Expanded program of immunization

PES covers the period 7/81-7/83 and is based on an attached final evaluation (XD-AAN-495-A). An expanded program of immunization (EPI) has been established nationwide; 11 mobile teams are active and 26 of 30 maternal/child health (MCH) centers conduct vaccinations. Depending on the vaccine considered, at least 46% of the target population has been reached. More than 57,500 children have been vaccinated against tuberculosis, 41,200 against measles, 117,300 against diphtheria, tetanus, and whooping cough, and 113,200 against polio. In addition, a new central vaccine warehouse supported by automatic generators has been established in Nouakchott. Although it appears that the incidence of targeted diseases has in fact been reduced, poor disease surveillance and a high rate of vaccination card loss by mothers prevent statistically valid quantification of the program"s epidemiological impact. Also, prolonged drought conditions have had an adverse effect on coverage, as many villages have moved or been dispersed. Coverage seems best at Catholic Relief Service food distribution centers, which require that recipients have immunization cards. Although some progress has been made in resolving problems identified by the midterm evaluation, operational problems have developed which will need attention as EPI is integrated into the national primary health care program. The project has demonstrated the feasibility of establishing integrated immunization services. Vaccination programs in Mauritania cannot be carried out solely by either fixed centers or mobile teams. Although urban MCH centers are becoming increasingly important due to rising rural-to-urban migration, mobile teams cannot be phased out during the foreseeable future. Moreover, these teams are performing a key function in supervising and supporting MCH activities. The rapid growth of mobile activities during the project has strained central level management, demonstrating a continued need for midlevel personnel training. Eleven action decisions are presented in regard to integrating EPI and primary health care activities.