A team of 20 campaign assessors drawn from the Pakistan Field Epidemiology and Laboratory Training Program monitored the campaign in 21 union councils. The 21 union councils were randomly selected from the pool of 120 union councils that took part in the campaign, with probability of selection proportional to estimated size. Campaign assessors visited selected vaccination sites, fixed and outreach, where they assessed staffing patterns and vaccine delivery procedures, including the quality of intradermal injections, vaccine supply and cold chain management, and compliance with the open-vial policy† (8).
Among 726 (590 outreach and 136 fixed) vaccination sites visited (Table), 74 (10%) were either nonfunctional or experienced delays in commencing their activities. Of the 566 functional outreach vaccination sites, 32% were not at the locations indicated in the campaign microplan. Furthermore, vaccinators at 67 (12%) outreach stations were different from those listed in the microplan. All but one (134 of 135) of the vaccinators at fixed sites reported having previous experience with intradermal injections, compared with 90% of vaccinators at outreach stations. Nine percent of vaccinators stated that the training they received did not adequately prepare them for administering intradermal fIPV injections during the campaign.
All IPV vials were within their expiration dates, and 98% had valid vaccine vial monitors (VVMs), thermochromic labels that change color when the vaccine has not been maintained at the appropriate temperature. Although 95% of vaccinators were knowledgeable about the different stages of VVMs and their significance related to vaccine viability, 32% of vaccinators at outreach stations and 19% at fixed sites were observed to not review VVMs before administering the vaccine (Figure 2). Each campaign assessor observed an average of three intradermal fIPV injections per vaccination station visited. Among 1,960 injections observed, 96% were administered at the appropriate site; bleb formation, indicative of intradermal delivery of fIPV, was observed in 82% of injections. Blebs were more commonly observed among children vaccinated at fixed sites (92%) than at outreach stations (80%). There were no adverse event reporting forms at 119 (17%) of the stations visited, and 15% of vaccinators at outreach stations were not aware of procedures for reporting adverse events. There was also considerable confusion about the open-vial policy: 51% of outreach stations and 24% of fixed sites were not reusing open IPV vials the next day, even if the VVM was valid, there was no leakage from the vial septum, and the vaccine was within its expiration date (Figure 2).
To assess the level of campaign awareness, campaign assessors interviewed 1,968 caregivers at vaccination sites. Seventy percent of caregivers were from rural union councils and 30% from urban union councils. Awareness of the campaign before its commencement was lower among caregivers from rural union councils (57%) than among those from urban union councils (83%). Of the 1,273 (65%) caregivers who were aware of the campaign, three-quarters gained their awareness through a single information source. Among this group, the principal sources of information about the campaign were social mobilizers (75%) and vaccinators/health workers (15%). Mass media, such as radio and TV, accounted for <5% of caregiver campaign awareness. Despite the pivotal role of social mobilizers in creating awareness in the community, deficiencies were noted in their performance. Among 517 social mobilizers, 63% did not have a social mobilization plan with a route map and 17% did not have a checklist to mark off houses they had visited.