POST 00814E : OTHER INTERVENTIONS WITH VACCINATION
Follow-up on Posts 00789E, 00791E, 00793E, 00798E and 00807E
23 July 2005
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Jenny Meya Nyirenda (mailto:[email protected]) from Zambia, contributes
some answers to my questions in Posts 00807E. I admit some of my questions
were pretty naïve. However, if integrating with routine immunization is not
practical because of age group, then in some other countries, they provide
deworming treatments from 12 months, even younger. In one of the
presentations, it is said that Zambia targets children 12-59 months.
Wouldn't it be a good idea to provide deworming with the measles dose at
nine months, for example? Of course the need for successive treatments
until age five remains.
There are more and more campaigns, even with integrating many interventions
into one campaign. I'm not sure that it serves any health promotion or
prevention in an active manner. I'm rather afraid that parents will only
count more and more on campaigns to get some preventive health care for
their children and discharge themselves of their responsibilities on a
continuous basis. In industrialized countries, there are no campaigns as
such any more, and children generally get immunized. Some parents even
exaggerate and run to the pediatrician for a small red spot on a child's
skin. But most mothers do bring their children for check-ups regularly.
All the interventions that are grouped into a campaign or child health week
should be available on a routine basis at health centers. Are they really,
and offered? It is likely that in many countries, parents would have to pay
something at the health center while in campaigns, it is free, so why not
wait for the campaign? So it becomes a vicious circle. I know it will take
long until parents bring their children regularly to health centres whether
they are ill or not, probably as long as sanitation will take to do the
trick for worms. But I believe that this should be the goal. I'm not sure
we are moving towards it or away from it.
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Dear all,
I would like to attempt providing some comments and some of the answers to
the questions posed in this posting.
My name is Jenny Meya Nyirenda, I was formerly EPI Manager in Zambia where
we integrated deworming twice a year either with Child Health Weeks or
polio eradication campaigns depending on the time of the year and districts
where polio campaign was or was not taking place.
1. Integration of deworming in routine vaccination is feasible but not
practical. My experience is that generally only younger infants (0-11
months) are brought for routine immunisations, which leaves out the target
age group for deworming (24-59 Months old).
2. Integration with general primary health care services: This will not
serve the primary purpose of health promotion and prevention for which mass
immunisation campaigns and deworming are conducted. Only the sick
presenting with complaints of either vomiting or passing some worms, or
those identified through some medical/laboratory tests will have the
opportunity of receiving the deworming treatment. Hence a well -looking
child will not be captured through this modality.
3. Treating the whole family or mothers only: This would be ideal and only
partial solution to the repeated infestations. The challenge would be the
logistical requirements of accomplishing this task.
How can we reach family members? Unless we conduct a door - to- door
campaign. What about the cost of deworming tablets and other logistical
arrangements required to mount such a campaign twice a year? Lastly not all
children are escorted to the campaign vaccination posts by their mothers.
Some are brought by even young siblings and others come on their own.
4. Reducing the reinfestation rate after treating mothers: It is worth
noting that children get infested with different types of intestinal worms
through various portals of entry. For instance because of poor
environmental sanitation, the grounds on which most of these kids play can
be heavily infested with hookworm ova/larvae. Some children can get worms
just as they play with infested soil around their homes, not necessarily
from an adult preparing their meals. Poorly washed vegetables and fruits as
well as uncooked meats can also be a source of the infection and not just
the unwashed hands of the food handler. Where as treating the family and
commercial food handlers would contribute to this cause, environmental
sanitations is also key.
5. Net advantage of treating as many as possible at the same time
The child health week offers a wide range of interventions. We take
advantage of the periodic contacts with both young and older children to
promote their health by giving them Vitamin A and prevent illnesses (or
their worsening) (such as anaemia, malnutrition) by treating them with
deworming tablets and offering retreatment of mosquitoe nets and giving
health education talks to guardians about diarrhoea prevention - making
drinking water safe & use of ORS etc.
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