child surmw& of - world health organization
TRANSCRIPT
THE REPOF3 OF
PRlMAIlY m m CARE
AND
CHILD suRmw& AcrMTIES
THE S?aTE OF
QAm
TABLE OF CNTlWTs
Page No.
2. Methoclology
3. Sumnary f i.fidings and IM jor recomnendatlons
4 . Country p ro f i l e
5. Oryanisatlon and admmistration
6. Primary Heal.th Care
7 . Maternal and chi1.d health service:;
8. 'The nat;.oiwl i ~ m n i z a t i o n prqr~mxile
'3. Vaccines and cold chain
10. Disease surveillance
11. Nutrit ion
12. Health d u c a t i o n
13. Control of diarrheal disease
1 4 . Drugs and drug management
15. Findings and r e c m n d a t i o n s
ANNEXES -- -----
(1) Map of Qatar
(2) ~ a p of c lus t e r s outside Doha
(3) Map of c lus te rs inside Doha
( 4 ) Map of Health Centres i n Qatar
(5) 'rime table of a c t i v i t i e s
(6) M a r s of Review team
(7) Team romposition f o r f i e l d survey
(8) MOPH oryanizat~on chart
(9 ) Sumnary of mothers ' r e spnses
(10 )Hmd G.H. pat ients with Measles aM3 Pertussus
(11) Camnlcab le diseases not i f icat ion form
(12)Cold cham equipxml:
(13)Vaccine stock a s on b Septmker 1987
(14)Glossary oE abbreviations and term
(15)Otf ic ia ls interviewed
The .Jo~nt Review Mlssion Teal1 wishes to acknowl~~~je
=and thank a l l Uiose who have particip.~t~d in llhe
f?i3JI.EW.
111 particular, tile T e r n wislles t o ,,ckr~wlec?yc and
lrhsnk Mrs. 1Iouda Den Jcm2.a ald Mrs. :;alJ.y blai-ilews
who b t h typcd th is report, and Mr. Rdik Salcahie1
Deplty Resident Representative, UNDP for hls krnd
assistance and moperation.
'Tile Tean also wishes t o thuLlk ML-S. Es111era arid
Mr . Said of the Preventive Medecine Dzprlmclit
who assistcd in the prduction of this document.
1. I N T R O O U C T I O N
At the request of the Government of Qatar, a team consisting of members
from the- Ministry of Health, the World Health Organisation and UNICEF
jointly carried out a review of the primary health care and child survival
activity in Qatar with emphasis on some of its aspects like Expanded
Immunisation Programme and Maternal Child Health services. Other aspects
of PHC namely School (Health, Nutrition, essential drugs, Health Education,
Control of Diarrhoea1 diseases were also looked at briefly.
The Terms of Reference for the Review Mission are :
- to undertake an assessment of the facilities and resources at
H.Q. and H.C. levels.
- carry out a detailed study of the immunisation and MCH activities
at all levels of health delilvery systems.
- to evaluate immunisation coverage of children between the ages
of 12 to 23 months for the 6 EPI vaccines.
- assess the level of integration of the child survival activity into
the MCH/PHC services in the country.
- to study the management and supervisory structure of the immunisation
and MCH services at all levels.
- assess intersectorial coordination.
- assess the quality and coverage of training undertaken and its
impact on staff performance.
- assess community participation in regard to planning, implementation
and monitoring of the activities in the target population.
- make recommendations for improvement and for revision of policy
strategies.
- set a time table for implementation of t h e recommendations.
- 2 - 2. M E T H O D O L O G Y
The team spent a week reviewing aspects of the PHC at the Headquarters level
of the Ministry of Public Health in Doha, then carried out a coverage survey
for the entire country and visited all 19 Health Centres throughout the
country.
The review a: natibnal level was carried out by teams concentrating on
different aspects of PkiC, rather than individual programmes in order to be
able to analyse the question of integration in more detail.
The asuects observed included :
- Planning, organisation and integration
- Budget and finance
- Supplies and logistics
- Manpower and facilities
- Management and supervision
- Training
- Information systems
- Diseases surveillance
- Health education
The areas which particularly were covered included MCH, Nutrition, EPI,
vaccines and cold chain.
Many officials were consulted at all levels.
For visiting the Health Centres and carrying out the cluster survey the
Review Team divided in four groups.
The evaluation of immunisation coverage was based on the cluster sampling
technique developed by WHO. This survey was designed to sample the whole
population of Qatar. It was done by four teams, each consisting of one
international member, one national resource member, one female Nurse and
one male Statistician field worker from the Central Statistical Organisation.
special forms were designed and the field teams were trained. The evaluation
took nine days with each team covering 7 to 8 clusters. Each team also
visited 4 to 5 Health Centres.
2.1 The Cluster Survey :
2.1.1. The Selection of the Clusters :
To select the clusters, data was collected from the Central
Statistical Organisation population tables. The whole country is
divided into 9 Municipalities, 90 zones and 2354 Blocks. An
accumulativ~ population list was prepared block by block from the
1986 census data. 85% of the population lives in the capital, Doha,
and its outskirts. 30 clusters (blocks) have been selected using
the WHO/EPI cluster sampling technique. The 30 clusters are
distributed in the following districts :
DOHA 18
RAYYAN 7
WAKRA 2
UMM SALAL 1
AL KHOR 1
JUMALIYA 1
212 eligible children in the target age group were included in
these 30 clusters.
a total of 1152 households were visited. The average time spent for each
cluster was 2.5 hours.
2.1.2. The Interview :
Children aged 12-23 months at the time of the evaluation were sampled.
Immunisation cards and Birth certificates were used to determine whether a
child had received immunisation against Tuberculosis, Diphtheria, Petrussis,
Tetanus, Poliomyelitis, Measles, Mumps and Rubella. In the absence of an
immunisation card, the verbal history given by the mother was accepted.
The child's BCG scar was checked. The mothers of the Index children were
interviewed about their knowledge, attitude and practises, as well as their
utilisation of the Health services.
3 . SUMMARY FINDINGS AND MAJOR RECOMMENDATIONS
3-1 Summary Findings
The review team was extremely impressed by t h e progress made i n
development of h e a l t h se rv ice de l ive ry , and t h e a v a i l a b i l i t y of h igh
l e v e l of medical s e rv ices wi th in t h e reach of every one.
The hea l th cen te r s a r e w e l l equipped, s t a f f e d by a team of
dedicated h e a l t h p ro fes s iona l s . Many of h e a l t h c e n t e r s work two s h i f t s
and the main h e a l t h cen te r s on a 24 hours b a s i s . There a r e widely
recognized r e f e r a l h o s p i t a l s of a high s tandard. 96% of the d e l i v e r i e s
a r e c a r r i e d out i n the h o s p i t a l .
Po l iomyl i t i s has been v i r t u a l l y el iminated, Tetanus and Diphther ia
cases a r e very few.
The review team was extremely impressed by t h e development of t h e
c e n t r a l medical s t o r e s vaccine s to rage f a c i l i t i e s .
The programme has reached high l e v e l s of immunization coverage f o r
~ i p h t h e r i a , P e r t u s s i s , Tetanus and Po l iomyl i t i s (68%) throughout t h e
country. I n i t i a l immunizations were being given t o 82% of a l l e l i g i b l e
ch i ld ren and BCG t o 84%. These f i g u r e s suggest a high l e v e l of m n t a c t
between i n f a n t s i n t h e i r e a r l y l i f e and t h e h e a l t h s e r v i c e s .
Nevertheless i n s p i t e of these successes, problems s t i l l p e r s i s t i n
o t h e r a reas .
The major problems seen by the Review Mission team inc ludes :
* There i s a s e r ious l ack of coordina t ion between t h e va r ious
departments of the Minis t ry of Publ ic Heal th.
* There i s no na t iona l s tandard immunization pol icy . D i f f e r e n t
providers have adopted d i f f e r e n t p o l i c i e s .
* There is no systematic supervision of health delivery activities.
* Mothers are not well informed about health matters, particularly
breast feeding.
* Measles coverage is low and does not protect 40% of the eligible
children. Measles incidence in 1986 was the highest in the last
15 years. A special effort is called for to halt the spread of
the disease.
* 65% of children under one year of age are not fully immunized!
The risk to the child from the vaccine preventable diseases is
at its highest in the first year of life. The failure to
immunize 'fully within the first year is a serious problem.
* Communicable disease trends are not analysed at the health center
level. The data is compiled at the central level, but is not
analysed and used fully for planning and action. However, it is
the conclusion of the Review Mission that the potential for the
provision of primary health care of a high standard is very
great.
3-2 Major Recornendations
1 - The Departments of Preventive Medicine and Primary Health Care should be examined by an independent team to suggest ways for
more coordination of activities and to determine their optimal
structure, responsibilities, levels of staffing, organization
and support for senior staff.
2 - A high level steering/coordinating committee for immunization/CDD activities should oversee the programme and coordinate and set
policies, and arrange for an annual evaluation. In this committee
representatives of the Department of Preventive Medicine, Primary
Health Care, Hamad and Maternity Hospital, School Health, Army,
and Petroleum Health Services should be represented.
3 - An EPI/CDD programme coordinator should be appointed to be responsible for all imunization and CDD activities and should
be supported by the EPI/CDD Coordination Committee to manage the
pr.bgrame planning, training, supervision, disease surveillance,
overlook vaccine di~tribution~and conduct coverage surveys.
He should be given a chance to participate in any international
EPI courses to be established or arrange for his orientation on
study/observation tour of another successful programme.
4 - A manual of operating proceduresselected PHC element should be developed to include national policy guidelines and standard
procedurel. This mannual should be made available to all health
centres and should be used for government training and staff
development.
As a part of this manual, a manual for MCH activities in health
centers and specifically immunization should be prepared. In
this manual immunization practice, vaccine handling and care,
cold chain, sterilization practices, recording and reporting
of immunization out-put should be fully and simply referred to.
5 - Except surprise visits, a schedule of supervisory routine visits to each health centre should be prepared in advance. Check-lists
should be used as the basis for all supervisory visits at all
levels and should also form the basis for visit reports. Such
visits should include technical as well as administrative
components. Findings should be left with the unit and staff
visited.
6 - The media especially T.V., Radio should be utilized regularly for dissemination of health information to public.
7 - Measles control should become a high priority health programme in the country. The coverage level is low and contraindications
to measles immunization are numerous.
Measles vaccine should be provided to eligible children
admitted in Paediatric Hospital and in out pat5ent clinics.
Social mobilization, and follow up of defaulters is called
f ~ r .
8 - Immunization of children within first year of life should become a rule. Health centre staff should make sure that
the child becomes fully immunized before he reaches his
first birth date.
9 - Disease reporting should be revised and simplified. Epidemiological
data should be analysed and utilized at Health centres as well
as at national level. ?ledical officers should be required to
record diagnosis accurately and held responsible for reporting.
4. COUNTRY PROFILE
The State of Qatar is peninsular s ika t ed halfway along the western
coast of the Arabian Gulf. I t is bordered by the Kingdom of Saudi
Arabia t o the south, the United Arab Rnirates to the SQltheast and
the island of Bahrain t o the West. The peninala: of Qatar i s
approximately 160 kms in length and cwers an area of 11,000 5q.m
in total .
The climate is extrenely hot and humid from June t o Septenber and
rroderate t o warm from October to April. In sumner the average
daily temperaature reaches 4 1 X . Humidity r a i n s high most of the
year with rainfal l averaging 50 - 77mn per year and occurs i n winter.
4 .1 . TRANSPOW AND COME1I]NICATION
Air, sea and land colrerunications with other countries of the world
are greatly developed in Qatar. A high standard network of internal
roads runs t h r c u g h t the country and connects a l l the major tayns
w i t h the capital. External cmmunications include di rect telephone
links and world wide telex fac i l i t i es are available.
4.2. THE ECONOMY
The principle exports of the State of Qatar are petroleum, natural
gas and agricultural fert i l izer .
As a result of the mrld-wide f a l l in o i l and energy prices which
m a n in 1983 the economy has been contracting. This has led to a
significant decline in Govmen t and personal i n c m s .
4 . 3 . EOPULATION
According t o data issued fran the 1986 Census by the Central
Sta t is t ica l Organization, the poplation is about 350.000.
Doha
RaYYan
Wakrah
Umn Sa l a l
Al Khor
Al Sham31
Al Ghuwayriyah
J e r i an Al Batna
Total 369,079
N.B. : The m1e:Femle ratio is 2%1 Cue to the anployment of l a rge nurrber of expa t r i a te males.
Children under 1 year of age 8,161 (2%)
Children 1 year t o 4 years 32,993 (9%)
Farales 15 years to 45 y w s 61,151 (17%)
A k u t 85% of the p o p l a t i o n l i v e in the cap i t a l Doha and i t s v i c in i t y .
Wst of the r a i n i n g 15% of the p o p l a t i o n l i v e i n 9 t m n s .
4.4. VITAX STATISTICS
This statistical i n f o m t i o n was provided by the Ministy of Public
Health, Preventive Medecine D e p r t m m t and is f o r t h e year 1986.
Cmde B i r t h r a t e 27 per 1,000 p o p l a t i o n
Crude Death r a t e 2 per 1,000 p p l a t i o n
Natural growth r a t e 25 pe r 1,000 p o p l a t i o n
Neonatal m r t a l i t y rate 9 per 1,000 l i v e births
In fan t Mrtality rate 14 per 1,000 l i v e births
Chi ldMor ta l i ty rate (1-4 yrs) 4 per 1,000 l i v e b i r t h s
Maternal rmr t a l i t y rate 0
L i fe expectancy a t b i r t h Male: 71 years
Female: 74 years
5. ORGANISATION AND ADMINISTRATION
5.1. GENERAL ADMINISTRATION
Qatar is an independent sovereign Arab country, its religion is Islam. The
ruler of the State of Qatar is The Amir. A cabinet of Ministers is responsible
for the different Ministries' affairs. Doha is the capital and is the
country's administratiJe and financial centre.
Administratively Qatar is divided into nine municipalities, these are divided
into 90 zones.
5.2 HEALTH ADMINISTRATION
The Ministry of Health is the overall authority for provision of preventi\:e
and curative services to the population. Other Ministries and Agencies share
responsibility, the Ministry of Education for School Health, Armed Forces,
Police Forces and The Qatar General Petroleum Corporation (QGPC), for their
working personnel and their families. As far as environmental services are
concerned, the Ministry of Regional Municipality affairs cares for sanitation
activities as water, refuse and sewage disposal.
All functions of the Ministry of Health are administered by the Minister of
Health assisted by an Undersecretary of Health who is assisted by two
Assistants for Administration and Technical Affairs. There are four central
General Directorates which are administered by the Director Generals for the
preventive affairs, the primary health care services, Pharmacy and medical
supplies and medical councils. the organisational chart is appended (Annex ) .
All health services are provided through 3 hospitals: maternity, general
and chronic diseases, as well as 19 health centres under the Directorate of
Primary Health care. These three hospjtals constitute the Hamad Medical
Corporation (HMC). Though officially within the MOPH, HMC is quite autonomous
with its own pay scale. the Minister of Public Health is the Chairman of
HMC's Board of Directors, the Undersecretary is its Vice-Chairman and
Managing Director, and the Assistant Undersecretary for Technical Affairs is
a Member of the Board.
All health care services are provided free of charge.
5.3. HEALTH BUDGET
According to the data available at the Planning Office of the NOH, about
3 to 4 per cent of the Government budget is allocated to the Ministry of
Health.
Table ( 5.3 ) shows the comparative percentage of the health component to
the overall budget of -the country for the years 1983-1987.
GOVERNMENT AND HEALTH BUDGET
(1983-1986 (in Thousand Riyals) ...............................
YEAR GOVERNMENT MINISTRY OF HEALTH %MOH TO GOV.
In this period the declining price of oil which provides much of the income
of the State, has led to a reduction in funding of all governmental services
including health.
The relative increase, in health provision in 1987 reflects the increased
commitment of the Cabinet for expanding promary health care.
5.4 HEALTH ESTABLISHMENTS
5.4.1. HOSPITALS
There are three hospitals in Doha as part of the Hamad Medical Corporation.
Hamad General H o s p i t a l is the largest with 540 beds. It has departments for
paediatrics medical, surgery, along with a special care unit. Besides its
outpatient clinic, it is the main referral hospital.
Rumailah hospital has about 180 beds mainly for chronic diseases with wards
for TB, psychiatry, developmental disabilities, geKatrics, rehabilitation,
and a unit for burns.
Women's hospital for obstetrics, gynaecology and paediatrics, with a capacity
of 200 beds.
5.4.2. HEALTH CENTRES
A network of 19 health centres exist. The table shows their distribution by
administrative regions. Each Health Centre has a defined catchment area.
They provide medical care, laboratory services, dental, and pharmacy services.
In 17 of these centres, MCH services including vaccinations are offered.
Distribution of Health Centres by Region
HEALTH CENTRE REGION
9 Doha
2 Rayyan
2 El Wakrah
1 Umrn Salal
1 A1 Khor
1 A1 Shamal
1 A1 Ghuwayriyah
1 A1 Jumayliyah
1 Jerian A1 Batna
19 TOTAL
5.5 HEALTH MANPOWER
The table shows the health manpower as reported by the Planning Office in M.O.H. Sept. 1987 :
CATEGORY HAMAD MED. CORP. MIN. OF PUBLIC TOTAL RATE PER HEALTH 1000 DOD.
Physicians 334 150 484 1.3
Dentists 18 27 45 0.1
Nurses 1091 183 1274 3.4
Assistant Nurses 19 16 3 5 0.1
Sanitarians - 56 56 0.2
Health Assistants 328 - 328 0.9
In addition 3 social workers are employed in health education activities.
The health services in Qatar are mostly dependent on non-Qatari health
staff. A national health manpower plan has not been developed.
5.6 OTHER HEALTH PROVIDERS
5.6.1. School health services are the responsibility of the Ministry of
Education. It provides care for student population in Government, non-
Government schools and the University, as well as for teachers, other
employees and their immediate families. Services are provided through
450 school clinics in big schools, 10 school health units, one for every
8000 school children in Doha and for every 2000 outside Doha. In addition
the Ministry of Education operates a polyclinic within the capital with
12 specialised clinics. The school health service programme includshealth
education activities and the provision of training for healthy living at
school.
5.6.2. The army, police and the QGPC have their own health services
forthe employees and their families. the private sector is rather limited
and there are no private hospitals.
Until 1978 mrative services were offered a t a few clinics and a t one
hospital i n the capital. Maternity seririces were available a t the
W c m e m Hospital.
The Primary Health Care D e m e n t was established i n 1Y78,with the
agreement of the cablnet and on the approval of the Emir, to lmpkm2nt
the Naaonal Primary Health Care Plan.
Under th i s plan the State of Qatar is divided into Health Service
Areas of bdzween 25,000 t o 50,000 poplation. Each health service
area w i l l eventually be served by a Primary Health Care Centre, Clinic,
o r a PHC Centre w i t h sane in-patient faci l i t ies .
Under the Director of Technical Services, the Director of Primary
Health C a r e is assisted by the Director of W H Services, and the
Director of Nursmg. The PHC Deparhent is responsible for administering
the implementation of the P r m x y Health Care Plan.
The PHC department is responsible for the medical staff of a l l P r q
H e a l t h Care Centres. Tne Director of P h m c y and Drug Control, a separate
directorate, is responsible for all p h m c y personnel, pharmacy supplies,
including vaccines, and equipnent.
The operational and technical role and respns ib i l i ty ot the Preventive
Medicine Department in the provision of preventive healtn services and
i n the control of cammicable disease within the Primary Health C a r e
service is not clear o r well defined.
Wlilding mintenance, repair, and construction, is the responsibility of
tne Mrnistxy of Public Works. Cleankg services and waste disposal are
the responshil i ty of private contractors.
6-1- PrUm-y H e a l t h Care IPescurces
A t the present tune there are 19 Primary Health Care Centres func t iomq
thrcugncut the State, w i t h a further three centres scheduled to ccme
into operation by the end of 1988.
The national cannitment and support for tne m n t m d , expansLon of
the Prmary Health Care system is daronstrated by the forward b d g e t
allocation of QRs.92,226,520 in 1987/1988 (USS25.4 million) for tne
construction and inn>ruvement of PHC centres by the Miustry of Public
Works.
The operatingcosts of tne centres are subsumed i n the general Ministry
of H e a l t h Eudget, and represents a significant MOH cmmnittrnent.
Tnat t h i s is ocar ing a t a tlrne when a l l deparfnxmts and Ministries
are facing h d g e t reductions is rarwrKabLe.
6.2. P r m a y H e a l t h Care Strategy
6.2.1. Servxce Delivery
The approach t o primary health care that the State of Qatar has implement&
follows the general practitioner/family doctor c l in ic mxlel. These
c l in ics operate six days a week with mst centres providing m m m g
and evening clinics. A rnutlber of health centres offer 24 h a r service
seven days a week. Both walk-in and appintmsnt services are available.
Ante-natal, well-baby, and irrnunization clurics are scheduled once o r
twice a week a t mst health centres. An appointment system for these
cl inlcs is being implemented.
While treatment sexvices are available a t a l l centres, and inpatient
services in a few health centres, the physicians a t PHC centres refer
d i f f i a l o r r isk cases to either Hmad General Hospital o r the Wornens
Hospltal in the Capitd.
It has been proposed to develop a m r e specialized secondary referral
service w l t h i n the primary health care centres, p a r t i a l a r l y for the
maternal and child health services.
The PHC pysic ian m l d refer a patient to a special ist a t the sane
health centte, rather than du&ly t o the m i n referral hospital
services. A t the present tm, consultant c l i n l o a r e held m s m
PHC centres.
There is no cormunity participation in the provision or primary health
care services a t any level.
other ministries, as well as large c a p m i e s provide additional f i r s t
contact and preventive health services.
A t the present time there are no charges or fees for PHC services o r '.
drugs. Fees for non-nationals is under disass ion .
6.2.2. In fomt ion System
Health servlce roJmbers, patient records and health status will eventually
be linked m a networked canplter data system w i t h terminals in all
health centres. This medical informtion system based on the registration
of the p p l a t i o n and the issuance of health service numbers is part ial ly
irplemented (sane 180,uOO of approx. 300,000 pop. t o date) .
A l l hospital births (sane 98% of a l l births) w l l l be rtqisterd a t the
hospital. A system for tollow up through neo-natal clinics, m W e l l
Baby cl inics and MCH clinics is planned. It is expected that all
n-ms w i l l be registered and covered by PHC servlces by 1990. The
intention or the PHC department is to m ~ t o r ana follow-up the develo-
pnent of children from birth t o 4 years of age.
Provision is to ke rade t o provide in fomt ion to PHC centres, the
Ministry of Fhcation's schcol Health Service, other health providers,
as w e l l as Ministry of Health Departments.
6 . 3 . Service Targets
In aadition t o evenaally providing a PHC Centre for each Health
Service area (25,000 to 50,000 p p l a t i o n ) , a number of service delivery
priorities have been stated.
Tne further expansion and d w e l o ~ t of maternal and child health
services includillg the provision of specialized care is a major priori ty
for the PHC. Deparhnent .
The department has propsed t o privide c m n i t y m e n t a l health services
based i n each health' centre.
A general irmunization coverage target of 90% is envisaged w i t h no
specific taqets for comrunicable disease reduction.
IIB case identification and follow-up, as well as hypertension and
diabetes treatment, maintenance, and follow-up through the PHC centre
are now prcgramne targets.
6.4. Field Observations
In reviewmg primary health care activity, the f le ld t e a m s concentrated
on examining the iqlementation of primary health care and child survival
act ivi ty a t the f i r s t contact health faci l l t ies .
All 19 Primary Health Care Centres were v i s l t d . They are d i s t r i h t e d
widely -ghat the State of Qatar, though only 7 are outside of the
Coha/Rayyan metroplitan area.
The review mission used the WHO P a r t 3 h d t h centre R6view Protom1
which was modified to s u i t the neeis of the State of Qatar.
6.4.1. Gealth Service Utilization
An indication of health service utilization has been derived both from
the review team v i s i t s to healtn fac i l l t i es and from the cluster survey
household v i s i t s .
In the two mnth p e r i d prior t o this review 81% of the index households
surveyed had a t leas t one &r of the famiiy who attended a health
faci l i ty .
Of these scme 97% attended a g o v m t facility (Prinwy Health C a r e
centre) .
Only 4% or the hmsholds reported that they were further &an one hmr
f ran a health centre.
For the 7 Primary H e a l t h Care Centres which provide3 data to the teams,
the average patlenr v i s i t s were abaut 4,UOO per mnth in the period
before the current b r u z a ~ i o n campaign.
6.4.2. Healtn Centre Managenent
6.4.2.1 Staffing
A l l Primary Health Care Centres were well s t a f f a . Large health centres
had as many as 14 Physic~ans and 24 nurses. Smal l Health centres might
only have one mrse a d a pnyslcian.
I t has been the view of medical personnel that Social workers are
respnsible for providing Health Education. Currently only 3 social
mrkers are gnploya in Primary H e a l t h Care Centres . In 1986-87
m m s social worker posts have been closed &e to bDPH budget r&ctions.
6.4.2.2. Physical Laycut
Of the 15 recently bui l t Primary Health Care C e n t r e s the general l a y a t
was w e l l planned and conducive t o efficient work.
In all ht tu~ of these P.H.C. centres waitmg areas were mil, w i t h
no seating for patients. Thls m y prove to be a LiaDillty m pmid ing
Health Fducatlon sessions 2 Recently designed Health Centres w e r e
planned with large central waitlng areas.
Older centres are in need of some rehabll i tat~on.
6.4.2.3. Superv~sion
There are no written job descript~ons. Staff reetings are rarely held
and are not a r q u l a r part of the H e a l t h Centres Operations.
While c c c a s i o ~ l v i s i t s by Senior WPH staff are made, there is li t t le
in the way of actual technical o r w a g e r i a l supxvision. Checklists fo r supervibry v i s i t s are not used, no catmats or r-tations
are recorded. There is m f o l l w u p supenrisory activity.
6.4.3. PHC and Child Survlval Services
A l l kt one health centre provided m n i z a t i o n services for children.
.While 1/3 of the centres prwided imrunization on one day a week,
2 / j of the centres had bebeen 8 and 16 sesslons mnthly for an wer-al l
average of 2 sessions per week.
75% o t a l l healtn centres provided oral rehydratlon therapy, and
sweral had rehydration r m . Oral rehydration is prescribed by
the physician on an as needed basis.
85% of the health centres visited prwided ante-natal care whicn was
r e p r t d to include fccd dmntra t ion i n 17% of the centres. Ante-natal
cl inics are held weekly in mst centres, with a national average
of 6 clinics per centre each mnth.
90% of the centres have 'child health cl inlcs, most of which are offerred
on one aay each week, with an average of 6 sesslons per centre a mnth.
only 9 of 19 Primary Heakth C a r e Centres were reported to have occasional
health &cation activity, including person t o person contact, films,
health talks, and psters.
25% of the heaLth centres r e~or t ed naking v i s i t s t o patients homes in
connection with the mintenance of diabetic invalids.
No activity related t o water supply or sanitation was carried at by
any health centre. These act iv i t ies are the responsibility of the
Mmistry of Reglorn1 Mmicipdiity Affairs.
6.4.4. In tqra t ion of Services
90% of the health centres were r e p r t d to offer a r a t i v e treatment
t o children attending child health cl inics. 95% of the centres offer
treatment to mthers during an t ena t a l and child health clinics.
Sane 63% of all health centres repr ted rcutinely screening children
attending any c l ln ic for their w n i z a t l o n status, while 76% screened
for mt r i t i bna l status.
Only 51% ot chlldren attending an k n i z a t i o n session were routinely
screened for nutxitianal status, wnile only 63% were m t i n e l y screened
tor thei r over-all developnent.
6.5. Olratlve Services and Cnild survival
I t is clear from the analysis of the f leld observations as well as
lntervlews w i t h national ofriclals that the major actlvity o r the
P r m r y Health care sys tm 1s t o provide curative services.
The Child Survival and preventive nealth interventions are limited
i n both frequency and extent.
While curative services are universally available in the State of
Qatar, ante-natal care, imrunization services, and oral rehydration
therapy are available on a more lirmted basis.
Health &cabon activities for mothers and children is limited and
almost non-existant.
Tne range ana provision of services for rrothers and children, who
constitute a large proportion of the poplation, is not standardised fo r
a l l Primary ~ e a l t h care Centres.
It is the conclusion of the Review Mission that the potential for the
pmvislon of uniform primary health care of a very nigh standard,
i n m q r a t i n g mre preventive health services, is very great.
7. MA- AND CHILD EEALH SERVICES
7.1. D J 3 A . O m
The national uni t for WH services was related t o the Preventive
Medicine Cepil-bwnt where MCH activi t ies were provided and
supervised. Farly in 1987, as part of the developnent and
integration of pr- health care services, this I433 unit was
incorprated in the PHC Department. The uni t i s n w the
responsibility of a Director who is responsible for planning and
supervising MCH activi t ies in Health Centres. An MCH programne
Coordinator ass is ts the Director i n management, implementation
and l q i s t i c s , as well as i n developing educational and training
materials for the unit.
The Coordination of WH activi t ies with other units in the PHC
and the Preventive department is not adequately developed. This
lack of coordination has lead t o inadequate integration of
primary health care services. Recently a joint Coordination
Cornnittee has been formed. The members are the Director and
Coordinator of K H , the Medical Director of Health Centres,
Head of the H e a l t h %cation Deprtment, and the principal
Nursing Officer. I t is expected that the manbers of this
Camittee w i l l meet every week to discuss MCH problems -ma
f o m l a t e regulations and standard operating procedures tor
b K 3 services.
7.2. I433 STRA'IWX
7.2.1. PHC/ICH
In October 1986 the Director o f ' the section developed a plan
for developing and inproving the MCH programne in Qatar. This
plan included the follwing steps:
1- Administratively establishing a focal point for p r m t i n g
and ccordinating I433 policies, training schedules and supervisory
plans.
2- Incorporation of the MCH prqramne i n the primary Health
care system t o have access to the available resources of the
department. The mrdina t ion w i t h other p r c y r m s such as
health education and nutrition activi t ies would be dwelo@.
3- Cooperation with other sectors having act iv i t ies related
t o MCH such as universities school health, and nunicipality
environrrental services.
4- Prcimting poli t ical ard legislative support to I43 services
5- C m n i t y involvement i n sane aspects of health service
deliverysuchas theselection of c m n i t y health workers,
and linking MM act ivi t ies with c m n i t y goals.
6- Dareloping continuity of care services t h m g h pregnancy
and on t o child care.
7- Developnent of training prqramnes i n I43 for the existing
staff in health centres, W~nens Hospital and the Nursing School.
7.2.2. HOSPITALS
The antenatal and neonatology de-ts in the W m ' s
Hospital have as objectives for the year 1987 the continued
reduction of the perinatal mortality rate, integration of
primary and secondary medical care, through the training of the
health centre doctors, 4 involving m r e consultants i n visi t ing
health centres. A priority is the establishment of hiqh r ish
pregnancy clinics. Two MCH projects have recently started:
A National child health survey for evaluating MCH act ivi t ies
ard the health status of w a w n and children in Qatar and the
Ollf c m t r i e s with the support of the Arab Gulf Rtnd for Developnent
and the assistance of UNICEF. The other project
is for the developnent of health &cation with an enphasis on
K H . It aims a t the training of 300 of the health centre
personnel, as w e l l as the dwelopwnt of a heath education p rog rme
for the m n i t y . This project is a UNDP, U N m and the PDPH
assisted project (Cost-Shariq) and it is gwemment executed.
7.3. ORGANIZATION AND MANAGEMFAT
KE services provided in the State of Qatar include the following
activi t ies:
7.3.1. An antenatal c l in ic once or twice every week is provided
by 17 out of the existing 19 health centres i n Qatar. Pregnant
mothers are examined and anteparturn records completed. Wthers
are ins tn~cted to v i s i t every mnth. In case of any abnormal
condition o r when the pregnancy is 34 weeks, the mther is
referred to the Maternity Hospital, carrying a P.H.C. Cooperation
Card w i t h the appropriate case records.
7.3.2. Most of Doha's health centres are visited by a consultant
from the Women's Hospital once per week for examining needed cases
and doolmenting the at-risk staas.
7.3.3. From the 34th week of pregnancy the care for mthers is
provided by the W a n e n ' s Hospital a t -pa t ien t Clinic, where follow--
up care a d the subsequent delivery is carried-out
Nearly a l l deliveries in Qatar o c a r i n the Women's Hospital
which contains 200 beds. A new Maternity hospital is now i n the
f inal stages of construction w i l l add 250 beds to the department.
Luring 1986 &st a l l births were in the hospital. (9866 out of
9942 bir ths i n Qatar during this year).
7.3.4. BCG innunization is given t o a l l infants before discharge
f run the Hospital.
7.3.5. Wthers are instructed to come back for post-natal care
a f t e r 2 meks. They are issued with an appintment card and an
imunization card for the child.
7.3.6. The neonatolcgy depa%xmt in the hospital contains a
Special Care Baby U n i t with 30 cots and an intensive Nursing
Care Unit w i t h 6 cots.
The neonatal death ra te has fallen during 1986 t o 7 per thcusand
ccsnparedto 1985. The first week death rate has fallen in the
same period from 7 per thousand to 5 per *sand.
7.3.7. Neonatal clinics for follow-up of dwdopnent and hearing
are now provided in 6 -P.H. Centres fran the ages of 2 - 4 weeks.
It is planned t o extend these services to the rerraining health
centres in the near future.
7.3.8. Well-Baby Clinics are provided once or twice weekly in
17 cut of the 19 Health Centres from the 8th mnth t o 4 t h year.
Records including gru.ith and dwelopnent charts, hearing tests,
and medical history are maintained. Nutrition &cation t o
mthers is provided.
7.3.9. m n i z a t i o n sessions are provided in a l l health centres
according t o the national sche&le. No ECG inrmnization is per-
formed in these centres. These sessions are held twice or 3
tires a week in the morning and afternan.
7.3.10. Health &cation :Individual health instructions are
sametimes given t o mthers, but g m p education act iv i t ies are
few.
N.B.: Qatar General Petrolam Corporation provides antenatal
and under f ive Clinics where similar services are provided.
7.4. INFOF?l"mTION SYSTEM
A t present no regular reporting occurs from the health centres
to the central PKH Director - a l l reporting is directed t o the
Canplter Health Registration Unit of the WPH. No feed back
t o the Health Centres or to MCH Section occurs.
7.5. TRAINING AM) SUPERVISION
NO regular schedule for c o n t ~ c u s training of personnel i s established,
kt s m of the physicians in health centres are sawtimes trained
in the Hamad Paediatric ward or i n the WQnen's Hospital for a period
of one or m r e qn ths . For Nursing s taff , a training progranmte
was developed 18 mnths ago by the principal Nursing Officer
and Assistant. The pqramne includes orientation for 1 - 2 weeks
by lectures abcut iqmrtant subjects such as antenatal care,
hun iza t ion , recording, and primary health care services. This is
followed by in-service training i n the health centres-for growth
assessment, hearing testing arid nutrition education.
A t present, the supervisory systan does not include a l l health centres,
and needs m r e supervisors with chek lists and a reporting system
The Director and Cmrdinator of K H v l s i t Doha health centres, but
do not use check lists, nor do they r e ~ o r t on their vis i ts .
7.6. FIELD OBSERVATION
7.6.1. ANTENATAL CARE
91% of the surveyed mthers have been examined during the i r pregnancy
of the index child. Among these,71% of the mthers have been
seen m r e than 6 times, the mininum reamended rolmber of times.
12% were seen 3 - 6 times and 17% were seen less than 3 times &ring
their pregnancy.
Instructions given to the mthers as an e l m t of health education
in the health centres was provided t o only 53% of those sen& by
the health centres. Thls indicates the need tor Increased Health
-cation activity &rmg antenatal care.
7.6.2. PEXIN&TAL CARE
96% of the surveyed mthers were delivefed in hospital - only 3%
of the mthers were delivered cutside Qatar w i t h the help of
traditional bir th attendents .
There are no TEA'S in Qatar. 92% of the mthers knew that their
infants were examined af ter birth and 70% said that thei r infants
were seen two or m r e times by a physician or Nurse. No growth
charts were given to the mthers except one expatriate vho had
her chlld 's growth chart issued in her hem? country. The systan
here ' is t o keep growth charts in the health centres. 87% of the
mthers said that their infants have been weighed 2 or m r e
times af ter discharge frcm the Maternity Hospital. These v i s i t s
to Health Centres could be taken as an opportunity for educating
mthers , and to pramte breast-f eedmg , better weaning practices
and mtr i t ion.
./.6.3 Availability of health services
96% of the srveyed families l ive within one hcur of the nearest
health facil i ty. 83% o f t h e families had visited a health
fac i l i ty durirq the previous 2 months. The mjor i ty of these
(97%) visited a govermnent fac i l i ty (health centre o r hospital),
while only 3% attended other clinics. No home v i s i t s by a trained
health wrker o r a camunity health worker were reported.
8. NATIONAL ImUNISATTION PROGRAMME
8.1 POLICY
The p o l i c y o f MOPH i s t o immunise c h i l d r e n under 6 years o f age f o r e i g h t
diseases, the s i x EPI t a rge t diseases p1t.s Mumps and Rubel la. Ch i l d ren over
6 years rece ive booster vacc ina t ion through the School Hea l th Programme.
The p o l i c y o f MOPH doeg not r e q u i r e Tetanus Toxoid vacc ina t i on f o r pregnant
women.
VACCINATION SCHEDULE : BCG i s g iven a t Women's H o s p i t a l (Doha)
where about 965 o f d e l i v e r i e s are conducted and i t i s g iven j u s t a f t e r b i r t h
o r w i t h i n one month. DPTP/OPV vaccinat ions are g iven i n t h ree v i s i t s 2 months
apar t s t a r t i n g from second month o f age (Age 2 - 4 - 6 m). Measles vaccine
i s g iven a t 9 months o f age. MMR i s g iven a t 15 months o f age. DPTP/OPV
f i r s t booster dose i s g iven a t the age o f 18 months and a second booster
o f DT/OPV i s g iven a t the age o f four years.
Table 8.1.1. Innnunisation schedule fo r t h e S ta te o f Qatar.
Age o f c h i l d Ant igen
F i r s t month BCG
Second month DPTP f i r s t dose and Ora l P o l i o vaccine t i rst. dose
T h i r d month DPTP second dose and Ora l P o l i o vaccine Second dose
Six month DPTP Th i rd dose and Ora l P o l i o vaccine Th i rd dose
Nine month Measles Vaccine
F i f t e e n month MMR
Eiqhteen month DPTP booster dose and Ora l P o l i o vaccine booster.
E igh t years DT booster does and Ora l P o l i o vaccine booster.
I f a c h i l d at tends the immunisation c l i n i c for the f i r s t t ime a f t e r the
age o f one year, the c h i l d i s g iven DT vaccine, OPV, and a t u b e r c u l i n t e s t .
If the t u b e r c u l i n t e s t i s negat ive BCG i s g iven on the subsequent v i s i t .
An i n t e r v a l o f 6-8 weeks i s requ i red between the subsequent doses o f DT/OPV
and any o the r irnrnynisation. Measles, mumps and r u b e l l a are g iven four
weeks a f t e r the second dose o f DT/OPV.
Table 8.1.2. Vaccinat ion Schedule
f o r c h i l d r e n who s t a r t vacc ina t ion a f t e r one year o f age.
V i s i t No. Time Antigen
1 F i r s t v i s i t DT 1 s t and OPV 1 s t Tubercul in Test (see Text)
2 A f t e r 6-8 weeks D l 2nd and OPV 2nd
3 A f t e r 4 weeks MMR
4 A f t e r 6-8 weeks DT 3rd and OPV 3rd
5 A f te r 6-12 months DT booster and OPV booster
The immunisation shcedule o f the M i n i s t r y o f Pub l i c Hea l th i s fo l lowed by
a l l o ther irnmunisation prov iders ( i . e . MOE, QGPC, MOD).
The School Health Service of the MOE provides booster immunisation according to the following schedule :
Table 8.1.3. Imnunisation Schedule for Schoolchildren
Age Antigen Notes
6 years DT/OPV Booster
10-13 years BCG After tuberculin test
11-13 years Rubella Female only
11-13 years Mumps Male only
15-19 years DT Booster
8.1.2. Contraindication
A policy of multiple contraindications is followed. these include mild
fever (37.50C), diarrhoea, rhinitis, acute respiratory infections, allergies,
and any other acute illness.
This policy on contraindications is - not in accordance with the recommendation
of The International Association of Paediatrics Regional Meeting in Lahore
in 1984, and the recommendation of The Global Advisory Group on EPI
in 1985.
8.2 Targets and Strategy
There are - no immunisation or disease reduction targets in Qatar.
The strategy for achieving immunisation coverage is to provide immunisation
services at the Women's Hospital for BCG and Health Centres for all other
vaccines.
Other providers, such as MOE, QGPC, and the MOD provide an immunisation
service.
8.3. lNFURM&TION SYSTEM
8.3.1. In health centres, irmunizations are recorded on the child5
irmunization card, the patient f i l e , a registration book, and a
mnthly report form is c q l e t e d .
The mnthly repo&ng form is sent t o the C q t e r Health m i s t r a t i o n
Dlvision of the MOPH im Doha.
In s m health centres the patient f i l e is the only record of
inmunizahon retained.
8.3.2. The ampter Health Registration Dlvision: The mnthly reprrs
are entered into the canplter registration. Periodic reports a r e
forwarded to the Primary B d t h Care and Preventive Medicine Departments.
8.3.3. The Preventive Medicine Departments receives mntnly reports
frcxn the Schcol H e a l t h Department, MOD health services and the GPC.
Yearly reports on BCG inmunization are received frcxn tne wonws Hospital.
The Department prcduces an Annual Report on imrunization and the
incidence of disease. m n i z a b o n activity is shown by age, sex
and nationality. Irmunization is - not shown agewise by antigen dose.
Table 8.3.3. shows innunization activity, 1982 - 1986.
Tabie 8.3.3.
Total inmmzation performed in
1982-1986
8.4. P R X M MANAGEQWl' AND OFGANIZATION
The h n i z a t i o n programne is managed by 7 organisations each of which has its
own systan of operation.
iimunization policy was developed by a m t t e e of: the PHC Department
and Hamnad Hospital Corporation Consultants i n 1985. This aami t tee
has met twice. No representative from prwentive medicine or s c h a l
health services were involved.
'rhe six m n i z a t l o n providers use the lmrunization Scheciule of
t ?e Deparbnent of P,rwentive medicine (DPH) . There is no central
vaccine procurement.
Tne preventive -cine deparknent corrnunicable disease control
section collects c m n i c a b l e disease data and m n i z a t l o n reports.
8.4.1. The contraints of EPI management: Tnere is no camina t ion ,
planningl evaluation and supervision of irimunization a c t ~ v i t i e s .
There are no technical relations w i t h international organizations.
There has been no participation m international courses, r q i o n a l
conferences and workshops on EPI o r cold chain.
Olrrent EPI and cold chain information is not available wil-hin
the WPH.
8.4.2. It is clear f m m the analysis of EPI programre nanagenent
that there is an urgent need for a p r o g r m manager to be
appomted.
It is the view of the review mission tha t the program m g e r
should be responsible for: Increasing hmrnzation coverage and
achievuq the rduction of the 6 EPI diseases.
The manager's terms of reference for achieving these g a s shculd
be planning, coordination of a l l servlce providers, trainmg,
supervis~on, mnitoring evaluation, and vaccine and cold cham
operations.
8.5. FIELD OBSERVATIONS
This was the f i r s t international review of the national innrunization
p r o g r m in state of Qatar. Imunization coverage was evaluated,and
innunization a t l e t s were visited.
8.5.1. Innumzation merage results.
T h ~ s includes MMR i f measles vaccine had not been given.
VACCINE
DPTP/OPV I dose
DFTPIOW I1 dose
DPTP/OW I11 dose
*Measles vaccine
BCG vaccination
BCG scar present
Fblly inmunized
Fully imrunized under one year
MMR
Drop cut ra te (111 to I DPTP/OW)
DPTP/OPV, coverage was high a t 82%, however only 69% received the
3 r d b e . The drop cut ra te observed was 16%. Wnile 56% of
children were fully irrarunized before the age of 2 years only
35% where innurnzed before the age of one year.
A s ch~ldren under one year are m r e a t risk of contracting the
target diseases with a greater r i s k of severe cunplications, it
IS i n p r t a n t to acniwe early irmunization.
It is the reconendat~on of the WHO that a l l children should receive
a q l e t e course of imtunization betore the age of one year.
%
82
78
69
60
85
75
56
35
31
16
8.5.2. Reasons for fai lure to complete innunization: 51% of.
the mtners did not know the need for imtunization or the n& to
return t o complete. 46% of mtners reported obstacles t o cxanple+Acg
kmnizations mainly i l lness of the child. 12% of ill children
w e turned away by the health centres. Another 12%-of children
were kept haw on the day of thei r appontmmt because of illness.
REASONS FOR ~ I Z A T l O N FAILURE
%
25 11 9 1 0
51
1 2 0
3
13 1 0 0 4 1
12 12 0 0 3
46
Lack of
l*OmtlO1'
Lack of
Motivation
Obstacles
-
I. Unaware of need for Irmunizatlon 2. Unaware of need to return ror next dose (s) 3. Place/time of innunization unknown 4. Fear of side-ef fects 5. Wrong ldeas abcut contraindiacions
Total
1. Postponed un t l l another time 2. No fa i th in imrunization 3 . Funcurs
Total
I. Imn'n place too far away 2. Time of IIIPlu 'n inconvenient 3 . Vaccmator absent 4. Vaccine not available 5. Wther too h s y 6. Family problems(inc.mthers i l lness) 7. Child ill; not brmght 8. Child ill; brought but not given 9. Ung waitkg tm 10. Lack of transport 11. Other Total
8.5.3. Irmunization services: Wcmens ' Hospital: BCG is given
t o all new borns wlthin the 1st 2 days. For premabre infants
it is given af ter 3-4 weeks.
A BCG sca was found in 75% of the surveyed cl-jldren.
All health centres provide irmunizations for the target diseases
except BCG. ~hkre are no innunization targets. 47% of the
centres claimed that they follow defaulters by telephone.
Irmunization procedure was faund correct m dl health centres.
Age screening and vaccine dozage was correct m a i l centres.
Only 25% ; : i .. .L:>IL::.. . . of mthers were informed abcut plrpose
of m n i z a t i o n , and 60% were info& aboJt the need t o r e a m
for the next dose and the possibility of side etfects mre contraindications than the MOPH pollcy tor m n i z a t l o n were
practiced.
9. VACCINES AND COLD CHAIN
I n the State of Qatar the cold chain mst mintain vaccine quality
for the entire national vaccine requir-t i n a t r o p ~ c a l and desert
e n v ~ r o ~ t where the tanperature can reach m r e than 50QC, and
wherestrong sunlight is present a h s t daily.
~t the central level of the cold chain the Ministry of Public Health,
the Ministry of &cation, &e Muistry of Defense, and several para--
s t a t a l ccmpanies operate thei r own parallel vaccine procurerent,
storage, and &stribution system.
A t the peripheral level it is the respns ib i l l ty of the individual
m n i z a t i o n service provider t o request, transport, and safely store
vaccines.
For the prpose of this revled the cold chain of Ministry of Public
Health, as the main provider of immnization services, was examined
i n detail .
3.1. ~ a r i o n a l vaccine Requirments
National EPI vaccme r e q u i r m t s are specified by the Drug Supply
Ccrrmittee on an annual basis. This ccnmittee under the chairmanship
of the Assistant Uder-Secretary for Technical Affair, is c m p s e d
or four pharmacists and an administrator. The Director of Primary
Health Care is the acting chairman in the absence of the Assistant
Under-Secretary. The Director or Irmutuzation and Cormunicable Disease
Control of tlle Preventive Medicine Department is not represented on
the d t t e e . The camnittee meets weekly.
Vaccine requirements are estimated by the amunittee on the basis of
historical usage and an estimate of the expected growth of b u n i z a t i o n
activity. Some provision is mde in tnese estimates for reserve supplies
in case of emergencies.
In the event of a tbreaks of vaccme preventable dlsease, the Preventive
Medicine D e p a r t n w t requests the Camittee to obtain vaccines.
It is the policy of the camittee t o request the procuranent of vaccines on
the basis of m f a c t u r - rep ta t ion , and nth the advlce of technical
consultants to the ccmnittee. The provision of single dose prefilled
syr-es is preferred.
9.2. Vaccine Proolr-t
The major p r t l o n of vaccmes imprted into the State of Qatar are
prc5ased through the secretariat General or Health for Arab Gulf States
(SGS) . Other vacclnes are plrchased m g h the tender process of the
State Procuranent Deparbwnt.
I n urgent s iba t ion vaccines can be p r w r e d through tne Harnad Hospital
Corpration. NHO has provided vaccines in mrgencies.
The quantity of vaccines imported and used l a s t year are s n m m table
9.1.
9.2.1. Vaccine Proarmtent Specifications
The Ministry of W l i c Health has adopted the "Special terms, and conditions
for vaccine and Sera" of tne Secretariat General or Health for Arab Gulf
s ta tes a s its vaccine proolr-t Speclficatlons .
World H e a l t h Organisation and U ~ t e d States Food and Drug Acininistration
vaccine quallty certification is required for a l l vacclnes with verif i-
cation q the goverrrment of the supply- country and a representative
of an Arab Gulf State m the prcducirq ccuntry.
4
While these terms are s t r i c t on vaccine quallty certification, the
shippig, transport and delivery control and waluatlon t- are not
sufficiently clear ard specific to insure the delivery of ful ly potent
vaccines.
In particular the use of the WHO Vaccine Monitor Marker Card does not
conform to the Jolnt WHO/UNICEF (aidelines for international packing
and shipping of vaccines.
Even tne joint gulddines would be inadequate w i t h r q a r d to sinJle
dose vaccine packages and wculd need a 20 fold increase i n the number
of monitors to safeguard international shlpnents. Tne WHO Monitor
Markers have only been lncluded i n sh~pnents of Oral Polio Vaccine.
Recently a s h i p a t of D v was received frozen as a resul t of shipnent
by air in an un-insulated box. An insulated box would have been
appropriate as well as tne notification t o the a i r carrier tnat the
shiprent should not be frozen. Unheated a i rcraf t cargo holds can
easily reach -40X,
9.3. Vacclne Quality Control
Vacclnes are visuably ~nspected on arrival a t the Central Medlcal
Stores. The decislon t o accept o r reject a snipnenc of vaccines is
made by the receivixq Inspection Cararuttee canpsed of representatives
of the Pharmacy and Drug Control Deparbnent and staff of the Centrdl
Medical Stores.
Oral Polio vaccine would be rejected i f it is received in a liquid
s t a t e o r i f no dry ice rennin5 in the shipping container. While
mnitor markers do accanpny the OW shipnents, the receiving s taff
had no information on thei r use and consequently discqrded them on
arrival.
m, 'IT and DPrP vaccines are Inspected for gross precipitate i f they
arrlve frozen. Frozen vacclnes are rejected.
Occasionally suspect vaccines are sex to the vaccine m f a c b r e r
for testing. A s single dose packaged vaccines are in use in the State
of Qatar it may be economic to test suspicious batches of vaccine.
No other quality control measures are in use.
9.4. Tne C e n t r a l Level Cold Chain
International s h i p r a t s o t vaccine arrive a t Doha International
Airport, where they are rapidly cleared through astoms by the
W s t q of Health Receiving Section. This process is reported to
t&e no mre than a few hours.
Upon mstoms clearance the vaccines are transported to the Central
Medical Stores in the Harrad Hospital Ccmpcund.
9.4.1. The Central Vaccine Stores
H a s 4 in a very modern alrcondltioned warehouse, the central vaccine
stores are under the dlrect supervision of a Pharrnaclst and an
assistant phannaclst.
Oral Polio vaccine is stored a t -25K in one of 2 freezers of two cubic
meters capacity. Each freezer has a 7 day tgnperature chart recorder
and are f i t t ed w i t h a r a t e over-temperature alarm. Reagents and
other materials are stored i n the freezers w i t h the vaccine.
A l l other vaccines are smrd i n a cold roan of abcut 50 a h i c meters
capacity. Sera a m ph-cwticals are also stored in th l s unit . This
cold rcan f i t t ed w i t h a remote over-temperature alarm, bur: does not have
a t m p r a t u r e recorder. !the assistant pharmacist m a l l y maintams a
daily tanperature chart. Vaccme storage t-atures were in the range
of + 4 K to +6W. T-ature charts for tne l a s t few years were on f i l e
available for examination. A second cold ram of about 80 able
meters is located on the premises but is not used for vaccmes.
The central vaccine stores fac l l i ty is connected t o an automatic
standby generator which provldes e l e c t r i c ~ t y m tne went of pmer
f allure.
While the cold rcxans were swen years old they were w e l l maintained
and in excellent condition. The tm freezers were only tm years
old and appeared dLmost new. Insignificant f ros t was present a t the
t i n e of the review.
9.4 .2 . Vaccine S t o c k Control
Stock records are held on romplter and enabled excellent stc& control
with -st no overstocking or understockirq.
The use of the canplterized stock control systan fac i l i t a tes the
detemuna . .
t ion of national vaccine supply requirerents and serves as a
stock m n a g m t tool.
9.4.3. Central Vaccine D i s t r h t i o n
The Central M d c a l Stores supplies vaccines t o a l l Primary H e a l t h
Centres; the Wornens Hospital, and otner lmrunizatlon outlets.
It is izhe respns ib l l i ty of each irmunization service provider to
request vaccines frm the Central Medical Stores. Each servlce au t le t
sends a vehicle and a "picnic" cold box wlth two frozen 3 l i t r e water
f i l l ed cold packs, as well as staff to carry out the transaction.
A varlety of cold boxes of differing sizes and quali t ies are in use.
The cold ~ a c k s are typically placed in the top and b t t c m of the cold
kox, whlle the mixed quantity of a l l vaccines are places in between.
Typically the cold packs are deep frozen as is the oral p l i o vaccine.
While travel tm are relatively short in the State of Qatar, the
process of packing, t ranspr t ing, and unpacking the vaccines a t health
centres can take up to several haurs.
The packing of vaccine sh ipen ts does not contom to gaxi cold chain
practice. No thenmwters or monitor markers are used in the shipnent
or the vaccines.
S-le dose vaccme p a a s w l t h thei r low tml mss can be quickly
and easily frozen in contact w i t h the cold packs and OPV a t -25X.
Even though travel tlmes are short, vaccines mst be considered to
be a t risk.
9.4.4. Training and Supervision
The pharmacist and assistant pharmacist supervise the packhq of
vaccines fog s h i p m t to the periphery.
The staff directly connected wlth vaccine rranagmnt, cold chain, and
l q i s t i c s , have received no specialized cold chain train- ather
in-cantry or abroad. They have not receivd any in fomt lon or
.guidance i n concaqorary good cold chain practice.
-rramirq is a contmous process whlch e n a l e managers, pharmacists
storekeepers, nurses, a x i other staff to carry cut thei r &ties and
responsibilities effectively.
9.5. Other Central Vaccine Stores
The Central Vaccine Stores of the Ministry of E f U ~ a t l ~ n ' S School
H e a l t h Service was visited m tne m r s e or th ls review.
Vaccines are stored in elght ddanestic refrigerators, with no themmeters.
The t-mre in all of the Schcol Health Service retrigerators was
higher than 10QC.
Large quantities of expired vaccine was present.
9.6. Peripheral Cold Chain
All m n i z a t l o n service outlets collect the= vacclnes and transport
t h e m to the centre. The vaccine is unpacked Into dchnestic refrlgerators
in tne Centre's pharmacy. The retrigerator is used to store drugs,
sera and vaccines. Fccd and drink was £cum in 10% of the refrlgerator
exanuned.
In each health centre a further 2 refrlgerators are usea to store vaccmes,
one in the male treamt roam, and the other i n the femle treatment
roan. A l l of those refrigerator w e r e founa to concain drugs, vaccine and
sera.
Only one refrlgerator was not i n gccd w r k h q order and has been replaced.
None of the refrigerator seen by the revlew mission teems had a thermometer !
Table 9. b . Tne vaccrne storage t a p r a t u r e f ie ld measur-t results were:
Refriqerator storage (+4QC to +8QC)
LeSS than 4QC = 10% "* 4 ' X to 8% = 40% / a v e 8QC = 50%
'Evidence of frozen DFTP, DT,-or TP vaccine was fcund a t 1/3 of the
11 centres ere the shake test was p e r f o m . The rrecomnendation or
the World Health Orgguzation is that one f reez~ng event 1s sufficient
to destroy the potency of Dm, , and TP vaccines and they shculd
n3t be used.
As no trozen D m , UT, or TP vaccines were fcund a t the Central Vaccine
Stores, it is likely that the vaccrnes were frozen i n the health centres
o r in transport.
O r a l Polio Vacclne was stored m the "frost Free" freezer -t
of the health centre refrigerators. In 90% of the freezers the OW was
either liquid or p a s l y frczen. In a "Frost Free" freezer the t-ahre
varles from arcund -20QC t o just &ve OX under the control of an
automatrc t-. Tne average t a p r a w r e may be in the range or -4oC to
- 6 . This causes the OPV t o freeze and thaw repeatedly. The m f a c m r e
of the O W vaccine states, ht does not guarantee or recamad, that
the vaccine may be frozen and thawed up t o 10 times w i t h a u t loosing
potency. The O W in health centres mybe melted and trozen several times
each day. OW is a t risk.
To avoid the problem of thawing and refreezing the O W it is a simple
ratter t o nwer refreeze it once it has l e f t tne Central M e d i c a i
Stores. As the O r a l Polio Vaccine in use has a storage l i f e of between
7 and 18 mnths a t + 4 X to +8QC there is no technical justification fo r
storing it in a health centre i n frozen form.
Cold packs are necessary ror the transport of vaccing. the t m p r a t u r e
s tab i l i ty of the refrigerator, and to keep vaccine cold during the
imunlzation session. No health centre had sufficient cold packs.
The cold packs i n use were large, 3kg. Water f i l l ed plast ic packs.
These are mch too large for the cold boxes in use and can c a s e the
freezing of a -11 percentage of the vaccines i n t r a n s p r t . On the
other hand since each refrigerator only had 4 cold packs they were
insufficient i n m m k r for the maintenance of stable rerrigerator
temperabres .
There were insufficient cold boxes t o allow safe clean- of the
refrigerator, particularly as the suigle dose vaccine packages are
rather h l k y .
No vaccine Wnitor Marker Cards, or any other form of temperature
rronitor- were in use.
Expired vaccines were found in 12% of the centres visited.
9.6.1. The m n i z a t i o n Session
The imunization sessions generally are conducted as part of the
"Well-Baby" screen- clmic. In mst cases it takes place in a
canfortable room with a m t h flow of patients.
Vaccines are W e n directly from the refrigerator fo r each chlld m
53% or the sessions observed. In the ranainder of the sessions seen
the vaccines were kept over some form of ice un t i l given to the child.
Keeping tne vaccines over ice o r cold packs protects the vaccine from
exposure to heat, while a t the same the allowing the vaccine in the
refrigerator t o stay cold behind a closed refrigerator door. The use
of large vacclne carriers and ice packs i n trays wculd be an appropriate
solution here.
In 20% of the centres partially used vials of vaccine w e r e not discarded
a t the end of the irmunization session. Tnese vaccines are a b j e c t to
contamination and loss of ptency due to exposure to heat and l ight .
9.6.2. Waste Dispsal and Bio-Hasards
Used syrmges, vaccine vials, and contaminated wipes are a hazard for
toth medical' staff and the general plblic urdess they are properly
destroyed.
In the State of @tar the standard system for the disposal of wastes
is that they are placed i.g sharp b3x supplied by the C.M.S..
The snarps b3x is collected. by the Health Centre cleaning contractors
ana taken to Hamd General Hospital for inceneration.
78% of the health centres visited followed this p r w d r e .
28% of the centres used a plastic bag or bowl on the flcor to collect
the sharps and waste. This was collected and disposed of with ordinary
refuse.
-
I m m m m I
m I 0 X) J) 1) m m m m m - ~ m m m m I m I m m m 1 m m I I rl I m 1 1 1 r - I I
--I 9 ,-I v ~ m m 3~ 4
w r l - m m 0 3 - O N m
5
U
t- 3 v rl
W
- n n N o o m 3~ m m N N U 29 Ln
N
r - r l - m m t - m m m r l ~ q r l m n n r l m n w d rl m r l r l s m m r - D N
--I m 4
0 0 0 0 0 0 0 0 3 0 0 2 3 0 3 0 ~ 3 n m o o o 3 N W L O P N N 0 0
m ?i -
3
m . m 0
0
10. DISEASE SURVEILIANCE Present ly v i r t u a l l y all t h e p p l a k o n enjoys tree h e a l t h care and
u s e s the mdical se rv ices extens ively . The total number of consultatj .ons
i n Health Centres i n 1986 w e r e reported to k 1,760.000 v i s i t s . 'fiiis
muid averaqe 5 to 6 ' v i s i t s per ixrson per year.
The t e n mst f r a p e n t ccxlimnicable d i seases reporteri and the ten
m s t frequent causes of death in 1986 are presented i n Table (10.1 and
10.2).
Table 10.1
NUbIBER OF KEPORrFD TkN MOST Fl-ZQUEW
CX35YUNICABLE DISEnSES D W G 1986
I DISEASES
S t r e p t t h r o a t In fec t ion
Measles
Chicken-Pox
ms Scabies
A a l t e Resp. Inf ec t ion
Goilorrhoea
V i r a l Hepa t i t i s
Malaria
Table 10.2 -
l l 3 l MOST F~?UE@P CAUSES OF DFAlII I N 1986
1 U . 1 . REWM'ZNG SYSTEM:
For t h e not l f ica t lon of mmunicable dlseases 2 Forms are belng used - one f o r no t i f ica t ion of individual cases, which i s expected t o be r e p r t f d
dai ly , and tne ocher is the Form f o r surnn7m-y reporting and is suhnitted
each mnth. These have entries t o r 45 comnunicable diseases; f o r 19
of them a n h e d l a t e telepnone report is required. Ecxlr of the -1
t a rge t diseases - Pollomyelltis. Diphtnerla, Tetnnus and Turaerculosis
are amongst this list. The other 2 EPI diseases, bleasles arsl Pertussis
a r e anangst o ther n o t i f l c a l e aiseases. Neonatal Tetanus is not reported
separately.
CAUSE OF DEATII
Skull Fractures
Acute myocardial infract ions
Cario Vascular Causes
Neoplasms (mlj.gnant and unspec.~f
Hypertensive disease
Seni l i ty
P n m n i a
Cerebro Vascular
Congeni-tal Anamlies
IIypxia, b l r th asphyxia
The mdiviaual Repr t ing Fonns have en t r ies fo r age, seu, nat ional i ty ,
diagnosis, da t e of onset, i t not the previous vaccination hlstory, nor
is t h i s infomation recorded on the sumary reporting forms. B t h the
forms a r e unnecessarily long time consuming and a r e not t i l l e d prowrly .
It takes a long time t o reach the department concerned. l'he da i ly o r
telephonic reports should m n s i s t of only a few diseases that required
immediate action.
NO.OF DEA? RATE/lOU.OUO
70 18.97
63 17.07
61 16.53
j.c) .43 1.1.65
3 1 10.02
32 8.67
30 8.13
28 7.59
27 7.32
25 6.77
25 6.77
For EPI: target diseases a reference to m n i z a t l o n status should be
made.
It is planned t o fully introduce a m p u t e r system t o record and
canpile rzported ccqunicable diseases from the heaLth centres. The
m n p e r engaged is not sufficient to c o p with the masses of data
being repr ted , and as such only entrles from 1 2 Aealth centres are
so f a r complterized and a heavy backlog does exist. The coordination of surveillance activities and routine disease reporting is the respon-
s lb i l i t y of the Ikpartmnt of Preventive Medicine. Thls deparlment
compi.lcs nctifiahle di.scases data fron the Department of Prinmry ITealth,
Hamad Hospitals, School Health Services, the Pollce and m l i t a r y health
services.
No mechanism for feed back exists.
The reporting system in Hanad tlospltal provides a wealth of information
abcxlt c m n l c a b l e diseases which is readily retrieveable. Th i s
i n fomt ion is of great value not only for planning and evaluation of
m n i c a b l e diseases control in Qatar. A significant omission is the
fal lure t o provide data on immni.zation status of the patient.
The surveill.ance data are not being uti l ized t o thei r f u l l potential
a t health centres o r even a t higher levels.
10.2. INCIDENCE OF C(3WlLNICABLE DISEASES
The pattern of mrbidlty and nnrtallty due to comnicable dlseases has
charged t o a great extent i n the past 15 years. This i s mainly due t o the
rapid the developgnent of the medical services 7n the ccuntry. Nowadays
the leading cause of death are accidents, myocardial inkarction and
cardiovasalar diseases. S t i l l it is dif f icul t t o establish a precise idea
of the extent of c m r u c a b l e disease, because of s h o r t - c m ~ ~ s i n
reporting diagnosis. Though the hospital records are m r e aca ra t e , it
only reflects a part of the overall mrbidlty and mr t a l l t y .
10.3. EPI TARGET DISEASES
The roJmber of cases of the six targe t diseases from 19.73 to 1986 is
shown in Table 3 and. Graph 1. Djring this period the p o p l a t i o n has
grea t ly increased and the completness of: reporting has grea t ly inproved.
Insp i te of t h l s , there has been a decline i.n the number of cases of
a l l the ta rge t diseases, except measles. The incidence r a t e per 100.00U
p o p l a t i o n f o r T.B., Diphtheria, Pertussis, Te-tams and Measles is
shown i n Fig.2.
- TEIRNUS: In the l a s t decade between 2 and 7 cases of Tetanus were
reported each year. No neonatal Tetanus was specifically reprtd.
IIcwever t h a t 2 ccaes of Nfonatal Tetanus had occurred - one j.n 1984 and
another j.n 1986.
To readi ly indentify occurance of NNT cases i n the country, NNT shmld
be recorded separately from other Tetanus.
- DIPHTHERIA: Less than 10 cases of: Diphtheria have been reported
every year s ince 1973 u n t l l 1982. The number of cases were going down
u n t l l 1983 when no case was reported. No cases were reported f o r 3
years. However, i n 1986, 6 cases w e r e reported - fcur under 1 year of
age 2 others in children of 5 and 7 years of age. The cases occurred
i n d i f f e ren t m n t h s of the year - 3 m Qata r i families and other 3 i n
Pakistani fanul ies . F a r were confirmed by Laboratory diagnosis.
Diphtheria has not been considered a p tb l i c health problan i n the l a s t
few years.
- PERIUSSIS: F r ~ n the recorded data it is hard t o es tabl ish any trend f o r
per tussis i n the l a s t 15 years. Hcwever the incidence r a t e has shown
a steady decline s ince 1983. Most o t these cases are reported by the
Hospital and probably only t h e mst severe ones. I t is reasonable
t o assume that the real m m k r of per tussis cases is nuch higher than
reported.
The m n i z a t l o n of children against Pertussis starts la te , a t (2 months)
and the 3rd dose is not given before the 6 mlth. Most of the children
do not complete the fu l l collrse of hun lza t ion before thei r first
birth date. Analysis of inmnization records of 1468 children immnized
in 12 health centres, i n 1986 shows that only 2% of th is group received
thei r 3rd dose of vaccine a t the recamended age of 6 months. 15% receive
the i r 3rd dose of DPl' a t the age of 7 and 8 months and 70% of them
i n fact flnish the course of imn lza t ion between 9 and 15 nonths. (see
the table below) .
THE AGE O F CHILD WHEN RECEIVED T I E THIRD COSE
O F Dm-PO VACCINE - SELECTED HWTH CENTRES
1986 - QATAR
Analysis of Hamad Hospital Record reveal that out of 125 Pertussis cases
hospitalized between April 1986 and June 1987, 33% of them were i n age
grcup under 6 mnths of age.
A G E
6
7 - 8
9 - 11 12 - 15
Unknown
T O T A L
I t appears that the l a t e inmunization as practised in Qatar w i l l not
protect one third of the children who get the disease a t less than 6 mnths.
NO. I w ' I u N I Z ~
24
218
874
167
185
1468
%
-
2
15
60
11
12
100
Further analysis of the same 125 Pertussis case i n Hamad Hospital reveals
that 52% of'children get the disease a f te r 12 ~mnths and infact 39%
a f t e r 2 years o t age.
This cal ls for ~0nti.mation of admmistration o t DPT rather than DT a t t e r
one year of age and continuation of that upto 5 years as recmended by WHO.
Tb ensure that imwmzation has a real impact of Pertussis incidence the
course of innlunization shculd start ear l ier and t o be canpletfd earl ier .
The EPI global advisory group recamends rmnimun age tor DPT a t 6 weclcs
and internal of doses ;t 4 weds. In this s d ~ a l u l e tile child w i l i receive
the f u l l course of immnization in 1 4 weeks.
AGE OF PEHNSSIS CASES HOSPITALISED I N HRMAD
H O S P I ~ - APRIL 1986 m JUNE 1987 - QATAR
A G E NUMBER % (Months)
0 - 5 42 33
6 - 11 11 9
12 - 23 26 21
24 - 59 28 22
6 0 t 11 Y
U n k n m 7 6
T O T A L 125 100
- POLIOMYELITIS: In the 6 years between 1973 t o 1978 about 20 t o 30
cases of poliomyelitis were reported each year i n Qatar. These cases
dropped t o 4 cases and belm and r a i n e d a t that level till 1382. No
case has been reported since then with exception o t a smgle case reported
in 1985.
This case - an 18 m n t h old fenale from a Qatar i family had onset on
12 February 1985 a d was diagnosed at Hamad Hospital. She w a s not
vaccinated. The imrunization prqramne s m to have had a grea t
lmpact on poliomyelitis incidence.
- ~~: Betweeri 1973 t o 1980 each year 100 t o 400 cases of n~easles
were reported. In the absence of a systematic innunization programw
a t the time, this is a c lear lndlcation of under reporting. In 1981,
the reported cases suddenly i n c r e a s d to a t 1500 cases, dropped
again f o r 3 consecutive years and rose warn i n 1985 to the previms
level of 1400. 1986 witnessed the highest incidence i n the l a s t 1 4
years, with a s many a s 2000 cases r e p r i e d . Fig.3. Clearly medsles
irmuruzation has shown no impact i n reduction of measles cases. The
major reason fo r this increase is the accumulation of s susept ible
t a rge t pop la t ion due poor measles h u ~ z a t i o n policy and l a u coverage.
The coverage survey conducted along w i t h t h i s revieul i n Qatar showed
only 60%coverage.Those vaccinated w e r e not a l l i n the a t r i sk age
group. Analysis of 1379 innunuat ion records from the 12 health centres
shows t h a t 1 4 children have been imunized before the recornnended 9 m n t h s
of age.
TIE AGE OF CHILD WHEN RECEIVED MEASLES VACCIIE
SELECTED HENX"I' C m W S 1986 - QATAR
A G E (Months)
0 - 5
6 - 8
9 - 11 12 - 15
unknown
T O T A L
--
NO. I m I Z G D
-
196
935
148
100
1379 ---- -------
%
-
1 4
68
11
2
100
There are other obstacles to measles innunization. In the Health
centres every opprtunity is taken t o p s t p n e the measles innunization.
These obstacles include:
- Any child yho has fever of 1 / Z degree or mre; - A l l children who show symptoms of diarrhoea; - Children who have not yet finished the cmrse
of thei r DPT/Polio-inrmnization;
- Children who are s c h ~ l e d for other h n i z a t i o n t o avoid sirmltaneous irmunizatlon.
The examnation of age distribution of atout 5107 cases of measles
reported between 1981 ara3. 1985, reveals that 13% has occurred under one
year of age, 44% in 1-4, 30% in 5-9 aqe group and the remining 13%
i n the older ones. (Fig.4) r a n i n unprotected.
- T L B ~ S I S : Fuhmnary TB is still a problem mainly m r q imnigrants
m n g for work i n Qatar. Most cases are reported i n 25 - 34 year age
group, malnly i n Males. The prevalence of the disease has remained
uncharqed for the last 10 years. The lncldence r a t e per 100.000
poplat ion for p lmnary tuberculosis has risen sl ightly i n the past
two years. The new e n f o r c e n t of case finding started in 1985 m y
have been the c o n t r h t o r y factor. The influx of forelgn Arab patients
m r q frm neigNXRlring States and seeking f ree treatment and
hospitalisation constitxtea fa l r ly high percentage of T.B. cases in Qatar.
10.4. OTHER COmICABLE DISEASES
The reported cases due to s e l e c t e d other important corr~runicable diseases
f o r the last 6 yea r s are shown i n Table 6. N o p a r t i a l a r t r e n d can be
es t ab l i shed .
NCYTIFICATION OF OTHER COMMUNICABLE DISFXSES
1982 - 1986 - QATAR
D I S E A S E S 1981 1982
002 Tyhoid and Paratyphoid 48 93
03\ i s n c 17:il 3 ---- ......................... ------- -------
052 Chiken-Pox 1299 ---- ......................... ------- -------
056 Rubella 194
---- ......................... I 0701 V i r a l Hepatitis ---- ......................... ------ -------
---- ......................... 098 -laria Gonococcal I n f e c t i o n
Table 3: NOTIFIED CASES OF THE SIX DISEASES IN THE
1973 - 1986 - QPIIlAR
YEAR DISEASES
ACUTE POLIMYEZITIS
DIPHTHRIA
TETANUS
WHCOPING COUGH
MEASLES
ACUTE P W N O R Y
TmERCLILOSIS
1973
29
10
1
57
306
65
1983
-
-
2
547
816
160
1974
18
7
-
88
215
72
1986
-
6
3
134
209
154
1976
28
6
1
61
242
220
1984'
-
-
3
201
886
146
1975
9
5
2
49
126
191.
1985
1
-
5
119
1410
196
1977
LO
9
2
12
376
160
1978
2 1
3
2
27
319
147
1979
4
5
7
46
402
129
1981
4
-
2
193
1489
175
1900
2
1
7
219
392
146
1982
3
2 1
5
20
506
137
- 56 - 35 P- EPI T A R G E T DISEASE R E P O R T E D C A S E S ,mp,,
30 - 1973-1986 Q A T A R 25 - 20 - 15 - 10 -
5 - PO~IO?IYELITIS
0 I . 1 I
. . I I I I I I I 1 - 1
L
- - - - - - - MEASLES
I I I I I I I I 1 I 1 I I I
E P I T A R G E T D I S E A S E S - I N C I D E N C E R A T E P E R l O O . O o O POP- - 57
600
500
400
300
200 MEASLES
100
M E A S L E S C A S E S
S E A S O N A L V A R I A T l O N
1980 - 1 9 8 6 QATAR
M E A S L E C A S E S
B Y AGE G R O U P
A c c u m u l a t e d n o . o f c a s e s
19sr -198s QATAR
- 60 - A SUMMARY OF F I E L D OBSERVATIONS
EVAUATICN OF S(IINEII.?JIG? ACTIVITIES
IN 19'HEALl'li cB?EP.S . I N . QATAR
M A L A R I A
OBSERVATICN
Is one person r e spns@le for disease recording and reporting ?
Was l a s t mn th ' s report submitted i n t i r e ?
Were a l l reports che for p r e v i a s year sutmitted ?
Are Zate on vaccine preventable diseases available?
Is sumeillance date available by age of cases?
Is surveillance date available by imrunization stab~s of cases?
Is a map of catchrrent area available?
NO OF OBSERV.
16
16
15
13
1 6
15
16
Are stocks of anti-malaria drugs suf f ic ien t to m e e t d m e s o r treatrrent
Is chmprophylaxis practised?
Are stocks of chemprophylactic drugs suf f ic ien t t o met d m d ?
Are f z c i l i t i e s for microscopic examination of d a r i a s l ides available? '
DIARRHOEAL D I S E A S E S
NUMBER YES
10
13
1 4
4
6
0
4
r Is mrbid i ty of diarrhoea1 diseases recorded?
Is r ror td i ty of diarrhoeal. diseases recorded?
Are ORS packages used?
Is there a rehydration rcam/centre,or place here?
16
1 6
11
16
% YES
62
81
9 3
3 1
37
0
25
18
15
1 6
17
11
5
6
8
69
31
54
50
5
-
15
2
28
0
94
12
11. Mltrition
luo mt r l t i on surveys have been conducted in Qatar. It 1s suspected
that the relatively high inmes could be contrlhuting t o the r d c e d
observation of mtr l t ional problem?,. No m t n t i o n support p r q r m e
exists.
Results of tne f ield survey have shown that mthers ao not keep thei r
childrens growth charts it hcune - without tnis m f o m t i o n they are
not aware or the relatlon of n o m l weight and height to teeding
h a b ~ t s and early detection of overteeding and mal-rmtrit~on.
11.1. Eeeaing Patterns
Only 39% of mothers breast feed thel r children for one year o r mre.
The average period of breast feeding is 5 mnths thmgh 18% were
strll breast f & a t the t h e of the survey. 10% of the mthers did
not breast feed thei r children a t a l l . See Graph 11.1
55% of children stop@ breast feeding bofore 6 mnths of age. These
children are a t risk of mlmt r i t i on and contracting infectious
diseases.
73% of mthers bottle feed the= children. In 59% the b t t l e was
intrcduced before the age of 6 m3nths.h 45% the b t t l e was used
before 4 months. 28% took the bottle from birth. The average age of
i n t d c k q bott le feeding is 10 weeks. This can lead t o early
termmation of breast reeding and the consequent n sks . Additionally
there are risks associated with bott le feeding. Health education for
mthers is called for.
IUm>st a l l children (97%) were taking solid food a t the time of the
survey. The average age of intrcducing solid roods was 5 mnths,ranghq
from one mntn to 12 mnths.
Wst mthers used carkhydrates as 1st foods. Fruits o r vegetables
were used by less than 15% of the mthers. This requlres a change
in feeding habits for children.
% A g e When B o t t l e W a s i n t r o o u c e d
% A g e When B r e a s t F e e d i n g W a s s t o p p e d
12. HEALTH ENKATION
12.1. Org*ization
The health education section is part of the preventive medicine deprtment.
The section is headed by a qualified p b l i c health doctor and staffed by
a medical offlcer, 5 health educators, 2 p r d c t i o n specialists and a
technician.
12.2. EUdget
No separate budget exists. Recently a tr- project for health centre
staff has began with a tots cost of US$210,000, shared between WPH,
UNICEF d UNDP.
12.3. Planned oblectives
Tne health education section states that their act iv i t ies include: - i n tq ra t ion of H.E. i n health services; - Special education prcgramnes t h m g h the mass-media; - Pra3uction and d i s t r h t i o n of mterials;
- Training and research activi t ies.
12.4. Topics covered
The section is concerned with M.C.H. senrices,nutrition, breast feeding,
innunization, seasons diseases, =king, drugs, blood donation, Dental
health, home accidents, cholera, AIDS, Brucellosis and measles.
Material i n these topics is prodhlced spradicaly . The f ie ld teams
reported a m s t no mter ia l s a t the H.C. level.
12.5. Trainhg
The H.E. section participates i n tne training of st71dents a t the sanitarian
inst i tute. T w short cmrses Lor nurses and social workers took place
i n 1983-1984.
The joint UNDP, UNICEF and M3PH project is planning t o t r a m 300 mrses
and medical officers .
12 -6. Survey results
Mothers knowledge about ORS was high a t 60%, of those mthers who know
ORS 50% have actually used it.
Mothers knowledge about proper preparation of ORS was 49%. Health
personnel were the main source of informtion for 87% or mthers.
Table
Mother's knowledge arm3 scurce of information about ORS
Knowledge about: ORS 1 60% 1 Literacy
ORS preparation I 49% I
62%
Scurce of knowledge T r u e 3 health worker
Relatives/Friend
Availability of ORS a t home 10%
W i t h regard t o mther ' s knowledge about the EPI target diseases, 52%
of wmen knew a t least three diseases. When mthers were asked about
the rain s a r c e of information about the EPI target diseases, health
personnel were found t o be the best source a t 49%.
I.Btherls knowledge and mrce of m f o m t i o n abcxlt EPI target diseases
* %
52% -
39% -
19%
49%
4 %
17%
2%
1%
1%
6%
Knowledge of mother
Abcut 3 EPI t a rge t diseases
Irmunization f u l l y
Pa r t i a l ly
Source of knowledge Health workers
Relatives/£ riend
T.V.
Radio
N='Spaper
Posters
Others
13. CfWEOL OF DIARRHOEAL DISEASES
13.1. INCIDENCE OF DIARRHOEFL DISFASE: Although a c a r a t e s t a t i s t i ca l
data is not a v d a b l e . the MIPH feels that Diarrhoea1 disease is
not a m j o r problem m Qatar. The table be lw shws mmber of cases
w i t h diarrhoea symptans reported to the Camtunicable Diseases and
Epidanic Control Section of the Ministry of Public Health, inclucljq
Sahne l lo s i s , ~h lge i lo s i s and Fccd poisoning:
Records of the ped ia t r ics un i t of Hamad Hosp~tal for 1985 shws tha t
75% of all admitted cases were children under 5 years. ALmost half
of a l l the cases ccmrred in children under 1 year of age. No
deaths were recorded amongst 365 cases admitted i n that year.
YEAR
19 82
1983
1984
1985
1986
Althcugh diarrhoea1 disease morbidity m y be a health problem for
children under 5 years of age, the severity of disease and mortality
has been reduced t o a very low level so that it is no longer considered
a m j o r health problem.
13.2. O W FEHYDRATION THERAPY:
Om packets are provided t o health centres by the Deparbnent of
NO. OF CASES
837
2046
1596
3379
1328
Phamacy, of the Ministry of Health. I t is being prescribed m
health centres. A t the Children's A a t e Care Unit (an extension of
Paediatric u m t of Hamad Hospital) a l l non-severe dehydrated diarrhoea
~ R B I D I T Y HATE (per 1,000)
3
8
6
12
5
cases are given OFT urder observation. A s a policy OKS packets are
not given t o mothers for home use.
A t the Paediatrics uni t of Harnad Hospital, OKT usage has been practiced
smce 1982 and IV therapy is considered only for severely dehyrated
cases. There is still hwwer, some resistance tor wide use of 0%.
13.3. HEXLTH CElJTRX OBSEmTATIONS
28% of Primary ~ & l t h Care Centres reported that they record Morbidity,
but not m r t a l i t y tor-diarrhoed Disease.
0% Packets are used in 94% of a l l health centres.
'I'm centres had a r m for mpenrised oral rehydration.
1 3 . 4 . PIED m Y
The survey a t home lwel shows that a t leas t 50% o t mthers interviewed
knew b t ORS, tut only 10% of them ever used it.
Half of mothers h e w h w t o prepare ORS, and they c l a m that they
learned i f £ran the health personnel.
14. Drugs and Drug Managmt
The supply of ph-catical drugs is an elgnent of primary health
care which is of major imprtance in the provision of health services
to the ptblic.
The 'provision of drugs t o health centres, hospitals, and private
pharmacies is unaer the C o n t r o l and %pervision of the Pharmacy and
Drug SJ.pply Department of the KIPH. Under recent law a l l drugs
imported into the m n t r y m s t be registered. All drugs are imported
in to the ccuntry ana are under the technical supaxision of the
directorate. In general WHO and USFDA standards and r e c m n t a t i o n s
are follwed. Abmt 200 drug prcducts are registered for i m p r t
t o the State of Qatar.
On receipt the drugs are stored m tne excellent and modern Central
Medical Stores i n the Hamad Hospital C~n~cund. The CMS sends a stock
catalogue of drugs and other e c a l supplies to a l l Prircary Health
Care Centres every 6 mnths along w i t h the appropriate order forms.
There is a p h a m c i s t o r assistant pharmacist a t every PHC Centre.
These pharmac~sts are unaer the technical s u v i s i o n o t the Central
Health U n i t of the Pharmacy a m Drug Control Directorate. The
p n m c i s t is responsible for a l l drugs a t the PHC Centres.
W i t h the exception of one PHC Centre, a l l healtn centres had sufficient
supplies of a l l e s sen t~a l drugs, and maintained a drug inventory.
All centres r ep r t ed that they replenished their drug supplies mnthly.
1/3 of the health centres reviewed had some expired drugs i n stock.
15. Flndlngs and FEamwmhtions
The pages h i c h follow contain the detailed Findings of the Review
Mission in each area of Pr- Health Care and Child %rvival
Activity.
In the format followed by the misslon the problan is defined, a
recamendation is made to deal with the problan, and saw implemen-
tat ion steps are suggested.
These reommendations have ken discussed w i t h national off ic ia ls
and were agreed by representatives of the de-nts concerned.
The implementation dates are those suggested by the national officials .
O R G - PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
-
TINE TAIGET 1 7 E C O E l E l E N D A T I O N
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The Depnrtments of Preventive Medicine and Primary Health Care should be studied by an indepen- dent team to suggest ways for more coordination of activities and to determino thair optimal structure, responsibilities, levels of staffing , orgnnizot.i.on and suppnrt for senior staff, in order to allow them more time Tor planning, sr~pervision an<l evnluntion of the field nctivi 1 . i ~ ~ .
STEPS TO DE TAKEN
Review Committee
- IESPONSIULE OFFICEIt
M.O.P.11.
, . P It' 0 1) '1,. E El
'.
CPI / CDD n ~ c o M M E N D A T I o N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
T I W TAIGET
Oct. 1987
Dec. 1987
STEPS TO DE TAKEN
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Reorganization of this committee with continuous follow-up
policier:activities
- to p,It the policy in a scientific way and present it to Undersecy.
I,Subject with Undersecy.
2)Letter to participant by P.M.D.
3)Representatives identified
k)Date of 1st meeting set.
I I E C O E I H E N D A T I O N
A high level st,eering/coordinating commit tee for irnmr~ni;:ation/CDD activities ahoi~lcl oversee the programme and coordinate set and arrange for an annual evaluation Jn this commit.tee reprcsentatives of depnrtmcnt of Preventive Medicine Primary llenltll Care, Hninad and Maternity Ilospitnl, School Health, Army and Petroletlm llealth services should bo represented.
- - -
4
IIESPONSIDLE OFFICEIt
. . P II o n' L' E E!
-_......--.*IP.II-m*
* -
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- m f i o * O w m CI. r. I r. 0 w w I r. 3 Z m r r m z ++ \ O ~ C 1 m r r , 3 n - ~ m r m ' c o r m 3 0 C . E \ rm u m u " r o - 7 a u 1 m \ m o o
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I
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5 : L
~ E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
d
I I E C O E I I I E N D A T I O N .
P u l l implemnntntion o f t h o c o m p u t e r i s r d medical r e c o r d s systenl s h o u l d b e c a r r i e d o u t , r r p e c i f i c n l l y t h e r e g i s t r a t i o n o f b i r t h s shou ld b e l i n k e d t o immuniznt.ion nnrl h e a l t h s t a t u s r e c o r d s at h e a l t h c e n t r e l e v e l s .
..--
TIM3 TAIGET
Nov. 1987
. .
P II 0 I) ' L' I? kI
I t i n d i f f i c u l t t o t r n c c d e f a u l t e r s i n t h e Ileal I l l System.
.
STEPS TO UE TAKEN
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- Review o f u s t u d y o f blicliael Jolin, Rep.Coils111 t a n t on t h e s u b j e c t .
- Committee o f PMT)
PllC and Computer t o f o l l o w
1LESM)NSIULE OFFICE11
Preven t i v e Eledicine
0 R G - MAN - I , S C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
I
~ E C O M M E N D A T I O N
~ - ~ ~ ~ ~ ~ ~ ~ ~ * ~ ~ = = ~ * = ~ a s ~ ~ = m m ~ ~ = ~ = ~ : ~ = s ~ ~ a ~ = ~ ~ = = ~ a = ~ a a ~ = ~ ~ ~ ~ = = a = * ~ n . ~ ~ ~ - = ~ = = ~ * ~ ~ ~ = * ~ - ~ ~ ~ ~ - ~ - - - = = - - - = = ~ ~ ~ ~ ~ ~ ~ . ~ - - - = = n = ~ . ~ - ~ * . - - . * . - - - . ~
A national evaluation system including creation of an evaluation team should set up to carry out periodic field evaluation of programmes such as immunization, MCII, Nutrition etc.
r TIME
TARGET
Yearly
STEPS TO DE TAKEN
Creation of teams Plan evaluation survey Conduct field survey Analyse data Provide feedback to depnrtmetlts.
RESPONSIDLE OFFICER
P.M.D. & P.H.C. departments
- - - -
*
P R:O n L E PI
There is a shortage of managerial and technical staff. There is no rryr~lar evaluation and ft-ed-hack system.
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
I I 1
R E C O M M E N D A T I O N
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The target population to be covered by each health faeility should be precisely defined.
Vaccination coverage should be routinely compared with expected number of live births.
TIME TARGET
1988
STEPS TO LIE TAKEN
Catchement a m s for each facility should be well defined.
Immunization data and birth data should be correlated
P I I O ~ L E M
llealth Centres do not know their immunization target population
F
IES PONS IIILE OFFICEII
Statistical Dept.
M.C.Il.
. ---
H E C O M M E N D A T I O N S
S U R - PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
.
1
TIl5 TARGET
? ASAP
STEPS TO DE TAKEN
Request higher authority for approval
R E C O M M E N D A T I O N
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Considering the scope and rcsponsibility of department of Preventive Mcdicine and the high work load, more technical staff should be recruited.
. ---
4
RESPONSIDLE OFFICE11
Director of Preventiv Medicine Department
P R'O D - L E El
Shortage of technical staff in department of Preventive Medicine (especially in the ~ommunicable Disease Control aud Vital Statistics Section) causes a high work load.
Health Education, Environmental ileal th Food Hygiene Dept.
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
~ E C O M M E N D A T I O N
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The media e s p e c i a l l y T.V., Radio shou ld be u t i l i z e d r e g u l a r l y t o d e s i m i n a t i o n o f h e a l t h i n f o r m a t i o n t o p u b l i c .
T I M TAHGET
1988
STEPS TO DE TAKEN
- a r r a n g e f o r a weelcly % hour T.V. programme on p r e v e n t i v e h e a l t h s u b j e c t s .
- p r e p a r e h e a l t h a r t i c l e s on p r e v e n t i v ? h e a l t h p r a c t i c e s f o r newspapers and magazines.
- a r r a n g e f o r s h o r t messages i n r e l a t i o n
t o EPI and MCH th roug r a d i o and T.V. (30 secs . s p o t a d v e r t i s e m e n t )
P I I O D L E H
T h e media h a s n o t been utilized to its full extent for dessimination o f s u b j e c t s .
I IlESPONSIDLE OFFICEI(
P.II.D. ll.E. s e c t i o n
I
. ---
+
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
J
STEPS TO DE TAKEN
Request modules from WllO
Arrange t u t o r s
Arrange c o u r s e s
f
4
I P R ' O d L E El
T r a i n i n g is l i m i t e d i n I'IIC e l e m e r l t s
RESWNSIDLE OFFICER
P r e v e n t i v e Medicine Dept. [real t l ~ Educat ion U n i t and t h e Primary I l e a l t h Care Depts.
R E C O M M E N D A T I O N
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Workshops and s h o r t c o u r s e s shou ld h e h e l d f o r ; > j s i r i a n s , n u r s e s and p h a r m a c i s t s as a p p r o p r i a t e i n MCH, EPI v a c c i n e , col11 cchain ,control of d i a r r h o e a 1 d i s e a s e s . EPI and CDD t r a i n i n g modrlles c o u l d be u t i l i s e d .
TIME TARGET
E a r l y 1980
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
- - -
4
TIME TA K E T
STEPS TO DE TAKEN
- a Of
supervisory visits in advance.
- prepare a checklist for supervision in different fields.
- make provision making additional
Of supervis0r) reports.
I p R 0' D L 'E I1
. Supervision generally is inadequate
I1ESPONSIULE OFF ICE11
P.M.D. and P.H.C. departments and Clinical Service Department.
n E c o M N E N D A T I o N
_ _ ~ I I ~ I ~ ~ I - P I P * I ~ ~ P z * = = = ~ m ~ ~ = ~ ~ = = ~ = ~ ~ = ~ = ~ ~ = ~ = a ~ = = ~ = = = ~ ~ ~ ~ = m ~ = ~ ~ a ~ ~ m m = = = = = - a = = ~ ~ = = m = = = = = = - - = ~ P = ~ = = - = - ~ = = - = - = - - - = = - = . - - - m - - - - - - - - - - - -
, Except surprise visits, a schedule of supervisory routine visits to each health centre should be prepared in advance. Check-lists should be used as the basis for all supervisory visits at all levels and should also form the basis for visit reports. Such visits should include technical as well as administrative components. Findings should be left with the unit and staff visi tecl.
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
TIffi TAIGET
Jan. 1988
Jan. 1 9 R O
MSWNSIDLE OFFICEII
MCH Section
EPI Section
STEPS TO DE TAKEN
- MCH Department to prepare MCII Manual
- Preventive Medicine ~epartment to prepare EPI and cold chain Manual.
R E C O M M E N D A T I O N
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As a part of a more general manual for MCll and Health service activities a manual T o r . i.rnni!lni.:..:? tion should be prepared. In this manual immunizatio? practi.ce,vaccine handling and care, cold chain, sterilization practices, recording and reporting of immuniza- tion out-pait should he fully and simply referred to.
4
. .
P 11.0 d L E El
'
Different organi7ations are following different practices in relation to immunization. Most of the health expatriates follow the practices prevniling in their own countries
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
TIW, TARGET
1988
STEPS TO DE TAKEN
A decision m,rst be made to provide health visitors service.
description to be developed. Staff to be
R E C O M M E N D A T I O N
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Health Visitors to be appointed at each health centre in order to increase the level of MClI activities. Home visits particularly should be included in the MCll programme of each health centre. This is needed to encourage early attendance of pregnant women at ante-natal clinics and to establish a system of tracing defaulters from immunization.
- - - -
4
RESPONSIDLE OFFICEI(
The Minister of nealth
P R O D L E M
.--- .=I. . . . .P*
Regular home visits are not a port of EICH activities in the health centres.
E P I - R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
.- - -
4
R E C O M M E N D A T I O N
l~3=~ilE.=P~===~IlP?.P~;I'iPili.=PP=3.~S~=.~=3~~~=~~~=P~13P~=--li.I~IP~=~LI~=3i==~3=~~E=i.==~=l=ili.~iilPI~~l..I.I..P.I=~.I~.I...~~.~I.~-...
A closer relationship should be encouraged at the health centres between the curative and preventive section. More active participation and promotion of immunization by physicians and nurses on the curative side is desirable. All the children visiting health facilities should be screened for immunization status and given appointment for immunization
P I t O D L E b !
_-_;I=.=-
No attention is paid to immunization status of children attending out- patient clinics in Health Centres.
STEPS TO UE TAKEN
A circular to be sent to all Doctors in charge to screen all children for immunization status on all visits to health centres and other health providers
IlESWNSIDLE OFFICEH
Preventive Medicine Departmetit
TIM4 TAHCET
Dec. 1987
I H M - R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
.
-
. - - -
.
P I ~ O D L E M R E C O M M E N D A T I O N
_ _ - _ ~ = ~ ~ 1 ~ 3 1 1 = 1 P ~ 1 ~ ~ = ~ ~ = P = * = = ~ P i l i i l E ~ i i P P ~ l = = = ~ ~ = = ~ l = i ( = = ~ ~ = P = = = 3 1 = ~ . ~ ~ ~ ~ ~ 3 1 ~ = = P ~ = = = = ~ = = P = = E = = = = ~ = = = ~ = ~ ~ O ~ P ~ 3 1 3 - I P E 1 3 = D i ~ ~ I I - 1 . . 1 1 ~ 1 1 1 . . 1 1
C h i l d r e n a d m i t t e d t o p e d i a t r i c i f e l i g i b l e and n o t immunized a g a i n s t meas les , s h o u l d b e immunized. This p r a c t i c e is s a f e and e f f e c t i v e . Measles immunizat ions do n o t a d v e r s e l y a f f e c t t h e c o u r s e o f t h e c h i l d r e n ' s i l l n e s s and t h e r i s k o f meas les c r o s s i n f e c t i o n w i l l be diminished.
TIM% TAHGET
2 Weeks.
STEPS TO I3E TAKEN
D i r e c t o r PEID t o c o n t a c t t h e Nedical D i r e c t o r o f llamad 1 losp i ta l t o recommend in~plemen t a t i c
IlESPONSIULE OFFICE11
D i r e c t o r , P.M.D.
1
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
E P I - PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
~ E C O M M E N D A T I O N
. Immunization of children lvithin first year of life slioulrl become a rule Iiealtli p-orirkrs ~taff shoi~ld malce sure that the child becomes fully immrlnized before 11e reaches his first hirth date.
TIPE TARGET
June 1988
. . STEPS TO DE
TAKEN S . = D ~ = = = ~ = - ~ = = ~ ~ = ~ z ~ = ~ = = ~ * = = = = ~ = ~ = ~ = = = = ~ = = = = = = ~ a ~ a ~ ~ ~ ~ a = ~ = ~ a ~ = = = ~ a m a = = ~ = = = ~ = a = = = = = = ~ = ~ = ~ a ~ = . ~ = . - = = = = . = a . - . . . = - . - - - - ~ ~
- circular to be mass media
- health education - improved defaulter tracing
P R 0 D ' L ' E b1
-:lill....l-l-- .
. l Immunization coverage of children below 1 year is only 3516.
- llES WNSIDLE
OFFICER
llealth Education section of PMD and Nurses section of P.1I.C.
F~
*
E P I - 1 ~ E C O N M E N D A T I O N S
PIlC / EPI P R O G R A M M E R E V I E W
Q A T A R
- - - - ~ E C O M M E N D A T I O N
~-~IIIIIIIP31PPI3.~=~~===m~**~=~=~=~~==~===~==~7=====~========*~m.=.=~===m~==~=~=-=*~====~===3=====~=*=.=~=2--==-==-~.=--------.--=
Policy for contra-indications to immunizations should he revised and simplified. A more relaxed policy should he adopted especially for measles for which coverage has been lower than other vaccines. If the child looks healthy and has no specific complaints, the immunization course rhor~ld he followed. Only obviously sick children should be excluded. Fever, respiratory tract infection, diarrhoea and malnutrition should not be consirlered as contra- indication to immllnization.
P I~'O n t E EI
Contra-indications to imnunizations are innumerous and leads to keep the child un-protected for long time.
TINE TAHCET
1988
STEPS TO OE TAKEN
To be included in the Training Manual
NSPONSIDLE OFFICEIt
PbID Communicable Disease Dept.
I M M - n E c o M M E N D A T I O N S
PHC / EPI P R O G R A M M E R E V I E W
Q A T A R
TIbE TAUGET
End October
STEPS TO UE TAKEN
A circular to be sent to Health Centres. A workshop for physicians to be held
I I E C O E I M E N D A T I O N
. . i . ~ I ~ - . I ~ P 3 1 D * = ~ ~ P C . ~ = = ~ 3 ~ ~ ~ ~ . = . i L . = ~ ~ = 3 . = S = = = = 3 . = = = ~ = = = ~ P = = ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ = = ~ ' l = = P i i ~ E l ~ ~ = i l ~ = = = ~ D = ~ ~ ~ = ~ ~ D P ~ = P - ~ - ~ = - - = = - - I = - - - - - - - - - - = - - - =
Multiple antigens such as BCG, DPT, Polio and Measles vaccine can be given simultaneously. Neither their safoty nor their efficacy is compromised.
1 IIESWNSIULE OFFICEI~
ECII Section
P - R 0' n L E EI
Measles vaccine is not given simultaneo~lsly wit11 DPT, Polio vaccines and postponed another visit
I M M - - E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
I I E C O F l M E N D A T I O N
- * ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ = ~ ~ ~ * = ~ = ~ = ~ n ~ ~ ~ ~ = ~ r ~ = * ~ s ~ ~ ~ ~ ~ = ~ ~ ~ ~ ~ ~ ~ ~ = ~ s ~ ~ = ~ ~ = - ~ a * ~ . . ~ = = = = * ~ = = ~ ~ = ~ * ~ = ~ * = = ~ ~ a = = ~ ~ - = ~ ~ ~ ~ ~ ~ - ~ - - ~ - - = = . n ~ ~ ~ - - - - - - - - - - - - - -
Interrupted immnnizntions need not be restarted. The remaining dose or dosen should be given as if the prolonged intervnl had not occurred. For all practical purposes there is no maximum interval between doses of DPT or polio vaccine.
+
TIM3 TAHGET
Oct. 1987
STEPS TO DE TAKEN
- A circular to be sent to llealth facilities
-To be discussed in training courses.
p II 0 D ' L ' E El
Occasionally interrupted immunizations are restarted from dose one.
ItESPONSIDLE OFFICE11
M C II
PllC / EPI P R O G R A H H E R E V I E W
Q A T A R
-..
I
P II o ~ . I . - . F . rl
C o l d c l in in n;ld v a c c i n e I ~ a n ~ l - . l i n g o p e r a t i o n s a r c vcnh it1 t r a n s p o r t nnd I lea l t h C e n t r e s . Supe rv lmion i R , ' inn<lc~l !~nt .c , m o n i t o r i n g a n d e v a l u n I. i r n l
a r b n o t performed.
I I I . : C O E I ~ I E N D A T I O N
:....~~.)..~-P~~.~~I~2..~--.-.';.~D:~-i~.P~~3s3a~3~~~i.~=='33aP3~~33~~~11~~PP.~P.~'~~3i.33E113~=3PP333~3i.P~3~~~~'-IP--3..D~-.I.=-----------P
a ) I!ccrlli L nnrl c s t n l l l i s h n s t r o n g tean. o f e x i s t i n g s t a i r Lo c o n d u c t e x t e n - s i v e p rnc t . i cn l t r a i n i n g i n c o l d c h a i n opc rnLion anrl v a c c i n e h a n d l i n g c . f o r a l l pcrso1111c1 i n v o l v c d i n t h e o p e r n t i o n , u s e nnd s r ~ p c r v i s i o n o f t h e col r l c h n i n . T h i s would e n a b l e n m a j o r .improvcmcnt i n v a c c i n e rlual i t y ns s l l r ance .
I,) 111 o r r l c r 1.0 mnirr lnin t l ic improved o p e r a L i o n or Ll ic c o l d c h a i n , it i~ r~common<lrd LlnnL, oli t h e comple t io l - o r i n i t i n 1 s t a f f t r a i n i n g , t h e t r a i n i n g tcnm IJC i l c s i g n n t e d as a s u p e r v i s o r y i.cnrn t o mnke s u p e r - v i s o r y v i s i t s Lo n l l I l e n l t h C e n t r e s
c ) 'Clrr! ~lcvr!lopmr?nt of s t a n d a r d p rocc - < l # ~ r c s nlnnrlnl f o r t h e o p e r n t i o n o f t h o c o l d c l ln in n t a l l l c v o l s would n s s i s t i n L r n i n i n g , o p c r n t i o n a n d plnnnilrg of tile immuniza t ion .. programnte. T h i s con h e a p a r t of i m m u ~ ~ i z n t i o n ninnunl.
TIM3 TAIGET
3 Months
3 Months
4 Months
STEPS TO DE TAKEN
a. Dc te rminc t h e t r a i n i n g r cqu i r e rncn t .
b. I l c c r ~ ~ i t Lra in i r ig s t o T r a i n t h o team.
d. Sc l i cdu lc and colldllcl t r a i n i n g .
e . UNICEF C o n s u l t a n t t o n s s i s l . .
n. Develop s u p e r v i s i o n clleclc-1 ist.
b. S c h c d u l e v i s i t s Lo a l l c e n t r e s .
n. D e f i n e nnd s p e c i f y p r o c e d u r e s .
b. T r a i n s t n f C t o f o l l o w p r o c e d u r e s .
c. C i r c u l a t e mnnunls.
1 . UNICEF C o n s u l t a n t
IIESPONSIIILE OFFICEll
prlc pllar,nacy
f f
'PHC pharmacy
PHC Pharmacy . .
PllC / EPI P R O G R A M M E ~ E V I E W
q A T A R
TIKS TAIGET
0 c t o b e e 1 8 7
STEPS TO ne TAKEN
~~~~I..~~;.~.z~r..;l~=3~DE~;lrl.1~il~z.=~~.3z~P~~~.~1~.....lC~P3.~E1~3Ei.3P~~~.~-.=~3-*=-l..-==-=-.=--==-=.=--------------~
I s s u e a c i rc111ar
I I E C O E I I . I E N D A T I O N
OPV shoulcl 110 sliippecl 4.0 t l ie 1 l l e n l t l ~ c e r ~ t r r s i n t h c l i q u i d s tate
( + ' I ~ C t o fI°C) and s l ~ o u l d n e v e r be f rozen .
l l o n l t l ~ c e ~ ~ t r c s t o r n g e o f OPV at +'to iO°C is rocon~mendcd
OW c o n t i t i u c s t o hc s torecl i n
C c n t r n l S t o r c i t 1 f r o z e n s t a t e .
i
I I E S ~ N S I U L E O F F I C E I ~
D i r e c t o r of ElCll
D i r e c t o r o f Pl~armacy
. . P n o 'n L' F.. r~ .
,s,.lll---...~lllm..
O r a l p o l i o v a c c i n e is exposed t o r e p e n t e d ( r e e z i n a n d thawing a t .lien1 111 c e n t r e s .
PllC / EPI P R O G n A M H E R E V I E W
Q A T A R
P R o . n : L E EI I n E c o , l n r t i o r r r o N I STEPS TO DE I ItESWNSIULE TAKEN OFFICE11 1 ZZT
Measles incidence is 'I Measles control should become a high highest i n the last 15 year. priority health programme in the country. The coverage level is low and contraindications to measles imm~lnization are numerous.
- give measles immr~. to - llamad llospithl Cor children when admitted to paediatric Hospital 1 - relaxation on contra - Preventive Mod. indications applied 1 and Primary Ilealtl~ presently for measles Care Dept. immunization.
- give measles immu. to all eligihle children in outpatient clinics of every health centre and clinic
- Primary Ileal tli Car and Ilealth Centres staff and all other clinics.
- have a seminar on measles control for al' health workers of hospi tals/heal th centrt discussing control measures.
- mnke an ample propa- - Dept. of H.E<uc, ganda and arrange I .. .
social mobilization fo measles immunization.
- Preventive Med.Dep
s
- follow-up from H.C. records all measles eligible children defaulting.
- to consider a mcasle4 - Preventive Mod.
- llealth Centre staf
Jan. 1988
Jan. 1988
Jan. 1988
Jan. 1988
Jan. 1988
. . Jan. 1988
R
I mass camp i ,,,,,,,, ~~ec-t:,,. I
S U R - R E C O M M E N D A T I O N S
PIlC / EPI P R 0 G R A M E R E V I E W
Q A T A R
TI* TAHGET
J a n . 1908
STEPS TO DE TAKEN
Revise and i s s u e N e w N o t i f i c a t i o n Report
n E c o M M E N D A T I O N
~--~~~il*PI=~~~~;..P~i.=i.E.*~;.~~=*i~E=D==;.~I~~==3~~~~==~~~~=~=~~~~~II~~II==~~=====~====;.===-========.=-==.=--=--==---==------------*-
The number of t e l e p h o n i c n o t i f i a b l e d i s e a s e s shou ld be reduced t o o n l y t h o s e t h a t have a P u b l i c H e a l t h s i g n i f i c a n c e o r f o r which s p e c i f i c c o n t r o l programmes e x i s t s and a c t i o n s can be t aken .
- Neonatal T e t a n u s shou ld b e r e p o r t e d s e p a r a t e l y from o t h e r forms of t h e
1 d i s e a s e . - A l l EPI t a r g e t d i s e a s e s s h o u l d b e r e p o r t e d by a g e ( f o r Measles and P e r t u s s i s s p e c i f i c a l l y by month) and t h e i r immunization s t a t u s - Diar rhoea1 m o r b i d i t y s h o u l d b e r e p o r t e d r o u t i n e l y .
- - - -
4
IESPONSIULE OFFICEI(
Communicable D i s e a s e Control S e c t i o n PMD
Cooperat ion of a l l r e p o r t i n g Cent res .
P I X O ~ L E N
D i s e a s e N o t i f i c a t i o n is l e n g t h y and laclcs i m p o r t a n t i n f o r m a t i o n on EPI t a r g e t d i s e a s e s .
R E C O M M E N D A T I O N S
PllC / EPI P R O G R A M M E R E V I E W
Q A T A R
. - - -
I P R O D L E M
The present disease report- ing system is inadequate for planning management and epidemiological purposes.
STEPS TO BE TAKEN
New foml to be distributed and implemer~ted
R E C O M M E N D A T I O N
- - -= I - I - l=a=P=41=1P==-===*=========~=============a======aa====-~~m~.=====~==========-===~==<===========-a -===-====~== .~=~- . - - - - - - . .
Disease reporting should be revised and simplified. Epidemiological data should be analysed and utilized at Health centres as well as at national level. Medical officers should be required to record diagnosis accurately and be held responsible for reporting.
ILESPONSIULE OFFICEIt
Director of Comni.Dis. PblD
TIW, TAHGET
~overnbet-1987
R E C O M M E N D A T I O N !
PIIC / E P I P R O G R A M M E R E V I E W
Q A T A R
R E C O N N E N D A T I O N
-.~=l~.p~p=.=.1=~~==5=.~p~.P3=PEil=3P=~3~~9~-i~ii=~i.==.=3~3=~a=~~lPPY~3l=E.ii.Ia==~~P==~=il===~P~l~P=.~=i.~-al~P.IP--~1~-1..1.111-11111
containing A regular epidemiological bulletin] data on E P I target diseases should be produced and circulated.
This bulletin should be used as a medium through which chnnges in policy are transmitted to all staff concerned. Such a bulletin is ideal means for feed-back to service providers.
S T E P S TO BE TAKEN
- A'monthly report of Ilorbidity and tlortality to be produccd
.- - - P R O I J L E P I
No mechanism exists for
feed-back of epidemiolo~ical
information
LU3SPONSIULE OFFICEH
P. M.' D.
TIES TAUGET
Jan. 19,
I I E C O M M E N D A T I O N S
PllC / EPI P 11 0 G R A M M E R E V I E W
Q A T A R
.. - -
4
I I E C O E I H E N D A T I O N
.__.1~..~.31~~~~.~3~~~=~~P~.~~.~li~l~~=~3=~~=~~3=~~==~~3P3=-~~P~~*..~~~~E~P~=~P.3=~i.5~===.P~1~~P.i.Ci.~l=i.-~.3=--il=-~-=I-=-----...--=il
To follow up the recommendations of this programme review a Focal Point should be identified and nsnigned to carry the responsibi- lity of following up the implemento tion of the recommendation in this review. The national members of this review team sholrld become act.ively involved in this process
, .
P I ~ O n ' ~ E EI
'
TIME TAIGET
.. . .
STEPS TO UE TAKEN
. .
IIESPOtlSIlILE OFFICEII
Secretary of
Coordinating Committee
. .
. .
., .. . .
.. .. .. .
. .
Annex 2
CLUSTERS OUTSIDE DOHA
Anncx 3
CLUSTERS INSIDE DOHA
AD DAWHAH (DOHA )
Annex It
HEALTH CENTRES IN QATAR
,+I Abu Dlu
MADINAT A ' SlIIL'l.
U W I .-. _.- GERIAN AL BlLTNA
Annex 6 P H C I K D E P T H R E V I E W
M E M B E R S 0 F R E V I E W T E A M
QATAR 5 - 30 SEPTEMBER, 1987
NATIONAL MEEmER.5:
1. Dr. Khalifa A. Al Jaber,
2. Dr. Aisha Al Ka~ari,
3. Dr. M. Yassin Mahdy,
4. Mrs. Fawzia A1 Naimi,
Director of Preventive Medicine
Director of M.C.H.
Head of Health Education
Principal Nursing Officer
INTERNATIONAL MEMBERS :
1. Mr. Allan Bass, Raporteur UXICEF Consultant
2. Dr. Haider Dek El Bab W.H.O. Consultant
3. Dr. Samia Riyad, Raporteur W.H.0. Consultant
4. Dr. Ehsan Shafa, Coordinator W.H.O. Consultant
RESOURCE MEMBERS :
1. Dr. Salah Madkour.
2. Dr. Nadia Bassiouni,
3. Dr. Ahmed Siddiq,
Director of Communicable Diseases Control Section
Health Educator
Madinat Khalifa Health Centre, Medical Officer-in-Charge
4. Dr. k'agdi Shaker, A1 Khor Health Centre, l , ic2l?~: Officer-in-Charge
5. Dr. Emthithal El Nahus, Coordinator M. C. H.
FIELD TEAM MEYEERS:
1. Kassem Saad Salem, Statistic Investigators from the
2. Ahmed Ibrahim, Central Statistical Organization.
3 Bassem Marmush,
4. Ziyad Abou Harb,
5. Azza Hamed, , Chief Nurse Umm Guelina Health Centre
6. Soheir Harbi,
7. Sanaa Zeitoon,
8. Nervin Nassar,
9. Fatma' '~emeihi ,
Nurse Keigua Health Centre
Vurse Al Khor Health Centre
Chief Nurse Umm Salal Health Centre
Nurse A1 Rayyan Health Centre . .
10. Maureen Grimshaw Health Education Section.
TEAM COMF'OSITION FOR F I E L D SURVEY
PHC PROGRAW REVIEW QATAR SEPTEMBER 1987
" GROUP
NO.
1
1 1 , . 1 2 A 1 S h a m a l D r . A h m e d S i d d i q i
13~14 A 1 S h a h a n i y a D r . H e i d e r D e k E l Dab
A z z a H a m e d
. 1 5 , 1 6 A 1 W a l k ih
k h d i n e t K h a l i f a
Dr . S a m i a R i y a d ' F a t m a R e m e i h i
N e r v i n N a s s a r Mr. A l l a n B a s s 4 z8v29 Umm salal
S a n a a Z e i t o u n 30~18 A 1 K h o r
~1 ~ u m a y l iyah Z i a d A b o u H a r b
L !
1
INTERNATIONAL MEMBER
Dr . E h s a n A l l a S h e f a
NATIONAL MEMBERS
-. ..
D r . Salah M a d k o u r
Soheir H a r b i
B a s s e m M a r m u s h
CLUSTER
NO.
1.2
994 ,596
7
-- w HEALTH F A C I L I T Y
OBSERVED
A 1 K h a l i g
A 1 G h a r a f a
A 1 N a i j a
A1 Matar
Annex (8) MINISTRY OF . PUULIC HEALTH
O R G A Y I Z A T I O N C H A R T I P P I = I I D I = I I I P I 1 1 3 1 1 = * = = - ~ = - 1 I = D ~ I = ~ ¶ = I 1 ¶
HAMAD MEDICAL CORPORATION BOARD
I UNDER SECRETARY 1 I 1 I
I Assistant for Administrative Affairs I I Assistant for Technical Affairs I I
)er H. 0 B W C T TU $VIEW
L Sla. DT]l Planning Xanpower
I 1
Directorate of Directorate of Preventive Directorate of Rimary Health Directorate of Pharmacy & Medicel Council Care Medical Supplies
I I I I
Nursing Services Hedical Services -- - - - - -
Health Centres
I I I I .
I I 1
Food Handlers Immunization Epid. Surveillance
Annex 9
I R E Y I E W OF P R l f l A R Y H E A L T H CARE / E P I : PART 6 : H O M E L E Y E L
-&J.~\~L~\;u- ) \ ,&\;C~L;-~\Z c ) ;,L;\ 1
- - . -- I NEAREST HEALTH FACILITY : TYPE DISTANCE
I r ,
Summary o f m d e r s rESr3onses I
r . /..
2 l 1 ;TOTAL
2. If Yes h o ~ manu times ?
.S~'L;JL&~LWLO~ - - J-, 3. ~ i d i h e f i a imd health vorker, THW
dve her any health talks ?
. ss,
durina her last preonancu ? No 3
)-r
.. f*j\9y,J\zdo\
- g l J 9 177
/ over6 7,,.\
2
4. Where W8: the deiiveru conducted ? Other
Hc~pit81- .=: \\ Home J.A\
I 'y. /-J/ \\\&
No
7/11 53$
96% 31!
3-6 y-, 1 i 2 T
I
16. What were the f i r s t foods ?
7. HOW did mother learn about vsccl nes ?
Page 3
neER Of CHILD IN ClUSTER
). Crm mother rsEd thls 7 NO
. h father red ? NO
P; /oo;/. ?. is there safe
dv~i lable fg the hocse 7 NO
J.\t - Goby +93a - Yes
i. Is there a prcper latrine in the house ? NO 9 O $
Yes
. Is g r b w dine& of crooerly 7 No . ..
Annex 19
HAMAD GENERAL HOSPITAL INFECTIOUS AND PARASITIC DISEASES
PATIENTS WITH A PRIMARY DISCHARGE DIAGNOSIS - OF YEASLES-AND PERTUSSIS -1CD9 CODE ( 0 3 3 )
JANUARY 1986 THRU JUNE 1987
I TOTAL ALL 1986 AND I I JASCARY THRU JUNE
I 1987 ?lEASLES CASES..
AGE OF PATIEXT / PfEASLES I 1
AGE TWO MOXTHS OLD......... THREE MONTHS OLD....... I FIVE HONTHS OLD ........ . .
SIX HONTHS OLD......... SEVEN HONTHS OLD....... .
I ' EIGHT MONTHS OLD..... .. NINE MONTHS OLD........ TEN MONTHS OLD......... ' ELEVEN MONTHS OLD. .....
i TWELVE MONTHS OLD.. .... 13 MONTHS TO 18 MONTHS. 19 MONTHS TO 24 MONTHS. OVER 2 TO INCLUDING 3
YEARS OF AGE........ OVER 3 TO INCLFDING 4
Source: Hedical Records Discharge Abstracts
YEARS OF AGE........ 22 OVER 3 TO INCLUDING 4 I
OVER 4 TO INCLODING 5 1 11 YEARS OF AGE........ OVER 5 TO INCLUDING 6
9 YEARS OF AGE........ OVER 5 TO ISCLUDING 6 ...... OVER 6 TO INCLUDING 9 YEARS OF AGE.. 15 YEARS OF AGE........
OVER 9 TO INCLUDING 12 YEARS OF AGE........
OVER 12 TO ISCLUDING 15 YEARS OF AGE........
OVER 15 YEARS OF-AGE... 16
L f I
'AGE OF PATIEST
1.- I WHOOPING COGGH n
AGE 3 1 ONE MONTH OLD,......... i 12 I i 2 ' TWO MONTHS OLD......... 15 !
...... 3 1 THREE MONTtlS OLD.
3 1 FOUR MONTHS OLD. ....... FIVE XONTHS OLD........ SIX MONTHS OLD.........
11 ... SEVEN MONTHS OLD.... I 2 i 2 8
3 7 19 31
2 8 YEARS OF AGE....... 4 '
.... EIGHT MONTHS OLD... NINE MONTHS OLD........ TEN MONTHS OLD......... TWELVE MONTHS OLD...... 13 MONTHS TO 18 MONTHS. 19 MONTHS ~0.24 MONTHS- OVER 2 TO INCLUDING 3 .
3 2 3 4 6 5
nnex 11
ate of atificatlon : -
ame :
v: sex
ationality :
seast: :---
ate of Onset : -~ ~tient at :
late of admission :
ddresr :
-
el. No. : --
COMMUNICABLE DISEASES NOTIFICATION FORM
#$L STATE OF OATAR Ministry of Public Heal th
+ J-J9 L W I d l ;,I j,
Preventive Medicine Dept. ;U)I 411 ;,I>I Communicable Diseases and Epidemics Control Section 4 391 ~ijUY1&1,5'I &lS, + Epidemiological Unit. %,I1 L L Y I ;&, 4 . Off. Tel. : 4265761 193164 f4r\lf ,- f r ~ o v ~ a
N O T l F l C l l T l O H O F I i F E C l l O U S D I S E A S E
T o : The Preventi\.e Medicine Dept.
I hereby certify and declare tha t in my opinion the person named below is suffering
from :
Patlent NAME & No. : I Age I Disease or Food Poisoning I Date of Onsct
Nationality : i jeX i I
Patient Home Address : i If Patient is in Hospital :
Address from which admitted :
Tel. No. :
1 Notifying Hospital :
Diseases to b e Notified Bv Teleohone :
Ward :
Primary Health Centre :
Cholera Typhoid & para typhoid fevers Other salmonella infections Food poisoning (Bacterirl) Tukrculosis of Respiratory system Other tuberculosis Plague Brucellosis Lebrosy Diphtheria Meningococcal meningitis Other meningococcal infections TeEnus Acute poliomyelitis Meningitis due to enterovirus Smallpox Viral Hepatitis Louse borne typhus Malaria
Date of Admission :
Other Notifiable Diseases :
C94 Shigellosis 006 Amoebiasis
007.009 Other ill defined Intestinal infections
033 Whooping cough 034 Streptococcal sore throat & Scarlatina 038 Septicaemia 052 Chickenpox 053 Herpes zoster 054 Herpes genitalis 055 Measles 056 Rubella 060 Yellow Fever
062-064 Viral encephalitis (arthropod-borne) 072 Mumps 076 Trachoma 087 Relapsin:, fever
090.097 Syphilis 098 Gonococcal infections 099 Other venereal diseases 120 Schistosomiasis 132 Pediculosis & Phthirus infestation 133 Acariasis
390-393 Acute rheumatic fever 460-456 Acute respiratory infections
487 Influenza 695 Erythematous conditions
D a t e : -
Signature of Medical Officer or Notifying Person
Annex 12
Cold Chain Equipment: Manufacturers procurement information
The cold chain equipment listed below is suggested as being suitable for use in the vaccine cold chain in the State of Qatar and is available through UNICEF/~IPAC. In no way does this list constitute a recommendation of a specific manufacturer this list constitute a recommendation of a specific manufacturer.
1. Cold Dox Model 688, Uh'IPAC Ref: P. I. S. E4/29
Supplier: IGLOO Corporation P.O. Box 19322 1001 West Belt Drive Houston, Texas 77224-9322 USA
Price: US$ 39.78 each
2. Cold Packs (for above): Freezepack 9701 Uh'IPAC Ref: P. I. S.E5/07
* * * Supplier: IGLOO Corporation The purchase order must request that the cold packs be shipped unfilled.
3. Vaccine Carrier model 3504, Uh'IPAC No. 11 850 00, Ref: E4/18
Supplier: King Seely-Thermos Thermos Division Norwich, Connecticut 06360 USA
Price: US$ 23.00 FOB
4. Cold Pack (for above): Ice pack model 3500/P UNIPAC No.11 850 10, Ref: E5/1
Supplier: King Seely-Thermos
Price: US$ 75.00 per 100 units, FOB
5. Thermometer, WHO Liquid Crystal O'C - 20'C model 2291 UNIPAC Ref: ~6/11
Supplier: American Thermometer Company Inc. P.O. Box 1509 Dayton, Ohio 45401 U. 5. A.
Price: US$ 0.85 each
6. Dial Thermometer model No. 418, UNIPAC No. 11 830 10, Ref: E6/7
Sppplier: Moeller-Therm GmbH Postfach 1260 D-6983 Kreutzwertheim Federal Republic of Germany
Price: US$ 1.00 each FOB
7. decording Thermometer model 615P (lexan cover) Ref: E6/09
Temperature range - 40'C to +70'C Supplier: Pacific Transducer Corp.
2301 Federal Avenue Los Angeles, CA 90064
Price: US$ 148.85 each, plus US$ 8.50 per 100 spare charts.
Annex ilt
GLOSSARY OF ABBREVIATIONS AND TERNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Primary Hea l th Care
Expanded Programme on Immunization
Ora l r e h y d r a t i o n S a l t
Maternal -chi ld I l e a l t h
T r a d i t i o n a l B i r t h At tendan t
World Hea l th O r z a n i g ~ t i o n
Q a t a r General Pet roleum C o r p o r a t i o n
M i n i s t r y of P u b l i c H e a l t h
Hamad Medical Corpora t ion
Hea l th Cen t re
P r e v e n t i v e Medicine Department
C e n t r a l S t a t i s t i c s O f f i c e
M i n i s t r y of Educat ion
Arab Gulf Funds f o r development
Neonatal Te tanus
S e c r e t a r i a t General of Hea l th f o r Arab Gulf S t a t e s
Measles, Sumps, Rube l l a v a c c i n e
M i n i s t r y o f Defence
Computer Hea l th R e g i s t r a t i o n D i v i s i o n
I l e a l t h Educat ion
OFFICIAIS INTEflVIBD
WRING THE MISSION
D r . I I a j a r Ah& Hajar
D r . A l x l u l Ja l i l SaJ.11mn
D r . Nvnecl D a j a n i
D r . K h a l l f a A h n d A 1 Jaxr
D r . A i s h a Al. K a w a r i
D r . UrkhaL E l N a h a s
Mrs .17awzia Nammi
D r . EIcu1~1i E l Saj.d
D r . &la
Mr . ~ . x i u l . l a h N Assiri
M r . Mohama3 A 1 H a i l
D r . Sale& Madkour
D r . M o h m d Y a s s l n
M r . P lohaned A s h c u r
M r . Racf
D r . Cxnar I l a s h l s h o
Ms. C a r o l O b r i e n
D r . M i l d e r
D r . V a s N o v e l - l i
M r . Rnlxrt N a g a n
D r . F a w z i G a d a l l a
. Faafat l i l x t u l FIaud
D r . H~unCii
D r . fibhrak A y a d
D r . N e i m a t O l o u j e
D r . Mahmud mh. F l u s s e i n
D r . U s h a b a h
Under-Secretary of I l e a l t h
A s s i s t a n t U n d e r - S e c r c t < ~ r y for T c c l l n i c a l Services
D l ~ r e c t o r of P.H. C
D i r e c t o r o f P.M.D.
M.C.11. D i r e c t o r
C c o r d i n a t o r of M.c.H.
Chief N u r s e r y O f f l c e r
C l l i e i of D-ruq S p p 1 . y Section
P .II. P I - a n n i n g a d P e r s o n n e l
Fleacl ot C a l p t e r R q l s t r a t - ~ o n Section
D i r e c t o r o E I ' h a r n a c y and D r u g C o n t r o l D e p t .
I-lead of C a n ~ u n l c a b l e D i s e a s e Sectio ) \
IIad of M.E.
H e a l t h Inspector P.M.D..
P r q r ~ m analyst C o m p l t e r Section
D i r e c t o r of W a l e n H o s p i t a l
N u r s e / Infections D l s . C o n t r r o l I I a n a d tlosp.
C o n s u l tcwt i n f . D i s .Conk . Hamad Iqosp.
C h a i m Inf . D i s , C o n t . Mcm6 I l o s p .
M E d i c a l Information , I ~ I a n a d F I o s p i hl
C o n s u l t i m t UM)P
Ass t. D i r e c t o r of C e n t r a l S t a t i s . O r g . Act . i ny D i r e c t o r for sci~ool hc i3 l t i 1
A s s t . D i r e c t o r M l l i t a r y Services
MO of military clinic
Acting Chief Q.G.P.C. H. centre
~ a d i a t r i c i e n Q. G . P . C.
