AFENET conducts community defaulter tracking for catch-up vaccination in Uganda’s Hoima District
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by
AFENET
As a way of enhancing immunization coverage in Hoima District, Uganda, AFENET has launched a comprehensive defaulter tracking initiative. This campaign, involving 25 health facilities, aims to ensure that children who have defaulted or dropped out receive their necessary immunizations, thereby improving public health outcomes.
To equip health workers for this vital task, 72 healthcare workers (HCWs) received specialized training focused on intensifying defaulter tracing activities in the district. This training has been essential for improving the effectiveness of tracking efforts within the health facilities.
In addition to HCWs, 748 Village Health Team (VHT) members and community leaders, including sub-county chiefs, assistant chief administrative officers, and church leaders, were also trained. Their involvement is crucial for implementing defaulter tracing activities at the community level, ensuring a broader reach and more efficient identification of defaulters.
The initiative was further strengthened by 102 supportive supervision sessions provided by Field Epidemiology Training Program (FETP) members and the District Health Team (DHT). These sessions ensured that the tracking activities were conducted smoothly and that any challenges were promptly addressed.
Why defaulter tracking matters
Gaps in immunization coverage increase the number of children susceptible to vaccine-preventable diseases (VPD) and the likelihood of VPD outbreaks. Missed opportunities for vaccination (MOV) and under-immunized children—those who have not received their DPT3/Penta3 vaccine—are significant concerns. MOV occurs when a child visits a health facility but does not receive all eligible vaccines. Additionally, missed communities, clusters of zero-dose and under-immunized children, often arise due to multiple barriers such as limited access to and utilization of vaccination services.
The project’s key practices include defaulter tracing: Facilitating the timely and regular identification of all defaulting children in health facilities, supportive supervision: Providing supportive supervision to healthcare workers (vaccinators) in every selected health facility by FETP alumni and DHT members and engaging village health teams (VHTs): Utilizing community knowledge to promote effective and equitable Expanded Programme on Immunization (EPI) activities.
What is catch-up vaccination
Catch-up vaccination refers to the action of vaccinating an individual who, for various reasons, has missed doses of vaccines for which they are eligible, according to the national immunization schedule. This approach helps improve vaccination coverage, contributing to higher levels of population immunity.
Supportive supervision
FETP alumni and DHT members provide supportive supervision to health workers in selected districts. This supervision includes:
- Using child registers effectively.
- Line listing defaulters/dropout children.
- Identifying missed opportunities for vaccination.
- Proper administration of catch-up vaccines.
Specialized immunization consultants offer on-the-job training to healthcare workers, enhancing practices such as routinely checking the vaccination status of all children under 48 months and using defaulter tracing systems to identify defaulting children monthly.
Engaging VHTs
VHTs are engaged to provide community knowledge and promote effective EPI activities at the health facility level. Activities include:
- Building or updating a register of all children under five years, along with caregivers’ contact information.
- Identifying and referring zero-dose and dropout children to the nearest health facility.
- Conducting micro-planning sessions to prioritize high-risk communities for outreach activities.
- Ensuring VHT representatives participate in quarterly district-level EPI meetings to discuss performance.
Correct recording and reporting
All doses, regardless of when administered, should be recorded on home-based records, child health cards, tally sheets, child registers, and monthly reports. This accurate recording helps monitor and improve immunization coverage.
Defaulter tracking results
- Total Vaccine Doses Missed: 27,196 among 6,240 identified children.
- Average Number of Missing Doses: 4.
- Higher Dropout Rates: More children in the 12–47-month age bracket were identified as dropping out of vaccination compared to the 0–11-month age bracket.
Key findings
- BCG defaulters: 40% of Hoima’s identified BCG defaulters were found to be immunized when home records were checked.
- MCV1 defaulters: The most frequent outcome for children missing MCV1 was receiving the missing dose (56%).
- Penta1 and Penta3 defaulters: 40% of children missing Penta1 and 45% of children missing Penta3 received their missing doses.
Key messages
- Community-based defaulter tracing by VHTs can effectively identify and catch-up immunization defaulters, reducing dropout rates.
- Hoima had a high rate of missing health facility immunization information.
- Children are more likely to default on vaccines given at later ages, indicating that utilization is more of a challenge than access.
- The coordination and participation of VHTs are key to the success of the initiative.
This coordinated effort by AFENET, and its partners has significantly contributed to identifying and reducing the number of immunization defaulters in Hoima District, thereby enhancing public health and preventing disease outbreaks.
