Top

Published in:

Open Access 01-12-2017 | Research article

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage

Authors: Raveesha R. Mugali, Farooq Mansoor, Sardar Parwiz, Fazil Ahmad, Najibullah Safi, Ariel Higgins-Steele, Sherin Varkey

Published in: BMC Public Health | Issue 1/2017

Abstract

Background

Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births.

Methods

The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12–23 months.

Results

Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%).

Conclusion

The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Levine OS, Bloom DE, Cherian T, de Quadros C, Sow S, Wecker J, et al. The future of immunisation policy implementation, and financing. Lancet. 2011;378(9789):439–48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21664676. [cited 2014 Jul 9], doi:10.1016/S0140-6736(11)60406-6.CrossRefPubMed

Unicef P. Maternal and neonatal tetanus elimination initiative pampers UNICEF 2010 campaign launch. 2010; Available from: http://www.unicef.org/corporate_partners/files/APPROVED_MNT_Report_05.06.10.pdf.

Simons E, Ferrari M, Fricks J, Wannemuehler K, Anand A, Burton A, et al. Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data. Lancet. 2012;379(9832):2173–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22534001. [cited 2014 Jul 16].CrossRefPubMed

Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Policy and practice Vaccination greatly reduces disease, disability, death and inequity worldwide. 2008;40089(2007):140–7.

Omer SB, Salmon DA, Orenstein WA, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases; 2009. doi:10.1002/anie.200904156.

Burton A. WHO and UNICEF estimates of national infant immunization coverage: methods and processes. Bull World Health Organ. 2009;87(7):535–41. Available from: http://www.who.int/bulletin/volumes/87/7/08-053819.pdf. [cited 2014 Oct 24].CrossRefPubMedPubMedCentral

EMRO W. Afghanistan accelerates immunization activities; 2014. p. 1. Available from: http://www.emro.who.int/afg/programmes/epi.html. [cited 2014 Aug 1].

Afghanistan U. Elimination of maternal and neonatal tetanus [Internet]. 2014. Available from: http://www.unicef.org/health/index_43509.html. [cited 2014 Aug 1].

World Health Organisation. Afghanistan health profile. Available from: http://www.who.int/countries/afg/en/. [Accessed 4th Oct 2014].

10.

Afghan Public Health Institute, Ministry of Public Health (APHI/MoPH) [Afghanistan], Central Statistics Organization (CSO) [Afghanistan], ICF Macro, Indian Institute of Health Management Research (IIHMR) [India], and World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO) [Egypt]. 2011. Afghanistan Mortality Survey 2010. Calverton, Maryland, USA: APHI/MoPH, CSO, ICF Macro, IIHMR and WHO/EMRO. Available from: http://dhsprogram.com/pubs/pdf/fr248/fr248.pdf.

11.

National Immunization Program. Director General of Preventive Medicine, Ministry of Public Health. Islamic Republic of Afghanistan. Comprehensive Multi Year Plan (cMYP) 2011-2015. Available from: http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/afghanistan/afghanistan_cmyp_2011_-_2015.pdf.

12.

Bartlett LA, Mawji S, Whitehead S, Crouse C, Dalil S, Ionete D, et al., editors. Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999-2002. Lancet. 2005;365(9462):864–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15752530.

13.

The Inter-agency Group for Child Mortality Estimation (UN IGME), Child mortality final report 2015. Available from: http://www.childmortality.org/files_v20/download/igme%20report%202015%20child%20mortality%20final.pdf.

14.

Newbrander W, Ickx P, Feroz F, Stanekzai H. Afghanistan’s basic package of health services: its development and effects on rebuilding the health system. Glob Public Health. 2014; Available from: http://www.ncbi.nlm.nih.gov/pubmed/24865404. [cited 2014 Jul 11];(July):1–23.

15.

CSO 2015 est. population.pdf.

16.

Organisation CS. Afghanistan statistical yearbook 2014–2015. 2015. Available from: http://cso.gov.af/en/page/1500/4722/2014-2015.

17.

Bilak AA, Cardona-fox G, Ginnetti J, Rushing EJ, Scherer I, Swain M, et al. Global Report ON INTERNAL DISPLACEMENT. 2016.

18.

UNICEF. Humanitarian action for children 2014 Afghanistan. Kabul. Available from: https://www.unicef.org/appeals/files/Afghanistan_HAC_MYR_Revised_140730_GW2_final-Rev1_02092014_OB.pdf.

19.

Central Statistics Organisation (CSO) and UNICEF. Afghanistan Multiple Indicator Cluster Survey 2010-2011: Report. Kabul: Central Statistics Organisation (CSO) and UNICEF; 2012. Available from: http://cso.gov.af/en/page/1500/1494/6807.

20.

World Health Organization Vaccination Coverage Cluster surveys: Reference Manual [Internet]. Available from: http://www.who.int/immunization/monitoring_surveillance/routine/coverage/en/index2.html. Accessed 20th Oct 2015.

21.

WHO, Department of Immunization V and B. Training for mid-level managers (MLM): 7. The EPI coverage survey. 2008;(Mlm):8–9.

22.

Bolton P, Mph M, Anwar S, Anita MHA, Holt HE, Hughart DN, et al. Deficiencies in current childhood immunization indicators; 1998. p. 527–32. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1308436/pdf/pubhealthrep00031-0053.pdf.

23.

Waldman RJ, Newbrander W. Afghanistan’s health system: moving forward in challenging circumstances 2002-2013. Glob Public Health. 2014;9(Suppl 1):S1–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25034913. [cited 2014 Oct 27]. CrossRefPubMed

24.

Sheikh SS, Ali SA. Predictors of vaccination card retention in children 12-59 months old in Karachi, Pakistan. Oman Med J. 2014;29(3):190–3. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4052393&tool=pmcentrez&rendertype=abstract. [cited 2014 Aug 2].CrossRefPubMedPubMedCentral

25.

Babirye JN, Rutebemberwa E, Kiguli J, Wamani H, Nuwaha F, Engebretsen IM. More support for mothers: a qualitative study on factors affecting immunisation behaviour in Kampala, Uganda. BMC Public Health. 2011;11:723. doi:10.1186/1471-2458-11-723.

26.

NoKhan MNA, Rahman ML, Awal Miah A, Islam MS, Musa SAJM, Tofail F. Vaccination coverage survey in Dhaka District. Bangladesh Med Res Counc Bull. 2005;31:46–53. 31, (46–53)

27.

Brown DW. Vaccine 2014, in press home-based child vaccination records — a reflection on form. 2014.

28.

UNICEF. National Immunization Card Repository. Available from: http://www.immunizationcards.org. Accessed 20th Oct 2015.

29.

Report KI. Afghanistan demographic and health survey key indicators report. 2016.

30.

Sodha SV, Dietz V. Strengthening routine immunization systems to improve global vaccination coverage. Br Med Bull. 2015;113(1):5–14. doi:10.1093/bmb/ldv001.CrossRefPubMed

31.

Torun SD, Bakirci N. Vaccination coverage and reasons for non-vaccination in a district of Istanbul. BMC Public Health. 2006;6:125.CrossRefPubMedPubMedCentral

32.

Usman HR, Akhtar S, Habib F, Jehan I. Redesigned immunization card and center-based education to reduce childhood immunization dropouts in urban Pakistan: a randomized controlled trial. Vaccine. 2009;27:467–72. doi:10.1016/j.vaccine.2008.10.048.CrossRefPubMed

33.

Uddin MJ, Saha NC. Islam Z, khan IA, Shamsuzzaman, Quaiyum MA, et al. improving low coverage of child immunization in rural hard-to-reach areas of Bangladesh: findings from a project using multiple interventions. Vaccine. 2012;30:168–79. doi:10.1016/j.vaccine.2011.11.030.CrossRefPubMed

34.

Jamil K, Bhuiya A, Streatfield K, Chakrabarty N. The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain. Health Policy Plan. 1999;14(1):49–58. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10351469.CrossRefPubMed

35.

Payne S, Townend J, Jasseh M, Lowe Jallow Y, Kampmann B. Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in the Gambia. Health Policy Plan. 2014;29(2):193–203. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3944881&tool=pmcentrez&rendertype=abstract. [cited 2014 Jul 29]

36.

National education interim plan 2011–2013 [Internet]. 2013. Available from: http://moe.gov.af/Content/files/TheInterimPlan.pdf.

37.

UNICEF. Education in Afghanistan fact sheet • November 2011. Kabul; 2011. Available from: http://www.unicef.org/infobycountry/files/ACO_Education_Factsheet_-_November_2011_.pdf.

38.

Rainey JJ, Watkins M, Ryman TK, Sandhu P, Bo A, Banerjee K. Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: findings from a systematic review of the published literature, 1999–2009. Vaccine. 2011;29(46):8215–8221.

39.

Ce N, Oringanje C, Mm M. Interventions for improving coverage of child immunization in low- and middle-income countries (review). 2011;(7). doi:10.1007/s00421-016-3502-z.

40.

Goel S, Dogra V, Gupta SK, Lakshmi PVM, Varkey S, Pradhan N, et al. Effectiveness of Muskaan ek Abhiyan (the smile campaign) for strengthening routine immunization in Bihar, India. Indian Pediatr. 2012;49(2):103–108.

Title: Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage
Authors: Raveesha R. Mugali
Farooq Mansoor
Sardar Parwiz
Fazil Ahmad
Najibullah Safi
Ariel Higgins-Steele
Sherin Varkey
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-017-4193-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Evaluation of a physical activity intervention for new parents: protocol paper for a randomized trial

Correction to: Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods

Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study

A randomized controlled trial to evaluate the impact of a geo-specific poster compared to a general poster for effecting change in perceived threat and intention to avoid drowning ‘hotspots’ among children of migrant workers: evidence from Ningbo, China

Malaria control by commodities without practical malariology

A mixed methods study to assess the effectiveness of food-based interventions to prevent stunting among children under-five years in Districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol