title: Maiden immunization coverage survey in the republic of South Sudan: a cross-sectional study providing baselines for future performance measurement.
abstract: BACKGROUND
  Since the comprehensive peace agreement was signed in 2005, institutionalization of immunization services in South Sudan remained a priority. Routine administrative reporting systems were established and showed that national coverage rates for DTP-3 rose from 20% in 2002 to 80% in 2011. This survey was conducted as part of an overall review of progress in implementation of the first EPI Multi-Year Plan for South Sudan 2007-2011. This report provides maiden community coverage estimates for immunization.
  
  
  METHODS
  A cross sectional community survey was conducted between January and May 2012. Ten cluster surveys were conducted to generate state-specific coverage estimates. The WHO 30x7 cluster sampling method was employed. Data was collected using pre-tested, interviewer guided, structured questionnaires through house to house visits.
  
  
  RESULTS
  The fully immunized children were 7.3%. Coverage for specific antigens were; BCG (28.3%), DTP-1(25.9%), DTP-3 (22.0%), Measles (16.8%). The drop-out rate between the first and third doses of DTP was 21.3%. Immunization coverage estimates based on card and history were higher, at 45.7% for DTP-3, 45.8% for MCV and 32.2% for full immunization. Majority of immunizations (80.8%) were received at health facilities compared to community service points (19.2%). The major reason for missed immunizations was inadequate information (41.1%).
  
  
  CONCLUSIONS
  The proportion of card-verified, fully vaccinated among children aged 12-23 months is very low at 7.3%. Future efforts to improve vaccination quality and coverage should prioritize training of vaccinators and program communication to levels equivalent or higher than investments in EPI cold chain systems since 2007.
authors.affiliation: USAID/SPS Project in South Sudan, Management Sciences for Health, 784 Memorial Dr Cambridge, MA 02139, United States ; American Red Cross International Programs, P.O. Box 41275-00100 Nairobi, Kenya.
authors.forename: William
authors.initials: W
authors.lastname: Mbabazi
authors.affiliation: Ministry of Health, P.O. BOX 5 Juba, Republic of South Sudan.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Lako
authors.affiliation: UNICEF South Sudan Country Office, P.O. BOX 45 Juba, Republic of South Sudan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ngemera
authors.affiliation: Ministry of Health, P.O. BOX 5 Juba, Republic of South Sudan.
authors.forename: Richard
authors.initials: R
authors.lastname: Laku
authors.affiliation: WHO/South Sudan Country Office, P.O Box 5 Juba, Republic of South Sudan.
authors.forename: Mostafah
authors.initials: M
authors.lastname: Yehia
authors.affiliation: UNICEF South Sudan Country Office, P.O. BOX 45 Juba, Republic of South Sudan.
authors.forename: Nathan
authors.initials: N
authors.lastname: Nshakira
mesh_terms: D016000:Cluster Analysis; D003142:Communication; D003430:Cross-Sectional Studies; D006801:Humans; D007114:Immunization / Q000379:methods* / Q000706:statistics & numerical data; D017589:Immunization Programs; D007223:Infant; D010353:Patient Education as Topic / Q000592:standards; D013397:Sudan; D011795:Surveys and Questionnaires; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines
keywords: Immunization Coverage Survey; South Sudan