Experiences Using Mobile Phone Surveys to Monitor and Evaluate the Distribution of Health Services in Sierra Leone.

Objectives: Evidence-based programs to reduce child mortality and morbidity such as twice-yearly vitamin A supplementation (VAS) and mass drug administration (MDA) for neglected tropical diseases require real-time coverage data to ensure that all populations are reached with equitable coverage. Methods: The EpiSurveyor platform was introduced in 2011 for 'in' and 'end' process monitoring of VAS distribution and MDA for lymphatic filariasis (LF), and was later used in 2012 for a LQAS of the supplementary measles immunization program. In 2013, the Magpi platform was piloted for VAS distribution and MDA-LF, and the CommCare platform was piloted for routine reporting of MDA. Results: Twelve nation-wide surveys were conducted with a total of 266 enumerators and 59,465 respondents. Data compilation was available to the account administrator within 48 hours of field-work completion with all three applications. The CommCare platform had several benefits over EpiSurveyor/Magpi: (1) faster programming of skip logic with a friendlier interface (2) ability of the administrator to respond to an enumerator via SMS from the server (3) a prompt for photo evidence and/or Global Positioning System (4) automatic server-input synchronization during network availability (5) ability to program an 'other' category for questions allowing multiple responses. Conclusions: Monitoring and evaluation was enhanced in timeliness and data quality by all three applications. CommCare was found to be more comprehensive and user-friendly compared with EpiSurveyor and Magpi.

Integrating a Six-Month Contact Point for Vitamin A Supplementation, Infant and Young Child Feeding Counselling and Family Planning within Routine Health Services in Sierra Leone.

Objectives: Since 2004, twice-yearly mass vitamin A supplementation (VAS) has reached >85% of children 6-59 months. Although VAS coverage is consistently high, an additional 2.4% reduction in infant mortality could be achieved if all children receive VAS as soon as they turn six months. Therefore, the effectiveness of integrating a six-month contact point with VAS into the routine EPI schedule was examined. Methods: Twelve health units matched according to staff levels, cadre and work load were assigned to provide either a ‘full package’ of 1)VAS, 2)Infant and Young Child Feeding counselling (IYCF), and 3)family planning (FP) counselling and commodities; a ‘mini package’ of 1)VAS and 2)IYCF or control’ with routine health services. 400 infants were enrolled into each group between birth and 3 weeks of age and followed until they were 12 months old. Caregivers of all enrolled children received modified child health cards with a six-month contact point Results: More children in the full (74.5%) and mini (71.7%) groups received VAS at six months compared with the control group (60.2%)(p<0.05). At 9 and 12 months of age, mean WAZ was significantly higher for the full (0.24±0.98; 0.90±0.81), versus the mini (-0.05±1.05; 0.26±0.93) and control groups (-0.55±1.24; 0.39±1.41)(p<0.0001, p<0.01), respectively. FP commodities were provided to 67.3% of mothers in the full group compared with 3.0% in the mini and control groups (p<0.0001). Conclusions: A six-month contact point integrated into the EPI schedule increased VAS coverage and provision of family planning commodities at six months and was associated with improved growth in late infancy.

High Coverage of Vitamin A Supplementation and Measles Vaccination during an Integrated Maternal and Child Health Week in Sierra Leone.

Objectives: Mass distribution of vitamin A supplementation (VAS) and measles vaccination has contributed to the reduction in child mortality in Sierra Leone from 267/1000 in 2005 to 118/1000 in 2010. In May 2012, the twice-yearly Maternal and Child Health Week (MCHW) integrated VAS and supplementary measles vaccination to reach all children 6-59 months in Sierra Leone. Following the MCHW, a Post Event Coverage Survey (PECS) was conducted to validate coverage and assess Adverse Events Following Immunization (AEFI). Methods: Using WHO EPI sampling methodology, 30 clusters were randomly selected with fourteen caregivers of children 6-59 months interviewed per cluster for precision of ±5%. In addition, one health worker was interviewed per cluster with all responses collected via mobile phones using EpiSurveyor. Results: Overall coverage confirmed by campaign card for VAS and measles vaccination was 91.9% and 91.6%, respectively, with no significant differences by age group, sex, religion or occupation. Major reasons given for not receiving VAS and measles vaccination were not knowing about the MCHW or being out of the area. No serious AEFI’s were reported during the MCHW or PECs. Significantly more mild AEFIs (fever, pain at injection site) were reported via PECS (29.1%) than during the MCHW (0.01%) (p<0.0001). Conclusions: The MCHW reached >90% of children in Sierra Leone with equitable coverage. Increased reporting of mild AEFI’s during the PECs may be attributed to delayed onset after measles vaccination and/or direct enquiry from enumerators. While all reported AEFIs were mild, strengthened reporting of AEFIs during/after vaccination campaigns is recommended.