Introduction The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response. Methods A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations. Results Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05). Conclusion This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).

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This study revealed critical gaps in PMTCT service delivery under routine conditions in Cambodia. Service optimization by reducing gaps will help eliminate HIV infection among infants and improve maternal survival. Further operational studies are needed to identify determinants of service uptake.

Monitoring and evaluating national and subnational responses in support of children orphaned or made vulnerable by AIDS (OVC) present a number of challenges. Most OVC programmes require multiple interventions across different sectors. In most countries, targeting parameters for identifying 'vulnerable' children are fluid and difficult to define or measure concretely. Along with weak national monitoring systems and a lack of development partner or government interest and funds, these factors make the monitoring and evaluation (M&E) of OVC programmes difficult. Of the 15 countries in East and Southern Africa (ESA), which have developed national plans of action (NPAs) in support of OVC, nine have M&E plans. In their early periods of implementation, most countries are piloting the development of data collection systems and tools at community, district and national levels. Along with a desk review, semi-structured consultations were held with over 100 national OVC M&E stakeholders from 10 countries in ESA as part of a regional capacity-building exercise. This paper reviews their progress, constraints and lessons learnt, before making recommendations. Most countries do not have reliable baseline information or a clear 'denominator'. Subsequently, numbers rather than percentages are used frequently when reporting on coverage, which gives little indication of the scope or efficacy of interventions. Many countries also reported challenges in defining and monitoring the quality of care provided, therefore the consistency and quality of the support being provided is largely unknown. Another major gap is the fact that OVC indicators are rarely included across key sectors' data collection systems (e.g. health, education). To help overcome these challenges, recommendations include the following. While for national monitoring and evaluation purposes, measurable, discrete, evidence-informed criteria should be employed -for project or programming purposes, targeting criteria should be sufficiently flexible and responsive based on community realities and the child's immediate needs. Every opportunity to use and disaggregate existing data should be exploited, while the establishment of parallel data collection mechanisms should be avoided. While quality assurance mechanisms should be established to monitor service coverage, no pilot should be undertaken without the design and implementation of an evaluation to accompany it. These should include a baseline and the establishment of comparison control groups, isolating and assessing the outcomes that the intervention is having on children.

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