Nigeria's polio cases have increased dramatically this year as officials struggle to fight an outbreak set off by the polio vaccine three years ago. Gilbert da Costa looks at a new community-based drive to eradicate the crippling disease in this background report from Kano.

A grassroots mobilization initiative, the Community Participation for Action in the Social Sector, known as COMPASS, a United States Agency for International Development-funded project, is promoting oral polio vaccines and changing long-held suspicions in polio-endemic northern Nigeria.

Using a community coalition model COMPASS has succeeded in raising awareness and acceptance of vaccines in some of Kano's conservative, rural communities.  Kano accounts for nearly 40 percent of all new polio cases in Nigeria.

Dr. Kelvin Chukwuemeka runs the government-owned Gaya General Hospital, 64 kilometers from Kano.

"Polio has been a major issue and we have been getting some cases. This week we even got one, about two days ago," Chukwuemeka said.  "The trend has been going down because the awareness has been created through people like the community coalition, the advocacy is being carried out very well.  Before now, people used to attribute it to juju or some spirit and things.  But they have come to realize it is something that can be prevented and they can get help."

Grassroots-based community coalitions, have rallied support for polio immunization and galvanized low-income local communities to improve health facilities and services.

Halima Wada, who is in charge of the post-natal clinic at Gaya hospital, says insecticide-treated bed nets were provided as incentive for mothers to bring their children for immunization.

"If the mother is attending immunization three times or she comes for the last dose, we provide net for her baby," Wada explained.  "COMPASS are the ones that provide the nets to give to mothers.  Because of these nets, they are coming to the hospital.  Before, they were not agreeing to the immunization."

A polio advocacy worker in Kano, Aminu Ahmed, was paralyzed by the disease at an early age.  These days, he works part-time with vaccination teams trying to make inroads in conservative Kano neighborhoods.

"Most of the times we tell the people, 'Do you want your son to be like me?'  If you say 'Yes', we will leave you.  If you say 'No', I will say, 'Give your children to be immunized," Ahmed said.

Polio eradication efforts have been further boosted by the requirement that polio vaccines must be administered to Muslims from polio endemic countries before they are allowed into Saudi Arabia for Islamic pilgrimage.

More than 100,000 Muslims from Nigeria visit Saudi Arabia for pilgrimage every year.  Umar Bello is the chief imam of Gaya local government in Kano state.

"The commissioner and director told us that no one can go to Mecca except they take polio," Bello said.  "Even they showed us pictures of some [pilgrims] from Afghanistan, Pakistan taking polio [vaccines].  As we heard this, most of us must go to Mecca to perform our Haj, so now we accept [vaccines]."

Polio Campaigners are pleased with the progress in breaking down barriers in the previously inaccessible northern Nigeria.

"My name is Dr. Lola Mabogunje. I am the regional field activity director for COMPASS polio.  I am in charge of eight states that are high risk to polio," the doctor explained.  "The communities are now renewed.  In every mosque now, every Friday they will announce the importance of immunization.  At every [child] naming ceremony they do the announcement and they actually pray for the eradication of polio.  Which means something is being done by the communities.  I am quite impressed about that."

Polio is a viral disease that can damage the nervous system and cause paralysis.  The disease is preventable by immunization.  The World Health Organization has listed Nigeria, India, Pakistan and Afghanistan as the only polio-endemic countries in the world.