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Evaluation of Delivery of Multiple injection Vaccines in Namibia

Evaluation of administration and communication practices for multiple vaccines at a single immunization visit in the Republic of Namibia

AFENET in conjunction with CDC and the Ministry of Health and Social Services are conducting an evaluation in Namibia aimed at describing current practices for preparation and administration of more than one vaccine (especially injectable vaccines) in a single immunization visit.

The evaluation incudes provider communication to caregivers about multiple vaccines, post-vaccination care; and attitudes of caregivers about childhood vaccination and delivery of multiple vaccines to children under two years of age. Findings from this evaluation will be used to inform national and global guidance on best practices for preparation, administration and communication about delivery of multiple vaccines to a child during a single immunization visit, and needs for healthcare worker training about the introduction of the new immunization program guidelines in Namibia. 

Phase one was completed in Uganda, with observations made in 38 health facilities, where 366 children were observed receiving multiple injection vaccines, and 66 healthcare workers interviewed.

Phase two took place in Namibia, where 36 facilities and outreaches offering vaccination services will be evaluated. A team of data collectors were trained and deployed to observe and record the practices, techniques and communication around delivery of multiple injections, from 1 to 19 April 2019. This will be followed by analysis and dissemination of the data to relevant stakeholders. Also participating in the evaluation were Dr Kofi Nyarko (Resident Advisor), Ms Emmy-Else Ndevaetela (Program Director), Mr Joseph Magoola (Immunization Study Coordinator – AFENET Secretariat).

Vaccine preparation and administration is an area that has not been critically evaluated and guidance varies globally. In 2015, the Strategic Advisory Group of Experts (SAGE) on immunization recommended countries introduce at least one dose of inactivated poliovirus vaccine (IPV) into the routine EPI schedule. Like many LMICs, Namibia introduced IPV as the third injectable vaccine to the 14-week EPI schedule point in 2015. Understanding the processes and techniques used for preparation and administration of multiple vaccines, particularly injectable vaccines; as well as content, timing, and extent of provider communication about co-administration of multiple vaccines, is important to enhance guidance on best practices. In addition, understanding parental acceptance of the addition of IPV to routine immunization schedule and their acceptance of the administration of multiple injectable vaccines at a single visit will inform communication needs, framing of messages and future vaccination scheduling decisions.