Supporting Access to Immunization through Supplementary Immunization Activities

By Abubakar Shehu and Emerald Awa- Agwu

Supplementary Immunization Activities (SIAs) are one of the four strategies put forward by the Global Polio Eradication Initiative (GPEI) in 1988. In Nigeria, SIAs include Immunization Plus Days (IPDs), Outbreak Responses (OBRs) and other immunization outreaches conducted by the Nigerian government and its polio eradication partners. The aim of SIAs is to interrupt the transmission of the poliovirus by immunizing all children under five years of age with two doses of oral polio vaccine irrespective of their previous immunization status—unimmunized, partially covered or fully immunized.

A child receiving the Oral Polio Vaccine

SIAs are intended to complement Routine Immunization. However, in some areas, they represent the major strategy for catching unimmunized children and ensuring that they are vaccinated against polio and other vaccine-preventable diseases. Access to routine immunization services may be hindered for a variety of reasons including:

• Challenges with cold chain equipment leading to vaccine damage and loss of potency, and eventually, unavailability of vaccines. Caregivers are often reluctant to return to health facilities where vaccines were unavailable. This results in missed opportunities to commence or complete the vaccination course.

• Security challenges that make health facilities hard to reach by caregivers who bring children for immunization.

• Access-related challenges such as caregivers having to travel long distances to the health facility or being unable to afford the cost of transportation

• Wrong myths or perceptions about vaccinations such as loss of fertility as a result of vaccination.

SIAs take immunization services directly to children at their doorsteps, thereby bridging any gaps that may result from an inability to access vaccines at the health facilities. By achieving a vaccination coverage of at least 80% (that is, by vaccinating at least 80% of the targeted children with a potent vaccine), herd immunity can be achieved and the poliovirus can be deprived of the susceptible hosts which it needs to survive.

Through Supplementary Immunization Activities, children who were missed by routine immunization services can be reached with life-saving vaccines

Prior to 2012, Nigeria had been conducting SIAs but was still recording cases of wild poliovirus (WPV). After a holistic examination of the immunization program, it was discovered that there was a huge disparity between the actual versus reported immunization coverage. Reports from independent monitoring and supervision groups showed that the actual vaccination coverage of the SIAs was much lower than the reported coverage. There were many missed settlements and an even larger number of missed children. It was discovered that some vaccination teams never visited the communities, instead, they would discard the vaccines and record false information in the tally sheets to account for the empty vials. Not only was this frustrating the polio eradication efforts, but it was also causing the health system huge losses as a result of the wasted vaccines.

It became imperative to develop a methodology to improve vaccination coverage and ensure that the vaccination teams visited all the target settlements during SIAs. This led to the development and deployment of the Vaccination Tracking System (VTS) in 2012.

VTS provides healthcare administrators and partners in the polio eradication space with daily insight into the activities of vaccination teams during SIAs by collecting passive tracks of the vaccination teams using Geographic Information Systems (GIS technology-enabled android phones and uploading them onto a dashboard for visualization. This provides stakeholders with near-live data about the geo-coverage of the vaccination campaign. The system also identifies missed settlements on a daily basis so that immediate action can be taken and the settlements can be included in the ongoing campaign. Another benefit of the VTS is that it increases the accountability of vaccination teams because the vaccinators know that they are under constant supervision. This greatly reduces the risk of data falsification.

The VTS dashboard provides decision-makers with near-real-time data about the progress of immunization campaigns and outreaches

So far, VTS has been used to track 82 supplementary immunization activities in 30 states of Nigeria. A significant proportion of these states have seen an exponential increase in the vaccination geo-coverage rates from the first campaign tracked to the last tracked campaign.

Increase in vaccination coverage rates

VTS makes sure that eligible children who, for any reason, are unable to receive their vaccinations through the routine immunization sessions at the health facilities, have a second chance to be protected against vaccine-preventable diseases like Polio and Meningitis.

Meet The Team - Sally Williams

Balancing work and personal life can be difficult. This is especially true if you have a demanding job like Sally Williams.

Sally is the Project Manager for Sierra Leone’s 117 Call Center and she leads a nation-wide multi-disciplinary 44-man team of District Coordinators, Project Coordinators, Administrative Support and Technical Consultants and the entire staff at the call center in Freetown. While being a project manager extraordinaire during the day, she is still able to find time daily for her passion, fitness, and exercise. 
Sally believes that teamwork is a large part of the reason she is successful in her role and can find time to ensure work/life balance. She relies on all members of her team to perform well in their individual roles and work together to accomplish the goals set for the team and because they’re successful in this, she is able to focus on strategic initiatives that have moved the 117 Call Center forward. Some of these strategic initiatives include transitioning the 117 Call Center from an ebola emergency hotline to a surveillance platform and the 117 Call Center rebranding efforts.

Sally receiving her Team of the Quarter certificate

She recognizes the fact that her team’s dedication and efforts are a key factor in achieving their goals and getting some of the accolades and milestones they are celebrating. Her team’s dedicated work is paying off. In Quarter 2 of 2019, Sally’s team was voted the winner of ‘’Team of the Quarter,’ award,’ one of eHA’s ways of recognizing teamwork, having fulfilled certain criteria-including outstanding performance, innovation, and quality, during the course of a given quarter.

“My role is a challenging but thrilling one. I have an affinity for teamwork. The favorite part of my job is interacting with my team in the districts because they are the ones in the field that go day-to-day out in the community spreading the message of 117. Their dedication is priceless.”

— Sally Williams

“When Sally is around us, you would hardly tell who is the boss. She mixes well but knows how to get us to do a good job. Her positive attitude towards us motivates us to work harder for best results.”

— Maseray Sesay, Project Assistant, 117 Call Center project

Sally works well with everybody, both within the 117 Call Center team and the eHA team as a whole, and is an inspiration to all. She is always encouraging to others and makes others feel comfortable enough to communicate openly and honestly with her. She works collaboratively, allowing everyone to bring their strengths and motivates them to identify and work on areas where they need to get stronger.

Sally loves teamwork but is also passionate about serving in an organization or team that shares her vision. Like eHA’s mission, she finds joy in serving underserved communities, and this is what makes her go the extra mile as a member of the #eHA team.

Sally with some members of her team

Sally bringing her passion to the workplace, leading fitness activities during our employee engagement events

“I love an organization that is dedicated to helping the underserved population. eHealth Africa is also a family-oriented workplace and that was appealing, especially when one is already far away from home. Knowing that our services to the community do not go unnoticed, excites me the most. Although we have trying times, the day to day challenges motivates me to do more!”

— Sally

Lessons from the eHealth Africa-Emory University Schistosomiasis Study

By Tolulope Oginni and Emerald Awa-Agwu

Schistosomiasis and nineteen other diseases are classified by the World Health Organization as Neglected Tropical Diseases. It is an acute and chronic parasitic disease caused by blood flukes called schistosoma. People become infected when larval forms of the parasite (worms) penetrate their skin during contact with infested water. 

The disease can present in two main forms: intestinal and urogenital schistosomiasis. Intestinal schistosomiasis can result in abdominal pain, diarrhea,  blood in the stool, and liver and spleen enlargement in advanced cases. The most distinguishing symptom of urogenital schistosomiasis is haematuria (blood in urine). Fibrosis of the bladder and ureter, kidney damage, genital lesions and vaginal bleeding in women, and pathology of the seminal vesicles, prostate and other organs in men. In later stages, urogenital schistosomiasis may lead to bladder cancer and infertility.

The disease is endemic to Nigeria and existing data places Nigeria as home to the highest number of recorded cases in the world. While there are insufficient research data and medical records to paint a true picture of the disease burden in Nigeria, it is estimated that 29 million Nigerians are infected with the disease and almost half of this number are children.

In June and July, eHealth Africa partnered with Emory University on a study to compare three diagnostic methods to determine their effectiveness in detecting acute and chronic schistosomiasis in low-resource settings. Accurate diagnostics are crucial to yield more information about the disease and ultimately, to achieve the goal of eliminating the disease. One of the major challenges facing the elimination of schistosomiasis is that very few infected people present at the health facilities for treatment. This can be attributed to a myriad of reasons including stigma, insufficient medical services, affordability of medical services, low knowledge of the signs and symptoms of the infection, and local perceptions and myths about the disease. The wider effect of this passive case finding (that is, cases are discovered only when infected persons visit the health facilities for treatment) and poor health-seeking behavior is that there is inadequate data to support the prioritization of schistosomiasis control by decision-makers and health program planners. In addition, medical laboratory scientists and researchers are unable to make improvements to diagnostic procedures for schistosomiasis because very few patients visit health facilities to access treatment.

During this study, eHealth Africa and two Emory University MPH students also trained 10 community health workers to administer questionnaires aimed at assessing the knowledge, attitudes, and perceptions about Schistosoma haematobium infection(urinary schistosomiasis) among communities in five Local Government Areas in Kano State.

Training of Community Health Workers

The responses from the survey yielded astounding local interpretations of the symptoms of urinary schistosomiasis. Community members saw red urine (haematuria or blood in the urine) as a normal and rather harmless phenomenon, a rite of passage or a sign of manhood for young boys. It was also linked to the menstrual cycle for girls or women. Yet another misconception was that it could be caused by staying long hours under the sun. Among women especially, underreporting of the disease was exacerbated by socio-cultural norms and beliefs that prevent them from handling urine samples in public.

Administering questionnaires at Sani Marshal Government Arabic Secondary School, Kura LGA, Kano State

With this understanding and the results of the study, eHA and Emory University hope to influence policies, strategies and plans around the diagnosis and control of Schistosomiasis in Nigeria.

Meet the Team - Maryam Haruna

What do you do when you have to get 30 people to 25 destinations?

We don’t know but Maryam Haruna does.

Maryam Haruna works with the operations team at our Kano campus as the Senior Associate in charge of travel. Here is how she works traveling and accommodation miracles for our staff coming in and out of base locations on a daily basis.

1. Be prepared, even in your sleep

Keeping track of travels is no mean feat! Sometimes, demands for tickets come at odd times and require urgent attention. Maryam’s strategy is to have her work tools on her at all times so that she can access and verify information and respond to travel requests. Of course, this is slightly easier for her because she used to be a Project Field Officer (PFO). Before joining the operations team, Maryam worked on several field tracking and disease surveillance projects and this experience helps her to anticipate and mitigate the challenges of field staff who require her support.

2. Think fast but pay attention to detail

In Maryam’s line of work, it is all too easy to mix up information about who is going where and when. She prevents this with her keen eye for details and her best friend, Google Calendar! Her calendar is one of her most priceless tools and she uses it to manage her time and keep track of appointments and deadlines.

Maryam at work

3. Communicate frequently and clearly

There will always be changes and last-minute developments to accommodation and travel bookings. Sometimes, flights can get delayed for hours leading to changes in pick-up and drop-off arrangements. Maryam has to ensure that she shares information with the fleet team, the staff member and any other stakeholders as soon as possible.

4. Reward yourself

After a long day, she congratulates herself with a pat on the back and a bowl of frozen mango slices.