The reactive vaccination campaign against cholera emergency in camps for internally displaced persons, Borno, Nigeria, 2017: a two-stage cluster survey

Abstract

IntroductionIn 2017, amidst insecurity and displacements posed by Boko Haram armed insurgency, cholera outbreak started in the Muna Garage camp for Internally Displaced Persons (IDPs) in Borno State, Nigeria. In response, the Borno Ministry of Health and partners determined to provide oral cholera vaccine (OCV) to about 1 million people in IDP camps and surrounding communities in six Local Government Areas (LGAs) including Maiduguri, Jere, Konduga, Mafa, Dikwa, and Monguno. As part of Monitoring and Evaluation, we described the coverage achieved, adverse events following immunisation (AEFI), non-vaccination reasons, vaccination decisions as well as campaign information sources.MethodsWe conducted two-stage probability cluster surveys with clusters selected without replacement according to probability-proportionate-to-population-size in the six LGAs targeted by the campaign. Individuals aged ≥1 years were the eligible study population. Data sources were household interviews with vaccine card verification and memory recall, if no card, as well as multiple choice questions with an open-ended option.ResultsOverall, 12 931 respondents participated in the survey. Overall, 90% (95% CI: 88 to 92) of the target population received at least one dose of OCV, range 87% (95% CI: 75 to 94) in Maiduguri to 94% (95% CI: 88 to 97) in Monguno. The weighted two-dose coverage was 73% (95% CI: 68 to 77) with a low of 68% (95% CI: 46 to 86) in Maiduguri to a high of 87% (95% CI: 74 to 95) in Dikwa. The coverage was lower during first round (76%, 95% CI: 71 to 80) than second round (87%, 95% CI: 84 to 89) and ranged from 72% (95% CI: 42 to 89) and 82% (95% CI: 82 to 91) in Maiduguri to 87% (95% CI: 75 to 95) and 94% (95% CI: 88 to 97) in Dikwa for the respective first and second rounds. Also, coverage was higher among females of age 5 to 14 and ≥15 years than males of same age groups. There were mild AEFI with the most common symptoms being fever, headache and diarrhoea occurring up to 48 hours after ingesting the vaccine. The most common actions taken after AEFI symptoms included ‘did nothing’ and ‘self-medicated at home’. The top reason for taking vaccine was to protect from cholera while top reason for non-vaccination was travel/work. The main source of campaign information was a neighbour. An overwhelming majority (96%, 95% CI: 95% to 98%) felt the campaign team treated them with respect. While 43% (95% CI: 36% to 50%) asked no questions, 37% (95% CI: 31% to 44%) felt the team addressed all their concerns.ConclusionThe campaign achieved high coverage using door-to-door and fixed sites strategies amidst insecurity posed by Boko Haram. Additional studies are needed to improve how to reduce non-vaccination, especially for the first round. While OCV provides protection for a few years, additional actions will be needed to make investments in water, sanitation and hygiene infrastructure.

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

“…Active conflict/insecurity strongly influenced choice of service delivery modality, in particular the extent to which community mobilisers were involved in demand-generation activities. [ 33 – 49 ] Health financing Payment for performance Adaptive Variable evidence of effects on coverage for selected antigens depending on the study – one showing a positive effect, one showing no effect, and one showing a marginal decrease in coverage over time. All included studies applied in conflict-affected settings.…”

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

“…For example, two linked studies addressing different aspects of the same cholera vaccination campaign among displaced persons in Borno, in northern Nigeria, showed 90% (95% CI 88-92%) first dose, and 73% complete (68-77%) OCV coverage in the target population following a multi-dimensional intervention involving door-to-door and fixed-site delivery modes, multiple information dissemination and communication routes (word-of-mouth, flyers, announcements and media spots) and health worker capacity building. However, the two studies also note important contextual factors contributing to success: the campaign benefited from a long-standing partnership governance model in which the Ministry of Health led but agencies and NGOs supported on the ground delivery, and preparedness in two key areas before the outbreak: training in cholera preparedness that had incidentally been run by the Nigeria CDC earlier the same year, and the licensing of OCV for use in Nigeria in the months prior to the outbreak (30,31).…”

Water, Sanitation, and Hygiene (WASH) Practices and Outreach Services in Settlements for Rohingya Population in Cox’s Bazar, Bangladesh, 2018–2021

“…The government of Bangladesh along with international humanitarian agencies and NGOs provided support including relief, shelters, food, clean drinking water, medical care, and WASH services. It is well-known that particularly in emergencies and crisis settings, high levels of childhood malnutrition, worsening sanitary conditions, and repeated infectious diseases with inadequate health service delivery in settlements are common and are potentially life-threatening, predominantly in the case of disadvantaged children [ 20 , 23 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ].…”