Abstract
BackgroundFollowing the 2015 earthquake, a measles-rubella (MR) supplementary immunization activity (SIA), in four phases, was implemented in Nepal in 2015–2016. A post-campaign coverage survey (PCCS) was then conducted in 2017 to assess SIA performance and explore factors that were associated with vaccine uptake.MethodsA household survey using stratified multi-stage probability sampling was conducted to assess coverage for a MR dose in the 2015–2016 SIA in Nepal. Logistic regression was then used to identify factors related to vaccine uptake.ResultsEleven thousand two hundred fifty-three households, with 4870 eligible children provided information on vaccination during the 2015–2016 MR SIA. Overall coverage of measles-rubella vaccine was 84.7% (95% CI: 82.0–87.0), but varied between 77.5% (95% CI: 72.0, 82.2) in phase-3, of 21 districts vaccinated in Feb-Mar 2016, to 97.7% (CI: 95.4, 98.9) in phase-4, of the last seven mountainous districts vaccinated in Mar-Apr 2016. Coverage in rural areas was higher at 85.6% (CI: 81.9, 88.8) than in urban areas at 79.0% (CI: 75.5, 82.1). Of the 4223 children whose caregivers knew about the SIA, 96.5% received the MR dose and of the 647 children whose caregivers had not heard about the campaign, only 1.8% received the MR dose.ConclusionsThe coverage in the 2015–2016 MR SIA in Nepal varied by geographical region with rural areas achieving higher coverage than urban areas. The single most important predictor of vaccination was the caregiver being informed in advance about the vaccination campaign. Enhanced efforts on social mobilization for vaccination have been used in Nepal since this survey, notably for the most recent 2020 MR campaign.
Highlights
In Nepal, the Expanded Program on Immunization (EPI) was launched in 1977 and was expanded to all district by 1989
First phase conducted in in Aug-Sep 2015, in the districts highly affected by the 2015 earthquake. ◦ This phase was followed by the introduction of a second MR dose in the national routine immunization schedule targeting children aged months
Nepal has very well spread out network of Female Community Health Volunteers (FCHV) who were utilized for community mobilization
Summary
In Nepal, the Expanded Program on Immunization (EPI) was launched in 1977 and was expanded to all district by 1989. Nepal has very well spread out network of Female Community Health Volunteers (FCHV) who were utilized for community mobilization. Opinion leaders at national as well as sub-national levels are always involved in major public health activities like an SIA and they helped in communication and social mobilization. Nepal has an institutionalized mechanism of community ownership and engagement of opinion leaders through Immunization Coordination Committees at successive subnational levels; members include elected representatives (Mayors, Chairpersons of municipalities, municipal ward members etc.) and members of civil society organizations. Following the 2015 earthquake, a measles-rubella (MR) supplementary immunization activity (SIA), in four phases, was implemented in Nepal in 2015–2016. A post-campaign coverage survey (PCCS) was conducted in 2017 to assess SIA performance and explore factors that were associated with vaccine uptake
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