Defeating a leading child killer in Zambia

Jul 18, 2012


Lisa Anderson
Program Assistant for Vaccine Development at PATH

Children in Zambia are dying from three major killers: malaria, pneumonia, and diarrhea.

Children in Zambia are dying from three major killers: malaria, pneumonia, and diarrhea. Until recently, diarrhea was the only disease target without a comprehensive intervention and prevention mechanism in place, a tragic fact recognized by the Zambian National Ministry of Health (MOH), donors, NGOs, social entrepreneurs, and community advocates and champions alike. At this critical time, cross-sector opportunities among multiple stakeholders have prepared the stage for addressing the leading cause of childhood diarrhea with a national rotavirus intervention in Zambia.

Following World Health Organization guidelines advising rota control is needed in Zambia, the MOH decided to introduce a rotavirus vaccine. After community perception tests and pilot testing in Lusaka Province, a national rollout will take place in all districts next year. Such an endeavor called for capacity-building at the facility and community level alike. Rota vaccine cold storage facilities and cold chain capacity are in rapid scale up mode at the MOH headquarters in Lusaka in preparation for the national roll out. Clinician training and community health worker recruitment and education on the new rota vaccine are being conducted, in urban, peri-urban, and rural clinics and communities.

The Zambian MOH describes a three-pronged approach to diarrhea disease intervention: promotion, prevention, and control. Community health workers (CHWs) promote education and disease prevention messaging in the communities they serve, and educate on water safety (such as boiling or chlorinating water, covering boreholes, etc), household sanitation, the importance of giving vitamin A supplementation, exclusive breastfeeding up to 6 months of age, and when to seek treatment. Control is now championed by rotavirus vaccination. Delivery points for information and education regarding water, sanitation, and hygiene and the upcoming availability of rotavirus vaccine include heath care facilities, community health volunteers, local NGOs, churches, and schools.

Awareness and buy-in of the vaccine at the community level is extremely important in order for the intervention to be successful. In community perception testing groups, stakeholders discovered that the word "virus" in "rotavirus vaccine" as planned to be listed on immunization cards triggered negative responses; community members related the word to "virus" as in HIV. Additionally, community members like that is it an oral dose, and tastes sweet, as opposed to polio vaccine, which is bitter in taste. A sweet, oral, "rota vaccine" is not only acceptable, but parents are excited to soon have a vaccine that prevents diarrhea. Members of a community gathering outside Mukuyu Health Clinic, receiving education from their CHW, expressed excitement and eagerness to learn of the vaccine, and said with pride the roll-out should start in their province.

Mr. Vichael Silavwe, Chief Integrated Management of Childhood Illness Officer of the MOH's Child Health Unit is passionate about diarrhea control and worked first hand treating sick babies suffering from preventable diseases. "It is we [adults] who are responsible to care for the health and safety of the child. It is we who are responsible for them, to protect them from getting sick." Rotavirus vaccination, in conjunction with ongoing water and sanitation education, will help parents throughout Zambia echo Mr. Salavwe's heartfelt call to protect children from preventable disease.

-- Lisa Anderson is a Program Assistant for Vaccine Development at PATH