Elsevier

Vaccine

Volume 31, Issue 9, 18 February 2013, Pages 1259-1263
Vaccine

Brief report
Use of measles supplemental immunization activities (SIAs) as a delivery platform for other maternal and child health interventions: Opportunities and challenges

https://doi.org/10.1016/j.vaccine.2012.09.044Get rights and content

Abstract

Measles supplementary immunization activities (SIAs) offer children in countries with weaker immunization delivery systems like India a second opportunity for measles vaccination. They could also provide a platform to deliver additional interventions, but the feasibility and acceptability of including add-ons is uncertain. We surveyed Indian programme officers involved in the current (2010–2012) measles SIAs concerning opportunities and challenges of using SIAs as a delivery platform for other maternal and child health interventions. Respondents felt that an expanded SIA strategy including add-ons could be of great value in improving access and efficiency. They viewed management challenges, logistics, and safety as the most important potential barriers. They proposed that additional interventions be selected using several criteria, of which importance of the health problem, safety, and contribution to health equity figured most prominently. For children, they recommended inclusion of basic interventions to address nutritional deficiencies, diarrhoea and parasites over vaccines. For mothers, micronutrient interventions were highest ranked.

Highlights

► Programme officers from all 14 Indian states delivering measles SIAs responded to a survey. ► Respondents strongly support use of SIAs to deliver other maternal and child health interventions. ► Management challenges, logistics and safety may vitiate an expanded SIA strategy. ► Respondents recommended inclusion of non-vaccine over vaccine interventions. ► Nutritional screening should be added to future follow-up SIAs in India.

Introduction

WHO and UNICEF recommend delivering two doses of measles-containing vaccine (MCV) to all children through routine services and supplementary immunization activities (SIAs) [1], [2]. Intensified vaccination efforts have dramatically reduced measles mortality and increased child survival [1]. Globally, reductions in measles mortality due to widespread vaccination accounted for 23% of the estimated decline in all-cause child mortality from 1990 to 2008 [2], [3]. However, millions of children remain as yet unprotected.

Although their primary purpose is delivery of a specific vaccine, WHO and UNICEF promote the use of SIAs to strengthen health services [4]. India, one of the 47 priority countries where measles burden is highest, represents a key country to investigate the potential for such an approach. Of the estimated 19.1 million children in 2010 who never received a first dose of measles vaccine, 6.7 million (35%) were in India [2].

To accelerate its measles control efforts, between 2010 and 2012, India is delivering a second opportunity for measles-containing vaccine (MCV) through mass vaccination campaigns targeting 135 million children aged 9 months to 10 years. The measles SIAs are taking place in 14 of India's 28 states and 7 union territories selected due to low (<80%) coverage of the first dose of MCV [1]. These 14 states contain 52% of India's population and have relatively weak access to health services, particularly in rural or hard-to-reach areas and among the poor (Table 1).

At this juncture, Indian states offering the measles SIAs have not planned to use the SIA platform to offer other interventions. A more comprehensive SIA design has the potential to increase efficiency and improve health service delivery to the underserved, but these considerations have never been formally assessed in this context. To understand the opportunities and challenges related to use of measles SIAs as a delivery platform for other child and maternal health interventions, we conducted a survey of stakeholders involved in India's current measles SIAs.

Section snippets

Methods

We administered a questionnaire to programme officers involved in delivery of India's measles SIAs. The questionnaire considered characteristics important for policy design, including disease burden, cost-effectiveness, feasibility, logistics, equity, affordability, and budget impact. Questionnaire options were based on studies concerning the benefits and risks of a broader SIA strategy [7], [8], candidate add-on health interventions [2], [7], [8], [9], and outcomes of interest to policymakers

Survey respondents

Officers from all 14 state immunization programmes participated in the survey; the response rate was 100%. The survey took an average of 2.5 (range 1.5–5) h to complete. Twenty-three questionnaires were received: 3 from Manipur, 2 each from Arunachal Pradesh, Assam, Jharkhand, Madhya Pradesh, Meghalaya, Tripura and Uttar Pradesh, and a single survey representing a consensus view from the remaining 6 states. Results summarize responses for all 14 states.

Benefits and risks of broadening the scope of the measles SIAs

On a scale of 1–5, respondents strongly

Discussion

State programme officers involved in delivery of India's measles SIAs felt that integrating health services onto the immunization platform could be of great value in the Indian context. They viewed an expanded SIA as a potentially effective means to reinforce and extend the reach of health services, and thus as beneficial for attainment of national objectives such as the Millennium Development Goals. While conscious of the need for careful policy design [8] and consideration of health system

Author roles

MJ designed the study, analyzed the data and drafted the article. JKS conducted the interviews, and contributed to study design, interpretation of the data, and critical revision of the article for important intellectual content. M. Jit and SV contributed to study design, analysis and interpretation of the data, and critical revision of the article. All authors have approved the final version.

Role of the funding source

This study was funded by the World Health Organization (WHO)’s Initiative for Vaccine Research (IVR). The study sponsor played no role in study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication.

Conflict of interest

The authors declare that they have no conflicts of interest, financial or otherwise, in the conduct of this work.

Acknowledgements

This study could not have been completed without the support and guidance of Dr. Pradeep Haldar (Deputy Commissioner Immunization), Universal Immunization Program (UIP), Ministry of Health and Family Welfare, New Delhi, India. We would also like to thank the following individuals and organizations: Dr. Hema Gogia (UIP), Tony Burton, Alya Dabbagh, Rudi Eggers, Emily Simons, Peter Strebel (World Health Organization (WHO) Accelerated Disease Control Team (ADCT)); Kaushik Banerjee (WHO Department

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