Application of multiple methods to study the immunization programme in an urban area of Guinea

Abstract

During 1988-89, studies were conducted to evaluate the immunization system in Conakry, Guinea. The first, a health facility survey, found that health staff screened the vaccination status of only 30% of children who presented for curative care. A sterile syringe and needle were used for less than half of the injections. In the second survey, key informant interviews with vaccinators and health centre chiefs showed that there were minimal lines of communication between health workers and the community, but that health workers did not perceive this to be a problem. Focus group discussions in the community revealed a high level of general knowledge about vaccine-preventable diseases. However, mothers did not know how many vaccinations their children should receive or by what age they should be completed. They complained of long waiting times in health centres, the high costs of vaccination, poor rapport with health workers, and the occurrence of abscesses after vaccination. The final study, a "knowledge, attitudes, and practice" community survey, showed that missed immunization opportunities and inappropriately timed vaccinations reduced potential vaccine coverage by almost 30% among children with vaccination cards. Higher socioeconomic status, delivery in hospital, and whether mothers perceived the vaccinations to be affordable affected whether the child began the immunization series. Once a child had entered the immunization system, completion of the series was determined by the mother's education level, employment status, and experience with vaccination services.

PIP: Operational research studies of the immunization systems in Conakry, Guinea, conducted in 1988-89 following a series of mass campaigns, aided in the formulation of a comprehensive strategy for achieving high, sustained vaccination coverage. The first, an evaluation of service quality, found that only 30% of children who presented for treatment of diarrhea or malaria were screened by health center staff for their vaccination status; when injections were given, a sterile syringe and needle were used only half the time. In the second study, in-depth interviews with health workers revealed a lack of awareness of the importance of involving the community in immunization programs. In the third study, the focus group discussion technique was used to obtain users' perspectives on vaccination services. Mothers were supportive of vaccination, but lacked knowledge about the vaccination schedule and some complained about long waiting times, high costs of vaccines, a lack of rapport with health workers, and the occurrence of abscesses after vaccination. Finally, a KAP survey found that only 19% of eligible children had been completely vaccinated; an additional 19% had a sufficient number of contacts with the health center to be fully vaccinated, but had missed at least one opportunity. Factors associated with initial receipt of vaccine included higher socioeconomic status, hospital delivery, and the perception that vaccination was affordable, while the mother's educational level, employment status, and experience with the vaccination service were the key determinants of completion of the series. Taken together, these studies indicated a need for increased community involvement and efforts on the part of health personnel to reduce the number of missed opportunities for vaccination, especially in the curative sector.