Successful immunization of children in Bosnia-Podrinje Canton
“We updated the children’s medical records, we called parents who missed the vaccination appointments – and 80% of them Responded!”
Emina Pleh from Goražde regularly vaccinated her older daughter, but when her son was born, he started experiencing problems with his tonsils already when he was just one and a half months old, and he was often prescribed inhalation. In the meantime, the COVID-19 pandemic started, so she decided to wait with the regular vaccination. Earlier this year, she received a call from the Public Health Institute of Bosnia-Podrinje Canton, they reminded her of the regular immunization, and referred her to the pediatric service for more information. She responded and the boy received all necessary doses.
"They called me from the Institute and reminded me of the vaccines we missed, and said that we should do it before he starts preschool, and we did it. There were colleagues with me who also didn’t vaccinate their children for various reasons, and I told them got a call from the Institute and thus reminded them too, so they also responded and took their children for vaccination. We received all the necessary information from the pediatrician, he got all the necessary vaccines in order to be completely protected, and there is only the one vaccine left which is administered before start of school, we have already made an appointment, and that's it ", says Emina Pleh, one of around 500 parents from the BPC who received a call at the beginning of the year reminding them of some of the missed vaccination appointments.
The BPC Public Health Institute, in cooperation with three health centers and with the support of UNICEF BiH through the EU and UNICEF Program for Mitigating the Effects of the COVID-19 Pandemic on the Lives of Children and Families in the Western Balkans and Turkey, has reviewed all health records of children treated in the health centers of Goražde, Ustikolina and Prača who were born from 2014 to 2020,. All parents who failed to bring their child to one of the mandatory vaccines were registered, then through direct communication they were called by phone and invited to contact their pediatricians, and they received all the necessary information about immunization and appointments at the vaccination point from their local health centers.
According to Director of the BPC Institute of Public Health Dr. Medina Bičo, the response was excellent and about 80% of the invited parents responded and brought their children for vaccination. A significant number of children were vaccinated in May during the enrollment in primary school, and a second round of medical records review is currently underway in order to contact the parents, establish the reason why they did not show up and offer all the necessary information and remove any possible doubts.
“Herd immunity is very important for protection of children from infectious diseases, and our canton has had satisfactory coverage of children with immunization before, however we have noticed that parents postpone the first dose of MRP vaccine until the children are two or three years old based on the information they find on the Internet or from other sources. The review showed that this vaccine is most often missing because due to the postponement, parents often simply forget about the appointment, which many of them confirmed in direct communication”, says Dr. Bičo, adding that this way of direct contact with people has proven to be very successful.
"Thanks to the cooperation with UNICEF BiH, the problem was recognized, and at the beginning of this year, we started reviewing all the records," says Dr. Bičo, adding that an associate who invited parents was also hired through the project. She adds that through constant contact with health centers - especially with the Goražde Health Center which has the largest number of children, with good coordination, all efforts have been successful with significant progress, established contacts and a model for future action.
Dr. Bičo adds that the process was slowed down during March and April during the coronavirus wave, but she believes that through the second round of reviews, more parents will be reached and they will also bring children for vaccination:
"Immunization is a very important segment that we are always actively working on, but without the support of UNICEF, we would not be able to do something like this. The pause caused by the pandemic did somewhat hinder us, five months of the project have expired in the meantime but it did not occur to us not to continue with the started activities. We are continuing, we are not giving up and we will reach every parent and every child ", says Dr. Bičo.
Sanitary technician Eldin Kamenica, engaged in the project, contacted the parents whose names he received from the health centers on a daily basis, informed them about the missed appointments and instructed them to call the health center. He managed in different ways to find contact information of parents whose phone numbers were missing from the medical records or had changes in the meantime. He contacted parents on social media, some he contacted through shared acquaintances but, he says, they were all reached in the end and they received the necessary information. He adds that almost all the parents he contacted had positive reactions.
"In most cases, the parents simply forgot about some of the appointments, and they regularly thanked us for calling and reminding them, they contacted the health center and arranging appointments for vaccination, and finally had their children vaccinated. There were some who initially refused, they had their own reasons, but many contacted doctors, talked to them and got all the necessary information, and in the end decided that vaccination is the best protection for their child”, says Eldin Kamenica.
After the referral to the health center, nothing is left to chance and direct communication with parents continues. According to Azemina Baščelija, the nurse in charge of the children's dispensary of the Goražde Health Center, this type of communication proved to be very successful. After receiving calls from the Institute, parents very quickly began to report to the children's dispensary where they were scheduled appointments for each child, especially after the opening of a separate vaccination center in the clinic "Prvi maj" exclusively for that purpose.
"Although we write the date and time of each subsequent vaccination in their health insurance booklets every time, sometimes parents simply forget, go to work and don't think of it, or think it's a different date. So this reminder is important, if they are busy on the day of the scheduled appointment they can bring the child later, we wait for them to come and get the child vaccinated, and they are very satisfied.
If children do not come to one of the next scheduled vaccines after receiving one, we call the parents of each child to get feedback on why they did not come, when they will be able to come again, and then a new appointment is scheduled, "says Azemina Baščelija, adding that a large number of parents simply could come during March and April, since many of them were also in isolation during the pandemic wave. She reminds that after the stabilization of the epidemiological situation, a new revision was done and parents started coming again and scheduling appointments for vaccination of their children. She predicts that all children who can and should be vaccinated in that period will be vaccinated by the end of the year.
Funding of the Program for Mitigating the Effects of the COVID-19 Pandemic on the Lives of Children and Families in the Western Balkans and Turkey is part of the European Union’s assistance package for Western Balkans in response to COVID-19.