Age- and cause-specific childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing Haemophilus influenzae type b and pneumococcal vaccines.

Using age and cause-specific childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing Haemophilus influenzae type b (Hib) and pneumococcal vaccines, the study describes a cross-sectional, hamlet-level mortality survey in 40 of 305 villages in Lombok Island, Indonesia. Causes of death were assessed with a standardized verbal-autopsy questionnaire. One thousand four hundred ninety-nine births and 141 deaths occurring among children aged less than 2 years were identified, with 43% of deaths occurring during the first 2 months of life. The infant mortality rate was 89 (95% CI: 75, 104) per 1,000 live-births. All mortality rates are reported per 1,000 live-births. To examine children whose deaths could potentially have been prevented through vaccination with Hib or pneumococcal vaccine, deaths due to acute respiratory infection (ARI) and central nervous system (CNS) infections among children, aged 2-23 months, were analyzed. ARI and CNS infections caused 58% (mortality rate: 31 per 1,000 live-births; 95% CI: 23, 41) and 17% (mortality rate: 9 per 1,000 live-births; 95% CI: 5, 16), respectively, of all deaths within this age group. Between the ages of 2 and 23 months, 5% of all babies born alive died of ARI, and another 1% died of CNS infections. Our results indicate that current efforts to reduce childhood mortality should focus on reducing ARI and meningitis. These efforts should include evaluating the impact of Hib and pneumococcal vaccines within the routine Expanded Programme on Immunization system.

Use of SoloShot autodestruct syringes compared with disposable syringes, in a national immunization campaign in Indonesia.

Autodestruct syringes can reduce the improper reuse of syringes, which present a significant risk in the transmission of bloodborne pathogens in developing countries, especially during immunization campaigns owing to the high number of injections given per session. SoloShot is an autodestruct syringe, distributed by UNICEF, which has been shown to be safer and easier to use than standard syringes. This study analyses the accuracy and dose-efficiency of SoloShot, compared with disposable syringes, during a national tetanus toxoid immunization campaign on the Indonesian island of Lombok. Observation and dose measurements revealed that SoloShot syringes delivered more precise and consistent doses and 15% more doses per vial than disposable syringes. Vaccine savings may partially be offset by the higher price of SoloShot. Vaccinators preferred SoloShot, describing it as easier to use, faster, and more accurate than the disposable syringe. The study indicates that SoloShot is highly appropriate for use in immunization campaigns by reducing vaccine wastage and improving injection safety.

PIP: The reuse and improper sterilization of syringes used in immunization campaigns present significant risks of transmission of blood-borne pathogens. This study assessed the accuracy and dose-efficiency of SoloShot, an autodestruct syringe distributed by UNICEF, during a 1996 national tetanus toxoid immunization campaign on the Indonesian island of Lombok. The eight vaccinators were Indonesian Ministry of Health personnel and midwives from subdistrict health centers. Sites were randomly assigned to SoloShot or the disposable syringe. During the 4-day campaign, a total of 385 doses were delivered with SoloShot and 433 with the disposable syringe. SoloShot delivered an average of 1.02 (15%) more doses per vial than the disposable syringe and provided a mean dose closer to the ideal of 0.5 ml. As a result of a greater amount of dead space in the disposable syringe, an average of 2.6 doses of vaccine per vial were wasted compared with 1.2 doses for SoloShot. A questionnaire on user acceptability revealed that vaccinators preferred SoloShot on six of the nine indicators, including overall preference. SoloShot was considered faster, easier to use, and more accurate than the disposable syringe. Overall, these findings suggest that use of SoloShot in national immunization campaigns could reduce vaccine wastage while improving injection safety.