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A Job Half Done: missed childhood vaccination opportunities in MSF health structures

This study evaluates missed vaccination opportunities in MSF projects, focusing on age groups, vaccine types, and reasons for missed opportunities. It aims to identify the prevalence and inefficiency of missed opportunities. The baseline surveys in four sub-Saharan countries showed a prevalence of 48% missed opportunities. Reasons include lack of information and vaccines. Follow-up surveys in Niger showed ongoing missed opportunities in young children. Recommendations emphasize simplified tools, baseline and follow-up studies in all projects, and vigilant vaccination protocols. It highlights the need for improved performance and efficient practices in vaccination campaigns.

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A Job Half Done: missed childhood vaccination opportunities in MSF health structures

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  1. A Job Half Done: missed childhood vaccination opportunities in MSF health structures OCB OR day Brussels, 13th June 2014 Catherine Bachy

  2. Background • 1983: Vaccinate at every opportunity (WHO) • MSF keeps focus on reactive mass campaigns • 2008: Vaccination becomes a priority for MSF • 2010: EPI is integrated in some OCB projects

  3. Rationale • Vaccination monitoring fragmented • Blind on what we DON’T do… 2011-2013 Missed vaccination opportunities surveys in projects with routine vaccination

  4. Objectives • Measure the magnitude of missed opportunities • Describe misses by age group and by vaccine • Understand the reasons for missed opportunities  Is improvement needed? • Can we do something about it?

  5. Methods • Authorization by authorities • Standardized questionnaire • Exit interview of ALL children after consent • Vaccination cards or recall • Expanded age-group EPI calendar as reference

  6. Received all vaccines for which eligible Without contraindication Eligible for at least one vaccine Did not receive all vaccines for which eligible Study population With contraindication Vaccination up-to-date

  7. Missed vaccination opportunities Received all vaccines for which eligible Without contraindication Eligible for at least one vaccine Did not receive all vaccines for which eligible Study population With contraindication Vaccination up-to-date = Prevalence of missed vaccination opportunities

  8. Missed vaccination in eligible Received all vaccines for which eligible Without contraindication Eligible for at least one vaccine Did not receive all vaccines for which eligible Study population With contraindication Vaccination up-to-date = Inefficiency of the system

  9. Example Received all vaccines for which eligible = 2 Without contraindication = 4 Eligible = 4 Did not receive all vaccines for which eligible = 2 n = 100 With contraindication Vaccination up-to-date = 96 Missed vaccination opportunities = 2/100 = 2% Missed vaccination in eligible = 2/4 = 50%

  10. Description of baseline surveys • 14 baseline surveys • 4 sub-Saharan countries • MSF-supported health structures • Duration: 6 days [1-15] • Children:

  11. Main results: median [range] Vaccination card: 70% [20-100%] 100% [69-100%] Received all vaccines for which eligible 72% [51-95%] Without contraindication 147 [41-242] Eligible for at least one vaccine Did not receive all vaccines for which eligible With contraindication Study population Vaccination up-to-date

  12. Main results: median [range] Received all vaccines for which eligible Without contraindication Did not receive all vaccines for which eligible Did not receive all vaccines for which eligible Eligible for at least one vaccine Eligible for at least one vaccine With contraindication Study population Vaccination up-to-date Prevalence of missed opportunities: 48% [18-73%] Missed opportunities in eligible: 77% [20-100%]

  13. Reasons for visit of misses (n=14) • Curative consultation: 48% [27-99%] • Ambulatory feeding centre: 18% [0-49%] • Vaccination: 9% [0-43%] • Accompanying a patient: 5% [0-23%] • MCH consultation: 2% [0-36%]

  14. Reasons for missed opportunities (n=14) • Lack of information: 38% [10-79%] • Lack of vaccines: 31% [0-60%] • Unknown: 13% [0-44%] • Other: 11% [3-50%] • Long waiting time: 2% [0-6%] • Vaccinator absent: <1% [0-38%]

  15. Missed opportunities by age group

  16. Missed opportunities by vaccine

  17. Follow-up surveys: Did it change? • PHCC Sae Saboa and Guidam Roumdji, Niger • November 2011 & January 2013 • Missed vaccination opportunities in 0-11 months

  18. Conclusions • Performance needs to be improved • Reasons are easy to address • It can be done  Where is the real missed opportunity in MSF?

  19. Recommendations •  Simplified tools available • Baseline study in EVERY project • Follow-up studies • … In the meantime: check and vaccinate!

  20. Acknowledgements The national and international staff of all projects involved; Marie-Eve Burny & Isabella Panunzi: Vaccination Referents; Ilaria Porta & Ibrahim Barrie: MIO Vaccination; Michel Van Herp: Head of the Disease Control Unit The Operational Research Unit

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