Traumatic Injection Neuritis and Acute Flaccid Paralysis Surveillance in Nigeria
Background: Acute Flaccid Paralysis (AFP) surveillance is one of the main strategies for eradicating polio. There are many causes of AFP including infectious, autoimmune, and acquired causes. Traumatic Injection Neuritis (TIN) is an iatrogenic condition caused by unsafe intramuscular (gluteal) injection practices leading to different forms of clinical manifestations ranging from mild paresthesia to paralysis of the foot and permanent sequelae.
Objective: The objective of this study is to highlight the burden of TIN as a cause of AFP as well as to determine the epidemiological profile of TIN cases reported in Nigeria in 2018.
Materials and Methods: A retrospective study to determine the initial presenting diagnoses of reported AFP cases in Nigeria was conducted from January to December 2018. Analysis of the 2018 AFP database at the World Health Organization County Office (WCO) was conducted to determine the presumptive diagnoses of reported AFP cases and their epidemiological profile (age, sex, status of oral polio vaccination, location and period of onset of paralysis) of those with TIN.
Results: A total of 9,410 AFP cases were reported in 2018. The number of AFP cases with presumptive diagnosis was 2,938 (31%). Of the 2,938 cases with presumptive diagnoses, the majority, 832 (29%) were due to TIN. The Male to female ratio of TIN case was 3:2. The majority of TIN cases i.e., 72% belonged to age group between 1 to 5 years. The oral polio vaccination status of TIN cases showed that up to 96% had ≥3 doses of OPV. Most of the TIN cases i.e., 60% were from the northern zones of the country. Most TIN cases i.e., 57% occurred during the months of June to October 2018.
Conclusion: Traumatic Injection Neuritis is a significant and preventable health problem in Nigeria. Children under the age of 5 are most commonly affected and concerted efforts are needed by all levels of health care delivery and the community to address the problem.