Impact of an Intervention to Use a Measles Rubella and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal.

Friday, 6th of July 2018

J Infect Dis. 2017 Jul 1;216(suppl_1):S280-S286. doi: 10.1093/infdis/jix164.

Impact of an Intervention to Use a Measles Rubella and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal.

Wallace AS¹ Bohara R² Stewart S¹ Subedi G³ Anand A¹ Burnett E¹ Giri J³ Shrestha J³ Gurau S² Dixit S⁴ Rajbhandari R⁴ Schluter WW².

Author information

Abstract

BACKGROUND:

The potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures.

METHODS:

The intervention package was incorporated into existing SIA activities and materials to improve healthcare providers RI knowledge and practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100 randomly selected health facilities before and after the SIA and evaluated the following RI process measures: vaccine safety RI planning RI service delivery vaccine supply chain and RI data recording practices. Data collection included observations of vaccination sessions interviews with the primary healthcare provider who administered vaccines at each facility and administrative record reviews. Pair-matched analytical methods were used to determine whether statistically significant changes in the selected RI process measures occurred over time.

RESULTS:

After the SIA significant positive changes were measured in healthcare provider knowledge of adverse events following immunization (11% increase) availability of RI micro-plans (+17%) and maps (+12%) and awareness of how long a reconstituted measles vial can be used before it must be discarded (+14%). For the SIA 42% of providers created an SIA high-risk villages list and >50% incorporated this information into RI outreach session site planning. Significant negative changes occurred in correct knowledge of measles vaccination contraindications (-11%) correct definition for a measles outbreak (-21%) and how to treat a child with a severe adverse event following immunization (-10%). Twenty percent of providers reported cancelling ≥1 RI sessions during the SIA. Many RI process measures were at high proportions (>90%) before the SIA and remained high afterward including proper vaccine administration techniques proper vaccine waste management and availability of vaccine carriers and vaccine registers.

CONCLUSIONS:

Focusing on activities that are easily linked between SIAs and RI services such as using SIA high-risk village list to strengthen RI microplanning and examining ways to minimize the impact of an SIA on RI session scheduling should be prioritized when implementing SIAs.

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

KEYWORDS:

immunization systems; measles; polio; supplementary immunization activities

PMID: 28838201 PMCID: PMC5771484 DOI: 10.1093/infdis/jix164