Recently we highlighted some lessons that malaria control efforts could learn from immunization program management, and observed that this was important because malaria control interventions such as ITN distribution have often been linked with immunization campaigns.Â Another link is use of the Expanded Program for Immunization (EPI) services as a delivery mechanism for intermittent preventive treatment for infants (IPTi).
Pool and colleagues have reported on the acceptability of EPI as a channel for IPTi delivery in Tanzania. The researchers concluded that, “In this setting, IPTi delivered together with EPI was generally acceptable. Acceptability was related to prior routinization of EPI [emphasis added] and resonance with traditional practices. Non-adherence was due largely to practical, social andÂ structural factors, many of which could easily be overcome.”
For example, mothers would have preferred drops instead of tablets for their infants. As with vaccines, mothers knowledge about the whole process was vague and generally consisted of an understanding that the process promoted health rather than controlled specific diseases. Structural factors related to poverty. Despite potential limitations, EPI appears to be a good platform for IPTi delivery.
A review of the Demographic and Health Survey for Tanzania shows that the country has maintained a full immunization coverage rate of around 70% over the past 4 surveys (12 years), but that in the most recent survey (2004) at least 90% of infants had at last one EPI contact. This again speaks well for incorporating IPTi into an existing system that reaches most infants.
The DHS does show some other factors in EPI coverage that would also affect IPTi and reinforces structural factors as a concern. There was lower rural than urban immunization coverage.Â More educated and wealthier parents were more likely to get their infants immunized that less educated and poorer ones. DPT3 coverage in 2004 was only 75% for those in the lowest wealth quintile compared to 96% among those in the highest quintile.
These wealth/access disparities are no reason to dissociate IPTi from EPI, but they do emphasize the need for overall health reform so that disease prevention interventions equitably reach all children and families.