RESEARCH PROJECT/STUDY 1

REPORTING OF AEFIS IN INFORMAL SETTLEMENTS IN NAIROBI, KENYA

Principal Investigators: Lawrence Owino-Okongo1,2 Ombeva Malande2,3

 Collaborators: Collins Tabu4, collaborator 24, Collaborator 35, Andrew Musyoki6, Rose Burnett7, James Kipsang2, Carolyne Chemweno2, Mutunga Nzoka2, Carine Dochez7

COLLABORATING ORGANIZATIONS

  1. University of Nairobi, Department of Paediatrics & Child Health
  2. East Africa Centre for Vaccines and Immunization (ECAVI)
  3. Egerton University, Department of Paediatrics & Child Health
  4. Ministry of Health Kenya/ Division of Vaccines and Immunisation
  5. World Health Organization (WHO)- Kenya
  6. South African Vaccine and Immunization Centre (SAVIC)
  7. Network for Education and Support in Immunisation (NESI)

INTRODUCTION

Immunization is the most successful and cost-effective intervention in prevention of infectious diseases.  The vaccines currently used for routine childhood immunization are approved as safe and effective. However, vaccination occasionally leads to undesirable effects including adverse reactions that are referred to as Adverse Events Following Immunization (AEFI), frequent adverse events following immunization often because illnesses and sometimes loss of public trust in immunization programs. The immunization program in Kenya (KEPI) was started in 1980, “but there are only three cases of AEFI reported at the national level to date” (Ministry of Health; Division of Vaccines & Immunization (DVI), “Guidelines on Adverse Events Following Immunization (AEFI) in Kenya,” 2013). These adverse events are of concern and are believed to be caused by immunization. Health workers should be spontaneously reporting cases of suspected adverse events following immunisation (AEFI), they play a central role in monitoring immunization safety, but little is known about how health workers recognise and report adverse events following immunisation (AEFI).

An adverse event following immunization is defined as any untoward medical occurrence which occurs after immunization and which does not necessarily have a causal relationship with the usage of the vaccine. Usually AEFI can be either caused by the vaccine or immunization process (causally associated) or a coincidental event that, by chance, happened after immunization (temporally associated).There are three types of AEFIs caused by immunization, these are caused by: The inherent properties of the vaccine (vaccine reaction), An error in the immunization process (programme error), Injection-related reactions arising from anxiety about or pain of the injection

STUDY QUESTIONS

This activity seeks to answer the following questions

  1. Are there any adverse events following immunization (AEFI) in Kenya?
  2. Why is there low reporting of adverse events following immunization (AEFI) in Kenya?
  3. What are the knowledge, experience, perception, and practice levels on AEFI surveillance among health workers in Kenya?
  4. What is the knowledge, experience, and attitude of Health workers towards detecting and reporting AEFI
  5. In what ways can the Health workers advocate for public trust in immunization programs in the communities to reduce drop outs?
  6. How to equip the health workers and service providers with knowledge and skills to manage, adverse events following immunization (AEFI).

RESEARCH PROJECT/STUDY 2

HEALTH SYSTEM STRENGTHENING OF IMMUNIZATION SERVICES IN UGANDA: A CASE STUDY OF HOIMA DISTRICT

Principal investigators: Ombeva Malande1, 2 Mworozi Edison1, 2, Deogratias Munube1, 2, Rachel Nakatugga Afaayo1

Collaborators: Opal Bernard3, Kisakye Annet4, Jessica Nsungwa3, Andrew Bakainaga4, Andrew Musyoki5

COLLABORATING ORGANIZATIONS:

  1. East Africa Centre for Vaccines and Immunization (ECAVI)
  2. Makerere University, Department of Paediatrics & Child Health
  3. Ministry of Health Uganda/ UNEPI-Uganda
  4. World Health Organization (WHO)- Uganda
  5. South African Vaccine and Immunization Centre (SAVIC)

INTRODUCTION

Vaccine preventable diseases continue to be an important public health problem in developing countries like Uganda. Immunization is a cost-effective intervention for preventing morbidity and mortality caused by vaccine preventable infectious diseases, particularly in high-burden settings. Despite increasing efforts to reduce child mortality, approximately 10 million children under the age of five die every year. Majority of these deaths occur in children under five years of age, mostly in low income countries. It is estimated that vaccines prevent more than 2.5 million child deaths each year and that fully vaccinated children by 9 months of age suffer lesser related  morbidity and mortality. Immunization is therefore a central intervention towards attaining Sustainable Development Goal (SDG) 3 that aims at reduction of under-five mortality to less than 25/1000 live birth by 2030. There have been several interventions including the Abuja declaration, Millennium Development Goals( MDG’s), the Alma Atta declaration of 1978, the current Sustainable Development Goal (SDG) and child survival action convention for political mobilization, that have significantly improved child survival in many countries. There are several countries that are yet to attain the set targets. While global progress has been made to ensure provision of childhood vaccinations, difficulties still exist especially how to reach the most vulnerable, poorest, disadvantaged childhood populations in remote communities, especially within sub-Saharan Africa. Drivers of inequalities in vaccine coverage across populations include low education level of parents/caretakers, cultural/religious beliefs, age of caretakers, terrain, accessibility to health facilities, refugee status, mobility of populations, negative messaging/anti-vaccine sentiments and social economic status of the parents/caretakers.

In Uganda, the number of Under-five deaths fell by 6.3% per year over a 10-year period from 167/1000 live births in 1990 to – 90/1000 live birth in 2012.  According to the Uganda demographic and Health Survey (UDHS 2016), only 55% of children aged 12-23 months are fully vaccinated and full vaccination coverage is relatively higher in urban areas (61%) than rural areas (50%). While Uganda has an active National Immunization Program, Hoima, one of the largest districts has persistently performed poorly with low coverage. The district continues to frequently report frequent outbreaks of vaccine preventable diseases especially measles. Hoima still has challenges of achieving a DPT3 immunization coverage of >90%. For the fiscal year 2013/14, the district DPT3 and measles vaccination coverage were 73% and 68% respectively way below the national targets of 90% and 95%.respectively. It has been noted that hard to reach arrears and refugee dominated regions in Hoima are the most affected with low levels of vaccination, including other factors. Involving the community in their own vaccination to inspired good health seeking behaviour has been documented as an important aspect for the success of the immunization programme; therefore exploring the behavioural aspects influencing utilization of immunization services in Hoima District is equally important.  Using Hoima district as a pilot case study, we seek to find out why the district still suffers the burden of immunizable diseases and work with other stake holders to generate possible actionable, affordable and sustainable solutions to the identified problems, which can then serve as a guide which can be escalated at a national level to prove the overall National Immunization Program in Uganda.

STUDY QUESTIONS

This activity seeks to answer the following questions

  1. Why is Hoima district registering immunizable disease outbreaks in particular measles annually despite availability of an active national immunization program?
  2. What are the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District?
  3. What is the state of immunization services (staffing, staff training needs, stock of vaccines, storage, vaccine transport, cold chain, record keeping, coverage, referrals and linkages and reporting of AEFIs, REC micro plans) in Hoima District?
  4. In what ways can the capacity of Health workers in Hoima be strengthened in order to reach at least 90% of the unvaccinated children and support monitoring of National Immunization indicators?

STUDY OBJECTIVES

  1. To determine the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District
  2. To determine the state of immunization services (staffing, staff training needs, stock of vaccines, storage, vaccine transport, cold chain, record keeping, coverage, referrals and linkages and reporting of AEFIs, REC micro plans) in Hoima District.
  3. To establish ways in which the capacity of Health workers in Hoima district can be strengthened in order to reach at least 90% of the unvaccinated children and support monitoring of National Immunization indicators?
  4. To establish ways in which the communities can be promoted to demand for immunization services?
  5. To equip the health workers and service providers with knowledge and skills to manage, document and report on Immunization services.