Cutts F, Soares A, Jecque A V, Cliff J, Kortbeek S, Colombo S
Ministry of Health, Mozambique.
Bull World Health Organ. 1990;68(2):199-208.
Reported are the results of an evaluation of process indicators and outputs for the Expanded Programme on Immunization (EPI) in Mozambique which were used to modify immunization strategies from 1985 to 1987. In 1986 according to cluster sample surveys, 84% of children in Maputo, the capital, were fully vaccinated. In other cities in the country, vaccination coverage increased from an average of 36% in 1985 to 55% in 1987. The major determinants of low vaccination coverage were provision of vaccination services at health centres on less than 3 days per week; missed opportunities; and vaccinating too early or with too short an interval between doses. The results of sentinel site surveillance in Maputo indicated that EPI had a marked impact on neonatal tetanus and to a lesser extent on poliomyelitis and measles. Evaluation led to changes in EPI policy in Mozambique (e.g., adoption of a uniform national vaccination schedule and discontinuation of the use of expired vaccine) and strategies (elaboration of different strategies for urban areas, rural areas, and displaced people). Also, performance was improved by involving programme managers and implementors in evaluation, and by providing timely and widespread feedback of results to policy-makers, peripheral health workers, and the community.
本文报告了对莫桑比克扩大免疫规划（EPI）的过程指标和产出进行评估的结果，这些指标和产出被用于在1985年至1987年期间调整免疫策略。1986年，根据整群抽样调查，首都马普托84%的儿童完成了全程疫苗接种。在该国的其他城市，疫苗接种覆盖率从1985年的平均36%提高到了1987年的55%。疫苗接种覆盖率低的主要决定因素包括：卫生中心每周提供疫苗接种服务的天数少于3天；错失接种机会；接种时间过早或各剂次之间的间隔过短。马普托哨点监测的结果表明，扩大免疫规划对新生儿破伤风有显著影响，对脊髓灰质炎和麻疹的影响较小。评估促使莫桑比克的扩大免疫规划政策发生了变化（例如，采用统一的国家疫苗接种时间表并停止使用过期疫苗）和策略（为城市地区、农村地区和流离失所者制定不同的策略）。此外，通过让规划管理人员和实施人员参与评估，并及时向政策制定者、基层卫生工作者和社区广泛反馈结果，工作绩效得到了提高。
