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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3396.0: Monday, December 12, 2005 - 8:50 PM

Abstract #102497

'Chasing children’ in rural Ghana: Do Community-based Health Planning and Services improve the chances of complete and correct child immunization?

J. Koku Awoonor-Williams, MD, MPH1, Ellie Feinglass, MPH2, James Phillips, PhD2, and Maya Vaughan-Smith, MPP2. (1) District Director, Nkwanta District Health Administration, Ghana Health Service, P.O. Box 54, Nkwanta, Volta Region, Ghana, 233-20-816-1394, kawoonor@hotmail.com, (2) Policy Research Division, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017

Improving childhood immunization coverage is a centerpiece of Ghana's Community-based Health Planning and Services (CHPS) Initiative. CHPS has been organized more in the manner of a social movement than a bureaucratic process. From the community level to the most senior political leaders and health officials, strategies have aimed to build broad consensus around decentralized action. CHPS involves establishing village supervision and collective ownership of health activities. It aims to eliminate the financial, logistical, and cultural barriers that so often undermine positive parental health-seeking behaviour. In addition to its focus on expanding access to and use of safe and cost-effective vaccines, CHPS promotes the delivery of regular growth monitoring and vitamin A supplements at immunization contacts. 2002 Nkwanta survey results demonstrate that children living in areas exposed to the CHPS programme were 1.6 times more likely to be immunized compared to children not exposed to the programme (p<.01). CHPS also had a positive impact on child health record keeping; regression analysis showed that children in CHPS areas were over 2 times more likely to have a health card, controlling for age of mother, child's age, mother's education, birth order, sex, and household wealth indicators (p<.01). Within CHPS zones, 65% of CHPS children aged 12-24 months at the time of the survey were fully immunized. To be considered ‘fully vaccinated' according to WHO standards, a child must receive BCG, measles, the complete polio series, and the complete DPT/Penta series by the age of 12 months. Taking a closer look at coverage by antigen, it becomes apparent that even in CHPS areas, which were comparably better off, coverage ranged from 73% for measles to 80% for BCG. Thus, while immunization coverage is better in CHPS areas than in non-program areas, there is ample room for improvement. Based on this information, the NHDC has focused on identifying and addressing the reasons for missed opportunities to reach children during both static and door-to-door outreach in CHPS communities. This paper not only compares 2004 district-wide survey results to those from 2002 to measure improvement in immunization rates over time, but it also investigates cultural determinants of why female children may be easier to ‘chase' than boys.

Learning Objectives:

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

[ Recorded presentation ] Recorded presentation

Improving the Effectiveness of Immunization Programs

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA