Article révisé par les pairs
Résumé : Abstract Two simple methods were employed for evaluating immunization activities in three rural health districts of Zaire, with a view to improving service delivery. One method involves the use of cumulative frequency graphs for monitoring progress at the health centre level towards the achievement of coverage targets. The other requires a clinic-based audit and a population-based survey of children aged 12-23 months to ascertain whether they have been immunized against measles at the appropriate time. These approaches can help to identify operational problems and to motivate the people in charge of immunization at local level. PIP: In Zaire, immunization activities in 3 rural health districts were evaluated using 2 simple methods designed to measure the quality of immunization coverage at the local level. The quality of an immunization program is linked to the administration of the proper doses of vaccine at the proper times; missed opportunities and dropouts reduce the effectiveness of a program. One assessment method, therefore, used the cumulative frequency graph recommended by WHO which shows, in monthly intervals, the number of percentage of children who have to be vaccinated to obtain targeted yearly coverage. By adding the figures for all preceding monthly intervals, the cumulative number is reached. The final graphs shows expected and actual numbers. Multiplication of a targeted population by its estimated birth rate gives the number of children to be immunized monthly to achieve complete coverage of a birth cohort. Graphs for 1989 revealed problems such as a lack of vaccine in March and April and a widening gap between the number of children who received their first and third doses of polio and DPT vaccines. In 1990, the staff took measures to correct problems revealed by the 1989 graph. For the second assessment method, records of all children 12-23 months old were checked to determine if the child received measles vaccine--which is likely to be omitted in an incomplete vaccination program. This clinic-based audit gives a quick estimate of the proportion of vaccinated children among clinic clients and the proportion immunized at the proper time and allows local health managers to determine the ability of auxiliary nurses to schedule the administration of vaccines. To gather data on children who do not attend health centers, a population-based survey is useful. In January 1990, therefore, the whole 1988 birth cohort in 3 health areas was enrolled in a retrospective health survey. Of the 1771 children 1523 were registered at a clinic, 1251 were vaccinated, and 272 were not. The proportions differed among he 3 health areas and allowed useful comparisons which showed that the proportions were associated with paternal education level, maternal educational level, and distance from the clinic. This study identified the need for a network of outreach sites and indicated when health workers needed additional training and supervision. By focusing on the vaccination process, these assessment methods identify operational problems and motivate the people in charge of local level immunization to achieve better results. PMID: 8397734