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Evaluation database

Evaluation report

2001 ALB: National Measles-Rubella Vaccination Campaign, November 1-15, 2000



Author: Ylli, A.

Executive summary

Background

In February 2000, the Ministry of Health endorsed the proposed plan of action and decided to simultaneously implement vaccination and surveillance strategies that will result in indigenous measles elimination in Albania by 2007 and, at the same time, improve rubella control and reduce the risk of Congenital Rubella Syndrome. A catch-up campaign was conducted November 1-15, 2000, and implementation of other strategies has been planned to commence in 2001.

Purpose / Objective

The Evaluation Team was requested to:
- Review available data on coverage reached during the mass immunization campaign
- Assess the adequacy of activities conducted during the campaign planning and implementation including: immunization safety, social mobilization, and collaboration between partners
- Review progress towards implementing other strategies proposed in the National Plan for Measles Eliminating and Rubella/CRS control in Albania, and participate in developing a detailed plan and timetable for further activities

Methodology

The evaluation team met with the staff of the Institute of Public Health and reviewed reports. They visited 6 districts (Tirana City, Tirana Rrhet, Elbasan, Durres, Kruja and Shkoder) for semi-structured interviews with the staff of the District Directorate of Primary Health Care and health care facility staff.

Key Findings and Conclusions

Pre-campaign preparations were implemented thoroughly and on time. Planning was well managed and coordinated by the Task Force at the national and district levels. A rapid assessment of the cold chain was completed, and additional cold chain equipment was in place on time at the national and district levels. An assessment of injection safety was conducted, and guidelines and training were completed before the campaign. Comprehensive training of staff was conducted on time, and included information on standard procedures, use of forms, safe immunization practices, supervision, and social mobilization.

During preparations, it became clear that denominator data would pose a problem, due to high immigration especially in urban areas. Master Lists were supplemented with door-to-door investigation in certain communities that they thought had significant influx of newcomers.

During implementation, logistics and distribution functioned generally well.

Power outages occurred in certain areas; however, staff feel this was not a major problem since cold chain monitors were used in many areas and they used ice packs to prepare for potential outages.

Health care staff was generally familiar with standard procedures, including vaccine handling, administration and management of adverse events. Some staff reported a wide range of contraindications than recommended in the Standard Procedures document.

No staff kept vaccine longer than 6 hours; however, some indicated discarding open vials in less time. Such practice did not jeopardize the immunization safety, but it may have resulted in unnecessarily higher vaccine wastage in some health care facilities.

A standard questionnaire was used to monitor intra-campaign injection practices. The survey results suggested a generally high quality of practice. However, recapping of used needles was observed during the evaluation.

Safety boxes were reportedly used and destroyed during the campaign. However, a system was not put in place to continue this practice after the campaign for routine immunization activities.

Pre-campaign social mobilization training, production and distribution of materials, as well as inter-agency collaboration and use of mass media (especially TV) were strong. During the campaign itself, volunteer participation was limited.

Routine vaccination services were interrupted at all levels during the campaign. Staff were instructed to catch-up with the missed routine vaccinations after the campaign.

The campaign achieved a national reported coverage of 99% (district range 96% to 99.9%). During the campaign, 867,394 doses were administered versus the target population initially estimated to be approximately 1 million children aged 1-14 years. The master list produced a denominator of 876,678. Uncertainties remain about denominator data in areas of recent influx. Despite these uncertainties, the evaluators concluded that high coverage was achieved. However, we cannot ensure that this high coverage was uniformly achieved in all communities (e.g. peri-urban areas of Tirana).

Recommendations

Validate reported population coverage in certain sub-populations by conducting rapid PAHO-style coverage surveys. Undertake mop-up activities as indicated by these surveys.

Sustain the improvements made to the vaccination system during the campaign for routine services. These include both training capacity to reinforce safe immunization practices and further improvements of infrastructure (such as cold chain and systems for safe disposal of injection equipment).

To better characterize the suspected severe adverse events following immunization reported during the campaign, more detailed case reports should be prepared by reviewing the available medical documentation and, if possible, interviewing physicians who provided medical care and the patient and/or parents. In addition, the background reporting rates of these diagnostic entities should be estimated in order to interpret the data.

Implement the other strategies included in the National Plan to achieve and sustain Albania's goals for measles elimination, rubella control and CRS prevention.



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Report information

Date:
2001

Region:
CEE/CIS

Country:
Albania

Type:
Evaluation

Theme:
Immunization

Partners:
Institute of Public Health, Ministry of Health

PIDB:

Follow Up:

Language:
English

Sequence Number:
2001/801

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