Practice in Developing Countries

Abstract

After the Alma Ata Conference the Expanded Programme on Immunization (EPI) was declared a basic part of primary health care by the World Health Organization. The diseases chosen to be included in EPI were: tuberculosis (BGG) diphtheria pertussis and tetanus (DPT) poliomyelitis (oral polio vaccine) and measles. The rising prevalence of the human immunodeficiency virus infection among infants has modified the schedule of immunizations which have generally been delivered during the 1st year of life. EPI recommendations include not giving the BGG to children with clinical AIDS. The basic strategies of EPI are political managerial and technical. WHO and UNICEF have played key roles in ensuring that funding for EPI activities are available for the poorest countries. 15 of the 23 developing countries with more than 20 million people are currently producing 1 or more of the EPI vaccines. The constraints to EPI program include: 1) managerial difficulties; 2) delivery of services;3) funding dependency on external sources; 4) disappointing outcomes of the polio vaccine; and 5) unsatisfactory results of the measles vaccine in urban cities especially in West Africa. Since the original design of EPI vaccines 15 years ago there are now new ones on the way: 1) a Hepatitis B vaccine effective in reducing the prevalence of chronic carriage in children and adult deaths in AFrica and Asia by reducing liver disease and hepatocellular carcinoma. Because of differences in infection rates a policy of immunization would be recommended in Africa during the 1st year of life while for Asia immunization would be required during the 1st days of life; 2) a new protein-polysaccharide conjugated hemophilus vaccine and a pneumococcal one offer hope against the 3 major causes of death in Africa respiratory infections diarrhea and malaria. There still needs to be a vaccine developed against malaria and AIDS.