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Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Achieving this requires improving immunization coverage in hard-to-reach areas. The objectives of this analysis were to assess levels of oral polio vaccination coverage and challenges in pastoral and semi-pastoral regions in Ethiopia. The analysis included vaccination-related data for children aged 12-23 months from the 2011 Ethiopian Demographic and Health Survey (EDHS) and from surveys carried out by the CORE Group Polio Project (CGPP) in 2013, 2015, and 2017. The EDHS data were from the entire regions (states) of Somali; Oromia; Southern Nations, Nationalities, and Peoples; Benshangul-Gumuz; and Gambella, whereas the CGPP data were for portions of these states where the CGPP was working and consisted entirely of pastoralist or semi-pastoralist populations. The overall polio immunization coverage rate showed upward trend from 39.6% in the 2011 EDHS to 72.6% for 2017 survey of children in the CGPP intervention areas. The evidence suggests that the CGPP was able to achieve increasing levels of coverage in the hardest-to-reach areas of these states and that the levels were higher than those achieved in the states as a whole. The strategies used by the CGPP/Ethiopia to increase coverage appear to have been effective. Other characteristics associated with full polio immunization included mother's religion and education, whether the mother had heard about polio, knowledge on the effect of many polio vaccine doses, and age at first polio immunization.

The last case of wild poliovirus in Ethiopia was reported in 2014. Until the disease is eradicated globally, the risk of reimportation remains high. In 1999, the CORE Group Polio Project (CGPP) began its community-centered polio eradication efforts in Ethiopia, using community volunteers (CVs) to ensure that no child has missed polio vaccine. This article documents the efforts of CVs and highlights innovative strategies, successes, and contributions. Qualitative data were collected from the CGPP implementation areas in 85 border woredas (districts) of Benishangul-Gumuz; Gambella; Oromia; Southern Nations, Nationalities, and Peoples' Region; and Somali. A total of 151 in-depth interviews were conducted with CVs, parents, CGPP partners, and project stakeholders. Results of the study showed that CVs secured the buy-in of community members through open and fair eligibility and selection processes, thereby ensuring representation of community needs and perspectives. Community-driven participation consisted of identifying and choosing credible, trusted individuals who were willing to actively engage as caretakers of the community. Community volunteers then received specialized training and supportive supervision to build and expand their command of child health and vaccination information and interpersonal skills, fortifying the legitimacy of health messages and supporting the community's sense of collective efficacy. The robust network of CVs built by the CGPP continues to effectively reach the most remote, rugged, and underserved areas of Ethiopia. Stakeholders credit the CGPP with playing a significant role in keeping Ethiopia polio-free and increasing the population coverage of polio and routine immunizations.

In 2001, the CORE Group Polio Project (CGPP) began to support polio eradication initiatives in hard-to-reach pastoralist and semi-pastoralist high-risk border areas of Ethiopia by training and supporting community volunteers (CVs) for immunization promotion and community-based surveillance activities. This article describes the development and current status of the CGPP CV network in Ethiopia. It also reports the results of a 2016 survey of CVs. Community volunteers are selected jointly by the local community, local government officials, and local health facility staff. They work closely with the health extension worker in their area and are responsible for 50-100 households. More than 12,000 CVs have been trained and have reached six million people. They make routine home visits to 1) provide education on vaccine-preventable diseases, 2) promote healthy behaviors, 3) inform parents on how to access immunization services, and 4) report cases of acute flaccid paralysis, neonatal tetanus, and measles as well as births. The 2016 survey of 675 CVs demonstrated that 84.1% had conducted home visits in the previous month to 1) identify and register pregnant mothers and newborns, 2) provide health education, 3) conduct disease surveillance, and 4) search for and register immunization defaulters. Of the CVs, 98.2% reported that their work had led to improvements in the community. Knowledge of CVs about vaccine-preventable diseases was suboptimal. CVs expressed a desire for more training. Community volunteers have made notable contributions to polio eradication efforts in high-risk areas of Ethiopia as well as to immunization promotion and disease control more broadly.

Background: Strengthening routine immunization is one of the four pillars of the global polio eradication initiative., Objectives: To determine the magnitude and factors associated with vaccination coverage among children age 12 -23 months in Zone 4 of Afar Regional State, Ethiopia., Methods: A community based cross-sectional study using the WHO modified cluster sampling method was carried out in Zone 3 of Afar Regional State between January 01 and May 31, 2009. The calculated sample size was 762 and 740 were included in the analysis of vaccination status., Results: A total of 740 children aged 12-23 months were included in the study. Three hundred forty two (46%) respondents reported that their children were vaccinated at least once. Polio 3 coverage was found to be 35.0% and full immunization coverage was 20.6%. Respondents who could read and write had a higher likelihood of getting their children vaccinated compared to those who could not read or write [AOR = 0.18, 95% CI: 0.08-0.34]. Similarly age of the mother, husband's attitude and joint decision making by husband and wife were significantly associated with child immunization adjusted for other factors., Conclusion: The population immunity for polio measured by routine polio vaccine uptake in the study area indicated a high risk for wild polio virus outbreaks following importations, and the emergence and spread of circulating vaccine- derived polio virus. Literacy, positive attitude towards immunization and decision power are important factors to be addressed.

Background: Ethiopia interrupted indigenous polio transmission in April 2008. However, it remains at risk of reinfection because of importation of polio virus from bordering countries., Objectives: Assess polio immunization activities and risk of wild polio virus (WPV) importation in CORE Group Polio Project (CGPP) international border areas of Ethiopia., Methods: The study employed key informant interviews of community volunteers (CV), health extension workers (HEWs), program coordinators, managers and other stakeholders, as well as focus group discussions (FGDs) with community and religious leaders in six border districts (woredas) located in three regions of the country. It was conducted in March and April 2012., Results: Thirty-three key informant interviews and six FGDs were conducted. Immunization coverage was reported to be low and misconceptions about causes and transmission of polio were abundant. There was extensive cross-border movement of people for various reasons and mechanisms for prevention of cross-border polio transmission was almost non existent. AFP case detection and reporting was generally low., Conclusion and Recommendations: Cross-border transmission of polio can occur from several frontiers. Suggestions to control cross-border polio transmission included establishing and/or strengthening cross-border collaboration with responsible counterparts in neighboring countries by using existing cross-border forums and structures to create community awareness, share information and resources, design and implement strategies for identification of children who are eligible for vaccination or suspected AFP cases. In addition districts should coordinate supplemental immunization activities to coincide with when adjacent districts in neighboring countries are carrying out similar actions.

Background: In order to achieve immunization goals, two factors are necessary; the delivery of potent vaccines to children through properly maintained cold chain systems and achieving high vaccine coverage. Maintaining quality of vaccines has been one of the main challenges of immunization programs in Africa., Objective: To assess the cold chain status and practices in 116 health facilities located in three CCRDA/CORE Group Ethiopia operational districts (woredas)., Methodology: An institution based cross-sectional study was conducted in December 2011 and January 2012 in three districts (woredas) of Oromiya, SNNP and Amhara Regions of Ethiopia, data was collected from 116 health facilities and from the same number of immunization service providers. Multiple logistic regression analysis was carried out to identify factors related to knowledge of cold chain management., Result: Of 116 visited facilities, only 22 (19%) had functional refrigerators. The remaining facilities transported vaccines from nearby facilities having functional refrigerators. Complete temperature recording of the last month was observed in 13 (59.1%) facilities. Of 22 functional fridges, the thermometer reading was found to be outside the recommended range in 6 (27.3%) on the date of data collection. Vaccine storage in the refrigerator was not proper in 12 (54.5%) facilities. Sixty-five (56%) health workers had satisfactory knowledge on cold chain management. Professional qualification and year of service in the immunization program showed a statistically significant association with knowledge of cold chain management (P < 0.05)., Conclusion and Recommendations: Vaccines in some facilities were found to be at a high risk of losing their potency. There is an urgent need to improve knowledge and practice on cold chain management through improved supervision and training.