Catching Up Children Who Missed Immunizations In Kumasi Metropolis, Ghana

Before the pandemic, Dr. Akosua Gyimah Omari-Sasu says, 95% of the children in her Kumasi Metropolis district of Ghana were vaccinated with routine childhood immunizations.  As COVID-19 spread, however, “We started to notice a reduction in the absolute number of children coming for immunizations,” she says. In Ghana’s second-largest city, with three to four percent annual growth, that didn’t seem right to Akosua, the District Director of Health Services. “Then we had 15 confirmed cases of measles.”

The outbreak inspired Akosua to sign up for the COVID-19 Recovery for Routine Immunization Programs Fellowship offered by the Sabin Vaccine Institute and the World Health Organization last summer. She submitted her proposal, Reaching Every Child in Kumasi Metropolis in Ghana, and became one of those accepted in the Phase II of the Fellowship last fall. Her project was one of the 60 selected, with micro-grant funding to help bring her catch-up vaccination proposal to life and a mentor to help her overcome challenges during implementation.

Finding children in the urban setting

In her urbanized district, “it’s difficult to capture the entire population,” she notes. “We have a lot of schools and a lot of health facilities.” Often, when children present to the clinics, “they are sick and we can’t give vaccinations,” she notes. So one of the first activities for her project was to train front line health workers to screen vaccination records of all children for gaps and opportunities.

Another step was re-educating the community on the importance of vaccination. “Our message was, even if you missed vaccines at age five, we can give it to you now,” she says. “We have done periodic education about routine immunization, but now we are looking for places to target and find those that are missed.”

Akosua says she has been surprised at the number of children, particularly in preschools, who had missed vaccinations. “We knew we had missed some due to the lack of stock during the pandemic, but we are now at more than 5,000 children identified as missing vaccines. And we keep finding more.”

Integrating with other programs

Working with her mentor, Akosua says she has improved integration of vaccinations with other programs, such as regular vitamin A supplementation that is provided every six months to children in Ghana. “We found there’s more we can do to improve immunization rates as well.” The project has also identified opportunities for better tracking. “If we are admitting somebody to a school, the schools are supposed to check the vaccination card. For most of the private schools it appears we aren’t checking that one well.”

Another opportunity involved changing training for health workers using multi-dose vials of vaccine. “Some are reluctant to open a 10-dose vial for just one or two children, as they are thinking about wastage and vaccine supply,” she says. “My mentor encouraged me to push for opening the vials, as we found many of those missed children might not come back and they become vulnerable to a preventable disease.”

A refreshed communication campaign targeting parents, including radio messages and posters in local hospitals, informed families about the catch-up campaign. “We published the immunization schedule, so parents are able to see what’s essential. They are engaging.”

The biggest lesson learned, she says, is that “we don’t need to wait to do these campaigns once a year. Periodic training is more important.” Both parents and health workers, she says, appreciated the renewed immunization information.

Akosua says she has found new ways of integrating immunization with other programs to improve the immunization rates, and her mentor has helped her look for new sources of funding her efforts. The fellowship “encouraged me to try new ideas and to communicate in new ways,” she says. “It has made a big impact.”

See more about the Covid-19 Recovery for Routine Immunization Fellowship