Guidelines for improvement of childhood immunisation program in pastoralist communities of Somali Region, Ethiopia

Abstract

Background: The current Ethiopian health service delivery system is structured into three-tier systems. This includes primary, secondary, and tertiary-level healthcare tier systems. The administrative structure of the immunisation program in Ethiopia is based on the administrative structure of the country from the federal and down to the district and primary health care unite level. Purpose: The purpose of this study was to develop guidelines to optimize childhood immunisation programs in the pastoralist community of Somali Region, Ethiopia. Methods: The researcher employed an explanatory sequential mixed method technique combining quantitative and qualitative research designs. Three hundred (300) respondents and 64 health facilities were chosen from the quantitative designs at Shebele zones in Somali region using multi-stage cluster sampling and simple lottery methods respectively, while 12 participants in the qualitative designs were selected through purposive sampling methods. For quantitative and qualitative approaches, data were analysed using the Statistical Package for Social Sciences (SPSS) 25.0 version and Atlas ti 8, respectively. Results Quantitative results: Overall, 285(94.9%) of the 300 respondents had ever heard of immunisation. Less than half, 139(46.3%) the average value of knowledge indicators was below that of the respondents. Among children who had ever been vaccinated for regular vaccination, 184(79%) of parents/caregivers had child vaccination cards. The overall proportion of children, who received valid full vaccination was 81(27%), partially vaccinated 39(13%) and not vaccinated 180(60%). The findings revealed long distances to the place of immunisation 56(19%), bad rumours 89(30%), and long waiting time 55(18.3%) as some of the major barriers to not vaccinating children. From the observed 64 health facilities, 46%, 67%, and 64% have at least one trained health staff, available to reach every district or community (RED/C) and Micro-plan to provide specific vaccines respectively. Almost half 30(47%) of healthcare facilities have an equal number of Auto-Disable (AD) and re-constitution syringes, and more than three quarter 51(80%) of refrigerator temperatures were monitored twice daily. Qualitative results: Four themes emerged from the data including challenges with immunisation system, low immunisation coverage, low knowledge of parents/caregivers on vaccination, and low community involvement on vaccination service. Conclusion The qualitative findings were used to create a concrete understanding of the study topic. The investigator developed immunisation guidelines to improve childhood immunisation programs in pastoralist communities and guided healthcare professionals and immunisation implementing partners in improving immunisation coverage and reducing the number of unimmunised children.

Imeko-bume/Imvelaphi : Inkqubo yangoku/ yanamhlanje yokunikezelwa kwenkonzo yezempilo yase-Ethiopia inamanqanaba amathathu esakhiwo, oko kukuthi ukhathalelo lwezempilo olusisiseko, ukhathalelo olukwinqanaba lesibini kunye nelesithathu. Ubume bolawulo benkqubo yokugonywa e-Ethiopia busekwe kubume bolawulo belizwe ukusuka kumdibaniso/kubufederali ukuya kutsho kwinqanaba leyunithi yokhathalelo lwempilo esisiseko. Injongo: Injongo yolu phononongo yayikukuphuhlisa izikhokelo zokuphucula iinkqubo zokugonywa kwabantwana kuluntu lwasezifama/lwasemaphandleni kuMmandla waseSomalia, e-Ethiopia. Iimethodi/ iindlela zokuqhuba uphononongo:Umphandi usebenzise ubuchule bendlela yolandelelwano echazayo nexubileyo edibanisa uyilo lobungakanani kunye noyilo olusemgangathweni lophando. Abaphenduli abangama-300 kunye namaziko ezibonelelo zezempilo ezingama-64 zakhethwa kuyilo lobungakanani ngokwenani kwiindawo yommandla owenzelwe injongo ethile (zones) eShebele kwiNgingqi yaseSomalia kusetyenziswa ingqokelela yeesampulu zamaqela ezinezigaba ezininzi kunye neendlela ezilula kukhethwa ngokwamanani abawanikiweyo ngokungakhethiyo. Abathathi-nxaxheba aba-12 kuyilo olusemgangathweni bakhethwa ngeendlela zesampulu ngokunenjongo. Kwiindlela zobungakanani kunye nezisemgangathweni, idatha yahlalutywa kusetyenziswa uhlobo lwe 25.0 lwe-SPSS kunye ne-ATLAS.ti 8, ngokulandelanayo. Iziphumo Iziphumo zobungakanani: Kukonke, ama-285 (94.9%) kwabangama-300 abathe baphendula baye beva ngogonyo. Ngaphantsi kwesiqingatha, i-139 (46.3%), umyinge wezalathisi zolwazi kwinani elimelweyo lalingaphantsi kwelo labaphenduli. Kubantwana abakhe bagonywa ngokugonywa rhoqo, i-184 (79%) yabazali/abanonopheli babenamakhadi okugonya abantwana. Inani lilonke labantwana abafumene ugonyo olupheleleyo ngama-81 (27%), abangama-39 (13%) baye bagonywa ngokuyinxenye(ngokungaphelelanga) kwaye abangama-180 (60%) abazange bagonywa .Iziphumo zityhila imigama emide ukuya kwindawo yogonyo (56; 19%), amarhe amabi (89; 30%) kunye nexesha elide lokulinda (55; 18.3%) njengeminye yemiqobo ephambili ekungagonyweni kwabantwana. Ukusuka kuqwalaselo lwamaziko ezempilo angama-64, ii-46%, 67% kunye nama-64% ubuncinane abe nalo ilungu elinye lomsebenzi wezempilo oqeqeshiweyo, ebefumaneka ukuze afikelele kuzo zonke izithili okanye uluntu kwaye ebenesicwangciso esincinane sokubonelela ngezitofu ezithile ngokwahluka kwazo. Phantse isiqingatha (i-30; i-47%) samaziko ezibonelelo zezempilo zinenani elilinganayo zeesirinji I-auto-disable (AD) iisirinji ezingasebenzi ngokunokwazo emva kokusetyenziswa kanye. ii-Auto-Disable (AD) kunye neesirinji ezinokubuyiselwa kwisimo sazo sangaphambili/ ezinokuvuselelwa (reconstitution), kwaye ngaphezu kweekota ezintathu (51; 80%) zamaqondo obushushu ezikhencezisi zazihlolwa kabini ngemini. Iziphumo zohlobo olusemgangathweni: Imixholo emine yavela kwidatha: imingeni kwinkqubo yokugonya, ubuncinane beendawo ezifikekekwayo yokugonya, ulwazi olusileleyo /oluphantsi lwabazali / abanonophelo ngokugonya, kunye nokubandakanyeka okuphantsi koluntu kwinkonzo yokugonya. Isiphelo: Iziphumo ezisemgangathweni zisetyenziselwe ukuphuhlisa ukuqonda okubambekayo kwesihloko sophando. Umphandi wenze izikhokelo zokugonya ukuze kuphuculwe iinkqubo zokugonywa kwabantwana kwiindawo zasefama/ zasemaphandleni kunye nokukhokela iingcali zezempilo kunye namaqabane aphumeza ugonyo ekuphuculeni ukufikelela kwiindawo ezininzi zokugonya kunye nokunciphisa inani labantwana abangagonywanga.

Isizinda: Uhlelo lwamanje lokulethwa kwezinsiza zezempilo lwase-Ethiopia lunezinhlaka ezintathu, okungukuthi ukunakekelwa kwezempilo okuyisisekelo, okwesibili kanye nokwemfundo ephakeme. Isakhiwo sokuphatha sohlelo lokugoma e Ethiopia sisekelwe esakhiweni sokuphatha sezwe kusukela kuhulumeni wesifundazwe kuya ezingeni lesifunda kanye neyunithi yokunakekelwa kwezempilo okuyisisekelo. Inhloso: Inhloso yalolu cwaningo kwakuwukwenza imihlahlandlela yokuthuthukisa izinhlelo zokugoma izingane emphakathini wabafuyi besiFunda saseSomali, e Ethiopia. Izindlela: Umcwaningi usebenzise indlela yamasu exubile yokuqoqa imininingwane ehlanganisa echazayo kanye neyezinombolo. Kwakhethwa abaphenduli abangu-300 kanye nezikhungo zezempilo ezingama-64 ezinhlelweni zokuthola indlela abantu abacanga futhi abazizwa ngayo ezindaweni zaseShebele esiFundeni saseSomali kusetshenziswa amasampula ezigaba eziningi nezindlela ezilula zokwabela ilungu ngalinye inombolo; abahlanganyeli abayi-12 ekunikezeni imininingwane ejulile ngokuziphatha kwabantu bakhethwa ngezindlela zesampula ezihlosiwe. Mayelana nezindlela zocwaningo ezichazayo neyezinombolo, imininingwane yahlaziywa kusetshenziswa inguqulo ye-SPSS 25.0 kanye ne-ATLAS.ti 8, ngokulandelana. Imiphumela Imiphumela yezinombolo: Sekukonke, abangama-285 (94.9%) kwabangama-300 abaphendula babezwile ngokugonywa. Ngaphansi kwengxenye, 139 (46.3%), inani elimaphakathi lezinkomba zolwazi belingaphansi kwalaba abaphendulile. Phakathi kwezingane ezake zagonyelwa ukugonywa njalo, abazali/abanakekeli abayi-184 (79%) babenamakhadi okugoma izingane. Isamba sesisonke sezingane ezithole ukugonywa okugcwele okusebenzayo kwaba ngama-81 (27%), ama-39 (13%) agonywe ingxenye kanti eziyi-180 (60%) azigonyiwe. Okutholakele kuveza amabanga amade lapho okugonywa khona (56; 19%), amahlebezi amabi (89; 30%) kanye nesikhathi eside sokulinda (55; 18.3%) njengezinye zezithiyo ezinkulu zokungagomi izingane. Ezikhungweni zezempilo eziqashiwe ezingama-64, ama-46%, 67% kanye nama-64% okungenani anelungu elilodwa labasebenzi bezempilo abaqeqeshiwe, ezitholakalayo ukuze zifinyelele kuzo zonke izifunda noma umphakathi futhi zibe nohlelo oluncane lokuhlinzeka ngemithi yokugoma ethile, ngokulandelana. Cishe ingxenye (30; 47%) yezikhungo zokunakekelwa kwempilo inenani elilinganayo lemijovo yokugoma enesici sokuvimbela ukusetshenziswa kabusha nemijovo yokuvuselela kabusha, futhi ngaphezu kwezingxenye ezintathu (51; 80%) zamazinga okushisa esiqandisi aqashwe kabili nsuku zonke. Imiphumela echazayo: Izindikimba ezine zavela emininingwaneni: izinselele ngohlelo lokugoma, ukutholakala okuphansi kokugoma, ulwazi oluncane lwabazali/abanakekeli mayelana nokugoma, nokubamba iqhaza okuncane komphakathi ensizakalweni yokugoma. Isiphetho: Okutholwe ngocwaningo oluchazayo kusetshenziswe ukuthuthukisa ukuqonda okuphathekayo kwesihloko socwaningo. Umseshi wenze imihlahlandlela yokugoma ukuze kuthuthukiswe izinhlelo zokugoma kwezingane emiphakathini yabafuyi kanye nokuqondisa ochwepheshe bezempilo kanye nabalingani abasebenzisa ukugoma ukuze kuthuthukiswe ukutholakala kokugoma nokunciphisa inani lezingane ezingagonyiwe.