Missed opportunities for immunization during visits for curative care: a randomized cross-over trial in Sudan.

Infants who come to health facilities for curative care in developing countries are usually not vaccinated at the same time. To assess what could be done a randomized cross-over study was carried out in twelve urban health centres in Sudan where two approaches were investigated: (1) the place for vaccination was moved very close to the consulting room, and (2) the doctor seeing the infant wrote a prescription recommending vaccination for the child. On average, 55% of the infants needing immunization were vaccinated when either of these approaches was followed. No difference was found between the two interventions in terms of the proportion of eligible children who were immunized (mean difference, 2%; 95% Cl, -4% to +7%). The more sick an infant appeared to be to the mother, the more likely she was to refuse vaccination. Older infants and infants not previously vaccinated were also less likely to be immunized. The number of missed opportunities can thus be reduced using these simple approaches. However, to immunize infants who are sick, unvaccinated, or have limited access to health facilities will require more social mobilization, health education, and outreach activities.

PIP: Infants who come to health facilities for curative care in developing countries are usually not vaccinated at the same time. To assess what could be done, a randomized cross-over study was carried out in 12 urban health centers in Sudan where 2 approaches were investigated: where the site for vaccination was moved very close to the consulting room and when the doctor seeing the infant wrote a prescription recommending vaccination for the child. On the average, 55% of the infants who required immunization were vaccinated when either of these approaches was followed. No difference was found between the 2 intervention approaches in terms of the proportion of eligible children who were immunized (mean difference, 2%; 95% confidence interval, -4%-+7%). The sicker the infant appeared to the mother, the more likely she was to refuse vaccination. Older infants and those not previously vaccinated were also less likely to be immunized. The number of missed opportunities can thus be reduced using these simple approaches. However, to immunize infants who are sick, unvaccinated, or have limited access to health facilities will require more social mobilization, health education, and outreach activities.

The accuracy of mother's reports about their children's vaccination status.

Estimates of measles vaccination coverage in the Sudan vary on average by 23 percentage points, depending on whether or not information supplied by mothers who have lost their children's vaccination cards is included. To determine the accuracy of mother's reports, we collected data during four large coverage surveys in which illiterate mothers with vaccination cards were asked about their children's vaccination status and their answers were compared with the information given on the cards. Mothers' replies were very accurate. For example, for measles vaccination, the data supplied were both sensitive (87%) and specific (79%) compared with those on the vaccination cards. For both DPT and measles vaccination, accurate estimates of the true coverage rates could therefore be obtained by relying solely on mothers' reports. Within +/- 1 month, 78% of the women knew the age at which their children had received their first dose of poliovaccine. Ignoring mothers' reports of their children's vaccination status could therefore result in serious underestimates of the true vaccination coverage. A simple method of dealing with the problem posed by lost vaccination cards during coverage surveys is also suggested.

The accuracy of mothers' reports about their children's vaccination status

Estimates of measles vaccination coverage in the Sudan vary on average by 23 percentage points, depending on whether or not information supplied by mothers who have lost their children's vaccination cards is included. To determine the accuracy of mothers' reports, we collected data during four large coverage surveys in which illiterate mothers with vaccination cards were asked about their children's vaccination status and their answers were compared with the information given on the cards

Mothers' replies were very accurate. For example, for measles vaccination, the data supplied were both sensitive (87 percent) and specific (79 percent) compared with those on the vaccination cards. For both DPT and measles vaccination, accurate estimates of the true coverage rates could therefore be obtained by relying solely on mothers' reports. Within more or less one month, 78 percent of the women knew the age at which their children had received their first dose of poliovaccine

Ignoring mothers' reports of their children's vaccination status could therefore result in serious underestimates of the true vaccination coverage. A simple method of dealing with the problem posed by lost vaccination cards during coverage surveys is also suggested(AU)