Sabahelzain Majdi M, Almaleeh Alaa, Abdelmagid Nada, Abdalla Omayma, Nor Barni, Mounier-Jack Sandra, Singh Neha S
School of Health Sciences, Ahfad University for Women (AUW), Omdurman, Sudan.
School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Confl Health. 2024 Dec 23;18(1):76. doi: 10.1186/s13031-024-00639-9.
Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan.
We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts.
Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns.
Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations.
2023年，全球有2100万儿童未接种或未完全接种含白喉-破伤风-百日咳（DTP）疫苗。约20%的零剂次儿童，即未接种任何一剂DTP疫苗的儿童，生活在低收入和中等收入国家受冲突影响的地区。关于在这些地区识别和接触零剂次儿童的疫苗接种干预措施，证据不足。本研究旨在绘制和评估当前的疫苗接种策略，以识别并接触苏丹南科尔多凡州、南达尔富尔州和青尼罗州受危机影响地区的零剂次和未充分接种疫苗的儿童。
我们在疫苗免疫全球联盟（Gavi）制定的“识别-接触-监测-评估-倡导”（IRMMA）框架指导下开展了一项横断面定性研究。2022年11月至12月期间，我们进行了20次个人半结构化访谈。我们采访了联邦、州和地方各级的政府和非政府疫苗接种利益相关者。我们使用IRMMA框架分析访谈记录。
研究地点的零剂次和未充分免疫儿童集中在反对派控制地区以及游牧社区和偏远农村地区。可及地区的零剂次和未充分免疫儿童通过常规疫苗接种策略和监测报告来识别。在难以到达的地区采用了各种策略。这包括安排受社区信任的当地机构和个人来识别并接触儿童，以及将常规疫苗与其他卫生干预措施（如新冠疫苗接种和发放杀虫网）进行不频繁的整合和联合提供。存在人口估计不准确以及缺乏卫生部关于测量和监测零剂次和未充分免疫儿童的指导。受访者将倡导与动员混为一谈，倡导活动总体上被视为大多与免疫运动相关的临时活动。
我们的研究强调了在苏丹受危机影响地区为零剂次和未充分免疫儿童接种疫苗的复杂性。需要进一步研究来评估这些做法以及非政府组织（NGO）和社区参与在提高疫苗接种覆盖率方面的作用。此外，探索替代资金筹集方法并使用地理信息系统（GIS）可以改善疫苗接种数据并解决资金限制问题。
