|
Measles Catch-up Immunization Campaign in Bangladesh 2005-2006
Tuesday, April 04, 2006 — Bangladesh is situated in South Asia, bordered by the Bay of Bengal, Myanmar and India and covers a total area of 144,000 sq km. Most of Bangladesh lies within the broad delta formed by the Ganges and Brahmaputra rivers.
According to the National Census of 2001, the total population of Bangladesh was 123,851,120 of which 23% lived in urban areas and 77% in rural areas. Of the total population 13% are children under the age of five and 27% under 10 years of age. The crude death rate declined from 13 per 1000 in 1991, to 9.3 per 1,000 in 2002, while the infant mortality rate declined from 97.5 per 1000 live birth in 1991 to 64 per 1000 in 2002. The under-five mortality rate has also declined from 146 per thousand in 1991 to 82 per thousand in 2001.
Despite this recent progress in child survival indicators, measles still remains a leading cause of death and disability among young children in Bangladesh. It is estimated that approximately 20,000 Bangladeshi children die every year due to measles and related complications. Additionally, the current routine immunization coverage shows that nearly 1.5 million children in each birth cohort do not develop immunity to measles. This build-up of susceptible children over time causes measles outbreaks. Hence, a second opportunity for measles vaccination is needed to protect these children. In Bangladesh, at the moment, routine immunization coverage is not high enough to provide the second opportunity through the routine system.
To address this, the Government of Bangladesh develop and adopted, in accordance with the 2003 World Health Assembly resolution as well as the current global and South-East Asia Regional measles reduction strategy, a Measles Control Plan of Action. Guided by this plan (and the revised plan for 2004-2010), the National Steering Committee on Polio Eradication and Measles Control decided to conduct a two-phased, nation-wide measles catch-up campaign in 2005-2006.
Although generally it would be ideal to conduct a catch-up campaign for children aged nine months to 15 years, the total population in this age group in Bangladesh is 55 million.
Additionally, the internal migration in the country does not permit to phase the campaigns in to more than two phases. Furthermore, according to 2003 data, 86% of the measles cases have been found among children less than 10 years old. Hence, based on the most susceptible age group and due to the number of children to be vaccinated, Bangladesh decided to target all children from nine to 120 months, irrespective of their immunization status or previous measles infection. The estimated target population in this cohort is 35 million children.
The campaign is divided in to two phases. During the first week of each phase, all children
attending school (both formal and non-formal) will be vaccinated in their respective educational institutes. Children out side of the schooling system are vaccinated at the regular expanded programme on immunization (EPI) sites in subsequent two weeks. One immunization session is also planned in each routine EPI site during the campaign’s three week period. Routine EPI will not be interrupted and will run, throughout the campaign, as per the annual plan.
Phase I, targeting 1.5 million children, was carried out in Bogra and Rajshahi districts, as well as in Rajshahi City Corporation, in September 2005. Approximately 2,000 vaccinators and 14,000 volunteers were assigned to immunize children in more than 10,000 sites. During the first week of the campaign, 750,000 children were vaccinated in schools and 750,000 were vaccinated in routine EPI sites over the following two weeks.
Overall, international and national monitors concluded that the campaign was well executed.
Their reports highlight that effective planning, high awareness among the public, good training of vaccinators, and smooth supply of logistics all contributed to success. Of particular importance was also good collaboration and partnership between all sectors of society. Governments units such as the family planning, education, and religious affairs departments, local government as well as national and international non-governmental organizations such as the Red Crescent, all played a pivotal role in creating mass public awareness and in
ensuring successful implementation of the campaign.
The second phase of the campaign will be conducted during February-March 2006, and aims to reach 33.5 million children in 63 districts and five City Corporations.
Once completed, the campaign will be the largest public health undertaking in the history of Bangladesh; 35 million children will have been immunized by 40,000 skilled vaccinators and 150,000 mobilized volunteers, through more than 100,000 schools and 200,000 EPI centers.
The Government of Bangladesh and the Measles Initiative including partners the American Red Cross, UN Foundation, UNICEF, WHO and CDC provided invaluable financial support and technical assistance for planning, implementation and campaign monitoring and evaluation.
Related Content:
|
