Family Health Days program contributions in vaccination of unreached and under-immunized children during routine vaccinations in Uganda

Autoři: Ezekiel Mupere aff001;  Harriet M. Babikako aff002;  Violet Okaba-Kayom aff001;  Robert B. Mutyaba aff004;  Milton Nasiero Mwisaka aff005;  Emmanuel Tenywa aff006;  Albert Lule aff007;  Jane Ruth Aceng aff008;  Flavia Mpanga-Kaggwa aff009;  David Matseketse aff009;  Eresso Aga aff010
Působiště autorů: Department of Paediatrics & Child Health College of Health Sciences, Makerere University, Kampala, Uganda aff001;  Research and Data System Center, Child and Family Foundation Uganda, Kampala, Uganda aff002;  Child Health and Development Center College of Health Sciences, Makerere University, Kampala, Uganda aff003;  Information Systems and Programming, RBMTM Systems Consult Limited, Kampala, Uganda aff004;  Social Work Unit, Jinja Regional Referral Hospital Ministry of Health, Jinja, Uganda aff005;  Paediatrics, Jinja Regional Referral Hospital Ministry of Health, Jinja, Uganda aff006;  Nutrition Unit, Ministry of Health, Kampala, Uganda aff007;  Minister for Health, Ministry of Health, Kampala, Uganda aff008;  Health Office, UNICEF Uganda Country Office, Kampala, Uganda aff009;  Health Manager, UNICEF Jordan Country Office, Amman, Jordan aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



We explored the contributions of the Family Health Days (FHDs) concept, which was developed by the Uganda Ministry of Health (MOH) and UNICEF as a supplementary quarterly outreach program in addition to strengthening the routine expanded program for immunization (EPI), with the aim to increase coverage, through improved access to the unimmunized or unreached and under-immunized children under 5 years.


A cross-sectional descriptive study of the Uganda MOH, Health Management Information Systems (HMIS) and UNICEF in house FHDs data was conducted covering six quarterly implementations of the program between April 2012 and December 2013. The FHDs program was implemented in 31 priority districts with low routine vaccination coverage from seven sub-regions in Uganda in a phased manner using places of worship for service delivery.


During the six rounds of FHDs in the 31 districts, a total of 178,709 and 191,223 children received measles and Diphtheria-Pertussis-Tetanus (DPT3) vaccinations, respectively. The FHDs’ contributions were 126% and 144% for measles and 103% and 122% for DPT3 in 2012 and 2013, respectively of the estimated unreached annual target populations. All implementing sub-regions after two rounds in 2012 attained over and above the desired target for DPT3 (85%) and measles (90%). The same was true in 2013 after four rounds, except for Karamoja and West Nile sub-regions, where in some districts a substantial proportion of children remained unimmunized. The administrative data for both DPT3 and measles immunization showed prominent and noticeable increase in coverage trend in FHDS regions for the months when the program was implemented.


The FHDs program improved vaccination equity by reaching the unreached and hard-to-reach children and bridging the gap in immunization coverage, and fast tracking the achievement of targets recommended by the Global Vaccine Action Plan (GVAP) for measles and DPT3 (85% and 90% respectively) in implementing sub-regions and districts. The FHDs is an innovative program to supplement routine immunizations designed to reach the unreached and under immunized children.

Klíčová slova:

Data management – Health services administration and management – Health systems strengthening – Child health – Measles – Religion – Uganda – Vaccination and immunization


1. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86(2):140–6. doi: 10.2471/BLT.07.040089 18297169; PubMed Central PMCID: PMCPMC2647387.

2. Okwo-Bele JM, Cherian T. The expanded programme on immunization: a lasting legacy of smallpox eradication. Vaccine. 2011;29 Suppl 4:D74–9. Epub 2012/04/18. doi: 10.1016/j.vaccine.2012.01.080 22486980.

3. GAVI. Origins of GAVI. Geneva: GAVI, 2012.

4. Kamara L, Lydon P, Bilous J, Vandelaer J, Eggers R, Gacic-Dobo M, et al. Global Immunization Vision and Strategy (GIVS): a mid-term analysis of progress in 50 countries. Health policy and planning. 2013;28(1):11–9. Epub 2012/03/14. doi: 10.1093/heapol/czs020 22411879.

5. Palmer AC, Diaz T, Noordam AC, Dalmiya N. Evolution of the child health day strategy for the integrated delivery of child health and nutrition services. Food and nutrition bulletin. 2013;34(4):412–9. Epub 2014/03/13. doi: 10.1177/156482651303400406 24605691.

6. Government of Uganda. Immunisation practice in Uganda: a manual for operational level health workers. Ministry of Health, Uganda National Expanded Programme on Immunisation (UNEPI). Kampala, Uganda: 2007.

7. World Health Organization. AFRO-RED Guide—implementing the Reaching Every District approach: a guide for District Health Management Teams. Geneva, Switzerland: WHO Africa Regional Office in collaboration with UNICEF and USAID’s IMMUNIZATIONbasics Project, 2008.

8. Nuwaha F, Kabwongyera E, Mulindwa G, Barenzi E. National immunisation days for polio eradication in Uganda: did immunisation cards increase coverage? East African medical journal. 2000;77(2):66–70. Epub 2000/04/25. 10774077.

9. UNICEF. Combatting antivaccination rumors: lessons learned from case studies in East Africa. Nairobi, Kenya: UNICEF; 2012. 2012.

10. Banerjee K, Beyai PL, Brunkard J, Kelani R, Sequeira J, Watkins M, et al. Comprehensive evaluation of the RED Strategy: Uganda. 2007.

11. Ryman T, Macauley R, Nshimirimana D, Taylor P, Shimp L, Wilkins K. Reaching every district (RED) approach to strengthen routine immunization services: evaluation in the African region, 2005. J Public Health (Oxf). 2010;32(1):18–25. Epub 2009/06/23. doi: 10.1093/pubmed/fdp048 19542268.

12. WHO, UNICEF. UGANDA National Expanded Programme on Immunization: multi-year plan 2012–2016 WHO and UNICEF. 2012. 2012.

13. Nshimirimana D, Mihigo R, Clements CJ. Routine immunization services in Africa: back to basics. J Vaccines & Immun. 2013;1:6–12.

14. Uganda Bureau of Statistics (UBOS) and ICF International Inc. Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc., 2012.

15. World Health Organization. Epidemiology of the Unimmunized Child Findings from the Peer-Reviewed Published Literature, 1999–2009. Atlanta, GA, USA: Global Immunization Division Centers for Disease Control and Prevention, 2009.

16. Babirye JN, Rutebemberwa E, Kiguli J, Wamani H, Nuwaha F, Engebretsen IM. More support for mothers: a qualitative study on factors affecting immunisation behaviour in Kampala, Uganda. BMC public health. 2011;11:723. Epub 2011/09/29. doi: 10.1186/1471-2458-11-723 21942999; PubMed Central PMCID: PMC3187758.

17. Shen AK, Fields R, McQuestion M. The future of routine immunization in the developing world: challenges and opportunities. Global health, science and practice. 2014;2(4):381–94. Epub 2015/01/23. doi: 10.9745/GHSP-D-14-00137 25611473; PubMed Central PMCID: PMC4307855.

18. LaFond A, Kanagat N, Steinglass R, Fields R, Sequeira J, Mookherji S. Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies. Health policy and planning. 2015;30(3):298–308. Epub 2014/03/13. doi: 10.1093/heapol/czu011 24615431; PubMed Central PMCID: PMC4353894.

19. Olivier J. Local faith communities and immunization for community and health systems strengthening, Scoping review report for the Joint Learning Initiative on Faith and Local Communities, London. 2014.

20. DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. Health programs in faith-based organizations: are they effective? American journal of public health. 2004;94(6):1030–6. Epub 2004/07/14. doi: 10.2105/ajph.94.6.1030 15249311; PubMed Central PMCID: PMC1448385.

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