Figure 10: Vaccine coverage rates 2008-2012 Source: HMIS data 295. As a result of the EPI programme, the GoSL has seen a significant reduction in the morbidity prevalence and mortality rates for Acute Respiratory Infections, Measles and Polio among children under the age of 5 years. Sierra Leone has not identified any Wild Polio Virus since April 2010 and has achieved Maternal and Neonatal Tetanus elimination status in 2013. 296. In moving forward, the GoSL will continue to address the ongoing challenges of higher drop-out rates after first doses and capacity to support the ever-expanding immunization programme. It will continue to roll out and strengthen its outreach delivery models and special event campaigns. In addition, the EPI programme is working with other child survival programmes to develop full integrated child survival interventions across service delivery platforms to increase coverage and impact and reduce costs. For example, the Rotavirus vaccine will be integrated into key environmental health and sanitation initiatives such as the WASH campaign. 297. In collaboration with its development partners, the GoSL will continue to introduce new and under-used vaccines like the Rota-virus vaccine, HOV, Measles second dose, Hepatitis B at birth and switch from Measles to a combined Measles-Rubella, and from a Tetanus Toxoid to a Tetanus diphtheria vaccine for women of child bearing age. 298. The expansion of the cold chain system at all levels of the health system will be a priority to address findings of an Effective Vaccine Management Assessment and to accommodate the additional capacity needs brought about by the introduction of new vaccines. Malaria prevention and treatment 299. 80  Malaria is the leading cause of mortality and morbidity among children under five in Sierra Leone. It accounts for about 50% of outpatient treatments, with the mortality attributed to malaria being estimated to 33 percent among the under-5 age group and 25 percent for all ages. The disease is endemic with perennial transmission in Government of the Republic of Sierra Leone Initial Report on the African Charter on the Rights and Welfare of the Child 2002-2014