2011 ESARO Regional: Monitoring & Evaluation of Child Health Days in Madagascar and Ethiopia
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As part of the Accelerated Measles Control Plan for Ethiopia, nationwide integrated follow up measles SIAs were planned for 2010-2011, targeting 7 Regions in October 2010 and 4 Regions in February 2011.
The approach to the SIAs attempted to implement best practices that were identified in the planning phase, based on experiences from previous SIAs and other countries, within the feasibility of the local context. The best practices were identified through a consultative process at national level and addressed the various components of micro planning, training, advocacy and communication, logistics management, monitoring and evaluation.
Coordination mechanisms were established at national, regional, zonal and woreda levels, under the leadership of the Government and comprising of all stakeholders. Micro planning was conducted at the kebele level involving health extension workers and the local administration, and making use of a standard planning template that included social mapping. Emphasis was placed on early identification of hard to reach areas and special plans to ensure all areas are reached. Engagement of the Central Statistics Authority (CSA) was critical in the early stages of the planning and forecasting of requirements, and region-specific conversion factors were provided for the purpose of more accurate estimation of target populations. Following the micro planning, cascaded training was conducted. A Field guide, including an abridged version adapted for health extension workers (and translated in 4 local languages), were developed through an extensive consultative process at central level. Efforts were made to ensure good quality training.
Advocacy activities were launched to engage the political leadership at all levels. A multi-channel approach was adopted for social mobilization and included house to house canvassing using community volunteers, radio and television announcements, production of IEC materials, announcements using town criers, schools, religious groups and traditional leaders. A knowledge, attitudes and practices survey among selected communities and health workers guided the development of social mobilization messages and training materials.
The objective of the 2010-2011 integrated measles SIAs was to provide a supplemental dose of measles vaccine to at least 95% of children aged 9 months to 4 years; polio vaccine to all under-five children; vitamin A supplementation to all children 6-59 months of age; deworming medicine to children aged 24-59 months of age; and nutritional screening for under-five children, pregnant and lactating women. In addition, the SIAs set out to strengthen the routine immunization system using every opportunity in the preparations and implementation of activities.
The sampling methodology is a modified Lot Quality Assurance approach, leading to a categorization of whether an area has been adequately reached or not. In each area, children are evaluated both inside and outside of the house. "Inside the house" refers to evaluating the vaccination status of children in the target population by monitoring moving from house to house; "outside the house monitoring" involves evaluating children where they may gather outside the house (for example, playing in the street, at water collection points, etc). Data is also collected on social mobilization and reasons why children missed the SIAs doses if they did.
Findings and Conclusions:
The key findings of the community FGDs are summarized below:
- Caretakers sampled in all study sites in the four regions know about measles and its typical symptoms.
- Majority of the caretakers in the four regions considered measles as a severe and deadly disease.
- Majority of the caretakers sampled know the benefits of the measles vaccine and have had their children vaccinated for measles and other diseases. However, many caretakers in the rural communities in Somali region do not vaccinate their children fully due to unawareness about the benefits of measles vaccine, fear of side effects and inaccessibility to services due to frequent mobility of the caretakers. Furthermore illiteracy, lack of awareness and fear of side effects of vaccines among some rural and remote communities of SNNPR and Oromiya were identified as major barriers of immunization.
- Almost all caretakers sampled in the study sites do not know the importance of supplementary measles doses.
- Most caretakers in the four regions believed that children with measles should be treated at home by traditional means such as coffee ceremonies, application of herbal drugs and hiding the sick children.
- Health workers are the major source of information about measles (and immunization in general) for most people in the four regions. Mass media such as radio, and TV do not have significant roles in the transmission of educational messages about measles in the four regions, even radios are available.
The main conclusions of the survey included:
- Only one third of the health workers had ever received training on EPI and cold chain management
- 55% of health workers in the four regions knew the importance of additional doses of measles vaccine. However, more than 85% of them have positive attitude towards SIAs.
- 90% of the health workers did not know how to estimate vaccine and supplies needs.
- 71% of the health institutions had encountered shortage of at least one of the vaccines in the last 12 months and stock out of BCG, polio and the pentavalent vaccines were most common.
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