Impact evaluation of immunisation service integration to nutrition programmes and paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan

Abstract

ObjectiveTo 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.DesignRetrospective intervention study.SettingThree primary healthcare centres in Rumbek East county and three primary healthcare centres in Rumbek Centre county of Lakes state in South Sudan.ParticipantWe 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.ResultsThe 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.ConclusionIntegration 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.

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

“…Six studies considered system adaptation through service integration – four from sub-Saharan Africa and two from South Asia (Afghanistan and Pakistan). Two studies evaluated the impact of Mobile Health Teams (MHTs) offering integrated PHC including vaccination delivery in Afghanistan and Nigeria (54,55); two looked at integration between nutrition and routine immunisation services in South Sudan (56,57); and the final two studies considered integration of routine immunisation with polio outreach activities in Nigeria and Pakistan (58,59). All bar one were observational studies; the final study was a high-quality cluster RCT from Pakistan (59).…”

Are children on track with their routine immunization schedule in a fragile and protracted conflict state of South Sudan? A community-based cross-sectional study

“…This study observed that health facilities frequently conducting routine (static) immunization services on a daily basis were influential in reducing the amount of children off track with immunization. Policy on immunization in South Sudan advises the implementation of routine immunization outreach across communities outside the 5 km radius of a health facility [ 1 , 36 , 37 ]. Considering the need for improvement of immunization success in countries like South Sudan, continuous vaccine availability and punctuality of EPI vaccinators at health facilities, creation and sustainability of more outreach posts with regular supplementary immunisation activities in hard-to-reach areas could translate into higher vaccine uptake.…”

“…According to a unicef report, a ‘one-size-fits-all’ approach in this changing world is no longer appropriate [ 38 ]. Nevertheless, analysis of data available from DHIS2 have shown more vaccination still takes place during outreaches activities for most counties in south Sudan [ 1 , 39 ].…”

“…Since 2012, total immunization coverage in South-Sudan has been around 47.5%, and till date, the country has remained a conflict-prone region [ 1 – 3 ]. Data from the WHO vaccine-preventable diseases monitoring system shows that between 2017 and 2020, there has been an increasing prevalence of Measles and Rubella diseases in the country [ 3 , 4 ].…”

“…These challenges are linked to the South Sudanese Civil War which lasted between December, 2013 and February 2020, resulting in the vandalization and looting of about 50% of the cold-chain infrastructure in the country [ 6 ]. The low coverage of vaccine-preventable diseases in South Sudan is also related to the fragile health system [ 1 ], which is bedeviled with the several challenges ranging from health workforce shortages, poor public funding of the health system, limited access to healthcare services, as well as weak vaccine surveillance and monitoring systems [ 7 ]. The upsurge in some vaccine-preventable diseases clearly indicates the need for more attention to be given to immunization in South Sudan in a bid to forestall a resultant increase in childhood mortality that could ensue.…”