MEASLES ELIMINATION IN CHINA AND WESTERN PACIFIC/ THE WORK OF ELLYN OGDEN

Thursday, 12th of March 2009 Print

 
1) Measles Elimination in China and Western Pacific

Of the six WHO regions, four, including the Western Pacific, are committed to time limited elimination of measles.
 
Within WPR, China is by far the largest, accounting for more than half the population in the region. So regional elimination will depend importantly on the ability of China to stop transmission.
 
In China, like other large countries, the pace of vaccination varies between provinces, with the western provinces lagging behind the rest of the country. In China, as elsewhere, successful child vaccination has led to shifts in the age distribution of measles cases. 

See discussion at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a4.htm
 
 
Cheers, BD

 2

 It is a pleasure to note that the US government has recognized, for her heroism, the work of Ellyn Ogden, USAID's global polio eradication coordinator since 1997. Full text of the USAID publication is at

http://www.usaid.gov/press/frontlines/fl_feb09/p1_ogden.html

 

No one who has ever worked with Ellyn forgets her attention to detail. Every conclusion is supported by meticulous field observations, carefully gathered and shared with nationals before going to the international partners.

 Below is an example, from a 2008 field visit to India, of Ellyn's report writing. If only all field reports were like this one!

 Good reading.

 BD

 

 

Ellyn Ogden, USAID Worldwide Polio Eradication Coordinator

 Bihar, India

 January 6 - 9, 2008

 Places Visited:

Patna NPSU (6 Jan)

Darbhanga (7 Jan):

Manigadhi

.       Patham Kawai (Team #7);

.       Raghopur Mushahri (Team # 15);

.       Manihadhi PHC for meeting and MOIC and MOs. Met with DM, CS, DIO,

SMOs, SMCs, BMC

Madhubani (8 Jan)

Rahika PHC

.       Sugauna (Muslim area with mass refusals on first day)

.       Izra (Muslim area)

.       Shankarpur Sirkunda (Border with Dubhanga) Met with DM, DIO, SMO,

SMC. BMC

 Key Findings and recommendations:

 1.      Strategy: The strategy put forward by the IEAG is appropriate given the current epidemiologic situation in Bihar.  The top priority to stop transmission of the more virulent and highly transmissible P1 compared to P3 is sound and opportune.  Strategies to reduce transmission of P3 in the short-term are also in place and sound; while cases are likely in 2008, the current plan is appropriate to tackle P3 more aggressively after P1 transmission ceases.

 2.      Political Commitment: At all levels, the government staff are fully supportive and action oriented. DMs, CS's, MOICs, DIOs have all been informed, involved and rapidly solving problems.  The zero tolerance for poor performers is having an impact in the field and sending a strong signal to the workers that high quality is expected.  This should be continued. The District and block level task force meetings are reported to be successful and well attended.  More effort is needed to fully optimize/give specific instructions to the teachers, NGO, religious leaders and non-health sector for house-to-house activities.

 3.      Communication: There has been considerable progress in scaling up the human resources available for communication and social mobilization in Bihar.  The media workshop is a very positive step in media management for building long-term public trust.  Per the IEAG, communication and social mobilization need to be focused in high risk areas of Bihar (and UP).  Given the need to increase monitoring and impact of these efforts, a joint national/international Communication Review should be conducted in 2008 (closely linked to the IEAG) and focused on activities in these high risk areas and results of the media workshop

 4.      Routine immunization: is receiving a great deal of support from the state and the addition of newborn tracking to the SIAs is a very, positive development.  In order to increase and accelerate the rate of full coverage, it is important to assure that newborn tracking books are available to all teams, Every institutional birth receives OPV and BCG prior to discharge, RI vaccine is available with no stockouts, RI cards are printed and widely available and the request for cold chain supplies and equipment are filled.

 5.      Surveillance is at its most sensitive and the SMOs and field volunteers of NPSP are invaluable for the functioning of the program. The micro-analysis of SIA, surveillance, communication and social data should continue to guide program improvements.

 6.      SIA Quality - Based on Field visit

 General Findings

.       No missed children in the areas monitored.  Excellent.

.       Newborns encountered had been vaccinated; most had cards or had been counseled about RI

.       RI cards were in use for infants and mothers, where available.

.       Few incorrect housemarkings (team specific)

.       Teams were in the field with sufficient vaccine, all at VVM I, no stockouts reported. Teams were working according to the microplan, with few substitutions. Substitutes had been trained.

.       Transit teams were in action, including the depot manager

.       There were few refusals - most were due to relief supplies not reaching them, so they were opting out of the polio campaign

.       Very good X to P conversion

.       Evening meetings were productive, well attended and resulted in quick action to correct personnel problems, address refusals, etc.

.       Data analysis was excellent, rapid and detailed and used for improvements the next day.

 Areas for Improvement

 Newborn tracking: inconsistent.  Some teams did not have tracking books (some ANMs had locked them up for the strike).

 o       Redo tracking books if not available

o       Circle on tally sheet houses with newborns

o       Revisit missed newborn houses during B team activity

o       Increase training on use of newborn tracking

 Supervision of House to House teams: is still superficial and not used as an opportunity to take corrective action.  One exception - Supervisor Birendra Kumar, Ijra Are team 38 was excellent.

 o       many supervisors weren't carrying supervisory checklist

o       need to verify newborn list against cards to verify

o       look into long runs of Po houses.

 Mobilization:

 o       while there was good participation of families, people were not aware of the campaign unless the AWW had made a bindi mark on the house. Many areas are without an AWW.

o       Mosque miking was non-existent

o       Many children were in the madrassas and teachers were willing to immunize children there or send home messages - these can be better utilized

o       Although banners and poster are not generally the most effective means of informing the public (hearing from a local person is best), there were still a notable lack of banners and poster.  A few more, strategically placed, would be helpful, especially in urban areas.

o       Add communication indicators to monitoring forms and supervisory checklist

 Team Performance:  was overall very good and problems were isolated.

 o       Not carrying X house list or newborn tracking book

o       Revisits only on main road

o       ANMs had more errors with housemarkings, newborn tracking etc. They are well trained but a bit complacent.

o       AWW generally were excellent, but a few needed more supportive supervision.

 Border Areas:  Need to be monitored during the Jan 13 round. The demarcation lines were clear on the micro plan, but many children were moving back and forth. Coverage should be verified.

 Brick Kilns: While a list of brick kilns is available it would help to know which have residences on them to facilitate monitoring. Kiln owners were cooperative.

 Cold Chain - a few reports of melted ice packs were heard at the evening meeting, but I didn't observe this.

  

) The Work of Ellyn Ogden
 

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