Terrified with the extremely bad security situation and the

pamphlet distribution by Mulvi Fazl-u-llah against the polio drive

Noor Zali Khan Area Health Support Communication Officer

(AHCSO) thought about the idea of inaugurating the polio

campaign in one of the biggest mosque/madrassahs (religious

school) - Dar ul Uloom, in Wana South Waziristan. It was a very

challenging job given the fact that South Waziristan is bordering

Afghanistan –Angoor Ada and there is a lot frustration in the local

tribes because of the frequent drone attacks. Conducting a

gathering event of this scale in such unfavorable circumstances

was indeed a big challenge.

It was very strategic to conduct this activity in Dar-ul-Uloom

given three facts: first, various important mosque imams, pesh

imams and khateebs teach in this madrassah between 9-12 am

everyday. This place is an assembly point for the ulemas to make

decisions and issue fatwas (religious verdicts). Second, local

Wana students as well as student from far flung areas, including

bordering Afghanistan – Angoor Adda, come to study in Dar-ul-

Improving routine immunization

is one of the key indicators for

ensur ing a reduct ion in

childhood mortality. Pakistan

stands an improved chance of

achieving the Millennium

Development Goals (MDGs) by

improving routine immunization

through intensified efforts.

Unfortunately many children are

being needlessly affected by

measles and other vaccine

preventable diseases despite

the availability of safe and

effective vaccines which are

free for all. Improving routine

immunization still remains a

major challenge in Pakistan.

Accessibility to Extended

Programme for immunization

(EPI) services irregular outreach

activities, increase drop out and

defaulter rates, poor vaccine

and cold chain management are

2 0 0 9 E D I T I O N

Building Upon Evidence Based interventions - LHWs involvement

in routine EPI in NWFP

01-08-2008 - Minister of Health (MoH) Zahir Ali Shah speaking

at the launch of LHWs in routine EPI. Continued on page 03

We Deliver in The Face of All Challenges

18-01-2009 Dar ul Uloom South Waziristan WANA – Dr Ahmad

Noor explaining the polio eradication initiative.

Continued on page 04

A PUBLICATION OF THE EXPANDED PROGRAMME ON IMMUNIZATION

2 0 0 9 E D I T I O N

Building Upon Evidence Based interventions - LHWs involvement

in routine EPI in NWFP

TEEKU TIP“Always remember to vaccinate your children against eight deadly diseases”

Immunization Times, an initiative taken a year and a half ago with the

aim of bridging information gap amongst the large immunization family

working at different tiers of our country's health system is now firmly

on the ground. This indeed is a matter of satisfaction for me.

No endeavour can succeed without a strong communication support

and free flow of information both among the providers and between

the providers and recipients.

Immunization services are being provided in Pakistan through a well

established infrastructure that reaches out to the grass root level.

Provision of immunization to the populace remains a lynchpin of our

disease control efforts.

This issue focuses the need to upscale routine immunization and sheds

light on some landmark advocacy initiatives in areas like South

Waziristan which would be of particular interest to the readers.

Immunization Times offers an interesting collage of informative

articles, updates on immunization related activities from the four

provinces and most importantly a platform for interaction and

exchange of ideas. We see the Newsletter blossoming as an information

highway for those interested in immunization and associated with

public health.

I would urge health professionals and all those with an interest in child

health to contribute to Immunization Times on a regular basis, as

success of this initiative hinges on the level of their participation.

Let this become a forum for sharing best practices in immunization.

Message by the Secretary Health, Government of Pakistan

02

Khushnood Akhtar Lashari

Secretary Health

March 30, 2009

Building Upon Evidence Based interventions - LHWs involvement

in routine EPI in NWFP some of the major areas hindering efforts towards

improving routine EPI coverage. Keeping in view

all these challenges, Government of NWFP:

Provincial EPI cell and Provincial Project

Implementation Unit (PPIU), with the provincial

partners, started to train LHWs to be skilled EPI

vaccinators in 2005. This initiative was initially

piloted in six select districts of NWFP -

Abbottabad, Mardan, Peshawar, Swabi, Dir Upper

and Dera Ismail Khan.

The involvement of LHWs in routine immunization

activities involved intensive training of the LHWs,

in two phases. Initially LHWs participated and

observed the administration techniques of

vaccines followed by structured inoculation

training under the close supervision of the EPI

technician. After receiving training the LHWs

became capable of undertaking routine

immunization activities. In the first 2 phases a

total of 2,377 LHWs were trained in six districts of

NWFP. The most challenging job was the practical

involvement of the trained LHWs in routine

vaccination. The Government of NWFP

successfully overcame these hurdles and

today a total of 1850 LHWs have started

taking up these activities on regular basis

in these districts.

Preliminary reports and field visits have

shown dramatic improvement in routine

EPI coverage in the control intervention

areas of the pilot districts. For example,

one of the trained LHWs Rubeena

registered a population of 1003 in the

catchment area of Civil Dispensary

Nawakale in District Swabi. The total

number of eligible children in her area is 23

and all of them have received routine

doses, thus bringing the routine coverage

in her catchment area to 100%. Also there is

concrete evidence that there has been a

significant reduction in the number of drop

outs and EPI defaulters after the

involvement of LHWs. LHWs are considered

as one of the most effective and trust

worthy health related communication

channel in the communities in which they

are working. Being local, they are

conversant in the local languages and

sensitive to the cultural norms, their

involvement in routine EPI is also playing a

critical role in awareness raising and

demand creation for routine immunization

at the grass roots level.

Building on the initial success this initiative

is now being scaled up in other districts

including Nowshera, Charsada, Bannu.

Khyber, Bajour and Mohmand. The LHWs

from these areas are undergoing the third

phase of their training. LHWs are now being

trained in pilot districts throughout the

country as an additional support for

strengthening routine immunization.

Continued:

Tribal Polio Control Cell

On 21st January, 2009 a social mobilization

activity was conducted with the tribal elders and

note worthy leaders of Wazir, Dotani and Suleman

Khel tribes in Tank. A total of 60 tribal chiefs and

elders were present at the gathering. This activity

took place with the active support of the Member

of National Assembly (MNA) Maulana Abdul Malik.

The purpose of this programme was two fold: first

to seek support and cooperation from various

tribal leaders with the polio vaccination teams,

and second to share Tank polio control cell number

with the group to report and record missed

children and areas where no team had reached, as

reporting of the missed children to the

polio control cell is irregular and weak in

Tank. This was also a platform for the

adversary tribes to sit together and explore

areas of future cooperation for polio

eradication. Maulana Abdul Malik

requested tribal leaders to support the

polio drive in the country and shun all

negative propaganda against the

vaccination and associated myths in their

jirga and other public meetings.

Communication material in local languages

was shared with participants. At the end of

the ceremony, tribal elders pledged to

support upcoming NIDs and committed

themselves to report the missed and no

team areas to the polio control cell from

the March-09 and onward NIDs. The efforts

of FATA team are praiseworthy given the

extremely tense security situation and

continuous virus transmission from

bordering Afghanistan in this region.

01-08-2008 - Minister of Health (MoH)

Zahir Ali Shah speaking at the launch of LHWs in routine EPI.

21-01-2009 - Tank: Jirga held with tribal leaders

03

STORY FROM NWFP/FATASTORY FROM NWFP/FATA

04

STORY FROM NWFP/FATASTORY FROM NWFP/FATA

We Deliver in The Face of All Challenges

Uloom madrassah. This madrassah has a separate

provision for both male and female students. Given

the cultural norms of South Waziristan it was not

possible to conduct this activity with the female

groups. Third, this platform was also used to take

key messages to the Masood tribe living in the

extremely difficult and almost inaccessible

mountainous terrain of South Waziristan.

A total of 300 students were present at the polio

inauguration ceremony. Moreover 12 prominent

imams and pesh imams also participated. The

driving force behind conducting this scale activity

in the face of all challenges was good social

mobilization of the FATA team with Maulana Noor

Mohammad (ex MNA), an influential of this area. At

the end of this activity Maulana Noor Mohammad

negated the claims made by Maulvi Fazl-u-llah in his

pamphlet distributed against the polio vaccination.

He also cited examples of his own son who is

inflicted with polio and urged all participants to

support polio vaccination drive in full capacity.

Arranging a big gathering of religious scholars in a

religious school on a non religious topic of polio and

displaying a banner in mosques in a unique

example of social mobilization, said by Dr

Rafiq Programme Specialist FATA UNICEF

Peshawar. These types of mobilization

activities will be encouraged and

replicated in other parts of the FATA and

NWFP. The team deserves great

18-01-2009 Dar-ul-Uloom South Waziristan

WANA – Fitwa supporting polio vaccination by

Mufti Maulana Abdul Qayuum.

Continued:

appreciation of communicating so

effectively.

At the end Mufti Maulana Abdul Qayuum

issued a fatwa to support future efforts of

polio in WANA and adjoining accessible

areas of South Waziristan. Altogether 15

mosque announcements were made after

this ceremony. Teams from South

Waziristan reported a significant decrease

in the number of religious refusals and

those associated with the pamphlet.

According to the data total religious

refusals in November was 312 out of which

teams were able to cover only 76 (i.e 24%)

after the NIDs however, after this activity

in January the total religious refusals was

281 and teams were able to cover 99 (35%).

It can be said that the 10% increase in the

reported figures can be the outcome of

this activity.

18-01-2009 Dar-ul-Uloom South Waziristan WANA – 300 students gathered to inaugurate January polio round.

Addressing refusals through area specific plans

One of the main reasons for the upsurge in

polio cases in 2008 is the recurrent

movement of people across the district,

provincial and international borders due to

the unstable security situation in Pakistan.

The security crises in Bajaur resulted in a

movement of a large number of Bajaur

natives to other parts of country. Larama

Union Council of Peshawar became a

harbor for the displaced people from

Bajaur. Most of these people were chronic

refusals. After a short time their ideas

started influencing the locals of Larama

and refusal to polio vaccination emerged

as a big issue of this area. Similarly, in UC

Badaber refusal to vaccination was also a

big challenge. The total number of refusals

in Larama and Badaber I and II UCs was

calculated as 500 and 160 respectively.

In order to tackle the issue of refusals it

was planned to undertake a special door to

door refusal coverage activity in these two

areas by specially trained teams. Special

teams from the Public Health School were

mobilized to go house-to-house in this

area. The Public Health School provided

local school teacher well respected in the

community. In addition to involving school

human resources, local imams, nazims and

councilors were also mobilized to support

the activity.

Innovative and interesting messages

tailored according to the local context and

changing demographic profile were

developed to be delivered by the ten

women teams for the refusal families

during house to house visits. Under the new

s t rategy, some medic ines e .g . ;

paracetamol, mefnamic acid, packaged

with health education session, were also

given to the refusal families to ensure their

acceptance. Three trained Campaign

Qurdatullah DHCSO mobilizing teams in Badaber

Local vaccinator doing house

to house visits in Larama.

05

STORY FROM NWFP/FATASTORY FROM NWFP/FATA

Support Persons (CSPs) who were trained

medical doctors also checked the sick and

elderly of the refusal families to build their

confidence in the teams. Qudrat ullah

Shinwari District Health Support

Communication Officer (DHCSO) played a

special role in convincing the men and

decision makers of the refusal families to

support this initiative.

The key focus of mobilization is ensuring

the strategies are tailored to address the

local issues of the community.

This activity led to the coverage of 329

(61%) refusals in Larama and 94 (59%)

refusals in Badaber I and II.

06

STORY FROM ISLAMABADSTORY FROM ISLAMABAD

Japan to give 4.7m$ for polio eradicationSigning Ceremony

extending a grant of US $ 4.7 million (422

million-yen) to procure 26.2 million doses

of oral polio vaccine. Funds provided by the

Japanese government will be used to

procure 26 million doses of oral polio

vaccine during 2009, which constitutes 7%

of the total vaccine requirement for the

year.

The commitment was formalised at a

signing ceremony and exchange of notes

that took place between Japanese

Ambassador Mr. Chihiro Atsumi and Mr.

Martin Mogwanja, UNICEF Representative,

Pakistan. Federal Minister for Health Mir

Ijaz Hussain Jakhrani was also present to

witness the ceremony together with WHO

representative Dr. Khalif Bile. The transfer

The eradication of polio is the largest

public health initiative ever undertaken. It

has been noted that the eradication of

polio is such a complex and demanding task

that it would be impossible for one

government, one donor, or one NGO to

undertake it singly on its own. The

partnership established to eradicate polio

is one of the most unique and innovative,

b r i ng ing together government s ,

d e v e l o p m e n t a g e n c i e s , d o n o r

governments, private sector, NGOs and

most importantly health workers and civil

society of Pakistan. Recently, the

Government of Japan assured its

continuous support for the Polio

Eradication Initiative in Pakistan by

of funds to UNICEF will be channelled

through the Japan International

Cooperation Agency (JICA). UNICEF

Country Representative Mr Martin

Mogwanja said that “ in the wake of recent

upsurge of polio in Pakistan, the eyes of the

world are all the more on our polio

eradication efforts in the country”. He

offered continued support of UNICEF to the

government in the area of disease

prevention and child health.

While addressing those present at the

signing ceremony, Ambassador Chihiro

Atsumi said that Japan is proud of its one

decade long partnership with UNICEF and

the Ministry of Health of the Government of

Pakistan. Ambassador Atsumi also

expressed his hope that the Japanese grant

aid would be used effectively to alleviate

the suffering of all the children, especially

those affected by the October 8, 2005

earthquake in Azad Jammu and Kashmir,

mountainous regions of North West Frontier

Province (NWFP) and for the children

affected by the security situation in FATA.

For the past 13 years the support from the

Government of Japan has been

unwavering. The total contribution of the

Government of Japan to this project since

1996 adds up to US $ 78 million, a sum

which has been significant in reducing the

number of polio cases. JICA also started a

technical cooperation project from 2006 to

2011 with the funding of 3.4 million US

dollars for controlling the spread of

infectious diseases including polio. Without

the support of donors like Japan it would

have been very difficult for Pakistan to

undertake high scale polio eradication

efforts in the face of surmounting

challenges.

betweenGovernment of Japan and the United Nations Children’s Fund (UNICEF)

Islamabad – January 29, 2009

UNICEF representative and Japness ambassador (

shaking hands at the signing ceremony

Mr. Chihiro Atsumi )

07

STORY FROM ISLAMABADSTORY FROM ISLAMABAD

Detective Columbo in a Bazaar: a market survey experience!

As a reminder, a market survey is always

conducted on the catch-up day, after the

three regular days of National

Immunization days. The objective might

be simple – check the nail mark on 150

children – but it requires a lot of leg work,

bending backs towards toddlers and a

Hawkeye not to miss any child. In this

endeavour, we got once helped by a jewel

shop owner who knocked on his window to

call us in. There was, invisible to us, one

under five child and he did not want us to

miss him. That is the kind of social

mobilization, the program needs: at its

level, each and every citizen can

contribute to reach out every child and

therefore stop the circulation of the virus.

In this regard, market survey is also a

Public Relation operation by which the

Health authorities show how committed

they are to their work.

Grim Results

Be that as it may, from the very first

moments of the survey, it appeared very

quickly that the coverage would be weak.

Some would object that this specific

bazaar is largely populated by beggars

and therefore not representing the

society as a whole but the coverage

should be 95% in all layers of the

populations, anyway. The more children

we met and the more obvious it appeared

that the final countdown would yield a

disappointing figure. Too many nails were

not bearing the marker print. After three

long hours, the outcome confirmed our

initial fears. Out of 150 children, 19 were

unvaccinated and seven unmarked but

vaccinated according to the parents

testimony. So the actual coverage was

around 83% finger marked and 87% by

recall. Each unmarked child is recorded

on a tally sheet with his full name and

address. From the batch of 19 children, it

appears that nine of them originated from

the Bagri community (beggars), four

from UC Naudera and five from UC

Akil. This information, like a clue in

a police investigation, could lead us

to the culprits: poorly covered

areas. We just had to follow that

invisible link and move towards

these suspected locations.

Poorly Covered Areas

In the afternoon, we rendered

ourselves to these suspicious areas,

more precisely and firstly to the

village of Shahyro Bheel (UC Akil B,

Taluka Larkana). Out of the 65

children checked in one compound,

f ou r ch i l d ren we re f ound

unvaccinated. That poorly covered

area was worth the trip but our next

stage led us to even worse situation.

In this small settlement of humble

dwellings (behind Station Mohalla in

UC Pirbux, Taluka Tratodero), our

findings were more worrisome: 17

children (out of 115) were

unvaccinated! It is a very sad feeling

to find unvaccinated children at

every corner but rewarding too as

we are filled with the satisfaction

that these children might have just

been saved from a lifelong crippling

disease.

“The two main objectives of a

market survey are to assess the real

coverage and also to identify missed

or poorly covered area. This market

survey was a perfect example as it

achieved these two goals”, explain

Dr. Ibrahim Nabil, WHO supervisor

for the districts of Dadu, Khamber

and Larkana. In other words, our

s h o r t - t e r m m i s s i o n w a s

accomplished but the overall

objective to reach out every child

remains a challenge.

22-01-09, Shahi Bazar Larkana –Dr Ghulam Malik

(SO) conducting market survey

On 23 January, a joint WHO-UNICEF team conducted a market survey in Shahi Bazaar, the main market place in Larkana city. Often seen as a routine - not to say boring exercise- , this

survey turns out to be as fascinating as a Columbo episode.

21-01-09, Station Mohalla Taluka Tratdodero

Larkana: 17 out 115 children found unvaccinated

during the market survey

08

STORY FROM SINDHSTORY FROM SINDH

Double Coverage on the spot

If the fight against polio is often compared to a war against

a vicious and foxy enemy, then the role of 'commander”

is key in the success. Historians recorded that the mere

presence of Napoleon was enough to galvanize his troops.

The recent experience in UMERKOT with the active involvement

of the DCO has proven, once again, that “Yes. One man can

make a difference”.

On a preparatory meeting held on the 6th January, 2009 Mr.Ghulam

Akbar Laghari(DCO) was informed that lots of children were missed

at the 55 transit points in his district, mostly because of the lack of

cooperation of the transporters and because of a patchy and

irregular presence of police officers to “encourage” them to open

the doors of their vehicles.

Alerted by the situation, the DCO decided that he will pull up his own

sleeves and eyewitness the situation in two major entry points of

Umerkot in UC Gharibabad and Umerkot 1. Joined in his efforts by

Captain Dr.Abdul Majid, Special secretary Public Health Sindh, he

stood up for five hours on the frontline, showing by the example how

to reach every child.

Incognito

Having informed nobody about his plans (which explains why we

cannot provide pictures of that secret operation), he discovered a

gloomy reality. Most of the transit points were not populated by

policemen as they should have. A few angry phone calls later, the

police forces were deployed in a record time.

Inspired by his presence, the policemen and the vaccinators, showed

an unprecedented zeal. As for the transporters, impressed by this

VIP turmoil, they could only gladly cooperate. Even the private

vehicles started to stop by themselves without any instruction from

the police or vaccinators.

The result went beyond the wildest expectations. In the

last November round, less than one hundred children were

covered on these two spots visited by the DCO. This time,

that number was multiplied by more than…seven! Indeed,

731 children received the two pink drops in less than five

hours. Altogether, in four days, 5285 children got

vaccinated in the 55 transit points throughout the District,

twice as much as in the previous round! So, if so far you

thought that DCO stands for District Coordination Officer,

you were all wrong! Actually, in Umerkot, these letters

stand for “Double Coverage On the spot”.

In duty since March 2008, the DCO has also deputed officers

from all departments including revenue department to

monitor and ensure the quality of the vaccination

campaigns.

“Our moral duty as leaders is to show by the example and

encourage each citizen to be involved in the fight against

polio. The DCO's initiative in Umerkot is remarkable and

should become the norm all over Sindh and throughout

Pakistan”, insists the Special secretary Public Health

Sindh.

DCO

09

STORY FROM SINDHSTORY FROM SINDH

A Community Midwife Takes Her First Steps in Bringing Expert Care

to Mothers and Children in Rural Punjabskilled birth attendant. In rural areas, the

proportion is even smaller and contributes

to Punjab's high maternal mortality rate, of

227 deaths per 100,000 live births.

Conservative rural regions often lack

awareness of the importance of trained

SHEIKHUPURA, Punjab Province, December

2008 – Yasmin Faqir Hussain (22)

remembers the fear, confusion and tragedy

that often accompanied childbirth in years

past. It should have been a joyous time, but

in the event of a complication during

and expertly attend childbirth, monitor

women for signs of complications and refer

them to hospitals if necessary. She has been

trained in antenatal and post-natal care

and is expected to perform four checkups

attendants at birth, and many deliveries

are performed by dais or family members

delivery, things sometimes went badly

wrong. "My own neighbour was bleeding

profusely," Ms Hussain recalls. "The dai

[traditional midwife] insisted that there

was nothing wrong and kept her at home as

the woman bled to death. There was no one

to guide us."

In Punjab, Pakistan's most heavily

populated province, only 38 per cent of

births take place in the presence of a

Yasmin Faqir Hussain, a newly trained community midwife, checks a mother's blood pressure at her midwifery home in Sheikhupura

before childbirth and three after, to

monitor the health of mother and child.

STORY FROM PUNJABSTORY FROM PUNJAB

10

this programme started, I've had midnight

calls from students who have gone home for

the holidays and found themselves dashing

to take a woman facing complications to

the hospital, because she was the only one

who knew what to do and where to go.

Because a trainee community midwife was

there, in the midst of confusion and worry,

a mother and a child's lives were saved.

That is the true benefit of this programme."

to be better than the dai. But

they test me with small

problems, and then become

my regular clients.

The women who have

benefited from her care are

full of praise. Mumtaz Abbas,

who belongs to one of the

most influential families in

vi l lage, is one of her

supporters. Although she

delivered her one-month-old

daughter Zoya in a hospital,

she takes her to Ms Hussain for

post-natal checkups. She says

emphatically. "Women and

men like myself and my

husband, we are educated

enough to know that Yasmin

Faqir Hussain can be trusted

to be clean and skilful.

Because she was trained at

the Sheikhupura hospital, she

knows whom to contact there

to get prompt attention if we

face complications."

"Most maternal deaths are

preventable with skilled birth attendance,"

says Dr Naila Sarfraz, UNICEF's Maternal

and Child Health Officer in Punjab. "It is

critical to address the three delays that

cause maternal deaths: delay in seeking

care in an emergency, delay in reaching a

health facility, and delay in receiving

suitable care. Community midwives living

and serving within communities and

watching for complications, advising

women to save and prepare for childbirth,

and familiar with people and services in

hospitals, can address all three."

In January 2009, the Community Midwife

programme was officially launched, with

the deployment of 87 young women in

Kasur, Mardan and Sheikhupura districts by

UNICEF and the government's Maternal,

Newborn and Child Health Programme.

About 2,500 more midwives are in training,

and the programme hopes to deploy 15,000

trained community midwives in the next

three years. Each will establish her

Midwifery Home in a designated

underserved area, with delivery equipment

worth Rs 30,000 (US$ 375), and supplement

a monthly stipend with fees for her

services.

"You can't underestimate the importance of

having trained people on the ground," says

Zahida Khatun, the midwifery tutor. "Since

women undergoing complications with

secondary level healthcare quickly and

effectively. After birth, she has the

knowledge and access to advise mothers on

good practices during the critical weeks

following birth when most child deaths

occur, including the importance of routine

immunization.

Ms Hussain has overcome many barriers to

arrive here, caring for mothers in her own

Midwifery Home. She belongs to one of the

poorest families in the village. When she

was a little girl, she contracted polio. Today

she is healthy and strong, but still walks

with a limp. The experience has left her

with a commitment to work against

preventable diseases and death. In the

three months since she established her

Midwifery Home, it has also exposed her to

the ignorance and prejudice she must

overcome. "There are people who refuse to

let me touch them, saying that I have had

polio and they don't want to die at my

hands," she says. With her family's staunch

support, however, she works to end this

ignorance. "I have four women who come to

me regularly for antenatal care," she says.

"There are fifty more whom I visit at their

homes. As I give them good advice and care,

they trust me, and so my work is

increasingly accepted."

Since October, Ms Hussain has conducted

two deliveries already, and taken a third,

with complications, to the District

Headquarter Hospital. "The first time, the

dai told me to step back as I was only fit to

work in a hospital. She didn't use gloves,

and when the baby was born, she tried to

clean the child the traditional way, with a

handful of ashes." The second time,

however, Ms Hussain took control. She

overrode the dai's orders and made the

mother walk around to encourage dilation.

"Dais are good and experienced women,

but they lack knowledge of medicine and

hygiene," says Zahida Khatun, Ms Hussain's

tutor during her training. But dais are

important decision-makers so our

community midwives work closely with

them, learning from their experience and

simultaneously educating them.

After the second successful delivery, Ms

Hussain feels that a barrier has been broken

between her and the community. Women

have started coming to her with intimate

problems that they don't wish to take to a

male doctor. "Women didn't trust me at

first, as a young girl with polio who claimed

Thanks to the Community Midwife Programme,

mothers in rural Sheikhupura can now access

trained care during pregnancy and childbirth in

their own neighbourhoods.

STORY FROM PUNJABSTORY FROM PUNJAB

11

Fun Mela - An enter-educative event held at Balochistan

One of the most oft-quoted complaints by

the field teams is the reluctance/ refusals

of posh private schools to allow polio

vaccination within the school premises.

focusing n the theme of Polio free Pakistan.

The purpose of conducting this event with

broad electronic and print media coverage

was to underline the cooperation and

ownership of people from all tiers of the

society which is critical for eradicating

polio from Pakistan. The funmela was

inaugurated by the Provincial Minister for

Inter-Agency Coordination and Special

Advisor to the Chief Minister Capt. Dr.

Ruquiya Saeed of Balochistan. The

estimated number of visitors was about

4 ,600 inc lud ing media , e lected

representatives, high government officials,

and civil society members from all over

Quetta city.

Press and electronic media have given wide

coverage to this event. A total of 15

newspapers and 5 TV channels reported

this event. This activity proved quite

helpful in overcoming refusals from the 10

participant private schools in November,

2009 polio NIDs.

This remains a key challenge in covering all

children. In order to curtail this enter

educative event - Fun Mela with the theme

'Polio free Pakistan', was held at Quetta.

This event was organized by – Balochistan

Boy Scouts Association (BBSA), the City

School, WHO, and UNICEF. The purpose of

this event was to (ensure participation) of

all schools, both private and government,

in the polio eradication initiative.

A total of 10 private schools participated in

the Fun Mela. More than 300 children

participated in events like art competition,

cultural competition and fancy dress show

May 2008 Quetta: Glimpse from

fancy dress show.

May 2008 Quetta: Glimpse from art

competition

May 2008 Quetta: Inaugration by the

Provincial Minister Dr Ruqiya Saeed.

May 2008 Quetta : Inauguration session.

12

STORY FROM BALOCHISTANSTORY FROM BALOCHISTAN

13

A Tribute to Nisar Ahmad

During the January 19-21 polio campaign an

ill-fated incidence took place in District

Haripur. While performing his regular duties

on the fourth day of the campaign Mr. Nisar

Ahmed, Junior EPI Technician and Area in

Charge (AiC) of UC Jattipind, was run down

by a wagon at 10 am in the morning. At the

time of incidence he was riding his official

motorbike to cover recorded missed

children. Mr Nisar sustained a severe inner

chest injury as a result of the unfortunate

accident and was taken to DHQ Hairpur. At

the time of accident, one of the Campaign

Support Persons (CSP) Mr. Muddasir was

present at the spot who later narrated this

story.

It has been informed he was fully organized

with vaccine carrier and check lists to cover

the missed children. Unfortunately he was

caught in between two ford wagons that

were playing race on the main road. He tried

to escape by riding down on the katcha path

but was hit by one of the racing wagons.

Nisar Ahmad left behind his wife, one

daughter and two sons. He was highly

regarded by his colleagues and peers for his

commitment and untiring contributions to

the EPI programme and Polio Eradication

Initiative. Indeed he deserves a salute from

the health community for his contributions.

Mr Nisar Ahmad (Late) Junior EPI technicial Haripur.

What is Vitamin A?

Vitamin A (retinol) is a fat-soluble vitamin

which cannot be produced by the body. It is

stored in the body principally in the liver

and released into the bloodstream when

needed, becoming available for use by cells

throughout the body, including those of the

eye.

What will be the result of Vitamin A

deficiency (VAD?

Vitamin A deficiency (VAD) is a leading cause

of less than 5 mortality, childhood

blindness, and infectious disease morbidity

in developing countries worldwide. Night

blindness is one of the earliest eye signs of

VAD and is caused when retinol levels are

low in the body. Severe VAD may cause

blindness. An estimated 250,000 to 500,000

children become blind every year because

they are deficient in vitamin A. Tragically,

this blindness is avoidable

How does Vitamin –A Deficiency happen?

VAD occurs when insufficient vitamin A is

consumed in the diet, too little is absorbed

from the foods eaten, or too much is lost

due to illness. VAD can also result from rapid

utilization of vitamin A during illness

(particularly measles, diarrhea, and

fevers), pregnancy and lactation, and

during phases of rapid growth in young

children.

What are the natural foods Source of

Vitamin A?

The two main food sources rich in vitamin A

are Animal (breast milk, egg yolks, liver,

whole milk) and Plant (orange-or yellow-

fleshed fruits and vegetables (mangoes,

papayas, orange fleshed sweet potatoes,

pumpkin, orange-fleshed squash, dark

green leafy vegetables)

Who is at risk?

The most vulnerable population at risk of

VAD are:

Children under 5 years of age and pregnant

or lactating women.

Children under two years of age are at

highest risk of

death due to VAD.

Non-breastfed infants and children

between the ages of 25-59 months are also

at high risk.

Why is it very important to improve

Vitamin A status of deficient children?

There is mounting evidence that by

improving the vitamin A status of deficient

children:

The risk of death from measles can be

reduced by 50 %

The risk of death from diarrhea can be

reduced by 33 %

The risk of all cause mortality can be

reduced by 23 %

How can we prevent Vitamin A deficiency?

We can prevent Vitamin A deficiency

through the promotion of exclusive

breastfeeding of infants, including giving

colostrum, to ensure adequate nutritional

intake, and providing post-partum mothers

with a high dose of vitamin A to increase the

vitamin A content of their breast milk.

Nutrition education programs to diversify

diets and promote dietary change in order

to ensure an adequate intake of vitamin A

and other micronutrients can also be quite

effective.

How can we treat Vitamin A deficiency?

Supplementation with high doses of vitamin

A of children under 5 years of age on a

periodic basis, every 6 months and women

as soon as possible after delivery, but no

later than 6 weeks of giving birth. Periodic

supplementation improves vitamin A status

by increasing liver stores and tissue

concentrations of retinol.

When is the next opportunity to

administer Vitamin A

supplementation to children?

The polio round to be conduced

in the month of May, 2009 will

bring an opportunity for everyone

to administer Vitamin A

Unfortunately very few people know the

importance of Vitamin A

Face of the QuarterDr. Altaf Bosan

National Programme Manager, EPI

Dr. Altaf Bosan's return to the Expanded

Programme on Immunization has been widely

hailed by the health fraternity, both home

and abroad. His appointment came in the

wake of serious challenges faced by the Polio

Eradication Initiative as the country saw a

rapid upsurge in the number of polio cases

during 2008. Since assuming the role of

National Programme Manager Dr Bosan is

working very closely with the provincial

teams to ensure quality campaigns are held

and strict monitoring is carried out. He is

taking up innovative and bold initiatives to

eradicate polio and strengthen routine

immunization based on unique issues faced by

the country at the district level.

Known as a seasoned campaigner in public

health circles, Dr. Bosan also served as

Director Malaria Control where his

outstanding performance was formally

recognized by the Global Fund for AIDS, TB

and Malaria (GFATM).He also served as the

Head of Epidemic Investigation Cell at the

National Institute of Health where he helped

strengthen the surveillance and epidemic

investigation system through effective use of

the Disease Early Warning System.

Dr. Bosan has also served as National

Programme Manager of the AIDS Prevention

and Control Programme and as National

Immunization Adviser with the Global

Alliance for Vaccines and Immunization

where he played a pivotal role in securing the

Alliance's support for provision of free

Hepatitis-B vaccination for Pakistani children

as part of the EPI vaccination regime.

Enriched with experience and brimming with

positive energy, Dr. Bosan is Pakistan's

promise in the arena of child immunization.

Immunization Times wishes him good luck and

prays for his success in the days to come.

Standing on the right Dr. Altaf Bosan accepting an award in appreciation of his efforts to improve immunization

14

SPECIAL CONTRIBUTIONS

Bilal Ahmad

Francois Charlier

Mamunul Haque

Fatima Raja

Dr. Muhammad Rafiq

Qudrat ullah Shinwari

Dr. Tareen Latif

Mazhar Nisar Sheikh Melissa Corkum

Fatma Khan

Coordinating Editor

Editors

Ministry of HealthGovernment of Pakistan

Government of Japan World Bank

Expanded Programme on ImmunizationNational Institute of HealthMinistry of HealthGovernment of PakistanRotary International

Useful Links

www.unicef.org/pakistan

http://www.gavialliance.org/

http://www.whopak.org

http://www.polioeradication.org/

http://www.rotary.org/foundation/polioplus/

http://www.cdc.gov/

http://www.dfid.gov.uk/countries/asia/pakistan.asp

You can also contribute by sending us your write-ups at immunizationtimes@gmail.com