By Kemo Cham
With a 20 percent gap in vaccination coverage, Sierra Leone hopes to close it after a mass vaccination campaign slated for next week.
A major highlight of the week-long event is the introduction of the Rubella vaccine into the routine vaccine program.
Sierra Leone will be joining a growing list of countries which have adopted the global Measles Rubella (MR) vaccine initiative which seeks to use the combined intervention to tackle two different yet similar childhood diseases with debilitating and deadly effect on children and pregnant women.
The Ministry of Health and Sanitation (MoHS) and its partners have been putting together modalities in place ahead of the event which starts on June 10 and ends June 16.
Some 3.2 million children from nine months to under-15 years are being targeted in the integrated approach that also include administration of polio vaccine and distribution of Vitamin A Supplement and Deworming tablets.
Measles is a highly infectious disease that mostly affects children, with fatal consequences. The disease, which is caused by virus, spreads through the air by respiratory droplets when an infected person coughs or sneezes. Its symptoms include coughing, runny nose, inflamed eyes, sore throat, fever and skin rashes. In extreme situations it can lead to death.
Rubella, which is also a viral infection, has similar symptoms as those of measles, making it difficult to distinguish it from the latter. This difficulty in distinguishing the two diseases is what is causing countries to introduce the combined MR vaccine.
While measles generally causes mild diseases in children, in adolescents and adults it can cause arthritis and encephalitis.
According to the MoHS, measles is one of the causes of high deaths among children in Sierra Leone which has a very high infant mortality. Some 95 children under five years are dying out of every 1000 live births in the country, according to the 2017 Multiple Indicator Cluster Survey, ranking it as the country with the third highest under-five mortality rate in Africa.
In the last three years alone, Sierra Leone has recorded at least two outbreaks of measles. And several cases of Rubella were detected among the cases, including in the latest outbreak in Pujehun and Kambia in 2018.
Dr Linda Fama, Deputy Program Manage, Child Health and Expanded Program on Immunization (EPI), said sporadic cases have also been recorded in all other districts, accounting for around 15 and 20% of cases.
“We don’t want it to become a public health issue and that is why we need to take this opportunity,” she told journalists at an orientation session for media practitioners on the introduction of the MR vaccine.
Fama said the persistence of measles outbreaks and the detection of Rubella in some of the cases is the reason why Sierra Leone is introducing the combined vaccine. Both diseases, she noted, have far reaching implications on the family and the nation.
What makes Rubella so fearful is that pregnant women can lose their babies when infected with the virus, she stressed, noting that even if the baby is born alive, it can get deformities.
“And we start saying it’s because of witchcraft. It’s because she insulted her husband while she was pregnant or she took shower at night. We start tagging and subjecting that woman to a lot of unnecessary issues. But then, it is called congenital rubella syndrome,” she said.
The media orientation was part of a nationwide sensitization by the Health Education Division of the MoHS, ahead of the vaccination campaign. It’s one of a series of engagements with key opinion shapers, including school administrators, community and religious leaders, as well as politicians.
Integrated approach
Sierra Leone has always had only the single measles vaccine in its routine vaccine program, which was administered once at nine months after birth, until 2015 when a second [booster] dose was introduced and administered at 15 months.
Children living with HIV/AIDS get their first dose at six months, due to their weakened immune system, and a third dose at 36 months. In some countries with low level transmission of the virus, the first dose is administered at 12 months.
MR vaccine is also given to adolescents up to 15 years of age, especially in settings like Sierra Leone with high vaccination defaulter rate and difficulty in ascertaining who has received a particular vaccine. This explains why this campaign targets children up to under-15 years, said Dr Fama.
The campaign has been designed as an integrated program to incorporate the administration of the Polio vaccine for children 0-59 months, as well as the deworming tablet, Albendazole, for children 12 – 59 months and Vitamin A Supplement for children aged six to 59 months.
Polio, another debilitating childhood disease, is at its elimination stage globally.
The deworming tablets and Vitamin A supplement will however be distributed in only seven districts – Bonthe, Moyamba, Bombali, Port Loko, Kambia, Western Area Urban and Western Area Rural.
After the campaign, the MR vaccine will be available in all government hospitals. It will follow the usual routine for the measles in the routine program.
This GAVI-funded initiative is being implemented with technical support from the World Health Organization, UNICEF, and the United States CDS.
Pa Osman Manneh, Communication for Development Specialist at UNICEF, said the introduction of the vaccine is a positive milestone towards reversing the “worrying” under-five mortality rate in the country.
“Experiences from countries where this vaccine has been introduced have shown that the MR vaccine is very safe and is 95 percent effective in preventing measles and rubella diseases,” he said.
For the Health Ministry, this is all part of a larger effort to reach the WHO target of at least 95 percent vaccination coverage.
According to EPI figures, Sierra Leone currently has 79 percent coverage of children fully immunized from a total of eight vaccine preventable diseases: TB, Polio, Hepatitis, HIV, Pneumonia, DPT, Diarrhea, and Measles. Pneumonia and diarrhea are among the fueling factors of measles related deaths among children.
The EPI figures also show that many children often start dropping off the routine program at 14 months.
Inequities in access to service providing facilities, lack of awareness on the importance of vaccines, as well as weakness in the health system are among the reasons cited for the low coverage.
“When parents don’t have idea about the importance of vaccine they don’t take it serious,” said Dr Fama.
No child’s play
While the goal is to reach every child nationwide, focus will be on certain communities with high defaulter rates, which is either as a result of difficult terrains, like parts of the norther Kambia district, or mere apathy, like in the Western Area.
A recent KAPs study conducted by the MoHS and its partners identified Kambia as having one of the lowest immunization coverage in the whole country. The district was one of four low coverage districts included in the study designed to identify factors responsible for low uptake of immunization services.
By contrast, the Wester Area Urban, which comprises Freetown and its environs, has a surprisingly huge defaulter rate of about 20, 000 children, according to the MoHS. For measles alone, 17, 000 children in the region are unimmunized, representing 15 percent of the total 100, 000 unimmunized children in 2018.
The KAP study also revealed only 3 percent of Sierra Leoneans had heard about Rubella.
“We are hoping that with all this emphasis on this campaign, with all this engagement, we will reach 98 percent coverage,” said Dr Fama.
“Let’s be our neighbors’ keeper,” she added, while emphasizing the need for inclusive participation.
Dr Fama noted that the target population of 3.2 million is a huge number that will require everyone’s involvement.
“That is half of our population. So this is no child’s play. All hands should be on board.”
© 2019 Politico Online
