Routine Immunization: The Missed Child Perspective

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Routine Immunization The Missed Child
Perspective

• Maya van den Ent, PharmD MPH
• Edward Hoekstra, MD, MSc
• David Brown, DSc, MScPH, MSc
• Halima Dao, MD, MSc
• Satish Gupta, MD

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Coverage MCV1 globally and in 47 priority
countries
Source WHO/UNICEF immunization coverage for 2010
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MCV1 Coverage 2000 201047 Priority Countries
2000
2005
Number of countries (all countries) Number of countries (all countries) Number of countries (all countries) Number of countries (all countries) Number of countries (all countries)

MCV1 coverage MCV1 coverage 2000 2005 2010

  lt70 37 36 26

  70-79 27 17 17

  80-89 44 31 24

  90-99 84 109 127
2010
Source WHO/UNICEF immunization coverage for 2010
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Human Rights

• The Universal Declaration of Human Rights
• based on the principle of human equality
• everyone has right to equal access to public
  services in his or her country
• everyone has the right to a standard of living
  adequate for the health and well being of him/her
  and family, including food, clothing, housing,
  medical care and social services.

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Child Rights.

• Convention on the Rights of the Child
• four core principles
• non-discrimination
• devotion to the best interests of the child
• the right to life, survival and development
• respect for the views of the child.

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The poorest are more likely to die
Indonesia Under 5 Mortality Rate by Wealth
Quintiles 2002 - 2003
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Level of under - nutrition in children belonging
to the poorest households has remained stagnant
for decade
Proportion of children under 5 years who are
underweight, by household wealth quintile
Progress for Children Achieving the MDGs with
Equity September 2010 NFHS-2005-06
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19.1 million infants not having received MCV1,
2010
Every seventh child not reached
Country Coverage Infants no MCV1 (routine)
India 74 6,709,000
Nigeria 71 1,668,000
DR Congo 68 815,000
Uganda 55 630,000
Pakistan 86 619,000
Indonesia 89 468,000
Ethiopia 81 463,000
Afghanistan 62 458,000
South Africa 65 352,000
USA 92 342,000
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Reasons for under- or un-vaccination
Under vaccinated
Unvaccinated
Family Character- istics
Parental Attitudes And Knowledge
Immunization Systems
based on 33 reasons abstracted from 12 articles
on unvaccinated children
based on 887 reasons abstracted from 209
relevant articles
Under vaccinated Infants received at least one
vaccine, but no DTP3 Un-vaccinated Infants
received no vaccine at all
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India Immunization coverage varies
significantly among different population
categories
Percentage of children age 12-23 fully immunized
District Level Household Survey 2007-2008
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India Where are the unvaccinated? Children not
vaccinated with DPT3
Source DLHS 2007-08 children surveyed were
between 12-23 months
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India Where are the unvaccinated ? District -
level percentage of fully immunized children
Wide intra-state variations
Source DLHS 2007-08 children surveyed were
between 12-23 months
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India Predictors Only at least one vaccine vs
fully immunized

• Poor Education
• Mother no TT2
• Minority religion
• Rural
• No Radio/TV
• Poor
• Source Swiss Tropical Institute 2010

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The poorest are more likely not to be immunized
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Greater disparities between provinces than rural
urban
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How to Reach the Under-served Possible links
between SIAs and RI

• Measles Partnership explores ways to further
  strengthen routine immunization in 2012
• Plan for critical activities strengthening
  routine during SIA planning

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Possible links between SIAs and RI

• Coordination accountability for results
• Bottom-up Micro-planning
• Training
• Logistics Management
• Cold chain assessment maintenance
• Advocacy and Social Mobilization
• Evidence based
• Use of community health workers (defaulter
  tracing)
• Health education for caregivers

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Possible links between SIAs and RI

• AEFI monitoring and management
• Surveillance
• Monitoring and Evaluation
• Supportive supervision
• Monitoring charts
• Review meetings feeding into new microplans
• Rapid assessments

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Measles campaigns reach the poorest
Nationwide Measles Vaccination Coverage by Wealth
Quintile, Kenya, 2002
Source Vijayaraghavan M, et al. Health Policy
2007, 83 27-36
Source Vijayaraghavan M, Health Policy 2006
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Conclusions

• MCV1 coverage has steadily improved from 2000 -
  2010
• 19.1 million children remain unreached in 2010
• Focus on under-served populations will have
  highest impact