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. 2020 Jan 17;15(1):e0218239.
doi: 10.1371/journal.pone.0218239. eCollection 2020.

Family Health Days program contributions in vaccination of unreached and under-immunized children during routine vaccinations in Uganda

Ezekiel Mupere  1   2 , Harriet M Babikako  2   3 , Violet Okaba-Kayom  1 , Robert B Mutyaba  4 , Milton Nasiero Mwisaka  5 , Emmanuel Tenywa  6 , Albert Lule  7 , Jane Ruth Aceng  8 , Flavia Mpanga-Kaggwa  9 , David Matseketse  9 , Eresso Aga  10
Affiliations

Family Health Days program contributions in vaccination of unreached and under-immunized children during routine vaccinations in Uganda

Ezekiel Mupere et al. PLoS One. .

Abstract

Background: We explored the contributions of the Family Health Days (FHDs) concept, which was developed by the Uganda Ministry of Health (MOH) and UNICEF as a supplementary quarterly outreach program in addition to strengthening the routine expanded program for immunization (EPI), with the aim to increase coverage, through improved access to the unimmunized or unreached and under-immunized children under 5 years.

Method: A cross-sectional descriptive study of the Uganda MOH, Health Management Information Systems (HMIS) and UNICEF in house FHDs data was conducted covering six quarterly implementations of the program between April 2012 and December 2013. The FHDs program was implemented in 31 priority districts with low routine vaccination coverage from seven sub-regions in Uganda in a phased manner using places of worship for service delivery.

Results: During the six rounds of FHDs in the 31 districts, a total of 178,709 and 191,223 children received measles and Diphtheria-Pertussis-Tetanus (DPT3) vaccinations, respectively. The FHDs' contributions were 126% and 144% for measles and 103% and 122% for DPT3 in 2012 and 2013, respectively of the estimated unreached annual target populations. All implementing sub-regions after two rounds in 2012 attained over and above the desired target for DPT3 (85%) and measles (90%). The same was true in 2013 after four rounds, except for Karamoja and West Nile sub-regions, where in some districts a substantial proportion of children remained unimmunized. The administrative data for both DPT3 and measles immunization showed prominent and noticeable increase in coverage trend in FHDS regions for the months when the program was implemented.

Conclusion: The FHDs program improved vaccination equity by reaching the unreached and hard-to-reach children and bridging the gap in immunization coverage, and fast tracking the achievement of targets recommended by the Global Vaccine Action Plan (GVAP) for measles and DPT3 (85% and 90% respectively) in implementing sub-regions and districts. The FHDs is an innovative program to supplement routine immunizations designed to reach the unreached and under immunized children.

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Conflict of interest statement

Author disclosures: Ezekiel Mupere, Harriet M. Babikako, Violet Kayom Okaba, Robert B. Mutyaba, Milton Nasiero Mwisaka, and Emmanuel Tenywa were academic and health care officers who provided technical support to Child and Family Foundation Uganda (CFU), a non-government organization as community contribution, and CFU paid for their field supervision expenses during the study conduct. Albert Lule, Jane Ruth Aceng, Flavia Kaggwa Mpanga, David Matseketse, and Eresso Aga were Ministry of Health and UNICEF staff in charge of policy and program implementation. Robert B. Mutyaba was affiliated to RBMTM Systems, a commercial companywhich had no role in the study, and this affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials. Each author provided individual views to the development of the manuscript.

Figures

Fig 1
Fig 1. Annualized FHDs and routine contributions to measles and DPT3 vaccinations in 2012 and 2013 rounds in 31 implementing districts.
Source: Health Management Information System (HMIS) at Ministry of Health (MOH) 2013 and UNICEF In-house data; HMIS data contains both routine and FHDS data at MOH; denominators were UBOS estimates for children under 1 year in 2012 and 2013.
Fig 2
Fig 2. Annualized FHDs and routine contributions to measles vaccinations in 2012 and 2013 rounds in seven implementing sub-regions.
Source: Health Management Information System (HMIS) at Ministry of Health (MOH) 2013 and UNICEF In-house data; HMIS data contains both routine and FHDs data at MOH; denominators were UBOS estimates for children under 1 year in 2012 and 2013.
Fig 3
Fig 3. Annualized FHDs and routine contributions to DPT3 vaccinations in 2012 and 2013 rounds in seven implementing sub-regions.
Source: Health Management Information System (HMIS) at Ministry of Health (MOH) 2013 and UNICEF In-house data; HMIS data contains both routine and FHDs data at MOH; denominators were UBOS estimates for children under 1 year in 2012 and 2013.
Fig 4
Fig 4. Trends of measles vaccination coverage for notable districts during FHDs implementation periods in 2012 and 2013.
Source: UNEPI and Annual Health Sector Performance Report (AHSPR) at Ministry of Health.
Fig 5
Fig 5. Trends of DPT3 vaccination coverage for notable districts during FHDs implementation periods in 2012 and 2013.
Source: UNEPI and Annual Health Sector Performance Report (AHSPR) at Ministry of Health.
Fig 6
Fig 6. Measles vaccination coverage trends for districts with poor performance during FHDs implementation in 2012 and 2013.
Source: UNEPI and Annual Health Sector Performance Report (AHSPR) at MOH.
Fig 7
Fig 7. DPT3 vaccination trends for districts with poor performance during FHDs implementation, 2011–2013.
Source: UNEPI and Annual Health Sector Performance Report (AHSPR) at MOH.
See this image and copyright information in PMC

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