Curbing an outbreak of circulating vaccine derived poliovirus type 2 in Dollo Zone, Somali Region, Ethiopia: response to outbreak.

Introduction: although the oral polio vaccine prevents virus transmission from person to person, it is crucial for poliovirus eradication. The continued use of live attenuated poliovirus poses an ongoing risk of circulating Vaccine Derived Poliovirus-2 (cVDPV2) outbreaks. This study assesses the response to the cVDPV2 outbreak in Dollo Zone, Somali Region, Ethiopia. Methods: after examining and verifying the occurrence of the outbreak, a team was established and prepared by resource mobilization, advocacy, and social mobilization. The group endorsed a four-step vaccination strategy, first the rapid response within 14-days by vaccinating a monovalent oral poliovirus-2 (mOPV2) to all under 5-year children in the Zone. The team further enhanced Supplementary Immunization Activities (SIA) for all under-five children with repeated doses of vaccines. At the same time, the team initiated community-based surveillance of Acute Flaccid Paralysis (AFP). Results: in the rapid-response immunization, an average of 91.4% of 0-11 months old and 90.2% of 12-59 months children were vaccinated. In SIA-1, the team vaccinated an average of 88% and 97%, and in SIA-2, 94.8% and 97.6% of children 0-11 months old and 12-59 months old, respectively. The active community-based surveillance of AFP revealed the existence of the disease in a sporadic form, of which two cases were found in Bokh district. Conclusion: the response to curb the outbreak of cVDPV2 has shown a flow of actions to combat the outbreak. Strengthening and formation of response teams at different levels, resource mobilization, advocacy, and social mobilization are all essential components in maximizing the response to the outbreak.

Why Communities Should Be the Focus to Reduce Stigma Attached to COVID-19.

Since 1999, the CORE Group Polio Project (CGPP) has developed, refined, and deployed effective strategies to mobilize communities to improve vaccine uptake for polio (and other vaccine-preventable diseases such as measles) and conduct surveillance for infectious disease threats in high-risk, border, and hard-to-reach locations. CORE Group Polio Project teams have been called upon to address the COVID-19 pandemic, and, like with polio, the pandemic response is impacted by stigma in all areas of response, from health education, testing, contact tracing, and even treatment for infected individuals. The CGPP has reached back into its polio experience and is redeploying successful community engagement activities to address stigma as part of the COVID-19 response. Across country programs, community health volunteers communicate risk and behavior change at the household level by integrating health education and promotion activities with a focus on practical measures of COVID-19 prevention. Moreover, leveraging established and trusted partnerships with community networks and community leaders are providing lessons that can be adopted by the global community. The CGPP offers three overarching recommendations to curb stigma: 1) facilitating inclusive community engagement, 2) leveraging existing community networks and 3) cocreating with community leaders.

The Critical Role and Evaluation of Community Mobilizers in Polio Eradication in Remote Settings in Africa and Asia.

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative.

The CORE Group Polio Project (CGPP) has contributed to polio eradication by successfully engaging civil society, particularly the non-governmental organization (NGO) community. This engagement, which began with a grant from the U.S. Agency for International Development in 1999, has contributed to improvements in routine immunization programs, polio campaign quality, and surveillance for acute flaccid paralysis in many challenging geographic areas. The CGPP has worked closely with polio eradication partners in a collaborative and supportive role. The CGPP has focused largely on high-risk areas with marginalized or hard-to-reach populations where health systems and immunization programs have also been weak and where transmission of poliovirus had not been stopped. The CGPP has engaged local civic leaders and communities in ways to complement top-down vertical efforts of ministries of health and other partners in the Global Polio Eradication Initiative. The CGPP has developed innovative strategies to detect cases using community-based surveillance, promoted independent campaign monitoring, established cross-border initiatives, and developed a strong and creative cadre of community mobilizers to track missed children and deliver behavior change education. Many of the innovations and approaches that the CGPP helped to develop are now being replicated by governments and international agencies to tackle other public health priorities in underserved and marginalized communities around the world. This article is the first in a series of articles describing the work of the CGPP. Because the article describes the work of more than 40 NGOs in 11 countries over 20 years, it provides only an overview, leaving many important details and variations of the CGPP's work to be described elsewhere, including in other articles included in this series.

Lessons Learned from the CORE Group Polio Project and Their Relevance for Other Global Health Priorities.

Despite numerous setbacks, the Global Polio Eradication Initiative has implemented various community strategies with potential application for other global health issues. This article reviews strategies implemented by the CORE Group Polio Project (CGPP), including pursuit of the missed child, microplanning, independent campaign monitoring, using community health workers and community mobilizers to build community engagement, community-based surveillance, development of the capacity to respond to other health needs, targeting geographic areas at high risk, the secretariat model for non-governmental organization collaboration, and registration of vital events. These strategies have the potential for contributing to the reduction of child and maternal mortality in hard-to-reach, underserved populations around the world. Community-based surveillance as developed by the CGPP also has potential for improving global health security, now a global health priority.

Improvements in Polio Vaccination Status and Knowledge about Polio Vaccination in the CORE Group Polio Project Implementation Areas in Pastoralist and Semi-Pastoralist Regions in Ethiopia.

Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Achieving this requires improving immunization coverage in hard-to-reach areas. The objectives of this analysis were to assess levels of oral polio vaccination coverage and challenges in pastoral and semi-pastoral regions in Ethiopia. The analysis included vaccination-related data for children aged 12-23 months from the 2011 Ethiopian Demographic and Health Survey (EDHS) and from surveys carried out by the CORE Group Polio Project (CGPP) in 2013, 2015, and 2017. The EDHS data were from the entire regions (states) of Somali; Oromia; Southern Nations, Nationalities, and Peoples; Benshangul-Gumuz; and Gambella, whereas the CGPP data were for portions of these states where the CGPP was working and consisted entirely of pastoralist or semi-pastoralist populations. The overall polio immunization coverage rate showed upward trend from 39.6% in the 2011 EDHS to 72.6% for 2017 survey of children in the CGPP intervention areas. The evidence suggests that the CGPP was able to achieve increasing levels of coverage in the hardest-to-reach areas of these states and that the levels were higher than those achieved in the states as a whole. The strategies used by the CGPP/Ethiopia to increase coverage appear to have been effective. Other characteristics associated with full polio immunization included mother's religion and education, whether the mother had heard about polio, knowledge on the effect of many polio vaccine doses, and age at first polio immunization.

Trust, Communication, and Community Networks: How the CORE Group Polio Project Community Volunteers Led the Fight against Polio in Ethiopia's Most At-Risk Areas.

The last case of wild poliovirus in Ethiopia was reported in 2014. Until the disease is eradicated globally, the risk of reimportation remains high. In 1999, the CORE Group Polio Project (CGPP) began its community-centered polio eradication efforts in Ethiopia, using community volunteers (CVs) to ensure that no child has missed polio vaccine. This article documents the efforts of CVs and highlights innovative strategies, successes, and contributions. Qualitative data were collected from the CGPP implementation areas in 85 border woredas (districts) of Benishangul-Gumuz; Gambella; Oromia; Southern Nations, Nationalities, and Peoples' Region; and Somali. A total of 151 in-depth interviews were conducted with CVs, parents, CGPP partners, and project stakeholders. Results of the study showed that CVs secured the buy-in of community members through open and fair eligibility and selection processes, thereby ensuring representation of community needs and perspectives. Community-driven participation consisted of identifying and choosing credible, trusted individuals who were willing to actively engage as caretakers of the community. Community volunteers then received specialized training and supportive supervision to build and expand their command of child health and vaccination information and interpersonal skills, fortifying the legitimacy of health messages and supporting the community's sense of collective efficacy. The robust network of CVs built by the CGPP continues to effectively reach the most remote, rugged, and underserved areas of Ethiopia. Stakeholders credit the CGPP with playing a significant role in keeping Ethiopia polio-free and increasing the population coverage of polio and routine immunizations.

The CORE Group Polio Project's Community Volunteers and Polio Eradication in Ethiopia: Self-Reports of Their Activities, Knowledge, and Contributions.

In 2001, the CORE Group Polio Project (CGPP) began to support polio eradication initiatives in hard-to-reach pastoralist and semi-pastoralist high-risk border areas of Ethiopia by training and supporting community volunteers (CVs) for immunization promotion and community-based surveillance activities. This article describes the development and current status of the CGPP CV network in Ethiopia. It also reports the results of a 2016 survey of CVs. Community volunteers are selected jointly by the local community, local government officials, and local health facility staff. They work closely with the health extension worker in their area and are responsible for 50-100 households. More than 12,000 CVs have been trained and have reached six million people. They make routine home visits to 1) provide education on vaccine-preventable diseases, 2) promote healthy behaviors, 3) inform parents on how to access immunization services, and 4) report cases of acute flaccid paralysis, neonatal tetanus, and measles as well as births. The 2016 survey of 675 CVs demonstrated that 84.1% had conducted home visits in the previous month to 1) identify and register pregnant mothers and newborns, 2) provide health education, 3) conduct disease surveillance, and 4) search for and register immunization defaulters. Of the CVs, 98.2% reported that their work had led to improvements in the community. Knowledge of CVs about vaccine-preventable diseases was suboptimal. CVs expressed a desire for more training. Community volunteers have made notable contributions to polio eradication efforts in high-risk areas of Ethiopia as well as to immunization promotion and disease control more broadly.

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

Immunization service providers' knowledge, attitude and practice in primary health care units in pastoral and semi-pastoral areas of Ethiopia: CORE Group Polio Project

Background: Adequate knowledge is key for immunization service provision and related practices, such as providing the right vaccine at the right time, keeping vaccines potent, and to prevent vaccine failures. This study was conducted to assess the knowledge, attitude and practices of immunization service providers in primary health care units in pastoral and semi-pastoral areas of Ethiopia. Methods:A facility-based cross-sectional study was conducted of 1,280 health workers drawn from health centers (233) and health posts(632)in five regions of Ethiopia: Somali, Gambella, Benishangul-Gumuz, Oromiya and SNNPR. Data were collected using a self-administered questionnaire prepared in English and translated into three local languages, and analyzed using STATA version 13.0. Descriptive statistics and binary logistic regression analysis were carried out to determine the magnitude of, and identify associated factors for,knowledge, attitude and practice.A p-value of less than 0.05 was used to declare statistical significance. Results: Of all health center respondents,389 (61.3%) had a good knowledge of the vaccination schedule; 403 (63.5%) had poor practices relating to vaccine placement in refrigerators;and 321(54%) had poor attitudes in relation to vaccines and vaccination. With respect to the vaccination schedule, midwives and Health officers/Medical Doctors were 0.28(95% CI:0.08-0.95) times less knowledgeable than nurses; and health workers with more than five years'work experience were 2.78 (95% CI: 1.54-5.01) times more knowledgeable than health workers who had three years'work experience.Conclusions and recommendations: In this study, gaps were observed in health service providers' knowledge, attitudes and practices in relation to immunization. Support to address these gaps ­through training, supervision, monitoring and other mechanisms should focus on HEWs whose education is less than or equal to grade 12 at health post level, and on midwives and Health Officers (HOs)/MDs at the health center level. Similarly, attention should be given to enhance the vaccine and vaccination knowledge of semi-pastoral health facility service providers. The government, immunization working partners and other responsible bodies should give attention and take corrective measuresto use maximum vaccine preventive potency

Child vaccination coverage and dropout rates in pastoral and semi-pastoral regions in Ethiopia: CORE Group Polio Project implementation areas

Background: Vaccination programs are one of the priority health interventions, and all children in every country should be vaccinated. The World Health Organization (WHO) aims for 90% coverage of the Expanded Program on Immunization (EPI) by the age of 12 months. The CORE Group Polio Project (CGPP) Ethiopia implemented interventions in pastoral and semi-pastoral regions to increase routine immunization coverage and support supplemental immunization campaigns. Objective: Assess vaccination coverage, estimate dropout rates and identify associated factors. Methods: A cross-sectional study using the modified WHO EPI cluster survey method was conducted as part of the mid-term evaluation in 2015 in six pastoral and semi-pastoral zones in Ethiopia. A sample of 600 children age 12 to 23 months was selected, and mothers/caregivers were interviewed at home using face-to-face interviews, supported by mobile data collection using the Open Data Kit (ODK)system. Data were exported from the server, cleaned, and analysed using STATA 12.0.Both descriptive analytical methods were used and p-values less than 0.05 were used to declare statistical significance. Results: Of the estimated sample, 577 (96.6%) children were included in the analysis. The overall rate of full vaccination was estimated to be 44.0% (21.2%in pastoral areas and 71.6% in semi-pastoral areas). With vaccine specific coverage of 53.7% for Bacillus Calmette-Guérin(BCG);58.8% for oral polio vaccine 3 (OPV 3);58.8% for pentavalent 3;56.3% for OCV 3 and 53.6% for measles.Mothers'/caregivers' residence, age and education were found to be significant predictors for children not being fully vaccinated, i.e.children of mothers living in pastoralist communities, young age, and with no education were at a significantly higher risk of being not fully vaccinated. Among those children who had at least one vaccine, 20.5% failed to take at least one of the next higher doses. Specifically, among those who took BCG and pentavalent 1, 10.1% and 14.1%, respectively,failed to take the measles vaccination. Conclusions and recommendations: The proportion of children who were fully vaccinated in pastoral and semi-pastoral zones was low. Dropout rates for measles, BCG and pentavalent 1 immunization were above the acceptable rate of less than 10%.Therefore, efforts should focus on mobilizing the community to complete all child vaccinations, and community-based approaches with the integration of community volunteers, health extension workers and health center staff should be strengthened so that dropout children can be traced so that they can complete their vaccinations. More information is also required on why mothers/caregivers fail to ensure that their children take all available vaccinations

Community-Based Surveillance on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

Newborn tracking for polio birth dose vaccination in pastoralist and semi-pastoralist CORE Group Polio Project implementation districts (woredas) in Ethiopia.

BACKGROUND: Estimates of immunization coverage rates in Ethiopia varied widely, but were consistent in that polio birth dose coverage is much lower than other antigens, particularly in semi-pastoralist and pastoralist areas. OBJECTIVE: Examine pregnancy and child delivery practices and identify mechanisms for improving polio birth dose coverage in CORE Group Polio Project implementation districts. METHODS: A community based cross sectional study was conducted in March - April 2012 involving 600 women who delivered in the previous one year. Interviews were also conducted with key informants, Traditional Birth Attendants and, Health Extension Workers complemented by Focus Group Discussions (FGDs) with community leaders. RESULTS: Three hundred twelve women (52.0%) had attended antenatal care at least once during the last pregnancy. Five hundred forty nine women (91.5%) delivered their last baby at home. Polio coverage was 29.7%, 19.7%, and 32.7% by history, by card and by history or card respectively. Antenatal care attendance was the main predictor of polio birth does utilization adjusted for other factors. Discussion with FGD participants revealed the prevailing knowledge on polio including misconceptions, and immunization service utilization. CONCLUSIONS: Newborn tracking for improving polio birth dose requires raising awareness among women and the community at large, strengthening mechanisms for identification and follow up of pregnant women at the community level, coordinating and strengthening the activities of front line health workers, and improving accessibility of health service.

Acute flaccid paralysis surveillance status and community awareness in pastoralist and semi-pastoralist communities of Ethiopia.

BACKGROUND: Acute flaccid paralysis (AFP) surveillance is an essential component of the polio eradication strategy. The last laboratory confirmed wild poliovirus in Ethiopia was identified in April 2008. However, the country remains at risk for re-infection because of a number of silent areas and borders with high risk countries. OBJECTIVE: Assess AFP surveillance status and community perception on AFP/Polio in semi pastoralist and pastoralist areas. METHODS: Community and facility based cross-sectional survey was conducted complemented by Focus Group Discussions (FGD) from March - April, 2012. The study populations included District and health center AFP surveillance focal persons, WHO surveillance officers, community and religious leaders and women who delivered in the previous one year in purposively selected districts in Core Group Polio Project Implementation areas of Ethiopia. RESULT: Interviews with health center and district AFP surveillance focal persons revealed deficiencies in training, supervision and feedback. The performance of AFP detection varied in the study districts and knowledge about polio and AFP detection was found to be low in the study communities. CONCLUSION: There is a need to strengthen awareness of communities through targeted information, education and communication (IEC) interventions. Regular need-based training and supportive supervision should be conducted, involving all stakeholders including religious leaders and community leaders at each step of the awareness creation process, case detection and reporting and by giving special emphasis to silent and border districts.

Assessment of cold chain status for immunization in central Ethiopia.

BACKGROUND: In order to achieve immunization goals, two factors are necessary; the delivery of potent vaccines to children through properly maintained cold chain systems and achieving high vaccine coverage. Maintaining quality of vaccines has been one of the main challenges of immunization programs in Africa. OBJECTIVE: To assess the cold chain status and practices in 116 health facilities located in three CCRDA/CORE Group Ethiopia operational districts (woredas). METHODOLOGY: An institution based cross-sectional study was conducted in December 2011 and January 2012 in three districts (woredas) of Oromiya, SNNP and Amhara Regions of Ethiopia, data was collected from 116 health facilities and from the same number of immunization service providers. Multiple logistic regression analysis was carried out to identify factors related to knowledge of cold chain management. RESULT: Of 116 visited facilities, only 22 (19%) had functional refrigerators. The remaining facilities transported vaccines from nearby facilities having functional refrigerators. Complete temperature recording of the last month was observed in 13 (59.1%) facilities. Of 22 functional fridges, the thermometer reading was found to be outside the recommended range in 6 (27.3%) on the date of data collection. Vaccine storage in the refrigerator was not proper in 12 (54.5%) facilities. Sixty-five (56%) health workers had satisfactory knowledge on cold chain management. Professional qualification and year of service in the immunization program showed a statistically significant association with knowledge of cold chain management (P < 0.05). CONCLUSION AND RECOMMENDATIONS: Vaccines in some facilities were found to be at a high risk of losing their potency. There is an urgent need to improve knowledge and practice on cold chain management through improved supervision and training.

Cross-border wild polio virus transmission in CORE Group Polio Project areas in Ethiopia.

BACKGROUND: Ethiopia interrupted indigenous polio transmission in April 2008. However, it remains at risk of reinfection because of importation of polio virus from bordering countries. OBJECTIVES: Assess polio immunization activities and risk of wild polio virus (WPV) importation in CORE Group Polio Project (CGPP) international border areas of Ethiopia. METHODS: The study employed key informant interviews of community volunteers (CV), health extension workers (HEWs), program coordinators, managers and other stakeholders, as well as focus group discussions (FGDs) with community and religious leaders in six border districts (woredas) located in three regions of the country. It was conducted in March and April 2012. RESULTS: Thirty-three key informant interviews and six FGDs were conducted. Immunization coverage was reported to be low and misconceptions about causes and transmission of polio were abundant. There was extensive cross-border movement of people for various reasons and mechanisms for prevention of cross-border polio transmission was almost non existent. AFP case detection and reporting was generally low. CONCLUSION AND RECOMMENDATIONS: Cross-border transmission of polio can occur from several frontiers. Suggestions to control cross-border polio transmission included establishing and/or strengthening cross-border collaboration with responsible counterparts in neighboring countries by using existing cross-border forums and structures to create community awareness, share information and resources, design and implement strategies for identification of children who are eligible for vaccination or suspected AFP cases. In addition districts should coordinate supplemental immunization activities to coincide with when adjacent districts in neighboring countries are carrying out similar actions.

Factors associated with immunization coverage among children age 12-23 months: the case of Zone 3, Afar Regional State, Ethiopia.

BACKGROUND: Strengthening routine immunization is one of the four pillars of the global polio eradication initiative. OBJECTIVES: To determine the magnitude and factors associated with vaccination coverage among children age 12 -23 months in Zone 4 of Afar Regional State, Ethiopia. METHODS: A community based cross-sectional study using the WHO modified cluster sampling method was carried out in Zone 3 of Afar Regional State between January 01 and May 31, 2009. The calculated sample size was 762 and 740 were included in the analysis of vaccination status. RESULTS: A total of 740 children aged 12-23 months were included in the study. Three hundred forty two (46%) respondents reported that their children were vaccinated at least once. Polio 3 coverage was found to be 35.0% and full immunization coverage was 20.6%. Respondents who could read and write had a higher likelihood of getting their children vaccinated compared to those who could not read or write [AOR = 0.18, 95% CI: 0.08-0.34]. Similarly age of the mother, husband's attitude and joint decision making by husband and wife were significantly associated with child immunization adjusted for other factors. CONCLUSION: The population immunity for polio measured by routine polio vaccine uptake in the study area indicated a high risk for wild polio virus outbreaks following importations, and the emergence and spread of circulating vaccine- derived polio virus. Literacy, positive attitude towards immunization and decision power are important factors to be addressed.