KARACHI, March 22: The Executive District Officers for Health from different districts of Sindh and Town Health Officers of Karachi here on Tuesday discussed in detail their strategies to improve routine immunization programme across the province in the backdrop of constant decline in its coverage rate.

The Sindh Extended Programme for Immunization meeting for strengthening routine immunization was organized on Tuesday by the Sindh EPI in collaboration with the Unicef.

Sindh EPI Director Dr Ali Nawaz Shaikh, Additional Health Secretary Manzoor Memon, Director General Health Services Dr Hadi Bakhsh Jatoi, Unicef Sindh chief Rana Syed, WHO Consultant for Polio Eradication Dr Midhat, and Prof Iqbal Memon of the Pakistan Paediatrician Association, Sindh chapter, made their respective presentations at the meeting.

Dr Midhat expressed his serious concern regarding massive decline in the routine immunization coverage which went as low as 14 per cent in certain districts in February. Disagreeing with the often adopted plea of resource constraints, he was particularly astonished as how even in Karachi, four towns reported routine coverage below 50 per cent.

He underscored the need for urgent measures to strengthen and streamline the monitoring and supervision procedure with particular focus on apt supervision on part of hierarchy - right from medical officers, THOs, EDOs to DG Health Services and above.

The WHO’s consultant further suggested need to help people differentiate between polio and other diseases covered under EPI, as measles, BCG, DPT, HBV for kids and TT for pregnant ladies.

All participants of the meeting were unanimous in their opinion that while making efforts to eradicate polio by the end of this year there was also a dire need to control all other vaccine preventable diseases and maintaining zero prevalence polio through fool-proof routine immunization programme. People should be sensitized that diseases including polio, measles, diphtheria, prutusis, tetanus, Hepatitis B and others were equally hazardous for children and ought to be prevented through timely administration of available vaccines, offered free of cost under EPI Programme.

Unicef Sindh chief Rana Syed, in her presentation on “Acceleration of Routine Immunization (Priority Districts) – A case study”, mentioned that overall routine coverage rates in Sindh province during 2004 remained 34 per cent.

According to her, inadequate mobility for outreach activities; inadequate POL for outreach activities implementation and monitoring; low community awareness regarding routine immunization; poor visibility of fixed EPI centres; no or low involvement of health staff other than vaccinators in EPI at the health facilities were among the major causes for poor routine immunization.

Strategies adopted to combat the scenario were said to include measures focus on improved communication with families through local mass media besides lady health workers and vaccinators; increased social mobilization; EPI base line survey (coverage) in target districts/town; monthly meetings of EDOs with medical officers in charges, nazims, councillors, NGOs, CBOs and general practitioners.

With regard to acceleration of immunization, Rana Syed said that the Unicef in 2005 added two more districts to the three districts identified as priority districts under GAVI programme along with addition of two towns to the seven priority towns located in Karachi.

Targets under the strategy for 2005 was said to be completion of all three doses of DPT among 75 per cent of babies below one year of age, pertaining to the five districts and seven towns. Rana Syed said that the priority districts included Thatta, Hyderabad, Sanghar, Khairpur and Larkana. While the town were Korangi, Gulshan-i-Iqbal, Gadap, Saddar, Keamari, Orangi and Malir, he added.

Regarding other support provided by the Unicef, she said that 90 motorbikes, 275 cycles and 940 vaccine carriers (procured through funds generated by Sheraton Hotel) for vaccinators, had been handed over to the authorities concerned.

According to her, Unicef Sindh has also offered POL support for outreach activities, while visibility of 319 fixed EPI centres has also been improved through installation of special sign boards. Orientation of some 600 vaccinators regarding acceleration strategy was also initiated, she added.

Sindh EPI Project Director Dr Ali Nawaz Sheikh, in his presentation on “Strategies to improve routine immunization”, referred to maximum involvement of lady health workers in the EPI mentioning that each of these assigned to cover 100 households would help 59 per cent coverage of routine immunization in the province.

He observed that routine immunization was the single most cost-effective intervention to prevent child morbidity and mortality.—APP