Overview of Accelerated Disease Control in the African Region

This PowerPoint presentation was part of a November 2006 meeting hosted by the World Health Organization (WHO) African Regional Office (AFRO) in Zimbabwe. At this meeting, country-specific presentations were made by communication practitioners in 5 countries which have experienced ongoing cases of wild polio virus (WPV) from 2005 to 2006. The objectives of the meeting included the following:

1. To critically review country communication strategies and activities for polio eradication, routine immunisation and integrated expanded programme of immunisation (EPI)-polio action including progress in implementing the Yaounde 2005 TAG country recommendations.
2. To develop the technical recommendations for each country which, when implemented, would improve polio and routine communication performance.
3. To develop and propose communication indicators that can be effective in measuring the impact of communication strategies for improved polio eradication and expanded routine immunisation.

This presentation gives an overview of measles, maternal and neonatal tetanus (MNT) and yellow fever (YF) control in the African region. It also discusses the integration of child survival interventions through supplementary immunisation activities (SIAs) and related challenges and issues.

The regional goal for measles control between 2006-2009 was stated in this presentation as a 90% reduction in measles deaths by 2009 as compared to 2000 estimates, through introduction of a second dose of measles-containing vaccine (MCV-2) into the routine expanded programme of immunisation (EPI). Countries were selected for this process based on their likelihood of achieving and maintaining high coverage, and included: Benin, Ghana, Malawi, Rwanda, Tanzania, Zambia and Uganda.

According to the presenters, 244.4 million children were reached through measles SIAs in the African region from 2001-2006, with coverage reaching above 90% in nearly all countries. The number of districts reporting measles outbreaks has decreased from 80 in 2004 to 57 in 2006. These outbreaks were attributed to the following probable causes: low routine EPI coverage; population movement through areas with no control activities; and unvaccinated populations enclosed in refugee camps, settlements and institutions.

The World Health Organization (WHO) African Regional Office (AFRO) outlines future SIA follow up plans on a national level for 12 countries in 2007, eight countries in 2008 and two countries on a sub-national level during those years. Major challenges to these plans included: sustaining gains made through routine EPI; increasing costs for SIAs; unpredictable in-country financing; and the need to improve planning and implementation processes for integrated interventions.

The reported level of MNT vaccination by means of tetanus toxoid vaccine (TT) as stated in this presentation had reached over 3.5 million women of child-bearing age (WCBA) in 10 countries in 2006. MNT elimination was achieved in seven African countries by June of 2006, and is expected to occur in another four African countries soon. Funding for MNT elimination for 2006-2008 through the International Finance Facility for Immunization (IFFI) was granted to 14 countries, based on available resources and the burden of disease.

Yellow fever progress in 2006 was seen in three key areas: increases in routine vaccination coverage, with 7 countries attaining over 80% coverage by September 2006; a preventative campaign in Malawi (1.7 million children vaccinated); and YF surveillance expanded and maintained in 15 countries.

A number of child survival interventions were integrated with measles SIAs in the African region by 2006, including: Vitamin A (32 countries), anti-helminthes (12 countries), insecticide-treated nets (ITNs) (11 countries), oral polio vaccine (OPV) (12 countries), and TT (3 countries). Six operational issues specific to integrated SIAs are discussed, and illustrated by coverage results for a campaign conducted in Togo.

The presentation concluded with a discussion of the major communication challenges to integrated SIAs, including:

1. Poor access to electronic media and a lack of clear messages being conveyed through current media forms.
2. Inadequate response to rumours regarding adverse effects following immunisation (AEFI).
3. Overlooking of local languages.

In addition, the following lessons in social mobilisation for multi-intervention campaigns were discussed:

1. Involvement of local non-governmental organisations (NGOs) and civil society/religious organisations.
2. Local adaptations of standardised messages.
3. A multiple media approach.
4. Support for point of service communication through job aids.

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