Spotlight on missed children
Polio campaigns in Chad continue to miss large numbers of children, as demonstrated by ongoing virus transmission, and the low immunity status of AFP cases. Over 10% of non-polio AFP cases in Chad have received no doses of OPV. Although national coverage averages 90%, many provinces continue to miss upwards of 20% of children, particularly in Lac, Salamat, Mayo Kebbi Ouest, Wadi Fira and communities around the capital, N’Djamena (see Figure CHD1).
Why are we missing children?
According to October LQAS data conducted in 14 high risk districts, the major reasons for missed children were “house not visited by vaccination team” (59%) and “child absent” (36%) at the time of vaccinators’ visit. Refusals accounted for only 5% of missed children.
Independent monitoring data conducted nationally, on the other hand, shows child absence as the main reason for missed children, with 62% of children missed for this reason, and 27% of children missed due to “no team” (see Figure CHD2).
Low awareness and child absence
Monitoring data from 2011 shows consistently that in areas with low awareness levels (less than 80%), a high proportion of children are missed due to child absent. Logically, parents are not as prepared to participate in the polio eradication effort if they are not aware of the dates of the campaigns (see Figure CHD3).
The 2011 KAP study conducted in three regions (N’Djamena, Logone Oriental and Moyen Chari) suggests that a combination of low awareness, low threat perception of polio, and concerns over vaccine safety are key issues contributing to low demand for OPV, resulting in low participation in polio campaigns. Findings from qualitative research conducted in the N’Djamena area also suggest that caregivers do not trust vaccinators who come to the door due to their young age, and inability to engage families on issues related to immunization. The study also suggested that in some cases, parents may even be hiding their children from such vaccinators, which could be a contributing factor leading to high rates of child absence.
During 2011, the programme developed provincial level communication strategies and initiated a national mass media strategy, but lacked the human resources to implement at field level. As a result, activities were often ad-hoc, and rolled out without consistency or continuity in terms of programme support. Operational priorities also drew scarce resources away from communication activities.
Microplans at the zone (community), district and regional levels have been weak, and do not include communication activities at planning or implementation level. This is further compounded by the low capacity and lack of supervision of Village Chiefs, who act as both vaccinators and community mobilizers.
Chad also faces low levels of commitment at provincial and district levels, which often cover vast geographic areas lacking basic infrastructure, limited media access and a mostly illiterate population. So far Chad has not faced organized or deeply rooted resistance to OPV. It is therefore likely that the programme will demonstrate progress quickly, once increased resources and stronger management mechanisms can be put in place.