Amily Ali Sadiq, Lami Faris, Khader Yousef
Immunization Section, Wasit Directorate of Health, Iraqi Ministry of Health, Kut, Iraq.
Department of Community and Family Medicine, College of Medicine, Baghdad University, Baghdad, Iraq.
JMIR Public Health Surveill. 2019 Oct 7;5(4):e14451. doi: 10.2196/14451.
Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children's Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates.
The goal of this study was to assess the impact of training of primary health care centers' (PHCs) vaccinators on the quality of ISPs.
This was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, "Managing an Immunization Session", and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores.
A total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02).
The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services.
免疫接种每年可避免超过250万儿童死亡。世界卫生组织（WHO）和联合国儿童基金会对2015年伊拉克免疫接种覆盖率的估计显示，白喉-破伤风-百日咳疫苗第三剂的覆盖率为58%，麻疹疫苗的覆盖率为57%。高质量的免疫接种环节操作（ISPs）可确保疫苗接种更安全、有效，并提高覆盖率。
本研究的目的是评估对初级卫生保健中心（PHCs）接种人员的培训对免疫接种环节操作质量的影响。
这是一项在瓦西特省10个（18%）初级卫生保健中心开展的干预性研究。从每个卫生区随机选取两个初级卫生保健中心。通过直接在职观察，使用经修改的WHO免疫接种环节检查表对免疫接种环节操作进行评估。结果分为七个领域：疫苗和稀释剂管理、冷链管理、环节设备、登记、沟通、疫苗制备与接种以及废物管理。接种人员参加了为期一天的使用WHO模块“管理免疫接种环节”的培训，一个月后使用相同的工具和技术进行了第二次评估。然后我们计算了各领域分数的中位数差异。
共有42名接种人员接受了培训，其中25名（60%）毕业于卫生技术院校，但只有15名（36%）曾接受过标准免疫接种环节操作的培训。培训后，在三个领域有显著改善：疫苗和稀释剂管理（P = 0.01）、冷链管理（P = 0.01）以及疫苗制备与接种（P = 0.02）。
对初级卫生保健中心接种人员进行为期一天的培训对改善部分免疫接种环节操作有效。我们建议其他初级卫生保健中心使用该培训模块或更深入的模块，以提高免疫接种服务的利用率。
