{
  "abstract": "Background Ethiopia’s routine immunisation schedule has included the first dose of measles-containing vaccine (MCV1) since 1980, and MCV2 was introduced in 2019. However, challenges with MCV service delivery and frontline health worker (HW) practices persist.Methods A cross-sectional assessment was conducted between February and March 2021 among HWs (n=72) and Expanded Program on Immunization (EPI) focal persons (n=29) from 18 randomly selected districts and 36 health facilities that provide vaccination in Oromia, Ethiopia. Participants were interviewed about their practices during vaccination sessions, the availability of updated reporting tools for MCV2, the cold-chain system, immunisation programme operations and vaccine supply monitoring. Data management and descriptive analyses were carried out using R.Results Among HWs, 76% and 40% reported offering MCV at every static and outreach vaccination session, respectively, 72% needed at least five children to open a 10-dose MCV vial, 13% reported recent (past 12 months) cancellation of MCV sessions due to vaccine stock-outs and 29% regularly discussed with the performance monitoring team. The availability of updated reporting tools varied; 36% had updated immunisation registers, 40% had updated tally sheets, 63% had updated vaccination cards and 76% had updated monthly reporting forms. District EPI focal persons reported inconsistent power supply (68%) and at least one recent vaccine stock-out (17%).Conclusions Inconsistent delivery of MCV at all vaccination sessions and the reluctance of HWs to open the measles vaccine vial could lead to missed opportunities for measles vaccination. MCV coverage could be improved by switching to a five-dose MCV vial, re-enforcing HW training in open vial policies and session management, ensuring availability of updated monitoring tools and monitoring vaccine stock.",
  "authors": [
    {
      "affiliations": [
        "Oromia Regional Health Bureau, Addis Ababa, Ethiopia",
        "CDC Foundation contract consultant assigned to Oromia Regional Health Bureau, Addis Ababa, Ethiopia, Addis Ababa, Ethiopia"
      ],
      "name": "Tesfaye Deti Gelmessa"
    },
    {
      "affiliations": [
        "Oromia Regional Health Bureau, Addis Ababa, Ethiopia",
        "Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland",
        "African Field Epidemiology Network, Addis Ababa, Ethiopia"
      ],
      "name": "Abyot Bekele Woyessa"
    },
    {
      "affiliations": [
        "Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"
      ],
      "name": "Monica P Shah"
    },
    {
      "affiliations": [
        "Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA",
        "CDC-Ethiopia, Addis Ababa, Ethiopia"
      ],
      "name": "Almea M Matanock"
    },
    {
      "affiliations": [
        "CDC-Ethiopia, Addis Ababa, Ethiopia"
      ],
      "name": "Susan Nkengasong"
    },
    {
      "affiliations": [
        "Global One Health initiative (GOHi), Ohio State University, Addis Ababa, Ethiopia"
      ],
      "name": "Binyam Moges Azmeraye"
    },
    {
      "affiliations": [
        "The Ohio State University, College of Medicine, Internal Medicine Department, Infectious Disease Division, and GOHi, Columbus, Ohio, USA"
      ],
      "name": "Jeff Pan"
    },
    {
      "affiliations": [
        "Global One Health initiative (GOHi), Ohio State University, Addis Ababa, Ethiopia"
      ],
      "name": "Leuel Lisanwork"
    },
    {
      "affiliations": [
        "Global One Health initiative (GOHi), Ohio State University, Addis Ababa, Ethiopia"
      ],
      "name": "Getnet Yimer"
    },
    {
      "affiliations": [
        "The Ohio State University, College of Medicine, Internal Medicine Department, Infectious Disease Division, and GOHi, Columbus, Ohio, USA"
      ],
      "name": "Shu-Hua Wang"
    },
    {
      "affiliations": [
        "Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"
      ],
      "name": "Qian An"
    },
    {
      "affiliations": [
        "Oromia Regional Health Bureau, Addis Ababa, Ethiopia"
      ],
      "name": "Paulos Samuel"
    },
    {
      "affiliations": [
        "Oromia Regional Health Bureau, Addis Ababa, Ethiopia"
      ],
      "name": "Bekana Tolera Gonfa"
    },
    {
      "affiliations": [
        "Oromia Regional Health Bureau, Addis Ababa, Ethiopia"
      ],
      "name": "Birhanu Kenate"
    },
    {
      "affiliations": [
        "Oromia Regional Health Bureau, Addis Ababa, Ethiopia"
      ],
      "name": "Abebe Bekele Hurissa"
    },
    {
      "affiliations": [
        "UNICEF, Addis Ababa, Ethiopia"
      ],
      "name": "Getachew Wako"
    },
    {
      "affiliations": [
        "UNICEF, Addis Ababa, Ethiopia"
      ],
      "name": "Amsalu Shiferaw"
    },
    {
      "affiliations": [
        "Ethiopia Ministry of Health, Addis Ababa, Addis Ababa, Ethiopia"
      ],
      "name": "Yohannes Lakew Tefera"
    },
    {
      "affiliations": [
        "Ethiopia Ministry of Health, Addis Ababa, Addis Ababa, Ethiopia"
      ],
      "name": "Melkamu Ayalew Kokebie"
    },
    {
      "affiliations": [
        "African Field Epidemiology Network, Addis Ababa, Ethiopia"
      ],
      "name": "Tatek Bogale Anbessie"
    },
    {
      "affiliations": [
        "Ethiopian Public Health Institute, Addis Ababa, Ethiopia"
      ],
      "name": "Habtamu Teklie Wubie"
    },
    {
      "affiliations": [
        "Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"
      ],
      "name": "Aaron S Wallace"
    },
    {
      "affiliations": [
        "Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"
      ],
      "name": "Ciara E Sugerman"
    }
  ],
  "title": "Health worker practices and challenges surrounding routine immunisation service delivery of measles-containing vaccine: a cross-sectional assessment of health facilities in Oromia region, Ethiopia – 2021",
  "uid": "e49ab0dd-3acf-5d61-87eb-8ff1b129301d"
}