A Job Half Done: missed childhood vaccination opportunities in

MSF health structures

OCB OR dayBrussels, 13th June 2014

Catherine Bachy

Background

• 1983: Vaccinate at every opportunity (WHO)

• MSF keeps focus on reactive mass campaigns

• 2008: Vaccination becomes a priority for MSF

• 2010: EPI is integrated in some OCB projects

Rationale

• Vaccination monitoring fragmented• Blind on what we DON’T do…

2011-2013Missed vaccination opportunities surveys

in projects with routine vaccination

Objectives

• Measure the magnitude of missed opportunities

• Describe misses by age group and by vaccine

• Understand the reasons for missed opportunities

Is improvement needed? Can we do something about it?

Methods

• Authorization by authorities

• Standardized questionnaire

• Exit interview of ALL children after consent

• Vaccination cards or recall

• Expanded age-group EPI calendar as reference

Study population

Eligible for at least one vaccine

Without contraindicatio

n

Received all vaccines for

which eligible

Did not receive all vaccines for which eligible

With contraindicationVaccination

up-to-date

Missed vaccination opportunities

Study population

Eligible for at least one vaccine

Without contraindicatio

n

Received all vaccines for

which eligible

Did not receive all vaccines for which eligible

With contraindicationVaccination

up-to-date

= Prevalence of missed vaccination opportunities

Study population

Eligible for at least one vaccine

Without contraindicatio

n

Received all vaccines for

which eligible

Did not receive all vaccines for which eligible

With contraindicationVaccination

up-to-date

Missed vaccination in eligible

= Inefficiency of the system

Example

n = 100Eligible = 4

Without contraindication

= 4

Received all vaccines for which

eligible = 2

Did not receive all

vaccines for which eligible

= 2

With contraindicationVaccination

up-to-date = 96

Missed vaccination opportunities = 2/100 = 2%Missed vaccination in eligible = 2/4 = 50%

• 14 baseline surveys• 4 sub-Saharan countries• MSF-supported health structures• Duration: 6 days [1-15]• Children:

Description of baseline surveys

Main results: median [range]Vaccination card: 70% [20-100%]

Received all vaccines for

which eligible

Did not receive all vaccines for which eligibleStudy

population

147 [41-242] Eligible for at least one vaccine

Vaccination up-to-date

72% [51-95%]

With contraindication

Without contraindicatio

n

100% [69-100%]

Main results: median [range]

Prevalence of missed opportunities: 48% [18-73%]

Missed opportunities in eligible: 77% [20-100%]

Received all vaccines for

which eligible

Study population

Eligible for at least one vaccine

Vaccination up-to-date

With contraindication

Without contraindicatio

n Did not receive all vaccines for which eligible

Did not receive all vaccines for which eligible

Eligible for at least one vaccine

Reasons for visit of misses (n=14)

– Curative consultation: 48% [27-99%]

– Ambulatory feeding centre: 18% [0-49%]

– Vaccination: 9% [0-43%]

– Accompanying a patient: 5% [0-23%]

– MCH consultation: 2% [0-36%]

Reasons for missed opportunities (n=14)

– Lack of information: 38% [10-79%]

– Lack of vaccines: 31% [0-60%]

– Unknown: 13% [0-44%]

– Other: 11% [3-50%]

– Long waiting time: 2% [0-6%]

– Vaccinator absent: <1% [0-38%]

Missed opportunities by age group

Missed opportunities by vaccine

Follow-up surveys: Did it change?• PHCC Sae Saboa and Guidam Roumdji, Niger

• November 2011 & January 2013

• Missed vaccination opportunities in 0-11 months

2011 201372% 34%72% 28%

Conclusions

• Performance needs to be improved

• Reasons are easy to address

• It can be done

Where is the real missed opportunity in MSF?

Recommendations

Simplified tools available

Baseline study in EVERY project

Follow-up studies

… In the meantime: check and vaccinate!

Acknowledgements

The national and international staff of all projects involved;

Marie-Eve Burny & Isabella Panunzi: Vaccination Referents;

Ilaria Porta & Ibrahim Barrie: MIO Vaccination;

Michel Van Herp: Head of the Disease Control Unit

The Operational Research Unit