Routine Immunization System during an M/R SIA? Can House to House Social Mobilization Support Identification of Missed Children for the Routine Immunization System during an M/R SIA? Amina Ismail, MSc & Mary Agόcs, MD, MSc Health Advisor, Measles & Rubella Initiative, American Red Cross 8th September 2017

Presentation & Discussion Presentation: Overview of: Red Cross house to house social mobilization for an SIA Red Cross experience with collecting RI data (MCV1 status) during soc mob for an SIA Discussion If Red Cross line lists age eligible children missing MCV1, by name, address, caretaker cell phone (if available), how can that be used?

House to House Social Mobilization Long history: polio, measles, recommendation of AFRO Measles Technical Advisory Group, etc. Since helping found the Measles & Rubella Initiative, the American Red Cross has: Supported social mobilization in 110 vaccination campaigns in 46 countries In the past 5 years alone: Trained and mobilized over 55,896 volunteers Visited over 11.6 million households to encourage vaccination

House to House Social Mobilization Data Collection

Million Dollar Question Raised during UNICEF, IFRC, CDC, and AmRC Coordination Meeting? Why not also collect information to determine which children have been missed by routine immunization?

AmRC Experience: Integration of RI into House to House Soc Mobilization Purpose: identify missed children MCV1 selected as indicator antigen Discuss new strategy with MoH and in-country partners Collect information, as usual, on name of parent, contact details – ability to identify specific children Post SIA: share information with MoH and in-country partners Pilot countries: Kenya (May ‘16), Namibia (July ‘16) Zambia results

Zambia Children’s Clinic Card, with measles (MCV1 and MCV2) vaccination

Data Form with RI, Zambia, September 2016

Total No. of children 12 months -23 months in HH with vaccination card Identification of Missed Children Via House to House Activities, Zambia Example Total No. of children 12 months -23 months in HH with vaccination card Total No. of children 12months to 23 months with vaccination against measles marked on card % vxed Chawama 19,314 16,274 84 Kanyama 28,609 24,184 85 Chaisa 19,397 16,124 83 George 40,688 37,403 92 Mandevu 13,063 10,606 81 Chipata 40,014 28,489 71 ALL COMPOUNDS 161,085 133,080 Children identified by name & location known by volunteer. If had a cell, also cell phone number of caretaker

Lessons Learned RI is new set of data; more time required in training and supervision Because additional information was collected, volunteers reached fewer HHs Work ongoing to quantify reduction… up to half? Malawi pilot to quantify Information shared with MoH & partners, but to AmRC knowledge, no follow-up activities Are children missing receipt of other antigens? Validation & follow-up? Detracts from our primary mission during an SIA… raising awareness in the community Conclusion: Do not integrate collection of data on missed children during SIA social mobilization

Summary Do we agree that we need to reach the 10-15% of children missed by the routine system? Is it feasible to collect data to identify children missed by routine immunization by Red Cross volunteers going house to house? Can MoH and partners ensure follow-up & vaccinate these children? Should Red Cross collect this information during an SIA? If monies were available, should Red Cross collect this information outside an SIA? If volunteers direct families with missed children to the health clinic, but there is no vaccine… will we do more harm than good? Yes Yes ?? No RC could, if follow up (& $) Yes