|Year : 2010 | Volume
| Issue : 4 | Page : 224-227
Monitoring of mass measles campaign in AILA-affected areas of West Bengal
Samir Dasgupta1, Saumendra Nath Bagchi2, Pramit Ghosh3, Jadab Chandra Sardar3, Amal Sinha Roy3, Manabendra Sau4
1 Professor and Head, Department of Community Medicine, Medical College, Kolkata and Project Director, West Bengal State Immunisation Support Cell, Kolkata, India
2 Project Manager, West Bengal State Immunisation Support Cell, Kolkata, India
3 Assistant Professor, Department of Community Medicine, Medical College, Kolkata, India
4 Demonstrator, Department of Community Medicine, Medical College, Kolkata, India
|Date of Web Publication||3-Mar-2011|
Assistant Professor, Department of Community Medicine, Medical College, Kolkata
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A mass measles campaign was organized in AILA-affected areas of West Bengal in July-August 2009. The present cross-sectional study was conducted with the objectives to monitor and assess the cold chain maintenance, safe injection practices, IEC methods adopted, and to observe the conduction of the sessions in the campaign. All the cold chain points at the block level had adequate vaccines and equipments, twice monitoring of temperature which was in optimal range. 82% sessions had team according to microplan, AWW was present and team members were actively mobilizing the children in 83% sessions, puncture proof container was used and vaccines were given in correct sites in more than 95% sessions. The study observed satisfactory conduction of the whole campaign, still the injection safety procedures should be strengthened considering the potential harm to the health care providers.
Keywords: AILA, Cold chain, Injection safety, Mass measles campaign
|How to cite this article:|
Dasgupta S, Bagchi SN, Ghosh P, Sardar JC, Roy AS, Sau M. Monitoring of mass measles campaign in AILA-affected areas of West Bengal. Indian J Public Health 2010;54:224-7
|How to cite this URL:|
Dasgupta S, Bagchi SN, Ghosh P, Sardar JC, Roy AS, Sau M. Monitoring of mass measles campaign in AILA-affected areas of West Bengal. Indian J Public Health [serial online] 2010 [cited 2019 Oct 18];54:224-7. Available from: http://www.ijph.in/text.asp?2010/54/4/224/77267
Destruction of houses, breakdown of water supplies and sanitation, overcrowding, and disrupted health care services, all render the disaster-affected populations highly vulnerable to outbreaks of infectious diseases especially measles, which can be successfully prevented by prophylactic immunization. WHO and UNICEF recommend vaccinating all children from 6 months through 14 years of age with measles vaccine along with vitamin A supplementation during emergencies. 
On 25 May 2009 one devastating cyclone named AILA hit the coastal areas of West Bengal, an eastern state of India, and affected an enormous area of seven deltaic and riverine blocks of the state (Map)[Additional file 1]. Ministry of Health and Family Welfare, Govt. of West Bengal and UNICEF, Kolkata office decided to undertake a mass measles vaccination campaign in the affected blocks in last week of June. West Bengal State Immunization Support Cell (WBSISC), a techno-managerial support group formulated in collaboration with Department of Community Medicine, Medical College, Kolkata, Ministry of Health and Family Welfare, Govt. of West Bengal and UNICEF, Kolkata took the leading role in organization, supervision, monitoring, and evaluation of the whole campaign.
The present cross-sectional study had been conducted with the objectives of to assess the cold chain maintenance in the Block Primary Health centers and camp situations during the campaign, to observe whether the safe injection practices were being followed by the vaccinators, to assess the IEC methods adopted and as a whole conduction of the sessions in the campaign.
WBSISC organized a state-level workshop in the last week of June 2009 to review the campaign guidelines and develop a proforma for campaign monitoring. This was followed by a sensitization workshop for microplanning of the campaign and a training program involving all ANMs (Auxiliary Nurse Midwife) and supervisors at the block level, where 423 vaccinators and 59 supervisors were trained. It was decided to form a four member team at each session site consisting of one vaccinator assisted by grass root level workers like AWW (Anganwadi workers), ASHA (Acredited Social Health Activist), trained birth attendants, link persons and field volunteers. Extensive social mobilization was undertaken through mass media, using loudspeakers, postering, leaflet distribution, and inter-personal communication by community-level volunteers. To ensure safe disposal of immunization waste, the ANMs and block health officials were instructed to follow the guidelines as per bio-medical waste (Management and handling) rules, Ministry of Health and Family Welfare, Government of India. 
A proforma was planned and prepared in a workshop during the planning phase of the campaign for monitoring the sessions. Ethical clearance was taken from Medical College authority. The parameters for monitoring were expiry date of the vaccines, diluents, and vitamin A used, presence of team members according to microplan, status of cold chain, shortage of vaccine and logistics, injection safety, site and route of vaccine administration, maintenance of records and source of IEC, and social mobilization. Techniques followed were observation of the session by a check list and interview of the care givers of the beneficiaries present at the session. It was planned that each monitor would try to cover three to five sessions on each day of monitoring based on the distance to be traveled and feasibility, try to observe vaccination, and to interview up to five care givers. During monitoring of a particular session, the monitor would interview 5 mothers or caregivers came for measles vaccination to the session chronologically as they were listed with the ANM. If less than five beneficiaries were available, then the monitor would wait for the mothers to come; however, all the time it might not be possible to include five beneficiaries each from all sessions, especially in the late hours of the day.
The monitor would also try to have an overview of cold chain maintenance, distribution of vaccines, and logistics at the cold chain points at block and PHC levels to find out the problems if any for successful implementation of the campaign. The measles campaign has been conducted in difficult to reach areas in adverse situations facing all possible odds, so it was not possible to determine a sample size and sampling technique beforehand.
The mass measles campaign was conducted in the blocks, namely Sandeshkhali I and II and Hingalgunj in the district of North 24 Parganas and Basanti, Gosaba, Patharpratima, and Kultali in the district of South 24 Parganas covering a population of 16,29,762 living in 703 villages. The characteristics of these blocks included riverine and deltaic features (as evident from the attached map), dense forest (famous as Sundarban Tiger Reserve which was declared as World Heritage Site by UNESCO), scattered population, and poor communication facilities. The campaign was launched on 16 July 2009, continued in two phases up to 7 August. Days of activity varied from block to block, namely 20 days in Gosaba to 8 days in Sandeshkhali I due to difference in approach and availability of manpower. Total 1747 sessions were held in the first phase and 422 sessions in the second phase to immunize the left outs with a total of 2169 sessions. Out of 2169 total sessions, 523 sessions were in adverse situations like difficult to reach areas, with poor routine immunisation status and areas with vacant subcenters. Out of 98 monitored sessions, 51 sessions were in adverse situations as mentioned above. A total of 557 caregivers could be interviewed.
For measles campaign in seven blocks, 16 cold chain points were being operated with one designated person for each point for cold chain handling during the period of campaign. Monitoring of the cold chain points revealed that all cold chain equipments had not been attached with voltage stabilizer but all having functional thermometers and 24 h generator back up services had been ensured throughout the period. Block Public Health Nurse (BPHN) was the key person for organization of delivery of the vaccines to the campaign sites. Review of cold chain at block level did not observe any shortage of cold chain apparatus; temperature was being monitored twice and temperature was within the optimal range. No shortage of logistic and vaccine was reported. Vaccines were sent in zipper bag in vaccine carriers and for vaccine transportation to the session site, all the modes of transport, namely boats, auto rickshaws, engine vans, paddle vans, and link persons were utilized. Hub cutter was used to cut the needle and these needles were collected in the puncture-proof translucent container at the immunization site. From each camp, these translucent containers were collected at the end of each session while collecting unused vaccines for ultimate disposal by Sem Rambky, authorized organization for biomedical waste disposal in West Bengal. Out of total 172 IEC activities in the campaign area, 57% was conducted by van, 30.2% by auto and 12.8% with the help of boat. One representative from WBSISC was posted in the block to actively assist the whole campaign procedure.
Monitoring of the sessions revealed that manufacturer of measles vaccine and diluent was Serum Institute of India and for vitamin A were Gluconate India and Nicolus. All vaccines and vitamin A were within expiry date [Table 1]. Session site could be distinguished by display of banners in all sessions. As per the campaign guidelines, 92% team had four members; AWW was present in 82.7% teams followed by ASHA (53%), Link person (44.9%), other workers (40.8%), TBA (24.5%), and PRI (5.1%). A total of 557 caregivers could be interviewed regarding the source of information about the campaign and it was revealed that the predominant source was AWW (35%) [Figure 1]. In only 60% sessions, reconstitution time was written over the vials and in 58% sessions recapping was done by the ANMs in spite of a detailed training beforehand.
|Table 1: Conduction of session, maintenance of cold chain, and injection safety at session site (n= 98)|
Click here to view
Mass measles vaccination had been conducted successfully in several countries following a disaster situation. Lessons from Bihar during Koshi flood  and Dafur, Sudan  had shown that proper microplanning is absolutely essential for effective implementation of a mass measles vaccination. Though vaccine delivery is a priority area, but safety issues, i.e. using autodisable syringes and safety boxes were gaining increasingly more attention as observed by Pless et al. But Hersh et al. felt equally important issues are careful planning and managerial activities that include policy and strategy development, financing, budgeting, logistics, training, supervision, and monitoring. Matoo  identified the need of adequate supplies of cold chain equipments, auto-destruct syringes, safety boxes, monitoring forms, vaccination cards, tally sheets in this connection. Similar to the present experience at AILA-affected areas, cold chains were maintained by diesel generators, vaccines were carried by boat, porters, even by helicopters in Bihar after Koshi flood. 
The study observed satisfactory conduction of the whole campaign, still the injection safety procedures should be strengthened considering the potential harm to the health care providers and community.
The authors deeply acknowledge Unicef, Kolkata and Department of Health and Family Welfare, Govt. of West Bengal for providing support to the study.
| References|| |
|1.||WHO UNICEF Joint statement. Reducing measles mortality in complex emergencies. WHO/V andB/04.03; 2004 |
|2.||Government of India, Ministry of Health and Family Welfare. Bio-medical waste (Managemrnt and handling) rules. Available from: http://www.delhigovt.nic.in/dept/health/bmwm.asp [last cited on 2010 Jan 26]. |
|3.||Varkey S, Krishna G, Pradhan N, Gupta SK, Caravotta J, Hombergh HV, et al. Measles vaccination response during Koshi floods, Bihar, India 2008. Indian Pediatr 2009;46:997-1002. |
|4.||Elsayed EA, Mousa N, Dabbagh A. Emergency Measles Control Activities-Darfur, Sudan, 2004. MMWR Morb Mortal Wkly Rep 2004;53:897-89. |
|5.||Pless RP, Bentsi-Enchill AD, Duclos P. Monitoring vaccine safety during measles mass immunization campaigns: Clinical and programmatic issues. J Infect Dis 2003;187:S291-8. |
|6.||Hersh BS, Carr RM, Fitzner J, Goodman TS, Mayers GF, Everts H, et al. Ensuring injection safety during measles immunization campaigns: More than auto-disable syringes and safety boxes. J Infect Dis 2003;187:S299-306. |
|7.||Matoo TK. Disasters and Immunization. Indian Journal for the Practising Doctor 2005-09 - 2005-10;2(4). Available from: http://www.indmedica.com/journals.php [last cited on 2009 Nov 20]. |