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Oyo-Ita A, Oduwole O, Arikpo D, Effa EE, Esu EB, Balakrishna Y, Chibuzor MT, Oringanje CM, Nwachukwu CE, Wiysonge CS, Meremikwu MM. Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database Syst Rev 2023; 12:CD008145. [PMID: 38054505 PMCID: PMC10698843 DOI: 10.1002/14651858.cd008145.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Immunisation plays a major role in reducing childhood morbidity and mortality. Getting children immunised against potentially fatal and debilitating vaccine-preventable diseases remains a challenge despite the availability of efficacious vaccines, particularly in low- and middle-income countries. With the introduction of new vaccines, this becomes increasingly difficult. There is therefore a current need to synthesise the available evidence on the strategies used to bridge this gap. This is a second update of the Cochrane Review first published in 2011 and updated in 2016, and it focuses on interventions for improving childhood immunisation coverage in low- and middle-income countries. OBJECTIVES To evaluate the effectiveness of intervention strategies to boost demand and supply of childhood vaccines, and sustain high childhood immunisation coverage in low- and middle-income countries. SEARCH METHODS We searched CENTRAL, MEDLINE, CINAHL, and Global Index Medicus (11 July 2022). We searched Embase, LILACS, and Sociological Abstracts (2 September 2014). We searched WHO ICTRP and ClinicalTrials.gov (11 July 2022). In addition, we screened reference lists of relevant systematic reviews for potentially eligible studies, and carried out a citation search for 14 of the included studies (19 February 2020). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), non-randomised RCTs (nRCTs), controlled before-after studies, and interrupted time series conducted in low- and middle-income countries involving children that were under five years of age, caregivers, and healthcare providers. DATA COLLECTION AND ANALYSIS We independently screened the search output, reviewed full texts of potentially eligible articles, assessed the risk of bias, and extracted data in duplicate, resolving discrepancies by consensus. We conducted random-effects meta-analyses and used GRADE to assess the certainty of the evidence. MAIN RESULTS Forty-one studies involving 100,747 participants are included in the review. Twenty studies were cluster-randomised and 15 studies were individually randomised controlled trials. Six studies were quasi-randomised. The studies were conducted in four upper-middle-income countries (China, Georgia, Mexico, Guatemala), 11 lower-middle-income countries (Côte d'Ivoire, Ghana, Honduras, India, Indonesia, Kenya, Nigeria, Nepal, Nicaragua, Pakistan, Zimbabwe), and three lower-income countries (Afghanistan, Mali, Rwanda). The interventions evaluated in the studies were health education (seven studies), patient reminders (13 studies), digital register (two studies), household incentives (three studies), regular immunisation outreach sessions (two studies), home visits (one study), supportive supervision (two studies), integration of immunisation services with intermittent preventive treatment of malaria (one study), payment for performance (two studies), engagement of community leaders (one study), training on interpersonal communication skills (one study), and logistic support to health facilities (one study). We judged nine of the included studies to have low risk of bias; the risk of bias in eight studies was unclear and 24 studies had high risk of bias. We found low-certainty evidence that health education (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.15 to 1.62; 6 studies, 4375 participants) and home-based records (RR 1.36, 95% CI 1.06 to 1.75; 3 studies, 4019 participants) may improve coverage with DTP3/Penta 3 vaccine. Phone calls/short messages may have little or no effect on DTP3/Penta 3 vaccine uptake (RR 1.12, 95% CI 1.00 to 1.25; 6 studies, 3869 participants; low-certainty evidence); wearable reminders probably have little or no effect on DTP3/Penta 3 uptake (RR 1.02, 95% CI 0.97 to 1.07; 2 studies, 1567 participants; moderate-certainty evidence). Use of community leaders in combination with provider intervention probably increases the uptake of DTP3/Penta 3 vaccine (RR 1.37, 95% CI 1.11 to 1.69; 1 study, 2020 participants; moderate-certainty evidence). We are uncertain about the effect of immunisation outreach on DTP3/Penta 3 vaccine uptake in children under two years of age (RR 1.32, 95% CI 1.11 to 1.56; 1 study, 541 participants; very low-certainty evidence). We are also uncertain about the following interventions improving full vaccination of children under two years of age: training of health providers on interpersonal communication skills (RR 5.65, 95% CI 3.62 to 8.83; 1 study, 420 participants; very low-certainty evidence), and home visits (RR 1.29, 95% CI 1.15 to 1.45; 1 study, 419 participants; very low-certainty evidence). The same applies to the effect of training of health providers on interpersonal communication skills on the uptake of DTP3/Penta 3 by one year of age (very low-certainty evidence). The integration of immunisation with other services may, however, improve full vaccination (RR 1.29, 95% CI 1.16 to 1.44; 1 study, 1700 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Health education, home-based records, a combination of involvement of community leaders with health provider intervention, and integration of immunisation services may improve vaccine uptake. The certainty of the evidence for the included interventions ranged from moderate to very low. Low certainty of the evidence implies that the true effect of the interventions might be markedly different from the estimated effect. Further, more rigorous RCTs are, therefore, required to generate high-certainty evidence to inform policy and practice.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Health, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel E Effa
- Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ekpereonne B Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Moriam T Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Chioma M Oringanje
- GIDP Entomology and Insect Science, University of Tucson, Tucson, Arizona, USA
| | | | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Congo
| | - Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Smyth DS, Jordan T, Seiser R, Moran M, Hasager U, Sorby S, Kahl N, Shachter A, Oates K. Promoting RAPID Vaccine Science Education at the Onset of the COVID-19 Pandemic. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2023; 24:e00051-23. [PMID: 37614895 PMCID: PMC10443309 DOI: 10.1128/jmbe.00051-23] [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: 03/15/2023] [Accepted: 05/11/2023] [Indexed: 08/25/2023]
Abstract
At the onset of the 2019 coronavirus disease (COVID-19) pandemic, it was clear that we needed to support public education on the science of vaccines. This project was born of that need and led to the development of comprehensive educational materials that addressed the process of science, severe acute respiratory syndrome coronavirus 2 biology, vaccine development, and science communication and outreach. Called the "Online Vaccine Science Resources for COVID-19 Education," the materials generated were designed to be implemented by educators and community groups in various contexts. They took the form of four modules and general audience informational videos available on a YouTube channel. Each module was assembled as a toolkit with instructional videos, assessments, discussion questions, assignments, synthesis activities, and guides for constructing infographics and dual poster (science and general public audience) presentations. The materials were piloted and tested in various educational settings, including 2-year and 4-year colleges. Data gathered from surveys of faculty and student participants suggested that exposure to the materials promoted student trust in vaccination and the scientific process of vaccine development, and increased the likelihood of their getting a freely available vaccine. Assessment data indicated that the materials were successful in helping students achieve the learning objectives for the modules. Our results underscored the continued need for science education strategies that address the critical problem of vaccine hesitancy as we continue to emerge from the COVID-19 pandemic.
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Affiliation(s)
- Davida S. Smyth
- Department of Life Sciences, Texas A&M University—San Antonio, San Antonio, Texas, USA
| | - Trace Jordan
- College Core Curriculum, New York University, New York, New York, USA
| | - Robert Seiser
- Department of Biological, Physical and Health Sciences, Roosevelt University, Chicago, Illinois, USA
| | - Meghan Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ulla Hasager
- College of Social Sciences, University of Hawaiʻi at Mānoa, Honolulu, Hawaiʻi, USA
| | - Sheryl Sorby
- College of Engineering Education, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nathan Kahl
- George Mason University, Fairfax, Virginia, USA
| | - Amy Shachter
- Santa Clara University, Santa Clara, California, USA
| | - Karen Oates
- Department of Biology and Biochemistry, Worcester Polytechnic University, Worcester, Massachusetts, USA
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Rodríguez-Blanco N, Ibarra-González L, Vegara-López I, Orts-Cortés MI. [Evaluation of a community-based intervention to increase influenza vaccination coverage in pregnant women]. Aten Primaria 2023; 55:102652. [PMID: 37210972 PMCID: PMC10209675 DOI: 10.1016/j.aprim.2023.102652] [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: 01/30/2023] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVE To know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DESIGN Quasi-experimental study of community intervention. SITE: Two basic health zones belonging to the Elche-Crevillente health department, Spain. PARTICIPANTS Pregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. INTERVENTIONS Training session for the IG prior to the 2019/20 flu campaign. MAIN MEASUREMENTS Attitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. RESULTS The influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). CONCLUSIONS Joint training strategies for professionals and community assets improve the results of vaccination coverage.
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Affiliation(s)
- Noelia Rodríguez-Blanco
- Departamento de Enfermería, Universidad Cardenal Herrera-CEU, CEU Universities, Elche, Alicante, España; Departamento de Obstetricia y Ginecología, Hospital Marina Baixa, Villajoyosa, Alicante, España.
| | | | - Irene Vegara-López
- Departamento de Enfermería, Universidad Cardenal Herrera-CEU, CEU Universities, Elche, Alicante, España; Servicio de Obstetricia y Ginecología, Hospital Universitario del Vinalopó, Elche, Alicante, España
| | - María Isabel Orts-Cortés
- Departamento de Enfermería, Universidad de Alicante (BALMIS), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España; Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii), Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, España
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Gundogdu Z, Yendur Sezer O. Changing Parental Attitudes Towards Rotavirus Vaccine. Cureus 2023; 15:e35348. [PMID: 36974236 PMCID: PMC10039459 DOI: 10.7759/cureus.35348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Rotavirus is known to be one of the most common infections, usually associated with severe diarrhea. Despite the existence of two licensed vaccines, many countries, including Turkey, have not included rotavirus vaccination in their nationally funded vaccination program. This article explores what factors influence parents' decisions about whether to have their children vaccinated against rotavirus and which factors changed from 2010 through 2016. MATERIALS AND METHODS Data were collected over two periods via questionnaires. The first period was from January 2009 through March 2010, and data were gathered from a semi-private pediatric outpatient clinic in Kocaeli, Turkey. The second period was from August 2015 through May 2016, and data were collected from parents during their pediatric outpatient clinic visits. Two questionnaires were designed to find out the rotavirus vaccination status of the children, socio-demographic factors, and reasons for excluding/accepting the rotavirus vaccine. The level of knowledge about the rotavirus vaccine was investigated. Parents indicated their level of agreement with each statement using a five-point Likert scale. RESULTS While only 3.8% of the parents accepted the rotavirus in 2009-2010, it increased to 69.5% in 2015-2016. Significant factors influencing parents' decision to vaccinate their children for rotavirus were advice from a pediatrician, a lack of correct and timely rotavirus information, and the cost of the vaccine. CONCLUSIONS The acceptance of the rotavirus vaccine depends on parental perceptions, which may be influenced by accurate and timely information, the advice of their healthcare provider, and inclusion in the nationally funded vaccination program. In contrast to other studies reported, the education level of the mothers and fathers and their job types appear to be important. It was also found that parents' attitudes and perceptions changed over time.
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Sultana N, Hossain A, Das H, Pallikadavath S, Koeryaman M, Rahman M, Chowdhury AH, Bhuiya A, Mahmood SS, Hanifi SMA. Is the maternal health voucher scheme associated with increasing routine immunization coverage? Experience from Bangladesh. Front Public Health 2023; 11:963162. [PMID: 36817885 PMCID: PMC9937056 DOI: 10.3389/fpubh.2023.963162] [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: 06/07/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Bangladesh initiated the Maternal Health Voucher Scheme (MHVS) in 2007 to improve maternal and child health practices and bring equity to the mainstream of health systems by reducing financial and institutional barriers. In this study, we investigated whether the MHVS has an association with immunization coverage in a rural area of Bangladesh. Between 30 October 2016 and 15 June 2017, we carried out a cross-sectional survey in two low performing areas in terms of immunization coverage- Chattogram (erstwhile Chittagong division) and Sylhet division of Bangladesh. We calculated the coverage of fully immunized children (FIC) for 1151 children aged 12-23 months of age. We compared the coverage of FIC between children whose mothers enrolled in MHVS and children whose mother did not. We analyzed immunization coverage using crude odds ratio (OR) and adjusted OR (aOR) from binary logistic regression models. The overall coverage of FIC was 86%. Ninety-three percent children whose mothers were MHVS members were fully immunized whereas the percentage was 84% for the children of mothers who were not enrolled in MHVS. Multivariate analysis also shows that FIC coverage was higher for children whose mothers enrolled in MHVS compared to those children whose mothers did not; the aOR was 2.03 (95% confidence interval 1.11-3.71). MHVS provides a window for non-targeted benefits of childhood vaccination. Providing health education to pregnant mothers during prenatal care may motivate them to immunize their children. Programmes targeted for mothers during pregnancy, childbirth and post-natal may further increase utilization of priority health services such as childhood immunization.
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Affiliation(s)
- Nazia Sultana
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh,*Correspondence: Nazia Sultana ✉
| | - Aazia Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Hemel Das
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Saseendran Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mira Koeryaman
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mohammad Rahman
- Salford Business School, University of Salford, Salford, United Kingdom
| | | | - Abbas Bhuiya
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Shehrin Shaila Mahmood
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - S. M. A. Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Boisson A, Morgan CE, Fried B, Shea CM, Yotebieng M, Ngimbi P, Mbonze N, Mwandagalirwa K, Babakazo P, Thompson P. Barriers and facilitators to timely birth-dose vaccines in Kinshasa Province, the DRC: a qualitative study. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.35449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background National vaccine policies across the world have successfully improved infant vaccine coverage, but birth-dose (BD) vaccine coverage remains low. Countries such as the Democratic Republic of the Congo (DRC) aim to include the hepatitis B birth-dose (HepB-BD) vaccine in their national immunization schedule. HepB-BD’s short window for administration – within 24 hours of delivery to prevent mother-to-child transmission – adds to the complexity of streamlined and timely BD vaccines. This study aims to identify and understand barriers and facilitators to timely delivery of BD vaccine in Kinshasa Province, DRC, through individuals’ accounts with different perspectives on the uptake of the BD vaccine in preparation for its future roll-out. Methods We conducted semi-structured interviews in seven health facilities across Kinshasa Province from June to July 2021. We purposefully sampled health facilities from the provinces’ five most prominent facility types—private, public, Catholic, Protestant, and not-for-profit. We interviewed decision-makers and/or providers from various levels of the health care continuum, including midwives, immunization staff, heads of maternity and immunizations, and vaccine officials at the health zone and the Programme Elargi de Vaccination (PEV) to understand administrative barriers to BD vaccines. We also conducted interviews with expectant mothers to elicit knowledge and perceptions about infant vaccines. Results We interviewed 30 participants (16 informants and 14 expectant mothers). Interviewees were recruited from 7 health facilities, 2 health zones, and PEV. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Our analysis identified 13 constructs (2-3 per domain) related to the success of timely and streamlined BD vaccines. We found significant barriers within and across each domain; most notably, the multi-dose vials of existing BD vaccines determining when facility staff could vaccinate newborns, often resulting in untimely vaccinations; logistical concerns with regular national vaccine stockouts and ability to store vaccines; complex and unsynchronized vaccine fees across facilities; inadequate communication across delivery and vaccination wards; and limited and at times incorrect understanding of vaccines among mothers and other community members. Conclusions Using the CFIR framework, this study integrated perspectives from facility informants and expectant mothers to inform national policy and implementation of the HepB-BD in DRC. These stakeholder-driven findings should guide the streamlining of timely BD vaccinations upon HepB-BD implementation.
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Affiliation(s)
- Alix Boisson
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Camille E. Morgan
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bruce Fried
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher M. Shea
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nana Mbonze
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Peyton Thompson
- University of North Carolina, Chapel Hill, North Carolina, USA
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Bishop K, McMorrow M, Meiring S, Walaza S, Rossi L, Mhlanga S, Tempia S, Mathunjwa A, Kleynhans J, Appiah GD, McAnerney JM, Zar HJ, Cohen C. An evaluation of an influenza vaccination campaign targeting pregnant women in 27 clinics in two provinces of South Africa, 2015 - 2018. BMC Health Serv Res 2021; 21:941. [PMID: 34503508 PMCID: PMC8427945 DOI: 10.1186/s12913-021-06962-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/31/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Despite prioritization, routine antenatal influenza vaccine coverage is < 16% in South Africa. We aimed to describe maternal influenza vaccine coverage in 27 antenatal clinics (ANCs) in Gauteng and Western Cape (WC) Provinces, where in collaboration with the Department of Health (DoH), we augmented the annual influenza vaccination programme among pregnant women. Methods From 2015 through 2018, 40,230 additional doses of influenza vaccine were added to the available stock and administered as part of routine antenatal care. Educational talks were given daily and data were collected on women attending ANCs. We compared characteristics of vaccinated and unvaccinated women using multivariable logistic regression. Results We screened 62,979 pregnant women during the period when Southern Hemisphere influenza vaccines were available (27,068 in Gauteng and 35,911 in WC). Vaccine coverage at the targeted clinics was 78.7% (49,355/62682), although pregnant women in WC were more likely to be vaccinated compared to those in the Gauteng (Odds ratio (OR) =3.7 p < 0.001). Women aged 25—29 and > 35 years were less likely to be vaccinated than women aged 18—24 years (OR = 0.9 p = 0.053; OR = 0.9 p < 0.001). HIV positive status was not associated with vaccination (OR = 1.0 p = 0.266). Reasons for not vaccinating included: vaccine stock-outs where ANCs depleted available stock of vaccines and/or were awaiting delivery of vaccines (54.6%, 6949/12723), refusal/indecision (25.8%, 3285), and current illness that contraindicated vaccination (19.6%, 2489). Conclusion Antenatal vaccination uptake was likely improved by the increased vaccine supply and vaccine education offered during our campaign.
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Affiliation(s)
- Kate Bishop
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa. .,Division of Public Health Services and Response, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Susan Meiring
- Division of Public Health Services and Response, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,DST/NRF Vaccine Preventable Diseases/Respiratory and Meningeal Pathogens Research Unit (RMPRU), Johannesburg, South Africa
| | - Liza Rossi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Sarona Mhlanga
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwifarwi Mathunjwa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace D Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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Lv K, Zhao J, Zhang P. The effect of community comprehensive nursing using scenario-based health education on the infant and young child immunization rates. Am J Transl Res 2021; 13:9663-9670. [PMID: 34540093 PMCID: PMC8430158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effect of community comprehensive nursing using scenario-based health education on the infant and young child immunization rates. METHODS Ninety-eight infants and young children who were given immunizations in our hospital were divided into two groups, with 49 participants in each group. The control group was administered routine nursing, and the research group underwent community comprehensive nursing using scenario-based health education. The vaccination rates, the mastery of vaccination knowledge before and after the nursing, the adverse effects, the compliance, the satisfaction with the nursing, and the incidence of medical disputes were recorded and analyzed. RESULTS The delayed vaccination rate was significantly lower in the research group than it was in the control group, and the timely vaccination rate in the research group was significantly higher than it was in the control group (P<0.05). There was no statistically significant difference in the incidences of medical disputes between the two groups (P>0.05). The basic and total vaccination awareness rates were significantly higher in the research group compared with the control group (P<0.05). The incidence of adverse effects in the research group was significantly lower than it was in the control group (P<0.05). The full and total compliance rates in the research group were both significantly higher than they were in the control group (P<0.05). The proportions of very satisfied and completely satisfied were both significantly higher in the research group compared to the control group (P<0.05). CONCLUSION In the infant and young child immunization program, community comprehensive nursing using scenario-based health education can effectively increase the vaccination rate, increase the parents' knowledge, enhance their compliance, reduce the adverse effects, and improve the satisfaction with the nursing.
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Affiliation(s)
- Kuihua Lv
- Daodejie Community Health Service Station, The Fifth People's Hospital of Ji'nan Ji'nan, Shandong Province, China
| | - Jie Zhao
- Daodejie Community Health Service Station, The Fifth People's Hospital of Ji'nan Ji'nan, Shandong Province, China
| | - Panfeng Zhang
- Daodejie Community Health Service Station, The Fifth People's Hospital of Ji'nan Ji'nan, Shandong Province, China
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10
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Potter J, Lindblad AJ. Vaccine hesitancy in the office: what can I do? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:516. [PMID: 34261714 DOI: 10.46747/cfp.6707516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Adrienne J Lindblad
- Associate Clinical Professor in the Department of Family Medicine at the University of Alberta in Edmonton
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11
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Fuchs EL, Hirth JM, Guo F, Brown VG, Cofie L, Berenson AB. Infant vaccination education preferences among low-income pregnant women. Hum Vaccin Immunother 2021; 17:255-258. [PMID: 32460665 PMCID: PMC7872064 DOI: 10.1080/21645515.2020.1764272] [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: 11/24/2022] Open
Abstract
Childhood vaccination is an important public health intervention, yet many children remain under-vaccinated. The objective of this study was to examine infant vaccination education preferences in a population of low-income pregnant women by ethnicity, nativity, and language. Pregnant women 14–44 y old (n = 335) attending a participating low-income reproductive health clinic in southeast Texas from May 26-July 21, 2017, and who completed a paper survey offered in English and Spanish were included. Participants were asked to complete questions about their demographic characteristics and preferences about infant vaccination education. To examine differences in vaccine education preferences by participant demographic characteristics, chi-squared tests, or Fisher’s exact tests and one-way analysis of variance (ANOVA) were conducted using Stata SE Version 15.1 with α = 0.05. Nearly half (47.5%) of participants considered pregnancy the best time to get information about infant vaccination and were most likely (40.6%) to indicate the nurse who gives vaccines during pregnancy as the health-care worker with whom they would like to discuss infant vaccination. There were no demographic differences in preferred timing of vaccine education delivery or provider who delivers vaccine education. Prenatal, nurse-delivered vaccine educational programs would be well accepted in this low-income population.
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Affiliation(s)
- Erika L Fuchs
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA.,Sealy Institute for Vaccine Sciences, University of Texas Medical Branch , Galveston, TX, USA
| | - Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
| | - Fangjian Guo
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
| | - V Gnaukita Brown
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
| | - Leslie Cofie
- College of Health and Human Performance, East Carolina University , Greenville, NC, USA
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX, USA
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12
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Chen Y, Lv H, Liang H, Wang Y, Hu Y. Can vaccination coverage be improved through reducing the missed opportunities for immunization? Results from the evaluation in Zhejiang province, east China. Hum Vaccin Immunother 2020; 17:1483-1489. [PMID: 33180567 DOI: 10.1080/21645515.2020.1829316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND To evaluate the missed opportunities for vaccination (MOV) in Zhejiang province by using the global methodology from World Health Organization (WHO). METHODS Based on the WHO Planning Guide to Reduce Missed Opportunities for Vaccination (MOV) and Methodology for the Assessment of MOV, 33 health facilities from 11 cities in Zhejiang province were selected. For each health facility, exit investigations for 20 caregivers of children aged 0-23 months and knowledge, attitudes, and practices (KAP) surveys for 10 health workers was implemented. A MOV was determined based on the child's age on the date of investigation, eligibility for various vaccines. The prevalence of MOV was calculated and the risk factors of MOV were explored. RESULTS There were 660 completed exit investigations of caregivers of children aged 0-23 months and 330 health worker KAP investigations. Of the 658 children with documented vaccination records, 12.6% were still under-vaccinated. Among these under-vaccinated children, 54.2% still had a MOV. Children's age and their previous vaccination behavior, as well as caregivers' relationship to children and education level had a significant impact on the incidence of MOV. CONCLUSION The high proportions of visits with MOV in Zhejiang province suggested that interventions to reduce MOV in health service settings may be a potential quick win for improving coverage and equity. National immunization programs should explore the tailored efforts to improve health worker practices by making better use of existing health service contacts.
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Affiliation(s)
- Yaping Chen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Huakun Lv
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Hu Liang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Ying Wang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
| | - Yu Hu
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, Hangzhou, China
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13
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Papachrisanthou MM, Davis RL. The Resurgence of Measles, Mumps, and Pertussis. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2018.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Determinants of Timely Presentation for Birth Dose Vaccination at an Immunization Centre in North-central Nigeria. Ann Glob Health 2019; 85. [PMID: 30873798 PMCID: PMC7052312 DOI: 10.5334/aogh.725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Timely receipt of immunization is an essential prerequisite to ensure early protection of the child. However, a low proportion of children in Nigeria benefit from the timely administration of the birth dose vaccines. Objectives: These were identification of factors associated with timely presentation and reasons for presentation beyond 24 hours at an immunization centre in Ilorin, Nigeria. Method: A descriptive cross-sectional study involving 480 mother-infant pairs was conducted at an immunization centre. Socio-demographic, antenatal care (ANC) and delivery details, infant’s birthday and day of presentation for vaccination were recorded. Logistic regression was used to identify factors associated with time to presentation within day one. Findings: 239 (49.8%), 421 (87.7%) and 454 (94.6%) babies were vaccinated within days one, seven and 14 respectively. Post-secondary education level of mothers (OR = 3.60; 95% C.I: 1.30–9.91), antenatal care attendance (OR = 9.55; 95% C.I: 1.75–52.12), and hospital delivery (OR = 6.36; 95% C.I: 1.33–30.38) were associated with presentation within day one. Having correct knowledge of the immunization schedule increased the odds of early presentation by three times, p = 0.025. The commonest reason for presentation after day one for vaccination was weekend/public holiday delivery identified in 83 (35.2%) mother-infant pairs. Conclusion: Hospital delivery, attendance at antenatal care, postsecondary education and knowledge of the immunization schedule were factors associated with timely presentation for birth dose vaccination. Strategies to improve timeliness of the birth dose vaccination should target babies delivered outside the hospital as well as during weekends in the hospital. Also, inclusion of immunization into the health education curriculum of schools could be beneficial.
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Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:175-181. [PMID: 30867173 PMCID: PMC6515949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To provide primary care physicians with clinical guidance for addressing parental vaccine hesitancy. SOURCES OF INFORMATION The PubMed database was searched for English-language articles published in the 10 years before January 1, 2018. Search terms included vaccine hesitancy or confidence or acceptance, parents or children, and communication, counseling, or clinical practice. References of identified articles were assessed for additional relevant articles. A separate gray literature search was conducted using Google to find best-practice guidelines from public health and health care organizations, knowledge translation materials for health care providers, and resources that could be used in discussions with parents about vaccines. MAIN MESSAGE Practical tips for addressing parental vaccine hesitancy in primary care include starting early, presenting vaccination as the default approach, building trust, being honest about side effects, providing reassurance on a robust vaccine safety system, focusing on protection of the child and community, telling stories, and addressing pain. Also provided are statements that providers could use in vaccination-related conversations; answers to commonly asked questions on benefits, safety, and immunologic aspects of vaccines; and links to a number of online resources for physicians and parents. CONCLUSION Vaccine-hesitant parents who are on the fence far outnumber vaccine refusers; therefore, counseling this group might be more effective. Reasons behind vaccine hesitancy are complex and encompass more than just a knowledge deficit. As a trusted source of information on vaccines, family physicians play a key role in driving vaccine acceptance.
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Affiliation(s)
- Shixin Cindy Shen
- Resident in the Public Health and Preventive Medicine program at the University of Toronto in Ontario.
| | - Vinita Dubey
- Associate Medical Officer of Health with Toronto Public Health and Adjunct Professor in the Dalla Lana School of Public Health at the University of Toronto
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16
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Shen SC, Dubey V. Répondre à l’hésitation face à la vaccination. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e91-e98. [PMID: 30867188 PMCID: PMC6515971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectif Conseiller aux médecins de première ligne une approche clinique pour parler de l’hésitation face à la vaccination avec les parents. Sources de l’information On a recherché sur PubMed des articles publiés en anglais dans les 10 années ayant précédé le 1er janvier 2018. Les mots-clés anglais étaient vaccine hesitancy ou confidence ou acceptance, parents ou children, et communication, counseling ou clinical practice . On a épluché les références des articles relevés, à la recherche d’autres articles pertinents. Une recherche distincte de la littérature parallèle a été effectuée sur Google pour trouver les lignes directrices de pratique clinique publiées par les organisations de santé publique et de soins de santé, le matériel de transfert des connaissances à l’intention des professionnels de la santé et les ressources pouvant être utilisées durant les conversations avec les parents sur les vaccins. Message principal Les conseils pratiques pour répondre à l’hésitation des parents face à la vaccination dans les soins de première ligne consistent à commencer tôt, à présenter la vaccination comme l’approche par défaut, à établir une relation de confiance, à être honnête quant aux effets secondaires, à rassurer les parents en leur disant que le système d’innocuité vaccinale est solide, à s’attarder sur la protection de l’enfant et de la collectivité, à raconter des histoires et à parler de la douleur. Nous fournissons aussi des énoncés que les professionnels de la santé peuvent utiliser durant les conversations sur les vaccins; des réponses aux questions souvent posées sur les bienfaits, l’innocuité et l’aspect immunologique des vaccins; et des liens vers un certain nombre de ressources en ligne à l’intention des médecins et des parents. Conclusion Les parents qui n’ont pas pris position quant aux vaccins pour leurs enfants sont beaucoup plus nombreux que les parents qui refusent les vaccins; il serait ainsi plus efficace de conseiller ce groupe de parents. Les raisons qui incitent à la réticence chez les parents sont complexes et comprennent plus qu’un simple manque d’information. À titre de sources fiables d’information sur les vaccins, les médecins de famille jouent un rôle de premier plan pour stimuler l’acceptation des vaccins.
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Affiliation(s)
- Shixin Cindy Shen
- Résidente au programme de santé publique et de médecine préventive à l'Université de Toronto, en Ontario.
| | - Vinita Dubey
- Médecin-hygiéniste adjointe auprès de Toronto Public Health et professeure adjointe à la Faculté de santé publique Dalla Lana de l'Université de Toronto
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Larson Williams A, Mitrovich R, Mwananyanda L, Gill C. Maternal vaccine knowledge in low- and middle-income countries-and why it matters. Hum Vaccin Immunother 2018; 15:283-286. [PMID: 30252609 PMCID: PMC6422451 DOI: 10.1080/21645515.2018.1526589] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Maternal vaccines have the potential to reduce the global burden of neonatal morbidity and mortality by accessing the infant immune system before a vaccine administered in childhood would be effective. Maternal vaccines for influenza, tetanus, and pertussis have been shown to reduce neonatal disease and mortality, and other candidate vaccines for group B streptococcus and respiratory syncytial virus are being developed to continue this trend. However, safe and effective maternal vaccines will only successfully reduce neonatal illness if mothers decide to receive them. Maternal knowledge, attitudes, and beliefs around vaccines are key determinants to vaccine acceptance or vaccine hesitancy, and yet this issue is often understudied in low and middle-income country settings. A deeper understanding of these factors and how they influence maternal decision-making will allow public health practitioners and global and national policymakers to design more effective interventions. Addressing barriers to immunization at the policy and programmatic levels such as mothers’ knowledge, attitudes, and beliefs of maternal vaccines is essential to increasing vaccination rates at a global scale and reducing global vaccine-preventable neonatal deaths.
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Affiliation(s)
- Anna Larson Williams
- a Department of Global Health , Boston University School of Public Health , Boston , MA, USA
| | - Rachel Mitrovich
- a Department of Global Health , Boston University School of Public Health , Boston , MA, USA
| | | | - Chris Gill
- a Department of Global Health , Boston University School of Public Health , Boston , MA, USA
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Kaufman J, Ryan R, Walsh L, Horey D, Leask J, Robinson P, Hill S. Face-to-face interventions for informing or educating parents about early childhood vaccination. Cochrane Database Syst Rev 2018; 5:CD010038. [PMID: 29736980 PMCID: PMC6494431 DOI: 10.1002/14651858.cd010038.pub3] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Early childhood vaccination is an essential global public health practice that saves two to three million lives each year, but many children do not receive all the recommended vaccines. To achieve and maintain appropriate coverage rates, vaccination programmes rely on people having sufficient awareness and acceptance of vaccines.Face-to-face information or educational interventions are widely used to help parents understand why vaccines are important; explain where, how and when to access services; and address hesitancy and concerns about vaccine safety or efficacy. Such interventions are interactive, and can be adapted to target particular populations or identified barriers.This is an update of a review originally published in 2013. OBJECTIVES To assess the effects of face-to-face interventions for informing or educating parents about early childhood vaccination on vaccination status and parental knowledge, attitudes and intention to vaccinate. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, five other databases, and two trial registries (July and August 2017). We screened reference lists of relevant articles, and contacted authors of included studies and experts in the field. We had no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs evaluating the effects of face-to-face interventions delivered to parents or expectant parents to inform or educate them about early childhood vaccination, compared with control or with another face-to-face intervention. The World Health Organization recommends that children receive all early childhood vaccines, with the exception of human papillomavirus vaccine (HPV), which is delivered to adolescents. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two authors independently reviewed all search results, extracted data and assessed the risk of bias of included studies. MAIN RESULTS In this update, we found four new studies, for a total of ten studies. We included seven RCTs and three cluster-RCTs involving a total of 4527 participants, although we were unable to pool the data from one cluster-RCT. Three of the ten studies were conducted in low- or middle- income countries.All included studies compared face-to-face interventions with control. Most studies evaluated the effectiveness of a single intervention session delivered to individual parents. The interventions were an even mix of short (ten minutes or less) and longer sessions (15 minutes to several hours).Overall, elements of the study designs put them at moderate to high risk of bias. All studies but one were at low risk of bias for sequence generation (i.e. used a random number sequence). For allocation concealment (i.e. the person randomising participants was unaware of the study group to which participant would be allocated), three were at high risk and one was judged at unclear risk of bias. Due to the educational nature of the intervention, blinding of participants and personnel was not possible in any studies. The risk of bias due to blinding of outcome assessors was judged as low for four studies. Most studies were at unclear risk of bias for incomplete outcome data and selective reporting. Other potential sources of bias included failure to account for clustering in a cluster-RCT and significant unexplained baseline differences between groups. One cluster-RCT was at high risk for selective recruitment of participants.We judged the certainty of the evidence to be low for the outcomes of children's vaccination status, parents' attitudes or beliefs, intention to vaccinate, adverse effects (e.g. anxiety), and immunisation cost, and moderate for parents' knowledge or understanding. All studies had limitations in design. We downgraded the certainty of the evidence where we judged that studies had problems with randomisation or allocation concealment, or when outcomes were self-reported by participants who knew whether they'd received the intervention or not. We also downgraded the certainty for inconsistency (vaccination status), imprecision (intention to vaccinate and adverse effects), and indirectness (attitudes or beliefs, and cost).Low-certainty evidence from seven studies (3004 participants) suggested that face-to-face interventions to inform or educate parents may improve vaccination status (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.04 to 1.37). Moderate-certainty evidence from four studies (657 participants) found that face-to-face interventions probably slightly improved parent knowledge (standardised mean difference (SMD) 0.19, 95% CI 0.00 to 0.38), and low-certainty evidence from two studies (179 participants) suggested they may slightly improve intention to vaccinate (SMD 0.55, 95% CI 0.24 to 0.85). Low-certainty evidence found the interventions may lead to little or no change in parent attitudes or beliefs about vaccination (SMD 0.03, 95% CI -0.20 to 0.27; three studies, 292 participants), or in parents' anxiety (mean difference (MD) -1.93, 95% CI -7.27 to 3.41; one study, 90 participants). Only one study (365 participants) measured the intervention cost of a case management strategy, reporting that the estimated additional cost per fully immunised child for the intervention was approximately eight times higher than usual care (low-certainty evidence). No included studies reported outcomes associated with parents' experience of the intervention (e.g. satisfaction). AUTHORS' CONCLUSIONS There is low- to moderate-certainty evidence suggesting that face-to-face information or education may improve or slightly improve children's vaccination status, parents' knowledge, and parents' intention to vaccinate.Face-to-face interventions may be more effective in populations where lack of awareness or understanding of vaccination is identified as a barrier (e.g. where people are unaware of new or optional vaccines). The effect of the intervention in a population where concerns about vaccines or vaccine hesitancy is the primary barrier is less clear. Reliable and validated scales for measuring more complex outcomes, such as attitudes or beliefs, are necessary in order to improve comparisons of the effects across studies.
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Affiliation(s)
- Jessica Kaufman
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Louisa Walsh
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Dell Horey
- La Trobe UniversityCollege of Science, Health and EngineeringBundooraVICAustralia3086
| | - Julie Leask
- The University of SydneySydney Nursing SchoolSydneyNSWAustralia2050
| | - Priscilla Robinson
- La Trobe UniversityDepartment of Public Health, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Sophie Hill
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
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Ibraheem RM, Akintola MA. Acceptability of Reminders for Immunization Appointments via Mobile Devices by Mothers in Ilorin, Nigeria: A Cross-sectional Study. Oman Med J 2017; 32:471-476. [PMID: 29218123 DOI: 10.5001/omj.2017.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Immunization coverage in Nigeria remains low despite the protection it confers. Reminders via mobile phones may be deployed as a means of improving vaccination coverage but requires the participation and cooperation of the caregiver. Therefore, we evaluated the acceptability of reminders for immunization appointment by mothers in Ilorin, Nigeria. Methods This descriptive cross-sectional study recruited 526 mothers from two public hospitals in Ilorin. Semi-structured questionnaires were used to collect information on ownership and access to phones, willingness to receive reminders, household, antenatal, and delivery characteristics. Results The majority (92.7%) of mothers had a personal phone, and all willingly provided contact details. Over half (69.0%) of mothers were willing to receive reminders. Postsecondary education (odds ratio (OR) = 1.958; 95% confidence interval (CI): 1.232-3.111) and antenatal care attendance by mothers (OR = 8.381; 95% CI: 2.495-28.170) were significant determinants of mothers willingness to receive reminders. Mothers with less than or equal to four children had a three-fold increased odds of wanting reminders. Artisan mothers were less likely to want reminders compared with unemployed mothers (OR = 0.506; 95% CI: 0.291-0.847). Conclusions Most mothers are willing to receive reminders on immunization appointments via their mobile phone. Determinants of maternal willingness to receive reminders include mothers with less than four children, postsecondary education, and antenatal care attendance. Program planners should consider utilizing reminders as a strategy to increase the immunization uptake with access to contact details making this feasible.
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Affiliation(s)
- Rasheedat Mobolaji Ibraheem
- Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Frew PM, Lutz CS. Interventions to increase pediatric vaccine uptake: An overview of recent findings. Hum Vaccin Immunother 2017; 13:2503-2511. [PMID: 28949819 PMCID: PMC5703404 DOI: 10.1080/21645515.2017.1367069] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/15/2017] [Accepted: 08/09/2017] [Indexed: 01/17/2023] Open
Abstract
Although much is known about factors contributing to variation in pediatric immunization uptake, there is a need for synthesis of effective vaccine promotion strategies. With growing public health concern on how to best sustain high pediatric immunization rates, and improve where the rates are suboptimal, this review offers evidence gathered from several studies on the achievement of these goals. We identified and analyzed reported findings on childhood (primarily ≤ 7 years) immunization outcomes from tested intervention strategies that focused on parents, guardians, and caregivers, as well as providers, clinics/practices, and communities. The findings suggest that targeted and tailored interventions offer substantial possibilities, especially in a combined manner. We describe promising intervention models that have been operationalized with success and provide evidence for scalability across contexts. Moreover, they are sensitive to parents' and providers' needs, are feasibly integrated in daily clinical practice, and account for broader community concerns and issues.
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Affiliation(s)
- Paula M. Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, USA
| | - Chelsea S. Lutz
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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