Effectiveness of PHCU interventions and enhanced headcount to address zero dose and under-immunized children in pastoralist communities: experience from Afar and Somali regions, Ethiopia.

BACKGROUND: Reaching and vaccinating zero dose and under-immunized children requires effective strategies and quality data. Primary health care unit level interventions like hands-on training, mentoring, participatory planning and review and enhanced headcount of under two-year children were implemented in four primary health care units Afar and Somali regions. The aim of this manuscript is to describe and share the experience on the effectiveness of these interventions in reaching and vaccinating zero-dose and under immunized children through well planned headcount. METHOD: The intended interventions were implemented in four purposely selected woredas from Afar and Somali regions. One primary health care unit was chosen from each woreda based on different criteria. Following the interventions, headcount of under two-year children was conducted in all villages of four primary health care units' catchment with active engagement of community leaders. Modified periodic enhanced routine immunization template was used to register enumerated children. Identified zero-dose and under immunized children were referred to nearby immunization sites with referral slip for vaccination. Immunization indicators and the reason for missing immunization, descriptive analysis done using Microsoft Excel. RESULT: Improved primary health care linkage coupled with strengthened capacity enabled primary health care units to conduct enhanced head count to identify and vaccinate unreached children. The headcount led to the identification of 390 (24%) never vaccinated and 185 (11%) under-immunized children among 1478 enumerated 6 weeks-11 months children in 21 HPs under four primary health care units. Among 1,619 enumerated 12-23 months children, 332 (21%) were zero-doses and 355 (22%) were under-immunized children. Through referral linkage to immunization service, 92% (357/390) of never vaccinated and 97% (179/185) under-immunized 6 weeks - 11 months children were subsequently vaccinated for vaccines they missed. Likewise, 94% (620/658) above one-year children were vaccinated for the measles vaccine. The reasons for failure to vaccinate for 12-23 months old children were access barriers in 70% followed by lack of knowledge (15%). CONCLUSION AND RECOMMENDATIONS: Strengthening the primary health care unit linkage and its technical and managerial capacity accompanied by headcount through the involvement of community leaders can benefit the identification and reach of children missing vaccination and other essential health services.