Integrating immunization services into nutrition sites to improve immunization status of internally displaced persons� children living in Bentiu protection of civilian site, South Sudan

Abstract

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).

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

“…The vaccination study by Oladeji et al 53 which evaluated the effect of integrating immunization services within nutrition services reported improvements in vaccination uptake and dose completion. The study showed that children in the two selected sites offering a combination of immunization and therapeutic food were about 27% and 45% less likely to miss vaccination compared to those vaccinated at primary healthcare centers with no food program (odds ratio, OR: 0.45; 95% CI:0.36-0.55, P < 0.05) and (OR: 0.27; 95% CI: 0.20 -0.35, P < 0.05) respectively.…”

“…The study showed that children in the two selected sites offering a combination of immunization and therapeutic food were about 27% and 45% less likely to miss vaccination compared to those vaccinated at primary healthcare centers with no food program (odds ratio, OR: 0.45; 95% CI:0.36-0.55, P < 0.05) and (OR: 0.27; 95% CI: 0.20 -0.35, P < 0.05) respectively. 53 The other two vaccination studies focused on specific diseases and aims: yellow fever vaccination administration and effectiveness 44 and IDP perception of cholera vaccination. 54 Both studies reported exceeding the 90% WHO vaccination coverage standard requirement; and the high coverage level was linked to the IDPs' high of level awareness about the disease severity.…”

“…Although three studies had a food and nutrition component, 46,50,53 only one reported related outcome data on the intervention uptake. 46 The study by Jayatissa et al 46 showed reduced levels of all forms of acute malnutrition [Global-, Severe-and Moderate-Acute Malnutrition (GAM, SAM, MAM)] between 39% and 80%.…”

“…Interventions offering multiple PHC components appeared to have increased uptake and coverage the most. 53,70 As such, although water treatment and sanitation improvement studies highlighted the effectiveness of each component, combination of both as recommended by the Sphere guidelines, 6 would have offered more efficient and beneficial outcomes.…”

“…The review showed that the use of already existing structures amplified intervention successes and reduced costs. 49,53,55 Key contributors to high intervention uptake among the IDPs were availability of incentives, free services (e.g. water treatment, ITNs), and personal awareness of either general health conditions (e.g.…”