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Howard MC. Gender and vaccination: understanding the multifaceted role of a multidimensional conceptualization of vaccine hesitancy. PSYCHOL HEALTH MED 2024; 29:1055-1062. [PMID: 38017635 DOI: 10.1080/13548506.2023.2280462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
Popular press and academic articles alike speculate that gender influences vaccine receipt, but they often disagree whether men or women are less likely to become vaccinated. In the current article, we further test the relation of gender and vaccination in four datasets, and we assess the mediating role of vaccine hesitancy dimensions. Our results demonstrate that: (1) gender has significant relations with several vaccine hesitancy dimensions, which are mixed between both women and men having negative perceptions regarding vaccination; (2) gender does not significantly relate to flu and COVID-19 vaccination willingness or receipt, but women were more likely to receive other vaccines; and (3) a significant indirect effect did emerge in the two datasets collected after widespread access to the COVID-19 vaccine, such that the perception that vaccines cause health risks mediates the relation of gender with flu vaccination willingness as well as COVID-19 vaccination willingness and receipt. Our discussion integrates these findings with models of preventative behaviors and identifies directions for future research.
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Affiliation(s)
- Matt C Howard
- University of South Alabama, Mitchell College of Business, Mobile, AL, USA
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Osman MA, Waits A, Chien LY. Factors Associated with Vaccination Coverage among 0-59-Month-Old Children: A Multilevel Analysis of the 2020 Somaliland Demographic and Health Survey. Vaccines (Basel) 2024; 12:509. [PMID: 38793760 PMCID: PMC11125891 DOI: 10.3390/vaccines12050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15-49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women's literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake.
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Affiliation(s)
- Mohamed Abdalle Osman
- International Health Program, Yang-Ming Campus, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan;
- Faculty of Health Sciences, Sanaag University, Erigavo, Somaliland
| | - Alexander Waits
- Institute of Public Health, Yang-Ming Campus, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan;
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, Yang-Ming Campus, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan
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Vashi MD, Watkins M. Missed opportunities: Reducing zero dose children amongthe urban poor after COVID, Mumbai India, 2022. Vaccine 2024; 42:59-63. [PMID: 38016846 DOI: 10.1016/j.vaccine.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
Reaching urban poor populations poses challenges for equitable immunization coverage. Furthermore, COVID disrupted routine immunization services. In Mumbai, India, first dose diphtheria tetanus pertussis containing vaccine (DTPCV1)coverage dropped from 88% (2019) to 76% (2021). We identified and characterized 125 zero-dose (those withoutDTPCV1)migrant children in urban Mumbai in October 2022. Almost half were born elsewhere than Mumbai; 53% resided at their present location for less than a year. More than half were 12-59 months of age, well-beyond the age for first routine childhood immunizations.Three of four zero dose children had received birth dose vaccination in the hospital; but failed to receive DTPCV1. Vaccine hesitancy, awareness gaps and operational issues were common reasons for non-vaccination. Despite frequent visits to health facilities for illness,only a third of facility staff asked or advised parents about vaccination.Missed opportunities were much more common in private than government facilities.For the vast majority (88%), residential sites were included in local routine immunization micro-plans and distances to immunization sites were short (less than 1 km for 94 % of families).However, planned session frequency was inadequate half of the time. Expanded efforts to reach migrant urban poor children are needed to ensure vaccine equity.
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Sigdel B, Jin Y, Dhakal P, Luitel T, Ghimire PK, Wasti SP. Factors affecting on compliance of childhood immunization in Ilam District of Nepal; A case-control study. DIALOGUES IN HEALTH 2023; 2:100140. [PMID: 38515491 PMCID: PMC10953870 DOI: 10.1016/j.dialog.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 03/23/2024]
Abstract
Childhood immunization is one of the most important public health interventions to reduce child morbidity and mortality. Reaching all children with full immunization services is critical to meet Nepal's commitment to Sustainable Development Goals (SDGs). This study aimed to identify factors affecting compliance with childhood immunization in children aged 16 to 36 months in Nepal. A community-based unmatched case-control study was conducted with 250 (83 cases and 167 controls) respondents in the Ilam district of Nepal. Respondents were randomly selected using a multi-stage cluster sampling technique. Data were collected using a structured questionnaire and analysed using SPSS version 16 statistical software. Bivariate and multivariate logistic regression analyses were done to identify the factors influencing compliance with childhood immunization of the sampled respondents. More than two-thirds (66.8%) of the sampled children were fully immunized, and 19.3% of the children defaulted to the Measles-Rubella vaccines. Only 19.2% of the respondents had good knowledge about the type of vaccine, and more than half (59.2%) of the respondents had a positive attitude towards immunization. Multivariate logistic regression analysis revealed that lack of knowledge about vaccines (AOR = 49.4, 95% CI = 12.94 to 188.59), father's level of education (AOR = 2.1, 95% CI = 1.05 to 4.30), not getting immunization on the day of the appointment (AOR = 4.8, 95% CI = 2.30 to 9.89), lack of knowledge about immunization schedule (AOR = 2.4, 95% CI = 1.14 to 4.84), and negative attitude towards immunization (AOR = 2.1, 95% CI = 1.03 to 4.19) were independently impeded on compliance on the childhood immunization. Targeted intervention in health promotion activities at the household level should be promoted and integrated immunization services into the existing primary health care services.
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Affiliation(s)
| | - Yan Jin
- Xiang Ya Nursing School, Central South University, Changsha, China
| | - Pushpa Dhakal
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Luitel
- Emergency Department, Ilam Hospital, Ilam, Nepal
| | | | - Sharada P. Wasti
- School of Human Sciences, University of Greenwich, London, United Kingdom
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Krishnamurthy P, Mulvey MS, Gowda K, Singh M, Venkatesan NK, Syam SB, Shah P, Kumar S, Chaudhuri A, Narayanan R, Perne AL, Pangaria A. Drivers of vaccine hesitancy among vulnerable populations in India: a cross-sectional multi-state study. Front Public Health 2023; 11:1177634. [PMID: 37900017 PMCID: PMC10600374 DOI: 10.3389/fpubh.2023.1177634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives India's Covid-19 vaccination campaign engaged frontline workers (FLWs) to encourage vaccination among vulnerable segments of society. The FLWs report encountering a variety of barriers to vaccination and are often unsuccessful despite multiple visits to the same person. This cross-sectional study aims to pinpoint which of these barriers drive vaccine hesitancy among these segments, to help streamline vaccine communication, including FLW training, to better safeguard the population. Methods Trained field enumerators contacted 893 individuals from five states across India and collected self-reported assessments of fifteen vaccination barriers (identified through discussions with FLWs), current vaccination status and future vaccination intentions, and covariates (demographics/comorbidities). Factor analysis of the fifteen barriers yielded two factors, one relating to fear of vaccine adverse effects and a second focused on peripheral concerns regarding the vaccine. The covariates significantly associated with current vaccination status were combined under a latent class regime to yield three cluster types (health access, financial strength, and demographics). The primary analysis examined the effect of the two barrier factors, the covariate clusters, and comorbidity, on current vaccination status and future vaccine intentions. Results Fear of vaccine adverse effects was the primary driver of vaccine hesitancy; peripheral concerns frequently mentioned by the FLWs had no impact. Although cluster membership and the presence of comorbidities predicted vaccine uptake, neither of them materially altered the effect of fear of vaccine adverse effects with the following exception: fear of adverse effects was not associated with vaccination status among young Muslim men. Conclusion Subject to limitations, these results indicate that interventions to decrease vaccine hesitancy should focus primarily on fear associated with vaccines rather than spend resources trying to address peripheral concerns.
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Affiliation(s)
- Parthasarathy Krishnamurthy
- Department of Marketing and Entrepreneurship, C. T. Bauer College of Business, University of Houston, Houston, TX, United States
| | - Michael S. Mulvey
- Telfer School of Management, LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | - Prerak Shah
- Catalyst Management Services, Bengaluru, India
| | - Shiv Kumar
- Catalyst Management Services, Bengaluru, India
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Mueller K, Koury J, Sarangarm P, Hellinga RC, Shenk E, Stewart MB, Salas NM, Marshik PL, Seazzu M, Jakeman B. Pneumococcal Polysaccharide Vaccination (PPSV23) in High-Risk Pediatric Patients With Diabetes. J Pediatr Pharmacol Ther 2023; 28:417-422. [PMID: 38130496 PMCID: PMC10731932 DOI: 10.5863/1551-6776-28.5.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The Advisory Committee on Immunization Practices recommends the pneumococcal polysaccharide vaccine (PPSV23) following the pneumococcal conjugate vaccine (PCV13) for pediatric patients aged 2 to 18 years with high-risk medical conditions. The PPSV23 is not a routine immunization for all pediatric patients and children who meet criteria for high-risk conditions may not consistently receive the PPSV23 vaccine, despite current recommendations. The goal of this study was to determine PPSV23 -vaccination rates in the high-risk pediatric patients with type 1 or type 2 diabetes. METHODS A single-center retrospective cohort study was conducted. Patients were included if they were 2 to 18 years of age on January 1, 2019, with a diagnosis of diabetes, and had ≥1 encounters within the health care system in 2019. The primary outcome was PPSV23 vaccination rates in the high-risk diabetic pediatric population. Secondary outcomes included identifying missed opportunities for vaccinations and the incidence of invasive pneumococcal infections. RESULTS A total of 366 patients met criteria for study inclusion. Patients had a mean age of 13.3 years and were predominantly white (69.8%). A total of 32 (8.7%) patients had documentation of PPSV23 vaccination. Baseline characteristics were comparable between the two groups. There were 32 cases of pneumonia charted before patients received the PPSV23 and one case reported after patients received the PPSV23 vaccination. CONCLUSIONS PPSV23 vaccination rates were low in this high-risk diabetic pediatric group, with many -documented missed opportunities for vaccination. This may be attributed to the vaccine not being a -routinely recommended for all pediatric patients.
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Affiliation(s)
- Kelsey Mueller
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM (KM, JK, PS, RCH, ES)
| | - Jason Koury
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM (KM, JK, PS, RCH, ES)
| | - Preeyaporn Sarangarm
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM (KM, JK, PS, RCH, ES)
| | - Robert C. Hellinga
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM (KM, JK, PS, RCH, ES)
| | - Eleni Shenk
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM (KM, JK, PS, RCH, ES)
| | - Morgan B. Stewart
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM (MBS, PLM, MS, BJ)
| | | | - Patricia L. Marshik
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM (MBS, PLM, MS, BJ)
| | - Micaela Seazzu
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM (MBS, PLM, MS, BJ)
| | - Bernadette Jakeman
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM (MBS, PLM, MS, BJ)
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Muhoza P, Shah MP, Gao H, Amponsa-Achiano K, Quaye P, Opare W, Okae C, Aboyinga PN, Opare KL, Wardle MT, Wallace AS. Predictors for Uptake of Vaccines Offered during the Second Year of Life: Second Dose of Measles-Containing Vaccine and Meningococcal Serogroup A-Containing Vaccine, Ghana, 2020. Vaccines (Basel) 2023; 11:1515. [PMID: 37896919 PMCID: PMC10611024 DOI: 10.3390/vaccines11101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Understanding the drivers of coverage for vaccines offered in the second year of life (2YL) is a critical focus area for Ghana's life course approach to vaccination. This study characterizes the predictors of vaccine receipt for 2YL vaccines-meningococcal serogroup A conjugate vaccine (MACV) and the second dose of measles-containing vaccine (MCV2)-in Ghana. METHODS 1522 children aged 18-35 months were randomly sampled through household surveys in the Greater Accra Region (GAR), Northern Region (NR), and Volta Region (VR). The association between predictors and vaccination status was modeled using logistic regression with backwards elimination procedures. Predictors included child, caregiver, and household characteristics. RESULTS Coverage was high for infant vaccines (>85%) but lower for 2YL vaccines (ranging from 60.2% for MACV in GAR to 82.8% for MCV2 in VR). Predictors of vaccination status varied by region. Generally, older, first-born children, those living in rural settlements and those who received their recommended infant vaccines by their first birthday were the most likely to have received 2YL vaccines. Uptake was higher among those with older mothers and children whose caregivers were aware of the vaccination schedule. CONCLUSIONS Improving infant immunization uptake through increased community awareness and targeted strategies, such as parental reminders about vaccination visits, may improve 2YL vaccination coverage.
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Affiliation(s)
- Pierre Muhoza
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Monica P. Shah
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Hongjiang Gao
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kwame Amponsa-Achiano
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Pamela Quaye
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - William Opare
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Charlotte Okae
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Philip-Neri Aboyinga
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Kwadwo L. Opare
- Neglected Tropical Diseases Control Programme, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Melissa T. Wardle
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Aaron S. Wallace
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Sarder MA, Lee KY, Keramat SA, Hashmi R, Ahammed B. A multilevel analysis of individual and community-level factors associated with childhood immunisation in Bangladesh: Evidence from a pooled cross-sectional survey. Vaccine X 2023; 14:100285. [PMID: 37063304 PMCID: PMC10090204 DOI: 10.1016/j.jvacx.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Previous studies on childhood vaccinations in Bangladesh relied on single-level analyses and ignored the clustering and hierarchical structure of data collected from people living in different geographical units. This study, therefore, aimed to investigate the association between individual and community-level factors of full childhood immunisation with an improved analytical approach. Methods Participants were 13,752 children aged 12-59 months. Data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, and 2017-18. A two-level multilevel logistic regression method was used to analyse the data. Results Approximately 87% of the children were fully immunised. In the fully adjusted model, at the individual level, mothers who had primary and above education (Adjusted odds ratio [AOR] = 1.78; 95% Confidence Interval [CI]: 1.57, 2.01), mass media exposure (AOR = 1.14; 95% CI: 1.00, 1.30), having vaccination cards (AOR = 3.65; 95% CI: 3.23, 4.14), and having at least 4 antenatal care (ANC) visits (AOR = 1.24; 95% CI: 1.06, 1.44) were strongly associated with full childhood immunisation. At community-level, rural residency (AOR = 1.25; 95% CI: 1.08, 1.44), community women's education (AOR = 1.24; 95% CI: 1.07, 1.43), and community ANC utilisation (AOR = 1.38; 95% CI: 1.19, 1.61) were significantly associated with full childhood immunisation. Conclusion Along with individual-level factors, community-level factors have a significant effect on childhood immunisation. Policymakers should target improving community-level characteristics, such as community poverty, education levels, and the number of community-level ANC visits, to increase the national level of childhood immunisation. Public health intervention programs aiming at increasing awareness of childhood immunisation should include elements at both individual and community levels.
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Affiliation(s)
- Md. Alamgir Sarder
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna 9208, Bangladesh
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Corresponding author at: Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh
- School of Business, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Rubayyat Hashmi
- School of Business, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Benojir Ahammed
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna 9208, Bangladesh
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Goodman OK, Wagner AL, Riopelle D, Mathew JL, Boulton ML. Vaccination inequities among children 12-23 months in India: An analysis of inter-state differences. Vaccine X 2023; 14:100310. [PMID: 37234595 PMCID: PMC10205789 DOI: 10.1016/j.jvacx.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
Background Previous research has shown that socioeconomic and demographic risk factors in children are additive and lead to increasingly negative impacts on vaccination coverage. The goal of this study is to examine if different combinations of four risk factors (infant sex, birth order, maternal education level, and family wealth status) vary by state among children 12-23 months in India and to determine the impact of ≥ 1 risk factor on differences in state vaccination rates. Methods Using data from the National Family Health Survey (NFHS) conducted in India between 2005 and 2006 (NFHS-3) and 2015-2016 (NFHS-4), full vaccination of children 12-23 months was examined. Full vaccination was defined as receipt of one dose of bacillus Calmette-Guérin (BCG), three doses of diphtheria-pertussis-tetanus vaccine (DPT) vaccine, three doses of oral polio vaccine (OPV), and one dose of measles-containing vaccine (MCV). Associations between full vaccination and the four risk factors were assessed using logistic regression. Data were analyzed by the state of residence. Results A total of 60.9% of children 12-23 months were fully vaccinated, in NFHS-4, ranging from 33.9% in Arunachal Pradesh to 91.3% in Punjab. In NFHS-4, the odds of full vaccination across all states were 15% lower among infants with 2 risk factors versus 0 or 1 risk factors (OR: 0.85, 95% CI: 0.80-0.91), and 28% lower among infants with 3 or 4 risk factors versus 0 or 1 risk factor (OR: 0.72, 95% CI: 0.67-0.78). Overall, the absolute difference in the full vaccination coverage in those with > 2 vs < 2 risk factors decreased from -13% in NFHS-3 to -5.6% in NFHS-4, with substantial variation across states. Conclusions Disparities in full vaccination exist among children 12-23 months experiencing > 1 risk factor. Indian states that are more populous or located in the north were more likely to have greater disparities.
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Affiliation(s)
- Octavia K. Goodman
- College of Health Sciences, Old Dominion University, 5115 Terminal Blvd, Norfolk, VA 23529, USA
| | - Abram L. Wagner
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Dakota Riopelle
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | | | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Department of Internal Medicine, Infectious Diseases Division, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Raut A, Huy NT. Recrudescence of measles in India: an emerging threat. Pathog Glob Health 2023; 117:326-327. [PMID: 36995012 PMCID: PMC10177746 DOI: 10.1080/20477724.2023.2197670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Akshay Raut
- Department of Medicine, Bharatratna Dr. Babasaheb Ambedkar Municipal General Hospital, Mumbai, India
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
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Kundu S, Kundu S, Seidu AA, Okyere J, Ghosh S, Hossain A, Alshahrani NZ, Banna MHA, Rahman MA, Ahinkorah BO. Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: a multilevel mixed-effects analysis. BMC Public Health 2023; 23:862. [PMID: 37170088 PMCID: PMC10173930 DOI: 10.1186/s12889-023-15711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. METHODS Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data for this study on vaccination coverage among children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. RESULTS The overall prevalence (weighted) of full vaccination among children aged 12-35 months were 86.17% in 2011, 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of vaccination coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). CONCLUSION To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.
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Affiliation(s)
- Satyajit Kundu
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
| | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Abdul-Aziz Seidu
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Susmita Ghosh
- Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, Noakhali, Bangladesh
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, 21589, Saudi Arabia
| | - Md Hasan Al Banna
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
- Nutrition Initiative (NI), Kushtia, Bangladesh
| | - Md Ashfikur Rahman
- Development Studies Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Roy D, Debnath A, Sarma M, Roy D, Das K. A Decomposition Analysis to Understand the Wealth-Based Inequalities in Child Vaccination in Rural Southern Assam: A Cross-Sectional Study. Indian J Community Med 2023; 48:112-125. [PMID: 37082382 PMCID: PMC10112763 DOI: 10.4103/ijcm.ijcm_422_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/07/2022] [Indexed: 02/11/2023] Open
Abstract
Background The socio-environmental aspects of southern Assam reflect a general pattern of backwardness. Moreover, child healthcare resources in the region are inadequately used, leading to low vaccination coverage. Given this background, this paper attempted to comprehend wealth-based inequality in full vaccination in rural areas of southern Assam. Methodology Based on a multistage cluster sampling approach, 360 children of 12-23 months were selected from the study area. To identify the predictors of a child, a non-linear model was estimated by using the generalized linear model (GLM) approach followed by Erreygers decomposition technique to quantify the wealth inequality in the obtained predictors in explaining the disparity in full vaccination. Result The Bacillus Calmette-Guérin (BCG) vaccination recorded the highest vaccination coverage, at nearly 90% and the lowest was observed for the measles vaccine, around 61 percent. Slightly more than half of the eligible children (54 percent) were vaccinated against all the Universal Immunization Programme (UIP)-recommended vaccines. The decomposition analysis revealed that the occupation of the child's father, maternal age, birth order of the child, and health-seeking behavior such as antenatal care (ANC) were the prime factors related to inequality in full vaccination in the region. Conclusion Vaccination coverage in the region has improved over time, however, full vaccination is concentrated towards the economically advantaged section of the society in rural southern Assam. Targeted, context-specific, and expanded government initiatives could aid in addressing the overall wealth-related full vaccination inequalities in the valley.
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Affiliation(s)
- Dipankar Roy
- Department of Economics, Government Model Degree College, Borkhola, Assam, India
| | - Avijit Debnath
- Department of Economics, Assam University, Silchar, Assam, India
| | - Munmi Sarma
- Department of Economics, Assam University, Silchar, Assam, India
| | - Dipanjan Roy
- Department of General Surgery, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Kinnor Das
- Department of Dermatology, Consultant Dermatologist, Apollo Clinic Silchar, Silchar, Assam, India
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Assessment of the Timely Administration of Birth Dose Vaccines in Northern Nigeria and Associated Factors. Ann Glob Health 2022; 88:60. [PMID: 35974982 PMCID: PMC9336735 DOI: 10.5334/aogh.3743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Objectives: Method: Findings: Conclusion:
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Krishnamoorthy Y, Rehman T. Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey. Fam Pract 2022; 39:603-609. [PMID: 34564727 DOI: 10.1093/fampra/cmab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization. METHODS Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU). RESULTS In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups. CONCLUSION Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai, Tamil Nadu, India
| | - Tanveer Rehman
- Department of Preventive and Social Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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15
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Ali A, Zar A, Wadood A. Factors associated with incomplete child immunization in Pakistan: findings from Demographic and Health Survey 2017-18. Public Health 2022; 204:43-48. [DOI: 10.1016/j.puhe.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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Schön M, Heesemann E, Ebert C, Subramanyam M, Vollmer S, Horn S. How to ensure full vaccination? The association of institutional delivery and timely postnatal care with childhood vaccination in a cross-sectional study in rural Bihar, India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000411. [PMID: 36962219 PMCID: PMC10021874 DOI: 10.1371/journal.pgph.0000411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Incomplete and absent doses in routine childhood vaccinations are of major concern. Health systems in low- and middle-income countries (LMIC), in particular, often struggle to enable full vaccination of children, which affects their immunity against communicable diseases. Data on child vaccination cards from a cross-sectional primary survey with 1,967 households were used to assess the vaccination status. The association of timely postnatal care (PNC) and the place of delivery with any-dose (at least one dose of each vaccine) and full vaccination of children between 10-20 months in Bihar, India, was investigated. Bivariate and multivariable logistic regression models were used. The vaccines included targeted tuberculosis, hepatitis B, polio, diphtheria/pertussis/tetanus (DPT) and measles. Moreover predictors for perinatal health care uptake were analysed by multivariable logistic regression. Of the 1,011 children with card verification, 47.9% were fully vaccinated. Timely PNC was positively associated with full vaccination (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.06-2.08) and with the administration of at least one dose (any-dose) of polio vaccine (aOR 3.37 95% CI 1.79-6.36), hepatitis B/pentavalent vaccine (aOR 2.11 95% CI 1.24-3.59), and DPT/pentavalent vaccine (aOR 2.29 95% CI 1.35-3.88). Additionally, delivery in a public health care facility was positively associated with at least one dose of hepatitis B/pentavalent vaccine administration (aOR 4.86 95% CI 2.97-7.95). Predictors for timely PNC were institutional delivery (public and private) (aOR 2.7 95% CI 1.96-3.72, aOR 2.38 95% CI 1.56-3.64), at least one ANC visit (aOR 1.59 95% CI 1.18-2.15), wealth quintile (Middle aOR 1.57 95% CI 1.02-2.41, Richer aOR 1.51 95% CI 1.01-2.25, Richest aOR 2.06 95% CI 1.28-3.31) and household size (aOR 0.95 95% CI 0.92-0.99). The findings indicate a correlation between childhood vaccination and timely postnatal care. Further, delivery in a public facility correlates with the administration of at least one dose of hepatitis B vaccine and thus impedes zero-dose vaccination. Increasing uptake of timely PNC, encouraging institutional delivery, and improving vaccination services before discharge of health facilities may lead to improved vaccination rates among children.
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Affiliation(s)
- Mareike Schön
- Department of Paediatrics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Cara Ebert
- RWI-Leibniz Institute for Economic Research, Essen, Germany
| | - Malavika Subramanyam
- Social Epidemiology, Indian Institute of Technology Gandhinagar, Palaj, Gandhinagar, Gujarat, India
| | - Sebastian Vollmer
- Chair of Development Economics, Center for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Sebastian Horn
- Department of Paediatrics, University Medical Center Göttingen, Göttingen, Germany
- Department of Paediatrics, SRH Central Hospital Suhl, Suhl, Germany
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Srivastava S, Kumar P, Chauhan S, Banerjee A. Household expenditure for immunization among children in India: a two-part model approach. BMC Health Serv Res 2021; 21:1001. [PMID: 34551769 PMCID: PMC8459463 DOI: 10.1186/s12913-021-07011-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/10/2021] [Indexed: 01/12/2023] Open
Abstract
Background Despite the Indian government’s Universal Immunization Program (UIP), the progress of full immunization coverage is plodding. The cost of delivering routine immunization varies widely across facilities within country and across country. However, the cost an individual bears on child immunization has not been focussed. In this context, this study tries to estimate the expenditure on immunization which an individual bears and the factors affecting immunization coverage at the regional level. Methods Using the 75th round of National Sample Survey Organization data, the present paper attempts to check the individual expenditure on immunization and the factors affecting immunization coverage at the regional level. Descriptive statistics and multivariate regression analysis were used to fulfil the study objectives. The two-part model has been employed to inspect the determinants of expenditure on immunization. Results The overall prevalence of full immunization was 59.3 % in India. Full immunization was highest in Manipur (75.2 %) and lowest in Nagaland (12.8 %). The mean expenditure incurred on immunization varies from as low as Rs. 32.7 in Tripura to as high as Rs. 1008 in Delhi. Children belonging to the urban area [OR: 1.04; CI: 1.035, 1.037] and richer wealth quintile [OR: 1.14; CI: 1.134–1.137] had higher odds of getting immunization. Moreover, expenditure on immunization was high among children from the urban area [Rs. 273], rich wealth quintile [Rs. 297] and who got immunized in a private facility [Rs. 1656]. Conclusions There exists regional inequality in immunization coverage as well as in expenditure incurred on immunization. Based on the findings, we suggest looking for the supply through follow-up and demand through spreading awareness through mass media for immunization. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07011-0.
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Affiliation(s)
- Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India.
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
| | - Adrita Banerjee
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Schueller E, Nandi A, Summan A, Chatterjee S, Ray A, Haldar P, Laxminarayan R. Public Finance of Universal Routine Childhood Immunization in India: District Level Cost Estimates. Health Policy Plan 2021; 37:200-208. [PMID: 34522955 PMCID: PMC8826633 DOI: 10.1093/heapol/czab114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/06/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
India’s Universal Immunization Programme (UIP) is among the largest routine childhood vaccination programmes in the world. However, only an estimated 65% of Indian children under the age 2 years were fully vaccinated in 2019. We estimated the cost of raising childhood vaccination coverage to a minimum of 90% in each district in India. We obtained vaccine price data from India’s comprehensive multi-year strategic plan for immunization. Cost of vaccine delivery by district was derived from a 2018 field study in 24 districts. We used propensity score matching methods to match the remaining Indian districts with these 24, based on indicators from the National Family Health Survey (2015–16). We assumed the same unit cost of vaccine delivery in matched pair districts and estimated the total and incremental cost of providing routine vaccines to 90% of the current cohort of children in each district. The estimated national cost of providing basic vaccinations—one dose each of Bacillus Calmette–Guerin (BCG) and measles vaccines, and three doses each of oral polio (OPV) and diphtheria, pertussis and tetanus vaccines—was $784.91 million (2020 US$). Considering all childhood vaccines included in UIP during 2018–22 (one dose each of BCG, hepatitis B and measles–rubella; four doses of OPV; two doses of inactivated polio; and three doses each of rotavirus, pneumococcal and pentavalent vaccines), the estimated national cost of vaccines and delivery to 90% of target children in each district was $1.73 billion. The 2018 UIP budget for vaccinating children, pregnant women and adults was $1.17 billion (2020 US$). In comparison, $1.73 billion would be needed to vaccinate 90% of children in all Indian districts with the recommended schedule of routine childhood vaccines. Additional costs for infrastructural investments and communication activities, not incorporated in this study, may also be necessary.
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Affiliation(s)
- Emily Schueller
- Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Arindam Nandi
- The Population Council, New York, NY.,Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Amit Summan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Susmita Chatterjee
- George Institute for Global Health, New Delhi, India.,University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, India
| | - Arindam Ray
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India.,High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
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Elkalmi RM, Jamshed SQ, Suhaimi AM. Discrepancies and Similarities in Attitudes, Beliefs, and Familiarity with Vaccination Between Religious Studies and Science Students in Malaysia: A Comparison Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:2411-2427. [PMID: 33661436 DOI: 10.1007/s10943-021-01212-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
Little is known about the impact of religion on vaccine receptivity in Malaysia. Improved vaccine uptake is positively reflected in the reduction of vaccine-preventable diseases. This study aimed to explore and compare the attitudes, religious beliefs, and familiarity regarding vaccination between the religious studies and science students. A survey-based cross-sectional study was conducted between a convenient sample of students (N = 300) of religious studies and applied sciences in Kuantan, Malaysia. A new, face- and content-validated questionnaire was used for data collection. A total of 206 students responded to the questionnaire, giving a response rate of 86.6%. Overall, participants demonstrated positive attitudes towards vaccination (n = 185, 89.9%). Only a minority of respondents expressed an opposition to vaccination (n = 21, 10.2%). Religious factors (permissibility) of vaccines (n = 12, 57.1%) and harm associated with the vaccine (n = 13, 61.9%) were the most common reasons for not supporting vaccination among the non-supporters. Most (n = 135, 65.5%) respondents agreed that vaccination is parallel with the Islamic concept of protecting life and preventing harm. Almost half of the respondents (n = 98, 47.6%) admit to declaring "Fatwa" to oblige parents to vaccinate their children. Religious beliefs and safety issues surrounding immunisation were reported as the major barriers for the support of immunisation. Well-designed programs are recommended to reshape the religious beliefs and convictions among students toward vaccination.
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Affiliation(s)
- Ramadan Mohamed Elkalmi
- Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates.
- Department of Pharmacology, Faculty of Medicine, University of Sebha, Sebha, Libya.
| | - Shazia Qassim Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), 22200, Besut, Terengganu, Malaysia
| | - Azyyati Mohd Suhaimi
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam Campus, 42300, Bandar Puncak Alam, Selangor, Malaysia
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Alaba OA, Hongoro C, Thulare A, Lukwa AT. Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7114. [PMID: 34281051 PMCID: PMC8296912 DOI: 10.3390/ijerph18137114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The United Nations' 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for "leaving no one behind". However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa's and India's Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children's health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. METHODS Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. RESULTS The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (-0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother's education, and mother's age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. CONCLUSIONS The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother's education, and mother's age. In conclusion, if socioeconomic inequalities in children's health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely "some under-five children will be left behind".
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Affiliation(s)
- Olufunke A. Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Charles Hongoro
- Developmental, Capable and Ethical State, Human Sciences Research Council, Pretoria 0001, South Africa;
- School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Aquina Thulare
- National Department of Health, Pretoria 0001, South Africa;
| | - Akim Tafadzwa Lukwa
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
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Jain R, Chopra A, Falézan C, Patel M, Dupas P. COVID-19 related immunization disruptions in Rajasthan, India: A retrospective observational study. Vaccine 2021; 39:4343-4350. [PMID: 34154863 PMCID: PMC8196298 DOI: 10.1016/j.vaccine.2021.06.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
Disruptions during the COVID-19 lockdown caused children to miss immunizations. Government catch-up efforts substantially reversed these effects. Yet, children that were due vaccinations during the lockdown remained 10–15% less likely to be immunized 4–5 months later. Catch-up was more likely to be incomplete among children of low socioeconomic status. Ensuring all children are fully immunized requires careful tracking and disaggregated data.
Introduction Governments around the world suspended immunization outreach to control COVID-19 spread. Many have since resumed services with an emphasis on catch-up vaccinations. This paper evaluated immunization disruptions during India’s March-May 2020 lockdown and the extent to which subsequent catch-up efforts reversed them in Rajasthan, India. Methods In this retrospective observational study, we conducted phone surveys to collect immunization details for 2,144 children that turned one year old between January and October 2020. We used logistic regressions to compare differences in immunization timeliness and completed first-year immunization status among children that were due immunizations just before (unexposed), during (heavily exposed), and after (post-exposure) the lockdown. Results Relative to unexposed children, heavily exposed children were significantly less likely to be immunized at or before 9 months (OR 0.550; 95% CI 0.367–0.824; p = 0.004), but more likely to be immunized at 10–12 months (OR 1.761; 95% CI 1.196–2.591; p = 0.004). They were also less likely to have completed their key first-year immunizations (OR 0.624; 95% CI 0.478–0.816; p = 0.001) by the time of survey. In contrast, post-exposure children showed no difference in timeliness or completed first-year immunizations relative to unexposed children, despite their younger age. First-year immunization coverage among heavily exposed children decreased by 6.9 pp to 10.4 pp (9.7% to 14.0%). Declines in immunization coverage were larger among children in households that were poorer, less educated, lower caste, and residing in COVID red zones, although subgroup comparisons were not statistically significant. Conclusion Disruptions to immunization services resulted in children missing immunization during the lockdown, but catch-up efforts after it was eased ensured many children were reached at later ages. Nevertheless, catch-up was incomplete and children due their immunizations during the lockdown remained less likely to be fully immunized 4–5 months after it lifted, even as younger cohorts due immunizations in June or later returned to pre-lockdown schedules.
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Affiliation(s)
- Radhika Jain
- Stanford University, Stanford, CA 94305-6055, United States.
| | - Ambika Chopra
- The Abdul Latif Jameel Poverty Action Lab (J-PAL) South Asia, Institute for Financial Management and Research, New Delhi, Delhi, India
| | | | - Mustufa Patel
- The Abdul Latif Jameel Poverty Action Lab (J-PAL) South Asia, Institute for Financial Management and Research, New Delhi, Delhi, India
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Abstract
OBJECTIVES Childhood vaccination coverage in Nagaland has lagged almost all states in India for more than two decades. This study aims to find drivers and barriers of childhood vaccination in Nagaland from the perspective of demand, supply and local health governance. DESIGN A cross-sectional study was designed using a survey conducted by the Directorate of Health and Family in 2015. SETTING Households, community-based health centres and health committees were surveyed. PARTICIPANTS 285 children aged under 2 years with vaccination cards and data on households, health centres and health committees were included. OUTCOMES Variables indicating whether a child received each of bacillus calmette-guérin (BCG), diphtheria-tetanus-pertussis (DTP3), oral polio (OPV3) and measles vaccination and all of them were outcome variables. Associated factors were identified using multilevel logistic regressions. RESULTS Antenatal care at least three times was significantly associated with BCG, DTP3, OPV3 and full vaccination with adjusted ORs ranging from 2.4 (95% CI 1.1 to 5.1) to 3.3 (1.1 to 9.9). The availability of bus to health centre was slightly significant for BCG and OPV3 with the adjusted ORs of 2.0 (0.9 to 4.5) and 2.1 (0.9 to 4.8), respectively. Health committees' budget provision to health centres was significant for OPV3 and full vaccination with the respective adjusted ORs of 15.7 (1.0 to 234.1) and 15.9 (1.2 to 214.7), the wide 95% CIs of which were driven by a small sample size. Health committees' review of expenditure of health centres was significant for measles and full vaccination with the adjusted ORs of 4.0 (1.4 to 11.4) and 5.2 (1.4 to 19.4), respectively. CONCLUSION This study suggests that enhancing the utilisation of antenatal care and providing reliable transportation between villages and health centres are required to improve childhood vaccination coverage. Also, the significant association of budget administration of health committees suggests that supporting local health committees for effective financial management is important.
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Affiliation(s)
- Young Eun Kim
- Development Research Group and EAPCE Research Center, World Bank, Kuala Lumpur, Malaysia
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Rapidly modifiable factors associated with full vaccination status among children in Niamey, Niger: A cross-sectional, random cluster household survey. PLoS One 2021; 16:e0249026. [PMID: 33788877 PMCID: PMC8011818 DOI: 10.1371/journal.pone.0249026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Vaccination status becomes more equitable when interventions are carried out to eliminate poverty or to improve levels in maternal education. Low-income countries need to identify interventions that would have a more immediate and equitable effect. The present study aimed to identify rapidly modifiable factors associated with full vaccination status among children in Niamey, Niger. Methods A cross-sectional, random cluster household survey was conducted in Niamey’s five health districts. Data on vaccination coverage and socioeconomic household characteristics were collected. Logistic regression analysis was conducted with data on 445 mothers and their children aged 12–23 months. Results Of 445 children, 38% were fully vaccinated. Mothers who were satisfied with their health worker’s attitude and had correct vaccination calendar knowledge (adjusted odds ratio [aOR] 5.32, 95% confidence interval [CI] 2.05–13.82) were more likely to have fully vaccinated children. Mothers who had completed secondary school (aOR 2.04, 95% CI 1.17–3.55) were also associated with having fully vaccinated children. Conclusions A higher rate of full vaccination among children could be achieved by relatively short-term modifiable factors. These modifiable factors are mothers’ satisfaction with health workers’ attitudes and knowledge of the vaccination calendar. Maternal satisfaction with health workers’ attitudes could be improved through better interpersonal communication between health workers and mothers. Specifically, mothers should be given specific information on time intervals between appointments. Strengthened communication interventions may be effective in improving both the acceptability of health services and low vaccination coverage.
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Kannankeril Joseph VJ. Understanding inequalities in child immunization in India: a decomposition approach. J Biosoc Sci 2021; 54:1-13. [PMID: 33722313 DOI: 10.1017/s0021932021000110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The importance of childhood immunization for healthy child growth and development is well recognized and is considered to be the best and most cost-effective lifesaver. Low socioeconomic status has been shown to be associated with low child immunization and health care utilization, but the inequalities in immunization coverage due to social and economic factors are poorly understood. This study aimed to explore the association between child immunization coverage and various socioeconomic factors and to quantify their contributions to generating inequalities in immunization coverage in India. The study data are from the National Family Health Survey-4 conducted in 2015-16. The association between socioeconomic determinants and child full immunization coverage was estimated using the χ2 test and binary logistic regression. Concentration indices were estimated to measure the magnitude of inequality, and these were further decomposed to explain the contribution of different socioeconomic factors to the total disparity in full immunization coverage. The results showed that the uptake of immunization in 2015-16 was highly associated with mother's educational status and household wealth. The concentration index decomposition revealed that inequality (immunization disadvantage) was highest among poorer economic groups and among children whose mothers were illiterate. The overall concentration index value indicates that the weaker socioeconomic groups in India are more disadvantaged in terms of immunization interventions. The results offer insight into the dynamics of the variation in immunization coverage in India and help identify vulnerable populations that should be targeted to decrease socioeconomic inequalities in the country.
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Arya BK, Khan T, Das RS, Guha R, Das Bhattacharya S. Determinants of vaccine uptake in HIV-affected families from West Bengal. Hum Vaccin Immunother 2021; 17:2036-2042. [PMID: 33545012 DOI: 10.1080/21645515.2020.1851535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Children living with Human Immunodeficiency virus (HIV; CLH) have special vaccine needs. Determinants of household-level uptake of vaccines need to be examined in high-risk families with CLH. We previously conducted a study on the impact of Haemophilus influenzae type b conjugate vaccine and pneumococcal conjugate vaccine (PCV-13) in 125 HIV-affected families and 47 HIV-unaffected families in West Bengal. We then interviewed 99 of these 172 families who had participated in the study to understand the household-level factors that determine vaccine uptake. Sixty-four of the 99 families had one or more CLH. Within these 64 families, 30% of CLH had missed vaccines under the universal immunization program (UIP), compared to only 6% of HIV-uninfected children (HUC) (p = .001). Maternal HIV positivity in a family increased risk of missing UIP vaccines nearly five times (4.82, p = .001). Almost all families accessed UIP vaccines at local primary vaccination centers, but 14% of families experienced stigma due to HIV and avoided getting one or more vaccine doses. In contrast, in our study, 100% of HIV-affected families actively sought PCV-13 and HibCV, despite having to travel. Factors that influenced uptake included awareness generation and activation by an outreach worker and availability of vaccines on pick-up days for anti-retroviral therapy. Eighty-six percent of families strongly recommended PCV-13 to other families. To conclude, while we found that CLH have barriers to getting vaccinations, a program designed to take into consideration the obstacles that HIV-affected families face showed a high rate of vaccine uptake.
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Affiliation(s)
- Bikas K Arya
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Tila Khan
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Ranjan Saurav Das
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Rajlakshmi Guha
- Centre for Educational Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Sangeeta Das Bhattacharya
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
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Wagner AL, Shotwell AR, Boulton ML, Carlson BF, Mathew JL. Demographics of Vaccine Hesitancy in Chandigarh, India. Front Med (Lausanne) 2021; 7:585579. [PMID: 33521011 PMCID: PMC7844137 DOI: 10.3389/fmed.2020.585579] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
The impact of vaccine hesitancy on childhood immunization in low- and middle-income countries remains largely uncharacterized. This study describes the sociodemographic patterns of vaccine hesitancy in Chandigarh, India. Mothers of children <5 years old were sampled from a two-stage cluster, systematic sample based on Anganwadi child care centers in Chandigarh. Vaccine hesitancy was measured using a 10-item Vaccine Hesitancy Scale, which was dichotomized. A multivariable logistic regression assessed the association between socioeconomic factors and vaccine hesitancy score. Among 305 mothers, >97% of mothers thought childhood vaccines were important, effective, and were a good way to protect against disease. However, many preferred their child to receive fewer co-administered vaccines (69%), and were concerned about side effects (39%). Compared to the “other caste” group, scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy (95% CI: 1.52, 7.99). Those with a high school education had 0.10 times the odds of vaccine hesitancy compared to those with less education (95% CI: 0.02, 0.61). Finally, those having more antenatal care visits were less vaccine hesitant (≥4 vs. <4 visits OR: 0.028, 95% CI: 0.1, 0.76). As India adds more vaccines to its Universal Immunization Program, consideration should be given to addressing maternal concerns about vaccination, in particular about adverse events and co-administration of multiple vaccines.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Abigail R Shotwell
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Division of Infectious Disease, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Joseph L Mathew
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
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Hardhantyo M, Chuang YC. Urban-rural differences in factors associated with incomplete basic immunization among children in Indonesia: A nationwide multilevel study. Pediatr Neonatol 2021; 62:80-89. [PMID: 32962954 DOI: 10.1016/j.pedneo.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Identifying risk factors of incomplete immunization among children is crucial to developing relevant policies to improve immunization coverage. In this study, we investigated factors associated with incomplete immunization among children in Indonesia and elucidated differences in risk factors between urban and rural areas. METHODS The data came from a national-wide survey, the 2017 Indonesia Demographic Health Surveys. In total, 3264 children aged 12-23 months were included in the study. An incomplete immunization status was defined as a child who did not complete the ten doses of basic vaccinations, consisting of one dose of bacille Calmette-Guérin, one dose of hepatitis B, three doses of pentavalent vaccine (diphtheria, pertussis, tetanus, hemophilus influenza type B, and hepatitis B vaccine), four doses of polio vaccine, and one dose of measles vaccine. Generalized linear mixed models were constructed to examine the effects of different levels of risk factors on the incomplete immunization status. We further conducted stratified analyses by urban and rural areas. RESULTS About 40% of the 3264 children were incompletely immunized, among whom 45.3% were in urban areas and 54.7% were in rural areas. Eight of the 34 provinces had incomplete immunization rates exceeding 50%, and the Papua and Maluku regions had the highest rates of incomplete child immunization. The multivariate analyses showed that when women attended fewer than four antenatal care sessions and resided outside the Nusa Tenggara region, their children were more likely to have incomplete immunization in both urban and rural areas. On the other hand, having no health insurance was positively associated with incomplete immunization in urban areas, whereas having received a tetanus vaccination during pregnancy was negatively associated with incomplete immunization in rural areas. CONCLUSIONS Results of this study suggest that tailored interventions should be developed to address significant risk factors in rural and urban areas.
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Affiliation(s)
- Muhammad Hardhantyo
- School of Public Health, Taipei Medical University, Taipei, Taiwan; Faculty of Health Science, Universitas Respati Yogyakarta, Yogyakarta, Indonesia
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, Taipei, Taiwan.
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Bettampadi D, Lepkowski JM, Sen A, Power LE, Boulton ML. Vaccination Inequality in India, 2002-2013. Am J Prev Med 2021; 60:S65-S76. [PMID: 33097336 DOI: 10.1016/j.amepre.2020.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION India's childhood vaccination coverage has increased amid the implementation of national health policies intended to improve immunization levels. However, there is a dearth of contemporary studies comparing state-level childhood vaccination rates across India's highly diverse states and territories. This study assesses SES-based inequalities in childhood vaccination by state for 2002-2013. METHODS National surveys from 2002 to 2004, 2007 to 2008, and 2012 to 2013 were used for analyses. Household SES was assessed using an asset index created through principal component analysis. Full vaccination comprised 1 dose bacille Calmette-Guerin, 3 doses diphtheria-pertussis-tetanus vaccine, 3 doses oral polio vaccine, and 1 dose measles-containing vaccine at age 12-60 months. Inequality analyses were stratified by 3 time periods and by government-designated high focus group versus non-high focus group states. RESULTS Childhood vaccination steadily increased between 2002 and 2013 in high focus group states but fell in some non-high focus group states, whereas SES-based vaccination inequalities generally decreased in both. In 2012-2013, rural areas had lower vaccination rates than urban areas in high focus group states but similar vaccination rates as urban areas in non-high focus group states. Increases in vaccination rates were not consistently accompanied by improvements in SES-based inequalities in vaccination. CONCLUSIONS Childhood vaccination in India has improved overall, although increases are more pronounced in high focus group states than in non-high focus group states over the study period. The gap in coverage between these states decreased over time owing in part to the latter experiencing reductions in full vaccination rates during 2007-2013. SES-based vaccination disparities persist in India, highlighting the need to improve vaccination rates for all children, especially those from disadvantaged and underserved groups. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Deepti Bettampadi
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - James M Lepkowski
- Department of Survey Methodology, Institute for Social Research, Ann Arbor, Michigan
| | - Ananda Sen
- Department of Family Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Laura E Power
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Infectious Disease Division, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Infectious Disease Division, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
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Impact of Multiple Risk Factors on Vaccination Inequities: Analysis in Indian Infants Over 2 Decades. Am J Prev Med 2021; 60:S34-S43. [PMID: 33183900 DOI: 10.1016/j.amepre.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Several authors have explored the effect of individual risk factors on vaccination inequity in Indian infants. This study explores the combined impact of >1 risk factor on the probability of full vaccination. METHODS The proportion of fully vaccinated infants (aged 1-2 years) was calculated from the National Family Health Survey conducted during 1997-1998 (National Family Health Survey-2, n=10,211), 2005-2006 (National Family Health Survey-3, n=9,582), and 2015-2016 (National Family Health Survey-4, n=48,715). Full vaccination was defined as receiving Bacille Calmette‒Guerin (1 dose); diphtheria, pertussis, tetanus (3 doses); oral polio (3 doses); and measles (1 dose) vaccines. The association between full vaccination status and 6 factors (infant sex, birth order, family wealth status, maternal education level, residence type, and religion) was analyzed individually, followed by the combined impact of ≥1 of the first 4, using logistic regression models. RESULTS The AORs for full vaccination in the 3 surveys, respectively, were 1.09, 1.13, and 1.00 for male versus female infants; 0.68, 0.71, and 0.88 for birth order >1 versus birth order 1; 1.54, 1.96, and 1.20 for greater wealth versus lowest wealth stratum; 2.21, 2.27, and 1.27 for any maternal education versus none; 1.08, 1.10, and 1.08 for Hindu versus other religion; and 1.51, 1.10, and 0.88 for urban versus rural residence. The respective ORs of full vaccination in the 3 surveys by the number of risk factors were as follows: 1.26, 1.54, and 1.27 for 3 risk factors; 2.41, 3.23, and 1.68 for 2 risk factors; 4.42, 6.45, and 2.18 for 1 risk factor; and 7.32, 9.84, and 2.61 for no risk factor. CONCLUSIONS The presence of multiple risk factors had a cumulative negative impact on infant vaccination in India. Despite an improvement over 2 decades, significant inequities persist. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Mohanraj G, Mohanraj V, Senthilkumar J, Suresh Y. A hybrid deep learning model for predicting and targeting the less immunized area to improve childrens vaccination rate. INTELL DATA ANAL 2020. [DOI: 10.3233/ida-194820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been a major and rising interest in India for increasing vaccination rate among peoples to make the nation healthier and safer. In this paper, a new hybrid deep learning model is proposed to predict and target vaccination rates in the less immunized regions. The Rank-Based Multi-Layer Perceptron (R-MLP) hybrid deep learning framework uses the data collected from the recently updated District Level Household Survey-4 (DLHS). R-MLP model predicts and categorizes the percentage of partly immunized vaccination rates as extreme, low and medium ranges. This predicted findings are cross-verified by Deep Soft Cosine Semantic and Ranking SVM based model (DSS-RSM). DSS-RSM model uses the data obtained from the medical practitioners through a location-based social network. The proposed model predicts and extracts patterns with high similarity frequency for identifying vulnerable low immunization regions. It classifies the predicted patterns into two classes such as Class 1 is denoted as high ranked regions and Class 2 is denoted as low ranked regions based on the percentage of pattern matches. Finally, the results from R-MLP and DSS-RSM models are cross-linked together using ensemble model. This model finds the loss values to identify the target regions were health care program need to be conducted for increasing the level of immunization among children’s. The proposed hybrid deep learning models trains and validates using python-based Keras and TensorFlow deep learning libraries. The performance of the proposed hybrid deep learning model is compared with other variant machine learning techniques such as Decision Tree C5.0, Naive Bayes and Linear Regression. This comparative results are evaluated using evaluation measures such as Precision, Recall, Accuracy and F1-Measure. Our results show that the hybrid deep learning system is clearly superior to any other alternative approach.
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Affiliation(s)
- G. Mohanraj
- Department of Computer Science and Engineering, Sona College of Technology, Salem, Tamil Nadu, India
| | - V. Mohanraj
- Department of Information Technology, Sona College of Technology, Salem, Tamil Nadu, India
| | - J. Senthilkumar
- Department of Information Technology, Sona College of Technology, Salem, Tamil Nadu, India
| | - Y. Suresh
- Department of Information Technology, Sona College of Technology, Salem, Tamil Nadu, India
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Shenton LM, Wagner AL, Ji M, Carlson BF, Boulton ML. Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review. BMJ Open 2020; 10:e039693. [PMID: 33268412 PMCID: PMC7713201 DOI: 10.1136/bmjopen-2020-039693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status. DESIGN Scoping review. DATA SOURCES Electronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018. STUDY SELECTION All English studies with vaccination status as the outcome and the use of DHS data. DATA EXTRACTION Studies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted. RESULTS A total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1-86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO's Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child's sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition. CONCLUSIONS Researchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Bobo FT, Hayen A. Decomposition of socioeconomic inequalities in child vaccination in Ethiopia: results from the 2011 and 2016 demographic and health surveys. BMJ Open 2020; 10:e039617. [PMID: 33082196 PMCID: PMC7577064 DOI: 10.1136/bmjopen-2020-039617] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Monitoring and addressing unnecessary and avoidable differences in child vaccination is a critical global concern. This study aimed to assess socioeconomic inequalities in basic vaccination coverage among children aged 12-23 months in Ethiopia. DESIGN, SETTING AND PARTICIPANTS Secondary analyses of cross-sectional data from the two most recent (2011 and 2016) Ethiopia Demographic and Health Surveys were performed. This analysis included 1930 mother-child pairs in 2011 and 2004 mother-child pairs in 2016. OUTCOME MEASURES Completion of basic vaccinations was defined based on whether a child received a single dose of Bacille Calmette-Guerin (BCG), three doses of diphtheria, tetanus toxoids and pertussis (DTP), three doses of oral polio vaccine and one dose of measles vaccine. METHODS The concentration Curve and Concentration Indices (CCIs) were used to estimate wealth related to inequalities. The concentration indices were also decomposed to examine the contributing factors to socioeconomic inequalities in childhood vaccination. RESULTS From 2011 to 2016, the proportion of children who received basic vaccination increased from 24.6% (95% CI 21.4% to 28.0%) to 38.6% (95% CI 34.6% to 42.9%). While coverage of BCG, DTP and polio immunisation increased during the study period, the uptake of measles vaccine decreased. The positive concentration index shows that basic vaccination coverage was pro-rich (CCI=0.212 in 2011 and CCI=0.172 in 2016). The decomposition analysis shows that use of maternal health services such as family planning and antenatal care, socioeconomic status, exposure to media, urban-rural residence and maternal education explain inequalities in basic vaccination coverage in Ethiopia. CONCLUSIONS Childhood vaccination coverage was low in Ethiopia. Vaccination was less likely in poorer than in richer households. Addressing wealth inequalities, enhancing education and improving maternal health service coverage will reduce socioeconomic inequalities in basic vaccination uptake in Ethiopia.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Rauniyar SK, Munkhbat E, Ueda P, Yoneoka D, Shibuya K, Nomura S. Timeliness of routine vaccination among children and determinants associated with age-appropriate vaccination in Mongolia. Heliyon 2020; 6:e04898. [PMID: 32995607 PMCID: PMC7505765 DOI: 10.1016/j.heliyon.2020.e04898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction Routine vaccination at the recommended age is crucial to minimize the risk of acquiring vaccine preventable diseases. This study aimed to assess the proportion of children receiving routine immunization at the recommended age and determinants of timely (age-appropriate) vaccination in Mongolia. Material and method A total of 879 eligible children aged 12-23 months were included in this study. We investigated age-appropriate administration of Bacillus Calmette-Guerin vaccine (BCG); hepatitis B vaccine (Hep B); oral polio vaccine (OPV); pentavalent vaccine; and measles, mumps, and rubella vaccine (MMR) using Kaplan-Meier method. Multilevel logistic regression with random intercept at cluster level was used to assess the determinants of age-appropriate vaccination. Results Overall, the crude vaccination coverage for routine vaccinations were above 90% for all vaccines except MMR1 which was 86.0% (95% CI, 83.6-88.2). While the first dose of almost all the vaccines given at birth; BCG, Hep B, and OPV0, were administered in a timely manner, a substantial proportion of second and third doses of these vaccines were not given in a timely manner with age-appropriate vaccination coverage ranging from 35.9% (32.8-39.1%) for MMR1 to 67.7% (64.5-70.7%) for OPV1 respectively. Factors associated with age-appropriate administration of the investigated vaccines included socio-economic status of household, religion of household heads, area of residence, owning mobile phone, and season of childbirth. For instance, children belonging to households from richer wealth quintile had higher possibilities of getting age-appropriate OPV1-OPV3, PE1-PE3 and MMR1 vaccines compared to those from the poorest household wealth quintile. Conclusion Our findings suggest that the commonly used indicator 'crude vaccination coverage' could be supplemented by 'age-appropriate vaccination' to help to identify gaps in timely vaccinations and stimulate interventions in Mongolia. Factors such as household wealth quintile, place of residence and religion associated with timely vaccination in our study could be considered to promote effective intervention aiming to improve adequate vaccination coverage.
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Affiliation(s)
- Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Enkhtuya Munkhbat
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Peter Ueda
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
| | - Daisuke Yoneoka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Kenji Shibuya
- Institute for Population Health Science, King's College London, London
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Agrawal A, Kolhapure S, Di Pasquale A, Rai J, Mathur A. Vaccine Hesitancy as a Challenge or Vaccine Confidence as an Opportunity for Childhood Immunisation in India. Infect Dis Ther 2020; 9:421-432. [PMID: 32447713 PMCID: PMC7452967 DOI: 10.1007/s40121-020-00302-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 01/12/2023] Open
Abstract
Vaccines have contributed substantially to decreasing the morbidity and mortality rates of many infectious diseases worldwide. Despite this achievement, an increasing number of parents have adopted hesitant behaviours towards vaccines, delaying or even refusing their administration to children. This has implications not only on individuals but also society in the form of outbreaks for e.g. measles, chicken pox, hepatitis A, etc. A review of the literature was conducted to identify the determinants of vaccine hesitancy (VH) as well as vaccine confidence and link them to challenges and opportunities associated with vaccination in India, safety concerns, doubts about the need for vaccines against uncommon diseases and suspicions towards new vaccines were identified as major vaccine-specific factors of VH. Lack of awareness and limited access to vaccination sites were often reported by hesitant parents. Lastly, socio-economic level, educational level and cultural specificities were contextual factors of VH in India. Controversies and rumours around some vaccines (e.g., human papillomavirus) have profoundly impacted the perception of the risks and benefits of vaccination. Challenges posed by traditions and cultural behaviours, geographical specificities, socio-demographic disparities, the healthcare system and vaccine-specific features are highlighted, and opportunities to improve confidence are identified. To overcome VH and promote vaccination, emphasis should be on improving communication, educating the new generation and creating awareness among the society. Tailoring immunisation programmes as per the needs of specific geographical areas or communities is also important to improve vaccine confidence. Fig. 1 Plain language summary.
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Affiliation(s)
| | | | | | - Jayant Rai
- Medical Affairs Department, GSK, Lucknow, India
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Continuum of maternal health care services and its impact on child immunization in India: an application of the propensity score matching approach. J Biosoc Sci 2020; 53:643-662. [PMID: 32830633 DOI: 10.1017/s0021932020000450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015-16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15-49 were included in the analysis of maternal health care indicators, and 8246 children aged 12-23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.
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Socioeconomic inequality trends in childhood vaccination coverage in India: Findings from multiple rounds of National Family Health Survey. Vaccine 2020; 38:4088-4103. [DOI: 10.1016/j.vaccine.2020.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/26/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
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Hasan MZ, Dean LT, Kennedy CE, Ahuja A, Rao KD, Gupta S. Social capital and utilization of immunization service: A multilevel analysis in rural Uttar Pradesh, India. SSM Popul Health 2020; 10:100545. [PMID: 32405528 PMCID: PMC7211897 DOI: 10.1016/j.ssmph.2020.100545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/25/2022] Open
Abstract
The National Health Policy (2017) of India advocates Universal Health Coverage through inclusive growth, decentralization, and rebuilding a cohesive community through a participatory process. To achieve this goal, understanding social organization, and community relationships - defined as social capital - is critical. This study aimed to explore the influence of individual and community-level social capital on a critical health system performance indicator, three-doses of diphtheria-pertussis-tetanus (DPT3) immunization among 12-59 month children, in rural Uttar Pradesh (UP), India. The analysis is based on a cross-sectional survey from two districts of UP, which included 2239 children 12-59 months of age (level 1) from 1749 households (level 2) nested within 346 communities (level 3). We used multilevel confirmatory factor analysis to generate standardized factor scores of social capital constructs (Organizational Participation, Social Support, Trust and Social Cohesion) of the household heads and mothers both at individual and community level, which were then used in the multilevel logistic regressions to explore the independent and contextual effect of social capital on a child's DPT3 immunization status. The result showed only community-level Social Cohesion of the mothers was associated with a child's DPT3 immunization status (Adjusted odds ratio = 1.25, 95% confidence interval = 1.12-1.54; p = 0.04). Beyond its independent effect on utilization of immunization service, the collective Social Cohesion of the mothers significantly modified the relationship of child age, mother's knowledge of immunization, community wealth, and communities' contact with frontline workers with immunization status of the child. With a strong theoretical underpinning, the result substantially contributes to understanding the individual and contextual predictors of immunization service utilization and further advancing the literature of social capital in India. This study can serve as a starting point to catalyze social capital within the health interventions for achieving wellbeing and the collective development of society.
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Akshay Ahuja
- School of Public Policy at Central European University, Budapest, Hungary
| | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Deressa AT, Desta MS, Belihu TM. Vaccination Status and Associated Factors among Street Children 9-24 Months Old in Sidama Region, Ethiopia. Ann Glob Health 2020; 86:4. [PMID: 31934551 PMCID: PMC6952879 DOI: 10.5334/aogh.2650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Childhood non-vaccination can have different short-and long-term negative outcomes on their health. In Ethiopia, in addition to low coverage of full vaccination, street children were among the neglected part of the community who were missed during planning and reporting vaccination coverage. Moreover, there is no related research conducted on this title specifically. Objective The objective of the study was to assess the vaccination status and its associated factors among street children 9-24 months old in Sidama zone. Methods Community-based cross-sectional study design was conducted in four selected towns of Sidama region, southern Ethiopia. The convenience sampling method was applied to involve mothers of street children younger than two years during the study period. Data entry was done with EpiData version 3.1 and exported to SPSS22 for analysis. Bivariate and multivariable logistic regression analysis were performed to identify factors associated with immunization status of street children. Results A significant number (26 [24.3%]) of the street children younger than two years were not vaccinated. Those mothers who are ≤20 years old (P = 0.014, AOR = 0.216, 95% CI: 0.064-0.732) and who gave birth at home (P = 0.029, AOR = 0.292, 95% CI: 0.097-0.879) had less odds of vaccinating their child than those older than 20 and who gave birth at health facility respectively. Conclusion A significant number of the street children in this study are not fully vaccinated. Mothers aged <20 years and home births were significantly associated with non-vaccination status.
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Affiliation(s)
| | - Melesse Siyoum Desta
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, ET
| | - Teshome Melesse Belihu
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, ET
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Ntenda PAM. Factors associated with non- and under-vaccination among children aged 12-23 months in Malawi. A multinomial analysis of the population-based sample. Pediatr Neonatol 2019; 60:623-633. [PMID: 31040068 DOI: 10.1016/j.pedneo.2019.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non- and under-vaccination among children in Malawi have received little attention. Between 2010 and 2016, the proportion of children who received full immunization before their first birthday dropped from 81% to 76% in Malawi. This signifies that a certain fraction of children are either non-vaccinated or under-vaccinated. Thus, the present study attempted to examine the predictors of non- and under-vaccination among children aged 12-23 months in Malawi. METHODS Cross-sectional data obtained from the Malawi Demographic and Health Survey 2015-16 were utilized. The percentage of children aged 12-23 months who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of pentavalent, 2 doses of rotavirus vaccine, 3 doses of pneumococcal vaccine and 1 dose of measles-containing vaccine were calculated. The odds of being non-vaccinated and under-vaccinated compared to full vaccination relative to various sociodemographic factors were assessed using a multivariable multinomial logistic regression with logit link function which accounted for survey design. RESULTS Of 3111 children aged 12-23 months, 72% were fully vaccinated, 26% were under-vaccinated, and about 2% were non-vaccinated. The multinomial logistic regression showed that children from the poorest households, and children who did not have postnatal care within two months had increased odds of being under-vaccinated. On the other hand, children who had no health card or whose card was lost had increased odds of being both non- and under-vaccinated. Additionally, children from the northern region and who resided in households with either none or one under-five child had reduced odds of being non-vaccinated and under-vaccinated, respectively. CONCLUSIONS Women from the poorest households and those who are not attending PNC should be targeted when designing interventions that aim at improving childhood vaccination in order to reduce the barriers they face in accessing vaccination services.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, Taipei Medical University, College of Public Health, No. 250, Wu-Hsing St, Taipei City 11031, Taiwan.
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Wagner AL, Porth JM, Bettampadi D, Boulton ML. Have community health workers increased the delivery of maternal and child healthcare in India? J Public Health (Oxf) 2019; 40:e164-e170. [PMID: 28985399 DOI: 10.1093/pubmed/fdx087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/04/2017] [Indexed: 11/12/2022] Open
Abstract
Background Accredited Social Health Activists (ASHAs) are community health workers in rural India. This study estimates the proportion of villages with an ASHA and examines the impact of increased ASHA placement on changes in healthcare. Methods Information about ASHA placement and maternal and child healthcare was obtained from the District-Level Household Surveys from 2007 to 2008 and 2012 to 2013. In this ecological analysis, the difference in district-level proportions of maternal and child healthcare outcomes between 2012-13 and 2007-08 was regressed onto the difference in ASHA placement between those years. Results Within 218 districts from 21 states, the average proportion of villages with an ASHA increased from 39.1 to 76.2%, unmet need for family planning increased from 14.7 to 22.4%, institutional delivery increased from 61.6 to 82.5%, and full immunization coverage decreased from 71.2 to 65.1%. A 1% increase in ASHA placement resulted in 0.05% less unmet need for family planning and 0.22% more full immunization, but no changes in institutional delivery. Conclusions ASHAs provide essential services to their community by acting as a conduit to healthcare services, but they may require more training about certain services like promoting institutional delivery to be effective in increasing access to these health services.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Deepti Bettampadi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, MI, USA
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Wagner AL, Masters NB, Domek GJ, Mathew JL, Sun X, Asturias EJ, Ren J, Huang Z, Contreras-Roldan IL, Gebremeskel B, Boulton ML. Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries. Vaccines (Basel) 2019; 7:vaccines7040155. [PMID: 31635270 PMCID: PMC6963484 DOI: 10.3390/vaccines7040155] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022] Open
Abstract
Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO's 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother's education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (β: 0.56, P = 0.0001), however, mothers in Ethiopia (β: -0.54, P < 0.0001) and Guatemala (β: -0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Gretchen J Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA.
- Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA.
| | - Joseph L Mathew
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China.
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA.
- Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, B119, 13001 E 17th Place, Aurora, CO 80045, USA.
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China.
| | - Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China.
| | - Ingrid L Contreras-Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City 01015, Guatemala.
| | - Berhanu Gebremeskel
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Joe P, Majgi SM, Vadiraja N, Khan MA. Influence of Sociodemographic Factors in Measles-Rubella Campaign Compared with Routine Immunization at Mysore City. Indian J Community Med 2019; 44:209-212. [PMID: 31602104 PMCID: PMC6776951 DOI: 10.4103/ijcm.ijcm_236_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Vaccines are mostly delivered through routine immunization and catch-up campaigns. Measles-rubella (MR) campaign, one of the largest vaccination campaigns, was launched on February 8, 2017, in five states of India including Karnataka. Objectives The objective of this study was to compare the association of various sociodemographic factors influencing routine immunization and MR campaign and to identify the reasons for nonvaccination. Materials and Methods A cross-sectional study was done after the end of MR campaign, by interviewing parents of 147 children aged 9 months to 5 years in urban areas of Mysore. Sociodemographic factors and measles vaccination status by routine immunization and MR campaign were studied. Results The coverage of measles vaccination by routine immunization and the MR campaign was 93.9% (138/147) and 86.4% (127/147), respectively. While communication with field workers was significantly associated with both routine immunization and the MR campaign, religion and mother's educational status were associated with MR campaign (P < 0.05). The most common reason for not being vaccinated was lack of unawareness about the campaign and the location for vaccination which could have been curbed by health education. Conclusions The study has shown that there are many factors which can be prevented by the health system that might help in improving immunization coverage.
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Affiliation(s)
- Prathyusha Joe
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India
| | - Sumanth Mallikarjuna Majgi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India
| | - N Vadiraja
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India
| | - Mudassir Azeez Khan
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India
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Hajizadeh M. Decomposing socioeconomic inequality in child vaccination in the Gambia, the Kyrgyz Republic and Namibia. Vaccine 2019; 37:6609-6616. [PMID: 31558326 DOI: 10.1016/j.vaccine.2019.09.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/10/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Extant work suggested pro-rich distribution of vaccination coverage in low- and middle-income countries (LMICs). However, the current literature also suggested pro-poor distribution of vaccination in some countries, including the Gambia, the Kyrgyz Republic and Namibia. This study aimed to explain socioeconomic inequalities in the completion rate of the four-core vaccines (i.e., Bacille Calmette-Guérin [BCG], diphtheria-tetanus-pertussis [DTP, 3 doses], Polio [3 doses] and Measles vaccines) in the three aforementioned countries. We used the most recent available Demographic Health Surveys (DHS) to measure vaccination completion rates among children (aged 0-59 months, n = 16,752) in the three countries. The normalized concentration index (Cn) was used to quantify and decompose socioeconomic inequalities in vaccination coverage in each country. The negative values of the Cn index suggested that children belong to lower socioeconomic status groups were more likely to be immunized than their higher socioeconomic status counterparts in the Gambia (Cn = -0.101, 95% confidence interval [CI]: -0.128 to -0.074), the Kyrgyz Republic (Cn = -0.097, 95% CI: -0.13 to -0.063) and Namibia (Cn = -0.161, 95% CI: -0.199 to -0.124). The decomposition analysis of the Cn suggested that the difference in child vaccination completion rates between rural and urban areas was the main factor contributing to the concentration of child vaccination among the poor in the Gambia and Namibia. The concentration of child vaccination among the poor in the Kyrgyz Republic was chiefly determined by household wealth. These results suggest that there should be strategies to improve child immunization uptake among urban children in the Gambia and Namibia. Since household wealth was the main factor contributing to the observed pro-poor distribution of child vaccination in the Kyrgyz Republic, further studies are required to understand the reasons for lower vaccination rate among the wealthy children in order to implement the most effective strategies to increase child vaccination uptake.
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Affiliation(s)
- Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS B3H 4R2, Canada.
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Geremew TT, Gezie LD, Abejie AN. Geographical variation and associated factors of childhood measles vaccination in Ethiopia: a spatial and multilevel analysis. BMC Public Health 2019; 19:1194. [PMID: 31470822 PMCID: PMC6716824 DOI: 10.1186/s12889-019-7529-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is crucial for evidence-based decision-making. However, the spatial pattern of measles-containing vaccine (MCV1) and its predictors are poorly understood. Hence, this study aimed to explore the spatial pattern and associated factors of childhood MCV1 coverage. METHODS An in-depth analysis of the 2016 Ethiopia demographic and health survey data was conducted, and a total of 3722 children nested in 611 enumeration areas were included in the analysis. Global Moran's I statistic and Poisson-based purely spatial scan statistics were employed to explore spatial patterns and detect spatial clusters of childhood MCV1, respectively. Multilevel logistic regression models were fitted to identify factors associated with childhood MCV1. RESULTS Spatial hetrogeniety of childhood MCV1 was observed (Global Moran's I = 0.13, p-value < 0.0001), and seven significant SaTScan clusters of areas with low MCV1 coverage were detected. The most likely primary SaTScan cluster was detected in the Afar Region, secondary cluster in Somali Region, and tertiary cluster in Gambella Region. In the final model of the multilevel analysis, individual and community level factors accounted for 82% of the variance in the odds of MCV1 vaccination. Child age (AOR = 1.53; 95%CI: 1.25-1.88), pentavalent vaccination first dose (AOR = 9.09; 95%CI: 6.86-12.03) and third dose (AOR = 7.12; 95%CI: 5.51-9.18, secondary and above maternal education (AOR = 1.62; 95%CI: 1.03-2.55) and media exposure were the factors that increased the odds of MCV1 vaccination at the individual level. Children with older maternal age had lower odds of receiving MCV1. Living in Afar, Oromia, Somali, Gambella and Harari regions were factors associated with lower odds of MCV1 from the community-level factors. Children far from health facilities had higher odds of receiving MCV1 (AOR = 1.31, 95%CI = 1.12-1.61). CONCLUSION A clustered pattern of areas with low childhood MCV1 coverage was observed in Ethiopia. Both individual and community level factors were significant predictors of childhood MCV1. Hence, it is good to give priority for the areas with low childhood MCV1 coverage, and to consider the identified factors for vaccination interventions.
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Affiliation(s)
- Tesfahun Taddege Geremew
- Ethiopian Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 169, Gondar, Ethiopia
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 169, Gondar, Ethiopia
| | - Ayenew Negesse Abejie
- Department of Human Nutrition and Food Sciences, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
- Academic Center of Excellence for Human Nutrition, Food Science and Post-harvest Technology, Hawassa University, Hawassa, Ethiopia
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Tosepu R, Gunawan J, Effendy DS, Ahmad LOAI, Farzan A. The outbreak of diphtheria in Indonesia. Pan Afr Med J 2019; 31:249. [PMID: 31448005 PMCID: PMC6691314 DOI: 10.11604/pamj.2018.31.249.16629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/05/2018] [Indexed: 11/11/2022] Open
Abstract
Diptheria is commonly caused by the aerobic gram-positive bacteria, corynebacterium diphtheria. We herein report an unusual case of diphtheria outbreak in Indonesia in 2017 and its possible causes and current management.
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Affiliation(s)
- Ramadhan Tosepu
- Faculty of Public Health, University of Halu Oleo, Kendari, Indonesia
| | - Joko Gunawan
- Akademi Keperawatan Pemerintah Kabupaten Belitung Tanjung pandan, Sumatera Selatan, Indonesia
| | | | | | - Amrin Farzan
- Center of Research, Yayasan Cipta Anak Bangsa (YCAB), Sulawesi Tenggara, Indonesia
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Coverage and Determinants of Full Immunization: Vaccination Coverage among Senegalese Children. ACTA ACUST UNITED AC 2019; 55:medicina55080480. [PMID: 31416213 PMCID: PMC6723170 DOI: 10.3390/medicina55080480] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022]
Abstract
Background and Objectives: In line with the global success of immunization, Senegal achieved impressive progress in childhood immunization program. However, immunization coverage is often below the national and international targets and even not equally distributed across the country. The objective of this study is to estimate the full immunization coverage across the geographic regions and identify the potential factors of full immunization coverage among the Senegalese children. Materials and Methods: Nationally representative dataset extracted from the latest Continuous Senegal Demographic and Health Survey 2017 was used for this analysis. Descriptive statistics such as the frequency with percentage and multivariable logistic regression models were constructed and results were presented in terms of adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: Overall, 70.96% of Senegalese children aged between 12 to 36 months were fully immunized and the coverage was higher in urban areas (76.51%), west ecological zone (80.0%), and among serer ethnic groups (77.24%). Full immunization coverage rate was almost the same between male and female children, and slightly higher among the children who were born at any health care facility (74.01%). Children who lived in the western zone of Senegal were 1.66 times (CI: 1.25–2.21; p = 0.001) and the children of Serer ethnic groups were 1.43 times (CI: 1.09–1.88; p = 0.011) more likely to be fully immunized than the children living in the southern zone and from the Poular ethnic group. In addition, children who were born at health facilities were more likely to be fully immunized than those who were born at home (AOR = 1.47; CI: 1.20–1.80; p < 0.001), and mothers with recommended antenatal care (ANC) (4 and more) visits during pregnancy were more likely to have their children fully immunized than those mother with no ANC visits (AOR: 2.06 CI: 1.19–3.57; p = 0.010). Conclusions: Immunization coverage was found suboptimal by type of vaccines and across ethnic groups and regions of Senegal. Immunization program should be designed targeting low performing areas and emphasize on promoting equal access to education, decision-making, encouraging institutional deliveries, and scaling up the use of antenatal and postnatal care which may significantly improve the rate full immunization coverage in Senegal.
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Hailu S, Astatkie A, Johansson KA, Lindtjørn B. Low immunization coverage in Wonago district, southern Ethiopia: A community-based cross-sectional study. PLoS One 2019; 14:e0220144. [PMID: 31339939 PMCID: PMC6655723 DOI: 10.1371/journal.pone.0220144] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Immunization is a cost-effective intervention that prevented more than 5 million deaths worldwide from 2010 to 2015. Despite increased vaccination coverage over the past four decades in many African countries, including Ethiopia, universal coverage has not yet been reached. Only 39% of children aged 12-23 months received full vaccinations in Ethiopia, according to the 2016 Ethiopian Demographic Health Survey. This study aimed to evaluate immunization coverage and identify individual and community factors that explain incomplete vaccination coverage among children aged 6-36 months in the Wonago district of southern Ethiopia. METHODS We conducted a community-based, cross-sectional study in three randomly selected kebeles in the Wonago district from June to July 2017. Our nested sample of 1,116 children aged 6-36 months included 923 child-mother pairs (level 1) within kebeles (level 2). We conducted multilevel regression analysis using STATA software. RESULTS Among participants, 85.0% of children aged 12-36 months received at least one vaccine, and 52.4% had complete immunization coverage. After controlling for several individual and community variables, we identified six significant predictor variables for complete immunization: Older mothers' age (AOR = 1.05, 95% CI: 1.00-1.09), higher utilization of antenatal care (AOR = 1.36, 95% CI: 1.14-1.62), one or more tetanus-toxoid vaccination during pregnancy (AOR = 2.64, 95% CI: 1.43-4.86), mothers knowing the age at which to complete child's vaccinations (AOR = 2.00, 95% CI: 1.25-3.20), being a female (AOR = 0.64, 95% CI: 0.43-0.95), and child receiving vitamin A supplementation within the last 6 months (AOR = 2.79, 95% CI: 1.59-4.90). We observed a clustering effect at the individual and community levels with an intra-cluster correlation coefficient of 48.1%. CONCLUSIONS We found low immunization coverage among children in the Wonago district of southern Ethiopia, with significant differences across communities. Promoting maternal health care and community service could enhance immunization coverage.
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Affiliation(s)
- Samrawit Hailu
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.,School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Ayalew Astatkie
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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Sarker AR, Akram R, Ali N, Sultana M. Coverage and factors associated with full immunisation among children aged 12-59 months in Bangladesh: insights from the nationwide cross-sectional demographic and health survey. BMJ Open 2019; 9:e028020. [PMID: 31289076 PMCID: PMC6629384 DOI: 10.1136/bmjopen-2018-028020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the coverage and factors associated with full immunisation coverage among children aged 12-59 months in Bangladesh. STUDY DESIGN The study is cross sectional in design. Secondary dataset from Bangladesh Demographic and Health Survey was used for this analysis. Immunisation status was categorised as 'fully immunised' if the children had received all the eight recommended vaccine doses otherwise 'partially/unimmunised'. SETTINGS Bangladesh. PARTICIPANT Children aged 12-59 months were the study participants. Participants were randomly selected through a two-stage stratified sampling design. A total of 6230 children were eligible for the analysis. RESULTS About 86% of the children (5356 out of 6230) were fully immunised. BCG has the highest coverage rate (97.1%) followed by oral polio vaccine 1 (97%) and pentavalent 1 (96.6%), where the coverage rate was the lowest for measles vaccine (88%). Coverage was higher in urban areas (88.5%) when compared with rural ones (85.1%). Full immunisation coverage was significantly higher among children who lived in the Rangpur division (adjusted OR (AOR)=3.46; 95% CI 2.45 to 4.88, p<0.001), were 48-59 months old (AOR=1.32; 95% CI 1.06 to 1.64, p=0.013), lived in a medium size family (AOR=1.56; 95% CI 1.32 to 1.86, p<0.001), had parents with a higher level of education (AOR=1.96; 95% CI 1.21 to 3.17, p=0.006 and AOR=1.55; 95% CI 1.05 to 2.29, p=0.026) and belonged to the richest families (AOR=2.2; 95% CI 1.5 to 3.21, p<0.001). The likelihood of being partially or unimmunised was higher among children who had the father as their sole healthcare decision-maker (AOR=0.69; 95% CI 0.51 to 0.92, p<0.012). CONCLUSIONS There were significant variations of child immunisation coverage across socioeconomic and demographic factors. These findings will inform innovative approaches for immunisation programmes, and the introduction of relevant policies, including regular monitoring and evaluation of immunisation coverage-particularly for low-performing regions, so that the broader benefit of immunisation programmes can be achieved in all strata of the society.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Raisul Akram
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Francis MR, Nuorti JP, Kompithra RZ, Larson H, Balraj V, Kang G, Mohan VR. Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore, southern India, 2017. Vaccine 2019; 37:3078-3087. [PMID: 31040085 DOI: 10.1016/j.vaccine.2019.04.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/18/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vellore district in southern India was selected for intensified immunization efforts through India's Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore. METHODS We conducted a cross-sectional household survey among parents or primary caretakers of children aged 12-23 months during August-September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models. RESULTS A total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents' familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26-3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13-4.12) were significantly associated with full vaccination status of the children. CONCLUSIONS We found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.
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Affiliation(s)
- Mark Rohit Francis
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland
| | - J Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland; Infectious Diseases and Vaccines, Department of Health Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Rajeev Zachariah Kompithra
- Well Baby Immunization Clinic, Department of Pediatrics Unit - I, Christian Medical College, Vellore, Tamil Nadu, India
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
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Shenton LM, Wagner AL, Bettampadi D, Masters NB, Carlson BF, Boulton ML. Factors Associated with Vaccination Status of Children Aged 12-48 Months in India, 2012-2013. Matern Child Health J 2019; 22:419-428. [PMID: 29285631 DOI: 10.1007/s10995-017-2409-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives India has more unvaccinated children than any other country despite provision of free vaccines through the government's Universal Immunization Program. In this study, we calculated the proportion of children aged 12-48 months who were fully vaccinated, under-vaccinated, or who had not received any vaccines. Childhood, household, and sociocultural factors associated with under-vaccination and non-vaccination were evaluated. Methods Using data from India's 4th District-level Health and Facility Survey, 2012-2013 (DLHS-4) and the 2012-2013 Annual Health Survey (AHS), we calculated the proportion of children who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of diphtheria-pertussis-tetanus, and 1 dose of measles-containing vaccine. The odds of full vaccination compared to non-vaccination and under-vaccination relative to various factors was assessed using a multivariable, multinomial logistic regression which accounted for survey design. Results Of 1,929,580 children aged 12-48 months, 59% were fully vaccinated, 34% were under-vaccinated, and 7% were non-vaccinated. Compared to children born in government institutions, children delivered in non-institutional settings with a skilled birth attendant present had higher odds of non-vaccination (OR 1.66) and those without a skilled attendant present had still greater odds of non-vaccination (OR 2.39) and under-vaccination (OR 1.11). Conclusions for Practice India's vaccination rates among children aged 12-48 months remains unacceptably low. The Indian government should encourage institutional delivery or birthing with a skilled attendant to ensure women receive adequate health education through antenatal care that includes the importance of childhood vaccination.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Deepti Bettampadi
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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