Abstract
Objective To evaluate the impact of immunisation service integration to nutrition programmes and under 5-year-old paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan. Design Retrospective intervention study. Setting Three primary healthcare centres in Rumbek East county and three primary healthcare centres in Rumbek Centre county of Lakes state in South Sudan. Participant We extracted the data for the uptake of pentavalent vaccine (first, second and third dose) given to children aged between 6 weeks and 23 months from immunisation records for January-June 2019 before immunisation service integration and July-December 2019 after immunisation service integration from the District Health Information System 2 website to estimate the immunisation uptake ratios and drop-out rates. Results The uptake of the first dose of the pentavalent vaccine improved from 61% to 96% (p<0.001) after immunisation service integration into the nutrition programmes of the primary healthcare centres in Rumbek Centre county. The uptake of the second pentavalent dose improved from 37% to 69% (p<0.001) and for the third pentavalent dose from 36% to 62% (p<0.001), while the drop-out rate reduced from 57% to 40% (p<0.001). While in Rumbek East county, the uptake of the first dose of the pentavalent vaccine improved from 55% to 77% (p<0.001) after immunisation service integration into the under 5-year-old paediatric outpatient departments. The uptake of the second dose improved from 36% to 62% (p<0.001) and for the third dose from 44% to 63% (p<0.001), while the drop-out rate reduced from 40% to 28% (p<0.001). Children were 23% more likely (RR 1.23, 95% CI 1.12 to 1.36, p<0.001) to be immunised with the first dose of the pentavalent vaccine on immunisation service integration into the nutrition programmes of primary healthcare centres of Rumbek Centre county in comparison to integration into under 5-year-old outpatient departments of Rumbek East county. Conclusion Integration of immunisation service delivery to nutrition sites and children's outpatient departments improved the immunisation coverage and decreased drop-out rates in the Rumbek East and Rumbek Centre counties of South Sudan. This evidence of positive impact should encourage the stakeholders of the Expanded Programme on Immunisation to focus on the sustainability and scale-up of this intervention to other counties in South Sudan, as logistically as possible.
| Original language | English |
|---|---|
| Article number | e001034 |
| Journal | FAMILY AND COMMUNITY HEALTH |
| Volume | 9 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Aug 2021 |
| Externally published | Yes |
| Publication type | A1 Journal article-refereed |
Funding
4Department of Nutrition for Global Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK 5Department of Epidemiology and Medical Statistics, University of Ibadan College of Medicine, Ibadan, Nigeria 6Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 7Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK Acknowledgements We thank the Expanded Programme for Immunisation Operation team of the State Ministry of Health, Western Lakes State of South Sudan for their involvement and support of the immunisation service integration into the existing nutrition and under 5-year-old paediatric outpatient department programmes. We thank the clinical officers, vaccinators and nutrition workers who participated in the study. We also acknowledge Olusola Oladeji and his team for also providing evidence in support of immunisation service integration in South Sudan. KA is supported by the Vaccine Impact Modelling Consortium (OPP1157270). Contributors IOI conceptualised this study, supervised the implementation of the intervention, organised data management, planned the methodology, analysed the data and led the report writing. SAL planned the methodology, participated in data management, analysed the data and participated in report writing. JT participated in data analysis and report writing. KA was involved in study conceptualisation, participated in data analysis and report writing. VAO was involved in the study conceptualisation and report writing. JGO was involved in the study conceptualisation, supervised the implementation of the intervention and report writing.
Keywords
- child health
- communicable disease control
- community health services
- delivery of health care
- health plan implementation
- integrated
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Family Practice