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Uganda was one of 13 countries in WHO’s African Region which organized a measles campaign in 2012. Staff from the World Health Organization worked together with colleagues from Uganda’s immunization program to write this report about the campaign, which aimed to reach more than 6.3 million children with measles vaccine.

Follow up measles SIAs in Uganda: May 2012

Jacinta Sabiiti, Andrew Bakainaga2, Dr Annet Kisakye2, Uganda National Expanded Program on Immunization (UNEPI)1, World Health Organization-Uganda2,

Uganda has been implementing its Expanded Program on Immunization (EPI) since 1983. In line with global and African regional goals, the Uganda EPI program includes a specific focus on the eradication of polio, the elimination of measles, and of neonatal and maternal tetanus. The core strategies for achieving the above goals for all three diseases are: achieving and maintaining high coverage with routine immunization, targeted supplemental immunization activities (SIAs), and sensitive surveillance system to detect and respond as appropriate to all cases of polio, tetanus or measles. In line with the National Measles elimination strategy (2012 – 2015), integrated follow-up measles SIAs were conducted from 26th – 28th May 2012, with the following objectives:

1. To provide a second opportunity measles vaccination to at least 95% of 6,314,309 children aged 6-59 months
2. To provide a booster dose of tOPV to 6,996,937 children aged 0-59 months.
3. To provide other appropriate child survival interventions like vitamin A and Albendazole to at least 90% of 6,314,309 and 5,665,812 children respectively, within the age target of 6 – 59 months.

In terms of financial support, the government of Uganda made USD 1,265,000 available for the operational cost of the SIAs. The Measles and Rubella Partnership financed the purchase of vaccines and also supported the operations through WHO and UNICEF. Other partners, including UKaid, Uganda Red Cross, Lions Club International, Rotary International, Buganda Kingdom and the Church of Jesus Christ of Latter Day Saints provided exceptional support towards the implementation of the integrated measles campaign.

The National Coordination Committee, chaired by the Ugandan Ministry Of Health (MoH) and including the health development partners, provided operational guidance and led the coordination of the preparation of the SIAs. Cascaded training activities were conducted and a regional training of trainers was held to ensure that the training activities at county and sub-county level are completed on time. Cold chain capacity was strengthened with the establishment of regional freezing centers and the provision of sufficient cold chain equipment and vaccine carriers for every vaccination post. Social mobilization was effectively carried out with community participation. Local village chairmen, Village Health Teams and radio proved very effective in reaching mothers and caregivers.

The President of Uganda, His Excellency Yoweri Kaguta Museveni, launched the measles campaign in Pader district.

The SIAs took place in more than 18,000 vaccination service delivery sites and were successfully implemented over a period of 3 days. A total of 36,333 health workers and 19,129 volunteers participated in this activity. Monitoring and supervision was done by the MoH and development partners using an effective team approach. The reported national administrative coverage for measles was 100%, while 99.5% of the target age children received polio vaccines in the 112 districts. A total of 85 districts (76%) attained administrative coverage of 95% or more with the measles vaccination. Mop-up vaccination activity was conducted four days after the end of the SIAs in some districts where coverage did not reach the 95% target.

Five children in 4 different districts were reported to have developed minor adverse events following immunization (AEFI), all of which were managed accordingly.

Independent convenience monitoring at the end of the campaign covering 33,512 children aged between 6 and 59 months from the 112 districts ascertained that 5% of eligible children had not received the measles vaccine doses. Further analysis of the reasons for low coverage in weak performing districts is ongoing and will be documented for future interventions.

The major challenge faced in this SIAs was the delays in making financial resources available at district level. The other challenges were resistance by some religious sects, sub-optimal training mostly in those districts where funds were released late, and the late deployment of national supervisors to the districts.

For future vaccination campaigns, basket funding will help to ensure that priority cross-cutting activities are implemented on time.