EPI IN BAMENDA HEALTH DISTRICT, CAMEROON, FROM 1999 – AUGUST 2005

EXPANDED PROGRAMME ON IMMUNISATION (EPI) IN BAMENDA HEALTH DISTRICT, CAMEROON, FROM 1999 – AUGUST 2005

INTRODUCTION
The Expanded Programme on Immunisation is implemented in Bamenda Health District as defined by the Central Level – The Ministry of Public Health in the norms and standards of the Expanded Programme of Immunisation.
The target populations concerned are children 0-11months, with the administration of Vitamin A to children to children from 6 month to 5years, and pregnant women as indicated in the following calendars.

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The sources of total population have varied from local health census for1999, through the national immunisation days for 2000 and 2001, to the update of National Census of 1987 from 2002 to 2005 using the growth rate of 2.9% as shown in the table below.

Sources of total populations

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The target population for children 0-11 months is 4% of the total population and that of pregnant women is 5% of the total population.
The Health District synthesis of EPI returns from Health Areas was done manual until 2000. In 2001 the District Health Service obtained a computer from running credits. The author developed an excel computer programme for the District synthesis that was adapted and improved upon as the Central Level - Ministry of Public Health, modified the data collection tool for health areas, from 2001 to August 2005.

THE GAOL of EPI is to reduce the infant morbidity and mortality due the child hood diseases preventable by vaccination to the lowest level; and to eradicate poliomyelitis in association with Polio National Immunisation Days (NIDs).

THE OBJECTIVE of EPI for Bamenda Health District for 2005 is to obtain 70% vaccination coverage rate for DPT 3 (BCG, Measles, and Polio 3) for children 0-11 months; and Tetanus Toxoide 2+ (TT2+) for pregnant women. The national objective is 80% vaccination coverage rate.

GOAL OF THE REPORT

The goal of the report is to present the results of Routine EPI for children 0-11 months from 1999 to August 2005 to serve as a reference for the improvement of performance and research.

OBJECTIVES
- Present a summary table of results from 1999 to August 2005
- State the results of main indicators of EPI for children 0-11 months.
- Present graphs of indicators.
- Show graphic result of the evaluation of vaccination coverage during the Demographic and Health survey carried out in 2005.

METHOD
Results of EPI returns from 1999 and 2000 were extracted from the register in which synthesis were done manually.

The excel computer programmes provided the District syntheses of EPI returns from 2001 to August 2005.

RESULTS:

The results are presented in the tables and graphs below.

Indicators of EPI for children 0-11 months:

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DISCUSSIONS:

The number children 0-11 months having received DPT3 varied from 4662 in 1999 to 6341 in 2004 with decrease in 2001 and 2003. The vaccination coverage rates fluctuated during the period with high coverage rates in 1999, 2000, and 2003 especially for DPT3. The lowest coverage rates for DPT3 were recorded in 2001 and 2003.
The coverage rate for DPT3 rose from 56.3% in 2003 to 63.5% at the end of August 2005.

Some contribution factors to increase in vaccination coverage rates:
- Daily vaccination at vaccination centres
- Facilitative Supervision by District Health Team, the Provincial Delegation, and Central Level
- The supply of fridges to all vaccination centres in the Health District
- The supplementary support given by Global Alliance for Vaccines and Immunisation (GAVI)
- The motivation and commitment of social mobilisers and staff to reach every child
- The introduction of tools to improve data collection and monitoring
- The creation of some functional health areas.
- Active search of drop outs
- Intensive social mobilisation both by mobilisers in health areas, and by the radios in Bamenda

Some contribution factors to low vaccination coverage rates:- Closure of routine vaccination centres during National Immunisation Days
- Non application of daily vaccination despite the presence of a fridge
- Human errors in recording, extracting and compiling of data at vaccination centres
- The chronic insufficient human resources

The vaccination coverage rate for DPT3 in the North West Province obtained from the demographic and health survey in 2004 was 82.9%, with 76.0% of children having vaccination cards, the highest in the Country. The total population might influence the vaccination coverage rates. The number of declared suspected cases of measles has greatly reduced since the NIDs against Measles in 2002, with no confirmed case of measles, although the measles vaccination coverage rate has been between 52.1% in 2003 to 55.3% in August 2005.

The population erroneously believes measles vaccination is no longer necessary because they do not observe measles cases again in the community. The health personnel should increase social mobilisation to bring children for vaccination against measles.

The appreciation of the real vaccination coverage rate for the Health District could be done through carrying out survey in the community yearly to evaluate the vaccination coverage rate, pending the next national census.

A form for recording children and vaccines received during vaccination sessions to improve identification and quality of data.

CONCLUSION

There has been a lot of input for the improvement of routine EPI although the 2005 objective of 70% vaccination coverage rate for DPT3 has not yet been attained, 63.5% in August 2005.

Two methods of evaluation could always be used to evaluate the output of the programme in the field and the level of achievement of the EPI objectives at all levels:
- The vaccination coverage rates are obtained from the monthly returns, and
- A yearly survey in the community is carried out to evaluate the vaccination coverage rates.

The combination of the routine EPI and NIDs especially the vaccination campaign against measles has revealed the effectiveness of vaccination to the population but there still has to be permanent and continuous social mobilisation vis-à-vis vaccination.

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