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Vaccinating Haiti's children

By Michelle Osmond

Despite advanced strategies and national campaigns, many children in Haiti are not fully vacci­nated. Dr. Donna Moralejo and her team wanted to find out why.
Dr. Moralejo, a professor in the School of Nursing, is co-principal investigator on the project Determinants of Non-Vaccination of Children in the Nippes Region of Haiti. She collaborated with members of the Association de santé publique d'Haïti (ASPHA) and the Canadian Public Health Association. They documented and analyzed the causes of immunization drop-out in 20 districts of the Département Sanitaire des Nippes and, together with community leaders, identified strategies to improve the vaccination process.

"The focus was not on providing clinical services but on capacity building and addressing one specific problem – how to increase vaccination coverage in one health department," noted Dr. Moralejo.

First, the research team surveyed 240 Haitian households (308 children aged one to five years). What they found was that overall, 62 per cent of children were completely vaccinated. This varied by district however, with fewer than 50 per cent of children being completely vaccinated in five of 20 districts. Only three of the districts met the World Health Organization (WHO) target coverage rate of 80 per cent being completely vaccinated.

Surprisingly, even though about half of the participants in the survey lived more than a 30-minute walk from a health centre, physical access was not the most important reason for incomplete vaccination.

Mothers' knowledge and beliefs and poor organization of health services were found to be more important. Caregivers were also reluctant to subject their children to the side effects, especially since acetaminophen is not readily available. Age, birth order (younger children, or those who were third or higher in birth order in larger families, were less likely to be completed vaccinated) and a lack of post-partum consultation were contributing factors, as well.

The team then conducted focus groups with healthcare workers, mothers and guardians, community leaders and traditional practitioners. The focus groups identified possible strategies for reorganizing vaccination services, including going door-to-door, holding vaccination clinics in community locations such as local markets, getting community members involved in campaigns and training local workers just for vaccination services.

This project also aimed to strengthen the research capacity of ASPHA.
"They now have research experience and are better prepared to fulfill their mission of organizing programs and activities based on local evidence," Dr. Moralejo said. "ASPHA members have a tool kit that can be used as a template for similar types of studies, and they have experienced research assistants trained for data collection. And based on this project, they also have better communication and collaboration within and between departments and agencies."

The collaborative project with Haiti began in 2009 but groundwork, which was supposed to begin in February 2010, got delayed until the following October due to the devastating earthquake in January, the cholera epidemic and the national elections.

Dr. Moralejo and her team received nearly $100,000 for the Initiative in Global Health Research through the Canadian International Immunization Initiative for Haiti. It was Dr. Moralejo's second project in Haiti. The first was in 2002 related to the WHO's Stop Transmission of Polio program.