Oladeji Olusola, Campbell Penelope, Jaiswal Chandrakala, Chamla Dick, Oladeji Bibilola, Ajumara Christopher Otti, Minguiel Lydie Maoungou, Senesie Joseph
Health section, UNICEF, Juba Country Office, South Sudan.
Nutrition section, UNICEF Bentiu Field Office, South Sudan.
Pan Afr Med J. 2019 Jan 16;32:28. doi: 10.11604/pamj.2019.32.28.15464. eCollection 2019.
The protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response.
A community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations.
Integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05).
This study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).
南苏丹的长期战争导致了严重的人道主义危机，营养不良情况严重，卫生系统遭到破坏，人口持续流离失所，免疫覆盖率低，使民众易感染疫苗可预防疾病。本研究旨在评估在资源有限的人道主义应对行动中，将免疫服务与已有的营养服务相结合对免疫覆盖率的影响。
一项基于社区和卫生设施的干预性研究，于2017年1月至12月期间在本提乌难民营的两个门诊治疗项目（OTP）中心将免疫服务纳入营养服务。主要假设是，在OTP和社区外展活动的营养服务期间纳入免疫服务是减少所有获得营养服务的 eligible children免疫接种错过机会的有效策略。使用STATA 15版进行数据分析，并使用逻辑回归进行双变量分析以确定错过疫苗接种的预测因素。
通过OTP中心将免疫服务纳入营养服务，增加了接种各种抗原的儿童数量，并且在研究地点，在OTP中心接受免疫接种的儿童的辍学率远低于初级卫生保健中心（PHC中心），且具有统计学意义。在第2区的OTP中心接种疫苗的儿童错过疫苗接种的可能性比在PHCC接种的儿童低45%（OR：0.45；95%CI：0.36 - 0.55），p<0.05，而在第5区的OTP部门接种疫苗的儿童错过疫苗接种的可能性比在PHCC接种的儿童低27%（OR：0.27；95%CI：0.20 - 0.35），p<0.05）。
本研究表明，将免疫服务与营养服务相结合可有效提高免疫覆盖率，这是一种符合儿童疾病综合管理（IMCI）和全球免疫远景与战略（GIV）的儿童健康综合免疫规划模式。
