The Ministry of Health (MoH) of the State of Eritrea launched the EPI program in 1980. However, before liberation, only small portions (less than half) of the urban areas of the country were covered. Hence, a nation-wide expansion of the program was possible only after the liberation in 1991. The main objective of the program is to reduce morbidity and mortality due to vaccine-preventable diseases i.e. measles, tuberculosis, diphtheria, pertussis, tetanus and polio. The specific objectives are to vaccinate children under one year against the above diseases, and mothers against tetanus with tetanus toxoid. To achieve these objectives, daily immunization of children and mothers at static and outreach sites are carried out. Immunization is integrated with other activities at health facilities (hospitals, health centers and health stations) and at village outreaches.
Purpose / Objective
The National EPI coverage survey in Eritrea was carried out in December 2000 to verify the reported immunization coverage, identify reasons for not immunizing and make recommendations for strategies and interventions that will enhance the achievement and sustainability of EPI planned activities.
- To establish the immunization coverage for all six antigens among children aged 12-23 months
- To determine TT immunization coverage among mothers of children aged 0-11 months
- To elicit reasons for not immunizing children 12-23 months and other associated factors
- To know the NIDs immunization status among children aged 12-23 months
The target age groups were children aged 12-23 months to assess infant immunization and mothers of children aged 0-11 months to assess tetanus toxoid immunization among women. Information on infant immunization was obtained from 647 children aged 12-23 months. The country was divided into 3 study areas, according to the reported immunization coverage from the 6 zones. Thirty clusters were selected from each of the study areas, making a national total of 90 clusters.
Key Findings and Conclusions
At the onset of this EPI community-based household survey, three distinct areas where the coverage was high (Central and Anseba zones), medium (Gash Barka and Southern Debub zones) and low (North and South Red Sea zones) were identified. The results of the survey show a very high coverage in all the above study areas, with variation of coverage consistent with the above classification. The percentage of fully immunized children as evidenced by card and history was high (86.6%), with a high card retention of 91.2%
Immunization program indicators are good i.e. access to immunization services evidenced by DPT1 crude coverage was above 90% in all the three study areas, with a national average of 97.4%; DPT1 to DPT3 and BCG to Measles drop out rates were 4.6% and 10.1% respectively. Majority of the immunizations are received from static units. Displacement due to the current conflict was the main reason given for non-immunization/partial immunization by the few mothers/guardians who had not immunized their children.
All children surveyed were eligible for NIDs 2000 and 98% and 99% of the children had received OPV during the 1st and 2nd round of NIDs 2000 respectively. This almost tallies with the reported national NIDs 2000 coverage of 91% and 90% in the first and second rounds respectively.
Vitamin A supplementation, together with measles immunization at 9 months, is not included in the routine immunization program.
A total of 658 mothers of children aged 0-11 months were interviewed, of whom 72.8% had cards. TT coverage (card and history) was TT1 92.7%, TT2 86.9%, TT3 66.0%, TT4 44.2% and TT5 28.9%. Only 55.8% of the children were born protected against neonatal tetanus as evidenced by card, yet majority of the deliveries (54.2%) occur at home. The TT2 coverage based on card and history is above 80%, slightly below in Study Area 2. This is better than what was obtained in the 1995 EPI coverage surveys and higher than what is reported routinely.
The Immunization program should aim at maintaining the achieved immunization coverage and improve on those shortfalls that were identified during the EPI program review. Updated information on the population should be made available to the zoba health offices and health facilities so that they can prepare more accurate reports on coverage for their target areas.
Outreach services need to be increased in Study Area 3 in order to reduce the measles dropout rate.
Vitamin A supplementation, together with measles immunization, should be included in the routine immunization program.
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Ministry of Health, WHO