Maiden immunization coverage survey in the republic of South Sudan: a cross-sectional study providing baselines for future performance measurement

William Mbabazi,Richard Laku,Mostafah Yehia,Daniel Ngemera,Anthony K Lako,Nathan Nshakira

doi:10.11604/pamj.2013.16.110.3164

Abstract

IntroductionSince the comprehensive peace agreement was signed in 2005, institutionalization of immunization services in South Sudan remained a priority. Routine administrative reporting systems were established and showed that national coverage rates for DTP-3 rose from 20% in 2002 to 80% in 2011. This survey was conducted as part of an overall review of progress in implementation of the first EPI Multi-Year Plan for South Sudan 2007-2011. This report provides maiden community coverage estimates for immunization.MethodsA cross sectional community survey was conducted between January and May 2012. Ten cluster surveys were conducted to generate state-specific coverage estimates. The WHO 30x7 cluster sampling method was employed. Data was collected using pre-tested, interviewer guided, structured questionnaires through house to house visits.ResultsThe fully immunized children were 7.3%. Coverage for specific antigens were; BCG (28.3%), DTP-1(25.9%), DTP-3 (22.0%), Measles (16.8%). The drop-out rate between the first and third doses of DTP was 21.3%. Immunization coverage estimates based on card and history were higher, at 45.7% for DTP-3, 45.8% for MCV and 32.2% for full immunization. Majority of immunizations (80.8%) were received at health facilities compared to community service points (19.2%). The major reason for missed immunizations was inadequate information (41.1%).ConclusionThe proportion of card-verified, fully vaccinated among children aged 12-23 months is very low at 7.3%. Future efforts to improve vaccination quality and coverage should prioritize training of vaccinators and program communication to levels equivalent or higher than investments in EPI cold chain systems since 2007.

Highlights

Since the comprehensive peace agreement was signed in 2005, institutionalization of immunization services in South Sudan remained a priority
General characteristics of the survey respondents A total of 10,727 households were visited in the 300 sampled clusters surveyed in 10 states; in which caretakers for 2,246 children aged 12-23 months were interviewed
Majority of participants (87.5%) reported to have been residents of their survey location for more than 2 years compared to 12.5% that had residence status of less than 2 years

Summary

Introduction

Since the comprehensive peace agreement was signed in 2005, institutionalization of immunization services in South Sudan remained a priority. Routine administrative reporting systems were established and showed that national coverage rates for DTP-3 rose from 20% in 2002 to 80% in 2011. This survey was conducted as part of an overall review of progress in implementation of the first EPI Multi-Year Plan for South Sudan 2007-2011. Since the initiation of Expanded Programme on Immunization in 1974 by the World Health Organization (WHO)[1,2], there has been substantial increases in the vaccination coverage against the six major vaccine-preventable childhood diseases: tuberculosis, polio, diphtheria, pertussis, tetanus and measles. Vaccination coverage (measured by estimates of the third dose of Diphtheria Tetanus and Pertussis vaccine – DTP-3) has been on an upward trend; increasing from 74% in 2000 to a record 85% in 2010 [4]. The African region reached a record high vaccination coverage level of 74%.[5,6] the good coverage levels should not be used to mask the high absolute numbers of infants who continue to miss their 3rd DTP dose; estimated to have been 22.4 million in 2011[5]

Methods

Results

Discussion

Conclusion