. Polio is only one out of the many causes of AFP. AFP is thus a complex clinical syndrome with a broad array of potential etiologies. AFP surveillance in Nigeria is sensitive and an average of 12,000 AFP cases have been reported annually in the last five years. Physiotherapists provide evaluations, treatment and rehabilitation to individuals with physical disability including AFP cases. Physiotherapy management primarily focuses on movement, reduction of pain, preserving, developing and restoration of physical function, and prevention of disability. Despite ample evidence of effectiveness of Physiotherapy in the management of AFP cases, many of such cases continue to live with physical disabilities in most communities in Nigeria due to poor knowledge and access to such services. In order to reduce long term complications, timely access to physical therapy is advocated for all AFP cases to enable them participate fully in school life and contribute to other socioeconomic development of their communities. Objectives: The objective of this study is to determine whether there is adequate access to Physiotherapy services for AFP cases; and also to identify major barriers to obtaining optimal Physiotherapy services in Nigeria. Methods: We conducted a retrospective review of reported AFP cases in Nigeria in 2016 from the AFP database at the World Health Organization Country Office. We also obtained the distribution of health facilities that provide Physiotherapy services and institutions that train Physiotherapists in the country from the Medical Rehabilitation Therapists (Registration) Board of Nigeria. We conducted analysis of the data to identify any skewing of the distribution of Physiotherapy centres and Physiotherapy training institutions in the various geopolitical zones as this relates to the burden of reported AFP cases. We also conducted literature search on the role of Physiotherapy in the management of physical disability including cases of AFP. Results: A total of 17,840 AFP cases were detected in the country in 2016. Although there is variation in the number of AFP cases reported by geopolitical zones of the country, most of the AFP cases were reported by the three northern zones. The number of Physiotherapy centres in the country as at 2016 was 143. There was a marked skewing in the distribution of physiotherapy centres in the country (Table1). The mal-distribution of physiotherapy centres is at the disadvantage of the northern zones of the country that reported most of the AFP cases. Conclusion: There was poor access to physiotherapy services for cases of Acute Flaccid Paralysis in Nigeria. Although the number of Physiotherapy centres and training institutions was generally inadequate in the country, more of such centres and training institutions were located in the southern geopolitical zones of the country at the disadvantage of northern zones that reported most of the AFP cases. Timely provision of access to physiotherapy services to AFP cases will go a long way to reducing long term complications as well as enable AFP cases participate fully in school life and contribute to other socio-economic development of their communities.