title: Measles supplementary immunization activities and GAVI funds as catalysts for improving injection safety in Africa.
abstract: BACKGROUND
  In 2000, reuse of disposable syringes and inadequately sterilized syringes resulted in 39% of all injections being unsafe, causing 22 million infections. We describe the contribution of measles supplemental immunization activities (SIAs) and Global Alliance for Vaccines and Immunisation (GAVI) funding in replacing disposable and sterilizable syringes with auto-disable (AD) syringes to improve injection safety in 39 African countries.
  
  
  METHODS
  We assessed trends in nationwide introduction of AD syringes against measles catch-up SIAs and GAVI funding using World Health Organization/United Nations Children's Fund (UNICEF) Joint Reporting Form for Immunization and UNICEF supply data.
  
  
  RESULTS
  In 19 (49%) of 39 countries, the measles program catalyzed the introduction of injection safety equipment, including AD syringes and safety boxes, training, and procurement of safety equipment during SIAs. GAVI was catalytic through financial support in 14 countries (36%) for including safe injection equipment in routine immunization. Additionally, GAVI funded 21 countries that had already introduced AD syringes in their national program. UNICEF AD syringe shipments to sub-Saharan Africa increased from 11 million to 461 million from 1997 to 2008. All 39 countries stopped using sterilizable syringes by 2004.
  
  
  CONCLUSIONS
  The measles mortality reduction program and GAVI complemented each other in improving injection safety. All countries continued with AD syringes for immunization after measles catch-up SIAs and GAVI funding ended.
authors.affiliation: United Nations Children's Fund (UNICEF) Program Division, Health Section, New York, New York 10017, USA. ehoekstra@unicef.org
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hoekstra
authors.forename: Maya M V X
authors.initials: MM
authors.lastname: van den Ent
authors.forename: Halima
authors.initials: H
authors.lastname: Dao
authors.forename: Hala
authors.initials: H
authors.lastname: Khalaf
authors.forename: Annika
authors.initials: A
authors.lastname: Salovaara
mesh_terms: D004209:Disposable Equipment; D005380:Financing, Government / Q000191:economics; D014943:Global Health; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000600:supply & distribution; D007267:Injections / Q000009:adverse effects; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D017744:Medical Waste Disposal; D013594:Syringes / Q000009:adverse effects* / Q000600:supply & distribution; D014480:United Nations
chemical_list: D008458:Measles Vaccine; D017744:Medical Waste Disposal