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This approach also presented a number of challenges:
• Classes include girls of different ages and a few are above 15 years old (could be sexually active).
• Classes also include girls under the age of 10 years, who must be screened out (the vaccine is
licensed for ages 10 years and older; the project was planned for those in Primary 5 or 10 years
of age).
• Time is required to explain to the community why a particular class is selected.
HPV Vaccine Immunization in Nakasongola
Dr. Gerald Kalule Ssekitto
District Health Officer, Nakasongola District
Ministry of Health, Uganda
In the district of Nakasongola, HPV vaccinations were integrated into CDP, a routine program to deliver
health interventions to children at schools twice per year. This meant that the first and third HPV
vaccine doses could be delivered as part of CDP, but the second dose, which occurs one month after the
first, had to be delivered by outreach, also at the schools.
The project targeted 10-year-old girls both in and out of school, identified by age. Preparation for
vaccination sessions included registering girls who were 10 years of age by checking school records,
asking families, or simply estimating age from other information.
As in the school-based program in Ibanda, district and
sub-county opinion leaders were sensitized and
mobilized, health workers were trained, and
microplanning for logistics was carried out. Parents and
girls received IEC leaflets and were invited to information
sessions. The project team assessed the capacity of the
district to handle HPV vaccinations in addition to routine
work and made adjustments as necessary.
The high coverage rates indicated
that sensitization and
mobilization efforts had paid off:
stakeholders clearly accepted the
HPV vaccinations.
While the Nakasongola strategy was incorporated into CDP, almost all CDP activities occurred in schools
and 98 percent of girls targeted for vaccination were attending schools. Some challenges did arise,
including absenteeism that required the health workers to return several times to schools to ensure that
all eligible girls were vaccinated.
Routine administrative data showed that vaccine coverage was high, indicating that the CDP strategy
was successful and that the infrastructure could support the vaccinations, although some budget
increases would be necessary if the strategy were to be adopted by the district. The high coverage rates
indicated that sensitization and mobilization efforts had paid off: political leaders, health officials,
communities, and families clearly accepted the vaccinations, and the program was feasible.
Report of an African Regional Meeting on Cervical Cancer: September 2010 20