Little Karima held her father, Muhammad Nasiru’s arm, struggling to keep pace with him. Her flowing gown obscures her uneven gait –the way she swings one leg and limps with the other.

The father raised her gown as they walked some more, exposing her dusty legs from knee to ankle. One of Karima’s legs is stiff and bent.

Until mid-last year, Karima’s legs were straight, and she already walked well at one year and six months old. But her gait began to change. One of her legs had become stiff, and the little girl was limping.

At the time, the Surveillance Focal Person at the Primary Healthcare Centre, Kajiji, Shagari Local Government Area (LGA), Sokoto State, Mubarak Umar, suspected a case of polio. He took the girl’s samples –faeces and urine– and those of other children in the neighbourhood and sent them to the Ibadan National Polio Laboratory (Ibadan NPL) for a test.

Karima’s result came back positive for circulating Vaccine-Derived Poliovirus type 2 (cVDPV2), a strain of the Wild Polio Virus (WPV) currently endemic in Nigeria. The cVDPV2 is found among populations with low herd immunity. It has caused more polio cases annually than the wild poliovirus since 2017, according to the World Health Organisation (WHO).

Sokoto’s Polio burden

Although Nigeria had been declared polio-free since 2020, the country has battled the spread of the cVDPV2 variant in the North-west states, including Kebbi, Sokoto and Zamfara. The situation has persisted due to low routine immunisation coverage, population movement and vaccine hesitancy.

Mr Nasiru insisted all of his children, including Karima, were vaccinated and didn’t know how his daughter contracted the disease. But multiple sources, including immunisation officers and traditional rulers in the community, said Mr Nasiru’s household was known for rejecting vaccinations. Karima’s test results, seen by our reporter, indicate ‘unknown’ for all other vaccines she ought to have taken at that age.

The refusal of vaccines remains one of the biggest challenges facing the eradication of polio, the Sokoto State’s Immunisation Officer (SIO), Bashar Garba, told PREMIUM TIMES.

Although there have been more suspected cases in other LGAs, Mr Garba said vaccine hesitancy is more prevalent in metropolitan areas, comprising three LGAs — Sokoto North, Sokoto South and Wamakko. They have recorded the highest level of non-compliance in polio vaccine administration.

“There was a campaign we implemented in Kano and other northern states, and Arkilla Ward in Wamakko LGA emerged as the leading ward with the highest number of rejections and non-compliance,” he said, explaining how much of a problem the situation poses.

Vaccine hesitancy isn’t without a consequence. Last year, Sokoto recorded at least 20 cases of the cVDPV2. At least six of them were recorded in the Kajiji ward of Shagari LGA.

Community vanguards to the rescue

However, government- and citizen-led initiatives, including UNICEF-employed Volunteer Community Mobilisers (VCMs), traditional rulers, and other volunteers, have formed a line of defence in communities, helping to track and identify unvaccinated children and report suspected polio cases.

In Shagari LGA, for instance, Routine Immunisation (RI) providers have now increased immunisation outreaches to nearby villages from once to twice a week.

Abdullahi Liman, an RI provider at PHC Kajiji, said they used to administer routine immunisation at the hospital on Tuesdays and conduct outreach once a week.

However, since cases of cVDPV2 surged last year, all 28 providers covering over 200 settlements in Shagari LGA now conduct at least two outreach visits a week.

Another challenge is the manpower shortage, which Mr Garba said the state government was already addressing. According to him, some health workers were recently hired but have yet to be posted to health centres.

The RI providers also work with community leaders to ensure vaccine acceptance, sometimes setting up shop at the community leaders’ palaces.

One official who supervises immunisation data told PREMIUM TIMES that adding one more weekly outreach visit helped increase coverage in Shagari to 88 per cent last year, a feat he said would be impossible if they conducted only one outreach visit a week.

House-to-house campaign

One Friday morning in February, a group of women draped in blue Hijabs that carry inscriptions of Nigeria’s coat of arms on the left and UNICEF on the right, clutched vaccine carrier boxes, and marched through communities in Sokoto North LGA, in search of newborns and their mothers.

Their first stop was the Fakon Idi area, where they spread a mat under a tree and set up to attend to mothers and infants.

A mother, Asmau Adamu, presented her five-day-old, wrapped in several layers of clothes, to one of the women known as VCMs, an inscription boldly written at the back of their blue hijabs.

An RI service provider, Hafsat Isa, unlocked the vaccine carrier box, drew up doses into an injection and inserted it into the arm of Mrs Adamu’s child. She then opened the child’s mouth and dropped doses of another vaccine on his tongue. Before returning the child, another VCM scribbles something into a card presented by the mother.

Mrs Adamu collected her child and stood from the mat as another mother, Asmau Mustapha, took her place, presenting her own child to the VCM for a similar routine.

“They explained that the vaccines would prevent the child from having polio and other diseases,” Mrs Adamu told PREMIUM TIMES.

The VCMs are employed by UNICEF to help improve health outcomes, particularly on polio eradication and routine immunisation. They go house to house to enquire about the newborn, educate mothers on how to care for their children and check immunisation cards to tell parents when to take their children for another round of immunisation. On some days, like this Friday, they follow RI service providers for outreach to the communities.

Track, Report, Engage

Across Sokoto State, the VCMs and RI providers work with community leaders and influential figures to identify and track households that refuse vaccines.

Ms Isa, who works at the Primary Healthcare Centre Kofar Rini, Sokoto North LGA, said the VCMs are instrumental in tracking households that haven’t brought their newborns for vaccinations. They also note households that refuse vaccines and report them to community leaders.

“When we talk to them (the traditional leaders) and give them the names of the parents, they will go to the house and tell them to bring their children for vaccination,” she told PREMIUM TIMES. “Even when they want to reject vaccines, he’ll encourage them to do it.”

“Just days ago, there was someone who was reported to me for refusing the Polio vaccine for his children,” the district head of Fakon Idi, Aminu Muhammad, narrated. “When I met him and explained the importance of the vaccines, he succumbed and allowed the vaccination.”

Cash-for-vaccines

At PHC Kofar Rini, Tuesdays are now a beehive at the immunisation unit. New Incentives, a Non-Governmental Organisation (NGO), offers cash to mothers who bring their children for vaccination at the hospital or during outreaches.

“Every time my child gets a vaccine, I receive N1,000,” said Mrs Adamu, during an outreach at Fakon Idi.

When the children completed their doses, the mothers received an additional N6,000 as a lump sum.

“Since New Incentives came, the population has increased,” said Ms Isa, the official in charge of immunisation at the hospital.

“I used to hold Waziri B and C wards, and I get to immunise about 70 babies a day when New Incentives is around, but I didn’t get that much before.”

Ms Isa explained that the cash incentives are to help the mothers with transportation, in case that is a barrier to taking the vaccine.

But that too has its challenges. This cash-for-vaccine initiative also faces some criticisms, as some push the narrative that they are being paid to ‘sell their children’.

“We explain to them that it is to help them with transportation, because some people have spread false information about it,” said Ms Isa.

Why do they reject polio vaccines?

Vaccine hesitancy has a long history in Nigeria, particularly in the northern part of the country. One of the most notable causes of it was the 1996 Pfizer Trovan drug trial conducted in Kano during a meningitis outbreak. The trial failed and left close to a dozen children dead and many others permanently disabled. The episode would later serve as a fodder for a boycott of the polio vaccine campaign in the region a few years later.

The misinformation spread about the polio vaccine as containing ingredients that cause infertility or reduce populations have failed to die in 2026. Not only did the situation lead to a resurgence of polio cases at a time Nigeria was already making progress, but the mistrust sown continues to remain. In Sokoto, those who refuse the vaccines offered similar reasons, ranging from religious and personal beliefs to political reasons.

“Some will say the vaccines make children stubborn, and others will say the ingredients were made with monkeys’ blood and other things that are not lawful for a Muslim to eat,” said Mr Umar, the surveillance focal person in Kajiji.

A resident of Kajiji, Liman Jabi, now 65, said he also got sceptical and refused polio vaccination for his child at one point, even though his older children had received them.

“We started hearing that it causes infertility. Honestly, at the time, we got scared,” he recalled. “But I was able to dismiss that thought because all of my children who took the vaccine now have children of their own, and they are all healthy.”

In the course of his advocacy within the community, the community leader in Kajiji, Umar Umar, said some wondered why they were never given free drugs when they were sick, but had vaccines taken to their doorsteps.

“Some will say when the government is sharing things, it never gets to them except this vaccine,” he said.

Although Abubakar Sahabi now works alongside Mr Umar and other elders in the community to ensure every child is immunised, he too used to reject the vaccine.

“I used to turn the outreach officials back whenever they got to our doorsteps,” he admitted. “We were told it has ingredients that cause infertility.”

The last time the vaccine was rejected at his home, he was summoned to the community leaders’ palace for a meeting. “When I got there, they told me that the vaccines help prevent polio in children and that it doesn’t have any side effects. They did a lot of explaining,” he said.

“They even brought clerics to talk about it, not contradicting the teachings of Islam. They gave me an example of how vaccines were used to eradicate an illness that used to be prevalent among our grandparents. They told me that the only way to eradicate polio in our society is through vaccination.”

Now, Mr Sahabi is one of those who receive reports of households that refuse the vaccine and talk them into accepting it.

Challenges here, progress there.

“Though we are not there yet, the quality of our campaign has improved,” said Mr Garba, the state immunisation officer.

READ ALSO: INTERVIEW: Old narratives surrounding polio vaccines still haunt eradication initiatives in Sokoto – Official

He said the challenge has helped the state become better prepared and develop more effective ways of handling cases.

According to him, the digitisation of the state records is one of the biggest wins, as it eases the process of monitoring progress.

But some challenges, particularly about data quality, remain. Mr Garba said some of the immunisation officers, despite the rigorous process of hiring and training them, fail to report households rejecting the vaccines and sometimes even collude with them to report false positives.

“They will go to the households, collude with caregivers who refuse vaccination, finger-mark them with the assumption that anybody can just show them that we vaccinate,” he said.

“We need to have a very serious mindset change for people to understand that they need to tell the truth, just to help the community.”

However, at the community level, volunteers are winning souls for the polio campaign.

“These days, people are so aware that anyone calls me or the Disease Surveillance and Notification Officer (DSNO),” said Mr Umar, the Surveillance Focal Person in Kajiji

“There’s an uncle of mine who doesn’t allow polio vaccines, but I was able to convince him to allow it, and he agreed,” said Mr Sahabi, himself a polio vaccine reformist.

Many Nigerians who wake up unable to move, speak or call for help often describe the experience as a spiritual attack, saying “something pressed me” or “a witch held me down.”

However, health experts say the frightening phenomenon, known as sleep paralysis, has a medical explanation rooted in the brain’s sleep cycle and is often linked to stress, sleep deprivation and irregular sleeping patterns.

Speaking with PT Health Watch, Joshua Nnatus, a senior manager at Lagos MiND and a public health professional, explained that while the experience can feel terrifyingly real, it is a recognised sleep condition with a well-understood neurological basis.

When the brain wakes before the body

Mr Nnatus described sleep paralysis as a temporary inability to move or speak that occurs either while falling asleep or, more commonly, while waking up.

“It is classified as a parasomnia, one of the sleep-related experiences recognised in the American Psychiatric Association’s DSM-5 and the International Classification of Sleep Disorders,” he said.

He explained that the condition is closely tied to rapid eye movement (REM) sleep, the stage of sleep associated with vivid dreaming, which typically accounts for about 20 to 25 per cent of an adult’s sleep cycle.

During REM sleep, the brain activates a protective mechanism called REM atonia, which temporarily switches off voluntary muscles to prevent people from physically acting out their dreams.

Normally, this muscle “off-switch” ends immediately upon waking. However, in sleep paralysis, the transition between sleep and wakefulness becomes misaligned.

“The mind becomes awake and aware before the muscle switch has been turned back on,” Mr Nnatus said.

As a result, the person is conscious, aware of their environment, but unable to move or speak. Breathing and eye movements remain unaffected, which is why people can still look around and breathe normally despite feeling completely “frozen”.

Episodes typically last from a few seconds to a couple of minutes and resolve on their own.

A common but misunderstood experience

Although many people are reluctant to discuss it, sleep paralysis is relatively common.

Research suggests that a significant proportion of people experience at least one episode during their lifetime, particularly adolescents, university students and young adults who are exposed to high levels of stress, sleep deprivation or irregular sleeping schedules.

Because the experience is often sudden and frightening, it is frequently misunderstood and interpreted through cultural or spiritual beliefs.

Why it feels like a spiritual attack

Mr Nnatus said the experience is often interpreted as supernatural because several frightening sensations occur at the same time.

The first is the sudden loss of control, which triggers intense fear. Second is the persistence of dream-like activity in the brain, which produces vivid hallucinations.

These may include sensing a presence in the room, seeing a figure, feeling pressure on the chest, or believing something is sitting on or holding the body down.

He added that the brain’s fear-processing centres remain highly active during REM sleep, which amplifies panic and makes the experience feel extremely real.

“The result feels absolutely real because, in a neurological sense, it is real to the person experiencing it. It is not imagination, and it is not a sign of madness,” he said.

Across cultures, similar experiences have been explained through spiritual beliefs.

In parts of Europe, it has been described as the “Old Hag” phenomenon. In some Middle Eastern traditions, it is linked to Jinn. In parts of China, it is associated with ghost oppression.

In south-west Nigeria, it is widely referred to as ogun oru, interpreted by many as nocturnal spiritual attack, while others describe it as a witch “pressing” the body during sleep.

Mr Nnatus said these interpretations reflect cultural frameworks, but the underlying process remains the same across populations.

Stress, disrupted sleep and lifestyle factors

According to Mr Nnatus, the strongest trigger for sleep paralysis is disrupted sleep.

Common risk factors include sleep deprivation, irregular sleep schedules, late-night studying, shift work, and constantly changing sleep routines.

He noted that stress and anxiety, particularly among students and young professionals, significantly increase vulnerability.

Other triggers include sleeping on the back, caffeine or alcohol close to bedtime, jet lag, and prolonged screen use at night, which delays sleep onset.

Mental health conditions such as anxiety, depression and post-traumatic stress disorder may also increase the likelihood of episodes.

In some cases, sleep paralysis occurs alongside narcolepsy, a neurological sleep disorder characterised by excessive daytime sleepiness and sudden sleep attacks.

He added that research suggests a possible genetic component in some individuals.

When it becomes a concern

Mr Nnatus stressed that sleep paralysis is not physically dangerous.

He, however, said repeated episodes can lead to significant distress, including fear of sleeping, anxiety and poor-quality rest.

He advised medical attention if episodes become frequent or are accompanied by excessive daytime sleepiness, or sudden uncontrollable sleep episodes during the day, symptoms that may suggest narcolepsy.

“That pattern is a core warning sign and should be properly evaluated,” he said.

Managing and reducing episodes

Mr Nnatus recommended maintaining consistent sleep and wake times, ensuring adequate sleep duration, and reducing stress levels.

Limiting caffeine and alcohol intake in the evening, reducing screen exposure before bedtime, and improving sleep environment can also help.

According to sleep health guidance from the US Centres for Disease Control and Prevention (CDC), adults require at least seven hours of sleep per night for optimal health.

He also noted that sleeping on one’s side may reduce the likelihood of episodes in people who are prone to them.

For people experiencing frequent or distressing episodes, Mr Nnatus said support and referral services are available through Lagos MiND’s Lagos Lifeline on 070 0000 6463, 020 1410 6463, or via WhatsApp on 090 9000 6463.