Защита детей от кори в Румынии
Родители из общины рома, проживающей в городе Стрехае на юго-западе Румынии, кивают и с облегчением улыбаются после просмотра короткого видеоролика о пользе иммунизации для их детей, показанного местным врачом. Врач отвечает на вопросы родителей, прежде чем они вместе со своими детьми перейдут в следующий кабинет, где всем детям будет проведена вакцинация. Здесь дети разного возраста: те, кто только начинает ходить, и те, кому уже исполнилось 18 лет. Самые маленькие крепко держат своих мам за руку, а те, кто постарше, улыбаются и просят посмотреть фильм еще раз. Производство и показ данного фильма осуществляется в рамках программы ЮНИСЕФ в Румынии по поддержке усилий министерства здравоохранения страны, направленных на повышение показателей охвата иммунизацией и предотвращение распространения кори. С 2000 года показатели охвата иммунизацией в Румынии значительно снизились. В 2017 году только 75 процентов детей получили две дозы вакцины MMR - комбинированной вакцины против кори, эпидемического паротита и краснухи. Этот показатель намного ниже рекомендованных 95 процентов, необходимых для защиты всех детей. В результате низких показателей охвата иммунизацией в Румынии произошла вспышка кори. В 2016 году ею заболели более 15 000 человек, из которых 59 человек умерли. Большинство из них составили дети. В рамках непрекращающихся усилий по повышению охвата детей иммунизацией, в июле 2018 года стартовала организованная министерством здравоохранения Румынии кампания по вакцинации детей, которые не были привиты. Для информирования населения о важном значении иммунизации участники кампании ходили по домам. В целях поддержки данной кампании ЮНИСЕФ разработал серию информационных материалов, предоставляющих предоставить родителям фактическую информацию о преимуществах и самом процессе иммунизации детей в доступной для понимания взрослых форме. В состав этих информационных материалов входит короткометражный фильм, который посмотрели семьи в Стрехае. Фильм демонстрируется семьям из наиболее уязвимых общин Румынии - родителям, живущим в труднодоступных районах, семьям, пострадавшим от нищеты, и общинам рома. Показатели иммунизации среди детей в этих общинах чаще всего самые низкие по стране. В этом фильме рассказывается о необходимости и преимуществах вакцинации, и одновременно даются ответы на часто задаваемые и волнующие родителей вопросы относительно вакцинации: Безопасно ли делать прививку моему ребёнку? Что делать, если она/он заболеют другой болезнью? Что, если мой ребёнок заболеет после прививки? Эта прививка бесплатна? A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. Девочка получает прививку в общинном центре в Бухуши, в восточной Румынии, в рамках кампании по проведению вакцинации детям, которые её не прошли. Эта кампания проводится при поддержке ЮНИСЕФ и ВОЗ. «Вначале родители не хотели прививать своих детей, но потом они доверились нам. Мы рассказали родителям о пользе прививок и попросили их задавать врачу все вопросы, которые могут возникнуть у них в ходе проведения кампании. Таким образом, родители смогли получить чёткое представление о пользе вакцинации», - сказала Габриэла Стан, медицинский работник в городе Бухуши, в Восточной Румынии. Габриэла была членом группы, ходившей по домам, для того чтобы информировать родителей из уязвимых сообществ о преимуществах вакцинации. И хотя за последние несколько месяцев в Румынии произошли положительные сдвиги в деле вакцинации уязвимых детей спасающей жизни прививкой MMR, дети будут по-прежнему находиться в опасности до тех пор, пока охват иммунизацией не достигнет 95 процентов. ЮНИСЕФ в Румынии будет и впредь помогать в проведении информационно-разъяснительных кампаний о важном значении и необходимости вакцинации и поощрять всех родителей и лиц, обеспечивающих уход за детьми, к своевременному проведению этой профилактической процедуры. Таким путём они смогут защитить своих детей от болезней, предотвратимых с помощью вакцинации.
Protecting children against measles in Romania
Parents living in Strehaia, a Roma community in South-West Romania, nod and smile in relief after watching a short video shown by their local physician on the benefits of immunizing their children. The physician answers questions from the parents before they gather their children and move to the next room where all of the children are vaccinated. The children range in age from young toddlers to 18 years old. The young ones hold their mothers’ hands tightly, but the older ones laugh and ask to watch the film again. The film is part of UNICEF Romania’s ongoing support to the Ministry of Health’s efforts to increase immunization coverage and prevent the spread of measles. Vaccination coverage in Romania has declined since 2000. In 2017, only 75 per cent of children had received two doses of Measles, Mumps and Rubella (MMR) vaccine – a coverage rate far below the recommended 95 per cent needed to protect all children. As a result of low immunization coverage, Romania has experienced a measles outbreak, with over 15,000 people affected since 2016. This includes 59 deaths, the majority being children. As part of ongoing efforts to increase immunization coverage, in July 2018 Romania’s Ministry of Health launched a door-to-door catch up campaign to vaccinate children who missed their vaccinations. In support, UNICEF developed a series of materials to provide parents with easy to understand, factual information about the benefits and process of children being immunized. These materials include the short film watched by families in Strehaia. The film is shown to parents and families in the most vulnerable communities in Romania - people living in hard to reach areas, those affected by poverty, and Roma communities. These communities often have children with the lowest rates of immunization. The film talks about the necessity and benefits of vaccination and, at the same time, addresses the most common vaccine-related questions from parents: Is it safe to vaccinate my child? What if she/he catches another disease? What if my child gets sick after the vaccination? Is the vaccine free of charge? A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. “In the beginning parents did not want to vaccinate their children, but then they put their trust in us. We told them vaccines are good and we encouraged them to ask the doctor all the questions they have during the campaign. So they were able to have a clear picture on the benefit of vaccination,” said Gabriela Stan, a health mediator in the town of Buhuși, in Eastern Romania. Gabriela was part of the team that went door-to-door to inform parents from vulnerable communities about the benefits of vaccination. Although there have been positive developments in reaching vulnerable children with lifesaving MMR immunizations over the past few months in Romania, until the coverage rate reaches 95 per cent, children will remain at risk.
“I’d settle for a year being sick, as long as it’s not her, not for a single day”
Little Varya was 3 years old when Alexei and Nastya Naumov adopted her from an orphanage. They had long dreamed of children, when they found this girl who looked so much like Alexei Naumov. Nothing could stop them: neither difficulties, nor Varyusha's diagnosis – HIV, which the orphanage told them about right away. Varya Varya at the New Year celebration Nastya and Alexei decided that they wouldn’t conceal their now 9 year old daughter’s diagnosis. It is better to put all the cards on the table, than constantly have to look over their shoulder, they say. The parents always emphasize: they have never regretted their decision. In November 2018, when Varya was in the first grade, she fell ill with scarlet fever. The family had just moved to Almaty from Atyrau. Nastya Naumova brought her daughter to two pediatricians, but they did not suspect anything. And then their infectious disease specialist at the AIDS center confirmed the diagnosis. ‘Guys, you have scarlet fever,’ she said. “It seemed to me that this was a forgotten disease, that it is simply impossible. Varya has recovered, but I was still afraid. And as it turned out, not in vain,” says Nastya. The Naumovs were warned that live vaccines are contraindicated for a child with HIV. “I was afraid that Varya would get infected,” Anastasia says. “I didn’t know how the virus would work with her diagnosis, how it would affect the body. And, thank God, for a long time she was able to avoid infection. But, as it turned out, not measles.” In Kazakhstan all children diagnosed with HIV usually receive a medical contraindication for vaccination, which applies to the so-called live vaccines against measles, mumps and rubella. Although in accordance with the WHO clinical protocol, a vaccine against measles, mumps, and rubella (MMR) and other measles-containing vaccines (MCV) should be considered for HIV-infected patients who are asymptomatic or mildly immunosuppressed, as per the routine national schedule. For infants with high risk of exposure to the measles virus, an additional dose of single-antigen measles vaccine administered at 6–11 months of age is recommended, followed by a first dose of routine MMR or another MCV at age 12 months or older (with a minimum interval of 1 month between doses).1 Parents can learn more about each vaccine, included into the National Vaccination Calendar, at a special website dedicated to children routine vaccination: EGU.kz In February 2019, when Varya was preparing to go to school, she noticed red dots on her legs: hemorrhagic vasculitis. Nastya and Varya were immediately taken to the hospital; they thought it was an allergy. For 3 weeks the child was not diagnosed, doctors had not realised that it was measles. Anastasia Naumova shares her story Anastasia Naumova shares her story Later, it turned out that hemorrhagic vasculitis was Varya’s body's reaction to measles. The incubation period was already in progress. But the doctors the Naumovs visited did not understand this. Their infectious disease specialist arrived at the hospital only after Varya's temperature rose to 40 degrees, and diagnosed her with measles. Varya and her mother were taken to the infectious diseases hospital. Varya at the hospital with measles Varya at the hospital with measles “I will never forget the following 10 days…,” Nastya says. Varya fell seriously ill. She was burning with a fever, crying from pain at night. There was nothing Nastya could do to help her child. “I have hardly slept these ten days. I would lean on the table, doze off, the timer would go off - I set Varya's temperature to be measured every hour. And you can't do anything - the treatment is symptomatic,” Nastya says. The complications were the worst. Varya had right-sided pneumonia, so severe that she could not swallow saliva. How would Nastya give her pills? Water? Food? “I was almost shoving this pill into her mouth, and Varya cried and shouted: ‘Mom, it hurts! Mom, don't!’ Almost two years have passed since that moment, and I am still shaking. I’d settle for a year being sick, as long as it’s not her, not for a single day. When you see that your child suffers so much simply because someone did not give her the vaccine, how would you feel about it? I have no words,” Nastya says. In total, they spent about 6.5 weeks in the hospital. During their stay the hospital was full. Children and many adults - all with measles. Fortunately, Varya pulled through. Emaciated, she weighed 17 or 18 kilograms, weak, but alive. Varya does not mention her illness. Nastya noticed that after the illness Varya started having problems studying. Apparently, this ten day long fever affected her cognitive abilities. “I believe if opponents of vaccination ever saw how people bear measles, they would think about it. It's a shame that children who have medical contraindication are at risk,” Nastya says. The Naumovs then vaccinated their daughter (with those vaccines that are not contraindicated for her) in an ordinary district hospital. “The child has HIV infection, an incurable disease, but even she did not have a reaction to the vaccine,” Nastya says. In 2019, there was an outbreak of measles in Kazakhstan with 16,871 cases, of which 13,326 (78.9%) were laboratory confirmed.2 19 children and two adults dies from the disease. Among the victims of measles, 8 children were not vaccinated due to medical contraindications. In 2020, 3,270 cases of measles were registered, of which 2,265 were children under 14 years of age. False contraindications and medical exemptions have been identified as one of the main causes of missed opportunities to vaccinate against measles during the root cause analysis conducted by UNICEF Kazakhstan. The analysis was the part of the UNICEF Kazakhstan Measles Outbreak Prevention Program funded by the US Agency for International Development (USAID). “We sincerely thank USAID for partnering in such an important program for children's lives to prevent a measles outbreak in the future and strengthen the immunization programme in Kazakhstan. We believe that this project will help save and preserve the lives and health of Kazakhstani children and families," said the UNICEF Representative in Kazakhstan Arthur van Diesen. The Program provided technical support to analyze the causes of the measles outbreak, study parents' views on vaccination and awareness campaigns, as well as recommendations for improving the supply of vaccines and building the capacity of healthcare workers for immunization. For example, UNICEF is providing a series of trainings to address false contraindications in cooperation with the Association of Family Doctors of Kazakhstan in Aktobe, Atyrau, Eastern-Kazakhstan, Kyzylorda, Turkestan, Karaganda oblasts, Almaty and Shymkent.
Safeguarding the health of refugee and migrant children during COVID-19
, the initiative has supported UNICEF’s efforts to improve the immunization process for refugee children and migrants by strengthening the assessment and monitoring process. As a result of such efforts, refugees and migrants have been included in the national COVID-19 Immunization Plan.
Navigating pregnancy during the COVID-19 pandemic
Many expectant mothers are fearful of going to appointments while they are taking precautions, such as staying home and practicing physical distancing when outside. “You do see a lot of adaptation happening at the moment in the world where midwives are doing clinics or certain appointments by phone, so that the actual looking at the baby and the growth of the baby appointment can be short,” says Cadée. “I expect that pregnant women will find they’re seeing their healthcare professional less, to protect them and the healthcare professional from getting infected and that they will be seen live when it’s necessary.” Modifications may also be tailored for individual patients depending on their respective conditions, for example lower vs. higher-risk pregnancies. Cadée advises mothers to find out what options are available to them from their healthcare professional and in their communities. “The person who’s taking care of you is perfectly geared to you and your own needs, so your midwife or obstetrician will know best.” After your child is born, it is also important to continue receiving professional support and guidance, including routine immunizations. Speak to your healthcare provider about the safest way to have these appointments, for you and your baby. >> How to get routine childhood vaccinations during COVID-19
Strengthening the implementation of health policies
The initiative also promotes and supports multi-disciplinary approaches and teams to address the complex causes of health problems among refugee and migrant children – from trauma, anxiety and over-crowded conditions, to lack of hygiene facilities and immunization. As a result, support from the ‘RM Child-health’ initiative builds trust between refugee and migrant families and health providers. At the Centre for refugees and migrants near Bela Palanka in south-eastern Serbia, for example, the needs of refugee and migrant women have shaped the development of the Community Centre run by ADRA, with its Mother and Baby Corner for women with infants. Here, women can take part in language classes, sports activities and, crucially, in workshops about their own health and rights. “ The most important thing is that all the advice from our doctor is in line with their economic circumstances and current living situation [in Reception centres],” explains social worker Andja Petrovic. “The advice is tailored to their life and I think they particularly like that, because they can see that their situation is acknowledged. Because when they go to a doctor [in other facilities], they get advice that they can’t follow because they don’t have the living conditions for it.” Also in Serbia, funding from the ‘RM Child-health Initiative’ supports work by UNICEF and the Institute of Mental Health that looks beyond the provision of basic health care to assess the scale and nature of substance abuse among refugee and migrant communities. This cutting-edge field research will guide the development of materials and capacity building specifically for health and community workers who are in regular contact with young refugees and migrants, helping these workers to identify and tackle substance abuse by connecting children and youth to support services. As one researcher involved in the research commented: “Most of those children have spent several years without a home or any sense of stability. They can't make a single plan about the future since everything in their life is so uncertain. I can't begin to imagine how frightening that is.” By building greater rapport between frontline workers and children, and by equipping those workers with the support, skills and resources they need, the ‘RM Child-health’ initiative is helping to transform health policies into health practice. This vital work has been particularly crucial in 2020, as frontline workers have had to confront – and adapt to – the greatest public health crisis in living memory: the COVID-19 pandemic. Logo This story is part of the Project ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe’, Co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative).It represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
Strengthening national health capacity for refugee and migrant children
At first glance, helping a 10-year girl from Iran, now living in Bosnia and Herzegovina, get a new pair of glasses might seem a simple thing. For Maisa, however, this is the end result of a continuum of intensive support, from identifying a girl who struggles with an eye condition, to connecting her to a skilled ophthalmologist. And now Maisa stands in front of a mirror, trying on the glasses that will enhance her life, learning and play. Such a momentous day is only possible when an established health system is equipped to accommodate and respond to the complex needs of refugee and migrant children. Support from the ‘RM Child-Health’ initiative aims to reinforce and enhance health systems across five European countries (Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia) so that these systems can deliver the high-quality services that are the right of every child – and that every child needs, regardless of their origins. The aim: to ensure that health systems catch every refugee and migrant child who is in danger of slipping through the gaps. And there are additional benefits: a health system that works for these vulnerable and excluded children is a health system that works for every child, and that can reach those who are so often the very hardest to reach. This 24-month, €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, aims to strengthen the capacity of health systems to deliver health care to refugee and migrant children. That means ensuring access to life-saving immunization, to mental health and psycho-social support, and services to prevent and respond to gender-based violence, as well as maternal and new-born health care and nutrition. Stronger health systems are needed to overcome the bottlenecks that confront so many refugee and migrant families when they try to access health care. “ The profound challenges that often confront populations – especially children – on the move can include cultural and language barriers, stigma and discrimination on the part of health providers, and a lack of detailed medical records or paperwork,” says Dr. Basil Rodriques, UNICEF Regional Health Advisor. “They may also have their own reasons to distrust state-provided services, including fears of deportation.”