Reaching the unreached with polio vaccine and other child survival interventions through partnership with military in Angola

Fekadu, Lemma; Okeibunor, Joseph; Nsubuga, Peter; Kipela, Jean Marie; Mkanda, Pascal; Mihigo, Richard

doi:10.1016/j.vaccine.2016.05.069

Cited by 16 publications

(21 citation statements)

References 9 publications

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“…The findings are consonant with previous approaches to reach similar populations in other regions affected by conflict and insecurity 26, 27. Our experience provides objective evidence that it is possible to gain community trust and achieve gains in immunisation and OPV and IPV coverage using an integrated approach, and has implications for geographies facing resistance and limited community engagement.…”

Section: Discussionsupporting

confidence: 86%

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial

Habib

Soofi

Cousens

et al. 2017

The Lancet Global Health

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SummaryBackgroundPakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan.MethodsWe did a community-based three-arm cluster randomised trial in healthy children aged 1 month to 5 years that resided within the study sites in three districts of Pakistan at high risk of polio. Clusters were randomly assigned by a computer algorithm using restricted randomisation in blocks of 20 by an external statistician (1:1:1) to receive routine polio programme activities (control, arm A), additional interventions with community outreach and mobilisation using an enhanced communication package and provision of short-term preventive maternal and child health services and routine immunisation (health camps), including OPV (arm B), or all interventions of arm B with additional provision of IPV delivered at the maternal and child health camps (arm C). An independent team conducted surveys at baseline, endline, and after each round of supplementary immunisation activity for acceptability and effect. The primary outcome measures for the study were coverage of OPV, IPV, and routine extended programme on immunisation vaccines and changes in the proportion of unvaccinated and fully vaccinated children. This trial is registered with ClinicalTrials.gov, number NCT01908114.FindingsBetween June 4, 2013, and May 31, 2014, 387 clusters were randomised (131 to arm A, 127 to arm B, and 129 to arm C). At baseline, 28 760 children younger than 5 years were recorded in arm A, 30 098 in arm B, and 29 126 in arm C. 359 clusters remained in the trial until the end (116 in arm A, 120 in arm B, and 123 in arm C; with 23 334 children younger than 5 years in arm A, 26 110 in arm B, and 25 745 in arm C). The estimated OPV coverage was 75% in arm A compared with 82% in arm B (difference vs arm A 6·6%; 95% CI 4·8–8·3) and 84% in arm C (8·5%, 6·8–10·1; overall p<0·0001). The mean proportion of routine vaccine doses received by children younger than 24 months of age was 43% in arm A, 52% in arm B (9%, 7–11) and 54% in arm C (11%, 9–13; overall p<0·0001). No serious adverse events requiring hospitalisation were reported after immunisation.InterpretationDespite the challenges associated with the polio end-game in high-risk, conflict-affected areas of Pakistan, a strategy of community mobilisation and targeted community-based health and immunisation camps during polio immunisation campaigns was successful in increasing vaccine coverage, including polio vaccine coverage.FundingBill & Melinda G...

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Section: Discussionsupporting

confidence: 86%

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial

Habib

Soofi

Cousens

et al. 2017

The Lancet Global Health

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“…Other studies have highlighted hard to reach areas and nomadic lifestyles as major challenges for immunization [41]. Research in Angola identified vast unreachable areas due to poor infrastructure and also security [45,46]. Security remains an issue in Galkacyo District due to regular armed volatile clan clashes.…”

Section: Discussionmentioning

confidence: 99%

Factors contributing to the uptake of childhood vaccination in Galkayo District, Puntland, Somalia

Abdullahi

Williams

Sahlén

et al. 2020

Global Health Action

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Background: As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children's Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country's health authorities. Objective: This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers. Methods: Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District-Galkayo city, Bayra and Bacadwayn. Results: From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia's patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders. Conclusions: Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers' involvement is lacking. This may be boosted by highlighting fathers' obligation to protect their children's health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets.

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“…A suggestion for the use of military personnel for vaccination activities was made from the experience of insecurity in the Lake Chad region [12] but experts argued that this method should be used with caution as it can be counterproductive by deepening false perceptions regarding the vaccine [10]. However, partnership with the military was seen to improve coverage of polio vaccination among insecure and hard-to-reach areas in Angola [13]. It was also found to address some issues of vaccine hesitancy.…”

mentioning

confidence: 99%

Factors affecting the successful implementation of Global Polio Eradication Initiative (GPEI) in low- and middle-income countries

Mshelia¹,

Blackmore²,

Archer³

2020

Journal of Global Health

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Reaching the unreached with polio vaccine and other child survival interventions through partnership with military in Angola

Abstract: Military is a potentially productive force that can be used for any development activities in any country. The Angolan experience has demonstrated that it is possible to form a partnership with the military for basic health intervention activities with little training and investment.

Cited by 16 publications

References 9 publications

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial

Factors contributing to the uptake of childhood vaccination in Galkayo District, Puntland, Somalia

Factors affecting the successful implementation of Global Polio Eradication Initiative (GPEI) in low- and middle-income countries

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