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Post Integrated Measles Campaign and Routine Immunization Coverage Evaluation Survey 2011

Ifakara Health Institute, (I.), Ministry of Health,Tanzania, (M.), World Health Organization, (W.) and American Red Cross, A. (2012) Post Integrated Measles Campaign and Routine Immunization Coverage Evaluation Survey 2011. Technical Report. Ifakara Health Institute. (In Press)

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Abstract

The United Nations Millennium Development Goal 4 (MDG4) aims for a two-thirds reduction in mortality among children aged, 5 years in 2015 as compared to baseline in 1990. Measles is one of the most contributors to under five child mortality. The estimated measles-related mortality among children aged, 5 years worldwide however has been steadily under decline since in 1990 (86% reduction). Routine childhood immunization with measles vaccine is recommended as an effective intervention to reduce mortality due to measles. The Expanded Programme on Immunization (EPI) in Tanzania routinely vaccinates intants at birth with Bacillus Calmette-Guérin/Bacille Calmette-Guérin (BCG) for protection against turbeculosis and Oral Polio Vaccine (OPV) against polio viruses. At one month, two and three months later of life other rounds of vaccination against polio (OPV1, 2&3) and difteria, pertussis, tetanus, hepatitis B and hemophilus influenza viruses (DPT-HepB-Hib vaccine) are conducted. Finaly at nine months of infancy measles vaccine is olso given. Despite global support to increase coverage of routine vaccination with six targeted antigens against infants’s illness, the national coverage of these antigens is still not optimal. Few unvaccinated children who normaly miss the routine immunization are expected to carry dangerous strains of infections. In the vaccinated group there is another few children whose immunity may not respond well with given vaccine. It is due to these reason the programme considerered an intergrated measles campaign in order to give a second opportunity to those who were missed during the routine immunization and those who got the vaccine but couldn’t seroconvert. Here we report the intergrated measles campaign (IMC) coverage evaluation for the campaign that was conducted in November 2011. This evaluation was conducted by Ifakara Health Institute (IHI) in the aftermath of the campaign. The evaluation was to document the campaign coverage in terms of target antigens; measles and bOPV. The evaluation was also aimed to document essential indicators for routine immunization coverage in children between 12-23 months and tetanus coverage among reproductive age women with children below 11 months on the date of survey. This survey was designed to specifically answer the following objectives: I. To determine the measles and bOPV vaccination coverage II. To determine the reason why children missed were not vaccinated and source of information III. To determine the status of routine vaccination coverage of children 12-23 months and the reasons for not completing the vaccination schedule; and IV. To determine tetanus toxoid vaccine coverage of mothers with children aged 0-11 months. In November 2011 following a four days nationwide IMC in 21 regions in the mainland Tanzania and 2 on the Zanzibar islands a sample of 300 enumeration clusters (villages) per region were surveyed. Survey was conducted such that in each cluster nearly 14 children or mother/care takers were interviewed during the survey that was completed at the household level. Children under five years who were 0-59 months at the time of survey represented age group for campaign population in which bOPV and measles was evaluated. Furthermore this evaluation provided opportunity to document coverageof other antigens that are immunized through routine immunization in children between 12-23 months who werethe representative age group. In the reproductive women, this survey also mapped coverage of tetanus toxoid (TT) immunization in mothers that gave
birth to children less than 11 months at the time of 2011 campaign. There were11695 children available to be evaluated for measles and bOPV vaccination. Among all children 8,066 (91.6%) with 95% confidance intervals (CI; 90.9-92.1) aged between 9 to 59 months (with their mothers/care takers) and were seen by the survey teams to confirm that have been vaccinated with measles vaccine during the campaign. The bOPV coverage was 10,622 (90.8%) with (95% CI; 90.3-91.3). The overall campaign coverage was high on the Zanzibar islands( 96%). The three leading regions in coverage of both antigens were Kagera, Shinyanga and Arusha. The main source of information was community leaders and health care workers in all regions except in Rukwa were health workers highly dominated. Under the routine immunization, information was available for a total of 9,132 children who were between 12 to 23 months old. Overall 75.7% retained vaccination cards. Tabora region had high cards retention rate of nearly 99.8%. Nationwide 90.1% children were fully immunized (with 95% CI; 86.5% - 93.8%) through card and history. The valid immunization coverage was 63.7% with (95% CI; 57.4%-71.2%). The overall crude immunization coverage was BCG 98.6%, [DTP-HepB-Hib1] 97.1%, [DTP-HepB-Hib3] 95.1%, [OPV1] 96.6%, [OPV3] 91.9% and Measles 95.1%. while valid immunization coverage was BCG 98.0%, [DTP-HepB-Hib1] 31.2%, [DPT-HepB-Hib 3] 25.4%, [OPV1] 32.4%, [OPV3] 23.4% and Measles 58.5%. The countrywide drop-out rate was 1.8%. Shinyanga and Ruvuma are the two regions with high drop-out rates with Shinyanga leading top by 10.9%. The ability to target children below one year was above 80% across regions with exception of Pemba, Rukwa and Ruvuma. The main three reasons given by mother or caretakers whose children were found not vaccinated wasthe fear of child to get side effects 23%. This was the main perceived leading problem in Ruvuma 8.9%, Mwanza 8.8% and Rukwa 5.7%. The crude tetanus vaccine coverage for women with infancy was 93.6% for TT1 while crude TT2+ was 65.7%.The 2011 IMC was completed on time (12-15 November 2012) and coverage of both campaign and the routine immunization has been evaluated from 16-20th November 2011 across Tanzania. In IMC both antigens (measles and bOPV) the coverage was above 90% and slightly high on the Zanzibar islands. A stratified coverage by regions in both antigens was above 85% with exception of Tabora and Rukwa regions. The campaign coverage rates have improved as compared to those recorded back during the 2008 survey. The 2011 survey was a follow-up campaign after the 2008 integrated measles campaign that recorded nearly 80.6% of all vaccination in both antigens. The main source of information was community leaders and health care workers almost in all regions except in Rukwa were the most prevalent source of information was health care workers. There were 4% of children that reported to have Adverse Events Following Immunization (AEFI). All these cases were mostly pain at the site of injection. Among the routine immunized 9,132 children 4,684 (51.3%) were male and 4,448 (48.7%) females. The crude country rate was 90.4% whereas the valid one was 62.9%. Across Tanzania, Rukwa region presented the lowest valid coverage of measles vaccine while Tabora was the most immunized region with 78.9% of measles vaccination. The overall card retention rate was 77.8% and significantly high in Tabora and still very low in corresponding Pemba (50.5%), again highlighting the required urgent serious level of programme intervention to improve immunization activities in this region. The crude tetanus vaccine coverage for TT1 in women with infancy was significantly high but very low in corresponding valid TT2+. The vaccination system access and management/utilization was nearly 1.8% whereas Shinyanga and Ruvuma were the two regions with high drop-out rates with Shinyanga leading top with 10.9%. The programme ability to target children during infancy was good with the exception of Pemba, Rukwa and Ruvuma; these regions were not able to reach a country benchmark of at least 80% immunization with measles vaccine. The immunization campaign activities are crucial programmatic milestone necessary to reach never-vaccinated children who might also have never had vaccine preventable diseases for them to develop sufficient natural active immune response in places where programmatic coverage is low. These campaigns are in particular important also to provide protection to a cohort of under-five who might have missed routine immunization of the target antigens or have had primary vaccine failure. These activities are therefore required to be systematically implemented and evaluated at the same time to guide progamme’s performance and forecast. The 2011 post campaign coverage evaluation has documented good immunization coverage across Tanzania both in bOPV and Measles. It has further documented an optimal vaccination system access and management/utilization for routine immunization. The evaluation has furthermore documented achievements in the programme’s ability to reach children with target antigens during infancy with the exception of isolated places like Pemba, Rukwa and Ruvuma; where more programmatic emphasis is therefore advised to be directed. It is therefore imperative to note here that, the programme has to maintain the achieved gains as documented in this report in order to reach the measles pre elimination goal the country has set forward.

Item Type: Report (Technical Report)
Keywords: Measles campaign, Immunization coverage, Under five child mortality, Evaluation Survey
Subjects: Health Systems > Surveillance, monitoring & evaluation
Maternal & Neonatal Health > Neonatal Health
Divisions: Ifakara Health Institute > Health Systems
Depositing User: Mr Joseph Madata
Date Deposited: 17 Jan 2017 12:48
Last Modified: 17 Jan 2017 12:48
URI: http://ihi.eprints.org/id/eprint/4029

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