Increasing Immunisation Coverage in Uganda

The Community Problem Solving and Strategy Development

Approach

Including a Job Aid in English and French: �Common Questions and Answers about Immunisation�

UNEPI November 2003

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INCREASING IMMUNISATION COVERAGE IN UGANDA: The Community Problem Solving and Strategy Development Approach

During the past decade, immunisation coverage in Uganda has been as low as 30% in some districts. Poor social mobilisation and insufficient community participation are two of the reasons identified as major contributing factors for poor coverage. A Knowledge, Attitude, and Practices survey in 1998 found that health workers were deficient in their understanding of immunisation and that community participation in immunisation services was low, despite the willingness of communities to fully support programs. The existing top-down approach of the health system and the lack of capacity building in interpersonal skills for health workers were found to be critical inhibitors to a successful immunisation program.

To address these challenges, the UNEPI (Uganda National Expanded Program on Immunisation) Policy and Revitalisation Plan of the National Health Policy and Health Sector Strategic Plan calls for community involvement in health and linkages between health workers and the community. This approach is aligned with the Reaching Every District (RED) strategy that was developed and supported by the GAVI partners, including UNICEF and WHO. The RED strategy identifies the need for �links between community and service�regular meetings between community and health staff� and states that �immunisation services need to integrate better into community structures in an environment of consultation between the community and health managers.� The Uganda MOH support of immunisation as a national health priority is now being facilitated by the Community Problem Solving and Strategy Development approach.

WHAT IS CPSSD? The Community Problem Solving and Strategy Development (CPSSD) activities in Uganda have been designed to help health workers learn to work with communities, understand community perspectives about the services, and encourage community support and participation in the delivery of services, so that immunisation coverage is raised and sustained. Immunisation coverage and drop out rate monitoring have been introduced to help health workers track their progress and provide information to the communities they serve.

Through CPSSD, health workers in health facilities (Health Centers II, III, and IV) are trained by a team of district facilitators (in turn supported by the UNEPI and BASICS II staff) in activities that involve community participation in immunisation programming. In the CPSSD approach:

• Health workers are encouraged by district facilitators to interview parents in their community to discover what these parents know about immunisation services and what their perceptions are about the services.

• Health workers then attend a three-day consultation with fellow health workers from their Health Sub-District (HSD) to compile and analyse the information gathered.

• During this consultation, facilitators share information that suggests a new approach to working with parents and communities. Then the health workers develop a plan of action to apply this new approach in one community, to learn more about how to communicate effectively with individuals and communities.

• Two months after the initial consultation, health workers attend a two-day second consultation during which they share their experiences, progress, and lessons learned; this encourages the workers to learn from others� experiences. The Drop Out Rate Monitoring Wall Chart and its use is introduced during this second consultation meeting. Charting and interpreting data are practiced.

• Following the second consultation, health workers return to their communities and perform outreach activities, such as making home visits, holding community meetings, calling sessions with local civic groups (Parish Development Committees) and LC III (Local Council) leaders, having regular discussions with community leaders, and forming partnerships with community mobilisers. During

Reaching Every District ≥80% or more DTP3 coverage in all districts in ≥80% of developing countries by 2005 through components such as establishing outreach, linking communities and health services, and monitoring performance at all levels.

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these activities, the health workers discuss information regarding immunisation, identify problems, and agree consensually on solutions to increase coverage in the community.

• At the end of each consultation, health workers develop a new action plan, then agree on a date for the next meeting for a continuous stream of information and education.

WHAT ARE THE RESULTS OF CPSSD? In addition to the health workers� individual plans, a strategy for each of the five project districts has been developed, based on the districts� priorities; activities and results have varied from district to district. So far the results are showing improvements in immunisation services.

After health workers and the District Health Team in Kiboga District shared the low immunisation coverage figures with local political leaders, the two groups held community meetings and conducted home visits where they encouraged communities and families to get their children immunised. Additional and more convenient outreach sites were also planned. As a result, there has been a steady increase in coverage, as well as a distinct decline in the drop out rate. For example, in May 2003 nearly 1000 infants received their third dose of DPT. In May 2002 only half that number (512) had received DPT3. The district�s drop out rate for DPT has declined from 39% last year to only 22% by September 2003. This improving trend is even more impressive when the very low ratio of health workers per capita is considered. While immunisation coverage in the district had increased for a few months prior to the implementation of CPSSD, this increase was short lived, and probably resulted from the one-time release of funds from UNEPI headquarters to pay allowances for mobilisers. The central level cannot sustain such financial support. But the relatively low cost of implementing the CPSSD strategy in a district, approximately USD $7,000, is leading not only to long-term and sustained reductions in morbidity, mortality and disability, but also to more cost-efficient health services. The current trend in Kiboga District indicates a steady and sustained increase of fully immunised infants.

Notes: The CPSSD strategy was initiated in Kiboga District in September 2002, with the second consultation in May 2003.

• Lira District made the involvement of political, cultural, religious, and civic leaders a priority at all levels in the efforts to increase the number of children fully immunised. As a result, sub-counties decided to earmark budgetary funds for immunisation activities, which have subsequently been dispersed. Since then immunisation coverage in Lira District began increasing. However, due to the unfortunate deterioration in the security situation in the district, immunisation coverage has recently declined somewhat.

Infants Immunised with DPT3, and DPT1-3 Drop Out Rates, by Month, Kiboga District: 2001 - September 2003.

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• An important and impressive result�key to the success of the approach�is how health worker and parent interpersonal communication has dramatically changed and how attitudes and perceptions of roles have been altered, which are demonstrated by the quotes from CPSSD participants below:

�Communication between the health workers an the community has improved. Before we just assumed that the mothers knew [about immunisation].��Participant from Ikoba Health Centre III, Masindi

� Mothers are now more free and friendly. So am I.�� Participant from Inomo Health Centre II, Apac

�I talk with the community now, and more children are being brought for immunisation. Before, I was telling people what to do. Now I am discussing with them.�� Participant from Masode Health Centre, Kiboga

�As for the Council, our relationship has improved and they are interested. They have allocated USH 400,000 from the sub-county budget to encourage the mobilisers. We update the leaders on the drop out and coverage information.� � Participant, Abako Health Centre III, Lira

FOR RESOURCES AND FURTHER INFORMATION ON CPSSD: The three modules shown below are available online at http://basics.org/publications/abs/abs_Uganda_immunisation.html If you do not have online access, or if you would like hard copies, contact: BASICS II, 1600 Wilson Blvd., Suite 300, Arlington, Virginia USA 22209; tel: 011 1 (703) 312-6800; email: msiddiqi@basics.org or infoctr@basics.org; or UNEPI/MOH Program Manager, P.O. Box 7272 Kampala UGANDA; tel: 256 321365. Additionally, 15 facilitators in 5 districts have been trained to technically support health workers to conduct the consultations with their communities. A directory including the names of these facilitators is available from UNEPI.

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ANNEX

Immunization Questions & Answers (Q&A): A locally-prepared job aid The Q&A (in English and French) was generated as part of the �Community Problem Solving and Strategy Development (CPSSD)� approach developed by the Uganda National EPI (UNEPI) with technical assistance from BASICS II. The CPSSD approach improves the linkage between health staff and communities at the most peripheral levels, with support from district and sub-district teams. Using adult learning methods, the CPSSD is based on a series of consultations between facilitators and health workers, who then move out to work with their communities in a participatory fashion that leads to follow-up action at the community level. The initial Q&A was developed as a local initiative by peripheral health workers in one consultation meeting. They had conducted brief interviews with parents in their communities to learn what they understood about immunization and what their experience had been. Later on, in a large group discussion with the District Health Team, the consultation participants analyzed the information gathered and developed the Q&A document as a job aid to help them communicate accurately about immunization in their communities. The process through which the document was developed was as important as the document itself. It was important that the entire learning process was followed to allow authentic learning and attitudinal change among health staff so as to identify and reflect concerns of the community.

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Consultation II � Lira District Questions and Answers

The following questions were asked by people in Moroto County during interviews in their homes. In the second consultation, participants and facilitators discussed and agreed upon answers that should be given to the questions. What is immunisation?

• Why do we immunise?

• How does the vaccine work?

• How long does the vaccine stay in the

body?

• What happens if we don�t immunise a child?

Immunisation is a way to protect the body from some specific diseases. We immunise to protect children against TB, polio, whooping cough, diphtheria, tetanus and measles. These diseases make children very ill or even kill them, but every child can be protected if he/she is properly immunised. Each vaccine teaches the child�s body how to fight a particular disease. The body learns to recognize the disease. If the child comes in contact with that disease, the body will be able to defend itself. This is like teaching an army how to fight its enemies. Some vaccines (BCG, measles) vaccines teach well after only one injection. Others (DPT, polio) make the body stronger when they are given more times, so we give them three or more times. Some vaccines are for just one disease. DPT teaches the body to protect itself from three different diseases. When a child receives immunisation his/her body will be able to fight the diseases throughout the childhood years. If not immunised, the child�s body will not know how to fight the diseases we can protect him/her from. This means he/she could become seriously ill if attacked by a disease, such as measles.

When should a child be immunised? Children should receive their first immunisation as soon after birth as possible. If he/she receives the immunisations according to the recommended schedule, the body is protected from the diseases early. Also, the injections are less troublesome when the child is very young. Birth BCG Polio 0 6 weeks old DPT1 Polio 1 10 weeks old DPT2 Polio 2 14 weeks old DPT3 Polio 3 9 months old Measles

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Who should receive immunisation?

• Why do we immunise children more? • Why do some women get immunisation,

while others do not?

• Why don�t we immunise men as well?

• Why did they immunise adult/grown people in the past?

Children under five years, women in child bearing age should receive the routine immunisations. Children need immunisation so their bodies can learn how to fight the six diseases. Without immunisation, they cannot fight the diseases well and they may die.. Women, from age 15 until they no longer bear children, should take Tetanus Toxoid (TT)from time to time. It teaches their bodies to fight tetanus disease and their bodies share this knowledge with their unborn babies, so the babies are protected when they are born. If the mother has not had TT, the baby might get tetanus. Most babies with tetanus die when they get it. When a woman is no longer bearing children, she does not need the immunisation. Men�s bodies are usually strong and can fight diseases well. There are some immunisations they might need if certain diseases come to the area where they live and work. We have vaccines against meningitis and yellow fever, which are given only when these diseases come to your District. For many years, children, women and men were vaccinated against smallpox. In 1977 the disease was no longer seen anywhere in the world, so smallpox immunisation was stopped. We are now working to get polio out of the world in the same way.

Which diseases can we protect children against?

• Why is measles vaccine given only one time? Does it protect the child for life?

• Does vaccination protect a child from all

diseases?

For many years, children, women and men were vaccinated against smallpox. In 1977 the disease was no longer seen anywhere in the world, so smallpox immunisation was stopped. We are now working to get polio out of the world in the same way. Children can be protected against tuberculosis (TB), polio, whooping cough, diphtheria, tetanus and measles. (Soon we will be able to protect them against hepatitis B and haemophilus influenzae as well.) Measles vaccine gives full protection for more than six years. It continues to protect, but less strongly, throughout the person�s life. Sometimes a �booster� dose is given when the child starts school, to be sure the protection is strong. No. Each vaccine protects the child from one disease, as measles BCG and polio, or more diseases, as with DPT (diphtheria, whooping cough, tetanus).

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• Why don�t you immunise children

against malaria?

• Why does a child get cough even after taking BCG?

There is no vaccine against malaria yet. Doctors are working to make one now. BCG protects against tuberculosis (TB) only. There are many other causes of cough.

Why do we have National Immunisation Days (NIDs)?

• What is the difference between NIDs and routine immunisation?

• Why don�t we have NIDs now?

We have NIDs when we want eradicate a particular disease such as polio, or want to significantly control a disese such as we are doing with measles. During NIDs, the vaccine for one disease only is given. The government has done this with polio, because if we can immunise all children, polio will be gone from Uganda and hopefully will soon be gone from the entire world. During routine immunisation we give vaccines for the six diseases. Polio vaccine was given in NIDs for five years in Lira, which should be enough, unless we see children becoming lame again. If any child in your area goes lame, please take him/her to your health worker as soon as possible.

Where are the vaccines given? What is the difference between immunisations given on the upper arm and the ones given on the thigh?

IMMUNISATION SITES: BCG Injection on right upper arm Polio Drops in the mouth DPT Injection on the left thigh Measles Injection on left upper arm Each vaccine is given in a different place.

What side effects should I expect, and what can I do about them?

• Why does the child get a fever after immunisation?

• If the child gets fever after immunisation, is it true he/she should not get any more immunisation?

• How severe is the fever after

immunisation?

• Why does BCG form a wound?

• When there is swelling or pus does it mean the immunisation did not work?

The main side effects are fever and crying on the night following immunisation. BCG should make a sore on the arm, and there may be a bit of pus. Some mothers notice swelling at the place DPT was given. Fever is normal after the child gets DPT. Fever tells us the vaccine is working to teach the body how to protect itself. It is not true. Fever following DPT immunisation is normal. It is a sign that the body is learning to fight the diseases. It is mild. It should go after one day. If the fever continues as long as three days, get advice from a health worker. They child may be sick. BCG makes a reaction in the skin where it is given. This shows it has worked and the child�s body is protected from TB. Pus in the BCG sore is normal. Swelling is normal after DPT, but not every child gets

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• Why does the child not eat for one or two days following immunisation?

• If immunisation gives the child fever, will the health worker treat the child free of charge?

• If my child has swelling after the DPT, is it bad or good to put a warm/hot compress on the area?

• Why does my child cry after

immunisation? What can I do?

• Why was there bleeding after the injection? Was the immunisation effective, or did the vaccine come back out with the blood?

• Is it true that immunisation causes paralysis?

• Why do some children die after

immunisation?

• Why do I experience pain when I receive immunisation?

swelling. It does not tell us anything about how (or if) the immunisation is working. The child may be sick from another cause. Immunisation does not cause the child to refuse food. After DPT, there will be a fever, but this is not malaria. If the fever does not go away within three days, take the child to the health worker. It is better to put something cool/cold on the area. The heat may cause more trouble. Some children may feel pain at the site of the injection. They may also get some fever. Use a cool damp cloth to press around on the body, to reduce the fever. Sometimes a small amount of blood comes after an injection, because the needle has passed through the tissue. When you see this, it is blood, not vaccine. The vaccine stays inside. Very soon after, the blood will stop. It is not true. Immunisation does not cause paralysis. Immunisation is not the cause. It is possible some other illness caused the death. The needle pricks your skin. Any prick causes pain. When you are pricked by a thorn, do you feel pain?

Are vaccines safe for children?

• Is it true that there is HIV/AIDS in some vaccine?

• Will vaccines give any other disease? • Is it true that immunisation causes

paralysis? (40)

• Which is stronger vaccine, drops or

injections?

Now, the Ministry of Health, the World Health Organization and UNICEF all check and test the vaccines to be sure they are safe and effective. It is not true. UNEPI and our health workers are working hard to protect children from disease, not to give them any disease. Remember, we were immunizing children for a long time before AIDS came to Uganda. No. Immunisation does not cause paralysis. If the child is not protected from polio, he or she could get the disease and become paralysed. Babies should begin receiving polio immunisation right after they are born and get it at 6, 10 and 14 weeks of age. Any child who has not yet taken polio should begin taking it right away and receive 3 doses?. Both drops and injections are strong. The child�s body makes the best use of polio vaccine when it

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• Why did the nurse refuse to give any more polio after she dropped the polio vial?

• If a child receives immunisation more than five times, what will happen?

• Is it good for a sick child to take immunsation?

• Why can�t the government train the vaccinators so we don�t have to fear them?

is given as drops. The other vaccines are made in a way they should be given by injection. Because it became dirty (contaminated) when it touched the ground. It was for your child�s safety that she refused to continue giving vaccine from that vial. Nothing will happen. If the child�s body has already learned how to protect itself, the vaccine has no effect. Yes, even if the child is sick, his/her body needs to learn how to protect itself from the immunisable diseases. The Ministry of Health has been working to train all the vaccinators. The ones in your area have now been trained.

Other questions people asked: • Should we pay for immunisation?

• If a woman who is barren takes immunisation, will she be able to produce?

• If a child is partially immunised and becomes sick with measles, can he/she transmit measles to others?

• Before immunisation was available, children grew well. What will happen now when a child is not immunised?

• What should local government do to be sure children are immunised?

• Can anything be done to fathers who are irresponsible about getting their children immunised?

• If the Child Health Card is lost, what

should I do?

• Will I be charged for the new card?

No, you should not pay for immunisation. The government pays all the costs. Immunisation will have no effect on her ability to bear children. Instead, it protects her body. If she becomes pregnant, her baby will also be protected. Yes the child can transmit measles to others. Immunisation protects the child�s body after measles immunisation is given. If the child is not immunised in time and becomes sick, he/she can give it to others. Before immunisation was available, many children died from measles, polio, TB, whooping cough and tetanus. Ask the elders. They will tell you many children died. Today, children are better protected from these diseases through immunisation, so more children grow well than in the past. At every level, leaders should support the programme so that all our children are protected from immunisable diseases. You should talk with them. Find out why they have not made sure their children are protected. Encourage them to become involved. Tell the vaccinator or any health worker the card is lost and they will work with you to make a new one. You will not be charged for the new card. Keep it in a safe place, and always take it with you when you take the child for any health activity.

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Consultation II � Lira District Questions et Réponses

Les questions suivantes ont été demandées à la population de Moroto County au cours des interviews à domicile. Dans la deuxième consultation, les participants et facilitateurs ont discuté et se sont mis d�accord sur les réponses qui devraient être données aux questions.

QUESTIONS REPONSES Que-ce qu�est la vaccination?

• Pourquoi devons-nous vacciner?

• Comment agit le vaccin?

• Combien de temps le vaccin reste-t-il

dans le corps?

• Que ce qui arrive si nous ne vaccinons pas un enfant?

Vaccination est un moyen pour protéger le corps des maladies spécifiques. Nous vaccinons pour protéger les enfants contre TBC, polio, coqueluche, diphtérie, tétanos et la rougeole. Ces maladies rendent les enfants très malades et peuvent même les tuer, mais chaque enfant peut être protégé s�il est correctement vacciné. Chaque vaccin enseigne à l�organisme de l�enfant à combattre une maladie donnée. L�organisme apprend à reconnaître la maladie. Si l�enfant entre en contact avec cette maladie, le corps sera en mesure de se defender soi-même. Ceci est comme apprendre à l�armée comment combattre les ennemies. Quelques vaccins (BCG, VAR) enseignent bien seulement après une injection. D�autres (DTPC, polio) rendent le corps plus fort lorsqu�ils sont administrés plus d�une fois, ainsi, nous les donnons trois fois ou plus. Certains vaccins sont pour une maladie. DTC enseigne le corps à se protéger contre trois maladies. Quand un enfant reçoit un vaccin, son corps sera en mesure de combattre les maladies pendant la période de son enfance. S�il n�est pas vacciné, son corps ne saura pas combattre les maladies auxquelles nous pouvions le protéger. Ceci signifie qu�il peut tomber sérieusement malade s�il est attaqué par une maladie comme la rougeole.

Quand devrions-nous vacciner un enfant? Les enfants devraient recevoir leurs premières vaccinations le plus tôt possible après leur naissance. Si l�enfant reçoit les vaccinations selon le calendrier recommandé, il sera protégé des maladies assez tôt. Aussi, les injections sont moins traumatisantes si l�enfant est très jeune. Naissance BCG Polio 0 6 semaines DTC1 Polio 1 10 semaines DTC2 Polio 2 14 semaines DTC3 Polio 3 9 mois VAR

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QUESTIONS REPONSES Qui devrait recevoir la vaccination?

• Pourquoi devons-nous vacciner plus d�enfants?

• Pourquoi certaines femmes se font

vaccinées et d�autres pas?

• Pourquoi nous ne vaccinons pas les homes aussi?

• Pourquoi vaccinait-on les adultes / population en pleine croissance dans le passé?

Enfants de moins de 5 ans, femmes en âge de procréer devraient recevoir la vaccination dans la routine. Les enfants ont besoin de vaccination pour que leur corps apprennent comment combattre les six maladies. Sans la vaccination, ils ne peuvent pas bien se protéger et peuvent même en mourir.. Les femmes en âge de procréer devraient recevoir le vaccin anti-tétanique (VAT) de temps en temps. Ce vaccin enseigne à leur corps de combattre le tétanos et leurs corps partage cette connaissance avec les bébés non encore nés pour combattre le tétanos; de cette façon, les bébés peuvent se protéger contre maladie au moment de leur naissance. Si la mère n�a pas reçu le VAT, le bébé peut attraper le tétanos à la naissance. La majorité d�enfants avec tétanos en meurt. Les femmes qui ne peuvent plus avoir d�enfants n�ont pas besoin de cette vaccination. Les corps des homes sont normalement forts et peuvent également combattre les maladies. Il existe cependant certains vaccins dont ils ont besoin si certaines maladies surviennent là où ils vivent ou travaillent. Nous avons les vaccins contre la méningite et la fièvre jaune qui sont données si les maladies surviennent dans votre District. Depuis des années, les enfants, les femmes et les homes étaient vaccines contre la variole. En 1977, la maladie n�était plus observée dans le monde; donc la vaccination contre la variole a été interrompue. Nous sommes en train de travailler de la même façon pour faire disparaître la polio du monde.

Quelles sont les maladies que nous pouvons prévenir chez les enfants?

• Pourquoi le VAR n�est donné qu�une fois? Protège-t-il pour la vie?

• La vaccination protège-t-elle contre

toutes les maladies?

Les enfants peuvent être protégés contre la tuberculose (TBC), la polio, la coqueluche, la diphtérie, le tétanos et la rougeole. (Bientôt nous serons en mesure de les protéger contre l�hépatite B et l�hémophilus influenza.) Le vaccin anti-rougeoleux (VAR) procure une protection totale de plus de six ans. Il continue à protéger, mais avec une efficacité réduite, tout au long de la vie de l�homme. Quelque fois, une dose de rappel est donnée quand l�enfant commence l�école pour se rassurer que la protection reste forte. Non. Chaque vaccin protégé l�enfant contre une maladie donnée comme la rougeole, la tuberculose et la polio ou contre plusieurs maladies, comme avec DTC (diphtérie,

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QUESTIONS REPONSES coqueluche, tétanos).

• Pourquoi nous ne vaccinons pas les enfants contre le paludisme?

• Pourquoi l�enfant attrape-t-il la toux même après avoir reçu le BCG?

Il n�y a pas encore un vaccin contre le paludisme. Les docteurs sont en train d�y travailler pour en avoir un. BCG protégé contre la tuberculose (TBC) seulement. Il existe beaucoup d�autres causes de toux.

Pourquoi les Journées Nationales de Vaccination (JNVs) ?

• Quelle est la différence entre JNVs et la vaccination de routine?

• Pourquoi nous n�avons plus des JNVs maintenant ?

Nous organisons les JNVs quand nous voulons éradiquer une maladie particulière comme la polio ou quand nous voulons contrôler d�une manière significative une maladie comme la rougeole. Lors des JNVs, un vaccin contre une maladie est donné. Le gouvernement l�a fait avec la polio parce que si nous vaccinons tous les enfants contre la polio, la polio va quitter le pays et avec beaucoup de chance, va bientôt disparaître du monde. Pour la routine, nous donnons les vaccins pour les six maladies. Le vaccin polio oral a été donné lors des JNVs pendant 5 ans Lira, lequel devrait être suffisant, à moins qu�on voit un enfant devenir boiteux encore. Si un enfant dans votre aire devient boiteux, de grâce, amenez-le le plus rapidement possible chez votre agent de santé.

Où administres-t-on les vaccins? Quelle est la différence entre les vaccines donnés dans la partie supérieure de l�arme et ceux donnés dans la cuisse?

SITES DE VACCINATION : BCG Face interne du bras Polio Gouttes dans la bouche DTC Injection dans la cuisse gauche VAR Injection dans la partie supéro- externe du bras gauche Chaque vaccin est donné à une place différente. ???

Quels sont les effets secondaires sont attendus et que dois-je faire quand ils surviennent?

• Pourquoi est-ce qu�un enfant présente-il la fièvre après la vaccination?

• Si l�enfant présente une fièvre après la vaccination, est il vrai que l�enfant ne devrait plus avoir d�autres?

• Quelle est la sévérité de la fièvre après la

Les principaux effets secondaires sont la fièvre et les pleurs la nuit à la suite de la vaccination. BCG devrait produire un abcès sur le membre et il devrait y avoir un peu de pus. Certaines mères observent un �dème à l�endroit où la piqûre a été donnée. La fièvre est normale après que l�enfant ait reçu le DTC. La fièvre signifie que le vaccin est en train de travailler pour enseigner au corps comment se protéger soi-même. Ce n�est pas vrai. Fièvre à la suite de l�injection de DTC est normale. C�est un signe qui montre que le corps est en train d�apprendre comment combattre la maladie. Elle est bénigne. Elle devrait disparaître après un jour. Si la fièvre se prolonge jusqu�à trois jours,

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QUESTIONS REPONSES vaccination?

• Pourquoi le BCG forme-t-il une plaie?

• Lorsqu�il y a abcès ou pus au site d�injection, ce la signifie-t-il que le vaccin n�a pas marché?

• Pourquoi l�enfant ne mange pas un ou deux jours après la vaccination?

• Si la vaccination provoque la fièvre chez un enfant, l�agent de santé va-t-il le soigner gratuitement?

• Si mon enfant a un oedème après DTC, est-il conseillé ou pas de mettre une compresse chaude à l�endroit gonflé?

• Pourquoi mon enfant pleure-t-il après la

vaccination? Que dois-je faire?

• Pourquoi y-avait-il de saignement après la vaccination? Le vaccin était-il efficace ou le vaccin serait il sorti du corps avec le sang?

• Est-ce vrai que la vaccination provoque

la paralysie?

• Pourquoi certains enfants meurent-ils après la vaccination?

• Pourquoi j�ai la douleur quand je reçois le vaccin?

demande le conseil de l�agent de santé. L�enfant peut être malade. BCG fait une réaction sur la peau là où le vaccin est injecté. Ceci montre que le vaccin a travaillé et que le corps est protégé de la tuberculose. Pus en cas d�un abcès BCG est normal. �dème est normal après DTC, mais cela n�arrive pas chez chaque enfant. Cela ne nous dit rien sur comment le vaccin est en train de travailler. L�enfant peut être malade pour une autre cause. La vaccination ne cause pas un refus de manger chez un enfant. Après DTC, il y aura une fièvre mais cette fièvre n�est pas causée par la malaria. Si la fièvre ne disparaît pas dans les trois jours, amener l�enfant chez l�agent de santé. Il est mieux de mettre quelque chose froid à cet endroit. La chaleur peut causer plus de problèmes Certains enfants peuvent sentir la douleur au site d�injection. Ile peuvent également avoir de la fièvre. Utiliser une étoffe imbibée d�eau froide et couvrir l�enfant pour réduire la fièvre. Quelque fois, une petite quantité du sang sort après injection, parce que l�aiguille traverse les tissus. Quand vous voyez ça, il s�agit du sang et non du vaccin. Le vaccin reste à l�intérieur. Après quelque temps, le saignement va s�arrêter. Ce n�est pas vrai. La vaccination ne provoque pas la paralysie. La vaccination n�est pas la cause. Il est possible que certaines autres maladies qui ont causé la mort. L�aiguille pique votre peau. Chaque piqûre cause la douleur. Quand vous êtes piqué par une épine, sentez vous la douleur ?

Les vaccines sont ils sans danger pour les enfants?

• Est-il vrai que le HIV/SIDA se trouve dans certains vaccines?

Maintenant, le Ministère de la santé, l�OMS et l�UNICEF vérifient et testent tous les vaccines pour se rassurer que les vaccines sont sûrs, sans danger et efficaces. Ce n�est pas vrai. Le PEV et les agents de santé sont en train de travailler dur pour protéger les enfants contre les maladies et non pour leur donner des maladies. Rappelez-vous que nous étions en train de vacciner les enfants bien longtemps avant l�apparition de SIDA.

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QUESTIONS REPONSES

• Est-ce que les vaccines donnent d�autres maladies?

• Est-il vrai que la vaccination cause la

paralysie? (40)

• Lequel des vaccines est le plus efficace,

gouttes² or injections?

• Pourquoi l�infirmière refuse de d�utiliser un flacon de vaccin polio si ce dernier est tombé par terre ?

• Si l�enfant reçoit le vaccin plus de 5 fois, que va-t-il se?

• Est-il bon pour un enfant malade d�être vaccine?

• Pourquoi le Gouvernement ne peut-il pas former les vaccinateurs, comme ça nous ne pouvons plus avoir peur d�eux?

Non. La vaccination ne provoque pas la paralysie. Si l�enfant n�est pas protégé de polio, il / elle peut attraper la maladie et devenir paralysé(e). Les bébés devraient recevoir le vaccin polio juste après leur naissance et continuer à le recevoir à 6, 10 et 14 semaines d�âge. Tout enfant qui n�a pas encore reçu le vaccin polio devrait commencer à le recevoir et totaliser les trois doses. Ensemble, gouttes et injections sont efficaces. Le corps de l�e,nfant fait une bonne usage de vaccin polio lorsque ce dernier est donné par gouttes. Les autres vaccins sont fabriqués de la manière où ils ne peuvent être donné que par injection. Parce que il devient sale (contaminé) lorsqu�il touché le sol. C�était pour la sécurité de votre enfant qu�elle a refusé de continuer le vaccin de ce flacon. Rien ne va se passer. Si le corps de l�enfant a déjà appris comment se protéger, le vaccin n�a plus d�effet. Oui, même si l�enfant est malade, son corps a besoin d�apprendre comment se protéger des maladies évitables par la vaccination. Le Ministère de la Santé était en train de travailler pour former tous les vaccinateurs. Ceux se trouvant dans votre aire de santé sont formés.

D�autres questions que les gens ont demandé : • Devrions-nous payer pour la vaccination?

• Si une femme qui est sterile est vaccinée, sera-t-elle à même de reproduire?

• Si un enfant est incomplètement vaccine et devient malade avec rougeole, peut il transmettre la rougeole aux autres?

• Avant que la vaccination ne soit disponible, les enfants grandissaient bien. Que va-t-il arrivé maintenant si l�enfant n�est pas vacciné d?

Non, vous ne devriez pas payer pour la vaccination. Le Gouvernement paie tous les coûts. La vaccination n�aura aucun effet sur sa capacité d�avoir des enfants. A la place, il protège son corps. Si elle devient enceinte, son bébé sera également protégé. Oui, l�enfant peut transmettre la rougeole aux autres. La vaccination protège contre la rougeole si le vaccin anti-rougeoleux est donné. Si l�enfant n�est pas vacciné et devient malade, il peut transmettre la maladie aux autres. Avant que la vaccination ne soit disponible, les enfants mouraient de rougeole, de polio, de la TBC, de coqueluche, et de tétanos. Demandez aux vieux. Ils vont vous dire que beaucoup d�enfants sont morts. Aujourd�hui, les enfants sont mieux protégés de ces maladies à travers la vaccination , donc plus d�enfants grandissent mieux que dans le passé.

15

QUESTIONS REPONSES

• Que devrait faire le Gouvernement local pour se rassurer que les enfants sont vaccinés?

• Y a-t-il quelque chose à faire pour les papa qui sont irresponsables pour la vaccination de leurs enfants?

• Si la carte de santé est perdue, que

devrais je faire?

• Vais-je payer pour la nouvelle carte?

A chaque niveau, les leaders devraient apporter leur appui au programme pour que tous les enfants soient protégés des maladies évitables par la vaccination. Vous devriez leur parler. Chercher à savoir pourquoi ils ne se rassurent pas que leurs enfants sont protégés. Les encourager à s�impliquer. Parler au vaccinateur ou à n�importe quel agent de santé que la carte est perdue. Il va voir avec vous comment établir une autre pour l�enfant. Vous n�allez pas payer pour la nouvelle carte. Gardez la dans un endroit sécure et, toujours l�amener avec vous chaque fois que vous allez avec l�enfant pour une activité de santé.