Children under the age of one year globally suffer from various diseases that can be avoided by administering the required vaccines right from birth.

According to official World Health Organization (WHO) website the statistics indicates that the global vaccination coverage of the world’s children who receive recommended vaccines has remained the same over the past few years.

During 2019 about 85% of infants worldwide which represent 116 million infants received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability.

By 2019, 125 WHO member states had reached at least 90% coverage of DTP3 vaccine.

Global immunization coverage 2019

Some of the diseases highlighted by WHO include Haemophilus influenza type b (Hib) which causes meningitis and pneumonia. Hib vaccine had been introduced in 192 member states by the end of 2019 with global coverage with 3 doses of Hib vaccine is estimated at 72%.

Hepatitis B: is a viral infection that attacks the liver and the vaccine for infants had been introduced nationwide in 189 member States by the end of 2019 with the global coverage with 3 doses of hepatitis B vaccine estimated at 85%.

Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2019, 85% of children had received one dose of measles-containing vaccine by their second birthday, and 178 Member States had included a second dose as part of routine immunization and 71% of children received two doses of measles vaccine according to national immunization schedules.

Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2019, 86% of infants around the world received three doses of polio vaccine.

Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 12 countries, mainly in Africa and Asia.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2019, yellow fever vaccine had been introduced in routine infant immunization programmes in 36 of the 40 countries and territories at risk for yellow fever in Africa and the Americas. In these 40 countries and territories, coverage is estimated at 46%.

The challenges for WHO team is that in 2019 14 million infants did not receive an initial dose of DTP vaccine pointing to lack of access to an immunization and other health services and an additional 5.7 million are partially vaccinated. Of the 19.7 million more than 60% of these children live in 10 countries namely Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan and the Philippines.

Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with life-saving vaccines.

However despite the global effort, scientists at school of Public Health Makerere University jointly with those at Kampala Capital City Authority have been conducting programme in a bid to improve the electronic data systems in private clinics in and around the greater for purposes of improving the vaccination exercise

The case of Uganda
Dr Eric Ssegujja from the School of Public Health Makerere University who was the principal investigator of the project notes that his team saw a gap of urban immunization thereby coming up with a project to improve it through the private sector health service provides mainly grass root clinics.

The aim of the project that run for one year from March2020 to March 2021 was to improve data quality in the private clinics which clinics were identified by KCCA with funding worthy $25,000  from the WHO-Alliance for Health Policy and Systems Research (AHPSR).

According to Dr Ssegujja this was an implementation research project whose objectives included building capacity for private immunization service providers to collect accurate and submit timely immunization data to KCCA where they usually receive immunization vaccines.

Dr Sarah Zalwango, the director of public health and environment at KCCA explaining modalities of the research project noted that previously health workers compiled data about vaccines they administer to children under the age of one year using hard copy papers.

Her team sensitized the health workers in the private health service providers in Kawempe and Makindye division through provision of enhanced supervision to the facilities by emphasizing use of electronic data which included use of computers for date recording which they must send to KCCA for accountability as well as messaging using phones.

“We selected 20 private health clinics in Kawempe Division and 20 in Makindye which we consider worse perfuming divisions in as far vaccine administering is concerned coupled with congested population.  We sampled two clinics in each division: one where vaccine service has been on going and one where the clinic was not engaged in vaccine administration. We realized that the later performed poorly about knowledge of administering vaccines to infants  in keeping records,” she noted.

This therefore meant health workers in the two divisions required more sensitization about vaccine data recording using electronic devises.

Names of the prominent Immunisable diseases

Dr Ssegujja explains that Uganda provides vaccination services for 10 target diseases among infants and below are some of them.

Diphtheria: It is a serious infection caused by strains of bacteria called Corynebacterium diphtheriae that make toxin (poison). It can lead to difficulty breathing, heart failure, paralysis, and even death

The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough called pertussis

Diarrhea that arises as a result of Rotavirus which is a virus that causes diarrhea and other intestinal symptoms.

Vaccines for rotavirus and cholera have the potential to reduce diarrhea morbidity and mortality burden.

Tuberculosi: is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attacks the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain although everyone infected with TB bacteria may not become sick..

 Dr Eric Contends that in countries with high rates of TB infection including Uganda infants are often given the Bacillus Calmette- Guerin vaccine, or BCG.

Pneumonia: The pneumococcal vaccine also known as pneumonia vaccine protects against serious and potentially fatal pneumococcal infections.  Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia which is a kind of blood poisoning and meningitis

Poliomyelitis: Scientists say polio vaccines are in two forms one in weakened form which is given by a drop in the mouth and inactivated type given by injection. WHO recommends all children be fully vaccinated against polio and vaccine names are given according to the brand of the manufacturer.

Pertussis: Two kinds of vaccines used today help protect against whooping cough, both of which also protect against other diseases such Diphtheria, tetanus and pertussis  which are (DTaP) vaccines.

Measles and in addition Human Papillomavirus vaccine (HPV) was introduced in 2015 and given to children aged 10 and below

Other new vaccines according to Dr Ssegujja introduced into routine vaccination schedule include; pneumococcal conjugate vaccine (PCV), Inactivated Polio Vaccine (IPV) and Rota vaccine introduced in May 2013, April 2016 and June 2018 respectively.

The new ones for specific infections include, OPV/IPV for polio, BCG for TB, Pertusis DP HEP-HIP for whooping cough, Texoid for tetanus, HEP DPI- HEP-HIP for Hepatitis B and Potavirs vaccine for Diarrhea among others.

The health service providers the team worked with during the survey

Dr Ssegujja contends that since the reproductive age is more pronounced in urban areas like Kampala, this therefore signified a great need for immunization services and that Population pressure is not at pace with planning for delivery of health services leaving the available public services overstretched.

The health facilities include all public health facilities under KCCA management, the national referral hospitals, private not for profit facilities such as Rubaga hospital, Mengo Hospital, Nsambya hospital and the private for profit) facilities which are both the corporate hospitals such as Kololo and Nakasero as well as the small private for profit clinics.

Statistical data

The statistics indicate that annually National referral hospitals by level which are Government, NGO, Private referral hospitals  are rated at 0.27%, health centre (HC IV) at 0.75%, HC III rated at 3.54%, HC II at 93.92%

Currently over 98% of immunization health services in Kampala are delivered through the private sector out of which 93% are lower level health facilities operating at HCII level. The situation is not different for immunization services which are majorly through the lower level private for profit due to their low cost investments required.

However because of the profit motivation of the private for profit sector, immunization services may not be the most prioritized meaning that to ensure quality coverage; ongoing monitoring and support supervision is key.

Quality immunization data is essential to ensure proper planning and yet private for profit facilities are at different capacity levels in ensuring quality data which translates into how immunization data is captured and transmitted.

Some of these private clinics may charge some fee for the immunization since some are operating in rented buildings though the service is supposed to be free of charge.

The E DATA initiative team created: This according to experts included electronic instant messaging platform for participating private immunization service providers to share experiences and learning regarding data quality improvements.

They are sent reminders to complete and send immunization data on time, sent queries and clarifications regarding immunization data to the supervisors, receive learning and feedback from the division focal persons.

While KCCA focused on the implementation aspects, Makerere University school of Public Health focused on the research and documentation of best practices and lessons learnt.

Some of the best practices are that specific staff are designated to provide immunization services at most of the private facilities, there has to be availability of data tools at private clinics and timely submission of monthly reports.

Ms Hajarah Basiraka the manager district Vaccine Store at KCCA noted that all hospitals in Kampala including health centers pick the various vaccines for immunization against various diseases from KCCA store every month. 

Meanwhile the private clinics are given vaccines at KCCA division hospitals. For instance in Nakawa division they are given from Kiswa Health Center and those in Rubaga division pick from Kawala health Center. The amount given depends on the demand.