Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Description of the Intervention
- Continuous training of the PHS, especially related to the data collection during the immunization sessions. Twice a month, a meeting between PHS and supervisors was held in order to address challenges faced during the implementation of routine immunization services, to clarify potential PHS doubts, to identify weaknesses in the activities carried out, and to share experiences and suggestions.
- Revision of PHS working time, with personnel rotation between fixed and outreach activities. Outreach sessions were usually more exhausting because of long road trips and the high number of children to be vaccinated on a single day (up to 250). Personnel alternation between fixed point and outreach sessions was perceived as necessary by PHS.
- Improving the monitoring of vaccine stockpile, with the creation of a dedicated sheet for registering, at the end of each session, the number of available doses for each single vaccine. In this way, trips to the Ombadja DHD to resupply vaccines were more accurately planned, avoiding both vaccine stockouts and the accumulation in the refrigerators of unneeded doses to avoid expiry before use.
- Strengthening of the collaborations with local Community Health Workers (CHWs) and Traditional Birth Attendants (TBAs). These figures represent an essential resource in the scenario of Mucope Comuna, where most of the territory is not reached by phone or internet connection, and the proportion of non-Portuguese speakers is high. CHWs and TBAs were involved in creating connections with community leaders of Mucope villages, in the distribution of sheets containing the plan of Chiulo PHS outreach activities and in translating to the local language.
- Shared decision with PHS, Chiulo Hospital management, Ombadja DHD and CHWs of the localities targeted by the outreach sessions. Outreach activity plans for Mucope Comuna were drafted every 4 months, with the selection of 6 to 8 villages usually reached at least once a month. Decisions to add, remove, or confirm communities in the plan were made on the basis of the estimated target population of the various communities, the number of vaccinated children in the villages in the 4 previous months, and the distances between Chiulo Hospital and the nearest immunization point.
- Enhanced collaboration with Ombadja DHD, particularly in terms of sharing immunization data and health information of Mucope Comuna obtained during the outreach sessions performed by the Chiulo Hospital PHS.
2.3. Study Design
2.4. Data Collection
2.5. Definition of Intervention Periods
2.6. Outcome Variables
- At birth: One dose of Oral Polio Vaccine (OPV0), one of Bacillus Calmette-Guérin (BCG) vaccine, and one of Hepatitis B (HepB_BD, Hepatitis B Birth Dose);
- At months 2, 4, and 6: One dose of OPV (OPV1-3), one of Pentavalent vaccine (Penta1-3, containing vaccine in DTP plus Haemophilus influenzae and Hepatitis B vaccine) and one of Pneumococcal Conjugate Vaccine (PCV1-3);
- At months 2 and 4, one dose of Rotavirus vaccine (Rota1-2);
- At month 4, one dose of Inactivated Polio Vaccine (IPV);
- At month 9, one dose of Measles-Containing Vaccine (MCV, from February 2018 combined measles/rubella vaccine was introduced in PAV) and one of Yellow Fever (YF) vaccine.
2.7. Statistical Analysis
2.8. Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Share and Cite
Fattorini, M.; Wilunda, C.; Raguzzoni, G.; Quercioli, C.; Messina, G.; Fantini, M.P.; Putoto, G. Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era. Int. J. Environ. Res. Public Health 2019, 16, 4572. https://doi.org/10.3390/ijerph16224572
Fattorini M, Wilunda C, Raguzzoni G, Quercioli C, Messina G, Fantini MP, Putoto G. Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era. International Journal of Environmental Research and Public Health. 2019; 16(22):4572. https://doi.org/10.3390/ijerph16224572
Chicago/Turabian StyleFattorini, Mattia, Calistus Wilunda, Gloria Raguzzoni, Cecilia Quercioli, Gabriele Messina, Maria Pia Fantini, and Giovanni Putoto. 2019. "Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era" International Journal of Environmental Research and Public Health 16, no. 22: 4572. https://doi.org/10.3390/ijerph16224572
APA StyleFattorini, M., Wilunda, C., Raguzzoni, G., Quercioli, C., Messina, G., Fantini, M. P., & Putoto, G. (2019). Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era. International Journal of Environmental Research and Public Health, 16(22), 4572. https://doi.org/10.3390/ijerph16224572