Social Mobilization Activities Research Articles

Bridging research to policy for the prevention and control of parasitic neglected tropical diseases in the Philippines: the War on Worms campaign

BackgroundIn the Philippines, the Department of Health (DOH) is the governing agency for the health system and is mandated to provide national policy direction and develop national plans, technical standards, and guidelines on health. Under the Local Government Code of 1991, local government units (LGUs) were granted autonomy and responsibility for provision of health services. This decentralisation has posed challenges in terms of capacity and coordination. Here, we describe the War on Worms (WOW) campaign, which was developed and implemented to provide technical support to DOH and LGUs in the prevention and control of helminth infections in the Philippines. MethodsIn 2012, the WOW Campaign was implemented in Davao del Norte, Philippines. Advocacy fora were conducted to forge partnerships between different sectors and solicit support of local officials. Health workers received training and resources, and social mobilisation activities were conducted in the community to raise awareness of helminth control. With the endorsement of the Department of Education (DepEd), children in schools aged 5–12 years were given anthelmintics via school-based, teacher-assisted mass drug administration (MDA). Combined MDA for soil-transmitted helminthiasis (STH) and schistosomiasis was eventually implemented in schistosomiasis-endemic sites to simplify and increase efficiency of treatment for both infections. Parasite assessment using the Kato-Katz technique was conducted in sentinel sites at the beginning of the project to provide baseline helminth status in the area. After MDA, we monitored coverage rates, and adherence to the programme. Follow-up parasitological assessment after four rounds of MDA was also conducted to monitor outcomes of the deworming programme. FindingsIn its 5 years of implementation, the WOW Campaign has generated evidence for policy formulation to improve control of intestinal helminthiasis. The combined MDA among school-aged children showed a marked increase from the 31% coverage rate in 2013 to 69% in 2014. This increasing trend continued with the 75% and 90% combined MDA coverage rates in 2015 and 2016, respectively. The baseline and follow-up parasitological assessments conducted in 2012 and 2015, respectively, showed reductions in the prevalence of STH and schistosomiasis. In 2012, the baseline parasitological assessment in school children showed a cumulative STH prevalence and moderate-to-heavy intensity STH prevalence of 14·7% and 0·5%, respectively, with 3·1% schistosomiasis prevalence. In 2015, the follow-up parasitological assessment showed a decrease in the prevalence of STH and moderate-to-high intensity STH to 4·2% and 0·3%, respectively. Schistosomiasis prevalence also showed a reduction to 0·3%, meeting WHO target schistosomiasis prevalence of <1%. Lessons from the WOW Campaign, such as the school-based teacher-assisted combined MDA, increased coverage rates, and decreased prevalence rates, contributed in the formulation of policies for the National School Deworming Day (NSDD), National School Deworming Month (NSDM), and Harmonized Schedule and Combined Mass Drug Administration (HSCMDA). Likewise, a memorandum of understanding among the DOH, Department of Education, Department of Interior, and local governments was developed for the implementation of policies. InterpretationAside from generating evidence to inform programmes and policies, research serves as a good platform to initiate intersectoral collaboration. Support of local governments was crucial in the implementation of the campaign. Initiating intersectoral collaboration and soliciting the support of local officials are key steps in bridging research to policy, particularly in decentralised health systems like the Philippines. FundingAsian Community Trust.

What is the Value of Educational Broadcast?

Over the years several developed and developing countries have used television broadcasting as a tools to enhance the dissemination of specific educational programs, as well as information and values to a large segment of their population. This paper sets out to measure the social value of one of this initiatives in the context of a developing country, namely the Futura TV channel in Brazil. The Futura is a communication project, ran by a non-profit foundation financed exclusively by private sector donations in Brazil. With almost 10 years of existence, Futura broadcast reaches almost 50% of the Brazilian population, and has approximately 33 million regular viewers in the whole country. Contingency valuation (CV) techniques using the referendum design were used to estimate the willingness to pay of a representative sample of the Brazilian adult population. Using both parametric and non-parametric techniques this paper is able to estimate the population willingness to pay for Futura, even in a sample in which a 60% of the population choose not to consume the good. The analysis suggest that the willingness to pay for the channel is positive and at least 16 times greater than the channel operation cost. The average minimum willingness to pay estimated using the Turnbull nonparametric model was R$ 3.7 per month, while the parametric average willingness to pay estimated with the Spike model suggested a value of R$ 5.9. When multiplied by the 5 million households with at least one member willing to pay something for the Futura TV channel, the total annual social value of the channel ranges from 330 to 550 million reais. Moreover, the complementary social mobilization activities promoted by the Futura channel seems to have a positive impact on its social value, suggesting that the method was successful in terms of disentangling embedded effects.

A descriptive study to assess the awareness of communication and social mobilization activities for tuberculosis control among households in rural area of Shivamogga, Karnataka

Background: Advocacy, communication, and social mobilization addresses four key challenges such as improving case detection and treatment adherence, reducing stigma and discrimination, empowering tuberculosis (TB) patients, and mobilizing the resources and political commitment required to combat TB. A multipronged approach included activities to disseminate information through information, education, and communication materials, and simultaneously initiating community-based activities by actively involving and sensitizing communities on TB. Objectives: The objectives of this study were as follows: (1) To assess the awareness of communication and social mobilization activities among households in rural field practice area of Shimoga Institute of Medical Sciences, Shivamogga and (2) to know the preferred sources of communication and social mobilization activities among households in rural field practice area of Shimoga Institute of Medical Sciences, Shivamogga. Materials and Methods: A cross-sectional community-based study was conducted among households in rural field practice area of Shimoga Institute of Medical Sciences, Shivamogga. After taking approval from the Institutional Ethical Committee, data were collected by doing house-to-house visits until all the houses in that particular village were covered. After taking informed consent, every household willing to be a part of the study was subjected to personal interviews using a semi-structured and pre-tested questionnaire, which was initially developed in English, and all the questions were translated into local language Kannada for the target population. Statistical analysis was done using SPSS software. Results: Of 100 households covered, females (74%) were more compared to males (26%), and among media information sources of TB; unaware (43%), television (TV) (26%), posters in health center (5%), and among community information source of TB; and unaware (34%), health-care provider (36%), and peers (11%). Most of them preferred TV and health-care providers as the priority to disseminate health education. Conclusion: The awareness of communication and social mobilization activities is very poor among rural people, which requires effective use of media information sources such as TV, radio, and digital innovations to convey the information with high priority to community participation in all social mobilization activities.

Low awareness and misconceptions of immature mosquito stages hinders community participation in integrated vector management in Malindi, Kenya

Understanding community perceptions of the significance, feasibility and utility of managing mosquito larvae and preventing breeding sites is important to developing strategies for improving implementation of larval control. The objective of this study was to explore community perceptions of mosquitoes and suggest ways of enhancing community based larval control. A cross sectional study was carried out in Malindi and Magarini sub counties in the coastal region of Kenya. Qualitative research methods were employed to collect data in four selected villages using participatory methodologies. The factors identified as hindering community participation in integrated vector management were inadequate knowledge about mosquito biology - lack of awareness of the fact that larvae represent the immature stages of adult mosquitoes responsible for transmission of malaria and other infectious diseases and consequently low community motivation to participate in larval control. The presence of mosquitoes in the area was associated with the presence of large natural water bodies such as river Sabaki and swamps. Participants did not know that small man-made water bodies were potential mosquito breeding places. Successful and sustainable community based larval source management will require innovative advocacy, communication and social mobilization activities explaining in a simple language understandable by the community, the mosquito biology, ecology and behaviour, taking into consideration community needs, knowledge and practices.

Polio supplementary immunization campaign evaluation: The Maban experience, South Sudan, August 2013

The recent polio outbreak in Somalia, Kenya and Ethiopia demanded a safety net Sub-National Immunization Days (SNIDs) for four bordering States, including Upper Nile. Aiming to reach children aged 0-59 months, a house-to-house strategy was employed from 20-23 of August 2013 to vaccinate all children in Maban County. The post Campaign evaluation is conducted to assess coverage by finger mark (quality by proxy) and help to ensure improvements for subsequent campaigns. The main objective of the evaluation was to assess the quality of the campaign to learn lessons for subsequent plans. A total of 31 clusters were covered from both host and refugee areas for this evaluation. Hence, 310 households have been visited by the evaluators. A total of 802 <5 children were enrolled for this evaluation purpose. According to the finding, 97.5% of the children living in the surveyed households have been vaccinated for this round of polio SNIDs, as reported by families; i.e., coverage by history. On the other hand, 87.7% of the children have been vaccinated based on the finger mark; i.e., coverage by finger marks. One hundred and nine children have been missed out of 802 children living in the surveyed households. Besides, 46 children have been identified as first doses of OPV in this campaign, which is 5.9% of the total surveyed children. In addition, 52.3% of families had been investigated for AFP by the vaccination teams. Besides, more than three-fourth of the families knew the campaign before the vaccination team visited their houses. It is recommended to strengthen basic/refresher training of vaccinators, improving supportive supervision, proper estimation of target population and improving social mobilization activities.

Knowledge, attitude, and practice regarding tuberculosis: Community-based study in Baghdad

He majority of respondents had several misconceptions in all aspects of the most infectious form of TB. a lot of respondents pursue a self-treatment option as their choice for primary health care. Cost and difficulties in transportation were mentioned as the main reasons for people to delay in seeking TB care. It would be better to establish an appropriate control measure such as establishing proper information, education, and a communication pathway that indicate the level of severity of the disease. In addition, creating proper awareness about its cause, transmission, prevention, and availability of public service are very essential. Furthermore, the national TB control program should consider coordinating advocacy, communication, and social mobilization activities on the communities to improve KAP of patients, to reduce misconceptions, and prevent transmission of TB in the community.

The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a retrospective analysis of the Viral Haemorrhagic Fever surveillance system, July 2014-June 2015.

In Sierra Leone, the Ebola virus disease (EVD) outbreak occurred with substantial differences between districts with someone even not affected. To monitor the epidemic, a community event-based surveillance system was set up, collecting data into the Viral Haemorrhagic Fever (VHF) database. We analysed the VHF database of Tonkolili district to describe the epidemiology of the EVD outbreak during July 2014-June 2015 (data availability). Multivariable analysis was used to identify risk factors for EVD, fatal EVD and barriers to healthcare access, by comparing EVD-positive vs. EVD-negative cases. Key-performance indicators for EVD response were also measured. Overall, 454 EVD-positive cases were reported. At multivariable analysis, the odds of EVD was higher among those reporting contacts with an EVD-positive/suspected case (odds ratio (OR) 2.47; 95% confidence interval (CI) 2.44-2.50; P &lt; 0.01) and those attending funeral (OR 1.02; 95% CI 1.01-1.04; P &lt; 0.01). EVD cases from Kunike chiefdom had a lower odds of death (OR 0.22; 95% CI 0.08-0.44; P &lt; 0.01) and were also more likely to be hospitalised (OR 2.34; 95% CI 1.23-4.57; P &lt; 0.05). Only 25.1% of alerts were generated within 1 day from symptom onset. EVD preparedness and response plans for Tonkolili should include social-mobilisation activities targeting Ebola/knowledge-attitudes-practice during funeral attendance, to avoid contact with suspected cases and to increase awareness on EVD symptoms, in order to reduce delays between symptom onset to alert generation and consequently improve the outbreak-response promptness.

Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia.

ObjectiveTo describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting.MethodIn April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.FindingsOverall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$ 0.41 per dose.ConclusionWe found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.

Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study.

BackgroundUnderstanding stakeholders’ (parents’, communities’ and health workers’) perspectives of communication about childhood vaccination, including their preferences for its format, delivery and content, is an important step towards designing better communication strategies and ensuring more informed parents. Our objectives were to explore stakeholders’ views, experiences and preferences for childhood vaccination communication in Cameroon.MethodsIn 2014, in the Central and North West Regions of Cameron, we gathered qualitative data for our case study using the following methods: semi structured interviews; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; document analysis of reports and mass media communications about vaccination; and a survey of parents. We conducted a thematic analysis of the qualitative data to identify themes relating to views, experiences and perceptions of vaccination information and its delivery. Survey data were analysed using simple descriptive statistics.ResultsAll of the parents interviewed felt that vaccinating their child was important, and trusted the information provided by health workers. However, many parents wanted more information. Parents did not always feel that they could ask questions during vaccination appointments. All participants felt that health workers and vaccination clinics were important sources of information. Social mobilisation activities such as door-to-door visits and announcements during religious services were important and accepted ways of communicating information, especially during vaccination campaigns. Information communicated through mass media and text messages was also seen as important. In general, stakeholders believed that more consistent messaging about routine vaccination through community channels would be helpful to remind parents of the importance of routine vaccination during ongoing rounds of vaccination campaigns against polio.ConclusionsThis study confirms that parents regard information about childhood vaccination as important, but that health services need to be organized in ways that prioritize and facilitate communication, particularly about routine vaccination.

Community Engagement in Liberia: Routine Immunization Post-Ebola

A national integrated polio, measles, and deworming campaign was implemented across Liberia May 8–14, 2015. The community engagement and social mobilization component of the campaign was based on structures that had been invested in during the Ebola response. This article provides an overview of the community engagement and social mobilization activities that were conducted and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunization in the post-Ebola context. Focus group discussions and interviews were conducted across four counties in Liberia (Montserrado, Nimba, Bong, and Margibi). Thematic analysis identified the barriers preventing and drivers leading to the utilization of routine immunization. Community members also made recommendations and forwarded community-based solutions to encourage engagement with future health interventions, including uptake in vaccination campaigns. These should be incorporated in the development and implementation of future interventions and programs.

The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi.

Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the ‘backlog cohort’, comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries’ plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction.

Current costs & projected financial needs of India's Universal Immunization Programme.

Background & objectives:India's Universal Immunization Programme (UIP) is one of the largest programmes in the world in terms of quantities of vaccines administered, number of beneficiaries, number of immunization sessions, and geographical extent and diversity of areas covered. Strategic planning for the Programme requires credible information on the cost of achieving the objectives and the financial resources needed at national, State, and district levels. We present here expenditures on immunization services in India in 2012 (baseline) and projected costs for five years (2013-2017).Methods:Data were collected from the Immunization Division of the Ministry of Health and Family Welfare, Government of India, and immunization partners, such as the World Health Organization and UNICEF. The cost components were immunization personnel, vaccines and injection supplies, transportation, trainings, social mobilization, advocacy and communication activities, disease surveillance, Programme management, maintenance of cold chain and other equipment, and capital costs.Results:Total baseline expenditure was 3,446 crore [1 crore = 10 million] (US$718 million), including shared personnel costs. In 2012, the government paid for 90 per cent of the Programme. Total resource requirements for 2013-2017 are 34,336 crore (US$ 5, 282 million). Allocations for vaccines increase from 511 crore in 2013 to 3,587 crore in 2017 as new vaccines are assumed to be introduced in the Programme.Interpretation & conclusions:The projections show that the government immunization budget will be double in 2017 as compared to 2013. It will increase from 4,570 crore in 2013 to 9,451 crore in 2017.

Assessment of the level of awareness about tuberculosis among the different stakeholders of a medical college, Tamil Nadu

Background: Globally, tuberculosis (TB) has been acknowledged as one of the deadliest infectious disease. The objectives of the study were to assess the level of awareness about TB among the different stakeholders of a medical college and to formulate a comprehensive action plan to strengthen the Advocacy, Communication and Social Mobilization (ACSM) activities. Methods: A cross-sectional descriptive study of five months duration (September 2015 to January 2016) was conducted among the representative section of the various stakeholders of a medical college. A pre-tested, semi-structured schedule was designed after thoroughly studying the national TB training modules. All the study participants were interviewed using the schedule after obtaining their informed consent. In addition, a thorough inspection of the hospital and medical college was done to assess the status of ACSM activities. Results: Among the different stakeholders (doctors, paramedical staff, patients, relatives) who participated in the study, the clinicians 38(24.8%) group accounted for maximum respondents. The knowledge level of medical fraternity (viz. specialists / pre and para-clinical doctors and MBBS doctors) pertaining to the definition of cure, drugs used for multi-drug resistant TB, honorarium for DOT provider, and utility of Mantoux test among adults was quite poor and recorded as only 31.1%, 37.7%, 44.3%, and 42.6% respectively. Conclusion: To conclude, the present study has provided valuable insights about the knowledge of TB among all the stakeholders and the status of the ACSM activities in a medical college. Based on the study findings, a comprehensive action plan has been developed to bridge the existing gaps and strengthen the overall ACSM activities pertaining to TB within the medical college settings.

INTEGRATING NUTRITION IN LOCAL GOVERNANCE STRUCTURES: AN EXAMPLE FROM SUAAHARA PROGRAM NEPAL

Study Objectives:This abstract presents the multi sector nutrition approach of integrating nutrition through the local governance structures at the district and village level and mobilization of these groups to commit resources to ensure the sustainability of integrated nutrition activities to support 1,000 days families.Methods:Suaahara worked closely with National Planning Commission Ministry of Health and Population, Ministry of Urban Development, Ministry of Agriculture Nepal and Ministry of Federal Affairs and Local Development for envision especially the planning, implementing, monitoring and evaluation. Suaahara facilitated to establish Nutrition and Food Security Steering Committees in 20 project districts and 884 VDC level Committee in 884 Village Development Committee (VDC) out of 955 VDC of 20 districts.Suaahara mobilized district, Village Development Committee (VDC), Ward Citizen Forum (WCF), Citizen Awareness Centers (CAC) community based groups, forums and households to generate awareness and advocate about the importance of nutrition, provision of VDC block grants for women and disadvantaged communities to increase their access to the grant for integrated nutritional programs. This evidence has been taken through the revision of district and VDC planning documents, meeting minute's revision, key informant interviews with VDC Secretaries and Local Development Officers and implementation of VDC block grants utilization in 20 program implemented districts.imageResults:Due to these joint efforts in social mobilization and governance activities by political stakeholders at the district and village level, 13 districts (142 VDCs) allocated a budget for integrated nutrition activities from their respective VDC block grant fund. The total allocated amount was $128,906 for 2014/ 2015. Of these funds $105,794.00 already used for the implementation of several integrated nutrition activities targeting 1,000 days mothers and their child. As a result more than 10,000 pregnant women and children under 2 years have benefited from the block grant. It ensures governance for improving nutrition outcomes in Nepal, through the active involvement of local government structure, development actors, donors, civil society and the private sector in sustaining political commitments.ConclusionIntegration, coordination, collaboration, and Implementation action of nutrition measures at all levels; districts and local community are expected to play an increasingly important role, which includes directly assisting communities and grass roots groups with identifying their priorities and implementing corresponding actions and achieving expected results.

Patient and community experiences of tuberculosis diagnosis and care within a community-based intervention in Ethiopia: a qualitative study.

BackgroundThe Ethiopian TB control programme relies on passive case finding of TB cases. The predominantly rural-based population in Ethiopia has limited access to health facilities creating barriers to TB services. An intervention package aimed to bring TB diagnosis and treatment services closer to communities has been implemented through partnership with health extension workers (HEWs). They undertook advocacy, communication and social mobilization (ACSM) activities, identified symptomatic individuals, collected sputum, prepared smears and fixed slides at community level. Field supervisors supported HEWs by delivering smeared slides to the laboratory, feeding back results to the HEWs and following up smear-negative cases. Patients diagnosed with TB initiated treatment in the community, they were supported by supervisors and HEWs through the local health post. Case notification increased from 64 to 127/100,000 population/year.MethodsThis qualitative study assessed community members’ treatment seeking behaviour and their perceptions of the intervention. In-depth interviews (n=36) were undertaken with participants in six districts. Participants were clients of the community-based intervention, currently on TB treatment or those screened negative for TB. Transcripts were translated to English and a thematic analytical framework was developed guided by the different steps symptomatic individuals take within the intervention package. Coding was done and queries run using NVivo software.ResultsPrior to the intervention many patients with chronic cough did not access TB services. Participants described difficulties they faced in accessing district level health facilities that required travel outside their communities. Giving sputum samples and receiving results from within their home communities was appreciated by all participants. The intervention had a high level of acceptability; particularly clear benefits emerged for poor women and men and those too weak to travel. Some participants appeared to prefer a diagnosis of TB, this is likely because receiving a negative smear microscopy result brought further uncertainty and necessitated seeking further investigation.ConclusionsThere is evidence rural populations with high levels of poverty, and in particular women, are at high risk of unmet health needs and undiagnosed TB. Embedding TB services within communities was an acceptable approach for vulnerable groups experiencing poor access to health facilities. In the Ethiopian context this approach can facilitate early diagnosis and improve treatment outcomes.

Progress toward poliomyelitis eradication in Nigeria.

Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone. This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria. Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states. Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.

Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand, India: implications for ACSM.

Forty hard-to-reach villages in the East and West Singhbhum Districts of Jharkhand State, India. To document knowledge and awareness of tuberculosis (TB) among the general population, understand gender differences and inform intervention activities for the improvement of TB control programmes in tribal-dominant hard-to-reach areas in India. A cross-sectional community-based survey was carried out among 825 respondents using population proportionate sampling. Most of the respondents were in the 18-35 years age group, tribal and married; 44% were illiterate. The study shows poor knowledge about TB symptoms, causes, modes of transmission and moderate awareness about government TB services. Correct knowledge about the cause of TB was negligible: half of the respondents reported local liquor as the cause, 61% considered TB as transmissible and one third considered sharing of food as the mode of transmission. Awareness about the availability of free treatment services at government health facilities was high, but awareness about DOTS was low. Significant gender differences were observed in knowledge and awareness levels. Study findings point to the importance of urgent intensification of culturally congruent and gender-sensitive advocacy, communication and social mobilisation activities.

Mass Vaccination with a New, Less Expensive Oral Cholera Vaccine Using Public Health Infrastructure in India: The Odisha Model

IntroductionThe substantial morbidity and mortality associated with recent cholera outbreaks in Haiti and Zimbabwe, as well as with cholera endemicity in countries throughout Asia and Africa, make a compelling case for supplementary cholera control measures in addition to existing interventions. Clinical trials conducted in Kolkata, India, have led to World Health Organization (WHO)-prequalification of Shanchol, an oral cholera vaccine (OCV) with a demonstrated 65% efficacy at 5 years post-vaccination. However, before this vaccine is widely used in endemic areas or in areas at risk of outbreaks, as recommended by the WHO, policymakers will require empirical evidence on its implementation and delivery costs in public health programs. The objective of the present report is to describe the organization, vaccine coverage, and delivery costs of mass vaccination with a new, less expensive OCV (Shanchol) using existing public health infrastructure in Odisha, India, as a model.MethodsAll healthy, non-pregnant residents aged 1 year and above residing in selected villages of the Satyabadi block (Puri district, Odisha, India) were invited to participate in a mass vaccination campaign using two doses of OCV. Prior to the campaign, a de jure census, micro-planning for vaccination and social mobilization activities were implemented. Vaccine coverage for each dose was ascertained as a percentage of the censused population. The direct vaccine delivery costs were estimated by reviewing project expenditure records and by interviewing key personnel.ResultsThe mass vaccination was conducted during May and June, 2011, in two phases. In each phase, two vaccine doses were given 14 days apart. Sixty-two vaccination booths, staffed by 395 health workers/volunteers, were established in the community. For the censused population, 31,552 persons (61% of the target population) received the first dose and 23,751 (46%) of these completed their second dose, with a drop-out rate of 25% between the two doses. Higher coverage was observed among females and among 6–17 year-olds. Vaccine cost at market price (about US$1.85/dose) was the costliest item. The vaccine delivery cost was $0.49 per dose or $1.13 per fully vaccinated person.DiscussionThis is the first undertaken project to collect empirical evidence on the use of Shanchol within a mass vaccination campaign using existing public health program resources. Our findings suggest that mass vaccination is feasible but requires detailed micro-planning. The vaccine and delivery cost is affordable for resource poor countries. Given that the vaccine is now WHO pre-qualified, evidence from this study should encourage oral cholera vaccine use in countries where cholera remains a public health problem.

Connaissances et attitudes des organisations de la société civile à la mise en œuvre du Programme élargi de vaccination de routine en Côte d'Ivoire

The objective of this study was to assess the level of involvement of leaders of Civil Society Organizations (CSOs) in implementation of routine EPI activities. This was a cross-sectional descriptive study of the knowledge and attitudes of CSOs concerning implementation of routine EPI activities in the health district of Adiaké (Côte d'Ivoire). This study shows that 77.1% of CSO leaders were literate and 92.9% of them were practicing Catholics or Muslims. They had a good knowledge of the existence of EPI (97.1%) and EPI target diseases, but were ignorant about the immunization schedule (82%). 90% of CSO leaders considered EPI to be an important activity for the prevention of childhood diseases. They considered the reception in immunization units to be satisfactory (60%) and believed that rumours about the sterility of women were the cause of refusal of vaccination by communities. Although 41.4% of leaders had participated in social mobilization activities, none had participated in the mobilization of resources. Vaccination was not rejected by CSO leaders, but their lack of participation in implementation of EPI could induce errors and lead them to believe the rumours and refuse vaccination of their community. The effective integration of the socio-cultural bases of communities in which immunization programmes are conducted will promote the adhesion of the people responsible for these programmes.

P6.069 Social Mobilization and Peer-Mentoring to Encourage Voluntary Counseling and Testing and Post-Testing Behavior: A Randomized Experiment in Senegal

BackgroundTo evaluate the effectiveness of two HIV/AIDS sensitization campaigns of the community-based organisations (CBOs) it financed, the National AIDS Commission of Senegal randomly assigned its financial support across the country’s...