Factors associated with non-uptake of measles-rubella vaccine second dose among children under five years in Mtwara district council, Tanzania, 2017

Determinants of second-dose measles vaccination dropout in Ethiopia: A community-based matched case-control study

Background

Measles vaccination is the most important public health intervention and a cost-effective strategy to reduce morbidity and mortality in under-five children. Although Ethiopia's government developed a measles elimination strategic plan by 2020, the full coverage of immunization was 43 %. Therefore, this study aimed to identify determinants of second-dose measles vaccination (MCV2) dropout among children aged 24-35 months in East Bale Zone, Ethiopia.

Method

A community-based matched case-control study was conducted among 351 children (117 cases and 234 controls). Children who received the first dose of measles vaccine but did not receive the second dose were cases, and children who received both doses of measles vaccine were control. The matches were based on age and residence. The data were collected using a structured questionnaire, entered into Epi Data 3.1, cleaned, exported, and analyzed using Stata version 16.1. A multivariable conditional logistic regression analysis was performed. Variables with a P value of <0.05 were considered significant determinants of the dependent variable at the 95 % confidence level.

Results

Mothers who were unable to read and write (mAOR: 4.0; 95 % CI: 1.59-10.2), did not receive counseling (mAOR: 3.19; 95 % CI: 1.62-6.27), spent ≥30 min to reach health facilities (mAOR; 2.76, 95 % CI: 1.25-6.1), and did not attend postnatal care (mAOR; 3.46, 95 % CI: 1.58-7.57) were significantly and positively associated with second-dose measles vaccination dropout. In addition, mothers who had poor knowledge of second-dose measles vaccination (mAOR; 3.20, 95 % CI: 1.50-6.70) and waited more than an hour for measles vaccination at health facilities (mAOR; 2.61, 95 % CI: 1.0-6.20) were significantly more likely to experience second-dose measles vaccine dropout.

Conclusions

The key factors associated with second-dose measles vaccination dropout are maternal illiteracy, lack of PNC, inadequate maternal knowledge and poor counseling about MCV2 vaccination, long distances travel to healthcare facilities and extended waiting times at vaccination providing sites. Health extension workers emphasize strengthening home visit programs in catchment households to improve mothers' awareness of measles vaccination.

Measles second dose vaccine uptake and its associated factors among children aged 24-35 months in Northwest Ethiopia, 2022

Measles is a major public health problem in under-five children, leading to lifelong complications. Therefore, the study aimed to assess the magnitude of measles second-dose vaccine uptake and its determinants among children aged 24-35 months in Northwest Ethiopia. A community-based cross-sectional study was conducted among 418 children aged 24-35 months in Northwest Ethiopia between January 2022 and February 2022. A simple random sampling technique was used to access study subjects. A binary logistic regression model was employed. An adjusted odd ratio with a 95% confidence interval (CI) and a p-value < 0.05 was used to declare significant predictors of measles second dose vaccine uptake. The magnitude of the measles second dose vaccine uptake among children aged 24-35 months was 41.39%. Postnatal care visits (AOR: 4.78, CI 1.49, 15.34), child vaccination status of other scheduled vaccines (AOR: 3.88, CI 2.23, 6.73), awareness of the measles second dose vaccine and its schedule (AOR: 8.924, CI 5.27, 15.09), and distance from the vaccination center (AOR: 0.21, CI 0.06, 0.77) were significantly associated with measles second dose vaccine uptake. The uptake of measles second dose vaccine in the study area was low. Therefore, health workers and other partners should initiate awareness creation programs for mothers/caretaker to improve the uptake of measles second dose vaccine.

Second dose of measles-containing vaccine coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023

Background

Measles caused 207,000 deaths worldwide in 2019. Ethiopia ranks among the top 10 countries in the world with the highest number of measles cases. However, the coverage of the second dose of measles-containing vaccine (MCV2) remains low. To increase coverage, the government of Ethiopia launched a nationwide measles vaccination campaign. Despite this intervention, the coverage is still below target, and there is scarce information in the study area. Therefore, this study aimed to assess MCV2 coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023.

Methods

A community-based cross-sectional study was conducted among 621 children aged 24-36 months using a systematic random sampling technique from 25 April to 25 May. A pre-tested, interviewer-administered, and structured questionnaire was used and collected using Kobo Toolbox and then transferred to Stata version 17 for further analysis. The binary logistic regression model was used to identify factors, and the presence of an association was declared using a p-value of <0.05. Similarly, an adjusted odds ratio with a 95% confidence interval was used to interpret the direction and strength of an association.

Results

A total of 621 children, with a response rate of 98.1%, participated in the study. The coverage of the second dose of MCV was 75.68% (95% CI: 72.1-78.9). The following factors were significantly associated with measles-containing vaccine second dose (MCV2) coverage: father as the household head (AOR: 3.06, 95% CI: 1.43-6.44), first birth order (AOR: 4.45, 95% CI: 1.21-16.3), four and above antenatal care (ANC) follow-ups (AOR: 5.18, 95% CI:1.62-16.5), postnatal care (PNC) service utilization (AOR: 2.57, 95% CI:1.27-5.15), at least two doses of vitamin A uptake (AOR: 6.39, 95% CI: 2.67-15.2), mothers having high awareness (AOR: 1.97, 95% CI:1.15-3.4), and good perception (AOR: 3.6, 95% CI: 2-6.47) about measles vaccination.

Conclusion and recommendations

The coverage of MCV2 in the study area is lower than the national and global target of above 95%. Head of household, birth order, ANC follow-up, PNC service utilization, vitamin A uptake, awareness, and perception of mothers about measles vaccination were significant factors for MCV2 coverage. Creating awareness, increasing the perception of mothers about measles vaccination, and strengthening the ANC and PNC services will increase the coverage.

Coverage and determinants of second-dose measles vaccination among under-five children in East Africa countries: a systematic review and meta-analysis

Background

One of the biggest breakthroughs of contemporary medicine is measles vaccination. It is essential for the total elimination of measles. Understanding the magnitude and determinants of effective second-dose measles vaccination coverage is a critical task. Accordingly, we set out to check the best available evidence of the pooled second-dose measles vaccination coverage among under-five children in East Africa.

Method

We searched electronic databases such as PubMed, Google Scholar, Cochrane, and others. Two reviewers separately carried out the search of the Joanna Briggs Institute, selection of studies, critical appraisal, and data extraction. A third party was involved in resolving the disagreement among the reviewers. Seven studies included in this study, four from Ethiopia, two from Kenya, and one from Tanzania were cross-sectional and published in English language, with publication dates before 29 November 2023. Articles lacking full-text, the intended outcome, and that are not qualitative studies were excluded from the analysis. The Microsoft Excel checklist was used to extract the data and then exported to STATA 11. In addition, I2, Funnel plots, and Egger's test were employed to measure heterogeneity and detect publication bias, respectively. A random effect model was used.

Result

The meta-analysis includes a total sample size of 4,962 children from seven articles. The pooled prevalence of second-dose measles vaccination among under-five children in East Africa was found to be 32.22% [95% CI; (18.82, 45.63)], and the significant factors were as follows: birth order (1.72; OR = 95% CI: 1.32, 2.23), information about measles-containing second-dose vaccine (MCV 2) (7.39; OR = 95% CI: 5.21, 10.50), mother's marital status (1.47; OR = 95% CI: 1.05, 2.07), complete immunization for other vaccines (2.17; OR = 95% CI: 1.49, 3.17), and distance of vaccination site (3.31; OR = 95% CI: 2.42, 4.53).

Conclusion

The current study found that pooled prevalence of second-dose measles vaccination coverage among under-five children was still very low. It was also observed that birth order, distance of the vaccination site, complete immunization for other vaccines, mother's marital status, and information about MCV were factors associated with second-dose measles vaccination. These factors imply that there is a need for countries and their partners to act urgently to secure political commitment, expand primary health service and health education, and increase vaccination coverage.

Predictors for low coverage of uptake of second dose of measles vaccine among children in sub-Saharan Africa, 2023: a systematic review and meta-analysis

Background

Measles became a public health important disease in sub-Saharan Africa. World Health Organization recommended measles-containing vaccine dose 2 (MCV2) through routine service delivery. This study aims to determine coverage of second-dose measles vaccination uptake and its predictors among children aged 24-35 months in sub-Saharan Africa.

Methods and materials

We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature.

Results

The overall uptake of the second dose of measles vaccine uptake was 41% (95% CI: 28.90-53.47). Caregiver's awareness of the importance of the second dose of measles (2.51, 95% CI 1.77, 3.25), educational status of mothers (1.30, 95% CI 1.16, 1.45), distance from vaccination site (1.22, 95% CI 1.12, 1.32), and attending four and above ANC visit (2.72, 95% CI 2.29, 3.15) were determinants for second dose measles vaccine uptake.

Conclusion

Coverage of the second dose of measles uptake in Sub-Saharan Africa was low (41%) which is lower than the recommendation from WHO. Therefore policymakers and stakeholders should increase mother's awareness. Also, special strategies should be developed for those who are far from the vaccination site.

Abbreviation and acronyms

ANC: Ante Natal Care; JBI: Joanna Briggs Institute; MCV1: Measles containing vaccine dose 1; MCV2: Measles containing vaccine dose 2; WHO: World Health Organization.

Understanding Sociodemographic Factors and Reasons Associated with COVID-19 Vaccination Hesitance among Adults in Tanzania: A Mixed-Method Approach

Although studies on COVID-19 vaccine hesitancy are being undertaken widely worldwide, there is limited evidence in Tanzania. This study aims to assess the sociodemographic factors associated with COVID-19 vaccine hesitancy and the reasons given by unvaccinated study participants. We conducted a mixed-method cross-sectional study with two components-health facilities and communities-between March and September 2022. A structured questionnaire and in-depth interviews were used to collect quantitative and qualitative data, respectively. A total of 1,508 individuals agreed to participate in the survey and explained why they had not vaccinated against COVID-19. Of these participants, 62% indicated they would accept the vaccine, whereas 38% expressed skepticism. In a multivariate regression analysis, adult study participants 40 years and older were significantly more likely to report not intending to be vaccinated (adjusted odds ratio [AOR], 1.28; 95% CI, 1.01-1.61; P = 0.04) than youth and middle-aged study participants between 18 and 40 years. Furthermore, female study participants had a greater likelihood of not intending to be vaccinated (AOR, 1.51; 95% CI, 1.19-1.90; P = 0.001) than male study participants. The study identified fear of safety and short-term side effects, and lack of trust of the COVID-19 vaccine; belief in spiritual or religious views; and belief in local remedies and other precautions or preventive measures as the major contributors to COVID-19 vaccine hesitancy in Tanzania. Further empirical studies are needed to confirm these findings and to understand more fully the reasons for vaccine hesitancy in different demographic groups.

Second Dose Measles Vaccination Utilization and Associated Factors in Jabitehnan District, Northwest Ethiopia

Background

Herd immunity against measles is essential to interrupt measles transmission, and this can only be attained by reaching at least 95% coverage for each of the 2 doses of measles vaccine provided in infancy and early childhood age group. It is important to provide everyone with 2 doses of the measles vaccine in order to effectively safeguard the population. Despite this, little is known about the second dosage of the measles vaccine utilization status and the factors that affect it. Therefore, this study aimed to assess second dose of measles vaccination utilization and its associated factors among children aged 24-35 months in Jabitehnan district, 2020.

Methods

A community-based cross-sectional study design was conducted at Jabitehnan District, Northwest Ethiopia, from September 1st, 2020 to October 1st, 2020. Systematic random sampling technique was used to select 845 mothers/caregivers who had children aged 24-35 months. Both bi-variable and multivariable logistic regression was fitted to identify the determinant factors of second dose measles vaccination utilization. Finally, the statistical significant variables were declared by using 95% CI and P value less than .05 in the multivariable logistic regression analysis. The Hosmer and Lemeshow test was used to check the model's fit to the data, and the variance inflation factor was used to assess multi-collinearity.

Results

The overall second dose of measles vaccination utilization was 48.1%, (95% CI: 44.7-51.6). Mothers with primary school education (AOR = 1.91, 95% CI: 1.15-3.17), information about MCV2 (AOR = 6.53, 95% CI: 4.22-10.08), distance from vaccination site (AOR = 3.56, 95% CI: 2.46-5.14), knowledge about immunization (AOR = 1.935, 95% CI: 1.29-2.90), and favorable attitude about immunization (AOR = 5.19, 95% CI: 3.25-8.29) were significantly associated factors with second dose of measles vaccination utilization.

Conclusion

Second dose measles vaccination utilization in the district was lower than the national target. Maternal education, distances from vaccination site, information about MCV2, and knowledge about immunization were significantly associated variables with second dose measles vaccination utilization. Therefore, in order to increase the utilization of the second dose of the measles vaccine, improved health education and service expansion to difficult-to-reach areas are required.

Second-dose measles vaccination and associated factors among under-five children in urban areas of North Shoa Zone, Central Ethiopia, 2022

Introduction

Measles remain a leading cause of vaccine-preventable infant mortality. In Africa, about 13 million cases and 6,50,000 deaths occur annually, with Sub-Saharan Africa having the highest morbidity and mortality. Ethiopia launched second-dose measles vaccination into the routine immunization program in the second year of life in 2019. However, little has been known about the coverage of the second-dose measles vaccine. Therefore, the purpose of this study was to assess the level of second-dose measles vaccine uptake and associated factors in North Shoa Zone, Central Ethiopia.

Objective

To assess second-dose measles vaccination and associated factors among under-five children and to identify reasons for not being vaccinated in urban areas of North Shoa Zone, Central Ethiopia, 2022.

Method

A community-based cross-sectional study was conducted from 1 February to 15 March 2022. The sample size was 410, and it was allocated proportionally to each kebelle. The study units were selected consecutively. The data were collected using structured interviewer-administered questionnaires. Four nurses were used as data collectors. Data were coded manually and entered into Epi-data Version 4.4.2.1. Frequency and cross-tabs were used for data cleaning. Data were analyzed using SPSS Version 21 software. Multicollinearity and model goodness-of-fit tests were checked. A multivariable logistic regression model at 95% CI was used to identify factors associated with the dependent variable.

Result

The response rate was 90.7%. The level of second-dose measles vaccination among children in urban areas of North Shoa Zone was 42.5% [95% CI (36.8, 47.3)]. Maternal age of ≤ 25 years [AOR = 9.12: 95% CI (1.97, 42.19)], 26-30 years [AOR = 9.49: 95% CI (2.33, 38.63)], 31-35 years [AOR = 7.87: 95% CI (1.78, 34.79)]; average time mothers had been waiting for vaccination at the health facility [AOR = 3.68: 95% CI (1.33, 10.23)]; awareness about vaccine-preventable diseases [AOR = 4.15: 95% CI (1.53, 11.26)]; and awareness on recommended measles doses [AOR = 17.81: 95% CI (3.91, 81.22)] were identified as factors associated with MCV2 vaccination. The major reason (48.1%) reported by mothers for not vaccinating second-dose measles vaccine was being unaware of the need to return for second-dose measles vaccination.

Conclusion and recommendation

The level of second-dose measles vaccination (MCV2) among children in urban areas of the North Shoa Zone was low. Maternal age, average time mothers had been waiting for vaccination at the health facility, awareness about vaccine-preventable diseases, recommended age for the last vaccination, and recommended measles doses were identified as factors associated with MCV2 uptake. The major reason for not vaccinating MCV2 was a lack of information (unaware of the need to return for MCV2, unaware of the need to return for MCV2, and the place and/or time of immunization unknown). Hence, enhancing awareness about vaccine-preventable diseases, shortening the average time for vaccination at the health facility by half an hour, creating an alerting mechanism for MCV2 appointments, and future studies on the effect of healthcare provider-related factors on MCV2 uptake are recommended.

Less than one-fifth of Ethiopian children were vaccinated for measles second dose; evidence from the Ethiopian mini demographic and health survey 2019

Ethiopia introduced the measles second dose vaccine from the routine expanded immunization program in 2018. Shreds of evidence are scarce on the measles second dose vaccination coverage and its associated factors in Ethiopia. We aimed to assess the measles second dose vaccination coverage and associated factors in Ethiopia using the recent Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 data. An in-depth secondary data analysis was conducted based on the Ethiopian mini demographic and health survey 2019 data; which was a cross-sectional survey targeted on key indicators of maternal and child health. A weighted sample of 965 children was included in the analysis. A multi-level mixed effect logistics regression model was fitted. Adjusted Odds Ratio (AOR) with 95 %CI was reported for statistically significant variables. The measles second dose coverage was 12.36 % (95 %CI = 10.89, 15.44). Not vaccinated for the third dose of pentavalent vaccine (Penta 3) (AOR = 0.60, 95 %CI: 0.37, 0.95), age of the child [13 to 23 months (AOR = 2.14, 95 %CI: 1.05, 4.36), 24 to 36 months (AOR = 2.58, 95 %CI: 1.32, 5.05)], household head educational status [no education (AOR = 0.51,95 %CI: 0.26, 0.99), primary (AOR = 0.44, 95 %CI: 0.23, 0.85)], and living in south nation, nationalities and peoples region (SNNPR) (AOR = 2.83,95 %CI: 1.12, 7.11) were significantly associated with measles second dose vaccination coverage. Measles second dose vaccination coverage was low in Ethiopia. Age of the child, being vaccinated for the Penta 3, educational status of the household head, and region of residence were significant determinants of measles second dose vaccination coverage.

Perceived Vaccine Availability and the Uptake of Measles Vaccine in Sudan: The Mediating Role of Vaccination Hesitancy

This study aimed to evaluate whether measles vaccine uptake can be predicted directly or indirectly by parental perceptions about the availability of measles vaccine services with parental hesitancy towards the measles vaccine as a potential mediator. This was a community-based cross-sectional study conducted at Omdurman locality in Khartoum state, Sudan in February 2019. The study population included parents/guardians having at least one child aged 2-3 years old. Mediation analysis was conducted using two models, the ordinary least squares path analysis and multiple logistic regression. These models considered perceived vaccine accessibility and availability as independent factors, vaccine uptake as dependent factors, and vaccine hesitancy (PACV scores) as a mediator. A total of 495 responded and the mean age of the mothers who participated in the study was 31.1 (SD = 5.73). Half of the respondents (50.1%) completed university education and nearly three-quarters of the respondents (74.7%) were housewives. After controlling for the other factors, including the mother's age and the number of children, parental perception about the accessibility and availability of the measles vaccine influences the uptake of the measles vaccine indirectly through the mediation effect of measles vaccine hesitancy. We suggest that intervening in measles vaccine hesitancy in addition to measles vaccination access issues will have a positive impact on the uptake and coverage of the measles vaccine in Sudan.

Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania

BACKGROUND

Timely vaccination maximizes efficacy for preventing infectious diseases. In the absence of national vaccination registries, representative sample survey data hold vital information on vaccination coverage and timeliness. This study characterizes vaccination coverage and timeliness in Tanzania and provides an analytic template to inform contextually relevant interventions and evaluate immunization programs.

METHODS

Cross-sectional data on 6,092 children under age 3 from the 2015-16 Tanzania Demographic and Health Survey were used to examine coverage and timeliness for 14 vaccine doses recommended in the first year of life. The Kaplan-Meier method was used to model time to vaccination. Cox proportional hazard models were used to examine factors associated with timely vaccination.

RESULTS

Substantial rural-urban disparities in vaccination coverage and timeliness were observed for all vaccines. Across 14 recommended doses, documented coverage ranged from 52 % to 79 %. Median vaccination delays lasted up to 35 days; gaps were larger among rural than urban children and for later doses in vaccine series. Among rural children, median delays exceeded 35 days for the 3rd doses of the polio, pentavalent, and pneumococcal vaccines. Median delays among urban children were < 21 days for all doses. Among rural and urban children, lower maternal education and delivery at home were associated with increased risk of delayed vaccination. In rural settings, less household wealth and greater distance to a health facility were also associated with increased risk of delayed vaccination.

DISCUSSION

This study highlights persistent gaps in uptake and timeliness of childhood vaccinations in Tanzania and substantial rural-urban disparities. While the results provide an informative situation assessment and outline strategies for identifying unvaccinated children, a national electronic registry is critical for comprehensive assessments of the performance of vaccination programs. The timeliness measure employed in this study-the amount of time children are un- or undervaccinated-may serve as a sensitive performance metric for these programs.

Vaccine Hesitancy among Parents and Its Association with the Uptake of Measles Vaccine in Urban Settings in Khartoum State, Sudan

Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother’s age and the number of children (aOR 1.055; 95% CI 1.028–1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620–0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.

Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: A Cross-Sectional Study

Determinants of vaccine hesitancy are not yet well understood. This study aims to assess measles vaccine hesitancy and characterize its determinants among Sudanese parents in Omdurman in Khartoum State. A community-based cross-sectional quantitative study was conducted in Khartoum State in February 2019. The Parent Attitudes about Childhood Vaccination (PACV) was used to measure measles vaccine hesitancy. Questions about the sociodemographic characteristics of the family, the perception of the parents about the measles vaccine, and the parental exposure to information were asked. Proportions of vaccine hesitancy and coefficients of linear regression were computed. Five hundred parents were recruited for the study. We found that a significant proportion of participants (about 1 in 5 parents) had hesitations regarding the measles vaccine. Significant predictors of measles vaccine hesitancy were parental exposure to anti-vaccination information or materials (β = −0.478, p-value < 0.001), the parents’ perception of the effectiveness of measles vaccines (β = 0.093, p-value = 0.020), the age of the mother (β = 0.112, p-value = 0.017), the birth rank of the child (β = −0.116, p-value = 0.015), and the total number of the children in the family (β = 0.098, p-value = 0.013). Vaccination access issues were the common justification for parental vaccination hesitancy. Our findings indicate that investment in vaccine communication as well as addressing access issues might be an effective intervention for improving measles vaccine acceptance and, ultimately, measles vaccine coverage.

Factors affecting non-coverage of measles-rubella vaccination among children aged 9-59 months in Tanzania

Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan that set a target to eliminate Measles-Rubella (MR) in five of the six World Health Organization (WHO) regions by 2020. This was cross-sectional study employed both quantitative and qualitative research methods. The sample size was calculated to provide overall, age- and sex-specific coverage estimates for MR vaccine among children aged between 9 and 59 months at the national level. Using desired precision of ±5% with an expected coverage of 95%, a total of 15,235 households were required. The age of children, a child who had received the MR vaccine before the campaign, household wealth quintile, the age of caregivers, and their marital status were associated with non-coverage of MR vaccination among children aged 9-59 months in Tanzania. Nationally, an estimated 88.2% (95% CI: 87.3-89%) of children aged 9-59 months received the MR campaign dose, as assessed by caregivers' recall. These estimates revealed slightly higher coverage in Zanzibar 89.6% (95% CI: 84.7-93%) compared to Mainland Tanzania 88.1% (95% CI 87.2-88.9%). These associated factors revealed causes of unvaccinated children and may be some of the reasons for Tanzania's failure to meet the MR campaign target of 95 percent vaccination coverage. Thus, vaccine development must increase programmatic oversight in order to improve immunization activities and communication strategies in Tanzanian areas with low MR coverage.

Parental concerns and uptake of childhood vaccines in rural Tanzania - a mixed methods study

BACKGROUND

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

METHODS

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards.

RESULTS

In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage.

CONCLUSIONS

Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies.

Mother's Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies

Background

Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. The most significant and preventable of these include HIV, syphilis, and rubella. To achieve elimination, mothers need to be aware of and to understand effective preventive measures against these infections. Lack of comprehensive knowledge on transmission and prevention of MTCT infections is one of the factors hindering achievement of the elimination goals for these infections. The aim of this study was to assess the knowledge of HIV, syphilis, rubella, and associated factors among mothers in the Kilimanjaro region of Tanzania.

Methods

We conducted a community-based cross-sectional study in three districts of the Kilimanjaro region from September to October 2016. The study involved mothers with children up to five years of age. Data collection involved the use of a questionnaire, administered by face-to-face interviews. Logistic regression analysis was used to assess predictors of mothers' knowledge on MTCT infections.

Results

A total of 618 mothers were recruited, with a mean age of 29.6 (SD 7.6) years. The overall knowledge on MTCT infections was low. The highest level of knowledge on MTCT infections was regarding HIV (89.2%). Fewer mothers had knowledge of syphilis (27.8%). Rubella was the least known; only 12% of mothers were aware of rubella infection. District of residence and having knowledge of syphilis were predictors for rubella knowledge, while for syphilis knowledge, significant predictors were age group, occupation, and those having knowledge on HIV and rubella. Predictors for HIV knowledge were residential district, having a mobile phone, and those having knowledge of syphilis and rubella.

Conclusions

This study confirmed that mothers have low overall knowledge on MTCT infections. To achieve the MTCT elimination goals, targeted interventions to improve knowledge among women of childbearing age are recommended.

Recent setbacks in measles elimination: the importance of investing in innovations for immunizations

The recent setbacks in efforts to achieve measles elimination goals are alarming. To reverse the current trends, it is imperative that the global health community urgently intensify efforts and make resource commitments to implement evidence-based elimination strategies fully, including supporting research and innovations. The Immunization Agenda 2030: A Global Strategy to Leave No One Behind (IA2030) is the new global guidance document that builds on lessons learned and progress made toward the GVAP goals, includes research and innovation as a core strategic priority, and identifies measles as a “tracer” for improving immunisation services and strengthening primary health care systems. To achieve vaccination coverage and equity targets that leave no one behind, and accelerate progress toward disease eradication and elimination goals, sustained and predictable investments are needed for the identified research and innovations priorities for the new decade.