Factors associated with routine immunization coverage of children under one year old in Lao People's Democratic Republic

Predictors of parental acceptance to live attenuated influenza vaccine for children

To determine the influencing factors of Chinese parents' intention and behavior for children to receive live attenuated influenza vaccine during the 2022-2023 influenza season. A theoretical model was developed and included seven constructs, and structural equation modeling was used to test 11 hypotheses. From October 2022 to December 2023, a survey was conducted across 38 medical institutions in four Chinese cities and their subordinate districts, counties, and rural areas. Parents who accompanied their children for vaccinations were selected through a randomization process based on their child's medical card numbers. Measures were taken to minimize method bias, including a diverse geographical representation and random sampling. The survey resulted in the collection of 936 valid responses, exceeding the recommended sample size for structural equation model analysis and providing robust statistical inferences. During the study period, 936 respondents were included in the study. Perceived ease of use was verified to be a predictor of perceived usefulness and perceived value. Perceived usefulness was verified as a predictor of perceived value and behavioral intention. Knowledge was a significant antecedent of perceived value and risk perception of influenza disease. Risk perception of influenza disease was proved to be a significant predictor of perceived value and self-reported vaccination behavior. Perceived value significantly affected behavioral intention, and behavioral intention significantly affected self-reported vaccination behavior. Six demographic variables significantly moderate the theoretical models. The low vaccination coverage of live attenuated influenza vaccine (LAIV) among children in China suggests a need for a deeper understanding of the factors that influence vaccination rates. Particularly, effective strategies are necessary from policymakers and practitioners to elevate childhood LAIV coverage.

Decentralization and immunization program in a single-party state: the case of the Lao People's Democratic Republic

BACKGROUND

The Lao People's Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied.

METHODS

A case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents.

RESULTS

The Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change.

CONCLUSION

Unprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program.

Factors associated with hepatitis B vaccination in Laos: findings from the multiple indicator cluster surveys in 2011/12 and 2017

Background

Within Laos, the vaccination coverage rates with the monovalent hepatitis B birth dose vaccine and hepatitis B antigen-containing combination vaccines remain stagnant with 75% and 64%, respectively, in 2021. In this study, we used data from the Multiple Indicator Cluster Surveys to identify possible factors that represent barriers for receiving these childhood vaccinations.

Methods

Data from the Multiple Indicator Cluster Surveys in 2011/12 and 2017 were analysed to examine factors associated with receiving the hepatitis B-containing vaccines using regression modelling. Data analyses were conducted in R.

Findings

In 2011/12, the weight-adjusted coverage rate for receiving the hepatitis B birth dose was 48%, while the coverage with the hepatitis B antigen-containing combination vaccine was 55.1% based on both vaccination documents and recall; compared to 69.3% and 59.4% respectively in 2017. Ethno-linguistic group, maternal education, healthcare utilization and wealth were associated with receiving the vaccinations against hepatitis B.

Interpretation

National estimates of vaccination coverage rates can conceal country-specific regional or socio-economic variations. Children from Hmong-Mien households, from less wealthier households and whose mothers were less educated and were not able to or did not utilize healthcare were identified as being less likely to receive the vaccinations. These findings indicate the need for improving access to healthcare, in particular for minority groups.

Funding

This work was supported by the Ministry of Foreign and European Affairs, Luxembourg and the Luxembourg Institute of Health (project "Luxembourg-Laos Partnership for Research and Capacity Building in Infectious Disease Surveillance").

Trends of inequality in DPT3 immunization services utilization in Ethiopia and its determinant factors: Evidence from Ethiopian demographic and health surveys, 2000-2019

BACKGROUND

Low levels of diphtheria, tetanus toxoid, pertussis (DPT3) immunization services utilization and high deaths among under five children are concentrated in economically and socially disadvantaged groups, especially in low and middle-income countries, including Ethiopia. Hence, the aim of this study is to assess levels and trends in DPT3 immunization services utilization in Ethiopia and identify inequalities.

METHODS

This study used data from 2000, 2005, 2011, 2016, and 2019 Ethiopian Demographic Health Surveys (EDHSs). The 2019 updated version of the world health organization (WHO's) Health Equity Assessment Toolkit (HEAT) software was used to analyze the data. Six measure of inequality was calculated: ratio (R), differences (D), relative index of inequality (RII), slope index of inequality (SII), population attributable fraction (PAF) and population attributable risk (PAR). The findings were disaggregated by the five equity stratifiers: economic status, education, place of residence, regions and sex of the child.

RESULTS

This study showed an erratic distribution of DPT3 immunization services utilization in Ethiopia. The trends in national DPT3 immunization coverage increased from 21% in (2000) to 62% in (2019) (by 41 percentage points). Regarding economic inequality, DPT3 immunization coverages for the poorest quintiles over 20 years were 15.3% (2000), and 47.7% (2019), for the richest quintiles coverage were 43.1 (2000), and 83.4% (2019). However, the service utilization among the poorest groups were increased three fold compared to the richest groups. Regarding educational status, inequality (RII) show decreasing pattern from 7.2% (2000) to 1.5% in(2019). Concerning DPT3 immunization inequality related to sex, (PAR) show that, sex related inequality is zero in 2000, 2005 and in 2019. However, based on the subnational region level, significance difference (PAR) was found in all surveys: 59.7 (2000), 51.1 (2005), 52.2 (2011), 42.5 (2016) and 30.7 (2019). The interesting point of this finding was that, the value of absolute inequality measures (PAR) and (PAF), are shown a decreasing trends from 2000 to 2019, and the gap among the better of regions and poor regions becoming narrowed over the last 20 years. Concerning individual and community level factors, household wealth index, education of the mother, age of respondent, antenatal care, and place of delivery show statically significant with outcome variable. Keeping the other variables constant the odds of an average child in Amhara Region getting DPT3 immunization was 54% less than for a child who lived in Addis Ababa (OR: 0.46, 95% CI: 0.34 - 0.63). Respondents from households with the richest and richer wealth status had 1.21, and 1.26 times higher odds of DPT3 immunization services utilization compared to their counterpart (OR: 1.21, 95% CI: 1.04 -1.41) and (OR: 1.26, 95% CI: 1.13 - 1.40) respectively.

CONCLUSION

We conclude that DPT3 immunization coverage shows a growing trend over 20 years in Ethiopia. But inequalities in utilization of DPT3 immunization services among five equality stratifies studied persisted. Reasons for this could be complex and multifactorial and depending on economic, social, maternal education, place of residence, and healthcare context. Therefore, policy has to be structured and be implemented in a ways that address context specific barriers to achieving equality among population sub-groups and regions.

Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study

INTRODUCTION

This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan.

METHODS

The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis.

RESULTS

The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers.

CONCLUSIONS

Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.

The determinants of immunization coverage among children aged between 12 and 35 months: a nationwide cross-sectional study in Lao People's Democratic Republic

BACKGROUND

Immunization is one of the most important public health interventions for reducing morbidity and mortality in children. However, factors contributing to low immunization coverage are not fully understood in the Lao People's Democratic Republic (Lao PDR). Therefore, this study aimed to identify factors associated with full immunization coverage among children between 12 and 35 months, providing up-to-date information for immunization programs in Lao PDR.

METHODS

We analyzed the subpopulation of a nationwide cross-sectional survey using a multistage cluster sampling procedure to evaluate the measles and rubella seroepidemiology. In addition, we categorized children aged between 12 and 35 months into two groups: "fully immunized" children with a birth dose of Bacillus Calmette and Guérin vaccine, hepatitis B vaccine (Hep B), one and three doses for the measles-containing vaccine (MCV) and pentavalent vaccine and pneumococcal conjugate vaccine (PCV) and "partially immunized" children who missed any dose of vaccine. Immunization coverage was calculated as the ratio of "fully immunized" to the total. We compared the groups' demographic characteristics and health service utilization as independent variables. Multivariate logistic regression was used to assess the relationship between immunization coverage, various demographic factors, and health service utilization.

RESULTS

Overall, 256 of the 416 targeted pairs were included in the analysis. In total, 67.6% of the children were fully immunized. Childbirth at hospitals or health facilities (adjusted odds ratio: 9.75, 95% confidence interval: 5.72-16.62, p < 0.001) was the predictor of full immunization coverage. The 83 children in the partially immunized groups were attributed to Hep B at birth (46, 55.4%), three doses of PCV (34, 41.0%), and the first dose of the MCV (27, 32.5%).

CONCLUSION

Our study elucidated that the immunization status among children aged between 12 and 35 months in Lao PDR is satisfactory in improving access to healthcare by strengthening communication with residents regarding health service utilization, and expanding mobile outreach services may play a pivotal role in this endeavor. Further research is warranted to evaluate efforts to increase immunization coverage and target populations with limited access to healthcare.

Estimating the burden of hepatitis B virus infection in Laos between 2020 and 2021: A cross-sectional seroprevalence survey

BACKGROUND

Laos is considered highly endemic for persistent infection with hepatitis B virus (HBV). To eliminate this burden, it has gradually implemented universal anti-hepatitis B immunisation of newborns over the past two decades.

METHODS

Using VIKIA® HBsAg, a rapid test for the qualitative detection of the HBV surface antigen, we conducted between Sep 1st, 2020 and Aug 31st, 2021 the largest prospective prevalence survey ever in Laos. This survey included blood donors (BD, n = 42,277), patients attending care in capital and provincial hospitals (n = 37,347) including attending mothers (n = 20,548), HIV-infected patients (n = 7439, recruited from 2009 to 2020), students from the Health Sciences University (n = 609), and outpatients (n = 350) coming for diagnosis at the Center Infectiology Lao-Christophe Mérieux in Vientiane. In total, 88,022 persons were tested, representing approximately 1.22% of the national population. To reach a reasonable estimate of HBsAg prevalence in Laos, we segmented the population according to three variables, age (≤20 years as a cut-off), sex, and geographical origin. BD values were used to estimate HBsAg prevalence in patients aged <20 while hospital survey prevalence was used to estimate the prevalence in those aged older than 20 years.

FINDINGS

We observed an HBsAg seroprevalence ranging from 2.6% in blood donors to 8.0% in HIV-infected patients. In BD, men were significantly more at risk to be carriers than women (RR = 1.2, P = 0.00063). For BD, attending mothers, or HIV-infected patients, HBsAg was significantly more prevalent in northern Laos (5.1-8.4%) than in central (2.0-8.1%) or southern parts of the country (2.2-6.9%), thereby delineating a North-to-South gradient.

INTERPRETATION

We considered that HBsAg prevalence probably ranges between 5.0% and 6.0% of the total population. Thus, we consider that Laos may no longer be highly endemic for chronic HBV infection but rather a country with intermediate endemicity.

FUNDING

The funding sources were the Agence Universitaire de la Francophonie, the French Government, the French Institute for Sustainable Development (IRD), and European Union's Horizon 2020 Marie Sklodowska-Curie Actions (MSCA) - Research and Innovation Staff Exchange - (RISE) under grant agreement N° 823935.

Haemophilus influenzae serotype b seroprevalence in central Lao PDR before and after vaccine introduction

INTRODUCTION

Vaccination has dramatically reduced invasive Haemophilus influenzae type b (Hib) disease worldwide. Hib vaccination was introduced in the Lao PDR in 2009, as part of the pentavalent vaccine. To contribute to the understanding of the epidemiology of Hib in Lao PDR and the protection levels before and after the introduction of the vaccination, we tested serum samples from existing cohorts of vaccine age-eligible children and unvaccinated adolescents for antibodies against Hib.

METHODS

Serum samples from 296 adolescents born before vaccine introduction and from 1017 children under 5 years (vaccinated and unvaccinated) were tested for anti-Hib antibodies by ELISA. Bivariate analyses were performed to investigate factors associated with long-term protection.

RESULTS

The vast majority of all participants showed evidence of short- (42.7%) or long-term (56.1%) protection against Hib. Almost all of the unvaccinated adolescents had antibody titers indicating short-term protection and almost half (45.6%) were long-term protected. Nearly all children (>99.0%) were at least short-term protected, even those that were unvaccinated or whose vaccination status was unknown. Among vaccinated children, participants vaccinated more than 1 or 2 years ago and with a mid-upper arm circumference z-score < -2 were less likely to be long-term protected.

DISCUSSION

Nearly all adolescents born before the introduction of Hib vaccination in the Lao PDR had antibody titers corresponding to at least short-term protection, indicating a high burden of Hib disease at that time. After vaccine introduction, all but four children (>99%) showed at least short-term protection. Possible explanations for the proportion of protected, yet apparently unvaccinated children, may be past infections, cross-reacting antibodies or faulty vaccination documentation. Our results highlight the need for robust surveillance and reporting of invasive Hib disease to determine the burden of disease despite vaccination.

Spatiotemporal distributions of immunization coverage in Ethiopia from 2000 to 2019

BACKGROUND

Vaccination is the most important mechanism to improve childhood survival. However, immunization coverage is very low and unevenly distributed throughout the country. Therefore, this study was aimed to investigate the spatiotemporal distribution of immunization coverage in Ethiopia.

METHOD

Immunization coverage data and geospatial covariates data were obtained from EDHS 2000 to 2019 and different publicly available sources. A Bayesian geostatistic model was used to estimate the national immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages.

RESULT

The overall immunization coverage in Ethiopia was 38.7%, 36.55%, 51.8%, 67.1% and 66.9% for 2000, 2005, 2011, 2016 and 2019 respectively. Spatial clustering of low immunization coverage was observed in Eastern, Southern, Southwestern, Southeastern and Northeastern parts of Ethiopia in EDHSs. The altitude of the area was positively associated with immunization coverage in 2000, 2005 and 2019 EDHS. The population density was positively associated with immunization coverage in 2000, 2005, 2011 and 2016. Precipitation is also positively associated with immunization coverage in 2016. Moreover, mean annual temperature was positively associated with immunization coverage in 2000, 2005 and 2019 EDHSs. Travel time to the nearest city is negatively associated with immunization coverage in 2000, 2005, 2011 and 2016. Likewise, distance to health facilities was negatively associated with immunization coverage in all the five EDHSs.

CONCLUSION

This study found that immunization coverage in Ethiopia substantially varied across the subnational and local levels. Spatial clustering of low immunization coverage was observed in Southern, Southeastern, Southwestern, Northeastern, and Eastern parts of the country. Altitude, population density, precipitation, temperature, travel time to the nearest city in minutes, and distance to the health facilities were factors that affect the spatial clustering of immunizations coverage. These findings can guide policymakers in Ethiopia to design geographically targeted interventions to increase programs to achieve maximum immunization coverage.

Analyses of blood donor samples from eight provinces in Lao PDR suggest considerable variation concerning HBV exposure and carriage

Introduction

Hepatitis B is endemic in Lao PDR and about 9% of the adult population is chronically infected. In this study, we investigated regional, occupational, age and sex-related differences in hepatitis B epidemiology in Lao blood donors.

Methods

5017 voluntary blood donors from 8 different provinces were tested for hepatitis B markers by ELISA. Predictors for the prevalence of hepatitis B surface antigen (HBsAg) and antibodies against the core antigen (anti-HBc) were assessed by bivariate and multivariable analyses.

Results

In total, 41% of the participants were positive for anti-HBc; the HBsAg prevalence was estimated at 6.9% among all participants (9.2% among first-time donors and 3.9% among repeat donors). Among first-time donors, HBsAg positivity was associated independently with being male (p<0.001), being from the North (p<0.001) and being soldier (p<0.001). Participants were more likely to be anti-HBc positive when they were male (p<0.001), from the Northern provinces (p<0.001) and older than 20 years (p<0.01).

Conclusion

In conclusion, our study confirmed an overall high HBsAg and anti-HBc prevalence in Lao PDR, albeit with considerable regional variation. The identification of a sizeable number of HBsAg positives among repeat donors warrants a thorough investigation of current blood screening, record keeping, donor identification and counselling practises.

Prevalence, Trends and Conditions for the DTP3 Vaccine: A 25-Year Historical Perspective

Background

The aim was to verify the prevalence of vaccination coverage, tendency and factors of the third dose of the vaccine against diphtheria, tetanus and pertussis-DTP3 in surveys over the period of 25 years in a state of the Northeast of Brazil.

Methods

Cross-sectional and temporal series, utilizing ad hoc database, were extracted from the Health and Nutrition State Research 1991, 1997, 2006 and 2015/2016. Children from 12 to 23 months of age with proof in the vaccination card were included. The vaccination coverage (outcome) of each year was calculated, the tendency throughout the period was analyzed and the associations through Pearson chi-squared were tested. The results of the first and last survey were compared with a significance level of 5%. The reasons of the crude prevalence and confidence intervals of 95% were estimated.

Results

The vaccination coverage in 1991, 1997, 2006 and 2015/2016 was 77.6%, 82.7%, 89.7% and 72.9%, respectively, with an increasing tendency from 1991 to 2006 (p<0.001) and decreasing between 2006 and 2015/2016 (p<0.001). Factors in 1991: low socioeconomic conditions; lack of access to health service and pre-natal care, nutritional deficit and diarrhea in children (p<0.005). In 2015/2016, low socioeconomic conditions and diarrhea persisted and a larger family size, black, negative self-perception of happiness, both from the mother (p<0.05), were identified.

Conclusion

The factors of the recent decrease of vaccination coverage are complex, multifactorial, dependent of context and even on subjective aspects of the maternal perception. Its identification contributed to the understanding of inadequate vaccination at the state level.

Indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with acute respiratory infection despite heterogeneous vaccine coverage: an observational study in Lao People's Democratic Republic

Introduction

Empiric data on indirect (herd) effects of pneumococcal conjugate vaccines (PCVs) in settings with low or heterogeneous PCV coverage are limited. The indirect effects of PCV, which benefits both vaccinated and non-vaccinated individuals, are mediated by reductions in vaccine-type (VT) carriage (a prerequisite for disease). The aim of this study among hospitalised children in Lao People’s Democratic Republic (Lao PDR) is to determine the effectiveness of a 13-valent PCV (PCV13) against VT pneumococcal nasopharyngeal carriage (direct effects) and the association between village-level PCV13 coverage and VT carriage (indirect effects).

Methods

Pneumococcal nasopharyngeal carriage surveillance commenced in December 2013, shortly after PCV13 introduction (October 2013). We recruited and swabbed children aged 2–59 months admitted to hospital with acute respiratory infection. Pneumococci were detected using lytA quantitative real-time PCR and serotyped using microarray. PCV13 status and village-level PCV13 coverage were determined using written immunisation records. Associations between both PCV13 status and village-level PCV13 coverage and VT carriage were calculated using generalised estimating equations, controlling for potential confounders.

Results

We enrolled 1423 participants and determined PCV13 coverage for 368 villages (269 863 children aged under 5 years). By 2017, median village-level vaccine coverage reached 37.5%, however, the IQR indicated wide variation among villages (24.1–56.4). Both receipt of PCV13 and the level of PCV13 coverage were independently associated with a reduced odds of VT carriage: adjusted PCV13 effectiveness was 38.1% (95% CI 4.1% to 60.0%; p=0.032); and for each per cent increase in PCV13 coverage, the estimated odds of VT carriage decreased by 1.1% (95% CI 0.0% to 2.2%; p=0.056). After adjustment, VT carriage decreased from 20.0% to 12.8% as PCV13 coverage increased from zero to 60% among under 5.

Conclusions

Despite marked heterogeneity in PCV13 coverage, we found evidence of indirect effects in Lao PDR. Individual vaccination with PCV13 was effective against VT carriage.

Seroprevalence of measles and rubella antibodies in vaccinated and unvaccinated infants in the Lao People's Democratic Republic

BACKGROUND

Even though measles vaccination was introduced in the Lao PDR in 1984, coverage rates remain consistently low and outbreaks continue to occur frequently. This study was performed to investigate the seroprevalence of measles and rubella antibodies in vaccinated and unvaccinated children from Central Lao PDR.

METHODS

Antibody titres of 1090 children aged 8-29 months who were vaccinated at different levels of the health care system were assessed by ELISA. Bivariate and multivariable analyses were performed to identify factors affecting seropositivity against measles and rubella.

RESULTS

Among the vaccinated children, 67.5% in Vientiane Province and 76.4% in Bolikhamxay Province were double positive/borderline for measles and rubella IgG. A high proportion of unvaccinated children at both study sites (24.4% and 38.4%) were positive/borderline for measles and/or rubella. Time since vaccination <180 days, more than two siblings, and a mother who is a farmer/labourer were negatively associated with seropositivity.

CONCLUSIONS

A high prevalence of measles and rubella antibodies was found in unvaccinated children, indicating widespread circulation of both viruses and underreporting of cases. The high proportion of vaccinated children still susceptible to measles suggests problems with vaccine immunogenicity, emphasizing the need for regular evaluations of vaccine efficacy and management.

The trends of socioeconomic inequities in full vaccination coverage among children aged 12-23 months from 2000 to 2017: evidence for mitigating disparities in vaccination service in Zhejiang province

OBJECTIVE

This study aimed to evaluate the trends and changes in inequities in the completeness of the primary vaccination (CPV) scheduled before the first year of age among children aged 12-23 months, from 2000 to 2017. Methods: Data were extracted from five rounds of the provincial vaccination coverage survey (PVCS) in 2000, 2004, 2008, 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequity analysis. The concentration index (CI) was used to quantify the degree of inequity, and the decomposition approach was applied to quantify the contributions from independent factors to inequity in the CPV. Results: The CPV was significantly improved from 2000 to 2017, with 67.0% for the 2000 PVCS and 86.0% for the 2017 PCVS. The CI value decreased from 0.29839 for the 2000 round to 0.03601 for the 2017 round. The decomposition analysis indicated that independent variables such as birth order, ethnic group, mother's education, maternal employment status, residence, immigration status and the percentage of the total health spending allocated to public health could explain the inequity in the CPV in varying degrees. Conclusions: A sharp reduction in socioeconomic inequity in the CPV was observed from 2000 to 2017. Policy recommendations to reduce the inequality in the CPV should focus on children with the risk factors found in this study, for better outcome in full vaccination and long-lasting herd immunity.

Trends and risk factors for infant mortality in the Lao People's Democratic Republic

A high infant mortality rate (IMR) indicates a failure to meet people's healthcare needs. The IMR in Lao People's Democratic Republic has been decreasing but still remains high. This study aimed to identify the factors involved in the high IMR by analyzing data from 53,727 live births and 2189 women from the 2017 Lao Social Indicator Survey. The estimated IMR decreased from 191 per 1000 live births in 1978-1987 to 39 in 2017. The difference between the IMR and the neonatal mortality rate had declined since 1978 but did not change after 2009. Factors associated with the high IMR in all three models (forced-entry, forward-selection, and backward-selection) of multivariate logistic regression analyses were auxiliary nurses as birth attendants compared to doctors, male infants, and small birth size compared to average in all 2189 women; and 1-3 antenatal care visits compared to four visits, auxiliary nurses as birth attendants compared to doctors, male infants, postnatal baby checks, and being pregnant at the interview in 1950 women whose infants' birth size was average or large. Maternal and child healthcare and family planning should be strengthened including upgrading auxiliary nurses to mid-level nurses and improving antenatal care quality.

Timeliness of immunisation with the pentavalent vaccine at different levels of the health care system in the Lao People's Democratic Republic: A cross-sectional study

Background

The timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People’s Democratic Republic. We also investigated factors associated with delayed immunization.

Methods

1162 children aged 8–28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses.

Results

Several discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination.

Conclusion

We observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.

Vaccine uptake and associated factors in an irregular urban settlement in northeastern Brazil: a cross-sectional study

Background

Globally, childhood immunization saves the lives of 2–3 million children annually by protecting them against vaccine-preventable diseases. In 2017, 116.2 million children were vaccinated worldwide according to the World Health Organization. Nevertheless, figures suggest that 19.5 million children around the world fail to receive the benefits of complete immunization.

Methods

This cross-sectional study analyzed vaccine uptake and the factors associated with incomplete vaccination schedule in children of up to 36 months of age assisted by the family health strategy in an irregular settlement located in a state capital city in northeastern Brazil. This study was nested within a larger study entitled “Health, nutrition and healthcare services in an urban slum population in Recife, Pernambuco”, conducted in 2015. A census included 309 children, with vaccination data obtained, exclusively, from their vaccination cards records. An ad hoc database was constructed with variables of interest. Absolute and relative values were calculated for the socioeconomic, demographic, obstetric and biological data. To identify possible factors associated with incomplete vaccination schedule, crude and multivariable Poisson regression analyses were performed, and conducted in accordance with the forward selection method with robust variance and the adjusted prevalence ratio was calculated with the 95% CI. Variables with p-values < 0.20 in the unadjusted stage were included in the multivariable analysis. The statistical significance of each variable was evaluated using the Wald test, with p-values < 0.05.

Results

Just half of the children (52,1%) was classified as complete vaccination schedule. In the final model, the factors associated with incomplete vaccination schedule were age 12–36 months and the mother who did not complete high school.

Conclusion

The percentage of vaccine uptake found was far below the recommendation of the National Childhood Immunization Schedule and was associated with child’s age and mother’s education level. Based on these findings, the family healthcare teams may elaborate vaccination strategies aimed at reaching the coverage rates established by the national immunization program. Optimizing coverage will ultimately prevent the resurgence, at epidemic level, of infectious diseases that are already under control in this country.

Factors associated with parental acceptance of influenza vaccination for their children: the evidence from four cities of China

BACKGROUND

It is necessary and urgent to vaccinate 245 million Chinese children against influenza pandemics. The main purpose of this study was to evaluate different psychological and demographic factors that influence parental willingness to vaccinate their children against influenza.

METHODS

A hybrid theoretical framework was expanded and verified with 462 sample data collected from four cities in China. Structural equation models were used to test nine theoretical hypotheses, and the non-standardized coefficient method was used to discuss the moderating effects among demographic variables.

RESULTS

Knowledge is considered to be the significant factor of performance expectancy (β = 0.228), effort expectancy (β = 0.227) and perceived risk (β = -0.138), and social influence also has the significant impacts on the above three variables, with β values of 0.437, 0.386, and -0.172. Performance expectancy (β = 0.402), effort expectancy (β = 0.343), and perceived risk (β = -0.244) thus significantly affect parental behavioral intention regarding children's influenza vaccination. Gender, education, and kids' gender are demographic variables with significant moderating effects, while age, income, number of kids are not significant.

CONCLUSION

To improve the acceptability of influenza vaccination among Chinese children, the promoting policies should emphasize on public knowledge and social influence, as well as effectiveness, affordability, and safety of vaccination.

Lasting benefit of infant hepatitis B vaccination in adolescents in the Lao People's Democratic Republic

OBJECTIVES

Hepatitis B is endemic in Lao PDR with 8-10% of the adult population being chronically infected. We investigated the impact of hepatitis B vaccination on infection in adolescents born shortly before and after the introduction of the vaccine in 2001.

METHODS

779 students from Vientiane Capital and Bolikhamxay province were tested for HBV markers by ELISA. Socio-demographic information was collected with a standardized questionnaire. Predictors/risk factors for seroprotection or exposure to hepatitis B infection were assessed by bivariate and multivariable analyses.

RESULTS

The prevalence of a serological vaccination profile increased significantly after the introduction of the vaccine (13.2%-21.9%, p < 0.05, in Vientiane; 3.0%-19.7%, p < 0.001, in Bolikhamxay), which translated into at least a 2-times lower prevalence of past infection. In logistic regression, older students in Bolikhamxay were less likely to be vaccinated and more likely to have been infected by HBV in the past.

CONCLUSION

Even though this study documented a sizable and lasting reduction in past hepatitis B infections in adolescents born after the introduction of infant hepatitis B vaccination, the overall levels of protective anti-HBs were low and warrant at least the introduction of a booster for adolescents. Furthermore, we suggest improving the coverage of the hepatitis B birth dose.

Etiologic agents of acute diarrhea in sentinel surveillance sites in Vientiane Capital, Lao People's Democratic Republic, 2012-2015

This study aims to identify the pathogens of diarrhea in Vientiane Capital, Lao People's Democratic Republic (Lao PDR). The data of 2482 patients who visited eight health facilities due to diarrhea in 2012-2015 were retrospectively reviewed. Stool or rectal swabs collected from all patients were tested for bacteria. Children who were under 5 years old were additionally tested for rotavirus. Of 2482 cases, 1566 cases were under 5 years old, and at least one enteropathogen was detected in 475 cases (19.1%). Salmonella species was the most commonly detected bacterial pathogen. Enteropathogenic Escherichia coli (EPEC) and Salmonella species was the major pathogen in the dry season and the wet season, respectively. Eighty-seven patients tested positive for multiple bacteria. Rotavirus was detected in 291 children under 5 years old (32.4%), mostly from October to April. The major bacteria of coinfection with rotavirus were EPEC followed by Salmonella species. Salmonella species was the predominant bacterial pathogen of diarrhea of all ages, and rotavirus was the predominant pathogen among children under 5 years old. Further studies examining other types of pathogens for diarrhea and the introduction of a rotavirus vaccine for children are needed in Lao PDR.