Microplanning and monitoring of a measles vaccination response

Example for Kasanga: 18,400 × 0.17 = 3,128; 3,128 × 1.18 = 3,691.04, so 3,692 doses; 370 vials; 3,128 × 1.1 = 3,440.8, so 3,441 AD syringes; (3,441 + 370) / 100 = 38.1, so 39 boxes. The diluent is supplied with the vaccine, in the same number as the vials, and must be kept cold before reconstitution.

Teams = ROUNDUP(target / (150 × 5)): Kasanga 5, Mulolwa 3, Kituku 6, Lambo 3, Mwindi 4, Kahinda 3, Bumba 2, Kilunga 4, Tambwe 3, Makala 4; total 37 teams.

To be adjusted according to: the dispersion of villages and travel times (mobile or outreach teams), access (rainy season, lake, security), population density (more than 150 children per day possible in town), nomadic or displaced populations not counted, and the availability of the cold chain (vaccine carriers, frozen ice packs).

Coverage = vaccinated / target; wastage = 1 - vaccinated / (vials × 10). At day 3, about 60% is expected (3 days out of 5).

Kasanga 64.3% (wastage 14.8%); Mulolwa 66.0% (13.9%); Kituku 43.3% (31.7%); Lambo 71.4% (13.8%); Mwindi 60.8% (13.3%); Kahinda 54.9% (16.0%); Bumba 75.9% (13.6%); Kilunga 85.6% (12.4%); Tambwe 68.1% (13.6%); Makala 42.9% (15.2%). Total: 14,310 / 23,513 = 60.9%; overall wastage 1 - 14,310 / 17,130 = 16.5%.

Kituku: low coverage and wastage double the assumption: vials opened for few children (poorly attended sites), vaccinated children not recorded, or vials taken out of stock without traceability. Check the tally sheets and the vial register, group the sessions. Reminder: a reconstituted vial is discarded 6 hours after opening or at the end of the session. Makala: low coverage with normal wastage: a demand or access problem (rumours, refusals, late information, villages not reached). Mobilise community leaders and community health workers, add mobile teams. Kilunga: high coverage, possibly children from neighbouring areas (Kituku?) or an underestimated denominator; check where the children come from. In all areas, independent monitoring (rapid convenience monitoring) confirms the real coverage.

"Doctor, at the end of day 3, 14,310 children aged 6 to 59 months have been vaccinated, i.e. 60.9% of the target of 23,513, in line with the expected pace. The overall wastage rate is 16.5% against 15% planned. Three areas require action: Kituku (43.3%, wastage of 31.7%) where we are checking vial management and tally sheets; Makala (42.9%) where low attendance suggests a mobilisation or access problem; Kilunga (85.6%) which is probably receiving children from neighbouring areas. We propose: 1) two additional mobile teams in Makala for days 4 and 5, with the community health workers; 2) joint supervision in Kituku tomorrow; 3) an additional catch-up day in Kituku and Makala if coverage remains below 80% on day 5. The stock of vaccines and syringes must be checked for these adjustments. We request your approval for points 1 and 3 before 18:00, and the start of rapid convenience monitoring from day 4."