Background Pakistan has been experiencing several immunization related challenges. The supply chain management information system (MIS) is considered an important component of immunization services as it can improve visibility in key areas such as vaccine shortages or wastage. This study assessed the effectiveness of the Visibility and Analytics Network (VAN) approach in improving vaccine supply and availability of stocks by comparing the situation in intervention and non-intervention districts in Sindh province of Pakistan. Methods We utilized a quantitative and qualitative approach to collect data to assess the VAN approach in two districts of Sindh province in Pakistan. The data were collected between August and October 2017. VAN is a systematic monitoring system which measures the performance of vaccine supply chain management based on a set of indicators. We assessed storage facilities of the Expanded Programme on Immunization (EPI) in Sindh and interviewed personnel involved using a pre-tested data collection tool. We also conducted in depth interviews with senior management to assess performance of VAN, adoption mechanism and needs to scale up the VAN approach. Results We assessed 52 EPI facilities of Sindh province government. In the intervention district 83.3% managers were using MIS data for decision making related to vaccine supplies whereas in the non- intervention district no MIS based data were available. Ninety percent of stores were maintaining a stock registry and 100% supplies matched with requisitions in the intervention district compared to 40% and 35% in the non-intervention district for the same variables. Vaccine wastage was high in the non- intervention district (BCG 46.7% vs 33.9; OPV 13.5% vs 9.5%; pneumococcal 11.4% vs 7.4%). In-depth interview findings suggested that the VAN approach provided data guided monitoring in Pakistan for the first time. The approach also enabled district managers to make timely decisions. Conclusion The VAN approach improves vaccine supply chain management. It should be scaled up and implemented at national or sub national especially in countries struggling with vaccine supply chain management.
Objective: To determine the status of vaccination among confirmed measles cases and to determine the association of vaccination status with the occurrence of measles infection. Methods: A cross-sectional survey was carried out in the province of Sindh from January 2016 to April 2016. The study included patients of both gender, ³9 months of age, fulfilling the case definition of measles by World Health Organization (WHO), who were reported to and/or picked by the measles surveillance officers. A sample of 3-5 ml of blood was collected from each registered patient between day 4 and day 28 of the rash to test for measles IgM antibodies. The samples were labelled and sent to National Measles Laboratory, National Institute of Health (NIH) Islamabad in reverse cold chain. Patients who tested positive for IgM antibodies were grouped as confirmed measles while patients negative for measles IgM antibodies were grouped as suspected measles. Data of both the groups was analysed using windows SPSS 21 for vaccination status, for frequency of measles infection against the number of doses of measles vaccine received. Frequencies of vaccination among confirmed measles cases were compared with suspected measles for statistical significance using Chi-square. P-value of <0.05 was taken as significant. Results: A total of 572 out of 915 study subjects were confirmed measles cases, of which 258 (45%)were never vaccinated against the disease as compared to 72 (12.6%) who were completely vaccinated. Overall, 128 (37.3%) were fully vaccinated amongst suspected measles. Vaccination sta- tus was not known in a quarter of patients in both groups. A significant association was found be- tween the vaccination status and measles infection with higher frequency of measles in unvaccinated as compared to the vaccinated (p<0.001). Conclusion: We conclude that the vaccination rate among measles patients was significantly lower than among non-measles patients. A sizable 12.6% got the disease in spite of completing measles vaccination.
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