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SHORT COMMUNICATION
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 229-230

Improving measles vaccination coverage in South Sudan: The necessity to adopt a coordinated and multisectoral approach


1 Member of the Medical Education Unit and Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission11-Feb-2020
Date of Acceptance08-May-2020
Date of Web Publication17-Jun-2020

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) - Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu - 603108
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_9_20

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  Abstract 


Measles is a life-threatening infectious disease, accounting for the deaths of more than 140,000 deaths worldwide in 2018. It is worth noting that the incidence of the disease is extremely high in the low- and middle-income nations, which are having multiple other competing public health priorities, a weak health-care delivery system, or ongoing humanitarian emergencies. South Sudan has been subjected to long-term conflicts, and with regard to measles, it has been reported that more than 4700 cases and 26 deaths have been reported in the nation since the disease outbreak began last year. Keeping this in mind and in order to avert fatal consequences and accomplish 95% vaccine coverage, the international welfare agencies have joined their hands together and initiated a vaccination drive to immunize 2.5 million children across the entire nation along with the provision of Vitamin A and deworming tablets. In conclusion, considering the fact that measles is vaccine preventable and every child deserves the right to receive the vaccine, it is high time that we take necessary steps to ensure political leadership, strengthening of health facilities, and involvement of the parents so that the planned vaccination campaign can accomplish the intended results in the conflict-affected South Sudan.

Keywords: Measles, South Sudan, World Health Organization


How to cite this article:
Shrivastava SR, Shrivastava PS. Improving measles vaccination coverage in South Sudan: The necessity to adopt a coordinated and multisectoral approach. Med J Babylon 2020;17:229-30

How to cite this URL:
Shrivastava SR, Shrivastava PS. Improving measles vaccination coverage in South Sudan: The necessity to adopt a coordinated and multisectoral approach. Med J Babylon [serial online] 2020 [cited 2020 Jul 7];17:229-30. Available from: http://www.medjbabylon.org/text.asp?2020/17/2/229/287060




  Introduction Top


Measles is a life-threatening infectious disease, caused by a virus in the Paramyxovirus family, and it is usually transmitted through direct contact and airborne route. The causative virus initially affects the respiratory tract and then spreads throughout the body. It is a human disease and is not known to occur in animals and has accounted for the deaths of more than 140,000 million deaths worldwide in the year 2018.[1] It is an alarming situation considering that the majority of the disease-attributed deaths have been reported among children before they attain 5 years of age.[1] Moreover, considering that an extremely safe and cost-effective vaccine has been available for decades together, such huge estimates about the disease and associated mortality are difficult to digest.

Owing to the accelerated efforts and intensification of the measles vaccination campaigns across the globe has resulted in a 73% decline in diseaseattributed deaths between the period of 2000 and 2018, nevertheless a lot needs to be done. [1,2] Owing to the availability of the vaccine and its potential in reducing the disease incidence and mortality, the international leaders have aimed for the global elimination of the disease.[1] However, it is worth noting that the incidence of the disease is extremely high in the low- and middle-income nations, which are having multiple other competing public health priorities and a weak health-care delivery system.[1],[3] The situation becomes even more challenging in settings which are facing humanitarian emergencies due to the ongoing conflicts and an interruption in the routine public health-care services.[3],[4]

South Sudan: Measles outbreak and potential challenges

With regard to measles, it has been reported that in South Sudan, more than 4700 cases and 26 deaths have been reported in the nation since the outbreak began last year in the January month, and thus, there is an immense need to improve the children health through vaccination campaign.[4] The nation has been subjected to conflicts, which are still ongoing, and it comes as no surprise that there is always a potential risk for the emergence of new disease outbreaks in the nation.[4],[5] The nation has people from a wide range of ethnicities and owing to the ongoing conflicts in the different parts of the nation, there is a major concern for the safety of people as well as the health sector, and these are the main reasons because of which it becomes really difficult for the policymakers to effectively implement any health initiative in the nation.[5]

Moreover, we have to give due consideration that the overall problem of low vaccination coverage is further compounded by the presence of various other factors, such as malnutrition, population migration, overcrowded internally displaced camps, limited access to basic health-care services, shortage of health workforce to ensure timely immunization, inability to improve the nutritional status and health status of the general population, lack of a multisectoral approach, and minimal funding to finance health-care activities.[4],[5] Simultaneously, it is important to strengthen the practices of administration of Vitamin A, deworming and strategies to improve the nutritional, all of which are extremely crucial to improve the vaccination coverage in the nation. These additional measures will significantly aid in the effective containment of the outbreak. The attention toward these domains needs to be given as the simultaneous presence of these factors enhances the possibility of the development of life-threatening complications.[1],[4]

South Sudan: Measles coverage and interventions to improve coverage

However, the ground reality is that vaccine coverage for the disease is only 59%, which is extremely low considering the global average which is much more than 80%.[1],[4] Such low percentage of vaccine coverage is significantly affecting the herd immunity and makes all the under-five children highly susceptible for acquiring the infection. The journey to improve the vaccination coverage will be a challenging task, and it will essentially require a multisectoral approach, wherein the health sector takes the lead and is well supported by the Health Ministry and other conflicting parties and the local community. In fact, the international welfare agencies such as the World Health Organization and United Nations Children's Fund (UNICEF) have realized the magnitude of the problem and have deployed a number of emergency medical mobile teams in different areas of the nation to support the response of measles vaccination coverage.

Moreover, as the support from the local community is a must, the UNICEF has taken specific steps to improve social mobilization and community engagement-related activities apart from ensuring the availability of the vaccines and arranging for the necessary logistics required for maintaining the cold chain in the nation.[4] Keeping this in mind and in order to avert fatal consequences and accomplish 95% vaccine coverage, the international welfare agencies have joined their hands together and initiated a vaccination drive to immunize 2.5 million children across the entire nation.[4] Further, to enhance the effectiveness of the entire campaign and as an opportunistic strategy, it has been decided to couple vaccination with Vitamin A supplementation and deworming tablets as well.[4]

The campaign has been planned to run in two phases with the first phase concentrating on more than two-third of the counties and is expected to end in March 2020.[4] The campaign envisages that all the under-five children can be immunized with one dose of the vaccine regardless of their immunization status. However, the success of the initiative will largely depend on the support from the national public health authorities and support of the health-care workers, especially because most of the potential children are living in hard to reach localities.[1],[3],[4],[5],[6]


  Conclusion Top


In conclusion, considering the fact that measles is vaccine preventable and every child deserves the right to receive the vaccine, it is high time that we take necessary steps to ensure political leadership, strengthening of health facilities, and involvement of the parents so that the planned vaccination campaign can accomplish the intended results in the conflict-affected South Sudan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Measles – Key Facts. World Health Organization; 2019. Available from: https://www.who.int/news-room/fa ct-sheets/detail/measles. [Last accessed on 2020 Feb 11].  Back to cited text no. 1
    
2.
Shrivastava SR, Shrivastava PS. Implementing measures to minimize the measles-associated deaths and accomplish global elimination. Environ Dis 2018;3:88-9.  Back to cited text no. 2
  [Full text]  
3.
Sabahelzain MM, Moukhyer M, Dubé E, Hardan A, van den Borne B, Bosma H. Towards a further understanding of measles vaccine hesitancy in Khartoum state, Sudan: A qualitative study. PLoS One 2019;14:e0213882.  Back to cited text no. 3
    
4.
World Health Organization. South Sudan Launches a Nationwide Campaign to Protect 2.5 Million Children Against Measles. World Health Organization; 2020. Available from: https://www.afro.who.int/news/south-sudan-launches-nationwide-campaign-protect-25-million-chil dren-against-measles. [Last accessed on 2020 Feb 11].  Back to cited text no. 4
    
5.
BBC News. South Sudan Country Profile; 2018. Available from: https://www.bbc.com/news/world-africa-14069082. [Last accessed on 2020 May 07].  Back to cited text no. 5
    
6.
Shrivastava SR, Shrivastava PS, Ramasamy J. World Health Organization raises concern over the urgent need to respond to the multiple outbreaks of infectious diseases reported in South Sudan amidst the ongoing conflict. Ann Trop Med Public Health 2017;10:1407-8.  Back to cited text no. 6
  [Full text]  




 

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