Evaluation of Training Workshops on Strengthening Measles Vaccination Held in Morang and Sunsari Districts Nepal

 

Nawaraj Subba*

 

Summary

This was a prospective study done in Morang and Sunsari districts. Training workshops was intervention conducted on Poush 2058 B.S. in two districts. Data for measles coverage of 12 months reported before intervention i.e. 'Pre' and after 12 months intervention i.e. 'Post' were analyzed under study. Both of the districts achieved measurable increase in coverage of measles vaccination (P<0.05) after interventions.

 

Background

The Department of Health Services (DoHS)/Child Health Division (CHD) had provided programme and budget to Eastern Regional Health Directorate (ERHD) for organizing  two workshops where comparatively low measles vaccine coverage among Terai districts was reported in the region. Two Terai districts Morang and Sunsari, were chosen on the basis of their low performance in measles vaccine coverage as per reported in HMIS. The ERHD conducted district level workshops[1] in Poush 2058 with the collaboration of District Health Office (DHO) Sunsari and District Public Health Office (DPHO) Morang. The In charges of Health Posts, Primary Health Care Centres, Sub Health Posts and Cold Chain Assistants, had participated in the workshops. Objective of these workshops was to increase measles vaccine coverage in the respective districts.

 

Table 1: The Coverage of Measles Vaccine in Terai Districts of EDR, Nepal (2057/58)

	2057/58
National	75%
EDR	74%
Jhapa	81%
Morang	75%
Sunsari	77%
Saptari	87%
Siraha	83%

 

Saptari had the highest coverage (87%) followed by Siraha (83%) and Jhapa (81%). Morang and Sunsari districts were having comparatively lower measles coverage among Terai districts in Eastern Development Region.

 

 

Study Design:

 

It is a Prospective study of training workshops, with a Pre-test Post-test design.  

                        O₁                    X                     O₂

                                                                       

 

Hypotheses:

(Two; null and alternative)

H₀ = Training workshops did not make any difference.

H₁ = Training workshops did work making different.

 

Study Area:

Morang, Sunsari (Training/ Workshop Intervention districts)

 

Rationale of the Study:

Virtually, There is lacking of practiced to evaluate those trainings, workshops which do organize in districts. Some people do perceived these training workshops as a fashion or just waste of resources. Above-mentioned factors fascinated the researcher to make effort for an evaluation of those training workshops that were coordinated and facilitated by researcher-self before.

 

Objective of the Study:

·        To analyze and evaluate the situation of measles vaccine coverage in Morang and Sunsari districts on the basis of HMIS.

·        To test these two situation of before and after intervention.

 

Limitation of Study:

·        Evaluation study was based on the HMIS data taken from annual reports published by DoHS, ERHD, DHO, DPHO.

·        Confounding factors such as other training workshops.

 

Method and Tools:

Health Management Information System (HMIS) data, document study, interview, and t-test.

 

Data Processing:

Epi-Info-6, Excel computer software.

 

 

 

 

Major Findings:

 

District Morang

Table 2: Measles Coverage Before and After the Intervention[2]

Before	Months	Target	Achievement	Coverage	After	Months	Target	Achievement	Coverage
1	2057-Poush	1978	1603	81	1	Magh-2058	2034	1928	95
2	2057-Magh	1978	1255	63	2	Falgun-2058	2034	1677	82
3	2057-Falgun	1978	1470	74	3	Chaitra-2058	2034	1586	78
4	2057-Chaitra	1978	1553	79	4	Baishak-2059	2034	1582	78
5	2058-Baishak	1978	1617	82	5	Jestha-2059	2034	1540	76
6	2058-Jestha	1978	894	45	6	Ashar-2059	2034	1842	91
7	2058-Ashar	1978	1665	84	7	Shrawan-2059	2079	2101	101
8	2058-Shrawan	2034	1776	87	8	Bhadra-2059	2079	1969	95
9	2058-Bhadra	2034	1789	88	9	Ashwin-2059	2079	1956	94
10	2058-Ashwin	2034	1596	78	10	Kartik-2059	2079	1662	80
11	2058-Kartik	2034	1402	69	11	Mangshir-2059	2079	1514	73
12	2058-Mangshir	2034	1167	57	12	Poush-2059	2079	2012	97
	Total	24016	17787	74		Total	24678	21369	87

 

The status of measles coverage reported before intervention (2057-Poush to 2058-Mangshir) has been compared with corresponding months after intervention (2058-Magh to Poush-2059) in Morang district. The coverage before training intervention was 74 percent and which reached 87 percent after intervention.

 

‘t’ test

Table 3: Results of ‘t’ test for Measles Coverage in Morang

Months	Before (A)	After (B)	x (B-A)	x-mean	(x-mean)2
	81	95	14	1.25	1.56
	63	82	19	6.25	39.06
	74	78	4	-8.75	76.56
	79	78	-1	-13.75	189.06
	82	76	-6	-18.75	351.56
	45	91	46	33.25	1105.56
	84	101	17	4.25	18.06
	87	95	8	-4.75	22.56
	88	94	6	-6.75	45.56
	78	80	2	-10.75	115.56
	69	73	4	-8.75	76.56
	57	97	40	27.25	742.56
			153	0	2784.25

 

The Mean observed increased coverage x = 12.75, SD=16.1674, SE= 4.6671, T₁₁ = 2.7319. At 11 degrees of freedom, 5 percent significant of ‘t’ is 2.20. The observed ‘t’ value is 2.7319 times the standard error hence there is no doubt that training workshop conducted has resulted higher coverage effect, (‘t’ = 2.7319, P<0.05, statistically significant).

District: Sunsari

Table 4: Measles Coverage Before and After the Intervention².

Before	Months	Target	Achievement	Coverage	After	Months	Target	Achievement	Coverage
1	2057-Poush	1485	1360	92	1	Magh-2058	1531	1391	91
2	2057-Magh	1485	1377	93	2	Falgun-2058	1531	1324	86
3	2057-Falgun	1485	1030	69	3	Chaitra-2058	1531	1318	86
4	2057-Chaitra	1485	1202	81	4	Baishak-2059	1531	1091	71
5	2058-Baishak	1485	1298	87	5	Jestha-2059	1531	1450	95
6	2058-Jestha	1485	835	56	6	Ashar-2059	1531	1406	92
7	2058-Ashar	1485	1448	98	7	Shrawan-2059	1577	1551	98
8	2058-Shrawan	1531	1197	78	8	Bhadra-2059	1577	1497	95
9	2058-Bhadra	1531	916	60	9	Ashwin-2059	1577	1481	94
10	2058-Ashwin	1531	1060	69	10	Kartik-2059	1577	1319	84
11	2058-Kartik	1531	881	58	11	Mangshir-2059	1577	1219	77
12	2058-Mangshir	1531	1384	90	12	Poush-2059	1577	1401	89
	Total	18050	13988	77		Total	18648	16448	88

 

The status of measles coverage reported before intervention (2057-Poush to 2058-Mangshir) has been compared with corresponding months after intervention (2058-Magh to Poush-2059) in Sunsari district. The coverage before training intervention was 77 percent and which reached 88 percent after intervention.

 

‘t’-test

Table 5: Results of ‘t’ test for Measles Coverage in Sunsari

Months	Before (A)	After (B)	x (B-A)	x-mean	(x-mean)2
	92	91	-1	-11.58	134.10
	93	86	-7	-17.58	309.06
	69	86	17	6.42	41.22
	81	71	-10	-20.58	423.54
	87	95	8	-2.58	6.66
	56	92	36	25.42	646.18
	98	98	0	-10.58	111.94
	78	95	17	6.42	41.22
	60	94	34	23.42	548.50
	69	84	15	4.42	19.54
	58	77	19	8.42	70.90
	90	89	-1	-11.58	134.10
			127	0.04	2486.92

 

The Mean observed increased coverage x = 10.58, SD=15.04, SE= 4.3417, T₁₁ = 2.4368. At 11 degrees of freedom, 5 percent significant of ‘t’ is 2.20. The observed ‘t’ value is 2.4368 times the standard error hence there is no doubt that training workshop conducted has resulted higher coverage effect, (‘t’ = 2.4368, P<0.05, statistically significant).

 

 

 

Discussion

Globally also it has been proved the training component is a tool for the success of the any project. Evaluation of Ergonomics Training Workshops, Washington State, 2001, reports that participants (n = 232) from around the State of Washington who attended a four-hour workshop on implementing the Washington State ergonomics rule completed pre and post workshop assessment questionnaires. Overall findings include a significant increase in the participants’ perception of their ergonomics rule knowledge[3]. Evaluation Study of Implementation and Achievements of Family Planning and Maternal and Child Health Project JICA/Nepal has been implementing a package program "Family Planning and Maternal Child Health (FP/MCH)" project in Kavrepalanchok from hill and Dhanusha from Terai districts with the aim of strengthening and expanding community health in the project area. The main objective of the study was to identify the achievements of the FP/MCH project in the project area with a view to improving and intensifying the MCH activities. The primary data was generated from health workers, beneficiaries and ex-counterpart Nepalese staff that had received training in Japan and had been on observation tour in the Philippines. The study team examined the IEC materials and equipment. The findings indicated positive changes[4]. 

 

Table 6: Measles Coverage in Terai Districts of EDR, Nepal (2058/59, 2059/60)[5],[6]

	2058/59	2059/60
National	76%	NA
EDR	80%	81%
Jhapa	89%	83%
Saptari	91%	88%
Siraha	91%	94%

The coverage of measles vaccine had decreased in Jhapa and Saptari whereas Siraha has got slightly increased during FY 2058/59 and 2059/60.

 

Measles vaccine coverage had increased after training workshops taken place in Morang and Sunsari districts.

 

 

Conclusion:

Training workshops were successful to result measurable increase in measles vaccination coverage in Morang and Sunsari districts. Districts have had experienced measurable increase in the coverage was statistically significant (P<0.05).

 

Recommendation:

Training workshops are useful for poor performing districts in order to strengthening EPI programme.

 

Acknowledgement: 

I would like to extend my sincere thanks to all staff of DHO Sunsari and DPHO Morang.

 

Copyright © 2004,  Nawaraj Subba

 

References: