A Job Half Done: missed childhood
vaccination opportunities in
MSF health structures
OCB OR day
Brussels, 13th June 2014
Catherine Bachy
Background
• 1983: Vaccinate at every opportunity (WHO)
• MSF keeps focus on reactive mass campaigns
• 2008: Vaccination becomes a priority for MSF
• 2010: EPI is integrated in some OCB projects
Rationale
• Vaccination monitoring fragmented
• Blind on what we DON’T do…
2011-2013
Missed vaccination opportunities surveys
in projects with routine vaccination
Objectives
• Measure the magnitude of missed opportunities
• Describe misses by age group and by vaccine
• Understand the reasons for missed opportunities
 Is improvement needed?
 Can we do something about it?
Methods
• Authorization by authorities
• Standardized questionnaire
• Exit interview of ALL children after consent
• Vaccination cards or recall
• Expanded age-group EPI calendar as reference
Study
population
Eligible for at
least one
vaccine
Vaccination
up-to-date
Without
contraindication
With
contraindication
Received all
vaccines for
which eligible
Did not receive
all vaccines for
which eligible
Missed vaccination opportunities
Study
population
Eligible for at
least one
vaccine
Vaccination
up-to-date
Without
contraindication
With
contraindication
Received all
vaccines for
which eligible
Did not receive
all vaccines for
which eligible
= Prevalence of missed vaccination opportunities
Missed vaccination in eligible
Study
population
Eligible for at
least one
vaccine
Vaccination
up-to-date
Without
contraindication
With
contraindication
= Inefficiency of the system
Received all
vaccines for
which eligible
Did not receive
all vaccines for
which eligible
Example
Eligible = 4
n = 100
Vaccination
up-to-date = 96
Without
contraindication
=4
With
contraindication
Received all
vaccines for which
eligible = 2
Did not
receive all
vaccines for
which eligible
=2
Missed vaccination opportunities = 2/100 = 2%
Missed vaccination in eligible
= 2/4 = 50%
Description of baseline surveys
•
•
•
•
•
14 baseline surveys
4 sub-Saharan countries
MSF-supported health structures
Duration: 6 days [1-15]
Children:
Main results: median [range]
Vaccination card: 70% [20-100%]
100% [69-100%]
72% [51-95%]
147 [41-242]
Study
population
Eligible for at
least one
vaccine
Vaccination
up-to-date
Without
contraindication
With
contraindication
Received all
vaccines for
which eligible
Did not receive
all vaccines for
which eligible
Main results: median [range]
Study
population
Eligible for at
least one
vaccine
Vaccination
Without
contraindication
With
contraindication
Received all
vaccines for
which eligible
Did not receive
all vaccines for
which eligible
up-to-date
Prevalence of missed opportunities: 48% [18-73%]
Missed opportunities in eligible: 77% [20-100%]
Reasons for visit of misses (n=14)
– Curative consultation:
48% [27-99%]
– Ambulatory feeding centre:
18% [0-49%]
– Vaccination:
9% [0-43%]
– Accompanying a patient:
5% [0-23%]
– MCH consultation:
2% [0-36%]
Reasons for missed opportunities (n=14)
– Lack of information:
38% [10-79%]
– Lack of vaccines:
31% [0-60%]
– Unknown:
13% [0-44%]
– Other:
11% [3-50%]
– Long waiting time:
2% [0-6%]
– Vaccinator absent:
<1% [0-38%]
Missed opportunities by age group
Missed opportunities by vaccine
Follow-up surveys: Did it change?
• PHCC Sae Saboa and Guidam Roumdji, Niger
• November 2011 & January 2013
• Missed vaccination opportunities in 0-11 months
2011
2013
72% 34%
72%  28%
Conclusions
• Performance needs to be improved
• Reasons are easy to address
• It can be done
 Where is the real missed opportunity in MSF?
Recommendations
 Simplified tools available
 Baseline study in EVERY
project
 Follow-up studies
… In the meantime: check and vaccinate!
Acknowledgements
The national and international staff of all projects involved;
Marie-Eve Burny & Isabella Panunzi: Vaccination Referents;
Ilaria Porta & Ibrahim Barrie: MIO Vaccination;
Michel Van Herp: Head of the Disease Control Unit
The Operational Research Unit