Health workers from different health facilities in the Kingdom of Eswatini have completed a three-days training on reporting and investigation of Adverse Events Following Immunization (AEFI). The training was supported by the World Health Organization.

This was the first training of its kind since the country experienced a serious AEFI during the Measles Rubella campaign in 2016 where a child died allegedly following the vaccine. The training took place at Bethel Court Hotel in Ezulwini from 19 to 21 June 2018. The Senior Medical Officer (SMO) in charge of public health, Dr Njabulo Lukhele whilst opening the workshop stated that vaccine efficacy and safety is important to enhance community acceptance of traditional and new vaccines.  The WHO Country Representative, Dr Tigest Ketsela Mengestu attended part of the workshop. She highlighted that immunization safety has become an element of the national immunization programme, thus vigilance in AEFI monitoring is eminent. 

Amongst the participants of the training were nurse managers from the country’s four regions: Hhohho, Shiselweni, Lubombo and Manzini as well as members of the AEFI committee.  It was noticeable that this cadre plays a major role in reporting AEFI cases and is responsible for investigating AEFI cases whilst the AEFI committee is responsible for causality assessment. Also in attendance officers from the  Expanded Programme on Immunization (EPI) from Ministry of Health and WHO country office as well as the pharmacovigilance unit, representatives from training institutions and four medical doctors. Of note is the fact that the number of doctors in attendance was less than what was expected. It was highlighted that doctors play an important role in reporting and investigation of AEFI cases therefore, more trainings were planned to build a capacity of doctors and other health workers involved in immunization.

The overall objective of the training was to strengthen AEFI surveillance in the Kingdom of Eswatini by training health workers and AEFI committee members on surveillance and causality assessment and to define roles and responsibilities of stakeholders in AEFI surveillance. The EPI Program Manager , Ms Xolisiwe Dlamini emphasised that the country has introduced more new vaccines and urged health workers to be more vigilant after vaccination. The country has embarked on a journey to strengthen and formalise AEFI surveillance and reporting after the AEFI case reported in 2016. National AEFI guidelines were developed and disseminated in 2017. It was observed however, that health workers were inadequately capacitated in reporting AEFI cases as only one case was reported in 2017. 

Dr Sujeet from WHO Intercountry Support Team who was the main facilitator of the workshop informed the participants that vaccines are not 100% safe and harm can result from errors in immunisation practice. In his presentation he discussed in detail the causes of specific types of AEFI which include vaccine product-related reaction, vaccine quality defect-related reaction, immunization error-related reaction, immunization anxiety-related reaction and coincidental event. The facilitator emphasised that it is important to conduct a thorough investigation of the reported case/s followed by causality assessment to come up with correct classification of the AEFI. He introduced participants on the use of Brighton Collaboration definitions to minimize errors in classification. Participants were practically engaged not only on the use of online causality assessment tools but also reporting and investigation forms. 

Dr Sujeet further elaborated that AEFI are not only caused by negligence of health workers but could be caused by other factors. He said it was therefore important to use vaccines within the stipulated protocol to prevent occurrence of infections and other adverse situations. He reminded health workers that anything that is of concern to the parent or caregiver should be reported to health systems. 

“Once a parent reports an AEFI to the health worker, it should be investigated immediately and reported within 24 hours,” he said. The health workers admitted that one could be sometimes tempted to break protocol as they try to cover the long queues for vaccination. They, however, agreed that community members come to the health facility because they trust health workers, hence it is important to always be on the lookout for things that are of concern to the community. It was also emphasized that effective communication increases accountability and transparency therefore, it is important to disseminate information to caretakers on what to do in case of an AEFI. Furthermore, participants were cautioned on how to communicate with media.  
“Some of the health workers were afraid to report AEFI cases because of fear of being blamed.  This training was to assure them that the reporting of AEFI cases was solely for correcting and not penalizing officers,” said WHO EPI officer Lonkululeko Khumalo.

During the training, health workers were also reminded to always check when last the child got a vaccine if brought to the clinic or hospital. This is done to ascertain if the child’s sickness is linked to a vaccine or not. Emergency Response personnel were urged to always remind parents to bring the child health card so that it is included in the history taking. 

As a way forward, the team agreed that the Ministry of Health and WHO country office should formalise the AEFI committee with Terms of References delineated, and also conduct regional training for health staff, including doctors on AEFI reporting and investigation using modules and tools provided by WHO.