IVACS: Improving vaccination awareness & coverage in Somalia

INTERVENTION: Participatory interventions with women’s groups using a Participatory Learning and Action (PLA) approach have shown positive impacts on maternal and child health outcomes in numerous settings. The women’s group PLA approach is based on the ideas of Paulo Freire and draws on the principle that sustainable social change is possible if teachers and learners engage in a dialogue, exchanging ideas and experiences, and implementing a cycle of learning, action, and reflection. We intend to adapt this approach to make it suitable for use in populations affected by humanitarian crisis in conflict settings, enabling them to better understand and make optimal use of the available health services, in particular childhood vaccination. We aim to implement a PLA intervention by working with indigenous Abaay‐Abaay groups. The groups typically comprise 10‐20 members and are traditional female social groups that are found throughout Somalia and usually meet every week or month. The groups are also commonly found in stressed and displaced populations, including most IDP camps in Mogadishu. The intervention will be randomly allocated to half the camps. Camps will be mapped using GPS handsets and their locations visualised using Google Earth Pro. They will then be listed in descending order of distance to the local health facilities and the first camp in the list allocated to intervention or control using a random number generator formula in Excel. Alternate camps in the list will then be allocated to the same arm. In the intervention camps trained Facilitators will run a series of eight meetings with the Abaay‐Abaay groups, identifying and learning about child health problems, identifying possible solutions, planning and CONDITION: Improvement in routine vaccination coverage for children. ; Not Applicable PRIMARY OUTCOME: ; 1. Measles vaccination coverage ‐ % of children 9 ‐ <59 months of age who received the measles vaccine, measured by novel questionnaire at baseline and end‐line; 2. EPI vaccination coverage ‐ % of children 0 ‐ <59 months of age who received all vaccines required by the national vaccination protocol, measured by novel questionnaire at baseline and end‐line; 3. Knowledge of vaccination and vaccination timings, measured by novel questionnaire at baseline and end‐line; 4. Attitudes to vaccination, vaccination coverage, measured by novel questionnaire at baseline and end‐line; INCLUSION CRITERIA: Children aged 0 ‐ 59 months and their primary caregiver SECONDARY OUTCOME: ; 1. Under‐five morbidity measured using questionnaire recall at baseline and endline; 2. Incidence of measles measured using symptom recall at baseline and endline; 3. Under‐five death rate measured using enumeration of household members at baseline and endline; 4. Causes of death ascertained using Verbal Autopsy (VA) interview following a reported death; ; Process indicators:; 5. Number of Abaay‐Abaay groups successfully established is measured by direct observation; 6. Safe conduct of group activities is measured by direct observation; 7. Prevalence of participation in an Abaay‐Abaay group by age and clan measured by questionnaire at baseline and endline; 8. Acceptability and utilisation of PLA training materials by group leaders (Khalifada) is measured by direct observation; 9. Completion of learning cycles and topic coverage by groups is measured by direct observation; 10. Any adverse events associated with group membership or activities is measured by direct observation and open ended interviews;