Assessment of Expanded Programme on Immunization Service Utilization in Sekyere West District of Ashanti Region, Ghana

Background: This project work presents a comparative study of the implementation of global WHO standards for expanded programme on immunization, and EPI yearly records at the district level within the health sector. The purpose of this project was to develop an understanding of the linkages between mothers’ attendance at immunization sessions and the gross effect on EPI service utilization, which is, immunization status of both children and the mothers, with special emphasis on measuring parameters like coverage and drop out rates in Sekyere West. The general objective of the study was to assess the expanded programme on immunization service utilization in the Sekyere West District Health Directorate. The study examined and compared the EPI coverage levels and drop out rates, the major reasons for immunization failure, the immunization coverage status of mothers for tetanus toxoid vaccine, and immunization strategy preferred by MCH/FP staff at the various health facilities. Methods: The immunization status of one hundred and ninety three children (aged 12-24 months) and one hundred and ninety three mothers (aged 19-45 years) were determined by interviewing mothers who were selected by employing cluster probability sampling technique. A review of immunization history was done for confirmation from immunization cards of children and mothers’ maternity cards (where available). A focus group discussion with the health service providers was conducted to find out the preferred immunization strategy with special emphasis on ranking/scoring all the approved strategies. Findings: Overall, default rate for the entire recommended series of vaccines was 15.0 percent and a coverage level of 92.7 percent for children immunization. Further, partially immunized children were 14.5 percent and fully immunized stood at 85.5 percent. Only 14 percent of entire mothers interviewed had received all the five doses of tetanus toxoid vaccine prescribed by WHO as an intervention for both maternal and neonatal tetanus. The major reason for immunization failure for children was obstacles and prominent amongst the reasons being postponement of immunization session(s) until another time. MCH/FP staff at the facility level preferred outreach services most that is 43 percent to the rest of the immunization strategies approved and under full operation by Ghana Health Services nationwide. Conclusions: The coverage level for infant immunization was fairly good since the finding was above what has been prescribed as worldwide indicator by WHO. However, the immunization status of mothers was unacceptable because 86 percent of mothers interviewed had not gotten full immunization status (permanent protection). Immunization clinic appointment default rate was still high. Postponement of immunization schedules was the most common reason for failure. MCH/FP confirmed outreach services as the best strategy for immunization blended with regular home visits. The key recommendation given was that the MCH staff should embark on educational campaigns at ANC and postnatal sessions on the number of vaccines each child and/or mother is supposed to receive to complete the entire immunization programme.

Source: KNUST