RESUMO
BACKGROUND: Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of "non-selective" measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign. METHODS: We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs. RESULTS: The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs. CONCLUSIONS: Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.
RESUMO
Conflict has a negative effect on immunization outcomes leading to epidemics of measles and other vaccine preventable diseases. Borno state, located in the North-Eastern parts of the country, started experiencing insurgency since 2009 by a militant group commonly referred to as "Boko Haram", leading to displacement of numerous persons from their homes. The state government created internally displaced persons (IDPs) camps with an estimated 600,000 persons and over 100,000 children aged 9 - 59 months. We explored the challenges in implementing the measles campaign in 2017 and its effect on measles elimination and control efforts in Borno State. METHODS: We conducted a retrospective review of the measles surveillance data from the Integrated disease surveillance and response (IDSR), the early warning alert and response system (EWARS), Measles SIA implementation strategy reports and the Post campaign evaluation survey data. RESULT: Seven (26%) of the 27 LGAs had security challenges in Borno state in November 2017. Following the measles campaign, 30 EAs were surveyed as part of the post campaign evaluation with a coverage validation of 72%, the lowest reported state level coverage in the country. Reported measles cases in the age cohort <1Year increased in 2018 by 14.3% compared to 2017. CONCLUSION: Despite the security challenges in Borno state, the 2017 measles SIA was conducted with the post campaign evaluation highlighting some areas of suboptimal performance. There remains a need to review the required strategies for successful implementation in Borno and other states affected by security challenges. The reestablishment of holding camps and vaccination posts at all entry points into IDP camps and host communities to ensure new entrants are screened and vaccinated with the measles vaccines, as has been successful in the polio programme in Nigeria will promotes efforts towards Measles control in the state.