Background: The current Ethiopian health service delivery system is structured into
three-tier systems. This includes primary, secondary, and tertiary-level healthcare tier
systems. The administrative structure of the immunisation program in Ethiopia is
based on the administrative structure of the country from the federal and down to the
district and primary health care unite level.
Purpose: The purpose of this study was to develop guidelines to optimize childhood
immunisation programs in the pastoralist community of Somali Region, Ethiopia.
Methods: The researcher employed an explanatory sequential mixed method
technique combining quantitative and qualitative research designs. Three hundred
(300) respondents and 64 health facilities were chosen from the quantitative designs
at Shebele zones in Somali region using multi-stage cluster sampling and simple
lottery methods respectively, while 12 participants in the qualitative designs were
selected through purposive sampling methods. For quantitative and qualitative
approaches, data were analysed using the Statistical Package for Social Sciences
(SPSS) 25.0 version and Atlas ti 8, respectively.
Results
Quantitative results: Overall, 285(94.9%) of the 300 respondents had ever heard of
immunisation. Less than half, 139(46.3%) the average value of knowledge indicators
was below that of the respondents. Among children who had ever been vaccinated for
regular vaccination, 184(79%) of parents/caregivers had child vaccination cards. The
overall proportion of children, who received valid full vaccination was 81(27%), partially
vaccinated 39(13%) and not vaccinated 180(60%). The findings revealed long
distances to the place of immunisation 56(19%), bad rumours 89(30%), and long
waiting time 55(18.3%) as some of the major barriers to not vaccinating children. From
the observed 64 health facilities, 46%, 67%, and 64% have at least one trained health
staff, available to reach every district or community (RED/C) and Micro-plan to provide
specific vaccines respectively. Almost half 30(47%) of healthcare facilities have an
equal number of Auto-Disable (AD) and re-constitution syringes, and more than three
quarter 51(80%) of refrigerator temperatures were monitored twice daily.
Qualitative results: Four themes emerged from the data including challenges with
immunisation system, low immunisation coverage, low knowledge of
parents/caregivers on vaccination, and low community involvement on vaccination
service.
Conclusion The qualitative findings were used to create a concrete understanding of
the study topic. The investigator developed immunisation guidelines to improve
childhood immunisation programs in pastoralist communities and guided healthcare
professionals and immunisation implementing partners in improving immunisation
coverage and reducing the number of unimmunised children.
Imeko-bume/Imvelaphi : Inkqubo yangoku/ yanamhlanje yokunikezelwa kwenkonzo
yezempilo yase-Ethiopia inamanqanaba amathathu esakhiwo, oko kukuthi
ukhathalelo lwezempilo olusisiseko, ukhathalelo olukwinqanaba lesibini kunye
nelesithathu. Ubume bolawulo benkqubo yokugonywa e-Ethiopia busekwe kubume
bolawulo belizwe ukusuka kumdibaniso/kubufederali ukuya kutsho kwinqanaba
leyunithi yokhathalelo lwempilo esisiseko.
Injongo: Injongo yolu phononongo yayikukuphuhlisa izikhokelo zokuphucula iinkqubo
zokugonywa kwabantwana kuluntu lwasezifama/lwasemaphandleni kuMmandla
waseSomalia, e-Ethiopia.
Iimethodi/ iindlela zokuqhuba uphononongo:Umphandi usebenzise ubuchule
bendlela yolandelelwano echazayo nexubileyo edibanisa uyilo lobungakanani kunye
noyilo olusemgangathweni lophando. Abaphenduli abangama-300 kunye namaziko
ezibonelelo zezempilo ezingama-64 zakhethwa kuyilo lobungakanani ngokwenani
kwiindawo yommandla owenzelwe injongo ethile (zones) eShebele kwiNgingqi
yaseSomalia kusetyenziswa ingqokelela yeesampulu zamaqela ezinezigaba ezininzi
kunye neendlela ezilula kukhethwa ngokwamanani abawanikiweyo
ngokungakhethiyo. Abathathi-nxaxheba aba-12 kuyilo olusemgangathweni
bakhethwa ngeendlela zesampulu ngokunenjongo. Kwiindlela zobungakanani kunye
nezisemgangathweni, idatha yahlalutywa kusetyenziswa uhlobo lwe 25.0 lwe-SPSS
kunye ne-ATLAS.ti 8, ngokulandelanayo.
Iziphumo
Iziphumo zobungakanani: Kukonke, ama-285 (94.9%) kwabangama-300 abathe
baphendula baye beva ngogonyo. Ngaphantsi kwesiqingatha, i-139 (46.3%), umyinge
wezalathisi zolwazi kwinani elimelweyo lalingaphantsi kwelo labaphenduli.
Kubantwana abakhe bagonywa ngokugonywa rhoqo, i-184 (79%)
yabazali/abanonopheli babenamakhadi okugonya abantwana. Inani lilonke
labantwana abafumene ugonyo olupheleleyo ngama-81 (27%), abangama-39 (13%)
baye bagonywa ngokuyinxenye(ngokungaphelelanga) kwaye abangama-180 (60%)
abazange bagonywa .Iziphumo zityhila imigama emide ukuya kwindawo yogonyo (56;
19%), amarhe amabi (89; 30%) kunye nexesha elide lokulinda (55; 18.3%)
njengeminye yemiqobo ephambili ekungagonyweni kwabantwana. Ukusuka
kuqwalaselo lwamaziko ezempilo angama-64, ii-46%, 67% kunye nama-64%
ubuncinane abe nalo ilungu elinye lomsebenzi wezempilo oqeqeshiweyo,
ebefumaneka ukuze afikelele kuzo zonke izithili okanye uluntu kwaye
ebenesicwangciso esincinane sokubonelela ngezitofu ezithile ngokwahluka kwazo.
Phantse isiqingatha (i-30; i-47%) samaziko ezibonelelo zezempilo zinenani
elilinganayo zeesirinji I-auto-disable (AD) iisirinji ezingasebenzi ngokunokwazo emva
kokusetyenziswa kanye. ii-Auto-Disable (AD) kunye neesirinji ezinokubuyiselwa
kwisimo sazo sangaphambili/ ezinokuvuselelwa (reconstitution), kwaye ngaphezu
kweekota ezintathu (51; 80%) zamaqondo obushushu ezikhencezisi zazihlolwa kabini
ngemini.
Iziphumo zohlobo olusemgangathweni: Imixholo emine yavela kwidatha: imingeni
kwinkqubo yokugonya, ubuncinane beendawo ezifikekekwayo yokugonya, ulwazi
olusileleyo /oluphantsi lwabazali / abanonophelo ngokugonya, kunye
nokubandakanyeka okuphantsi koluntu kwinkonzo yokugonya.
Isiphelo: Iziphumo ezisemgangathweni zisetyenziselwe ukuphuhlisa ukuqonda
okubambekayo kwesihloko sophando. Umphandi wenze izikhokelo zokugonya ukuze
kuphuculwe iinkqubo zokugonywa kwabantwana kwiindawo zasefama/
zasemaphandleni kunye nokukhokela iingcali zezempilo kunye namaqabane
aphumeza ugonyo ekuphuculeni ukufikelela kwiindawo ezininzi zokugonya kunye
nokunciphisa inani labantwana abangagonywanga.
Isizinda: Uhlelo lwamanje lokulethwa kwezinsiza zezempilo lwase-Ethiopia
lunezinhlaka ezintathu, okungukuthi ukunakekelwa kwezempilo okuyisisekelo,
okwesibili kanye nokwemfundo ephakeme. Isakhiwo sokuphatha sohlelo lokugoma e Ethiopia sisekelwe esakhiweni sokuphatha sezwe kusukela kuhulumeni
wesifundazwe kuya ezingeni lesifunda kanye neyunithi yokunakekelwa kwezempilo
okuyisisekelo.
Inhloso: Inhloso yalolu cwaningo kwakuwukwenza imihlahlandlela yokuthuthukisa
izinhlelo zokugoma izingane emphakathini wabafuyi besiFunda saseSomali, e Ethiopia.
Izindlela: Umcwaningi usebenzise indlela yamasu exubile yokuqoqa imininingwane
ehlanganisa echazayo kanye neyezinombolo. Kwakhethwa abaphenduli abangu-300
kanye nezikhungo zezempilo ezingama-64 ezinhlelweni zokuthola indlela abantu
abacanga futhi abazizwa ngayo ezindaweni zaseShebele esiFundeni saseSomali
kusetshenziswa amasampula ezigaba eziningi nezindlela ezilula zokwabela ilungu
ngalinye inombolo; abahlanganyeli abayi-12 ekunikezeni imininingwane ejulile
ngokuziphatha kwabantu bakhethwa ngezindlela zesampula ezihlosiwe. Mayelana
nezindlela zocwaningo ezichazayo neyezinombolo, imininingwane yahlaziywa
kusetshenziswa inguqulo ye-SPSS 25.0 kanye ne-ATLAS.ti 8, ngokulandelana.
Imiphumela
Imiphumela yezinombolo: Sekukonke, abangama-285 (94.9%) kwabangama-300
abaphendula babezwile ngokugonywa. Ngaphansi kwengxenye, 139 (46.3%), inani
elimaphakathi lezinkomba zolwazi belingaphansi kwalaba abaphendulile. Phakathi
kwezingane ezake zagonyelwa ukugonywa njalo, abazali/abanakekeli abayi-184
(79%) babenamakhadi okugoma izingane. Isamba sesisonke sezingane ezithole
ukugonywa okugcwele okusebenzayo kwaba ngama-81 (27%), ama-39 (13%)
agonywe ingxenye kanti eziyi-180 (60%) azigonyiwe. Okutholakele kuveza amabanga
amade lapho okugonywa khona (56; 19%), amahlebezi amabi (89; 30%) kanye
nesikhathi eside sokulinda (55; 18.3%) njengezinye zezithiyo ezinkulu zokungagomi
izingane. Ezikhungweni zezempilo eziqashiwe ezingama-64, ama-46%, 67% kanye
nama-64% okungenani anelungu elilodwa labasebenzi bezempilo abaqeqeshiwe,
ezitholakalayo ukuze zifinyelele kuzo zonke izifunda noma umphakathi futhi zibe
nohlelo oluncane lokuhlinzeka ngemithi yokugoma ethile, ngokulandelana. Cishe
ingxenye (30; 47%) yezikhungo zokunakekelwa kwempilo inenani elilinganayo
lemijovo yokugoma enesici sokuvimbela ukusetshenziswa kabusha nemijovo
yokuvuselela kabusha, futhi ngaphezu kwezingxenye ezintathu (51; 80%) zamazinga
okushisa esiqandisi aqashwe kabili nsuku zonke.
Imiphumela echazayo: Izindikimba ezine zavela emininingwaneni: izinselele ngohlelo
lokugoma, ukutholakala okuphansi kokugoma, ulwazi oluncane lwabazali/abanakekeli
mayelana nokugoma, nokubamba iqhaza okuncane komphakathi ensizakalweni
yokugoma.
Isiphetho: Okutholwe ngocwaningo oluchazayo kusetshenziswe ukuthuthukisa
ukuqonda okuphathekayo kwesihloko socwaningo. Umseshi wenze imihlahlandlela
yokugoma ukuze kuthuthukiswe izinhlelo zokugoma kwezingane emiphakathini
yabafuyi kanye nokuqondisa ochwepheshe bezempilo kanye nabalingani
abasebenzisa ukugoma ukuze kuthuthukiswe ukutholakala kokugoma nokunciphisa
inani lezingane ezingagonyiwe.
