“ Causes of Non - Polio Acute Flaccid Paralysis in Children Residing in the Province of Sindh ”

OBJECTIVE: To determine the frequency of the causes of non-polio acute flaccid paralysis in the paediatric population of Sindh. STUDY DESIGN: descriptive/ cross sectional survey. SETTING: it is a community based study carried out in all the districts of the province of sindh from the year 2000 – 2009 METHODOLOGY: The study included all cases of acute flaccid paralysis (AFP) aged 0<15 years, residents of sindh who were picked up during the active AFP surveillance of the community as a part of polio eradication initiative.AFP was diagnosed clinically through history and examination as per definition of the WHO. Stool examination for viral isolation was done in all cases while appropriate laboratory tests including serum electrolytes, cerebrospinal fluid (CSF) examination electrophysiological and radiological studies were done in most cases where required. The final diagnosis was based on the available clinical data, vaccination history, epidemiologic data for the province/ district and laboratory results. Data were analyzed using EPI Info V2 of windows. Results were described in frequencies / percentages. RESULTS: A total of 7891 cases of AFP were reported during the study period. 7555 cases were diagnosed as non-polio AFP. The most common cause of non-polio AFP identified in this series was GBS (21%) closely followed by hemiplegias and encephalitis / meningitis present in 20.7%, 7.06% of cases respectively. 35.7% of cases consisted of miscellaneous causes not coded by the WHO for line listing. The analysis of the other causes of nonpolio AFP revealed that the group of problems related to the peripheral nervous system (PNS) topped the list followed by joints and central nervous system disorders. The comparison of the other causes of non-polio AFP before and after the introduction of the liberal policy for AFP surveillance showed the increased reporting of pseudoparalysis specially related to the skeletal system rather than the true acute flaccid paralysis. The age group affected most by AFP belonged to 0 < 5 years (71%) with 2-< 5years being the group affected most. CONCLUSION: The study confirms GBS as the most common cause of AFP in the <15 years population of Sindh. The reporting of cases having pseudoparalysis is quite high.