Abstract
IntroductionThe protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response.MethodsA community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations.ResultsIntegration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05).ConclusionThis study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).
Highlights
The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases
In the Out Patient Therapeutic Program (OTP) centre in sector 2, a total of 1,646 malnourished children were enrolled into the nutrition program during the study period with 432(26.2%) of them immunised with BCG vaccines while 502(30.5%) received the third dose of Oral Polio Vaccines, 687(41.2%) were vaccinated with the third dose of pentavalent vaccines and 1482(90%) vaccinated with measles vaccines
In sector 5 OTP centre, a total of 2712 malnourished children were enrolled into the nutrition program during the study with 934(34.4%) of them immunised with BCG vaccines, 951(35.1%) received the third dose of Oral Polio Vaccine, 1096(40.4%) vaccinated with the third dose of pentavalent vaccines and 1875(69.1 %) were vaccinated with measles vaccines (Table 1)
Summary
The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. EPI coverage has been plateauing the last 10 years and having not reached the set coverage targets; twenty-two million children, mostly living in the world's poorest countries who haven't received the full course of recommended vaccine by the age of 1 year [1] and integrated and comprehensive service delivery has been reported to have potential to generate demand, strengthen routine immunization services, reduce missed opportunities and improve coverage [2]. In the Bentiu PoC, measles vaccination coverage verified by immunization card was found to be 23.4% during SMART survey conducted in 2016 and there was reported outbreak of measles in 2016 as a result of significant unimmunized children with missed opportunities during provision of nutrition services in the camp [4]. As part of an integrated health approach, immunization plays a critical role in curbing the devastating impact of malnutrition
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