Academic journal article Bulletin of the World Health Organization

Awareness about a National Immunization Day Programme in the Sunsari District of Nepal

Academic journal article Bulletin of the World Health Organization

Awareness about a National Immunization Day Programme in the Sunsari District of Nepal

Article excerpt

Voir page 605 le resume en francais. En la pagina 605 figura un resumen en espanol.

Introduction

One of the greatest achievements this century was the global eradication of smallpox, achieved through cooperation of all the countries of the world under the auspices of the World Health Organization (WHO). Today, the world stands on the verge of a similar achievement for poliomyelitis. The initiative to eradicate poliomyelitis globally by the year 2000 was launched by a resolution of the Forty-first World Health Assembly in May 1988 (1). Worldwide about 3997 cases of the disease were reported in 1996, with the reduction over the period 1995-96 amounting to 43% (2). In the South-East Asia Region, successful eradication strategies resulted in a 96% decrease in the number of reported cases of poliomyelitis from 25 711 in 1988 to 1116 in 1996 (3). Poliomyelitis-free zones are now emerging in Europe, northern and southern Africa, the Arabian Peninsula and the Western Pacific Region. In 1992, a total of 131 countries recorded zero cases, up from 81 in 1985 (4); 155 countries reported zero cases in 1996; and an estimated 81% of all eligible children in the world have received the recommended three doses of oral poliovirus vaccine (OPV). The whole of the Western Hemisphere was declared poliomyelitis-free in 1994. Almost two-thirds of the world's children under 5 years of age (about 419 million) received OPV on national immunization days (NIDs) (2).

In Nepal, 100-250 children are disabled by poliomyelitis each year. These cases may represent the tip of the iceberg since the majority of cases go unreported. The government is determined to eradicate poliomyelitis from the country by the year 2000 through the NID programme, which aims to immunize 3.3 million children under 5 years of age every year from 1996 onwards. For the first NID programme, the district health office was used as a local base for activities. In each district a high-level committee was formed under the chairmanship of the district development president (an elected post), including various government and nongovernment organizations, with the district health officer acting as secretary. Similar committees were constituted for each village, which included members from different political groups, teachers, students and health workers (5).

The campaign was launched with a massive information, education and communication (IEC) programme through radio, television, street speeches, skits, songs, school rallies, pamphlets and posters, and with the help of health workers and community volunteers.

The present article analyses the impact of such a campaign in the Sunsari district of Nepal, which lies in the plains of the eastern region in the Koshi Zone. The district has a varied topography, ranging from 152 m to 918 m above sea level and consisting of terai (80%) and middle hill (20%). It has an area of 1257 [km.sup.2] and a population of 492 718, with a density of 391.9 persons per [km.sup.2]. Only 52% of the population is literate. There are 150 km of permanent drivable roads and 70 km of seasonal drivable roads. The district has 17 subhealth posts, 9 health posts, 1 primary health centre, 1 district health office including a hospital, 1 teaching hospital with outreach clinics and 4 Ayurvedic dispensaries (6). The immunization coverage in the district is only 52% (7). This study was carried out during the first NID (6 December 1996) to evaluate the awareness of the local population about NIDs and the impact of the media on such awareness.

Materials and methods

This study was conducted in the 200 vaccination posts of the 50 village development committees in the rural areas of the district. Five structured questionnaires were sent to each vaccination post one day before the NID through the district health office. The questionnaires were in the local (Nepalese) language and contained guidelines for the health workers. …

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