Evaluation of Integrated Child Health Days as a Catch-Up Strategy for Immunization in Three Districts in Uganda

Abstract

Background: Uganda's Integrated Child Health Day (ICHD) initiative aims to improve children's access to vaccinations. Although widely used as a catch-up vaccination strategy, the effectiveness of the ICHD program in increasing immunization coverage, especially among vulnerable populations, has not been recently evaluated. This study assessed the reach and uptake of ICHD for immunizations in Uganda. Methods: A mixed-methods evaluation was conducted in three districts (Rakai, Kayunga, and Bukedea) where ICHDs occurred. The data collection included a cross-sectional household survey using validated WHO-adapted questionnaires of 1432 caregivers of children under five years old, key informant interviews with 42 health managers and workers, and nine focus group discussions with caregivers between October and December 2022. The vaccines assessed were Bacillus Calmette-Guerin, oral polio, Pentavalent, pneumococcal conjugate, rotavirus (RV), and measles-rubella (MR). Results: The immunization coverage based on child health cards was over 90% for all vaccines except for the second dose of RV (88.3%) and MR (16.2%). Among the children, 2.3% had received no Pentavalent vaccine, and 69.4% were fully vaccinated for their age. Of the 631 children who attended ICHDs, 79.4% received at least one vaccine during the event. Village Health Teams (49%), health workers (18.3%), and megaphone outreach (17.9%) were the primary information sources. Key informants cited challenges with coordination, vaccine delivery, and mobilization. Conclusions: Despite operational challenges, ICHDs appear to have contributed to routine childhood vaccinations. Further research is needed to assess the sustainability and cost-effectiveness of the program.

Keywords: EPI; Integrated Child Health Days (ICHDs); Uganda; catch-up vaccination strategy; immunization coverage; vaccine uptake.

Figure 1

Vaccination by vaccine type and ICHD attendance among children under five years of age, Uganda, 2022 (based on household survey and Child Health Card Records). Attended 558, not attend = 111 = total 669; Bacillus Calmette–Guerin (BCG); oral polio vaccine (OPV); diphtheria–tetanus–pertussis–hepatitis B–Haemophilus influenza type b (Penta); Pneumococcal Conjugate Vaccine (PCV); rotavirus vaccine (Rota); measles-rubella vaccine (MR). The numbers indicate 1st, 2nd, and 3rd doses.