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Santos TM, Cata-Preta BO, Wendt A, Arroyave L, Blumenberg C, Mengistu T, Hogan DR, Victora CG, Barros AJD. Exploring the "Urban Advantage" in Access to Immunization Services: A Comparison of Zero-Dose Prevalence Between Rural, and Poor and Non-poor Urban Households Across 97 Low- and Middle-Income Countries. J Urban Health 2024; 101:638-647. [PMID: 38767765 PMCID: PMC11189869 DOI: 10.1007/s11524-024-00859-7] [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] [Accepted: 03/18/2024] [Indexed: 05/22/2024]
Abstract
Urban children are more likely to be vaccinated than rural children, but that advantage is not evenly distributed. Children living in poor urban areas face unique challenges, living far from health facilities and with lower-quality health services, which can impact their access to life-saving vaccines. Our goal was to compare the prevalence of zero-dose children in poor and non-poor urban and rural areas of low- and middle-income countries (LMICs). Zero-dose children were those who failed to receive any dose of a diphtheria-pertussis-tetanus (DPT) containing vaccine. We used data from nationally representative household surveys of 97 LMICs to investigate 201,283 children aged 12-23 months. The pooled prevalence of zero-dose children was 6.5% among the urban non-poor, 12.6% for the urban poor, and 14.7% for the rural areas. There were significant differences between these areas in 43 countries. In most of these countries, the non-poor urban children were at an advantage compared to the urban poor, who were still better off or similar to rural children. Our results emphasize the inequalities between urban and rural areas, but also within urban areas, highlighting the challenges faced by poor urban and rural children. Outreach programs and community interventions that can reach poor urban and rural communities-along with strengthening of current vaccination programs and services-are important steps to reduce inequalities and ensure that no child is left unvaccinated.
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Affiliation(s)
- Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil.
| | - Bianca O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil
- Universidade Federal Do Paraná, Rua Padre Camargo, 280, Curitiba, PR, 80060-240, Brazil
| | - Andrea Wendt
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil
- Programa de Pós-Graduação Em Tecnologia Em Saúde, Pontifícia Universidade Católica Do Paraná, Rua Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Luisa Arroyave
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil
| | - Tewodaj Mengistu
- Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218, Geneva, Switzerland
| | - Daniel R Hogan
- Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218, Geneva, Switzerland
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Deodoro 1160, Pelotas, RS, 96020-220, Brazil
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Sowe A, Namatovu F, Cham B, Gustafsson PE. Missed opportunities for vaccination at point of care and their impact on coverage and urban-rural coverage inequity in the Gambia. Vaccine 2023; 41:7647-7654. [PMID: 37996292 DOI: 10.1016/j.vaccine.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Identifying actionable targets is crucial to improve overall and equity in vaccination coverage, and in line with the global Immunization Agenda 2030. Therefore, this study seeks to assess the prevalence of missed opportunities for simultaneous vaccination (MOSVs) and their impact on vaccination coverage and urban-rural inequity in The Gambia. METHODS We used data of children aged 12-23 months from The Gambia 2019/2020 demographic and health survey (weighted n = 1355) with seen vaccination cards. We analyzed: the frequency of MOSVs; percentage point coverage reduction attributable to MOSVs for 18 vaccine doses and full basic vaccination; and MOSVs' contribution to urban-rural coverage inequity through Blinder-Oaxaca decomposition. RESULTS Sixty percent of children experienced MOSVs, in both urban and rural areas, but urban MOSVs were more seldom corrected (35.9 % vs 45.3 %). All eighteen vaccine doses assessed could have achieved between one to eleven percentage points higher coverage if MOSVs had been avoided, with full basic vaccination gaining even more. While MOSV correction did not impact overall urban-rural coverage inequity, it did exacerbate (explained coefficient = -0.1007; P = 0.002) inequities among children who experienced MOSVs, explaining 95 % of the observed difference. CONCLUSION Our study highlights the prevalence and negative impact of MOSVs on overall vaccination coverage. Although MOSVs did not contribute significantly to the total urban-rural inequity in coverage, they have detrimental effects on vaccination coverage and urban-rural inequity among children who had experienced MOSVs. Addressing MOSVs, can enhance coverage and reduce the risk of under-vaccination, aligning with global initiatives.
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Affiliation(s)
- Alieu Sowe
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Expanded Program on Immunization, Ministry of Health, Banjul, the Gambia.
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bai Cham
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Bakau, the Gambia; School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Johns NE, Cata-Preta BO, Kirkby K, Arroyave L, Bergen N, Danovaro-Holliday MC, Santos TM, Yusuf N, Barros AJD, Hosseinpoor AR. Inequalities in Immunization against Maternal and Neonatal Tetanus: A Cross-Sectional Analysis of Protection at Birth Coverage Using Household Health Survey Data from 76 Countries. Vaccines (Basel) 2023; 11:752. [PMID: 37112664 PMCID: PMC10146835 DOI: 10.3390/vaccines11040752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Substantial progress in maternal and neonatal tetanus elimination has been made in the past 40 years, with dramatic reductions in neonatal tetanus incidence and mortality. However, twelve countries have still not achieved maternal and neonatal tetanus elimination, and many countries that have achieved elimination do not meet key sustainability thresholds to ensure long-lasting elimination. As maternal and neonatal tetanus is a vaccine-preventable disease (with coverage of the infant conferred by maternal immunization during and prior to pregnancy), maternal tetanus immunization coverage is a key metric for monitoring progress towards, equity in, and sustainability of tetanus elimination. In this study, we examine inequalities in tetanus protection at birth, a measure of maternal immunization coverage, across 76 countries and four dimensions of inequality via disaggregated data and summary measures of inequality. We find that substantial inequalities in coverage exist for wealth (with lower coverage among poorer wealth quintiles), maternal age (with lower coverage among younger mothers), maternal education (with lower coverage among less educated mothers), and place of residence (with lower coverage in rural areas). Inequalities existed for all dimensions across low- and lower-middle-income countries, and across maternal education and place of residence across upper-middle-income countries. Though global coverage changed little over the time period 2001-2020, this obscured substantial heterogeneity across countries. Notably, several countries had substantial increases in coverage accompanied by decreases in inequality, highlighting the need for equity considerations in maternal and neonatal tetanus elimination and sustainability efforts.
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Affiliation(s)
- Nicole E. Johns
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Bianca O. Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Luisa Arroyave
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Nicole Bergen
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Thiago M. Santos
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Nasir Yusuf
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Sarfo JO, Amoadu M, Kordorwu PY, Adams AK, Gyan TB, Osman AG, Asiedu I, Ansah EW. Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions. Eur J Med Res 2023; 28:80. [PMID: 36800986 PMCID: PMC9936673 DOI: 10.1186/s40001-023-01046-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Africa has a higher burden of malaria-related cases and deaths globally. Children under five accounted for over two-thirds of all malaria deaths in sub-Saharan Africa (SSA). This scoping review aims to map evidence of the prevalence, contextual factors and health education interventions of malaria amongst children under 5 years (UN5) in SSA. METHOD Four main databases (PubMed, Central, Dimensions and JSTOR) produced 27,841 records of literature. Additional searches in Google, Google Scholar and institutional repositories produced 37 records. Finally, 255 full-text records were further screened, and 100 records were used for this review. RESULTS Low or no formal education, poverty or low income and rural areas are risk factors for malaria amongst UN5. Evidence on age and malnutrition as risk factors for malaria in UN5 is inconsistent and inconclusive. Furthermore, the poor housing system in SSA and the unavailability of electricity in rural areas and unclean water make UN5 more susceptible to malaria. Health education and promotion interventions have significantly reduced the malaria burden on UN5 in SSA. CONCLUSION Well-planned and resourced health education and promotion interventions that focus on prevention, testing and treatment of malaria could reduce malaria burden amongst UN5 in SSA.
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Affiliation(s)
- Jacob Owusu Sarfo
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Peace Yaa Kordorwu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul-Ganiyu Osman
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- grid.413081.f0000 0001 2322 8567University of Cape Coast, Cape Coast, Ghana
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Boisson A, Morgan CE, Stover A, Ngimbi P, Mbonze N, Ntambua S, Matondo J, Parr JB, Yotebieng M, Mwandagalirwa K, James L, Mampunza S, Thompson P. Changes in hepatitis B vaccine perception in response to the COVID-19 pandemic: Development of the Shift in vaccine confidence (SVC) survey tool. Vaccine 2023; 41:623-629. [PMID: 36549941 PMCID: PMC9755009 DOI: 10.1016/j.vaccine.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 11/18/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has disrupted access to, adherence to, and perceptions of routine vaccinations. We developed the Shift in Vaccine Confidence (SVC) survey tool to assess the impact of the pandemic on routine vaccinations, with a focus on the HBV vaccine, in Kinshasa, Democratic Republic of Congo (DRC). This study describes the content validation steps we conducted to ensure the survey tool is meaningful to measure changes in vaccine confidence to regular immunization (HBV vaccine) due to the pandemic. Three rounds of stakeholder feedback from a DRC-based study team, content and measurement experts, and study participants allowed us to produce a measure with improved readability and clarity.
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Affiliation(s)
- Alix Boisson
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Camille E Morgan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Angela Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.
| | - Patrick Ngimbi
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Nana Mbonze
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Sarah Ntambua
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Jolie Matondo
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Jonathan B Parr
- Division of Infectious Diseases, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
| | | | - Linda James
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Samuel Mampunza
- Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo.
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA.
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McBride K, Moucheraud C. Rural-Urban Differences: Using Finer Geographic Classifications to Reevaluate Distance and Choice of Health Services in Malawi. Health Syst Reform 2022; 8:e2051229. [PMID: 35416748 PMCID: PMC9995164 DOI: 10.1080/23288604.2022.2051229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/05/2022] [Accepted: 03/05/2022] [Indexed: 02/03/2023] Open
Abstract
There is no universal understanding of what defines urban or rural areas nor criteria for differentiating within these. When assessing access to health services, traditional urban-rural dichotomies may mask substantial variation. We use geospatial methods to link household data from the 2015-2016 Malawi Demographic Health Survey to health facility data from the Malawi Service Provision Assessment and apply a new proposed four-category classification of geographic area (urban major metropolitan area, urban township, rural, and remote) to evaluate households' distance to, and choice of, primary, secondary, and tertiary health care in Malawi. Applying this new four-category definition, approximately 3.8 million rural- and urban-defined individuals would be reclassified into new groups, nearly a quarter of Malawi's 2015 population. There were substantial differences in distance to the nearest facility using this new categorization: remote households are (on average) an additional 5 km away from secondary and tertiary care services versus rural households. Health service choice differs also, particularly in urban areas, a distinction that is lost when using a simple binary classification: those living in major metropolitan households have a choice of five facilities offering comprehensive primary care services within a 10-km zone, whereas urban township households have no choice, with only one such facility within 10 km. Future research should explore how such expanded classifications can be standardized and used to strengthen public health and demographic research.
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Affiliation(s)
- Kaitlyn McBride
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Corrina Moucheraud
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Adetokunboh O, Iwu-Jaja CJ, Nnaji CA, Ndwandwe D. Missed opportunities for vaccination in Africa. Curr Opin Immunol 2021; 71:55-61. [PMID: 34087523 DOI: 10.1016/j.coi.2021.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this review is to assess the extent of missed opportunities for vaccination (MOV) in Africa, determine the associated factors, and provide recommendations that countries could adopt in reducing MOV. Two databases were searched for multinational studies and systematic reviews reporting MOV and involving African countries. A total of 288 records were identified and 12 studies included for synthesis. The prevalence ranged from 47.0% to 62.1%, with a weighted mean of 27.3%. This review highlighted caregiver utilization, health service delivery, and healthcare worker' factors associated with MOV. Understanding the extent of MOV in Africa presents an opportunity for multiple approaches to resolve the differential factors that contribute to MOV, and to bridge the gap in vaccination coverage in the continent.
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Affiliation(s)
- Olatunji Adetokunboh
- Department of Science and Innovation-National Research Foundation (DSI-NRF), Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa; Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
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Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal. Adv Prev Med 2021; 2021:1319090. [PMID: 33959398 PMCID: PMC8075685 DOI: 10.1155/2021/1319090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal. Methods The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model. Results A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant (P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55). Conclusion Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.
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Ameyaw EK, Kareem YO, Ahinkorah BO, Seidu AA, Yaya S. Decomposing the rural-urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries. BMJ Glob Health 2021; 6:e003773. [PMID: 33452139 PMCID: PMC7813364 DOI: 10.1136/bmjgh-2020-003773] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/21/2020] [Accepted: 12/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND About 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural-urban differential in full childhood immunisation in SSA. METHODS The data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant. RESULTS More than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural-urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural-urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility. CONCLUSION This study has emphasised the rural-urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.
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Affiliation(s)
- Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yusuf Olushola Kareem
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Li AJ, Tabu C, Shendale S, Sergon K, Okoth PO, Mugoya IK, Machekanyanga Z, Onuekwusi IU, Sanderson C, Ogbuanu IU. Assessment of missed opportunities for vaccination in Kenyan health facilities, 2016. PLoS One 2020; 15:e0237913. [PMID: 32817630 PMCID: PMC7440639 DOI: 10.1371/journal.pone.0237913] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background In November 2016, the Kenya National Vaccines and Immunization Programme conducted an assessment of missed opportunities for vaccination (MOV) using the World Health Organization (WHO) MOV methodology. A MOV includes any contact with health services during which an eligible individual does not receive all the vaccine doses for which he or she is eligible. Methods The MOV assessment in Kenya was conducted in 10 geographically diverse counties, comprising exit interviews with caregivers and knowledge, attitudes, and practices (KAP) surveys with health workers. On the survey dates, which covered a 4-day period in November 2016, all health workers and caregivers visiting the selected health facilities with children <24 months of age were eligible to participate. Health facilities (n = 4 per county) were purposively selected by size, location, ownership, and performance. We calculated the proportion of MOV among children eligible for vaccination and with documented vaccination histories (i.e., from a home-based record or health facility register), and stratified MOV by age and reason for visit. Timeliness of vaccine doses was also calculated. Results We conducted 677 age-eligible children exit interviews and 376 health worker KAP surveys. Of the 558 children with documented vaccination histories, 33% were visiting the health facility for a vaccination visit and 67% were for other reasons. A MOV was seen in 75% (244/324) of children eligible for vaccination with documented vaccination histories, with 57% (186/324) receiving no vaccinations. This included 55% of children visiting for a vaccination visit and 93% visiting for non-vaccination visits. Timeliness for multi-dose vaccine series doses decreased with subsequent doses. Among health workers, 25% (74/291) were unable to correctly identify the national vaccination schedule for vaccines administered during the first year of life. Among health workers who reported administering vaccines as part of their daily work, 39% (55/142) reported that they did not always have the materials they needed for patients seeking immunization services, such as vaccines, syringes, and vaccination recording documents. Conclusions The MOV assessment in Kenya highlighted areas of improvement that could reduce MOV. The results suggest several interventions including standardizing health worker practices, implementing an orientation package for all health workers, and developing a stock management module to reduce stock-outs of vaccines and vaccination-related supplies. To improve vaccination coverage and equity in all counties in Kenya, interventions to reduce MOV should be considered as part of an overall immunization service improvement plan.
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Affiliation(s)
- Anyie J. Li
- ASPPH/CDC Allan Rosenfield Global Health Fellowship and PHI/CDC Global Health Fellowship, Atlanta, GA, United States of America
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
| | - Kibet Sergon
- World Health Organization Kenya, Country Office, Nairobi, Kenya
| | | | | | - Zorodzai Machekanyanga
- Inter-Country Support Team (IST)–East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | | | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ikechukwu Udo Ogbuanu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
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11
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Li AJ, Tabu C, Shendale S, Okoth PO, Sergon K, Maree E, Mugoya IK, Machekanyanga Z, Onuekwusi IU, Ogbuanu IU. Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities. PLoS One 2020; 15:e0230783. [PMID: 32226039 PMCID: PMC7105087 DOI: 10.1371/journal.pone.0230783] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background In 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)—when eligible children have contact with the health system but are not fully vaccinated—to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment. Methods Using the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children <24 months of age visiting the selected health facilities on the day of the assessment were requested to participate in focus group discussions. Health workers were purposively sampled to capture a broad range of perspectives. Key informants were selected based on their perceived insight on immunization services at the county, sub-county, or health facility level. Results Six focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies. Conclusions Identified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.
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Affiliation(s)
- Anyie J. Li
- ASPPH/CDC Allan Rosenfield Global Health Fellowship and PHI/CDC Global Health Fellowship, Atlanta, GA, United States of America
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
| | | | - Kibet Sergon
- World Health Organization Kenya Country Office, Nairobi, Kenya
| | - Ephantus Maree
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | | | - Zorodzai Machekanyanga
- Inter-Country Support Team (IST)–East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | | | - Ikechukwu Udo Ogbuanu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
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