The coverage of pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV) with the supply-side factors in select health centres of Chilanga and Chirundu districts of Lusaka province in Zambia: a mixed methods study.

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Chabaputa, Rhoda
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The University of Zambia
Zambian children under age 5 continue to face multiple obstacles with respect to their survival and development. Specifically, beyond the neonatal period, Pneumonia, and Diarrhoea are leading contributors to the high under-5 mortality rate. While vaccinations have been introduced to counter these conditions, a serious weakness of the new vaccines has been identified in their poor coverage. Essentially, data indicate that delivery of Pneumococcal Conjugate Vaccine (PCV) and Rotavirus Vaccine (RV) have remained lower than existing vaccines in the Zambian immunisation schedule. This study aimed at establishing the coverage of Pneumococcal Conjugate vaccine (PCV) and Rotavirus vaccine (RV) and exploring supply-side factors in select health centers of Chilanga and Chirundu districts of Lusaka province in Zambia. This study used an embedded mixed method study design that combined a cross sectional design to compute quantitative data on immunisation coverage rates for the year 2017 and an exploratory case study to obtain a qualitative component that contextualised the results of the quantitative data. 4 health facilities were included in the study. Using complete enumeration of children under age 1, Chilanga health center and Makeni health center from Chilanga district provided a total sample 770 and 822 respectively. Chipepo health center and Lusitu health center from Chirundu district provided total samples of 664 and 1531 correspondingly. 6 In-depth interviews were included. Chilanga health center recorded coverage rates of 124%, 127% and 127% for RV 2 PCV 3 and DPT 3 respectively. The percentages of over 100 came as a result of the facility servicing populations outside its catchment thereby inflating the numerator. In the same order of vaccines, Makeni Konga recorded 44%, 47% and 47%. In Chipepo health center 71%, 73% and 73% were the coverage rates for RV 2, PCV 3 and DPT 3. In Lusitu health center, the immunization coverage rates for RV 2, PCV 3 and DPT 3 were recorded at 14%, 14% and 14% respectively. A further analysis of the ratio of PCV, representing new vaccines, and DPT, representing the older vaccines, obtained a ratio of 1.00 for all 4 health facilities. Since every child being given a dose of PCV is expected to also receive a corresponding dose of DPT, the ratio of 1.00 implied that the delivery of the new vaccines was in tandem with the older vaccines. The major supply side factors that are affecting the progress of the program are community engagement as a result of limited transportation, fuel and meal allowances for field workers. The shortage of staffing is also a challenge. Out of the 4 health facilities under investigation, only 1 is above the set national target of 90% per specific antigen when it comes to DPT, PCV and RV coverage rate. The supply side factors that seem to explain the observed coverage rates are community engagement and staffing. Comparison of new vaccines and traditional vaccines found them to be equally distributed. For these facilities, there are no supply issues that are influencing only the new vaccines. Resource allocation to alleviate lack of transport, fuel and allowances for field workers must be put in place to improve immunization coverage rates.
Thesis of Master of Public Health in Population Studies