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Epidemic meningococcal meningitis affects huge populations annually in sub-Saharan Africa with differentially higher death rates among children. Nigeria is one of the twenty-six countries that lie in ‘African meningitis belt’. This paper briefly describes the epidemiology of seasonal recurrent meningococcal meningitis, current efforts to address the epidemics, and then argues for an accelerated introduction of conjugated meningococcal vaccine into routine immunization in Nigeria. This paper also highlights the nature of the epidemics with its attendant impacts on the population; the weaknesses of the current strategies; the emergence of mixed pathogens; the challenges and potential opportunities associated with an introduction of routine vaccination against meningococcal meningitis. The quick introduction of the conjugated meningococcal vaccine into expanded program on immunization (EPI) schedule will mitigate the risk of future massive outbreaks and its attendant morbidity, mortality and larger societal cost. Furthermore, authors suggest the introduction of polyvalent conjugated meningococcal vaccine rather than monovalent (targeting only serotype A), as this will potentially prevent emerging outbreaks of other serotypes such as NmC and W135.
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Background: Immunization prevents over 2�million deaths each year worldwide. In India, even though vaccines are offered free of cost at public health facilities the coverage remains low. Limited scrutiny has been conducted at health service and client interface for routine immunization (RI) services, which may have been affecting the acceptance of vaccines. This emphasizes the importance of assessing the level of satisfaction and perceived quality of clients regarding RI services. Objectives: This study aimed to assess the perceived quality and level of overall general satisfaction with RI services of clients. In addition, determine the association of factors influencing clients perceived quality and overall general satisfaction with RI services. Methods: A community-based cross-sectional study was conducted in an urbanized village of Delhi from November 2015 to April 2017. A total of 279 RI visits were covered in the study, and the clients were interviewed at their residence using a pretested tool. Results: The dissatisfaction toward the domains of perceived quality of RI services was reported to be 3.2% for vaccine availability, 9.7% for vaccine information, 3.2% for staff behavior, 6.1% for doctor behavior, and 7.5% for infrastructure. Multivariable-regression analysis indicated that distance to health facility, literacy and age of the client, doctor behavior, staff behavior, and infrastructure had an effect on overall general satisfaction of client toward RI services. Conclusions: The client's perception is multidimensional; improvement in one domain is likely to strengthen the other. By understanding the client's perspective toward quality of RI service, the health-care mangers may improve the level of overall satisfaction.
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Background: India was one of the first countries to adopt the World Health Organization's Expanded Programme of Immunization (EPI). The program started globally in 1974 and was initiated in India in 1978. Immunization is considered to be one of the most important cost-effective and a powerful public health intervention. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The term 'defaulter' is used to refer a child who misses the scheduled vaccinations for any reason. The objective of this study was to explore the reasons behind defaulting from the routine immunization program.Methods: A study was conducted in Bowring and Lady Curzon Hospital, Bangalore between January 2012 and December 2012. A total of sixty six children's' details were gathered from mothers of defaulted children. Children below 5 years attending OPD were included in the study. Children above 5 years and inpatients were excluded. Observations and review of relevant documents was done.Results: Of the 66 children, in our study, males were more than females. Children in the age group of 2 years to 5 years were 17(25%) as compared to those between 1 to 2 years. Mothers were more literate than fathers. Muslim children had the best immunization coverage. The main determinant of defaulting was lack of knowledge and awareness regarding immunization by the mothers (21/31%) followed by sickness in children (11/16%), causing them to default immunization schedulesConclusions: The main reason for defaulting from the immunization program was lack of awareness, regarding immunization by mothers in the community.
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Background/Introduction:Health workers at primary health care facilities (PHCs) are primarily involved with routine immunization activities including detection, reporting and management of Adverse Events Following Immunization (AEFI). To undertake such responsibilities effectively, they need to have good knowledge on AEFI and its management. Objective:To assess the knowledge, attitude and reporting practices of Routine Immunization Service Providers in health facilities of Sokoto State, Nigeria.Methods:This was a descriptive cross-sectional study conducted at Primary Health Care (PHC) facilities of Sokoto State, Nigeria. Using a multi-stage sampling technique, a total of 285 routine immunization service providers were recruited from all the PHCs in one selected local government from each of the three health zones of the State. A semi-structured self-administered questionnaire was used to collect relevant information from eligible participants. Data were entered into SPSS version 20.0 and analyzed. Results:Of the 285 distributed questionnaires, 258 (90.5%) were duly completed and returned. The M: F ratio was 1.4:1, with mean age of 34.24 +8.06 years. Up to 164 (63.6%) respondents had good knowledge (score >50%), while 37(14.3%) and 57(22.1%) respondents had fair (score 41-49%) and poor (score <40%) knowledge respectively. Reporting practices were appropriate in 224 (86.8%) respondents. The most common method for reporting was by manual filing of AEFI forms. Some respondents would however not report an AEFI to avoid being blamed, feeling guilty or creating unnecessary anxiety to the patient. Conclusion:Though many respondents had good knowledge and reporting practices on AEFI, knowledge gap still exists; highlighting the need for continuous on-the-job training and retraining of these personnel
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Background: Supportive supervision (SS) as a public health strategy has gathered much consideration in cold chain anagement and effective service delivery of routine immunization (RI). Objectives: In this study, an attempt was made to assess the effect of mobile-based SS strategy on cold chain point’s (CCPs) management and RI service delivery. Materials and Methods: UNICEF supported mobile-based software was used to carry out the SS in Golaghat district of Assam. A total of 15 CCPs and 18 session sites were visited 2 times each in the year 2017. Data collected in the first visit were compared with the second visit to find out whether there was any improvement in cold chain management in CCPs and at routine immunization session sites following SS. Results: We observed a significant improvement in vaccine management and infrastructure handling at CCPs from initial to the second visit. Knowledge and skills of cold chain handlers regarding cold chain management at session site were improved adequately. This substantiates successful transfer of knowledge and skills during SS. Conclusion: The observed improvements in the CCP management practices and service delivery indicate positive influence of mobile-based SS. The improvement in the skills and knowledge of health workers on different components related to CCP management could be due to successful real-time hand holding of cold chain handlers and workers through SS.
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Background: Routine immunization coverage has been reportedly hampered by migration, and user characteristics, such as maternal knowledge and attitude. An understanding of these maternal variables could help modify preventive strategies. The objective of the present study was to assess and compare the Sabo and non-Sabo communities in Awka, Nigeria for sociodemographic determinants of maternal knowledge, attitude and uptake of routine immunizationMethods: A community based comparative study of 420 mothers and caregivers in Awka selected via multistage sampling technique, was conducted between July and October 2015. Data collection was by interview using semi-structured questionnaire, while analysis was done with Statistical Package for Social Sciences version 22.0. Chi-square, Fisher’s exact, Yates correction and student’s t tests were used to determine statistically significant associations between variables at p value of < 0.05.Results: There was normal distribution of age groups of respondents for both communities. Married women (53.0%) in Sabo communities had better knowledge of routine immunization than (47.0%) in non-Sabo communities (p= 0.000). Self-employed women were the most knowledgeable in routine immunization 310 (74.0%) (p= 0.042). Married women in the Sabo communities (53.0%) had better attitude than (47.0%) (p= 0.000).in non-Sabo communities. The maternal uptake of routine immunization among the different communities, ethnic and religious groups were higher in non-Sabo, Igbo/others and Christian groups than the Sabo, Hausa/Fulani and Muslim groups. (p= 0.010).Conclusions: This study found differences in baseline socio-demographic characteristics of the two communities, as well as better knowledge, attitude and uptake of routine immunization among the non-Sabo (Ibo/others and Christians) than the Sabo (Hausa/Fulani and Muslims). Addressing issues of factors identified to affect routine immunization will greatly assist in boosting uptake of routine immunization in both communities.
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Background: Immunization is an important among activity in the Public Health Services. The vaccines are highly temperature sensitive and vaccine potency once lost cannot be restored. A well-managed cold chain will increase the efficiency of immunization and reduce vaccine wastage. An assessment of cold chain system for vaccine storage was done in the all PHCs of the study area. Aims & Objectives: To evaluate the cold chain practices, with particular reference to assessing the availability of cold chain equipment, vaccine storage practices, monitoring of cold chain in primary health centres (PHCs) of Bhojpur district. Material & Methods: A cross-sectional study was conducted at all the cold chain points of 14 PHCs of Bhojpur district during January to May 2015. A predesigned, pretested checklist was used by the trained investigators during their visits. The information was evaluated on the basis of important components related to the cold chain points. Results: All the PHCs had a dedicated cold chain room with sufficient number of cold chain equipment. Consolidated effective vaccine management score for cold chain points of 8 (57.1%) PHCs were average (60-79%). None of the PHCs have satisfactory score (≥ 80%). Vaccine storage practice and availability of complete RI micro-plan were found satisfactory at 12 (85.7%) PHCs. Maintenance of cold chain equipment were satisfactory at 10 (71%) PHCs. But, temperature monitoring. (5) (35.7%) and waste disposal related to routine immunization 3 (21.4%) PHCs were disappointing. Conclusion: The primary health centres had average performance related to the cold chain system, which is a matter of concern warranting for the cold chain monitoring. We recommend supportive supervision as the key measures in improvement of cold chain system.
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Evaluation of the efficacy and safety is most important for introducing the vaccine. But when introducing widely using public resources such as routine vaccination, it is also necessary to consider cost-effectiveness. In this paper, we first introduce the situation of ACIP in the United States and JCVI in the UK as examples of using cost-effectiveness analysis for vaccine policy in other countries. Next, I will outline the situation of efforts at the immunization inoculation group of the Infectious Disease Subcommittee of the Welfare Science Council of Japan and the vaccination/vaccine section of the Health Science Council. Next, we describe the necessity of standardization of research methods and outline the research guidelines on the evaluation of the cost-effectiveness of immunization prepared by the authors so far. With reference to the analysis guidelines for cost-effectiveness evaluation already used in the Chuikyo, this guideline considers vaccinespecific issues such as loss of productivity and Herd effect while trying to unify within a possible range such as discount rate etc. Based on this guideline, the economic evaluation is carried out by a unified method. It will be possible to do scientific discussions on the appropriateness of introducing routine vaccination of each vaccine, the priority order, the subjects of inoculation, the method of inoculation, etc. based on the financial influence and the value from a social point of view.
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Objective: To check the effects of the vaccines on the hematopoietic system and weight of mice after immunization. Methods: The study was done with the Expanded Programme on Immunization vaccines donated by the Ministries of Health of Abia and Imo States of Nigeria. The vaccines were collected from the cold-chain stores and transported in vaccine carriers to the cold-chain facility in Nnamdi Azikiwe University Teaching Hospital within 3 hours of collection. They were used to immunize a total of 160 mice. The Ethics Committee of Nnamdi Azikiwe University Teaching Hospital, Nnewi of Anambra State, Nigeria approved the protocol. Results: Mice body weight changes test showed that the mice all had increased body weight at Days 3 and 7 post-immunization and none died during the 7 d post-immunization observation. The percentage weight gains of the mice compared with the control were 69%, 70%, 64%, 63%, 65% and 68% for oral polio vaccine, diphtheria-pertussis-tetanus, bacillus Calmette- Guérin, measles, yellow fever and hepatitis B vaccines respectively collected from Imo State. The mice immunized with oral polio vaccine, pentavalent, bacillus Calmette-Guérin, measles, yellow fever and hepatitis B vaccines collected from Abia State had 123%, 114%, 121%, 116%, 142% and 119% weight gain respectively compared with the control. Leukocytosis promoting toxicity test showed that none of the vaccines was able to induce proliferation of leukocytes up to ten folds. Leukopenic toxicity test showed that all the vaccines had an leukopenic toxicity test value higher than 80% of the control (physiological saline). Conclusions: The vaccine samples tested were safe and did not affect the hematopoietic system adversely. The storage conditions of the vaccines in the States' cold-chain stores had not compromised the safety of the vaccines.
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Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Using data collected through 30-cluster sample household surveys of caretakers of children aged 12-23 months, this paper assessed the effectiveness of house-to-house visits on routine oral polio immunization completion, using simple frequency tables, bivariate and multivariate logistic regression analyses. Logistic regression results demonstrated that children in households where the caregivers reported receiving a household visit by health workers were more likely to be fully immunized for polio through routine immunization than other children, although results were significant only after correcting for confounders. In Ethiopia and India, children of caregivers who remembered a house-to-house visit were significantly and positively associated with routine polio vaccination completion (OR=2.2 and OR=2.2 respectively). In Angola, the association was positive, though not significant (OR=1.3). The evidence suggests that targeting high-risk areas for house-to-house visits played a role in increasing routine polio vaccination.
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Vaccines have made a major contribution to public health but vaccines-preventable diseases (VPDs) are still responsible for significant deaths of under-five children. Despite Global efforts, the coverage in two WHO regions namely Africa and South-East Asia (SEA) still remain short of set targets for 2010. As a result, the SEA Regional Director has declared 2012 as the Year for Intensifying Routine Immunization (RI) in the Region. The recent immunization coverage surveys in India have shown gradual albeit a slow progress in the performance of RI in India over last few years but in some states the coverage is still quite low. Several new initiatives like introduction of Hepatitis B vaccine, second dose of Measles vaccine and pentavalent vaccine (two states), JE vaccine rounds, framing of the National Vaccine Policy, etc. are welcome steps. The challenges and barriers to achieve high immunization rates in the country are well recognized. Almost nonexistence of an effective VPD surveillance system in the country has further compounded the problem. The need is to address all the barriers to achieve high RI rates, which should include induction of innovative methods, proper monitoring of the program, improving operational efficiency and ‘reaching every community’, and integrated delivery of health interventions along with immunization. The development of an efficient VPDs surveillance, adverse event following immunization (AEFI) monitoring and post-marketing surveillance systems will go a long way in ensuring satisfactory performance of the health system. The decades old Expanded Program of Immunization (EPI), which was adopted in India as universal Immunization Program (UIP) also needs a revamp with inclusion of certain new vaccines. Decisions on implementing new and underutilized vaccines require scientific evidence and data, a reliable supply of affordable vaccines, which are adapted to the country’s immunization schedule, and an integrated disease monitoring and surveillance system.
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A cross-sectional study was conducted in a rural area of Anand District, Gujarat to measure the efficiency of immunization sessions and to identify the reasons for missing a vaccine in a session. Caregivers of infants aged less than one year and in need of any vaccine as per routine immunization schedule were interviewed by a house-to-house survey after immunization session was completed. Efficiency of immunization session was 66.7%. Reasons for 'missed' vaccination were prior reminder not given (32.9%, P<0.01); mother's forgetfulness (26.6%); unavailability of vaccine (15%). Higher birth order (OR=2.86; 3.16-2.56), mother's current residence at father's home (OR=3.17; 3.53-2.81) were associated with 'missed' vaccination. There are barriers in health care system such as lack of prior reminder and unavailability of vaccines which should be assessed and eliminated.
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Continuous wild poliovirus transmission despite 12 years of intensive surveillance has raised serious questions about the feasibility of polio eradication programme with current strategy in near future. At present most of the cases are confined to four endemic countries, which are causing sporadic outbreaks in non-endemic areas. India has experienced a significant increase in number of cases reported in 2006 compared to previous year. Outbreaks originated in western UP which was due to the accumulation of susceptibles between the last outbreak in 2002 and early 2006. Substantial improvement has been observed in strategies of polio eradication but still there are gaps in the programme implementation which needs immediate attention so that goal of polio eradication can be achieved at the earliest opportunity. Even though there are many issues but there are also many factors, which favour polio eradication. These factors include new tool in form of m OPV, natural immunity due to recent outbreak, limiting international spread of polio, new researches to guide programme in right direction, political commitments from endemic countries, etc. 2008 presents the best opportunity ever to interrupt wild polio virus transmission which will lead to global eradication of Polio. Since global eradication is within sight, it is scientifically possible to eradicate the disease in near future.