Impact of Training of Primary Health Care Centers'Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study

Background: Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children's Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objective: The goal of this study was to assess the impact of training of primary health care centers' (PHCs) vaccinators on the quality of ISPs. Methods: This was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, "Managing an Immunization Session", and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores. Results: A total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02). Conclusions: The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services.