EPI Coverage Assessment Survey

WEEKLY EPIDEMIOLOGICAL REPORT A publication of the Epidemiology Unit Ministry of Health, Nutrition & Indigenous Medicine 231, de Saram Place, Colombo 01000, Sri Lanka Tele: + 94 11 2695112, Fax: +94 11 2696583, E mail: [email protected] Epidemiologist: +94 11 2681548, E mail: [email protected] Web: http://www.epid.gov.lk Vol. 44 No. 13 25th – 31st March 2017 EPI Coverage Assessment Survey - Nuwara Eliya District, 2016 Introduction Justification for the survey Infections due to diverse organisms such as viruses, Public health services including the immuniza- bacteria, parasites, fungi etc. account for innumer- tion programme were conducted in Nuwara able deaths among children and adults in the world. Eliya district by the estate trust and the provin- Immunization is the most cost effective way of con- cial ministry of health. However, in keeping trolling these infections, which has been one of the with the government decision to deliver health greatest success stories in the past. services in the district, all health institutions The National Immunization Programme has an excel- including the public health services were fully lent record with extremely low incidence of Vaccine provided by the government. Accordingly Nu- Preventable Diseases and high coverage of EPI vaccines. wara Eliya district was selected to carry out the 2016 survey, to understand any impact on the The coverage of immunization is monitored by the routinely reported data forwarded by the MOOH immunization programme due to the change of through the EPI quarterly return. Conducting scien- service delivery in the district. tific surveys helps to validate the routine informa- Objectives of the Survey tion, evaluate the performances and find ways and To assess the, BCG, DPT,OPV, HBV, Hib, Live JE means to improve immunization activities. Coverage and MCV1 immunization coverage and protec- survey provides additional information such as private sector contribution for immunization, reasons for tion for CRS and NNT among 12 to 23 month non or partial immunization etc. old children Study setting To assess the DPT and OPV4 given at 18 Nuwara Eliya district is one of the three districts in months MMR at 3 years,, DT and OPV booster the Central Province of Sri Lanka. given at year five and JE immunization among The district has an area of 1741.5 square kilometers the 72 to 84 month old children and inhabits 706,505 populations. The average den- To assess the aTd Immunization coverage sity of population is 406 per square kilometers and among 13 to 15 year adolescents the population of the district consists mostly of To assess the Rubella immunization coverage Tamils (57.6%) out of which 53% being Indian Tamils. among the 16 to 44 year old females Most of the Tamil population (87%) lives in the estate sector. The district spreads in 1000 to 8000 feet To assess the source of immunization to as- from the sea level including the highest hilly area in certain the role of private sector in immuniza- the country. Nuwara Eliya District is divided into tion five Divisional Secretary's Divisions and 491 Grama To understand the reasons for non-or partial immu- Niladari divisions. nization and reasons for receiving Survey methods Table 1: Infant immunization coverage Not immunized /Not pro- Antigen With cards Card + History AEFI tected No. % No. % No % No % B.C.G. 299 99.6 300 100 92 30.7 0 0.0 PVV 1 299 99.6 300 100 190 63.5 0 0.0 PVV 2 299 99.6 300 100 179 59.8 0 0.0 PVV 3 299 99.6 300 100 175 58.5 0 0.0 OPV. 1 299 99.6 300 100 191 63.8 0 0.0 OPV 2 299 99.6 300 100 175 58.5 0 0.0 OPV 3 299 99.6 300 100 171 57.1 0 0.0 LJEV 298 99.3 299 Contents99.6 142 47.4 1 0.3 Page MCV 1 298 99.3 299 99.6 148 49.4 1 0.3 1. Leading Article – EPI Coverage assessment survey - Nuwaraeliya district — 2016 1 2. Summary of selected notifiable diseases reported - (18th – 24th March 2017) 3 3. Surveillance of vaccine preventable diseases & AFP - (18th – 24th March 2017) 4 WER Sri Lanka - Vol. 44 No. 13 25th – 31st March 2017 WHO recommended 30-cluster sampling technique for EPI Key observations coverage survey was used. Coverage, Infant Immunization The survey contains 30 clusters in the RDHS area (30 Grama All surveyed infants had received three doses of PVV and OPV Niladari divisions/RDHS area) selected using probability pro- Presence of scar rate, 97% among children immunized with portionate to the size method. BCG vaccine is satisfactory and it indicates that the technique Target population used in administration of BCG vaccine is of acceptable quality. Infant immunization All surveyed children except two children in the districts have retained their CHDR during the 2nd year of life. 12 to 23 month old infants and mothers of these index children to be assessed their protection against neo natal Out of 300 children surveyed only one child (0.3%) has missed tetanus at birth, rubella coverage for the protection against the LJEV and MCV 1 on completion of one year. congenital rubella–10 infants per cluster. Except two children, all infants (299) surveyed had their im- Childhood immunization muizations from the government sector. 72 to 83 month old children to be assessed DPT and OPV4, MMR, DT Eleven mothers (3.6%) of the surveyed children were not pro- and OPV booster and JE immunization coverage - 10 children per tected against Tetanus at the time of delivery while 17(5.6%) cluster were not protected against Rubella. Adolescents Immunization Coverage, Childhood Immunization 13 to 15 year old children to be assessed aTd immunization cover- Recording of presence or absence of AEFI in the CHDR was age found only in 69.0 % of the infant immunization cards observed Women in child bearing age DPT/OPV4, vaccine administered on completion of 18 16 – 44 Year old females to be assessed rubella immunization cover- months ,MR/MMR vaccine administered on completion of 3 age – 40 women per cluster years and DT/OPV5 vaccines administered for five year old chil- Source of information dren also has achieved high coverage of 99.6%, 99.3 % and 99.3 During the survey interviewers record the immunizations recorded % for the respective antigens in the immunization card or when the immunization card is not The other remarkable feature observed was that even up to the available those immunizations which the parents or any responsible 7th year of life, 96.6 % parents retaining CHDR as an important guardian provided were received accordingly in the survey forms. document in spite of lot of constraints Survey teams Out of 300 children surveyed 8.6% (n=26) were not protected Thirty senior nursing students of the Kandy Nurses’ Training School against JE were deployed as surveyors. Each surveyor was given two days to Service provider for the infant and childhood immunization is complete each cluster and one surveyor had to complete one clus- the government preventive health care sector and for BCG vac- ter. The PHM guided the survey team through homes within the cination, government hospitals. cluster. One supervisor was assigned to assist and oversee the work of two survey teams. Seven Medical Officers from the Epidemiologi- The Chief Epidemiologist, Coordinator of the survey, and Epidemi- cal Unit, Regional Epidemiologists and Medical Officers (Maternal ology Unit team acknowledge; and Child Health) were employed for this survey as supervisors. Children, their caregivers, and others who participated in the survey. Training The surveyors were given a basic training on EPI at the Kandy NTS PDHS Central province, RDHS and RE of Nuwara Eliya dis- prior to the survey. The surveyors and supervisors were given one tricts for concurrence and all provided administrative sup- day’s class room type training and one day’s field training on how to port to conduct this survey. identify the first household, subsequent households, how to inter- Principal, Nursing tutors of Kandy NTS and nursing students view parents, guardians, adolescents and how to complete the who participated as surveyors. forms etc. Consultants, Medical Offices of the Epidemiology Unit, REE, Results and other officers who participated as supervisors. During the period of two days of the survey 2777 houses were vis- Supporting staff including PHMM, drivers of all participating ited by the survey teams. There were 12,277 person living in these and supporting institutions. houses surveyed. On average one cluster consisted of 92 houses and UNICEF for financial support. average household in a cluster were four. Compiled by Dr. Manjula Kariyawasam of the Epidemiology Unit – Table 2:Immunization coverage among 72 to 83-month old chil- Co investigator and the coordinator of the EPI survey dren Antigen With cards Card + History Not immunized AEFI No. % No. % No % No % DPT4 290 96.6 299 99.6 1 0.3 152 52.4 OPV4 290 96.6 299 99.6 1 0.3 148 51.0 MMR 290 96.6 298 99.3 2 0.6 119 41.0 DT 289 96.3 298 99.3 2 0.6 79 27.3 OPV 5 287 95.6 296 98.6 4 1.3 77 26.8 Page 2 WER Table 1 RDHS Dengue Fever Dysentery Encephalitis Enteric Fever Food Leptospirosis Typhus Viral Human Chickenpox Meningitis Leishmani- WRCD : Sri Lanka A B A B A B A B A B A B A B A B A B A B A B A B T* C** Selected notifiable diseases reported by Medical Officers of Health MedicalofHealth Officers reported by diseasesSelected notifiable Colombo 528 6604 2 30 0 1 0 11 0 5 1 20 0 1 0 5 0 0 7 101 0 11 0 1 63 88 Gampaha 409 4083 0 15 0 10 0 10 0 8 0 21 0 5 0 5 0 1 2 70 1 15 0 4 13 53 Kalutara 176 1702 1 17 0 2 0 2 2 17 12 63 0 2 0 1 0 0 9 164 2 31 0 0 79 100 - Kandy 66 779 2 28 0 3 0 1 0 0 4 16 2 42 0 6 0 1 6 98 0 13 0 2 83 91 Vol.

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