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African Countries Push to Expand Child Immunizations

It costs only a few dollars to immunize children, yet half those living in Africa do not receive basic vaccines during their first year of life. As a result, many continue to die of preventable diseases. It is a tragedy industrialized leaders meeting in Scotland last week vowed to fight.

It is a typical day at the Kononbougou health clinic, where Doctor Oumar Coulibaly is examining 10-month-old Samu Traore. The tiny infant has a high fever, and his throat is red. It does not take long for Dr. Coulibaly to guess what is wrong with little Samu: like many children living in this vast, West African country, he has malaria.

But Dr. Coulibaly wants to know more about Samu's medical history. He questions the infant's 25-year-old mother, Awa Traore in Bambara, the local dialect.

Dr. Coulibaly is trying to find out whether Samu and Ms. Traore's two other children have been fully immunized. After lengthy questioning, it turns out her children have not received their tuberculosis shots. They may also have missed out on others, since Ms. Traore has not brought the family's vaccination records with her.

Ms. Traore's children are not the only ones who have not been immunized against basic diseases, such as polio, measles or tuberculosis. And the repercussions are chilling. About 1.5 million children under the age of five die each year from vaccine-preventable diseases, many of them in Africa, according to the UN Children's Fund.

Western countries have pledged to slash child mortality rates by two-thirds by the year 2015, as part of so-called Millennium Development Goals for poorer nations. But they have a daunting task before them. While vaccination rates increased in most parts of the world during the 1990s, they fell dramatically in Africa.

But Mali is one country bucking this dismal trend. Vaccination coverage in this vast, West African country almost doubled from only 45 percent in 1999, to 86 percent last year. Safiou Osseni Raimi, senior project officer for UNICEF in Mali, explains what is behind the change.

Increasingly, Dr. Raimi says, Mali's government considers immunization a public health priority. The government is investing in vaccines and cold storage units to store the perishable shots, and in new strategies to deliver vaccines in rural areas.

Located in a farming town about 100 miles east of Mali's capital, Bamako, the Kononbougou health center is one example of Mali's stepped-up public health commitment. The clinic serves the needs of about 20,000 people. The furthest villages - collections of neat mud huts with thatched roofs, surrounded by fields of sorghum and millet - are located about 14 miles away.

That is not far in America. But the clinic is still located a daunting distance for many locals, who do not own cars, or even bicycles. So, most days of the week, two medical interns travel to villages by motorcycle to deliver vaccines and basic health care. Today, this team is going out to stock up on serum used in the vaccinations.

Kononbougou's small clinic is stocked with aging medical equipment. Its tile floor is tracked with red dirt, but it is luckier than many others - it has a full-time doctor.

Dr. Coulibaly is showing UNICEF health care expert Suzanne Zomahoun the cold storage facility where the vaccinations are kept. All the vaccines are up to date. But the clinic has failed to keep a good record of the outings to rural villages.

Dr. Zomahoun also encourages the clinic's nurses to lobby Kononbougou's local government for another motorcycle to go out in the field.

Dr. Zomahoun says other clinics in Mali negotiate with local officials to borrow motorcycles on the days they go into the field. The nurse says she has cried out for assistance. But Dr. Zomahoun is not convinced. "You need to negotiate," she says, "not cry out."

Dr. Zomahoun knows what she is talking about. A licensed doctor, she headed a rural health district in the 1980s in her native West African country of Benin.

When she started out as a doctor, she said, her center in Benin did not even have a refrigerator to conserve the vaccines.

Today, many African clinics own refrigerators. But there are plenty of other problems. Dr. Nouhoum Kone, head of the immunization division at Mali's health ministry in Bamako, lists a few of them.

Dr. Kone says there are vast, desertified and sparsely populated regions of northern Mali that are hard to reach during immunization campaigns. There is very little health infrastructure, he says, which makes it very difficult to vaccinate people.

Most African countries also do not have the latest generation of vaccines, for example, ones that immunize a child with a single dose, or new combination vaccines that are more effective, but also considerably more expensive.

And, Mali is among half a dozen countries in the world where polio has resurfaced. Nineteen cases were registered last year. Health officials believe the disease was imported from Nigeria, where some areas have rejected the vaccinations.

But experts like UNICEF's Dr. Raimi believe Mali understands the basic message behind immunizations.

Dr. Raimi says, vaccinations are essential for the survival of Mali's children.