Wednesday, November 8, 2017

Immunizations for every child’s healthy future

By Chansereypich Seng

A smiley child after getting vaccinated against measles and rubella.
©UNICEF Cambodia/2017/Chansereypich Seng
Steung Treng, Cambodia, November 2017: Located about 30 kilometres from Steung Treng city, Sre Russey village is home to many farmers and villagers. Down the dirt path, about two kilometres, an immunization campaign poster appears before one’s eyes.

In the shade, underneath large trees, a local house serves as a village meeting point for vaccinations. It has been a busy morning since 7:15 AM. As soon as the health centre staff arrived, they started setting up the table and preparing the necessary documents and vaccines. There is no need to announce through microphones because villagers are already present at the site.

The outreach team consisted of two vaccinators, a registration clerk and a village health volunteer. There was also oversight from the acting health centre chief and village deputy chief throughout the whole morning.

Seeing children with tears strolling down their face was a common scene. Indeed, the needles frightened the kids, but health centre staff and volunteers managed to immunize 52 children in the first three hours. This exceeded the target number set for Sre Russey village. 

Families gathered at the measles-rubella vaccination campaign site.
©UNICEF Cambodia/2017/Chansereypich Seng

This initiative was part of the national measles-rubella vaccination campaign, launched by the Ministry of Health in Cambodia in response to the surveillance data from 2016, which indicated that measles was occurring in some parts of the country, mostly amongst children under the age of 5 years old.

Two phases were planned and implemented between March and May 2017 to cover the country’s 25 provinces and immunize over 1.6 million children from 6 to 59 months old.

What are measles and rubella?

Measles is a highly contagious viral disease, which affects mostly children (WHO). High fever and skin rash are common signs. While most affected people recover within two to three weeks, measles can cause serious complications including for malnourished children and those with reduced immunity. The good news is that measles can be prevented by immunization. When children are not fully immunized, the virus becomes a serious threat to children and communities.

Rubella, on the other hand, “is an acute, contagious viral infection. While the illness is generally mild in children, it has serious consequences in pregnant women, causing fatal death or congenital defects known as congenital rubella syndrome (CRS)”, according to the WHO. While rubella was not the immediate issue, vaccines come in pairs, and it is best to prevent these acute diseases as much as possible.

Visonra You, an experienced nurse at Thala Bariwat Health Centre and a vaccinator, described the procedures and challenges:

“We spread the information by carrying loud speakers on our motorbike 7 days prior to the campaign. In addition to general announcement, we gave invitation letters to families that have target children. The village chief also shared the information with villagers,” he said. “However, some parents did not give their consents on purpose. Other parents left home to go the farm in remote areas and brought their children with them, so we could not find where they were and vaccinate them,” he continued.

Nevertheless, he shared the joy and importance of the measles- rubella campaign. “Their (children’s) well-being is what is important. For us not to lose potential human capital in the future, we have to advocate [the importance of vaccination] to families, even in hard-to-reach villages,” Visonra said.

A health centre staff prepares the measles-rubella vaccine during the campaign.
©UNICEF Cambodia/2017/Chansereypich Seng

Samrith Iem, a village health volunteer since 2004, also played an important role before and during the MR campaign. Her main tasks were to share invitation letters and explain to families the potential harm of a measles outbreak, as well as that the most effective way to prevent this disease is to vaccinate their children.

On the day of the campaign, she assisted in setting up the vaccination site, and dipping children’s index finger into a purple ink, a mark to indicate that they have been vaccinated. “I love my work”, she said, “I’ve been working as a health volunteer because I want to spread the word to help prevent mothers and babies from dying.”

“Community members need to understand how harmful the measles virus is, and we need to further advocate because many families are still not exposed to important information related to health,” Samrith continued.

The outreach vaccination team which carried out the campaign in
Sre Russey village, Steung Treng province.
From left to right: a health volunteer, vaccinators,
acting health centre chief, village deputy chief, and health centre staff.
©UNICEF Cambodia/2017/Chansereypich Seng
Afternoon follow-up

After a morning vaccination session, Dr. Navy Kieng was on the move. She is a health officer at UNICEF Kratie Zone Office, and has been with the organization for 17 years. This afternoon, her mission was to have a final check and assure that every child in Sre Russey village has received their MR vaccination.

She walked to each house, talked to families, and asked to see if the target children had purple marks on their index fingers. A cooling box filled with MR vaccines was always ready for any child who had not received their shot in the morning.

This afternoon procedure is called “Rapid Coverage Assessment” or RCA. RCA happens on the day, or day after health staff declares that they are done with the vaccinations. During this important session, even if one child does not receive measles-rubella vaccination, the village fails the assessment. 

A peacefully sleeping child is getting immunized later in the afternoon, because he did not receive the measles-rubella shot in the morning.
©UNICEF Cambodia/2017/Chansereypich Seng
Navy shared her thoughts on this campaign:

“Authorities, communes, and health centre staff showed their commitment from the start until the end of this campaign, despite constrained time and staff,” she said. “However, if health centre staff had more budget, and a variety of transportation, they could go to more remote areas. As a result, the campaign in overall could also become more effective.”

“In addition to budget and equipment during the campaign, authorities could further raise awareness during village sharing sessions and national days to villagers. We need more support to increase health knowledge amongst people,” Navy concluded.

According to the Ministry of Health’s report on this year’s measles-rubella vaccinations campaign, over 1.45 million target children were immunized, falling short of the national target to immunize 1.6 million children in the age range of 6 to 59 months.

However in Steung Treng, the number of vaccinated children exceeded the planned target (131%)  as families who have moved to this province to engage in agriculture work and who have not yet officially registered with the local authorities also brought their children to be vaccinated. This accomplishment made Steung Treng the second most successful province in the campaign, after Ratanakiri where the number of children vaccinated also exceeded the planned number (141%).  Most provinces in the north east reported above 100% immunization coverage during the campaign.

This campaign was implemented by the Government of Cambodia, with support from Gavi (the Global Alliance for Vaccines and Immunization), UNICEF, and WHO.

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