Tag Archives: Measles

Uganda: Paediatric Vaccine Crisis

KAMPALA, 20 May 2013  – Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.

“We are getting reports and calls from all the districts about the stock-outs of all types of anti-immunization vaccines. They don’t have anti-TB [tuberculosis] vaccines, anti-tetanus, polio [vaccines]. The ministry is faced with inadequate funding for most of our programmes,” Asuman Lukwago, permanent secretary in the Ministry of Health, told IRIN.

“The current major problem on the vaccines is the distribution issue. We are working around the clock to have the problem solved and sorted out immediately.”

Most of the health centres across the country are facing critical shortages of vaccines to protect against tuberculosis, polio, tetanus, diphtheria, rotavirus and pneumonia, putting children at risk of largely preventable diseases.

Health officials now fear these frequent shortages could prevent mothers from bringing their children in for immunizations.

“You can’t [ask] mothers to move to health facilities three to four times and they don’t find vaccines. This practice discourages some of them to go back to the hospitals,” said Huda Oleru Abason, chairperson of the Parliamentary Forum on Immunization.

Procurement woes

In 2011, the government of Uganda shifted the procurement of vaccines and drugs from the Uganda National Expanded Programme on Immunization (UNEPI), under the Ministry of Health, to the National Medical Stores (NMS), an autonomous government corporation. The move was intended to inject efficiency into the country’s drug procurement system, but the drug shortages have continued.

Yet officials at NMS are blaming the shortages on late requisitions for vaccines by UNEPI. The procurement of drugs is the responsibility of NMS.

“Placing of orders is not the responsibility of NMS, it’s [the job of] UNEPI,” Dan Kimosho, a spokesperson at the NMS, told IRIN. “So if they don’t put request in time or under-quantified for the supplies, it’s not our problem. Our responsibility is to procure, store and deliver the requested vaccines. We can’t begin delivering vaccines to districts and health [facilities] if the orders have not been placed to us. We have the competency to deliver the requested drugs and vaccines.”

An estimated 48 percent of children under age five in Uganda are either unimmunized or under-immunized, meaning they do not complete their immunization schedules, according to the 2011 Uganda Demographic and Health Survey.

Uganda has recently experienced a decline in immunization levels, in part due to inadequate funding, health staff shortages and  [parents’]poor adherence to vaccination schedules.

In April 2013, the government launched a countrywide rotavirus and pneumococcal vaccination program targeting over 1.7 million children.

In an interview with IRIN, Director General of Health Services Ruth Achieng noted that, “Uganda is not doing very well in [its] immunization programme… We don’t want our children to die from preventable diseases. We need to act now. Otherwise, we shall get an outbreak of polio and tetanus.”

Uganda’s budget support for the Expanded Programme on Immunization, EPI, – which had been hailed for increased vaccination coverage between 2000-2007 – decreased by more than half in recent years, falling from 7.7 percent in the 2006-2007 financial year to 3.6 percent in 2009-2010.

Officials say the government has plans to revitalize the country’s immunization programs.
“We have worked out the revitalization plan, and if implemented well, we shall be able to change the low status of immunization in Uganda. The government has mobilized some funds and, with support from GAVI, everything is revisable. We are going to embark on [an] aggressive campaign to ensure there are no vaccine stock-outs in the country and ensure all the children are immunized,” the Ministry of Health’s Lukwago said.

There is also a legal push to improve immunization. An immunisation bill currently pending in parliament will make it illegal for parents and guardians to fail to have their children immunized. It also seeks to punish health officials who fail to offer immunization services to children.

[Courtesy of IRIN)

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Somalia: Building health systems from scratch.

MOGADISHU, 26 April 2013  – Lul Mohamed, director of the paediatric ward at Banadir Hospital in the Somali capital, Mogadishu, treated five children after two bomb attacks killed 30 people on 14 April. “And they were shooting last night. One died, a bullet in his liver,” she said of an eight-year-old boy.

Yet these are conditions of relative peace in Mogadishu. While the conflict is not over, insecurity has diminished since the withdrawal of insurgent group Al-Shabab in 2011. This relative security is allowing Mohamed to focus on preventative healthcare, a luxury she did not have two years ago.

In March 2013, she admitted 26 cases with measles, 19 with tuberculosis, 14 with tetanus and nine with meningitis. She is frustrated because all of these diseases are immunizable. Six of the children admitted that month died.

Mohamed hopes this year to immunize 1,000 children per month in the hospital’s tiny but brightly painted vaccination room. Two volunteers sit at a desk, another monitors those coming in and out. They say they became volunteers when donors pulled out and staff were let go. By 1pm that day, they had vaccinated 28 children.

“A huge improvement in a short time – if peace holds,” Mohamed said.

Vaccination

Coinciding with World Immunization Week, the Somali government announced on 24 April its intention to vaccinate all children under the age of one with a new five-in-one vaccine, known as a pentavalent vaccine, funded by the GAVI Alliance, with the UN Children’s Fund (UNICEF) and the UN World Health Organization (WHO) as implementing partners.

“Children in Somalia are dying of diseases that are prevented in the rest of the world,” said Maryam Qasim, the Minister of Development and Social Affairs, speaking at the vaccine’s launch. “Introducing this vaccine is a milestone in history.”

President of Somalia Hassan Sheikh Mohamud also presided over the launch, showing unprecedented support for improving child and maternal health in Somalia, two of the eight UN Millennium Development Goals. He also announced that his government would consider co-financing the vaccination programme, as other countries do, in the future.

Currently, fewer than half of children in Somalia have received the mandatory diphtheria, tetanus and pertussis (DTP) vaccine, a rate that Anne Zeindl-Cronin, senior programme manager at the GAVI Alliance, describes as “incredibly low”. Only 7 percent of children in Puntland and 11 percent of children in Somaliland receive the required three doses by their first birthday, according to a joint UNICEF and government survey.

The pentavalent will protect immunized children against these three diseases, as well as heptatitis B and Haemophilius influenzae type b.

Health system strengthening

“Coming from such a low base, if we have system strengthening, we should see a huge improvement in a short time – if peace holds,” Zeindl-Cronin said.

The pentavalent has taken 18 months to go from the country’s decision to use it to implementation, but she recognizes that GAVI’s implementing partners still have a difficult task ahead. “It’s easy to come here and put [the vaccines] in [a] fridge. It’s getting them into the children that’s the challenge.”

There is not a great deal of infrastructure to rely on. Somalia has suffered close to 25 years of civil war. Its health system is fragmented, supported by an unregulated pharmaceutical industry and dominated by private practitioners who offer help only to those who can afford it. Private doctors in Somalia are earning up to US$10,000 per month.

A legal framework for healthcare is absent, and the federal state, which includes the semi-autonomous regions Somaliland and Puntland, raises questions about how any system might be structured.

“Normally, there is one food and drug administration. But where? Is it in Mogadishu? Or in each of the zones [south-central Somalia, Somaliland and Puntland]?” said Marthe Everard, WHO’s representative for Somalia.

In addition to the systemic and infrastructural challenges of delivering healthcare in Somalia, large areas of the country are still controlled by Al-Shabab; others are inaccessible due to armed groups that have filled the vacuum left by Al-Shabab. Omar Saleh of WHO estimates that 30-40 percent of southern Somalia is accessible to external healthcare providers at any one time.

Risk persists

In his speech at the pentavalent launch, President Mohamud condemned Al-Shabab for blocking access: “In the certain areas they control, there have been no vaccinations at all in the past few years. Al-Shabab needs to understand that they are not only killing people through explosions, but every child that misses vaccinations they have practically killed.”

The pentavalent vaccine launch is being accompanied by an awareness-raising campaign. Sikander Khan, UNICEF Somalia Representative, hopes that, once demand is created, the vaccine will reach women even in areas that Al-Shabab controls. “There is no parent in the world who doesn’t care about the well-being of their child,” he said.

F[ourtesyarhiyo Mohamed, who has six children, brought her youngest to an outpatient clinic in Benadir, Mogadishu, to receive the pentavalent at no cost. The mother says she visited the clinic when Al-Shabab was still in the city, but that it was dangerous to do so. “Al-Shabab would question you when you came back. Today, we are happy,” she said.

While prospects are improving, inequitable access remains a major challenge. Paediatrician Mohamed, at Benadir Hospital, calls for a three-pronged commitment, not only from the government, but also the community and health workers. She says motivating and engaging private and public sector workers is critical to improving the reach of healthcare, and the reach of vaccines in particular.

[Courtesy of IRIN]

Congo Healthcare Initiative

6 April – The British government has announced a major new programme aimed at providing essential healthcare to six million people in the Democratic Republic of Congo (DRC). The five-year, US$270.7 million project will focus on rebuilding health facilities, training health workers, and supplying drugs and equipment.


Civil war has destroyed much of the country’s health infrastructure, as well as the road networks and vital services such as electricity, meaning patients often have to travel long distances to health centres that may not be equipped to handle their complications.

IRIN has put together a list of five health issues in DRC that require urgent attention:

Maternal and Child Health
 –
DRC’s maternal mortality ratio is 670 deaths per 100,000 live births, with an estimated 19,000 maternal deaths annually. The country has a severe shortage of health workers – less than one health professional is available per 1,000 people. 

With 170 out of every 1,000 children dying before they reach the age of five and 10 percent of infants underweight, DRC has one of the worst child health indicators in the world. It is one of five countries in the world in which about half of under-five deaths occur. Some of the biggest killers of children are diarrhoea, malaria, malnutrition and pneumonia.

Sexual violence – Several studies report high levels of sexual violence perpetrated against women, children and men in DRC, both by armed groups and within the home; one study, conducted in the North and South Kivu and Ituri in 2010, found that 40 percent of women and 24 percent of men had experienced sexual violence. 

Between the stigma of rape and the dearth of decent health services in DRC, sexual violence often leaves survivors injured, infected with sexually transmitted illnesses and severely traumatized. Some of the main requirements are first aid and trauma services, counselling, diagnosis and treatment of sexually transmitted infections, HIV post-exposure prophylaxis and access to contraception.

During a recent visit to eastern DRC, UK Foreign Secretary William Hague announced $312,110 in new funding to support the NGO Physicians for Human Rights, which works at Panzi Hospital in South Kivu Province, “to help efforts to develop local and national capacity to document and collect evidence of sexual violence”.

Diarrhoeal diseases – The consumption of unsafe water is one of the main causes of the diarrhoeal diseases – such as cholera – that infect and kill children and adults in DRC. A cholera epidemic that started in June 2011 has infected tens of thousands and killed more than 200 people. In the capital, Kinshasa, which has been hit by the epidemic, less than 40 percent of people have no access to piped water. According to the UN Children’s Fund, UNICEF, 36 million people in DRC live without improved drinking water, and 50 million without improved sanitation.

Some of the measures to boost access to safe water and sanitation include hygiene awareness campaigns, rehabilitation of water supply and of sanitation facilities, disinfection of contaminated environments, chlorination of water, and distribution of soap.

Immunization – Despite the existence of an effective vaccine for measles at a cost of roughly $1 per vaccine, the disease is one of the leading killers of children in DRC. According to the Global Alliance for Vaccines, 20-30 percent of children in DRC do not have access to immunization. Some challenges to universal vaccine coverage include the poor road network, the size of the country (DRC is Africa’s second largest country), unreliable electricity for vaccines that require refrigeration, and low awareness within the population.

HIV – More than one million people in DRC are living with HIV; 350,000 of these qualify for life-prolonging antiretroviral drugs, but only 44,000 – or 15 percent – are actually on treatment. Just 9 percent of the population knows of their HIV status, largely because of low awareness, but also because of a shortage of facilities – for instance, only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis.

Just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies; according to government figures, the mother-to-child transmission rate is about 37 percent.

Humanitarian agencies have called on the government and donors to urgently boost funding for HIV prevention, treatment and care.

[Courtesy of IRIN]

INDONESIA: Poor Health Care Deadly for Children

JAKARTA, 30 July 2012 (IRIN) – Poor knowledge of basic healthcare and lack of sanitation are contributing to the high number of deaths among children under the age of five in Indonesia. Among poorer households child deaths are more than three times higher than in richer ones.

According to Countdown 2015, a global collaboration to achieve health-related Millennium Development Goals, 151,000 Indonesian children died in 2010 before they reached the age of five – 35 out of every 1,000 live births. To reach the target of reducing child deaths by two-thirds of the 1990 death rate, seven more children out of every 1,000 births need to survive.

Causes of children under five years dying in 2010 included pneumonia, which accounted for 14 percent of deaths, preterm births caused 21 percent, injuries 6 percent, and measles and diarrhoea 5 percent each, according to the World Health Organization (WHO). The agency noted that 48 percent of children’s deaths took place in their first 28 days of life.

“Poor nutrition and lack of clean water are important contributors to child mortality in Indonesia,” said Isni Ahmad, a spokeswoman for the NGO, Plan International, in Indonesia.

“Efforts to prevent death from diarrhoea or to reduce the burden of diseases will fail unless people have access to safe drinking water and basic sanitation,” she told IRIN.

The 2010 Indonesia Health Profile revealed that 80 percent of the population were using clean water sources, but only 52 percent used hygienic, or “safe”, sanitation facilities.

The Indonesian Health Ministry says only around 12 percent of children aged between 5 and 14 wash their hands with soap after defecating, while 14 percent do so before eating. Improving the skills of health workers, especially those at community health clinics, is key to reducing child mortality.

A study by WHO noted in 2007 that diarrhoea cases could be reduced by 32 percent if more people practiced basic sanitation, 45 percent washed their hands with soap, and 39 percent treated household water. The government adopted a child illness management policy that focuses on disease prevention in addition to treatment.

Volunteers trained by local health departments organized monthly check-ups for mothers and children at more than 260,000 community health posts, but a perceived lack of support and waning volunteer interest have led to a decline in these services.

Plan Indonesia is working in 10 of the country’s 33 provinces where infant and maternal mortality rates are high by providing clean water, helping children access quality health services, and educating parents about child rearing, including nutrition.

Improved health policy and legislation, a renewed focus on reducing malnutrition, improved coverage of key maternal and child health services, such as antenatal care and control of common childhood illnesses; are all contributing to reductions in overall mortality, said the UN Children’s Fund (UNICEF).

Nuraini Razak, a UNICEF information officer in Jakarta, the capital, said the government is working with UNICEF to expand exclusive breast feeding, community newborn care, vaccinations, complimentary feeding, and access to clean water and sanitation.

[Courtesy of IRIN News]

HEALTH: Beating measles – one more push?

 

Vaccines against measles have been around for decades and are highly effective, yet the campaign against the disease in recent years has had a bumpy ride.

The first target of the 21st century – to halve the number of deaths from measles between 1999 and 2005 – was successfully met. So the World Health Organization (WHO) set an even more ambitious goal – to reduce deaths by 90 percent from 2000 levels by 2010.

Now some elaborate number crunching by experts from WHO, the US-based Centers for Disease Control and Prevention (CDC) and Pennsylvania State University has produced disappointing news. Their study, published today in the London-based medical journal,The Lancet, concludes that although gains were rapid between 2000 and 2007, progress slowed towards the end of the decade, and the final reduction in mortality by 2010 was only 74 percent – good, but not nearly as good as had been hoped.

The executive director of the UN Children’s Fund (UNICEF), Anthony Lake, says vaccination campaigns now reach around 95 percent of all the world’s children. “This shows,” he says, “that these campaigns can succeed, even in the world’s poorest countries and most remote communities. Really this is one of the most remarkable victories in the history of public health.

“The bad news is that every day measles still claims 382 lives, the vast majority of them children under five, and every one could have been saved by two doses of a 22 cent vaccine.”

Some parts of the world have been more successful than others. Measles has been effectively eliminated in the whole of the Americas since 2002 – reduced to the point where there is no more endemic transmission of the disease, and any cases or outbreaks are the result of imported infections from other regions. China and its neighbours are also getting close to getting rid of measles.

But the disease is so infectious and so efficient at seeking out those who have not been vaccinated that even these regions cannot afford to let their levels of vaccination coverage drop. Rebecca Martin, director of the Global Immunization Division at CDC, warns against complacency. “Measles is a serious and potentially fatal disease that will return when it has the opportunity to do so. In many countries the overwhelming success we have seen with the immunization programme has led to the decreased recognition and risk perception of the severe outcome of this disease, but it is always there and will come back if given the opportunity to do so.”

Almost all the cases now seen in the USA are imported, almost half of them from Europe. Europe has had outbreaks of measles in recent years, but contributes very little to the global death toll; good health care means that very few children there die of measles. It is the very fact that Europeans do not perceive it as a deadly disease that makes some parents careless about vaccinating their children against it.

India overtakes Africa

One of the biggest surprises from the new statistical estimates is that India has now overtaken Africa as the region with the most deaths from measles – 47 percent of estimated measles mortality in 2010, while the African region contributed 36 percent. One of the report’s authors, Peter Strebel from WHO’s expanded programme on immunization, told IRIN that, again, perceptions of how deadly measles is, influenced the priority given to prevention.

“In India they have used a single dose strategy right up until 2010 and really, I think, have not seen measles as a high enough public health priority to embark on the two-dose recommended strategy. The important thing to note is that in the Indian context the risk of dying from measles is less than in the African context… Up to 10 percent of children who get measles in an African setting will die. In India it is estimated at more like 1.5 percent. So there is a big differential in the risk of dying and this may partially explain why they were not as aggressive or as eager to take on the new strategy.”

Steve Cochi of CDC adds that measles also may have lost out to polio in the scale of priorities. “There was a lot of preoccupation with achieving polio eradication in India,” he told IRIN. “But now that polio has been eradicated from India, the last case being more than a year ago, in January 2011, India has been able to step up to the plate and expand greatly its measles activities.”

This new push in India should give a fresh impetus to the drive to cut measles deaths worldwide. There is also a new WHO Strategic Plan on Measles and Rubella which will link vaccines against both diseases in a single immunization. The GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization) has approved funding to immunize all children under 15 with the combined vaccine in the more than 50 countries which do not at present vaccinate against rubella. The higher age target is important, especially for girls, because rubella (sometimes known as German measles) contracted during pregnancy can cause babies to be born with congenital malformations.

WHO is not ready yet to set a target date to move from the elimination of measles in some regions to complete eradication worldwide, but the vaccines are effective, they are cheap, and experts say it is doable, so soon it may be possible to start planning for a world without measles.

[Courtesy of IRIN News]

Measles Immunization:1.7 million Children Targeted

NAIROBI, 21 December 2011 (IRIN) – Amid rising measles and polio cases, tens of thousands of children are being targeted for immunization in health campaigns in affected regions of the Democratic Republic of Congo (DRC), according to the UN Children’s Fund (UNICEF).

At least 128,965 measles cases, with 1,573 deaths, have been recorded in the DRC in 2011, and 89 wild polio-virus type 1 cases had been reported up to 13 December, UNICEF said.

The current campaign against measles in Kinshasa is targeting at least 1.7 million children aged 6-59 months.

Alphonse Toko, UNICEF’s immunization specialist in the DRC, said: “Vaccination is the most efficient tool to protect children from epidemics that kill or paralyze”.

On 16 December, Health Minister Victor Makwenge Kaput urged parents to get their children vaccinated.

A door-to-door polio vaccination initiative using mobile health teams, which started on 19 December, will end on 21 December in the provinces of Bandundu, Bas-Congo, Kasaï Oriental, Katanga, Maniema and South Kivu, where at least 1.1 million children under five are being targeted.

The polio virus re-emerged in the DRC in 2006, with 13 cases being recorded at that time, before peaking at 100 cases in 2010.

[Courtesy IRIN]

YEMEN: Child Polio “Humanitarian Disaster”

 

Routine immunization of children has dropped by 40 percent in some areas of Yemen, leading to outbreaks of polio and measles and reflecting a growing collapse of public services in a country that is on the brink of a humanitarian disaster, two senior UN officials warn.

“Yemen is on the verge of a true, deep humanitarian disaster,” Geert Cappelaere, the UN Children’s Fund (UNICEF) representative in Yemen, told journalists in Geneva on 24 October. “Every day we have hundreds of thousands of people who become food insecure.”

He and his counterpart from the World Food Programme (WFP), Lubna Alaman, painted a bleak picture of the situation

in Yemen, which he called “a chronically underdeveloped country”.

Yemen has the world’s second highest rate of chronic malnutrition, after Afghanistan, and about half the population live in deep poverty. More than half the children under five years of age suffer from chronic malnutrition.

According to UNICEF, preliminary findings of a September nutrition assessment in Abyan Governorate – a battleground in ongoing fighting between government troops and Islamic militants since 28 May – estimates global acute malnutrition (GAM) prevalence at 18.6 percent, which is beyond the emergency threshold, of which 3.9 percent are severe and 14.7 percent moderate cases. In  Sa’dah, high malnutrition rates continue to be identified and children referred for treatment.

According to the UN Under-Secretary-General for Humanitarian Affairs Valerie Amos, conflict, poverty, drought, soaring food prices and collapsing state services have created a daily struggle for survival for millions of people – including 100,000 displaced by recent fighting in the south, thousands of refugees from the Horn of Africa, and 300,000 displaced by previous conflict in the north.

In some parts of the country, one in three children are malnourished – among the highest malnutrition levels in the world, she said on 11 October. Hospitals and clinics are overcrowded or not working at all, and access to safe water is becoming increasingly difficult. Tens of thousands of children are losing their education due to school closures.

“The message is very clear, the humanitarian situation is deteriorating, and very fast,” said Alaman.

On 21 October, the UN Security Council urged President Ali Abdullah Saleh to step down. The non-binding resolution, passed unanimously by the Council’s 15 members, backed a Gulf-brokered plan that would end Saleh’s 33 years in power.

The Council also condemned human rights violations and the excessive use of force by the Yemeni authorities against peaceful protesters as well as violence by other groups and said that hundreds of people – mainly civilians, including women and children – had died in the violence of the past months.

According to UN Secretary-General Ban Ki-moon’s Special Adviser on Yemen Jamal Benomar, security has deteriorated “very dramatically” in Yemen with five or six provinces out of government control, a large area in the north controlled by Al-Houthi rebels, Al-Qaida militants holding three cities and an important geographic area in the south, and Sana’a, the capital, split between rival forces.

“We need an immediate ceasefire by all parties in the conflict, a political solution to the transition in line with the Security Council resolution,” said WFP Middle East director Daly Belgasmi. What is needed, he added, “is humanitarian stabilization, a political solution and recovery”.

Both WFP and UNICEF officials stressed that the road to recovery will be slow and arduous.

“It will take us many, many months, even in certain sectors several years, to undo the huge impact that the last several months have had,” said Cappelaere. “A political deal is, for the humanitarian community, not the end; it is just an element in a process of addressing the huge humanitarian needs.”

[Courtesy IRIN]