ABSTRACT
Background: Routine EPI reports have shown an upward trend in immunization coverage in recent years in Ethiopia; however; regional disparities exist. Objective: To determine regional coverage of child and TT immunization and assess reasons for not utilizing immunization services. Methods: The revised 2005 WHO-EPI regional coverage cluster survey method was used to determine the sample size for the study. Regional immunization status of 12-23 months of children and mothers with 0-11 months of infants forchild immunization and TT immunization respectively were taken as the unit of analysis. A sample of 6;903 children between 12-23 months and 6;952 mothers with infants between 0-11 months from 468 clusters in 11 regions of the country were surveyed in June 2006. Results: The weighted national immunization coverage assessed by card plus history for children aged 12-23 months vaccinated before the age of one year was BCG 83.4; DPT1 84.3; DPT3 66.0; measles 54.3; and fully immunized children 49.9. The weighted national TT2+ coverage and rate of Protection at Birth (PAB) assessed by card plus history was 75.6and 63.0respectively. Conclusion: The survey showed a 10 percentage point of increment in DPT3 coverage compared to 2001 survey coverage. However; progress was not uniform in all regions of the country. Despite the improve-ment in the access to immunization in the country; DPT3 coverage was less than 30and dropout rate remained very high in three emerging regions. Effective behavioral change communication (BCC) strategies need to be designed and implemented to tackle high dropout rate in the program. Besides; health workers training program on interpersonal communication and Reaching Every District (RED) approach should be fully implemented to increase and sustain high level of immunization coverage in Ethiopia
Subject(s)
Child , Data Collection , Diphtheria , Ethiopia , Mass Vaccination , Pertussis Vaccine , TetanusABSTRACT
Background: Diarrhoeal disease is one of the major causes of morbidity and mortality in under five children.Worldwide; there are about 1.3 million under five children deaths attributable to diarrhea. Health status in Ethiopia is one of the lowest in the world with estimated health service coverage of 60; and diarrhoeal disease remains one of the major causes of under five morbidity and mortality. Treatment with ORS does not affect the duration and severity of diarrhoea; hence acceptance of ORS is low and diarrhoea still remains the major cause of child morbidity and mortality. Diarrhoea is a commonly associated problem in children with Zinc deficiency and also leads to excess zinc losses. Objective: To assess variations in the usage of antimicrobial and/or antidiarreals in children with acute watery diarrhoea randomized to receive zinc supplementation as compared to those who do not receive it; and assess the adherence to zinc supplementation given with ORS in the management of an episode of acute watery diarrhoea. Methodology: This is part of a multicentre; multi-disciplinary; randomized and open effectiveness trial conducted in out-patient settings in Addis Ababa; Black Lion Hospital at the Department of Paediatrics. The sample size has been calculated for a two-tailed alpha of 0.05 and power of 0.2. Children aged 2-59 months and who presented with acute watery diarrhoea for less than 7 days were recruited. Results: There were 188 children randomized to the Zinc plus ORS arm and 226 children to the ORS arm. There were 193 (46.6) females and 221 (53.4) males. Fifty two percent of the cases were between 2-11 months of age and decreasing trend of proportion of older children was observed in the study population (P=0.0001). Zinc adherence rate was 95. Seventy three (39.3) patients from Zinc + ORS group and 71 (32.3) patients from ORS group took ORS when they came for the first follow up visit (P-value=0.115). From the total study subjects 16.1took antibiotic or antidiarhael tablets before randomization which was significantly higher than the second follow up visit observation with only 1.7(P=0.0001). Only 3 (1.7) patients from Zinc arm and 4 (1.8) patients from ORS arms took antibiotic/anti diarrhoeal on the second follow up visits. Conclusion: Proper counselling of care takers significantly reduces unnecessary use of antibiotic/anti diarrhoea drugs in the treatment of childhood diarrhoea. Zinc supplementation in the treatment of childhood diarrhoea is well tolerated by patients and there is good compliance of care takers. However; we could not observe any significant difference in antibiotic/antidiarheal drug use between ORS and ORS plus Zinc groups