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Konlan MY, Mahama F, Abubakari BB, Konka P, Appiah BO, Yeboah MO, Kwarteng PG, Apea PO, Adjei MR, Adokiya MN, Boadum O, Abiwu HAK. Predictors of vaccination card retention in Tamale Metropolis, Ghana. PLoS One 2024; 19:e0292765. [PMID: 38408074 PMCID: PMC10896499 DOI: 10.1371/journal.pone.0292765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. METHODS We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0-59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0-59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. RESULTS A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15-0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29-0.90) sub-Metro areas and being caregivers of children aged 24-59 months (AOR = 0.39; 95% CI = 0.22-0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95-8.95) was a positive predictor of vaccination card retention. CONCLUSION In this study, vaccination card retention among children aged 0-59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention.
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Affiliation(s)
- Matthew Y. Konlan
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Fuseini Mahama
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | | | - Paul Konka
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Benedict O. Appiah
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Maxwell O. Yeboah
- Department of Nursing, Northern Regional Hospital, Ghana Health Service, Tamale, Ghana
| | | | | | | | - Martin N. Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Oheneba Boadum
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, MS, United States of America
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Pagola-Ugarte M, Rakesh A, Gil-Cuesta J, Kidinda D, Kelly TM, Zahaf S, Mahmoud MMOE, Salem MOM, Houmeid M, Cheikh D, Ouldzeidoune N, Bachy C. Improved vaccination coverage after two rounds of multi-antigenic catch-up vaccination in Mauritania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002939. [PMID: 38354187 PMCID: PMC10866457 DOI: 10.1371/journal.pgph.0002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
Although Mauritania carried out its Expanded Programme on Immunization (EPI), in 2015 the goal of vaccination coverage (VC) remained unmet in Bassikounou district and Mbera camp, contexts with large migrant populations. In response, during 2018, the national authorities, together with Médecins Sans Frontières organised two rounds of multi-antigenic mass vaccination campaigns (2RMASVC). The campaigns included oral polio (OPV), pneumococcal (PCV13), pentavalent and rotavirus vaccines for all eligible children six weeks to 59 months old. This study describes the results of the 2RMASVC. Cross-sectional household VC surveys (VCS1 and VCS2) were conducted before and after the 2RMASVC. Data were collected on vaccination status according to self-reporting and vaccination cards, and on reasons for non-vaccination (RNV). In total, 4,569 children received at least one dose of vaccine in the first round and 5,602 children in the second. Baseline VC, as fully vaccinated, according to VCS1, was 59.9% of children 12 to 59 months in Bassikounou district and 65.8% in Mbera camp. After the 2RMASVC, the coverages increased to 84.7% and 75.9% respectively. Absence from home, lack of motivation, late initiation of vaccinations and lack of awareness about vaccination were the main RNV during the 2RMASVC. Although the 2RMASVC did not reach its goal of 90%-95% VC, the strategy significantly increased VC in the two settings for children aged 12 to 59 months. Therefore, this catch-up approach could be considered to improve VC of children who miss out of the EPI strategy in resource-limited settings.
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Affiliation(s)
- Maider Pagola-Ugarte
- Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières Luxembourg, Luxembourg
| | - Ankur Rakesh
- Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières Luxembourg, Luxembourg
| | - Julita Gil-Cuesta
- Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières Luxembourg, Luxembourg
| | | | | | | | | | | | - Mbareck Houmeid
- Department of Expanded Programme of Immunisation, Ministry of Health, Mauritania
| | | | | | - Catherine Bachy
- Médecins Sans Frontières, Operational Centre of Brussels, Belgium
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Khan A, Hussain I, Rhoda DA, Umer M, Ansari U, Ahmed I, Clary C, Muhammad Safdar R, Bashir Soofi S. Determinants of immunization in polio super high-risk union councils of Pakistan. Vaccine 2024; 42:583-590. [PMID: 38143197 PMCID: PMC10850981 DOI: 10.1016/j.vaccine.2023.12.056] [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: 11/04/2022] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current polio epidemiology in Pakistan poses a unique challenge for global eradication as the country is affected by ongoing endemic poliovirus transmission. Across the country, 40 union councils (UCs) which serve as core reservoirs for poliovirus with continuous incidences of polio cases are categorized as super-high-risk union councils (SHRUCs). METHODOLOGY A cross-sectional survey was conducted in 39 SHRUCs using a two-stage stratified cluster sampling technique. 6,976 children aged 12-23 months were covered. A structured questionnaire was used for data collection. Data were analyzed using STATA version 17. RESULTS Based on both vaccination records and recall, 48.3% of children were fully-, 35.4 % were partially-, and 16.3% were non-vaccinated in the SHRUC districts. A child is considered fully vaccinated when h/she completed vaccination for BCG, OPV0, OPV 1-3, Penta 1-3, PCV 1-3, IPV, and MCV1. Vaccination cards were seen for over half of the children in the SHRUC districts of Khyber Pakhtunkhwa (KP) and the majority of the SHRUC districts in Sindh, except for the SHRUC district of Malir the districts of Balochistan. Results for polio vacancies show that 60.9% of children from the SHRUC districts were vaccinated with at least three doses of OPV and one dose of IPV, while 20.4% were vaccinated with any OPV doses or IPV and 18.7% of children did not receive any polio vaccines. The dropout rate between vaccine visits was higher than the WHO-recommended cutoff point of 10% for all vaccine doses in the SHRUC districts. The likelihood of being fully vaccinated was higher among the children of educated parents. Full vaccination was found significant among the children of any SHRUC districts compared to district Killa Abdullah. CONCLUSION Context-specific strategies with more focus on community engagement and targeted mobilization, along with robust monitoring mechanisms, would help address the underlying challenges of under-immunization in the SHRUCs.
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Affiliation(s)
- Ahmad Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Uzair Ansari
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | | | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan; Department of Pediatrics & Child Health, The Aga Khan University, Pakistan.
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Yakum MN, Atanga FD, Ajong AB, Eba Ze LE, Shah Z. Factors associated with full vaccination and zero vaccine dose in children aged 12-59 months in 6 health districts of Cameroon. BMC Public Health 2023; 23:1693. [PMID: 37658309 PMCID: PMC10474728 DOI: 10.1186/s12889-023-16609-4] [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: 12/15/2022] [Accepted: 08/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Routine immunisation coverage in Cameroon is still below the target of the national Expanded Programme on Immunisation (EPI), with only 42% of children fully immunised according to Demographic and Health Survey (DHS) report in 2018. The objective of this study was to evaluate factors associated with full immunisation and zero-dose in Cameroonian children. METHODS A two-stage cross-sectional cluster survey was conducted in Yaoundé in November 2021, targeting children aged 12-59 months. The clusters were chosen with probability proportionate to population size (PPS), and households selected by restricted sampling technique. Data were collected from the vaccination card of the child or from parents' recall, if the card was not available, using electronic forms with tablets. Using R (version 4.1.0.), the proportion of fully immunised children was calculated. The household wealth index was described using principal component analysis, and factors associated with full immunisation assessed with multiple logistics regression. The threshold of statistical significance was set at 5%. FINDINGS A total, 273 children aged 12-59 months enrolled; 37% of participants were fully immunised, and 16% had never received any vaccine. Mother's level of education: Primary (OR = 3.59, p = 0.0200), high school (OR = 3.68, p = 0.0400*), and higher education (OR = 8.25, p = 0.0018), and sharing household with biological father (OR = 2.11, p = 0.0305) were significantly associated with full vaccination. Living in a richer (3rd-5th wealth quintiles) household (OR = 0.25, p = 0.0053); mother's education: Primary (OR = 0.07, p = 0.0271) and Higher education (OR = 0.10, p = 0.0419), living with the mother (OR = 0.05, p = < 0.0001) and living with the father (OR = 0.22, p = 0.0253) had significant negative association with zero-dose in children. CONCLUSION The proportion of fully vaccinated children in Yaounde is lower than the national average. Children from poor homes and those borne by uneducated mother have higher odds of not being vaccinated. Immunisation programmes in Yaounde need to be stepped up to improve coverage. Equally, there is a need to reconsider how the poor can the better reached with immunisation services.
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Affiliation(s)
- Martin Ndinakie Yakum
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Goundere, Cameroon
| | - Funwie Desmond Atanga
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Goundere, Cameroon
| | - Atem Bethel Ajong
- Department of Biochemistry, Faculty of Science, University of Dschang-Cameroon, Dschang, Cameroon
| | - Linda Evans Eba Ze
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang-Cameroon, Dschang, Cameroon
| | - Zahir Shah
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Goundere, Cameroon
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Yau IB, Zubair Mustapha M, Nwaze E, Nobila O, Maigoro A, Abdullah A, Gamawa A, Meissner P, Albrecht J, Müller O. Improving the timeliness and completeness of childhood vaccination through color-coded bracelets: a pilot study among Fulani tribe populations in Nigeria. J Public Health Afr 2023; 14:2079. [PMID: 37441119 PMCID: PMC10334432 DOI: 10.4081/jphia.2023.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/03/2022] [Indexed: 07/15/2023] Open
Abstract
Background Childhood immunization remains one of the most cost-effective public health interventions. Globally, millions of children are not being reached with safe and effective vaccines and Nigeria has the highest number of unprotected children. Objective The effects of locally adapted interventions on vaccination timeliness and completeness were studied amongst Fulani populations across 6 health facilities in 2 districts of Bauchi State, Nigeria. Methods The intervention group consisted of newborns who received 5-color-coded bracelets representing different immunization contacts, while the control group had no bracelets. Vaccination rates across contacts were followed for 11 months. In addition, mothers of children in the intervention group were voluntarily recruited as peer-to-peer mobilizers (PPM). Results In this study, 435 children were studied. Vaccination completeness was higher in the intervention group compared to the control group at all contacts during follow-up. The difference was most noticeable at the fifth contact, with 158/256 (62%) children in the intervention group completing, compared to 73/179 (41%) in the control group (P<0.0001). Vaccination timeliness was better in the intervention group compared to the control one, which reached statistical significance at the second and third vaccination contacts (P<0.05). 68% of women volunteered as PPM and recruited 82 additional children for vaccination. Conclusion This study demonstrated the feasibility of a composite intervention (bracelets and PPM) to increase the completeness and timeliness of childhood immunization and provided preliminary evidence for its efficacy among Fulani populations in Nigeria. Findings from this pilot study should be confirmed through a larger cluster randomized controlled trial.
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Affiliation(s)
- Inuwa Barau Yau
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Eric Nwaze
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Adamu Abdullah
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Adamu Gamawa
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Peter Meissner
- Department of Pediatrics and Adolescent Medicine, Ulm University, Germany
| | - Jahn Albrecht
- Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Olaf Müller
- Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
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Dhalaria P, Kapur S, Singh AK, Priyadarshini P, Dutta M, Arora H, Taneja G. Exploring the Pattern of Immunization Dropout among Children in India: A District-Level Comparative Analysis. Vaccines (Basel) 2023; 11:vaccines11040836. [PMID: 37112748 PMCID: PMC10143302 DOI: 10.3390/vaccines11040836] [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: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The dropout rate is one of the determinants of immunization coverage and program performance, program continuity, and follow-up. The dropout rate refers to the proportion of vaccine recipients who did not finish their vaccination schedules, and it is determined by comparing the number of infants who started the schedule to the number who completed it. It is the rate difference between the first and final dosage or the rate difference between the first vaccination and the last vaccine dropout; thus, it denotes that the first recommended dose of vaccine was received, but that the subsequently recommended dose was missed. In India, immunization coverage has shown significant improvements over the last two decades, but full immunization coverage has remained stagnant at 76.5%, of which 19.9% are partially immunized, and 3.6% are children who have been left out. In India, the Universal Immunization Programme (UIP) is challenged with cases related to dropout in immunization. Although immunization coverage in India is improving, the program is challenged by vaccination dropouts. This study provides an analysis of the determinants of vaccination dropout in India using data from two rounds of the National Family Health Survey. The finding shows that the mother's age, education, family wealth, antenatal care visit, and place of delivery were some of the variables that significantly contributed to reducing the dropout rate of immunization among children. The findings of this paper show that the dropout rate has reduced over a certain period of time. The overall improvement in the rates of dropout and increase in full immunization coverage could be attributed to various policy measures taken in the last decade in India, which brought structural changes with a positive impact on full immunization coverage and its components.
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Affiliation(s)
- Pritu Dhalaria
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Ajeet Kumar Singh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Pretty Priyadarshini
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Mili Dutta
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Gunjan Taneja
- Bill & Melinda Gates Foundation, New Delhi 110067, India
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Gebeyehu NA, Asmare Adela G, Dagnaw Tegegne K, Birhan Assfaw B. Vaccination dropout among children in Sub-Saharan Africa: Systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2145821. [PMID: 36459433 PMCID: PMC9762788 DOI: 10.1080/21645515.2022.2145821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Immunization is cost-effective preventive strategy for child morbidity and mortality. PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Data were extracted by Microsoft excel. Begg's rank test, and Egger's regression test was done. A pooled prevalence, Sub-group analysis, sensitivity analysis and meta-regression were conducted. A total of 12 articles were included in this study. The pooled prevalence of vaccination dropout was 26.06% (95% CI: 11.59, 30.53), I2 =91.2%. In sub-group analysis, Nigeria had the highest prevalence of immunization dropouts (33.59%). It was 18.01% and 29.25%, respectively, for published and unpublished research. Community-based studies and institutional-based studies also yield a prevalence of dropout 39.04% and 13.73% respectively. Dropout rate was 22.66% for sample sizes under 500 and 18.01% for sample sizes beyond 500. In Sub-Saharan Africa, the prevalence of vaccination dropout was high. Community education about vaccinations importance should be prioritized.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia,CONTACT Natnael Atnafu Gebeyehu Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, 02, My street, Sodo 138, Ethiopia
| | - Getachew Asmare Adela
- Department of Reproductive Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Belete Birhan Assfaw
- Department of Psychiatric Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
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Nchinjoh SC, Saidu Y, Agbor VN, Mbanga CM, Jude Muteh N, Njoh AA, Ndoula ST, Nsah B, Edwige NN, Roberman S, Zamir CS. Factors Associated with Zero-Dose Childhood Vaccination Status in a Remote Fishing Community in Cameroon: A Cross-Sectional Analytical Study. Vaccines (Basel) 2022; 10:vaccines10122052. [PMID: 36560465 PMCID: PMC9784537 DOI: 10.3390/vaccines10122052] [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: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Cameroon's suboptimal access to childhood vaccinations poses a significant challenge to achieving the Immunization Agenda 2030 goal-ranking among the top 15 countries with a high proportion of zero-dose (unvaccinated) children worldwide. There are clusters of zero-dose children in pockets of communities that traditionally miss essential healthcare services, including vaccination. The Manoka Health District (MHD) is home to such settlements with consistently low vaccination coverages (DPT-HepB-Hib-1: 19.8% in 2021) and frequent outbreaks of vaccine-preventable diseases (VPD). Therefore, the absence of literature on zero-dose children in this context was a clarion call to characterize zero-dose children in fragile settings to inform policy and intervention design. Methodology: This cross-sectional analytical study involved 278 children, 0-24 months of age, selected from a 2020 door-to-door survey conducted in the two most populous health areas in an archipelago rural district, MHD (Cap-Cameroon and Toube). We used R Statistical Software (v4.1.2; R Core Team 2021) to run a multivariable logistic regression to determine zero-dose associated factors. Results: The survey revealed a zero-dose proportion of 91.7% (255) in MHD. Children who were delivered in health facilities were less likely to be zero-dose than those born at home (AOR: 0.07, 95% CI: 0.02-0.30, p = 0.0003). Compared to children born of Christian mothers, children born to minority non-Christian mothers had higher odds of being zero-dose (AOR: 6.55, 95% CI: 1.04-41.25, p = 0.0453). Children born to fathers who are immigrants were more likely to be zero-dose children than Cameroonians (AOR: 2.60, 95% CI = 0.65-10.35, p = 0.0016). Younger children were likely to be unvaccinated compared to older peers (AOR: 0.90, 95% CI: 0.82-1.00, p = 0.0401). Conclusions: In the spirit of "leaving no child behind," the study highlights the need to develop context-specific approaches that consider minority religious groups, immigrants, and younger children, including newborns, often missed during vaccination campaigns and outreaches.
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Affiliation(s)
- Sangwe Clovis Nchinjoh
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
- Correspondence: ; Tel.: +237-678-687-939
| | - Yauba Saidu
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Institute for Global Health, University of Siena, 53100 Siena, Italy
| | - Valirie Ndip Agbor
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
- Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | | | | | - Andreas Ateke Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaoundé P.O. Box 2084, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui BP 157, Central African Republic
| | - Shalom Tchofke Ndoula
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaoundé P.O. Box 2084, Cameroon
| | - Bernard Nsah
- Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon
| | | | - Sveta Roberman
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
- The Gordon Academic College of Education, Haifa 3570503, Israel
| | - Chen Stein Zamir
- Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel
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Yakum MN, Funwie AD, Ajong AB, Tsafack M, Ze LEE, Ekukole ESR, Shah Z. Factors associated with routine vaccination card retention among children aged 0–59 months in Yaounde-Cameroon: A cross-sectional survey. PLoS One 2022; 17:e0273515. [PMID: 36026433 PMCID: PMC9416987 DOI: 10.1371/journal.pone.0273515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The routine vaccination card is an important health record for children, but recent findings suggest that vaccination card retention in Cameroon is low, varying from 29%-53%. The aim of this study was to assess factors associated with children’s routine vaccination card retention in Cameroon.
Methods
This cross-sectional survey was conducted in Yaoundé in November 2021, targeting children aged 0–59 months. Participants were selected using a 2-stage systematic cluster sampling in which households were selected by a restricted sampling technique. Data were collected by interviewing the children’s parents/guardians, and a vaccination card was said to be retained if it was presented to the interviewer by the interviewees. Data were analysed using multiple logistics regression with R version 4.1.0 (2021-05-18).
Findings
A total of 529 households were assessed with 361 children aged 0–59 months enrolled: 51% girls and 49% boys. Children aged 0–11 months represented 24.4% of all participants, and children aged 12–59 months were 74.6%. Vaccination card retention was 24% (87), and positive predictors of card retention included: girl child (adjusted Odds Ratio = 1.34, p-value = 0.0269), the respondent being one of the biological parents of the child: mother (adjusted Odds Ratio = 5.97, p-value = 0.0034) or father(adjusted Odds Ratio = 4.69, p-value = 0.0067), and living in a richer household (adjusted Odds Ratio = 1.56, p-value = 0.038). On the other hand, negative predictors of card retention were: child aged 12–23 months (adjusted Odds Ratio = 0.44, p-value = 0.0209) or aged 24-59months (adjusted Odds Ratio = 0.13, p-value = 0.0000), and having an employed mother (adjusted Odds Ratio = 0.34, p-value = 0.0066).
Conclusion
Vaccination card retention in children aged 0–59 months in Yaoundé is low when compared with findings reported by studies from other locations in Cameroon. Besides, the poor and older children have lower odds of keeping routine vaccination cards. There is a need to design interventions to improve vaccination card retention, which considers household wealth and the age of the child.
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Affiliation(s)
- Martin Ndinakie Yakum
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Cameroon
- * E-mail:
| | - Atanga D. Funwie
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Cameroon
| | - Atem Bethel Ajong
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Marcellin Tsafack
- Medical Department, Doctors Without Borders (MSF-OCG), Yaoundé, Cameroon
| | - Linda Evans Eba Ze
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Ekome Serge Raoul Ekukole
- Contract Development and Verification Agency (CDVA)-Performance-based Financing (PBF) for the South West region, Cameroon
| | - Zahir Shah
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Cameroon
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Elit L, Ngalla C, Afugchwi GM, Tum E, Fokom-Domgue J, Nouvet E. Study protocol for assessing knowledge, attitudes and belief towards HPV vaccination of parents with children aged 9-14 years in rural communities of North West Cameroon: a qualitative study. BMJ Open 2022; 12:e062556. [PMID: 36002223 PMCID: PMC9413282 DOI: 10.1136/bmjopen-2022-062556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite human papilloma virus (HPV) vaccine being incorporated in the National Immunisation Programme in Cameroon in 2019, HPV vaccine uptake among eligible girls has been poor (5%). The barriers to HPV vaccination in this high-burden setting have not been previously studied, especially in rural areas. We propose to evaluate the knowledge, attitudes and beliefs of parents of girls aged 9-14 years regarding HPV vaccine. METHODS AND ANALYSIS Study design: a qualitative descriptive study will be conducted using one-on-one semi-structured interviews with parents of girls aged 9-14 years from 3 health districts in Cameroon (Mbingo, Njinikom and Fundong) who can converse in English or Pidgin English. Enrolment will occur until thematic saturation-approximately 40 participants. Analysis: quantitative methods will be used to describe the interviewees. All interviews will be audio recorded, transcribed and loaded into a tool to facilitate analysis (ATLAS.ti). Transcripts will be coded and thematic analysis will be conducted. Analysis will occur concurrent with interviews. ETHICS AND DISSEMINATION Ethics: institutional review board approval will be obtained from the Cameroon Baptist Convention Health Board (CBCHB), Cameroon and McMaster University, Hamilton, Canada. Dissemination: study findings will be presented via a report and webinar to the Ministry of Health, the funders, the CBCHB and in person to healthcare providers and interested members of the general population in the study region. Plans are to share findings internationally through peer-reviewed publication(s) and presentation(s). TRIAL REGISTRATION NUMBER NCT05325138.
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Affiliation(s)
- Lorraine Elit
- Department of Surgery, Baptist Institute for Health Sciences, Mbingo, Cameroon
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Calvin Ngalla
- Women's Health Program, Mbingo Hospital, Mbingo, Cameroon
| | - Glen Mbah Afugchwi
- Department of Pediatric Oncology, Baptist Institute for Health Science, Mbingo, Cameroon
| | - Eric Tum
- Information and Vocational Orientation Centre, Bamenda, Cameroon
| | - Joël Fokom-Domgue
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Elysée Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
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11
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Powelson J, Magadzire BP, Draiva A, Denno D, Ibraimo A, Benate BBL, Jahar LC, Marrune Z, Chilundo B, Chinai JE, Emerson M, Beima-Sofie K, Lawrence E. Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice. BMJ Open 2022; 12:e057245. [PMID: 35292500 PMCID: PMC8928306 DOI: 10.1136/bmjopen-2021-057245] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Immunisations are highly impactful, cost-effective public health interventions. However, substantial gaps in complete vaccination coverage persist. We aimed to describe caregivers' immunisation experiences and identify determinants of vaccine dropout. DESIGN We used a community-based participatory research approach employing Photovoice, SMS (short messaging service) exchanges and in-depth interviews. A team-based approach was used for thematic analysis. The Increasing Vaccination Model guided the analysis and identification of vaccination facilitators and barriers. SETTING This study was conducted in Zambézia province, Mozambique, in Namarroi and Gilé districts, where roughly 19% of children under 2 start but do not complete the recommended vaccination schedule. PARTICIPANTS Participants were identified through health facility vaccination records and included caregivers of children aged 25-34 months who were fully vaccinated (n=10) and partially vaccinated (n=22). We also collected data from 12 health workers responsible for delivering immunisations at the selected health facilities. RESULTS Four main patterns of barriers leading to dropout emerged: (1) social norms and limited family support place the immunisation burden on mothers; (2) perceived poor quality of health services reduces caregivers' trust in vaccination services; (3) concern about side effects causes vaccine hesitancy; and (4) caregivers hesitate to seek and advocate for vaccination due to power imbalances with health workers. COVID-19 created additional barriers related to social distancing, mask requirements, supply chain challenges and disrupted outreach services. For most caregivers, dropout becomes increasingly likely with compounding barriers. Caregivers of fully-vaccinated children noted facilitators, including accompaniment to health facilities or assistance caring for other children, which enabled them to complete vaccination. CONCLUSIONS Overcoming immunisation barriers requires strengthening health systems, including improving logistics to avert vaccine stockouts and building health worker capacity, including empathic communication with caregivers. Consistent and reliable immunisation outreach services could address access challenges and improve immunisation uptake, particularly in distant communities.
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Affiliation(s)
| | | | - Abel Draiva
- Mozambique, VillageReach, Quelimane, Mozambique
| | - Donna Denno
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | | - Kristin Beima-Sofie
- Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Emily Lawrence
- Research, Evidence & Learning, VillageReach, Seattle, WA, USA
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13
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Ateudjieu J, Tchio-Nighie KH, Goura AP, Ndinakie MY, Dieffi Tchifou M, Amada L, Tsafack M, Kiadjieu Dieumo FF, Guenou E, Nangue C, Kenfack B. Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e32213. [PMID: 35230249 PMCID: PMC8924776 DOI: 10.2196/32213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Countries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. Objective We aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage. Methods This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Results Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Conclusions Findings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Trial Registration Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548
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Affiliation(s)
- Jérôme Ateudjieu
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon.,Department of Public Health, Faculty of Medecine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.,Division of Health Operations Research, Cameroon Ministry of Public Health, Yaounde, Cameroon
| | - Ketina Hirma Tchio-Nighie
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon.,Department of Public Health, Faculty of Medecine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - André Pascal Goura
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon
| | - Martin Yakum Ndinakie
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon
| | - Miltiade Dieffi Tchifou
- Department of Public Health, Faculty of Medecine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Lapia Amada
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon
| | - Marcelin Tsafack
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon
| | | | - Etienne Guenou
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon.,Department of Microbiology, Faculty of Sciences, University of Buea, Buea, Cameroon
| | - Charlette Nangue
- Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon.,University Teaching Hospital, Yaounde, Cameroon
| | - Bruno Kenfack
- Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.,Department of Gynecology and Obstetrics, Dschang District Hospital, West, Cameroon
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14
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Youdom SW, Njinkui DN, Nguefack-Tsague G, Ateudjieu J. Missed Opportunities for Vaccination and Associated Factors among Children Aged 12 - 23 Months in Cameroon: Further Analyses of 2018 Cameroon Demographic and Health Survey. Health (London) 2022. [DOI: 10.4236/health.2022.1410077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Idris IO, Obwoya JG, Tapkigen J, Lamidi SA, Ochagu VA, Abbas K. Impact evaluation of immunisation service integration to nutrition programmes and paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan. Fam Med Community Health 2021; 9:fmch-2021-001034. [PMID: 34433617 PMCID: PMC8388298 DOI: 10.1136/fmch-2021-001034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the impact of immunisation service integration to nutrition programmes and under 5-year-old paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan. Design Retrospective intervention study. Setting Three primary healthcare centres in Rumbek East county and three primary healthcare centres in Rumbek Centre county of Lakes state in South Sudan. Participant We extracted the data for the uptake of pentavalent vaccine (first, second and third dose) given to children aged between 6 weeks and 23 months from immunisation records for January–June 2019 before immunisation service integration and July–December 2019 after immunisation service integration from the District Health Information System 2 website to estimate the immunisation uptake ratios and drop-out rates. Results The uptake of the first dose of the pentavalent vaccine improved from 61% to 96% (p<0.001) after immunisation service integration into the nutrition programmes of the primary healthcare centres in Rumbek Centre county. The uptake of the second pentavalent dose improved from 37% to 69% (p<0.001) and for the third pentavalent dose from 36% to 62% (p<0.001), while the drop-out rate reduced from 57% to 40% (p<0.001). While in Rumbek East county, the uptake of the first dose of the pentavalent vaccine improved from 55% to 77% (p<0.001) after immunisation service integration into the under 5-year-old paediatric outpatient departments. The uptake of the second dose improved from 36% to 62% (p<0.001) and for the third dose from 44% to 63% (p<0.001), while the drop-out rate reduced from 40% to 28% (p<0.001). Children were 23% more likely (RR 1.23, 95% CI 1.12 to 1.36, p<0.001) to be immunised with the first dose of the pentavalent vaccine on immunisation service integration into the nutrition programmes of primary healthcare centres of Rumbek Centre county in comparison to integration into under 5-year-old outpatient departments of Rumbek East county. Conclusion Integration of immunisation service delivery to nutrition sites and children’s outpatient departments improved the immunisation coverage and decreased drop-out rates in the Rumbek East and Rumbek Centre counties of South Sudan. This evidence of positive impact should encourage the stakeholders of the Expanded Programme on Immunisation to focus on the sustainability and scale-up of this intervention to other counties in South Sudan, as logistically as possible.
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Affiliation(s)
- Israel Oluwaseyidayo Idris
- Health Policy Unit, Department of Public Administration and State Management, Simon Kuznets Kharkiv National University of Economics, Kharkiv, Ukraine .,Department of Preventive Medicine and Community Health, V N Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Justin Geno Obwoya
- Department of Field Operation and Project Coordination, Health Pooled Fund, Rumbek, South Sudan
| | - Janet Tapkigen
- Department of Nutrition for Global Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Serifu Ayobami Lamidi
- Department of Epidemiology and Medical Statistics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Victor A Ochagu
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaja Abbas
- Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK
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16
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Mekonnen ZA, Gelaye KA, Were M, Tilahun B. Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia. JMIR Mhealth Uhealth 2021; 9:e27603. [PMID: 34128813 PMCID: PMC8277338 DOI: 10.2196/27603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message-based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. OBJECTIVE This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. METHODS A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. RESULTS A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. CONCLUSIONS Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, United States
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Ateudjieu J, Yakum NM, Goura AP, Guenou E, Beyala LB, Amada L, Ngoche I, Kiadjieu FF, Nangue C, Djosseu EBS, Kenfack B. Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e21734. [PMID: 33555269 PMCID: PMC8409040 DOI: 10.2196/21734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. Objective This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. Methods Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. Results Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. Conclusions This trial is expecting to test an innovative approach to improving children’s immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. Trial Registration Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse International Registered Report Identifier (IRRID) DERR1-10.2196/21734
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Affiliation(s)
- Jérôme Ateudjieu
- Meilleur Accès aux soins de Santé (MA SANTE), Yaoundé, Cameroon.,Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon.,Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | | | - Etienne Guenou
- Meilleur Accès aux soins de Santé (MA SANTE), Yaoundé, Cameroon.,Department of Microbiology, Faculty of Sciences, University of Buea, Buea, Cameroon
| | | | - Lapia Amada
- Meilleur Accès aux soins de Santé (MA SANTE), Foumban, Cameroon
| | - Isabelle Ngoche
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | | | - Bruno Kenfack
- Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.,Department of Gynecology and Obstetrics, Dschang District Hospital, West-Cameroon, Dschang, Cameroon
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Tchatchouang S, Nzouankeu A, Hong E, Terrade A, Denizon M, Deghmane AE, Ndiang SMT, Pefura-Yone EW, Penlap Beng V, Njouom R, Fonkoua MC, Taha MK. Analysis of Haemophilus species in patients with respiratory tract infections in Yaoundé, Cameroon. Int J Infect Dis 2020; 100:12-20. [PMID: 32827751 DOI: 10.1016/j.ijid.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To identifyHaemophilus species and characterize antimicrobial susceptibility of isolates from patients with respiratory tract infections (RTIs) in Cameroon. METHODS Isolates (n = 95) were from patients with RTIs obtained from two Hospitals in Yaoundé, Cameroon. Isolates were identified by biochemical assay, PCR-based method, MALDI-TOF and whole genome sequencing. Antibiotic minimum inhibitory concentrations were determined by E-test. RESULTS H. influenzae was the most prevalent species varying from 76.8% to 84.2% according to different methods. The isolates were mainly nontypable (n = 70, 96%). Three isolates of H. influenzae were capsulated (b, e and f). The isolates were genetically diverse and 40 unique sequence types were identified including 11 new ones. Resistance to ampicillin was observed among 55.3% (52/94) and 9% (14/52) produced TEM-1 β-lactamase. PBP3 mutations occurred in 57.7% of ampicillin resistant isolates (30/52). Eleven isolates were chloramphenicol resistant with 80% producing chloramphenicol acetyltransferase (8/10). Four Haemophilus isolates were rifampicin resistant with two mutations in rpoB gene. Five isolates were ciprofloxacin resistant and harbored mutations in the quinolone resistance determining regions of gyrA and parC genes. CONCLUSION H. influenzae isolates are highly diverse and show high levels of antibiotic resistance. H. influenzae serotype b is still circulating in the post-vaccination era.
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Affiliation(s)
- Serges Tchatchouang
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Bacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Biochemistry, University of Yaoundé, Yaoundé, Cameroon; Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Ariane Nzouankeu
- Department of Bacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Eva Hong
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Aude Terrade
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Mélanie Denizon
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | | | | | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France.
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