Immunization service availability and readiness in primary health care in pastoral and semi-pastoral CGPP Ethiopia implementation districts

Background: The availability of immunization services and the readiness of skilled health workers in health institutions to deliver potent vaccines to end users when required to do so are important inputs that contribute to the reduction of child morbidity and mortality from vaccine-preventable diseases(VPDs). Objective: Assess immunization service availability and readiness in primary health care units (PHCUs) in pastoral and semi-pastoral regions of CGPP Ethiopia implementation districts. Methods: A facility-based cross-sectional survey was employed on 14­23 August 2016 in all health centers (HCs) and three randomly selected health posts (HPs) in each HC catchment area in 85 CGPP implementation districts. An observation checklist was filled in by trained data collectors for all study PHCUs. Results: Immunization service availability and service delivery, based on 19 tracer items ,were assessed in 860 PHCUs in both pastoral and semi-pastoral areas. In total, 92%of the PHCUs reported providing an immunization service. However, only 18.1% of the PHCUs were observed and 32.4% reported providing immunization on the day data were collected. Overall,immunization service readiness was 56.6%: 85% of the HCs and 46.6% of the HPs were ready for immunization service over the study period. The proportion of PHCUs found to have functional refrigerators was 65%. Conclusions and recommendations: Great variability observed in terms of service readiness among HCs and HPs in this study. All PHCUs should be equipped with functional refrigerators that are regularly maintained; all immunization antigens and schedule immunization services should be available at the PHCUs daily to avoid missed opportunities; cold chain managers/immunization service providers should be given supervisory support to ensure that they record refrigerator temperatures

Healthcare workers readiness to provide immunization services at primary health care units in pastoral and semi pastoral regions in Ethiopia Core Group Polio Project implementation areas

Background: Ethiopia has been implementing immunization programs for the past four decades. However, coverage remains low, especially in pastoral and semi-pastoral regions. Among the obstacles to achieving immunization targets is the level of health workers' readiness to provide immunization services, measured in terms of levels of motivation, capacity and involvement. Objective: To assess the extent of health care providers' readiness to provide immunization services at primary healthcare units in pastoral and semi-pastoral areas of Ethiopia. Methods:A cross-sectional survey was conducted on a sample of 1,283 healthcare providers involved in immunization services in 233 health centers, and 699 health posts in the health center catchment areas. From five CORE Group Polio Project intervention regions in Ethiopia, interviews were held with personnel in each health center ­an Extended Program on Immunization focal person, a midwife, and the medical director or head. From each health post, interviews were held with one health extension worker. Data were collected using a self-administered questionnaire facilitated by woreda and zonal health and CORE Group staff. The outcome variable of interest, readiness, was measured using three indicator variables­high to very high levels of self-reported motivation and involvement in immunization service provision, and having received at least one immunization-related training in the last two years. In addition to health care workers' background characteristics, where workers were based ­in pastoral or semi-pastoral areas ­ were included as factors for readiness. Data were entered into EpiData and exported to STATA version 12 for analysis. Binary logistic regression was used to identify independent factors associated with readiness, and p<0.05 was used to declare statistical significance. Results: Among health center respondents, those with a diploma were 2.3 times more likely to be ready compared to those with a first degree. Similarly, nurses and those who claimed higher satisfaction with supportive supervision were 2.1 and 6.2 times more likely to be ready to provide immunization services compared to midwives and those with a medium level of satisfaction, respectively. Among health post staff, being female (AOR=2.2), having more than five years of work experience (AOR=2.2) and having a high level of satisfaction with supportive supervision (AOR=4.5) showed higher readiness levels compared to males, those with less than or equal to two years of service, and those with a medium level of satisfaction, respectively. Conclusions: To ensure health care workers' readiness to provide immunization services, providing ongoing in-service training and improving supportive supervision, particularly for men in health posts, should be prioritized

Child vaccination timing, intervals and missed opportunities in pastoral and semi-pastoral areas in Ethiopia

Background: Immunization is one of the most powerful and cost-effective public health interventions. Most vaccines in the immunization schedule require two or more doses to trigger adequate immune response; appropriate timing, proper interval between vaccine doses, and completion of all vaccine doses are important to attain optimal protection. Objective: To evaluate and identify factors associated with the timeliness of vaccine doses; assess the interval between vaccine doses; and identify missed opportunities amon children aged 12 to 23 months. Methods: A cross-sectional descripive study was conducted that employed the 30 by 10 modified WHO immunization coverage cluster sampling technique. Considering pastoral and semi-pastoral areas, a total of 60 clusters with a sample of 600 children aged 12 to 23 months and mothers/care givers were included. Data were collected using smart phones loaded with the Open Data Kit (ODK) system and exported to STATA 12.0 for data description and analysis. Results: The response rate was 97%, with 54.8% of the sample from pastoral areas. About 51% of the respondents were Muslim, 68% had no education, and 67% were aged 30 or above. More than one fifth (21.9%) of children received at least one vaccine dose earlier than the recommended minimum age. Nearly half (47.7%) of children received at least one subsequent dose earlier than an interval of four weeks. The overall rate of missed opportunities was 42.7%, which was higher in pastoral (61.4%) compared to semi-pastoral areas (30.9%) (P <0.001). Children from pastoral areas had a higher rate of missed opportunities compared to children from semi-pastoral areas (OR=4.05; 95% CI: 2.28-7.22); and children from mothers/caregivers aged 30 or above had a higher rate of missed opportunities than mothers aged <30 (OR=1.89; 95% CI: 1.32-3.13). Conclusions: The study identified high proportions of children who started vaccination earlier than the recommended age (later for the first dose of Oral Polio Vaccine (OPV0)). In addition, multiple vaccine doses were administered before the minimum interval of four weeks. Children in pastoral areas have higher rate of missed opportunities compare to children in semi pastoralist and pastoralist areas for vaccines with same schedule. Recommendations: Strong interpersonal communication between mothers and vaccination providers is vital for the timely administration of vaccines. Emphasis should be placed on regular supervision and periodic in service training of health workers to practice timely vaccine commencement, and maintain proper intervals between doses. Immunization service providers should give all the recommended vaccines with same schedule to reduce rate of missed opportunities

Pastoral Care at Mulago Hospital

"The popular idea about pastoral care/ministry in a hospital situation is very often known to be; adminsitration of the sacraments; especially annointing of the sick; mistakenly called last sacrament ""Okusiibula Omulwadde"" praying for patients at their bedside; the celebration of the Eucharist for the hospital staff; help in moral decision making; baptism of children of Christians who are in the sick bed who might die while in the hospital ""to save their souls"". To my understanding pastoral care or the services of the Chaplaincy in a hospital situation goes beyond what I have described above. Pastoral care is a disciplined caring relationship offered in response to individuals and family members and friends who experience and are able to articulate the pains in their lives and they seek pastoral care in order to deal with it. It is to accompany the person in his/her feelings in the situation he/she is in. In short; it offers counselling and spiritual services very often during crisis situations. At Mulago Hospital; the pastoral care offered by St. Joseph's Chaplaincy staff has its priority to persons who are in some way estranged by illness (or other life's circumstance). Services are not restricted to the sick only. It is open and extended to their family members and friends; and to all the staff of the hospital. In the whole process of our ministry or services; the care is based on the central image of life and its meaning affirmed by our religious community."