An opportunity not to be missed – immunisation as an entry point for hygiene promotion and diarrhoeal disease reduction in Nepal

Diarrhoea is a leading cause of death in children under 5 years of age, due mostly to failures to increase access to safe water and improve sanitation and hygiene practices (WASH). Rotavirus vaccines are a useful addition to existing diarrhoeal disease control measures. Recommendations are to introduce the vaccine in low-income settings. A study was conducted in Nepal to examine whether immunisation programmes offer a useful entry point for hygiene promotion as part of a comprehensive approach for diarrhoea control. Service-provider and recipient perspectives on integration were explored in focus group discussions with Female Community Health Volunteers and caregivers of infants in Kaski district, Western Region. Key health, WASH and disease surveillance informants (government, I/NGOs and donors) were interviewed at national, regional and district level. Incorporating hygiene promotion into the immunisation programme was acceptable and fits with the recommendations of the National Committee on Immunisation Practice. Implementation through routine immunisation was preferred over a vaccination campaign approach. Discussions concluded that this approach should be piloted as a next step to ensure the development of a strategy that can optimise hygiene promotion delivery and uptake, and ultimately contribute to the reduction of the burden of diarrhoeal diseases in Nepal.