National Immunization Days Research Articles

Mass supplementation of vitamin A linked to National Immunization Day.

Main objectives were to assess the feasibility of linking vitamin A delivery with National Immunization Days (NIDs) and to see the impact on xerophthalmia. An Intervention study of mass distribution of vitamin A solution was undertaken to control widespread xerophthalmia prevalent in children living in about 26 slums of Chandigarh in the year 2000. Two rounds of mass distribution of Vitamin A solution covering 27642 and 31762 children in 1-5 years of age in first and second rounds, respectively, were undertaken. The findings of second round and post evaluation after intervention are presented here. An additional team of two persons per pulse polio immunization (PPI) centre delivered age specific doses of vitamin A solution through 98 centres and operational problems were recorded. PPI staff provided the supervision and PPI tally sheets were used. The programme achieved a vitamin A coverage rate of 99% in first round and 88% in second round. Only two parents refused vitamin A solution. No side effect or cases of toxicity due to vitamin A were reported by health institutions in the area or in a stratified random sample of 101 children. There was a significant decline (13.4%) in xerophthalmia after two rounds of mass distribution (P < .001). The strategy to deliver vitamin A was successfully integrated into NID's and appeared to achieve a significant decline in xerophthalmia. Linking of vitamin A distribution with PPI could be a basis for launching similar initiatives in other areas of India and other countries where xerophthalmia is a public health problem.

Frequency and determinants of breastfeeding in the State of São Paulo, Brazil

To meet the information need of Brazilian municipalities concerning breastfeeding practices as part of health care planning, a study was carried out to describe breastfeeding and to identify weaning-related factors. Of all municipalities in the State of São Paulo, Brazil, openly called to participate in the study, 84 joined in. Personnel underwent training to collect data during the national mass immunization day in 1998. A sample strategy, proportional to the infant population, was developed for each participant. Standardized questionnaires were applied to assess infant feeding practices in the previous 24 hours. Descriptive statistic analysis on breastfeeding prevalence and logistic regression analysis of risk factors for discontinuing exclusive breastfeeding of infants aged less than 4 months and weaning of infants aged less than a year were performed. Exclusive breastfeeding rates in the first four months of life were under 30%. The risk factors were: lower maternal education status; lack of access to the so-called "Baby Friendly Hospital Initiative"; primiparity; and early age pregnancy. Around 50% of children under a year old were breastfed. Lacks of access to the "Baby Friendly Hospital Initiative", primiparity, and mother's unemployment or engagement in an informal occupation activity were risk factors for weaning. Local breastfeeding rates are extremely variable in the State of São Paulo, reinforcing the importance of local, swift, and easily feasible health care actions.

Factors influencing participation in national immunization days in Kumasi, Ghana.

A study of the factors influencing participation in national immunization days (NID) in Kumasi, Ghana was carried out between the April and June of 1999. Polio-immunization coverage during NID was assessed among children aged < 5 years; > 90% of these children had received polio vaccinations on both of the two previous NID. The mothers who participated most in the NID tended to be those who were better educated and Ghanaian. Mothers who were salaried workers participated fully in NID. Radio and television played a major role in public education about NID, whereas the attitude of health workers was a strong factor that prevented many mothers/caregivers from bringing their children to be immunized. The coverage of the Expanded Programme on Immunization (EPI) was assessed in children aged 12-23 months; nearly 70% of these children were fully immunized. BCG had the highest coverage (97.0%) and measles the lowest (79%). Again, full coverage of the children of mothers who had been educated beyond primary level was higher than that of the other children (75.9% v. 65.2%), and coverage of the children of Ghanaian women was higher than that of the others (70.8%. v. 50.0%). Although the mothers/caregivers raised concerns about the costs of the routine immunizations, these charges apparently did not prevent them from taking their children to be immunized. NID complement the routine EPI-associated work in Ghana, increasing overall polio-immunization coverage. The results of this study will be used to improve the overall performance of immunization programmes, especially in the Kumasi metropolis. Hopefully, sustained, increased polio-immunization coverage will contribute positively towards polio eradication in Ghana.

Control of Vitamin A Deficiency in Vietnam: Achievements and Future Orientation

Vitamin A deficiency is one of the major nutritional deficiencies in Vietnam. The first survey, conducted in 1985-1988 showed that the prevalence of severe xerophthalmia was seven times higher than the cutoff point established by the World Health Organization (WHO) to define vitamin A deficiency as a public health problem. The result of this survey strongly convinced the government to launch a program to control vitamin A deficiency, which started in 1988. The program strategies included nutrition education, universal distribution of high-dose vitamin A capsules to children aged 6 to 36 months in combination with national immunization days, and promotion of production and consumption of vitamin A-rich foods at the family level. The implementation network was set up based on the existing preventive health structure at all administrative levels. Organizations such as the women's union and other social sectors have participated actively in the program. Surveys conducted in 1994 and 1998 showed that the prevalence of clinical xerophthalmia was significantly lower than that identified in the baseline survey and below the WHO criteria for a public health problem. The achievements of our program have demonstrated that an effective vitamin A supplementation program can be implemented successfully by the preventive health network with active community participation. In the coming years, it will be important for our program to develop approaches other than vitamin A supplementation in order to maintain the past achievements.

Three steps closer to a polio free Africa

Last month witnessed the final effort in a massive three stage polio vaccination campaign in war torn central Africa. Tens of thousands of door to door teams will complete the last of three synchronised rounds of national immunisation days in Angola, Congo, the Democratic Republic of the Congo (formerly Zaire), and Gabon. The campaign has been coordinated by the Global Polio Eradication Initiative, a collaborative group comprising members of WHO, Unicef, Rotary International, and …

What really matters?

The most recent report from UNICEF on The State of the World’s Children 2002 contains a sadly optimistic statement about children in Afghanistan: despite decades of internal armed conflict during 2000, four national immunization days were completed with an estimated 5.4 million children reached on each day. ‘Five further immunization rounds are planned in 2001’.

Rapid assessment and delivery of Vitamin A to slum children by using National Immunization Day in Chandigarh.

This study was done with the objective to see the feasibility of using National Immunization Days (NIDs) for rapid assessment, and delivery of Vitamin A solution to about 27,600 children dwelling in 26 slums in Union Territory of Chandigarh. The assessment of Vitamin A deficiency (VAD) was done in a stratified random sample of 1304 children during third round of Intensified Pulse Polio Immunization (IPPI) and delivery of Vitamin A solution was done during fourth round of IPPI in 1999-2000 covering 27,642 children in the age group of 1-5 years. An additional team of two persons per centre delivered age specific doses of Vitamin A solution through 72 centres and operational problems were recorded. IPPI staff provided supervision and same tally sheets as of IPPI were used. The prevalence rate of VAD was 24.6%, with conjunctival xerosis, bitot's spot and corneal xerosis as 23.7%, 0.6% and 0.2% respectively. 27,275 (98.7%) children out of 27,642 were administered Vitamin A solution, with no major operational problem. Only five parents (0.01%) refused Vitamin A solution. No case of side effect or toxicity due to Vitamin-A was reported. The strategy to assess and deliver Vitamin A during NID's was found to be feasible and successful and could be a basis for launching similar initiatives in other areas of India and other countries where VAD is a public health problem.

Mass measles vaccination in urban Burkina Faso, 1998.

To assess the impact of the National Immunization Days (NIDs) on measles vaccine coverage in Burkina Faso in 1998. During the week after the campaign, in which measles vaccine was offered to children aged 9-59 months in six cities regardless of vaccination history, a cluster survey was conducted in Ouagadougou and Bobo Dioulasso, the country's two largest cities. Interviewers visited the parents of 1267 children aged up to 59 months and examined vaccination cards. We analysed the data using cluster sample methodology for the 1041 children who were aged 9-59 months. A total of 604 (57%) children had received routine measles vaccination prior to the campaign, and 823 (79%) were vaccinated during the NIDs. Among those who had previously had a routine vaccination, 484 (81%) were revaccinated during the NIDs. Among those not previously vaccinated, 339 (78%) received one dose during the NIDs. After the campaign, 943 (91%) children had received at least one dose of measles vaccine. Better socioeconomic status was associated with a higher chance of having been vaccinated routinely, but it was not associated with NID coverage. The mass campaign enabled a substantial increase in measles vaccine coverage to be made because it reached a high proportion of children who were difficult to reach through routine methods.

Vitamin a Deficiency Control Programs in Eastern and Southern Africa: A Unicef Perspective

In several Eastern and Southern African countries, between one-third and one-half of the children are vitamin A deficient. Not just one strategy, but a combination of supplementation, fortification, and dietary diversification will provide the solution to the elimination of vitamin A deficiency. Food diversification in general is limited by increasing poverty and household food insecurity. Supplementation coverage rates increased from an average of 22% to 68% during the last four years. This was mainly due to integration of supplementation into national immunization days. Now the challenge is to integrate supplementation into sustainable delivery systems. Several countries have started or are planning maize and/or sugar fortification initiatives, but most of the experience so far has been on a pilot scale, and little is known about the impact of the interventions. There is a need to develop strategies for vitamin A supplementation and fortification of different foods to reach all areas and individuals in a country.

Progress Toward Poliomyelitis Eradication—African Region, 1999-March 2000

In 1988, the World Health Assembly resolved to eradicate poliomyelitis globally by 2000 (1). The African Region (AFR) of the World Health Organization (WHO) began implementing polio eradication strategies in 1996, including National Immunization Days (NIDs*) and acute flaccid paralysis (AFP) surveillance (2,3). This report summarizes progress toward polio eradication in AFR during 1999-March 2000, and suggests that although substantial progress has been reported toward interrupting poliovirus transmission in eastern and southern Africa, poliovirus remains endemic in other African countries in west and central Africa, especially among those experiencing internal strife or civil war.

Progress Toward Poliomyelitis Eradication—Democratic Republic of Congo, 1996-1999

In 1988, the World Health Assembly resolved to eradicate poliomyelitis by December 31, 2000 (1). Although progress has been extraordinary (2), full implementation of polio eradication strategies has been delayed in several countries affected by war. The Democratic Republic of Congo (DRC) has experienced continual armed conflict since October 1996. As a result, DRC is the last country in the African Region of the World Health Organization (WHO) to implement National Immunization Days (NIDs*). DRC is an important global reservoir for wild poliovirus and shares more than 5580 miles (9000 km) of border with nine countries; in at least seven of these countries polio is endemic. The large area of DRC, substantial amount of poverty, weak health-care infrastructure, poor transportation and communication, and competing demands for resources present considerable challenges to polio eradication. This report summarizes information on the existing health-care infrastructure and routine coverage, information from NIDs carried out in 1999, and results from the recently established surveillance system for acute flaccid paralysis (AFP).

Progress Toward Global Poliomyelitis Eradication, 1999

In 1988, the World Health Assembly resolved to eradicate poliomyelitis globally by 2000. Since then, substantial progress has been reported by all countries where polio is endemic in implementing the recommended polio eradication strategies (i.e., achieving and maintaining high routine coverage with oral poliovirus vaccine [OPV]; conducting National Immunization Days [NIDs] to rapidly decrease poliovirus circulation; establishing sensitive surveillance systems for polio cases and poliovirus; and carrying out mopping-up vaccination activities to eliminate the remaining reservoirs of poliovirus transmission). Although much progress has been made in many countries, substantial obstacles remain, particularly in 14 priority countries (i.e., global reservoir countries or countries with ongoing armed internal strife or civil war). This report updates progress during 1998 toward the global eradication target and describes accelerated activities to achieve the 2000 goal.

Causes of low attendance at national immunization days for polio eradication in Bushenyi district, Uganda.

The purpose of this study was to investigate the factors influencing attendance for polio National Immunization Days (NIDs) using the Attitudes-Social-influence-self-Efficacy (ASE) model as a guiding theoretical framework. The data was collected in Bushenyi district of south-western Uganda in 6 focus group discussions about outcomes of attendance at NIDs, about who decides on attendance, and about attendance barriers and supports. The purpose of NIDs - eradicating polio - was not known to the informants. The main reason mentioned for attending NIDs and other immunization was to weaken childhood diseases or to strengthen the children's capability in fighting diseases, whether they are immunizable or not. However, it was strongly believed that the previous NIDs had caused a severe malaria epidemic with a very high mortality, and this led to most parents not attending the next. Sources of social influence were mostly opinion and local leaders in communities, health workers, friends and relatives. Opinion leaders who did not immunize their children were said to hinder attendance at NIDs by other lay people. NIDs cards, on the other hand, were regarded as valuable means of support for attendance. Thus to improve immunization coverage, there is need for issuing NIDs cards, for using health education to change the belief that NIDs cause malaria, and to encourage local leaders to attend NIDs.

Staff awareness of oral polio vaccine vial monitor in Chandigarh.

This study highlights the awareness of pulse polio centre staff about polio vaccine vial monitor (VVM) during a National Immunization Day in Chandigarh. Out of the 79 staff members interviewed, only 53 (67%) had ever heard of the VVM and were further interviewed. Fifty (94.4%) staff members were aware that VVM is present on vaccine itself and majority (79.2%) told that it is the inner square with outer circle. Only half were aware of its function and 71.7% knew how to read it. It was observed that awareness among health staff [Health worker (F)/ANM] and volunteers was very poor. There is a need for effective training of staff before subsequent PPI to maintain an effective cold chain.

Viewpoint: immunization against poverty.

According to several demographic analyses there is a correlation between health and poverty. Data have shown that diseases and their underlying causes affect family economy in a number of ways: reduced productivity impediment of education or retained high dependency ratios. Hence it is concluded that the right investment in health is at least as important as education. One effect of this poverty reduction perspective is prioritizing and focusing on a limited set of predominantly infectious diseases. An advantage of investing in excess for poor people is that investments become self-targeting and could possibly become free or almost free. However impact of health reforms on immunization in other countries appears to be mixed. The use of quantitative randomized trials has resulted in better coverage compared to health center-driven strategies. Among the suggestions of this paper to achieve the objectives of the Global Alliance for Vaccines and Immunization include enhancing global funding for children vaccines strengthening of immunization infrastructure and coverage making of sustainable vaccine procurement securing research and development for vaccines for the poor and vaccine research discovery.

Universal immunization: the diphtheria control strategy of choice in the Republic of Tajikistan, 1993-1997.

During the 1993-1997 diphtheria epidemic in Tajikistan, the incidence rate was the highest observed throughout the Newly Independent States of the former Soviet Union (76.2 cases/100,000 population in 1995). Factors that contributed to this situation included an increase in the number of persons who were not fully immunized, a breakdown of health care services and disease surveillance, civil war, an increase in migration, shortages of qualified medical personnel, and shortages of products, resources, and services. The Ministry of Health and numerous international organizations have worked to address the needs of the republic, and in the fourth quarter of 1995, the number of reported cases began to decrease. It is believed that this decrease was largely the result of routine immunization, implementation of national immunization days, and use of a World Health Organization-recommended system for working with patients and contacts, and it underscores the importance of universal diphtheria immunization with special booster doses in such an epidemic setting.

Polio as a platform: using national immunization days to deliver vitamin A supplements.

In 1988 the 41st World Health Assembly committed WHO to the goal of global eradication of poliomyelitis by 2000 "in ways which strengthen national immunization programmes and health infrastructure". The successful use of polio National Immunization Days (NIDs) to deliver vitamin A is an example of how polio eradication can serve as a platform to address other problems of child health. Importantly, this integration is helping to achieve the World Summit for Children goal of eliminating vitamin A deficiency by the year 2000. It is estimated that between 140 million and 250 million preschool children are at risk of subclinical vitamin A deficiency. In 1998 more than 60 million children at risk received vitamin A supplements during polio national immunization days (NIDs). While food fortification and dietary approaches are fundamental to combating vitamin A deficiency, the administration of vitamin A supplements during NIDs helps raise awareness, enhance technical capacity, improve assessment and establish a reporting system. Moreover, polio NIDs provide an entry point for the sustainable provision of vitamin A supplements with routine immunization services and demonstrate how immunization campaigns can be used for the delivery of other preventive health services.

National immunization day to assess nutritional status of underfives in Chandigarh.

National Immunization Days (NIDs) are an additional opportunity to reach a large number of children and can be used to undertake additional activities beside immunization. This study highlights an attempt to assess nutritional status of under five children by using a NID. Seven thousand four hundred and thirteen underfives were selected randomly from urban, rural and slums areas of Chandigarh. Nutritional status was assessed by using weight for age criteria. Prevalence of protein energy malnutrition (PEM) was found to be about 42% while 22.7%, 14.5%, 4.1% and 0.7% children had grade I, II, III and IV PEM respectively. The prevalence of PEM was significantly higher among females (47.6%), in 1-3 years age group (53.80%), in slum area (67%) and children of labour class (60.5%) (p < 0.001). With increase in family size, the prevalence of malnutrition also significantly increased, and decreased with high literacy rate in parents (p < 0.001). The prevalence of PEM in present study (42%) was comparable to a community based survey (51.6%) among pre-school children of an ICDS block of Chandigarh. National immunization days can be successfully used to assess nutritional status of children. This approach can be used by others for screening common childhood problems, preparing normogram for a region or country, administering Vitamin A and educating mothers.

The Philippine Micronutrient Supplementation Programme

The Philippine micronutrient supplementation programme covers the three major international micronutrient deficiency problems: vitamin A, iron, and iodine. Supplementation is administered through provision of capsules and liquid preparations. There are two major occasions during which universal supplementation is conducted: National Immunization Day and National Micronutrient Day. On National Immunization Day, initially vitamin A supplements were given together with several vaccines. Starting in 1996, immunization was restricted to polio vaccine. Various types of micronutrient interventions are included in National Micronutrient Day, such as distribution of vegetable seeds and cuttings to promote home food production, education on proper nutrition, testing of salt for iodine, distribution of iodized salt to poor families, and promotion of fortified foods. Various health-related activities are also included. The existence of a well-functioning health infrastructure facilitated the establishment of the distribution system. Supplementation centres manned by volunteers were set up in neighbourhoods throughout the country. International organizations and other national governmental agencies contributed resources, not only to purchase supplements, but also to provide promotional materials and expertise in social mobilization. There was full media participation in the implementation of the programme. Funding limitations have led programme planners to prioritize target groups for supplementation. The campaign approach has been very effective for increasing the coverage levels for vitamin A and iodine capsules to well above 80% on average. There is the need to develop an effective record system at the field level to reduce the possibility that children will get high-dose supplements too frequently, which could result in toxicity.

Massive outbreak of poliomyelitis caused by type-3 wild poliovirus in Angola in 1999.

The largest outbreak of poliomyelitis ever recorded in Africa (1093 cases) occurred from 1 March to 28 May 1999 in Luanda, Angola, and in surrounding areas. The outbreak was caused primarily by a type-3 wild poliovirus, although type-1 wild poliovirus was circulating in the outbreak area at the same time. Infected individuals ranged in age from 2 months to 22 years; 788 individuals (72%) were younger than 3 years. Of the 590 individuals whose vaccination status was known, 23% had received no vaccine and 54% had received fewer than three doses of oral poliovirus vaccine (OPV). The major factors that contributed to this outbreak were as follows: massive displacement of unvaccinated persons to urban settings; low routine OPV coverage; inaccessible populations during the previous three national immunization days (NIDs); and inadequate sanitation. This outbreak indicates the urgent need to improve accessibility to all children during NIDs and the dramatic impact that war can have by displacing persons and impeding access to routine immunizations. The period immediately after an outbreak provides an enhanced opportunity to eradicate poliomyelitis. If continuous access in all districts for acute flaccid paralysis surveillance and supplemental immunizations cannot be assured, the current war in Angola may threaten global poliomyelitis eradication.