IMMUNIZATION

In 2002, WHO estimed that 1.4 million of deaths among children under 5 years were due to diseases that could have been prevented by routine vaccination. This represents 14% of global total mortality in children under 5 years of age.

Definition

Immunization is the process whereby a person acquires immunity (resistance) to an infectious disease, typically by the administration of a vaccine/antigen. vaccine stimulate the body's own immune system (antibody) to protect the person against subsequent infection or disease (WHO definition)
The number of doses in the immunization scedudule corresponds to the number of doses required to fully protect a child against the corresponding disease.

Immunization Scedules by antigen in Indonesia

1. BCG : Bacille Calmette Guering Vaccine, Number of dosis; 1, scedule ; 1 mounth
2. DT : Tetanus and Diphtheria toxoid children's dose, Number of dosis; 1, scedule 6 years
3. DTwp : Diphtheria and tetanus toxoid with whole cell pertussis vaccine, Number of dosis; 3, scedule ; 2,3,4 months
4. DTwPHep : Diphtheria and tetanus toxoid with whole cell pertussis and HepB vaccine, Number of Dosis ; 3, scedule ; 2,3,4 months; part of country
5. HepB ; Hepatitis B vaccine, Number of Dosis; 3, scedule ; birth 2 months; 3,2 months
6. Measles : Measles Vaccine, Number of dosis; 2, scedule; 9 months; 6 years
7. OPV : Oral Polio Vaccine, Number of dosis; 4, secudule; birth 1, 2, 3, 4 months
8. TT : Tetanus toxoid, Number of dosis; 2, scedule; 7,8 years
9. Vitamin A : Vitamin A supplementation, number of dosis; 2, scedule 6 - 11, 12 - 59 months

Immunization Contraindications
Each vaccine has specific contraindications, so it is in dispensable to always read the notice carefully before practicing immunization. nevertheless, some contraindications are common to all vaccines;

• In case of immunodeficiency and immunosuppressive treatment, except in special conditions.
• Using a long term corticosteroid treatment and healthy children treated with corticosteroid in common dose for more than 2 weeks, or in high dose (dose>2mg/kgBB or 20mg/day).

Immunizations in Specific Situations

• HIV patients a giving vaccine of OPV (oral polio vaccine), measles, MMR and BCG are contraindicated. Giving vaccine of DPT, infuenza, H. Influenzae, IPV (inactivated polio vaccin), and pneumonia may be allowed.
• In High incidence TB areas, WHO recomend to give BCG for asymtomatic HIV cases.
• The patients of Clinic HIV always in contact with their family is not allowed to receive OPV, but IPV.
• The child without HIV manifestation can receive imunization routinely. Premature baby; The immunization is according to age chronology. under weight baby at birth can receive the same immunization schedule but following points should be taken into consider:

• Passive immunity their titer through maternal trnsmission is lower than on non premature baby. if the baby's weight is under <1000>
• If the baby is still hospitalized after 2 months age, the polio vaccine to be given is IPV injection.

What is AEFI?
In addition to the desired reaction, all vaccines produce some degree of unwanted reaction. The vast majority of these are trivial and harmless. some are more noticeable and annoying. A very small number are serious and potentially life threatening.
AEFI (Adverse Events Following Immunization) can happen within one month after the immunizaiton. In specific situations, the duration of AEFI observation might take 42 days.

Some symptoms of AEFI are :

• Local reaction a abscess on injecton space of lymphadenitis, cellulite, and BCG itis
• SSP a acute parlyze, encephalopthy, encephalitis, meningitis, stiffness.
• Other a allergy reaction (nettle rash, dermatitis, edema), anaphylaxis reaction, anaphylaxis shock, arthralgia, high fever > 38,5oC, septic shock, continuing shout crying (>3 hours) osteomyelitis.

Causes Of AEFI?
Etiology factors based on WHO field clasification of Western Pacific (1999) :

1. Programmic Errors: high doses, wrong injection area, not sterile needle and syringe, vaccine and diluents has been contaminated, vaccine is not stored in the right place or in opotimal conditions (temperature/cold chain and light), Ignorance of the CI, Using an expired vaccine, ignored procedure's instructions
2. Injection Reacion : All clinical symptoms occurring because of needle stick trauma directly (feeling pain, swollen, and reddish on the injection space) or indirectly (feeling fear, dizzy, nausea, and syncope)
3. Vaccine Reaction : When the vaccine is no properly administered (obsolete or non appropriate vaccine toolls)
4. Coincident Factor : An illness or death occurring after immunization, but not linked with the vaccine itself or the orther factors cited above.

WHO recomendations on minimizing AEFIs

• Measles, BCG and yellow fever vaccines should be reconstituted only with the diluents supplied by the manufacturer.
• Reconstitured vaccines should be discarded no longer than six hours after reconstitution or at the end of each immunization session.
• In the refrigeraor , no other drugs and substances shourl be stored beside vaccines.
• Labels should be carefully read before a vaccine is prepared for administration. if the leable cannot be clearly read and there is doubt about the contents of a vial or ampoule it should not be used
• Immunization workers should be trained and closely supervised to ensure that proper proceures are being follwed.

Sources : Melisa Lilisari, Medical Editor, Health Messenger

CHILDREN'S RIGHT TO ACCESS HEALTH SERVICE

The first effective effort in defending children's right was the Declaration of Children's right made in 1924 by Eglantyne Jebb, followed in 1989 by the United Nations Convention on the Rights of the Child (UNHCR)

The United Nation Convention on the Rights of the Child (UNHCR) is an international rights treaty that grants all children and young people (aged 17 and under) a comprehensive set of rights, including :

• Special protection measures and assistance
• Acces to services such as education and health care.
• Develop their personalities, abilities and telents to the fullent potential
• Grow up in an environment of happiness, love and understanding
• Be informed about and participate in achieving theri rights in an accessible and active manner.

The four core principles of the convention are nondiscrimination; devotion to the best interests of the child ; the right to life, survival and development; and respect for the views of the child.

The Indonesian goverment celbrates the national children's day in Indonesia the 23rd of July and had also ratified the UN Convention on the Rights of the Child through Presidential Decree No. 36, Year 1990, that articulates the State's responsibility to provide services and programmers for the welfare of children in fulfillment of its obligations as a State Party to the UNCRC

Since 1954, the Children's world day is celebrated the 20th of November.

Extract Of The UNCRC
Article 24: Health

1. States Parties recognize the right of the child to enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. states Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.
2. States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures ;
   

• To diminish infant and child mortality;
• To ensure the provision of necessariy medical asistance and health to all children whith emphasis on the development of primary health care;
• To combat desease and malnutrition, including within the framework of primary health care, through, interalia, the application of readily available technology and through the provision of adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution;
• To ensure appropriate pre-natal and post-natal health care for mothers;
• To ensure that all segments of seciety, in particular parents and children, are informed, have acces to eductions and are supported in the use of basic knowledge of child health and nutrition, the advantage of breastfeeding, hygiene and environmental sanitation and the prevention of accidents ;
• To develop preventive health care, guidence for parents and family planning education and services.

3. States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.
4. States Parties undertake to promote and encourage international cooperation with a view to achieving progressively the full realization of the right recognized in the present article. In this regard, particular account shall be taken of the needs of developing countries.

Sources : Dr. Melisa Lilisari, Medical Editor, Health Messenger.

INDONESIA : CHILD HEALTH PROFILE

Demographics and information system
Under five population (2005) = 22000000
Annual number of births (2005) = 4000000
Birth registration coverage =55%
Coverage of vital registration of deaths (2002) = <25% style="color: rgb(0, 0, 153); font-weight: bold;">Health Status Indicators
Neonatal, infant and under five mortality
Neonatal mortality rate per 1000 live birth (2004) = 17
Annual number of neonatal deaths (2004) = 61000
Infant mortality rate per 1000 live births (2005) = 28
Annual number of infatn deaths (2005) = 126000
Under five mortality rate (2005) = 36
Annual number of under five deaths (2005) = 161000
Neonatal causes as a proportion
of all under five deaths (2000) = 38%

Distribution of under five deaths by age groups

Based on mortality estimates from the IACMEG for 2005 78% of all under five deaths in Indonesia occur during the first year of life : 38 % in net neonatal period and another 40% between the first and the eleventh month. the remaining 22% occur the second and the fifth years of age.
Infectious diseases such as diarrhea (18%), pneumonia (14%), and measles (5%) account for more 37% of the 161000 deaths the occured among under five in indonesia in 2005.
Among the 61000 neonatal deaths that the estimated to have occured in 2004-2005.

• About 22% were due to infections (severe infections including pneumonia, neonatal tetanus, and diarrhea),
• Another 69% were due to birth asphyxia (30%), preterm birth (32%), and congenital anomalies (7%)

Trends In Neonatal Mortality Rates
DHS has reperted a NNMRs for the following years/periods : 1987, 1991, 1994,1997, and 2002 - 2003. these were 27, 32, 30, 22, and 20 per 1000 live births, respectively. WHO estimated NNMRs were 18 and 17 per 10000 live births in the years 2000 and 2004, respectively.

Sources : World Population Prospects - the 2006 revision, UN population Division, New York, 2007, UNICEF, The State of The Wourld Childrend 2007, WHO, World Health Statistic 2007, UNDP, World Bank,

ACEH HEALTHY SCHOOLS PROGRAM

Mercy Corps' Aceh Healthy School Program is addressing the health and nutrition needs of school aged children in two districts in Aceh through an intergrated strategy designed to reduce anemia levels adn improve hygiene.

Initially, the program will reach 10,000 children with plans to scale up doubling that figure over two years. The program aims to reduce anemia levels by providing micronutrient supplementation, supporting initiatives in parasite elimination, promoting basic hygiene and improving nutrition practices.

Anemia Status in Aceh

While great strides have been made in Aceh since the december 2004 tsunami, children's helath status remains disturbing, with indications of chronic under nutrition and high prevalence of anemia.

In october 2007, Mercy corps conducted a preliminary assessment to more clearly understand anmia patterns in Aceh Province with plans to replicate, as appropriate, its long established Sumatra Healthy Schools Program. That Program succesfully reduced anemia rates and worm infestation throughout five provinces of Sumatra.
The results of the Aceh preliminary assessment show alarmingly high anemia and worm infection rates. intestinal worms contrubute to anemia and overll poor nutrition status and are associated with poor sanitary conditions. in Aceh Besar, anemia rates were 68.5% of 4 - 5 years old and in Nagan Raya, 56% of 6 - 7 years old were effected. worm infection rates in Aceh Besar were 32.2% and in Nagan Raya they were 64.2%. these finding reinforce the need for an anemia prevention project through focused interventions addressing the root couses of anemia.

What is anemia and why is it important?
Iron deficiency affecs a sgnificant part, and often a majority of the population in nearly every country in the world. Risk for iron deficiency varies with each stage of the life cycle due to changes in iron stores, level of intake and needs relating to growth or iron loss. for example, before six months iron stores are usually adequate from the perinatal period, however, iron storage levels in children begin to decline during the second year of life due to low iron content in the diet and rapid growth spurts. In areas with a high prevalence of hook worm infestation, school aged children as well as adults can also develop significant iron deficiency.
Iron deficiency is defined as a condition in which there are insufficient iron stores and in which there is compromised supply of iron to tissues. the more severe stages of iron deficiency are associated with anemia which is clinically determined if hemoglobin levels drop to less than 11 g/dL(6 months -<5 years old) or 11.5 g/dL (5 -< 11 years old). However, even mild to moderate forms of iron deficiency which may not clinically be qualified as anemia, tussues still are functionally impaired causing children to be tired, slow motor activity and inhibit a child's ability to learn. moreover, the affects of iron deficiency in childhood, a time of significant growth spurts, can be irreversible leading to leower functioning adults.

Sources : Paula miller, Aceh Healthy Schools Project Manager, Health Messenger

UNICEF Report, September 2005,