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Mbonigaba E, Yu F, Reñosa MDC, Cho FN, Chen Q, Denkinger CM, A McMahon S, Chen S. Knowledge and trust of mothers regarding childhood vaccination in Rwanda. BMC Public Health 2024; 24:1067. [PMID: 38632541 PMCID: PMC11022416 DOI: 10.1186/s12889-024-18547-1] [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: 08/25/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Knowledge and trust are some of the contributing factors to vaccine acceptance(VA) and Vaccine hesitancy (VH) is one of the top threats to global health. A significant drop in childhood vaccination has been observed in recent years. One important reason that influences mothers' choice to either postpone or avoid children's vaccinations is knowledge and trust in childhood vaccines. This study aimed to assess mothers' knowledge and trust on vaccination of their children, and to examine the association between vaccination knowledge and selected socio-demographic factors. METHODS A cross-sectional survey was conducted from January 2022 to March 2022 to assess the knowledge and trust of mothers regarding childhood vaccination. Data was collected with self-administered questionnaires. Multivariable logistic regression analysis was employed to assess factors associated with childhood vaccine knowledge and trust. RESULTS Of the 2,126 Rwandan parents who participated in the study, the proportions with good knowledge of - and good trust in childhood vaccination were 95.5% and 91.4%, respectively. The popular sources of information about childhood vaccination were health care professionals (91.8%) and mass media (28.9%). Multinomial logistic regression analysis showed that good knowledge of - and trust in childhood vaccination were associated with the relationship with child(ren), education, occupation, and monthly income. The Multinomial logistic regression also revealed that the determinants of good knowledge of - and trust in childhood vaccination were; caregiver (p = 4.0 × 10-4, adjusted Odds Ratio (aOR); 1.7, 95%C.I; 1.3 - 2.3), no formal educational status (p = 3.3 × 10-2, aOR; 1.7, 95%C.I; 1.0 - 3.0), the unemployed occupational status (p = 2.4 × 10-2, aOR; 1.2, 95%C.I; 1.0 - 1.4), and persons on more than $401 per month (p = 2.0 × 10-4, aOR; 3.5, 95%C.I; 1.8 - 6.8). CONCLUSION The majority of parents in Rwanda had both good knowledge of-and good trust regarding childhood vaccination. Public health strategies to promote vaccination, education programmes as well as improved communication tools between health care professionals/traditional leaders/religious leaders and parents need to be considered to achieve favourable vaccination attitudes and practices for all parents in Rwanda.
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Affiliation(s)
- Edward Mbonigaba
- Centre of Infectious Diseases, Division of Infectious Disease and Tropical Medicine, Universität Heidelberg, Heidelberg, Germany.
- College of Medicine and Health Sciences, School of Public, Health- University of Rwanda, Kigali, Rwanda.
| | - Fengyun Yu
- Interdisciplinary Centre for Scientific Computing, Universität Heidelberg, Heidelberg, Germany
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Frederick Nchang Cho
- , Buea, Cameroon
- Infectious Disease Laboratory, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Qiushi Chen
- Department of Industrial and Manufacturing Engineering, The Harold and Inge Marcus, The Pennsylvania State University, University ParkHarrisburg, PA, USA
| | - Claudia M Denkinger
- Centre of Infectious Diseases, Division of Infectious Disease and Tropical Medicine, Universität Heidelberg, Heidelberg, Germany
| | - Shannon A McMahon
- Centre of Infectious Diseases, Division of Infectious Disease and Tropical Medicine, Universität Heidelberg, Heidelberg, Germany
| | - Simiao Chen
- Centre of Infectious Diseases, Division of Infectious Disease and Tropical Medicine, Universität Heidelberg, Heidelberg, Germany
- Chinese Academy of Medical Sciences and Peking Union Medical College, Peking, China
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Boisson-Walsh A, Thompson P, Fried B, Shea CM, Ngimbi P, Lumande F, Tabala M, Kashamuka MM, Babakazo P, Domino ME, Yotebieng M. Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks. Glob Health Res Policy 2023; 8:50. [PMID: 38057919 PMCID: PMC10698958 DOI: 10.1186/s41256-023-00338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at birth-tuberculosis (Bacille Calmette-Guérin [BCG]) and polio (OPV0)-remains inconsistent. As countries such as Democratic Republic of the Congo (DRC) prepare to add yet another birth-dose vaccine to their immunization schedule, this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe. METHODS The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B (HepB3) immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels. The assessment leveraged survey data collected during a continuous quality improvement study (NCT03048669) conducted in 105 maternity centers throughout Kinshasa Province, DRC. The final sample included 2398 (BCG analysis) and 2268 (HepB3 analysis) women-infant dyads living with HIV. RESULTS Between 2016 and 2020, 1981 infants (82.6%) received the BCG vaccine, and 1551 (68.4%) received the first dose of HepB3 vaccine. Of those who received the BCG vaccine, 26.3%, 43.5%, and 12.8% received BCG within 24 h, between one and seven days, and between one and 14 weeks, respectively. Of infants who received the HepB3 vaccine, 22.4% received it within six weeks, and 46% between six and 14 weeks of life. Many factors were positively associated with BCG uptake, including higher maternal education, household wealth, higher facility general readiness score, and religious-affiliated facility ownership. The factors influencing HepB3 uptake included older maternal age, higher education level, household wealth, transport by taxi to a facility, higher facility general and immunization readiness scores, and religious-affiliated facility ownership. CONCLUSIONS This study demonstrated that the study participants' uptake of vaccines was consistent with the country average, but not in a timely manner. Various factors were associated with timely uptake of BCG and HepB3 vaccines. These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Christopher Michael Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fidéle Lumande
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marisa Elaine Domino
- Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Yendewa GA, James PB, Mohareb A, Barrie U, Massaquoi SPE, Yendewa SA, Ghazzawi M, Bockarie T, Cummings PE, Diallo IS, Johnson A, Vohnm B, Babawo LS, Deen GF, Kabba M, Sahr F, Lakoh S, Salata RA. Determinants of incomplete childhood hepatitis B vaccination in Sierra Leone, Liberia, and Guinea: Analysis of national surveys (2018-2020). Epidemiol Infect 2023; 151:e193. [PMID: 37920110 PMCID: PMC10728985 DOI: 10.1017/s0950268823001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018-2020) of children aged 4-35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Amir Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Tahir Bockarie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Ambulai Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Flavia A, Fred B, Eleanor T. Gaps in vaccine management practices during vaccination outreach sessions in rural settings in southwestern Uganda. BMC Infect Dis 2023; 23:758. [PMID: 37924008 PMCID: PMC10625286 DOI: 10.1186/s12879-023-08776-x] [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: 02/24/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Outreach efforts were developed to bolster people's access to and use of immunization services in underserved populations. However, there have been multiple outbreaks of diseases like measles in Uganda, prompting policy makers and stakeholders to ask many unanswered questions. This research study was created to uncover the discrepancies between vaccine management practices at immunization outreach sessions in rural South Western Uganda compared with existing standards. METHODS The observational qualitative study, was done in 16 public health facilities across four districts of Uganda. Data were collected using in-depth interviews, facility record reviews, and observation. We assessed the vaccine management procedures before immunization session, transportation used, set up at the outreach site, management practices during the outreach session and packing of vaccines - according to World Health Organization immunization practice recommendations. The data were transcribed, coded and categories were formed and triangulated. Themes were generated based on a socio-ecologic framework to gain a better understanding of healthcare provider practices during immunization sessions. RESULTS Fifty-one individuals were interviewed; four Assistant District Health Officers, four cold chain technicians, 15 focal persons for the Expanded Program on Immunization, and 28 health care providers. The respondents' mean age was 35, 43 (84.3%) were females and 24 (47.1%) had a diploma. 11 (69%) outreaches were conducted at a distance of 5-12 km from the health facility and 7 (44%) were conducted in a building. For 8 outreaches (50%) health facility staff did not check the vaccine vial monitor status before the outreach while 12(75%) did not keep the vaccine hard lid cover closed during the sessions. The main areas of concern were insufficient vaccine integrity monitoring, improper handling and storage practices, deficient documentation, and inadequate vaccine transportation. These were similar across immunization outreach sites regardless of vaccine preventable disease outbreaks occurrences. The majority of these gaps were located at the individual level but were enabled by policy/environmental factors. CONCLUSIONS There are poor vaccine management procedures during outreach sessions contrary to established guidelines. Specific tactics to tackle knowledge deficiencies, health worker attitude, and fewer equipment shortages could improve compliance to guidelines.
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Affiliation(s)
- Atwiine Flavia
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, P.O. BOX 1410, Mbarara, Uganda.
| | - Bagenda Fred
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, P.O. BOX 1410, Mbarara, Uganda
| | - Turyakira Eleanor
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, P.O. BOX 1410, Mbarara, Uganda
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Ilesanmi M, Olujobi B, Ilesanmi O, Umaefulam V. Exploring data trends and providers' insights on measles immunization uptake in south-west Nigeria. Pan Afr Med J 2023; 46:28. [PMID: 38107335 PMCID: PMC10724030 DOI: 10.11604/pamj.2023.46.28.37572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/10/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction measles outbreak remains a recurring episode and continues to be responsible for millions of deaths globally every year. This study examines measles immunization coverage and uncovers barriers and enablers to effective provision and uptake of measles immunization services from the supply end and provider´s perspective in a developing nation´s context. Methods the study employed a mixed-method approach to explore trends and patterns of measles immunization uptake in Ekiti State-a state in the southwestern region of Nigeria-utilizing DHIS 2014 - 2019 data of 789,518 under 1-year children and complemented the quantitative study with key informant interviews from appointed Immunization Officers in the state. Using deductive methods, we thematically analyzed the interview data using NVivo version 12 while STATA 16 was used to analyze the quantitative data. Results the annualized measles immunization coverage ranged between 49% and 86% from 2014 to 2019, which is below the WHO set threshold for measles infection prevention. Caregiver, geographical, human, and infrastructural factors were elicited as barriers, while potential enablers include increased public engagement and enhanced media involvement. Conclusion while programmatic efforts are being improved nationally to drive up the uptake, this study provides baseline information for benchmarking the subsequent level of efforts and recommends improved collaboration across contextually similar states to promote program efficiency. The results can inform policy and program development, execution and direct future research on measles immunization to address uptake challenges at both local and central administration levels, especially in the aspect of surveillance and monitoring.
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Affiliation(s)
- Marcus Ilesanmi
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Ekiti State Primary Health Care Development Agency, Ado Ekiti, Ekiti State, Nigeria
| | - Babatunde Olujobi
- Ekiti State Primary Health Care Development Agency, Ado Ekiti, Ekiti State, Nigeria
| | | | - Valerie Umaefulam
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kamal A, Waseem A, Siddiqa M, Ijaz M, Shakeel A, Iftikhar S. Contextual factors influencing incomplete immunization and investigation of its geospatial heterogeneity in Pakistan: a cross-sectional study based on PDHS (2017-18). BMC Public Health 2023; 23:1620. [PMID: 37620868 PMCID: PMC10463638 DOI: 10.1186/s12889-023-16508-8] [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: 02/28/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Immunization is one of the most effective public health initiatives, saving millions of lives and lowering the risk of diseases such as diphtheria, tetanus, influenza, and measles. Immunization saves an estimated 2-3 million lives per year. A study of the regional variations in incomplete immunization will be useful in identifying gaps in the performance of immunization programs that are not noticed by standard vaccination programs monitoring. The primary goal of this study was to identify factors influencing child immunization status and to examine regional variations in incomplete immunization among children aged 12 to 23 months in Pakistan. METHODS For the current study, the data were taken from the Demographic and Health Survey for Pakistan (PDHS 2017-2018). Ever-married women who had children aged 12-23 months were included in this study. The immunization status of children was used as an outcome variable. In order to determine the effects of different factors on incomplete immunization, multilevel logistic model was used. To study the geographical variation of incomplete immunization, hotspot analysis was done using ArcGIS 10.7 and SaTScan software and to identify significant predictors of incomplete immunization, GWR 4 software was used. RESULTS Place of delivery, gender of child, mother's educational level and region were identified as significant determinants of incomplete immunization of children in Pakistan. Chances of incomplete immunization of children were found significantly lower for educated mothers (AOR = 0.52, 95% CI 0.34-0.79) and mothers who had delivered children in the health facilities (AOR = 0.51, 95% CI 0.32-0.83). Female children were more likely (AOR = 1.44, 1.95% CI 1.04-1.99) to be incompletely immunized as compared to male children. FATA (AOR = 11.19, 95% CI 4.89-25.6), and Balochistan (AOR = 10.94, 95% CI 5.08-23.58) were found at the highest risk of incomplete immunization of children as compared to Punjab. The significant spatial heterogeneity of incomplete immunization was found across Pakistan. The spatial distribution of incomplete immunization was clustered all over Pakistan. The high prevalence of incomplete immunization was observed in Balochistan, South Sindh, North Sindh, South KPK, South FATA, Gilgit Baltistan, Azad Jammu Kashmir, South and East Punjab. Drang and Harcho were identified as hotspot areas of incomplete immunization in Gilgit Baltistan. Secondary clusters with a high risk of incomplete immunization were found in regions Balochistan, Sindh and FATA. CONCLUSION Gender biasedness towards female children, regarding complete immunization of children prevailed in Pakistan. Spatial heterogeneity was also found for incomplete immunization of children. To overcome the problem access to health facilities is the foremost step. Government should target hotspot areas of incomplete immunization of children to provide primary health care facilities by opening health care units in these areas. The government in collaboration with the media should launch awareness campaigns in those areas to convince people that complete immunization is the right of every child regardless of gender.
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Affiliation(s)
- Asifa Kamal
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Ayesha Waseem
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Maryam Siddiqa
- Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan
| | - Muhammad Ijaz
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan.
| | - Abeera Shakeel
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Soofia Iftikhar
- Department of Statistics, Shaheed Benazir Bhutto Women University Peshawar, Peshawar, Pakistan
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Jammeh A, Muhoozi M, Kulane A, Kajungu D. Comparing full immunisation status of children (0-23 months) between slums of Kampala City and the rural setting of Iganga District in Uganda: a cross-sectional study. BMC Health Serv Res 2023; 23:856. [PMID: 37580708 PMCID: PMC10424339 DOI: 10.1186/s12913-023-09875-w] [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: 10/14/2022] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Immunisation remains the most cost-effective public health intervention in preventing morbidity and mortality due to Vaccine-Preventable Diseases (VPDs). The study aims to compare the differences in immunisation coverage amongst children aged 0 to 23 months living in slums of Kampala city and Iganga as rural districts in Uganda. METHODS This study utilises data from a cross-sectional survey done in 2019 in the slums of Kampala City and the rural district of Iganga within the Health and Demographic Surveillance Site (HDSS). It included 1016 children aged 0-23 months and their parents. A logistic regression model was used to analyse the relationship between multiple independent variables and the binary dependent variables (fully immunised) using Stata statistical software. The measures of association were odds ratios reported with a corresponding 95% confidence interval. RESULTS Out of the 1016 participants, 544 participants live in the rural area and 472 participants in the slums. Slums had 48.9% (n = 231) of fully immunised children whilst rural areas had 43.20% (n = 235). The multivariate analysis showed that children living in slums are more likely to be fully immunised as compared to their counterparts in rural areas (Odds ratio:1.456; p = 0.033; CI:1.030-2.058). Immunisation coverage for BCG (98.9%), Polio 0 (88.2%), Penta1 (92.7%), and Pneumo1 (89.8%) were high in both settlements. However, the dropout rate for subsequent vaccines was high 17%, 20% and 41% for Penta, pneumococcal and rota vaccines respectively. There was poor uptake of the new vaccines with slums having 73.4% and 47.9% coverage for pneumococcal and rota vaccines respectively and rural areas had 72.1% and 7.5% for pneumococcal and rota vaccines respectively. CONCLUSION The low full immunisation status in this study was attributed to the child's residence and the occupation of the parents. Lack of education and poor access to messages on immunisation (inadequate access to mass media) are other contributing factors. Educational messages on the importance of immunisation targeting these underserved populations will improve full immunisation coverage.
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Affiliation(s)
- Awa Jammeh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Edward Francis Small Teaching Hospital, Banjul, The Gambia.
| | - Michael Muhoozi
- Center for Health and Population Research, Makerere University, Kampala, Uganda
| | - Asli Kulane
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dan Kajungu
- Center for Health and Population Research, Makerere University, Kampala, Uganda
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Ogundele OA, Fehintola FO, Salami M, Usidebhofoh R, Abaekere MA. Prevalence and patterns of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria: a facility-based cross-sectional survey. Osong Public Health Res Perspect 2023; 14:291-299. [PMID: 37652684 PMCID: PMC10493703 DOI: 10.24171/j.phrp.2023.0071] [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: 03/13/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This study aimed to examine the prevalence and pattern of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria. METHODS This descriptive cross-sectional study was conducted among 422 mothers of children aged 0 to 24 months attending any of the 3 leading immunization clinics in Ile-Ife, Nigeria. The respondents were selected using the multi-stage sampling technique. Data were collected using a pretested structured interviewer-administered questionnaire and analyzed using IBM SPSS ver. 26.0. The chi-square test was used to test associations, while binary logistic regression was used to determine the predictors of mothers' responses to adverse events following immunization (AEFIs). A p-value of <0.05 was considered statistically significant. RESULTS The mean age of the respondents was 29.99±5.74 years. About 38% of the children had experienced an AEFI. Most mothers believed that the pentavalent vaccine was the most common cause of AEFIs (67.5%). Fever (88.0%) and pain and swelling (76.0%) were the most common AEFIs. More than half of the mothers (53.7%) administered home treatment following an AEFI. Younger mothers (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.20-5.01), mothers who delivered their children at a healthcare facility (OR, 3.24; 95% CI, 1.08-9.69), and mothers who were knowledgeable about reporting AEFIs (OR, 2.53; 95% CI, 1.04-7.70) were most likely to respond appropriately to AEFIs. CONCLUSION The proportion of mothers who responded poorly to AEFIs experienced by their children was significant. Therefore, strategies should be implemented to improve mothers' knowledge about AEFIs to improve their responses.
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Affiliation(s)
| | | | - Mubarak Salami
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rahmat Usidebhofoh
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Mihret Fetene S, Debebe Negash W, Shewarega ES, Asmamaw DB, Belay DG, Teklu RE, Aragaw FM, Alemu TG, Eshetu HB, Fentie EA. Determinants of full immunization coverage among children 12-23 months of age from deviant mothers/caregivers in Ethiopia: A multilevel analysis using 2016 demographic and health survey. Front Public Health 2023; 11:1085279. [PMID: 36926180 PMCID: PMC10011448 DOI: 10.3389/fpubh.2023.1085279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Background Despite remarkable improvements in child health services utilization, childhood immunization has been poorly implemented in Ethiopia. However, evidence on the coverage of immunization among children from mothers/caregivers with no education (non-educated mothers were the most identified risk for underutilization of services) are scarce. Therefore, this study aimed to assess the determinants of full immunization coverage among children 12-23 months of age from deviant mothers/caregivers in Ethiopia. Methods We analyzed data from the 2016 Ethiopia Demographic and Health Survey (EDHS) on a sample of 1,170 children 12-23 months of age identified from deviant mothers/caregivers (mothers/caregivers with no education) through a two-stage stratified sampling. A multilevel mixed-effect binary logistic regression analysis was used to identify the individual and community level determinants of full immunization coverage among children 12-23 months of age with their deviant mothers/caregivers. In the final model, a p-value of < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to select statistically significant determinants of full immunization coverage. Results The overall full immunization coverage among children 12-23 months of age identified from deviant mothers/caregivers was 27.4% (95%CI: 25.0, 31.0) in Ethiopia. Deviant mothers/caregivers who are employed (AOR = 1.69, 95%CI: 1.68, 2.45), being in the rich household wealth status (AOR = 2.54, 95%CI: 1.53, 4.22), residing in city (AOR = 5.69, 95%CI: 2.39, 13.61), having one to three (AOR: 3.28, 95% CI: 2.12-5.07) and four and more ANC follow-up during the recent pregnancy (AOR: 3.91, 95% CI: 2.45, 6.24) were the determinants that increased full immunization coverage among children 12-23 months of age. Conclusions Full immunization coverage among children 12-23 months of age from non-educated mothers/caregivers was low and far behind the national target of coverage. Therefore, a system-wide intervention should be used to enhance employability, wealth status, and key maternal health services like ANC follow-up among non-educated mothers/caregivers to increase their children's full immunization coverage.
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Affiliation(s)
- Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ever Siyoum Shewarega
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tesfa GA, Yehualashet DE, Getnet A, Bimer KB, Seboka BT. Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. A spatial and multilevel analysis. PLoS One 2023; 18:e0279399. [PMID: 36608032 PMCID: PMC9821487 DOI: 10.1371/journal.pone.0279399] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Complete childhood vaccination considerably aids in the reduction of morbidity and mortality from vaccine-preventable childhood diseases. Understanding the geographical disparity of complete basic childhood vaccination and Identifying associated factors is vital to designing appropriate interventions. This study aimed to assess the spatial distribution and associated factors of complete basic childhood vaccination among children aged 12-23 months in Ethiopia. METHODS A two-stage stratified sampling technique was used based on the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,028 children was included in the analysis. ArcGIS version 10.8 software was used to visualize the spatial distribution of complete basic childhood vaccination. The Bernoulli-based model was used to detect significant clusters of areas using SaTScan version 9.6 software. To identify associated factors, multilevel logistic regression analyses were used, and all variables with a p-value less than 0.05 were reported as statistically significant predictors. RESULTS Complete basic childhood vaccination among children aged 12-23 months had a significant variation in Ethiopia (Moran's I = 0.276, p<0.001). The spatial scan analysis identified the most likely significant primary clusters with low complete basic childhood vaccination coverage in the Somali region's Afder, Liben, Shabelle, and Nogobe zones; the Southern Nation Nationality and Peoples Region's (SNNPR) Gedeo and Sidama zones; and the Oromia region's Bale and Guji zones. The second significant cluster was found in the Afar region's zones 1, 4, and 5, as well as the northern Somali region's Siti zone. In the multivariable multilevel analysis, maternal age 20-24, 25-29, 35-39, and 40-44 years, delivery at a health facility, four or more antenatal care (ANC) visits, orthodox religion fellowship, maternal primary education, Muslim religion fellowship, living in the Afar, Somalia, and Oromia regions, and living in rural areas were all found to be significantly associated with complete basic childhood vaccination. CONCLUSION A geographically significant variation of complete basic childhood vaccination was observed. Maternal age, maternal education, religion, place of delivery, ANC visit, region, and residence were significantly associated with complete basic childhood vaccination. Developing immunization campaigns targeting areas that had low basic vaccination coverage and designing healthcare programs that can motivate facility-based delivery and ANC follow-up is recommended.
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Affiliation(s)
- Getanew Aschalew Tesfa
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | | | - Addisu Getnet
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kirubel Biweta Bimer
- Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Galadima AN, Mohd Zulkefli NA, Said SM, Ahmad N, Garba SN. Theory-based immunisation health education intervention in improving child immunisation uptake among antenatal mothers attending federal medical centre in Nigeria: A study protocol for a randomized controlled trial. PLoS One 2022; 17:e0263436. [PMID: 36480545 PMCID: PMC9731461 DOI: 10.1371/journal.pone.0263436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Childhood immunisation coverage is very low in Nigeria (31%) with Zamfara State being amongst the states with the poorest coverage (<10%). Lack of maternal knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions of religious regulations of antenatal mothers towards childhood immunisation are the contributory factors to poor childhood immunisation uptake. This study aims is to develop, implement and evaluate the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunization uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. METHODOLOGY The study will be a single-blind parallel-group randomised controlled trial, where baseline data will be collected from 392 estimated antenatal mothers, after that they will be evenly randomised using randomly generated permuted block sizes (each containing two intervention and two control assignments). The study participants will be antenatal mothers of ages 18 years and above who are in third trimesters and attending Federal Medical Centre Gusau, Zamfara State, Nigeria; during the study period and fulfilled all the inclusion and exclusion criteria. The intervention group will undergo five-health education sessions on immunisation, which will be strictly guided by Social Cognitive Theory-based intervention module: while the control group will receive usual care (standard care). Follow-up data will be collected using the same questionnaire at 6-weeks post-delivery, 10-weeks post-delivery and 14-weeks post-delivery. The generalized linear mixed model will be carried-out to determine the overall effect of the intervention after controlling for 14 potential confounding variables. An intention to treat analysis will also be carried-out. Childhood immunisation uptake is the primary outcome while the secondary outcomes are: improved knowledge scores, attitude scores, outcomes expectation, self-efficacy scores, cultural beliefs scores and assumptions on religious regulations scores. DISCUSSION The study will be a randomised controlled trial, that focuses on the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunisation uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR202006722055635. Protocol registered on 09 June 2020.
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Affiliation(s)
- Abubakar Nasiru Galadima
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
- * E-mail:
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Saleh Ngaski Garba
- Department of Nursing Sciences, Faculty of Allied Health Sciences, Ahmad Bello University, Zaria, Nigeria
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Phway P, Kyaw AT, Mon AS, Mya KS. Continuum of care of mothers and immunization status of their children: A secondary analysis of 2015–2016 Myanmar Demographic and Health Survey. PUBLIC HEALTH IN PRACTICE 2022; 4:100335. [DOI: 10.1016/j.puhip.2022.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
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Ilesanmi MM, Abonyi S, Pahwa P, Gerdts V, Scwandt M, Neudorf C. Trends, barriers and enablers to measles immunisation coverage in Saskatchewan, Canada: A mixed methods study. PLoS One 2022; 17:e0277876. [PMID: 36417461 PMCID: PMC9683619 DOI: 10.1371/journal.pone.0277876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Many social, cultural, and systemic challenges affect the uptake of measles immunisation services. Prior studies have looked at the caregivers' perspectives, but little is known about the perspectives of the health care providers on the barriers of measles immunisation services in Canada. This study examined measles immunisation coverage trends across the regional health authorities in Saskatchewan and explored the barriers and enablers to measles immunisation coverage from providers' perspectives. The study adopted an explanatory sequential mixed method. We utilized the entire population of 16,582 children under two years of age available in the Saskatchewan Immunisation Management System (SIMS) registry for 2002 and 2013 in aggregate format and interviewed 18 key informants in pre-determined two-stages in 2016 and 2017. The quantitative analysis was done with Joinpoint regression modelling, while the qualitative interview data was analyzed using hybrid inductive and deductive thematic approaches. There was a 16.89%-point increase in measles immunisation coverage in the province from 56.32% to 73.21% between 2002 and 2013. There was also a persistently higher coverage among the affluent (66.95% - 82.37%) than the most deprived individuals (45.79% - 62.60%) in the study period. The annual rate of coverage change was marginally higher among the most deprived (16.81%; and average annual percentage change (AAPC) 2.0, 95% CI 1.7-2.2) than among the affluent group (15.42% and AAPC 3.0; 95% CI 2.0-4.0). While access-related issues, caregivers' fears, hesitancy, anti-vaccination challenges, and resource limitations were barriers to immunisation, improving community engagement, service delivery flexibility, targeted social responses and increasing media role were found useful to address the uptake of measles and other vaccine-preventable diseases immunisation. There is low coverage and inequity in measles immunisation uptake in Saskatchewan from social and institutional barriers. Even though there is evidence of disparity reduction among the different groups, the barriers to increasing measles immunisation coverage have implications for the health of the socio-economically deprived groups, the healthcare system and other vaccination programs. There is a need to improve policy framework for community engagement, targeted programs, and public health discourse.
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Affiliation(s)
- Marcus M. Ilesanmi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- * E-mail:
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, SK, Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Volker Gerdts
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Scwandt
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Health Surveillance & Reporting, Saskatchewan Health Authority (SHA), Saskatoon, SK, Canada
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Hijazi R, Gesser-Edelsburg A, Feder-Bubis P, Mesch GS. Pro-vaccination Groups Expressing Hesitant Attitudes: A Cross-Sectional Study About the Difference Between Attitudes and Actual Behavior in Israel. Front Public Health 2022; 10:871015. [PMID: 35570981 PMCID: PMC9092369 DOI: 10.3389/fpubh.2022.871015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Vaccines have contributed to the decline in mortality, morbidity, and even the eradication of various infectious diseases. Over time, the availability of information to the public and the request for public involvement in the health decision-making process have risen, and the confidence in vaccines has dropped. An increasing number of parents and individuals are choosing to delay or refuse vaccines. Objectives (1) Identifying hesitant attitudes among pro-vaccination parents; (2) testing the difference between the rate of hesitant attitudes and the rate of hesitancy in practice among pro-vaccination parents; and (3) examining the association of sociodemographic characteristics (gender, age, marital status education and religious affiliation) with the difference between hesitant attitudes and hesitancy in practice among pro-vaccination parents. Methods Descriptive cross-sectional survey using an online survey that measured vaccine hesitancy among pro-vaccination parents (n = 558) whose children were in kindergarten (3–5 years), according to a variety of sociodemographic characteristics. Results A significant difference was found between the rate of hesitant attitudes and the rate of hesitation in actual vaccination among pro-vaccination and hesitant parents, where despite that 26% of the parents had hesitant attitudes, only 19% hesitated in practice [P = 0.0003]. There was also a significant difference between the rate of hesitant attitudes and the rate of hesitancy in practice among women [P = 0.0056] and men [P = 0.0158], parents between 30 and 39 years of age [P = 0.0008], traditional parents [P = 0.0093], Non-academic parents [P = 0.0007] and parents with BA degree [P = 0.0474]. Conclusion Pro-vaccination individuals may have hesitant attitudes regarding vaccines. Therefore, it is very important for health authorities to address the public's fears and concerns, including those who are classified as pro-vaccination.
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Affiliation(s)
- Rana Hijazi
- School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Anat Gesser-Edelsburg
- Head of the Health Promotion Program and Head of the Health and Risk Communication Lab, School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gustavo S Mesch
- Department of Sociology, University of Haifa, Mount Carmel, Haifa, Israel
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Behl R, Ali S, Altamirano J, Leno A, Maldonado Y, Sarnquist C. Rebuilding child health in South Kivu, Democratic Republic of Congo (DRC): evaluating the Asili social enterprise program. Confl Health 2022; 16:21. [PMID: 35526031 PMCID: PMC9077969 DOI: 10.1186/s13031-022-00454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) has a long history of conflict and ongoing local instability; the eastern provinces, including South Kivu, have been especially affected. Health systems and livelihoods have been undermined, contributing to massive inequities in access to health services and high rates of internal displacement. Asili, an innovative social enterprise program, aimed to provide essential community services and improve the health of under-five children in two South Kivu communities, Mudaka and Panzi, via provision of small-format, franchisable health clinics and clean water services. METHODS We evaluated utilization and acceptance of Asili services in two study sites, Mudaka and Panzi. Data collected included questions on housing conditions, food security, and at follow up, Asili membership and use, satisfaction with services, and recommendations for improvement. Structured pre- and post-interviews with primary caregivers of families with under-five children were the primary source of data with additional community input collected through focus group discussions. RESULTS At baseline, we enrolled 843 households in Mudaka and 890 in Panzi. Market segmentation analysis illuminated service usage patterns, showing Asili services were well received overall in both Mudaka and Panzi. Families reporting higher levels of proxy measures of socioeconomic status (SES), such as electricity, land ownership, and education, were more likely to use Asili services, findings that were further supported by focus group discussions among community members. CONCLUSIONS Rebuilding health infrastructure in post-conflict settings, especially those that continue to be conflict-affected and very low SES, is a challenging prospect. Focus group results for this study highlighted the positive community response to Asili, while also underscoring challenges related to cost of services. Programs may need, in particular, to have different levels of costs for different SES groups. Additionally, longer follow-up periods and increased stability may be needed to assess the potential of social enterprise interventions such as Asili to improve health outcomes, especially in children. TRIAL REGISTRATION Institutional Review Board approval for this study was obtained at Stanford University (IRB 35216) and the University of Kinshasa, DRC. Further, this study has been registered on Clinicaltrials.gov (record NCT03536286), retrospectively registered as of 4/23/2018.
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Affiliation(s)
- Rasika Behl
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA.
| | - Sofia Ali
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| | - Jonathan Altamirano
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| | - Abraham Leno
- Eastern Congo Initiative, Bukavu, South Kivu, Democratic Republic of Congo
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
| | - Clea Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA, 94304, USA
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Determinants of pentavalent and measles vaccination dropouts among children aged 12-23 months in The Gambia. BMC Public Health 2022; 22:520. [PMID: 35296298 PMCID: PMC8926885 DOI: 10.1186/s12889-022-12914-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Every year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12–23 months in The Gambia. Methods The study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019–20 (GDHS). The percentage of children aged 12–23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout. Results Approximately 7.0% and 4.0% of the 1,302 children aged 12–23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout. Conclusion Tailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.
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Okello G, Izudi J, Ampeire I, Nghania F, Dochez C, Hens N. Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016. BMC Health Serv Res 2022; 22:40. [PMID: 34996445 PMCID: PMC8740046 DOI: 10.1186/s12913-021-07443-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/22/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. METHODS We analyzed data from the women's questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. RESULTS Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), - 16.1, - 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. CONCLUSION Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.
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Affiliation(s)
- Gerald Okello
- Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | | | | | - Carine Dochez
- Network for Education and Support in Immunisation (NESI), Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Mathematics and Statistics, Faculty of Sciences, Hasselt University, Hasselt, Belgium
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van Heemskerken PG, Decouttere CJ, Broekhuizen H, Vandaele NJ. Understanding the complexity of demand-side determinants on vaccine uptake in sub-Saharan Africa. Health Policy Plan 2021; 37:281-291. [PMID: 34918093 DOI: 10.1093/heapol/czab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/28/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA.
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Affiliation(s)
- Phylisha G van Heemskerken
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | | | - Henk Broekhuizen
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.,Department of Health and Society, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen 3000, The Netherlands
| | - Nico J Vandaele
- Access-To-Medicines Research Center, KU Leuven, Naamsestraat 69, Leuven, Belgium
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Kwiringira JN, Mugisha J, Akugizibwe M, Ariho P. 'When will the doctor be around so that I come by?!' Geo-socio effects on health care supply, access and utilisation: experiences from Kalangala Islands, Uganda. BMC Health Serv Res 2021; 21:1163. [PMID: 34702272 PMCID: PMC8549200 DOI: 10.1186/s12913-021-07204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. We argue that health care delivery has multiple intersections that are experientially complex, multi-layered and multi-dimensional to the disadvantage of vulnerable population segments of society in the study area. Methods We used a cross-sectional qualitative exploratory design. Qualitative methods facilitated an in-depth exploration and understanding of this island dispersed and peripheral setting. Data sources included a review of relevant literature and an ethnographic exploration of the lived experiences of community members while seeking and accessing health care. Data collection methods included in-depth interviews (IDI) from selected respondents, observation, focus group discussions (FGDs) and key informant interviews (KII). Results We report based on the health care systems model which posits that, health care activities are diverse but interconnected in a complex way. The identified themes are; the role of geography, access (geographical and financial) to health services, demand and utilization, Supplies, staffing and logistical barriers and a permissive and transient society. When and how to travel for care was beyond a matter of having a health need/ being sick and need arising. A motivated workforce is as critical as health facilities themselves in determining healthcare outcomes. Conclusion Geography doesn’t work and affect health outcomes in isolation. Measures that target only individuals will not be adequate to tackle health inequalities because aspects of the collective social group and physical environment may also need to be changed in order to reduce health variations.
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Affiliation(s)
| | - James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Mathias Akugizibwe
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Paulino Ariho
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
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Dheresa M, Dessie Y, Negash B, Balis B, Getachew T, Mamo Ayana G, Merga BT, Regassa LD. Child Vaccination Coverage, Trends and Predictors in Eastern Ethiopia: Implication for Sustainable Development Goals. J Multidiscip Healthc 2021; 14:2657-2667. [PMID: 34584421 PMCID: PMC8464587 DOI: 10.2147/jmdh.s325705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Every year, immunization prevents about 4–5 million child fatalities from vaccine preventable morbidities. Conversely, in Ethiopia, achieving full coverage of vaccination has continued to be challenging. Socio-demographic, caregivers and child related factors determine vaccination coverage. Therefore, this study aimed to find out recent coverage, trends in coverage, and its predictors in eastern Ethiopia. Methods A population-based longitudinal study design was conducted among 14,246 children aged 12–24 months from 2017 to 2021 in Kersa Health and Demographic Surveillance System site (KHDSS). The data were collected from caregivers of the child by face to face interview. Multinomial logistic regressions were used to identify predictors of vaccination. The association between vaccination coverage and its predictors was presented by adjusted odds ratio with 95% confidence interval. A p-value of <0.05 was used to establish statistical significance. Results From the 14,198 included children, only 39% of children were fully vaccinated, with highest proportion in 2020 (45%) and lowest proportion in 2019 (32%). In comparison to fully vaccinated, being partially vaccinated was positively associated with older maternal age, rural residence, unemployment, rich wealth index, no antenatal care, facility delivery, and birth order whereas negatively associated with semi-urban residence. In compared to fully vaccinated, being not vaccinated was positively associated with older maternal age, rural residence, maternal education, unemployment, and no antenatal care whereas negatively associated with semi-urban residence, poor wealth index, multipara, grand multipara, and facility delivery. Conclusion Less than two-fifths of children aged 12 to 24 months were fully vaccinated. Socio-demographic factors and maternity care utilization were found to be predictors of vaccination coverage. Therefore, strategies that emphasize women’s empowerment in terms of education, economy, and employment status, and enhancing maternal healthcare utilization may improve vaccination coverage.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health 2021; 21:1475. [PMID: 34320942 PMCID: PMC8320032 DOI: 10.1186/s12889-021-11466-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1–59 months were due to vaccine preventable diseases. Despite the benefits of childhood immunisation, routine vaccination coverage for all recommended Expanded Programme on Immunization vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa, as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake. Methods We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords and searching multiple databases (Medline, PubMed, CINAHL and Psychology & Behavioral Sciences Collection) dating back from inception to 2020. Results Out of 18,708 recorded citations retrieved, 10,396 titles were filtered and 324 titles remained. These 324 abstracts were screened leading to 51 included studies. Statistically significant factors found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further categorised into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation, whereas non-modifiable factors were sociodemographic factors of parent and child, logistic and administration factors. Conclusion Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women, focusing on the significant findings from this systematic review, would hopefully improve childhood immunisation uptake in African countries with poor coverage rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11466-5.
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Affiliation(s)
- Abubakar Nasiru Galadima
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
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Kalaij AGI, Sugiyanto M, Ilham AF. Factors Associated With Vaccination Compliance in Southeast Asian Children: A Systematic Review. Asia Pac J Public Health 2021; 33:479-488. [PMID: 34013786 DOI: 10.1177/10105395211014640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although vaccination coverage has reached a peak of 86% globally, around 19.9 million infants and children are yet to receive routine vaccinations-with Asia holding the highest prevalence of noncompliance. This implies notable gaps in vaccination coverage among some regions in the world. This study aims to analyze the factors associated with compliance toward childhood vaccination in Southeast Asia. A systematic review of observational studies was conducted using the following databases: PubMed, Scopus, and Cochrane. Included studies analyze factors affecting compliance with childhood vaccination in Southeast Asia, and assessed with Joanna Briggs Institute (JBI) and Newcastle-Ottawa Scale's criteria. Sixteen observational studies were included, with a total of 41 956 subjects, consisting of 15 cross-sectional studies and one case-control study. Our results suggested that parental personal-related, children and family status-related, socioeconomic, and health care-related factors strongly affected subjects' compliance with immunization. Prominent determinants were older maternal age, higher economics groups, parents in government or health care sectors, and frequent antenatal care visits. On the other hand, noncompliance were associated with younger age, large quantity of family members, lower economic groups, lower education, and unemployed parents. We hope that this comprehensive assessment thoroughly addresses challenges and inform strategies to raise compliance toward childhood vaccination in Southeast Asia.
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Budu E, Ahinkorah BO, Aboagye RG, Armah-Ansah EK, Seidu AA, Adu C, Ameyaw EK, Yaya S. Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys. BMJ Open 2021; 11:e045992. [PMID: 33986059 PMCID: PMC8126284 DOI: 10.1136/bmjopen-2020-045992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa. DESIGN Our study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa. PARTICIPANTS A total of 60 964 mothers of children aged 11-23 months were included in the study. OUTCOME VARIABLES The main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC). RESULTS The average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended. CONCLUSION The study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Collins Adu
- Department of Health Promotion, and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Fenta SM, Fenta HM. Individual and community-level determinants of childhood vaccination in Ethiopia. Arch Public Health 2021; 79:53. [PMID: 33879269 PMCID: PMC8059167 DOI: 10.1186/s13690-021-00581-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccines are one of our most important tools for preventing outbreaks and keeping the world safe. Most unvaccinated children live in the poorest countries including Ethiopia. Therefore, this study aimed to identify the determinants of vaccination coverage among children aged12-23 months in Ethiopia. METHODS A cross-sectional secondary data were obtained from the 2016 Ethiopian Demographic and Health Survey data (EDHS). A total of 1929 children were included. A Multilevel Proportional Odds Model was used to identify the individual and community-level factors associated with child vaccination. RESULT Among 1, 929 children, only 48.6% (95% CI: 46.3 to 50.8%) were fully vaccinated while 37.8% (95% CI: 35.7 to 40.1%) were partially vaccinated.. The multilevel ordinal logistic regression model reveled that housewife mother (AOR =1.522, 95%CI: 1.139, 2.034), institutional delivery (AOR =2.345, 95%CI: 1.766, 3.114),four or above antenatal care visits (AOR = 2.657; 95% CI: 1.906, 3.704), children of mothers with secondary or higher education (AOR = 2.008; 95% CI: 1.209, 3.334),Children whose fathers primary education (AOR = 1.596; 95% CI: 1.215, 2.096), from the rich households (AOR = 1.679; 95% CI: 1.233, 2.287) were significantly associated with childhood vaccination. CONCLUSION Child vaccination coverage in Ethiopia remains low. Therefore, there is a need to increase child vaccination coverage by promoting institutional delivery and prenatal care visits, as well as maternal tetanus immunization. Besides, public initiatives needed to improve child vaccination coverage, women's and husband's education, poor women, and further advancement of health care services for poor women, housewife women, women living in remote areas should be made to maintain further improvements in child vaccination. Furthermore, policies and programs aimed at addressing cluster variations in child vaccination need to be formulated and their implementation must be strongly pursued.
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Affiliation(s)
- Setegn Muche Fenta
- Department of Statistics, Faculty of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Haile Mekonnen Fenta
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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Budu E, Seidu AA, Agbaglo E, Armah-Ansah EK, Dickson KS, Hormenu T, Hagan JE, Adu C, Ahinkorah BO. Maternal healthcare utilization and full immunization coverage among 12-23 months children in Benin: a cross sectional study using population-based data. ACTA ACUST UNITED AC 2021; 79:34. [PMID: 33726859 PMCID: PMC7962345 DOI: 10.1186/s13690-021-00554-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/01/2021] [Indexed: 01/24/2023]
Abstract
Background Maternal and child health are important issues for global health policy, and the past three decades have seen a significant progress in maternal and child healthcare worldwide. Immunization is a critical, efficient, and cost-effective public health intervention for newborns. However, studies on these health-promoting indicators in low-income and middle-income countries, especially in sub-Sahara Africa are sparse. We investigated the association between maternal healthcare utilization and complete vaccination in the Republic of Benin. Methods We analysed data from the 2018 Benin Demographic and Health Survey (BDHS). Specifically, the children’s recode file was used for the study. The outcome variable used was complete vaccination. Number of antenatal care visits, assistance during delivery, and postnatal check-up visits were the key explanatory variables. Bivariate and multilevel logistic regression analyses were carried out. The results were presented as unadjusted odds ratios (uOR) and adjusted odds ratios (aOR), with their corresponding 95% confidence intervals (CIs) signifying their level of precision. Statistical significance was declared at p < 0.05. Results The prevalence of full immunization coverage in Benin was 85.4%. The likelihood of full immunization was lower among children whose mothers had no antenatal care visits, compared to those whose mothers had 1–3 visits [aOR = 0.11, 95% CI: 0.08–0.15], those who got assistance from Traditional Birth Attendants/other during delivery, compared to those who had assistance from Skilled Birth Attendants/health professionals [aOR = 0.55, 95% CI: 0.40–0.77], and mothers who had no postnatal care check-up visit, compared to those who had postnatal care check-up < 24 h after delivery [aOR = 0.49, 95% CI: 0.36–0.67]. With the covariates, religion, partner’s level of education, parity, wealth quintile, and place of residence also showed significant associations with full immunization. Conclusion The study has demonstrated strong association between full immunization and antenatal care, skilled attendance at birth, and postnatal care check-up visit. We found that full immunization decreases among women with no antenatal care visits, those who receive assistance from Traditional Birth Attendants during delivery, and those who do not go for postnatal care visits. To help achieve full immunization, it is prudent that the government of Benin collaborates with international organisations such as WHO and UNICEF to provide education to pregnant women on the importance of immunization after delivery. Such education can be embedded in the antenatal care, delivery and postnatal care services offered to pregnant women during pregnancy, delivery, and after delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00554-y.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Kwesi Armah-Ansah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Hormenu
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana.,Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Abdullahi MF, Stewart Williams J, Sahlèn KG, Bile K, Kinsman J. Factors contributing to the uptake of childhood vaccination in Galkayo District, Puntland, Somalia. Glob Health Action 2021; 13:1803543. [PMID: 32847489 PMCID: PMC7480419 DOI: 10.1080/16549716.2020.1803543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children’s Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country’s health authorities. Objective This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers. Methods Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District – Galkayo city, Bayra and Bacadwayn. Results From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia’s patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders. Conclusions Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers’ involvement is lacking. This may be boosted by highlighting fathers’ obligation to protect their children’s health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets.
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Affiliation(s)
- Mohamed Farah Abdullahi
- Department of Research and Development, Puntland University of Science and Technology , Galkayo City, Somalia
| | - Jennifer Stewart Williams
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University , Umeå, Sweden.,Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle , Callaghan, Australia
| | - Klas-Göran Sahlèn
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University , Umeå, Sweden
| | - Khalif Bile
- Senior National Advisor Health Systems and Policy and Board Member Somali and Swedish Researchers' Association (SSRA) , Vällingby, Sweden
| | - John Kinsman
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University , Umeå, Sweden.,Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet , Stockholm, Sweden
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Umoke PCI, Umoke M, Nwalieji CA, Igwe FO, Umoke UG, Onwe RN, Nwazunku AA, Nwafor IE, Chukwu OJ, Eyo N, Ugwu A, Ogbonnaya K, Okeke E, Eke DO. Investigating Factors Associated with Immunization Incompletion of Children Under Five in Ebonyi State, Southeast Nigeria: Implication for Policy Dialogue. Glob Pediatr Health 2021; 8:2333794X21991008. [PMID: 33614848 PMCID: PMC7868489 DOI: 10.1177/2333794x21991008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/10/2020] [Accepted: 01/08/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose. To investigate factors associated with immunization incompletion of children under 5 years in Ebonyi state, Southeastern part of Nigeria. Method. A cross-sectional and a cluster sampling design were implemented; 400 women of childbearing age in families with children between 0 to 59 months of age were interviewed in Ebonyi state. Demographic characteristics of the child and mother, the child’s immunization history, and reasons for partial immunization were obtained with the use of a self-administered questionnaire. Data were analyzed using descriptive statistics of mean, standard deviation, t-test and ANOVA with SPSS version 23 and hypothesis tested at P < .05. Results. Findings revealed that 180 (48.1%) females, and 194 (51.9%) males’ children were immunized; Less than half 155 (41.9%) of the children had 1 missed dose, considered as partial immunization cases indicating low coverage. Of the reasons given for incomplete immunization mothers, mothers agreed that immunization centers are far from home (x̄ = 2.55 ± 0.92). This reason significantly affects mothers who were young (≤20 years) (x = 2.86 ± 0.94; P = .018), single (x = 2.84 ± 1.05; 0.037), had secondary education (x = 2.65 ± 1.08;0.000), students (2.89 ± 1.08; P = .000), poor (x = 2.63 ± 1.05; P = .009), and primiparous (x = 2.50 ± 1.08; P = .036) are more affected and they agreed (grand mean >2.50). Conclusion. Immunization coverage was low, and far location from health facility was indicted thus policy implementers should locate health facilities close to homes. also health education on the importance of immunization should be given to mothers especially those who are young and has low socio-economic status.
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Affiliation(s)
| | - MaryJoy Umoke
- Ebonyi State Ministry of Health, Abakaliki, Ebonyi State, Nigeria
| | | | | | | | | | | | | | - Obinna Jude Chukwu
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria
| | - Nora Eyo
- WHO Office, Ebonyi State, Nigeria
| | | | - Kalu Ogbonnaya
- Ebonyi State Ministry of Health, Abakaliki, Ebonyi State, Nigeria
| | | | - David Onyemaechi Eke
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria
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Huang Y, Danovaro-Holliday MC. Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006-2018. BMC Public Health 2021; 21:351. [PMID: 33581740 PMCID: PMC7880859 DOI: 10.1186/s12889-021-10364-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. METHODS We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. RESULTS Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. CONCLUSION Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.
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Affiliation(s)
- Yue Huang
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland
- Present affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - M Carolina Danovaro-Holliday
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland.
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Kainga HW, Ssendagire S, Ssanyu JN, Nabukeera S, Namuhani N, Mangen FW. Proportion of children aged 9-59 months reached by the 2017 measles supplementary immunization activity among the children with or without history of measles vaccination in Lilongwe district, Malawi. PLoS One 2021; 16:e0243137. [PMID: 33428640 PMCID: PMC7799760 DOI: 10.1371/journal.pone.0243137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background The measles Supplementary Immunization Activity (SIA) was implemented in June, 2017 to close immunity gaps by providing an additional opportunity to vaccinate children aged between 9 months and up to 14 years in Lilongwe District, Malawi. This study was conducted to determine the proportion of eligible children that were reached by the 2017 measles SIA among those children with or without history of measles vaccination, and possible reasons for non-vaccination. Methods A cross-sectional survey using mixed methods was conducted. Caretakers of children who were eligible for the 2017 measles SIA were sampled from 19 households from each of the 25 clusters (villages) that were randomly selected in Lilongwe District. A child was taken to have been vaccinated if the caretaker was able to explain when and where the child was vaccinated. Eight Key Informant Interviews (KIIs) were conducted with planners and health care workers who were involved in the implementation of the 2017 measles SIA. Modified Poisson regression was used to examine the association between non-vaccination and child, caretaker and household related factors. A thematic analysis of transcripts from KIIs was also conducted to explore health system factors associated with non-vaccination of eligible children in this study. Results A total of 476 children and their caretakers were surveyed. The median age of the children was 52.0 months. Overall, 41.2% [95% CI 36.8–45.7] of the children included in the study were not vaccinated during the SIA. Only 59.6% of children with previous measles doses received SIA dose; while 77% of those without previous measles vaccination were reached by the SIA. Low birth order, vaccination history under routine services, low level of education among caretakers, unemployment of the household head, younger household head, provision of insufficient information by health authorities about the SIA were significantly associated with non-vaccination among eligible children during the 2017 measles SIA. Qualitative findings revealed strong beliefs against vaccinations, wrong perceptions about the SIA (from caretakers’ perspectives), poor delivery of health education, logistical and human resource challenges as possible reasons for non-vaccination. Conclusion Many children (41%) were left unvaccinated during the SIA and several factors were found to be associated with this finding. The Lilongwe District Health Team should endeavor to optimize routine immunization program; and community mobilization should be intensified as part of SIA activities.
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Affiliation(s)
| | | | | | - Sarah Nabukeera
- Makerere University School of Public Health–Uganda, Kampala, Uganda
| | - Noel Namuhani
- Makerere University School of Public Health–Uganda, Kampala, Uganda
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Shenton LM, Wagner AL, Ji M, Carlson BF, Boulton ML. Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review. BMJ Open 2020; 10:e039693. [PMID: 33268412 PMCID: PMC7713201 DOI: 10.1136/bmjopen-2020-039693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status. DESIGN Scoping review. DATA SOURCES Electronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018. STUDY SELECTION All English studies with vaccination status as the outcome and the use of DHS data. DATA EXTRACTION Studies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted. RESULTS A total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1-86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO's Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child's sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition. CONCLUSIONS Researchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Tesema GA, Tessema ZT, Tamirat KS, Teshale AB. Complete basic childhood vaccination and associated factors among children aged 12-23 months in East Africa: a multilevel analysis of recent demographic and health surveys. BMC Public Health 2020; 20:1837. [PMID: 33256701 PMCID: PMC7708214 DOI: 10.1186/s12889-020-09965-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background Complete childhood vaccination remains poor in Sub-Saharan Africa, despite major improvement in childhood vaccination coverage worldwide. Globally, an estimated 2.5 million children die annually from vaccine-preventable diseases. While studies are being conducted in different East African countries, there is limited evidence of complete basic childhood vaccinations and associated factors in East Africa among children aged 12–23 months. Therefore, this study aimed to investigate complete basic childhood vaccinations and associated factors among children aged 12–23 months in East Africa. Methods Based on the Demographic and Health Surveys (DHSs) of 12 East African countries (Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Mozambique, Madagascar, Zimbabwe, Kenya, Zambia, and Malawi), secondary data analysis was performed. The study included a total weighted sample of 18,811 children aged 12–23 months. The basic childhood vaccination coverage was presented using a bar graph. Multilevel binary logistic regression analysis was fitted for identifying significantly associated factors because the DHS has a hierarchical nature. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (−2LLR) were used for checking model fitness, and for model comparison. Variable with p-value ≤0.2 in the bi-variable multilevel analysis were considered for the multivariable analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the significance and strength of association with full vaccination. Results Complete basic childhood vaccination in East Africa was 69.21% (95% CI, 69.20, 69.21%). In the multivariable multilevel analysis; Mothers aged 25–34 years (AOR = 1.21, 95% CI: 1.10, 1.32), mothers aged 35 years and above (AOR = 1.50, 95% CI: 1.31, 1.71), maternal primary education (AOR = 1.26, 95% CI: 1.15, 1.38), maternal secondary education and above (AOR = 1.54, 95% CI: 1.36, 1.75), husband primary education (AOR = 1.25, 95% CI: 1.13, 1.39), husband secondary education and above (AOR = 1.24, 95% CI: 1.11, 1.40), media exposure (AOR = 1.23, 95% CI: 1.13, 1.33), birth interval of 24–48 months (AOR = 1.28, 95% CI: 1.15, 1.42), birth interval greater than 48 months (AOR = 1.35, 95% CI: 1.21, 1.50), having 1–3 ANC visit (AOR = 3.24, 95% CI: 2.78, 3.77), four and above ANC visit (AOR = 3.68, 95% CI: 3.17, 4.28), PNC visit (AOR = 1.34, 95% CI: 1.23, 1.47), health facility delivery (AOR = 1.48, 95% CI: 1.35, 1.62), large size at birth 1.09 (AOR = 1.09, 95% CI: 1.01, 1.19), being 4–6 births (AOR = 0.83, 95% CI: 0.75, 0.91), being above the sixth birth (AOR = 0.60, 95% CI: 0.52, 0.70), middle wealth index (AOR = 1.16, 95% CI: 1.06, 1.28), rich wealth index (AOR = 1.20, 95% CI: 1.09, 1.33), community poverty (AOR = 1.21, 95% CI: 1.11, 1.32) and country were significantly associated with complete childhood vaccination. Conclusions In East Africa, full basic childhood vaccine coverage remains a major public health concern with substantial differences across countries. Complete basic childhood vaccination was significantly associated with maternal age, maternal education, husband education, media exposure, preceding birth interval, number of ANC visits, PNC visits, place of delivery, child-size at birth, parity, wealth index, country, and community poverty. Public health interventions should therefore target children born to uneducated mothers and fathers, poor families, and those who have not used maternal health services to enhance full childhood vaccination to reduce the incidence of child mortality from vaccine-preventable diseases.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Faith MR, Juliet B, Tumuhamye N, Mathias T, Sacks E. Factors associated with the utilization of inactivated polio vaccine among children aged 12 to 23 months in Kalungu District, Uganda. Health Policy Plan 2020; 35:i30-i37. [PMID: 33165582 PMCID: PMC7649662 DOI: 10.1093/heapol/czaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/12/2022] Open
Abstract
Uganda officially introduced the inactivated polio vaccine (IPV) in May 2016 as part of the polio eradication strategy and integrated it into its routine immunization programme in addition to the oral polio vaccine. The current coverage stands at 60% as of July 2017. We therefore aimed to determine factors associated with the uptake of IPV among children in Kalungu District so as to inform the implementation of the vaccine policy. A community-based cross-sectional study was conducted among caregivers of 406 eligible children aged 12-23 months through multi-stage systematic sampling and a standardized semi-structured questionnaire. Nine key informant interviews were conducted through purposive selection of health care providers and members of Village Health Teams (VHTs) based on their expertize. Modified Poisson regression and thematic content analysis were used to determine factors significant to IPV uptake among children. 71% of sampled children aged 12-23 months had received IPV in Kalungu District. The survey found that being encouraged by health workers and VHTs was significant to children's uptake of IPV (Adjusted PR 1.24, 95% CI; 1.22-3.47). Distance to the immunization point (Adjusted PR 0.32,95% CI; 0.16-0.62) and caregiver's education level (Adjusted PR 1.16,95% CI; 1.05-2.22) were also associated with IPV uptake. Qualitative findings from health workers and VHT members further confirmed the perception that distance to the immunization post was important, and VHTs also stated that being encouraged by health workers was critical to IPV uptake. The current prevalence of IPV uptake among children aged 12-23 months in Kalungu is 71%, higher than the last reported national coverage (60%), though still below the recommended national coverage of 95%. Efforts should be focused on sensitization of caregivers through health workers and VHTs. Immunization outreach should be strengthened so as to bring services closer to patients.
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Affiliation(s)
- Mirembe Rachel Faith
- Ministry of Health, Uganda Sanitation Fund Programme, Kampala, PO Box 7272, Uganda
| | - Babirye Juliet
- Makerere University, School of Public Health, Kampala, Uganda
| | | | | | - Emma Sacks
- Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Cortaredona S, Diop R, Seror V, Sagaon‐Teyssier L, Peretti‐Watel P. Regional variations of childhood immunisations in Senegal: a multilevel analysis. Trop Med Int Health 2020; 25:1122-1130. [DOI: 10.1111/tmi.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sébastien Cortaredona
- Aix Marseille UniversityIRD, AP‐HM, SSA, VITROME Marseille France
- IHU‐Méditerranée Infection Marseille France
| | - Rokhaya Diop
- National School of Statistics and Economic Analysis Dakar Senegal
| | - Valérie Seror
- Aix Marseille UniversityIRD, AP‐HM, SSA, VITROME Marseille France
- IHU‐Méditerranée Infection Marseille France
| | | | - Patrick Peretti‐Watel
- Aix Marseille UniversityIRD, AP‐HM, SSA, VITROME Marseille France
- IHU‐Méditerranée Infection Marseille France
- ORS PACASoutheastern Health Regional Observatory Marseille France
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Aalemi AK, Shahpar K, Mubarak MY. Factors influencing vaccination coverage among children age 12-23 months in Afghanistan: Analysis of the 2015 Demographic and Health Survey. PLoS One 2020; 15:e0236955. [PMID: 32764770 PMCID: PMC7413477 DOI: 10.1371/journal.pone.0236955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background Childhood vaccination plays a key role in reducing morbidity and mortality from vaccine-preventable diseases. Numerous studies have assessed the influence of demographic and socioeconomic factors on child immunization around the world. There are few such studies in Afghanistan, however. Therefore, this study aimed to identify factors influencing vaccination status among children age 12–23 months in Afghanistan. Materials and methods Nationally representative data from the 2015 Afghanistan Demographic and Health Survey were used for this study. A sample of 5,708 children age 12–23 months with a vaccine card and immunization history was analyzed. Multinomial logistic regression was used to identify significant relationships between cofactors and vaccination status. Results In the study, 51% the subjects were boys, 48% were born at home, and 76% were residents of rural areas. Background characteristics positively associated with vaccination status included delivery in a health facility (RRR = 2.5, 95% CI = 1.9–3.3), maternal age of 30–39 years (RRR = 2.2, 95% CI = 1.2–4.1), attending at least four visits for antenatal care (RRR = 2.7, 95% CI = 1.7–4.5), health facility visit in the past 12 months (RRR = 1.9, 95% CI = 1.4–2.5), paternal professional occupation (RRR = 4.9, 95% CI = 2.0–12.3), family with richer wealth index (RRR = 2.4, 95% CI = 1.4–4.1), and living in the northeast region (RRR = 2.2, 95% CI = 1.2–3.9)were positively associated with vaccination status. Living in the southern region (RRR = 0.3, 95% CI = 0.2–0.5) was negatively associated with vaccination status. Conclusion This study identified maternal age, ANC visits, place of delivery, health facility visits in past 12 months, paternal occupation, wealth quintile, and geographic region as the factors influencing child’s vaccination status in Afghanistan.
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Affiliation(s)
- Ahmad Khalid Aalemi
- Department of Epidemiology, Kabul University of Medical Sciences, Kabul, Afghanistan
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
| | - Karimullah Shahpar
- Department of Infectious Disease, Kabul University of Medical Sciences, Kabul, Afghanistan
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Inequalities in Rotavirus Vaccine Uptake in Ethiopia: A Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082696. [PMID: 32295233 PMCID: PMC7216179 DOI: 10.3390/ijerph17082696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/04/2022]
Abstract
A previous study in Ethiopia reported significant variation in rotavirus vaccine uptake across socioeconomic strata. This study aims to quantify socioeconomic inequality of rotavirus vaccine uptake in Ethiopia and to identify the contributing factors for the inequality. The concentration curve (CC) and the Erreygers Normalized Concentration Index (ECI) were used to assess the socioeconomic related inequality in rotavirus vaccine uptake using data from the 2016 Ethiopian Demographic and Health Survey. Decomposition analysis was conducted to identify the drivers of inequalities. The CC for rotavirus vaccine uptake lay below the line of equality and the ECI was 0.270 (p < 0.001) indicating that uptake of rotavirus vaccine in Ethiopia was significantly concentrated among children from families with better socioeconomic status. The decomposition analysis showed that underlining inequalities in maternal health care services utilization, including antenatal care use (18.4%) and institutional delivery (8.1%), exposure to media (12.8%), and maternal educational level (9.7%) were responsible for the majority of observed inequalities in the uptake of rotavirus vaccine. The findings suggested that there is significant socioeconomic inequality in rotavirus vaccine uptake in Ethiopia. Multi-sectoral actions are required to reduce the inequalities, inclusive increasing maternal health care services, and educational attainments among economically disadvantaged mothers.
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Debie A, Lakew AM. Factors associated with the access and continuum of vaccination services among children aged 12-23 months in the emerging regions of Ethiopia: evidence from the 2016 Ethiopian demography and health survey. Ital J Pediatr 2020; 46:28. [PMID: 32131868 PMCID: PMC7057504 DOI: 10.1186/s13052-020-0793-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Child vaccination is an instrument for saving millions of lives. Only one in twenty children has access to childhood vaccination in hard to reach areas in developing countries. Although studies have been done on childhood vaccination, factors associated with access and continuum were not considered in Ethiopia. Therefore, this study aimed to identify the factors associated with the access and continuum of childhood vaccination in the emerging regions of Ethiopia based on the 2016 EDHS datasets. Methods The two-stage stratified sampling technique was used for the survey carried out on 642 mothers of children aged 12–23 months. Access is the provision of services in shorter waiting times and flexibly at all times and alternative methods of communication. Accordingly, continuum of care reflects the extent to which a series of discrete health care events are being experienced by people coherently and interconnected over time. As a result, access and continuum of childhood vaccination are determined using pentavalent-1 and measles vaccination status of children, respectively. A binary logistic regression model was fitted to identify the factors associated with access and continuum of the vaccination. Results Overall, 25.1% of children aged 12–23 months received all of the recommended childhood vaccines. Sixty-two percent of children accessed and 46.9% had continuum of childhood vaccination in the emerging regions of Ethiopia. Pentavalent_1 to 3 and BCG to measles dropout rates were 33.42 and 17.53%, respectively. Mothers’ formal education (AOR = 1.99; 95%CI: 1.20, 3.31), ANC (AOR = 4.13; 95%CI: 2.75,6.19), health facility delivery of last birth (AOR = 1.58; 95%CI: 1.19, 2.82), rich wealth (AOR = 1.57; 95%CI: 1.19, 3.14) and average child birth weight (AOR = 1.67; 95%CI: 1.03, 2.72) were positively associated with childhood access to vaccination. On the other hand, mothers’ ANC attendance (AOR = 3.68; 95%CI: 2.48, 5.47) and rich wealth (AOR = 2.07; 95%CI: 1.15, 3.71) were positively associated with the continuum of the services. On the contrary, children with rural resident mothers (AOR = 0.33; 95%CI: 0.14, 0.76) and small birth weight (AOR = 0.51; 95%CI: 0.33, 0.81) were negatively associated to the access and continuum of childhood vaccination, respectively. Conclusion Childhood vaccination status was low in the emerging regions of Ethiopia. Variables such as maternal education, birth weight of children, ANC, health facility delivery and wealth were associated with the access and continuum of the vaccination. Therefore, empowering women with education and strengthening maternal healthcare services might enhance childhood vaccination. In addition, the government needs to design a compensation mechanism for the cost relating to childhood vaccination to improve the access and continuum of the service.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Health Policy, Institute of Public Health, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Nabwana BW, Namayanja SS, Kemigisha C, Kisakye E, Kusetula AK, Wakabi S, Wambi I, Musiime I, Nekaka R, Gavamukulya Y. Socio-demographic Determinants of Vaccine Coverage for Pneumococcus and Rotavirus among under Five Children in Busolwe Town Council, Butaleja District, Eastern Uganda: A Cross Sectional Study. INTERNATIONAL JOURNAL OF TROPICAL DISEASE & HEALTH 2019; 39:1-13. [PMID: 34277509 PMCID: PMC8281921 DOI: 10.9734/ijtdh/2019/v39i330209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND AIMS There is a high burden of vaccine-preventable diseases in the children under five years of age, particularly pneumonia diarrhea and which is greatly affected by low immunization coverage despite the existing efforts and policies. This study was carried out in Butaleja district and was aimed at establishing the socio-demographic determinants of vaccine coverage for pneumococcus and rotavirus among under five children (U5C) in the district. STUDY DESIGN This was a mixed methods cross-sectional study. PLACE AND DURATION OF STUDY Busolwe Town Council, Butaleja District, Eastern Uganda. METHODOLOGY Structured researcher administered questionnaires were administered to 434 caregivers of U5C in different parts of Butaleja district. In-depth interviews with key informants and focused group discussions with Village Health Teams and community members were conducted. Review of Health Management Information Systems records was done. STATA 15 was used to analyze the data. RESULTS The study found that there is a declining trend in completion of the doses of Pneumococcal vaccine (PCV) and Rotavirus vaccine. For example, in quarter 1 of 2019, out of the 312 children who started immunization, only 2 completed Rota virus immunization and only 117 completed PCV vaccinations a trend that has been observed since 2016. The factors that showed a significant association with the the fact that they gave their child at least one dose of the vaccine were having been sensitized on the current immunisation schedule(P-value = <0.001), misunderstanding that vaccine is harmful for child (P-value = 0.007), willingness to take children to vaccination (P-value = <0.001), and social factors such as family (P-value = <0.030). Gender also played a key determinant role where the children's fathers lacked knowledge on significance of immunization and thus discouraged the mothers from taking the children for immunization. Inadequate funding was also highlighted from the Focus Group Discussions. CONCLUSION Vaccine coverage for pneumococcus and rotavirus is still low in Butaleja district mainly due to the attitudes and perceptions of caregivers as well as the knowledge gap. There is need for extensive sensitization of all community members to enable them understand the significance of immunization. It would further be important to increase the funding of the immunization programme to intensify and ensure effectual outreaches as well as the establishment and enforcement of a policy for immunization compliance.
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Affiliation(s)
- Brenda Wafana Nabwana
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Sylvia Sidney Namayanja
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Collette Kemigisha
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Erina Kisakye
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Amos Kuddiza Kusetula
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Silvester Wakabi
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Ivan Wambi
- Busolwe General Hospital, Butaleja District Local Government, Butaleja District, Uganda
| | - Innocent Musiime
- Busolwe General Hospital, Butaleja District Local Government, Butaleja District, Uganda
| | - Rebecca Nekaka
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
| | - Yahaya Gavamukulya
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, Busitema University, P.O.Box 1460, Mbale, Uganda
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Ntenda PAM. Factors associated with non- and under-vaccination among children aged 12-23 months in Malawi. A multinomial analysis of the population-based sample. Pediatr Neonatol 2019; 60:623-633. [PMID: 31040068 DOI: 10.1016/j.pedneo.2019.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non- and under-vaccination among children in Malawi have received little attention. Between 2010 and 2016, the proportion of children who received full immunization before their first birthday dropped from 81% to 76% in Malawi. This signifies that a certain fraction of children are either non-vaccinated or under-vaccinated. Thus, the present study attempted to examine the predictors of non- and under-vaccination among children aged 12-23 months in Malawi. METHODS Cross-sectional data obtained from the Malawi Demographic and Health Survey 2015-16 were utilized. The percentage of children aged 12-23 months who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of pentavalent, 2 doses of rotavirus vaccine, 3 doses of pneumococcal vaccine and 1 dose of measles-containing vaccine were calculated. The odds of being non-vaccinated and under-vaccinated compared to full vaccination relative to various sociodemographic factors were assessed using a multivariable multinomial logistic regression with logit link function which accounted for survey design. RESULTS Of 3111 children aged 12-23 months, 72% were fully vaccinated, 26% were under-vaccinated, and about 2% were non-vaccinated. The multinomial logistic regression showed that children from the poorest households, and children who did not have postnatal care within two months had increased odds of being under-vaccinated. On the other hand, children who had no health card or whose card was lost had increased odds of being both non- and under-vaccinated. Additionally, children from the northern region and who resided in households with either none or one under-five child had reduced odds of being non-vaccinated and under-vaccinated, respectively. CONCLUSIONS Women from the poorest households and those who are not attending PNC should be targeted when designing interventions that aim at improving childhood vaccination in order to reduce the barriers they face in accessing vaccination services.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, Taipei Medical University, College of Public Health, No. 250, Wu-Hsing St, Taipei City 11031, Taiwan.
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Peretti-Watel P, Cortaredona S, Ly EY, Seror V, Ndiaye S, Gaye I, Fall M. Determinants of childhood immunizations in Senegal: Adding previous shots to sociodemographic background. Hum Vaccin Immunother 2019; 16:363-370. [PMID: 31567044 DOI: 10.1080/21645515.2019.1649553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction. Today, in Sub-Saharan Africa, vaccine-preventable diseases still contribute heavily to high child mortality. Maintaining high coverage rates for childhood vaccines and reducing related social inequalities are public health priorities in Senegal. Our aim was to investigate the determinants of childhood vaccination, including sociodemographic factors and previous vaccine-related decision-making.Methods. Data come from the 2016 Senegalese Demographic and Health Survey, a nationally representative household survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues, including their children's health. We restricted the analysis to children aged 12-23 months (n = 1,143). We used bivariate and multivariate analyses for investigating the determinants of several childhood vaccinations (Bacillus Calmette-Guérin, pentavalent, polio, measles and yellow fever vaccines), including sociodemographic factors and previous shots.Results. We identified two main sociodemographic predictors of childhood vaccination in Senegal: the mother's education level, which was strongly and positively correlated to every vaccination considered, except from the BCG vaccination, and the region of residence, with higher vaccination coverage rates in the Centre and West of Senegal. Moreover, previous shots were also strongly predictive of subsequent shots.Conclusion. The positive impact of mother's education on child vaccination illustrates the wide-ranging benefits of educating girls, while the regional variability of immunization rates requires more research to be better understood. Previous shots are probably a proxy variable for unobservable factors strongly correlated to vaccinations, but beyond this 'proxy effect', they may also have their own specific effect on following shots. We believe this topic deserves further research.
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Affiliation(s)
- Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, VITROME, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, VITROME, Marseille, France
| | - Elhadji Yaya Ly
- Agence nationale de la statistique et de la démographie, Rocade Fann Bel-air Cerf-volant, VITROME, Dakar, RP, Sénégal
| | - Valérie Seror
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, VITROME, Marseille, France
| | - Samba Ndiaye
- Agence nationale de la statistique et de la démographie, Rocade Fann Bel-air Cerf-volant, VITROME, Dakar, RP, Sénégal
| | - Ibrahima Gaye
- Institut de Santé et de Développement, Université Cheikh Anta Diop (UCAD), VITROME, Dakar, Sénégal
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Krishna D, Mohd Zulkefli NA, Md Said S, Mahmud A. Sociodemographic and health care factors in determining immunization defaulters among preschool children in Petaling District, Selangor: a cross-sectional study in Malaysia. BMC Public Health 2019; 19:1275. [PMID: 31533790 PMCID: PMC6751745 DOI: 10.1186/s12889-019-7561-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization is an effective public health intervention to reduce morbidity and mortality among children and it will become more effective if the child can receive the full course of recommended immunization doses. The objective of this study was to determine the prevalence of childhood immunization defaulters and its associated factors among children below 5 years attending registered child care centers in Petaling District, Selangor. METHODS This was a cross-sectional survey among mothers with children below 5 years from 60 registered child care centers in District of Petaling, Selangor. Data was collected by a self-administered questionnaire from a total of 1015 mothers. Simple Logistic Regression, Chi-square or Fisher's exact test were performed to determine the association between individual categorical variables and childhood immunization defaulters. Multivariate logistic regression was used to determine the predictors of childhood immunization defaulters. RESULTS The study showed that the prevalence rate for defaulting immunization was 20.7%. After adjusting all confounders, six statistically significant predictors of childhood immunization defaulters were determined. They were non-Muslims (aOR = 1.669, 95% CI = 1.173, 2.377, p = 0.004), mothers with diploma and below educational background (aOR = 2.296, 95% CI = 1.460, 3.610, p < 0.0001), multiple children of 5 and above in a family (aOR = 2.656, 95% CI = 1.004, 7.029, p = 0.040), mothers with younger children aged 2 years and below (aOR = 1.700, 95% CI = 1.163, 2.486, p = 0.006), long travelling time of more than 30 min to the immunization health facility (aOR = 2.303, 95% CI = 1.474, 3.599, p < 0.0001) and had delayed at least one of the immunization schedule (aOR = 2.747, 95% CI = 1.918, 3.933, p < 0.0001). CONCLUSION This study highlights the need of implementation of intervention programs should be intensified to improve the childhood immunization status, focusing on the Non-Muslim community, mothers with low educational level, mothers with multiple children and mothers with children aged 2 years and below. In light of the growing problem of immunization defaulters in Malaysian children, identifying mothers at risk of not completing their children immunization schedule and educating them is an important strategy to recurrent outbreaks of infectious disease in the country.
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Affiliation(s)
- Damyanthy Krishna
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Aidalina Mahmud
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia
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Ntenda PAM, Nkoka O, Nana AW, Majoni P, Mhone TG, Tizifa T, Mwenyenkulu ET, Kazambwe JF, Putthanachote N, Motsa MPS. Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015-16 Malawi demographic and health survey. Trans R Soc Trop Med Hyg 2019; 113:534-544. [PMID: 31034078 DOI: 10.1093/trstmh/trz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 2010 and 2015, the percentage of children 12-23 months of age who received full immunization in Malawi decreased from 81% to 76%, prompting us to investigate the factors associated with completion of childhood immunization in Malawi. METHODS Using data from the 2015-16 Malawi Demographic and Health Survey, generalized linear mixed models were applied on 3145 children 12-23 months of age nested within 850 communities. Complete immunization was defined as the child having received a Bacillus Calmette-Guerin, three doses of pentavalent vaccine, four doses of oral polio vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine and one dose of measles vaccine before their first birthday. RESULTS Adjusted multilevel regression showed that children born to mothers with either none or one antenatal care visit (adjusted odds ratio [aOR] 0.56 [95% confidence interval {CI} 0.32 to 0.93]) and whose mothers had no card or no longer had a vaccination card (aOR 0.06 [95% CI 0.04 to 0.07]) were less likely to receive complete immunization. In addition, children from the poorest households (aOR 0.60 [95% CI 0.40 to 0.92]) and who resided in communities with a medium (aOR 0.73 [95% CI 0.53 to 0.98]) or high percentage (aOR 0.73 [95% CI 0.53 to 0.99]) of households that perceived the distance to the nearest health facility as a big problem had reduced odds of achieving complete immunization. Furthermore, the findings showed evidence of clustering effects of childhood complete immunization at the community level. CONCLUSIONS Our findings show that a series of sociodemographic, health and contextual factors are associated with the completion of childhood vaccination. Therefore interventions that aim at increasing the completion of childhood immunization in Malawi should not only address individual needs, but should also consider contextual factors and the communities addressed in this study.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | | | - Precious Majoni
- Department of Computer Science, Chancellor College, University of Malawi, Zomba, Malawi
| | - Thomas Gabriel Mhone
- Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, No. 100, Shiquan 1st Road, Sanmin District, Kaohsiung City, Taiwan
| | - Tinashe Tizifa
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Edward Tisungane Mwenyenkulu
- School of International Education, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, Guangdong, People's Republic of China
| | - Jane Flora Kazambwe
- NBS, House Corner Chipembere Highway & Johnstone Roads Ginnery Corner Blantyre, Chichiri, Blantyre, Malawi
| | - Nuntiput Putthanachote
- Roi Et Hospital, 111 Ronnachaicharnyut Soi 13, Tambon Nai Mueang, Amphoe Mueang Roi Et, Roi Et Province, Thailand
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Nakatudde I, Rujumba J, Namiiro F, Sam A, Mugalu J, Musoke P. Vaccination timeliness and associated factors among preterm infants at a tertiary hospital in Uganda. PLoS One 2019; 14:e0221902. [PMID: 31490987 PMCID: PMC6730875 DOI: 10.1371/journal.pone.0221902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Preterm infants are at increased risk of infections including vaccine preventable diseases. Therefore, timely vaccination is crucial to ensure adequate disease protection. Information on whether preterm infants are vaccinated according to chronological age as recommended is limited in low-income countries. Objectives We evaluated the timeliness of vaccination and associated factors among preterm infants at Mulago hospital, Uganda. Methods We conducted a mixed methods study between July 2016 and April 2017. Vaccination dates of preterm infants aged 6–24 months were obtained from child health cards. Additional data were collected using a questionnaire. Five key informant interviews with health workers and two focus group discussions with caregivers were conducted. Cox regression analysis was used to identify factors associated with vaccination timeliness. Qualitative data was transcribed and analysed manually using content thematic approach. Results We enrolled 350 preterm infants, with a median age of 8.4 months (IQR 6.8–10.8). Less than half, 149/350 (42.6%) of infants received all vaccines within the recommended time range. Timely vaccination was highest for BCG (92%) and lowest for OPV (45.4%). Untimely vaccination was highest for vaccines administered at 6 weeks (DPT 1, PCV 1 and OPV 1) compared to other vaccines in the EPI schedule. Delivering from home or private clinics and vaccine stock-out were significantly associated with untimely BCG and OPV 0 vaccination. Low maternal education level and being very preterm were associated with untimely DPT 1 and DPT 3 receipt. Admission and long stay in the neonatal unit were associated with untimely DPT 1 receipt while extreme low birth weight was associated with untimely DPT 3 vaccination. Increasing parity was associated with untimely measles vaccination. Qualitative findings revealed that lack of knowledge and poor attitudes of health workers and caregivers, gaps in documentation of vaccination status and inadequate communication by health workers hindered timely vaccination. Conclusion More than half of preterm infants attending a specialised clinic at Mulago National Referral hospital in Uganda did not receive vaccines within the recommended time range. Specific strategies to improve vaccination timeliness in preterm infants are needed especially among the extremely low birth weight, very preterm and those with prolonged hospitalisation.
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Affiliation(s)
- Irene Nakatudde
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ali Sam
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jamir Mugalu
- Mulago National Referral Hospital, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Makerere University-John Hopkins University Research Collaboration, Kampala, Uganda
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Evans DR, Yemeke TT, Kiracho EE, Mutebi A, Apolot RR, Ssebagereka A, Ozawa S. Trust in vaccines and medicines in Uganda. Vaccine 2019; 37:6008-6015. [PMID: 31447127 DOI: 10.1016/j.vaccine.2019.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 01/10/2023]
Abstract
Trust underlies numerous decisions in health care, affecting vaccine uptake as well as care seeking rates, treatment adherence, and health outcomes. Although trust in the doctor-patient relationship has garnered much attention, trust in health care commodities such as vaccines and medicines has rarely been examined. We report findings from a cross-sectional survey to assess trust in vaccines vis-à-vis their trust in conventional medicines and traditional medicines in Uganda. Trust in vaccines, conventional and traditional medicines were assessed by adapting the vaccine hesitancy scale developed by the SAGE Working Group on Vaccine Hesitancy. Reported trust in vaccines and conventional medicines was much higher than trust in traditional medicines. Significant associations were observed between trust in vaccines and trust in conventional medicines. Of the trust components explored, respondents were most concerned about access to and safety of vaccines and medicines. Further, respondents' previous health care experiences, primary source of health information, and trust in providers' skills were significantly associated with reported trust in vaccines and medicines. Although strong levels of trust in vaccines and conventional medicines were observed overall, the findings identify areas where policies and communication efforts can focus to strengthen trust.
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Affiliation(s)
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth E Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Rebecca R Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Chen CJ, Bakeera-Kitaka S, Mupere E, Kasirye P, Munube D, Idro R, Hume H, Pfeffer B, LaRussa P, Green NS. Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic. J Paediatr Child Health 2019; 55:795-801. [PMID: 30411430 PMCID: PMC6509021 DOI: 10.1111/jpc.14291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/31/2018] [Accepted: 07/15/2018] [Indexed: 11/28/2022]
Abstract
AIM We aimed to assess the receipt of recommended care for young children with sickle cell disease (SCD) in a central SCD clinic in Kampala Uganda, focusing on standard vaccination and antibacterial and antimalarial prophylaxis. METHODS A cross-sectional assessment of immunisation status and timeliness and prescribed antibacterial and antimalarial prophylaxis was performed in a sample with SCD aged ≤71 months in Mulago Hospital SCD Clinic. Government-issued immunisation cards and clinic-issued visit records for prescribed prophylaxis were reviewed. RESULTS Vaccinations were documented by immunisation cards in 104 patients, mean age 31.7 months (range 3-70 months). Only 48 (46.2%) received all doses of each of the four recommended vaccine types, including pneumococcal 10-valent conjugate vaccine (pneumococcal conjugate vaccine (PCV)-10), which became available in 2014. Vaccination completion was associated with younger age and, for polio, maternal employment. PCV-10 series was completed in 54.8% of the sample and in 18.2% of those aged 48-71 months. Of children completing all vaccination types, an average 68.8% were immunised on time, defined as <60 days beyond the recommended age. Only 17 (13.5%) children were both fully and timely vaccinated. In an overlapping sample of 147 children, with a mean age of 38.4 months (4-70 months), 81.6% had ≥1 documented prescription for penicillin and/or antimalarial prophylaxis. CONCLUSIONS Standardised vaccination and antibacterial and antimalarial protective measures for young children at this central SCD clinic were incomplete, especially PCV-10 for age ≥24 months, and often late. Child age, but not general maternal demographics, were associated with vaccination and chemoprophylaxis. Clinic-based oversight may improve timely uptake of these preventative measures.
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Affiliation(s)
- Chung-Jen Chen
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Sabrina Bakeera-Kitaka
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philip Kasirye
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Deogratias Munube
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Heather Hume
- Université de Montréal, Département de Pédiatrie, CHU Sainte-Justine, Montreal, Canada
| | - Betsy Pfeffer
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Philip LaRussa
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY,Corresponding author: 630 West 168 St., Black Building Room 2-241, Columbia University Medical Center, New York, NY 10032
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Full Immunization Coverage and Associated Factors among Children Aged 12-23 Months in a Hard-to-Reach Areas of Ethiopia. Int J Pediatr 2019; 2019:1924941. [PMID: 31263502 PMCID: PMC6556785 DOI: 10.1155/2019/1924941] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/20/2019] [Accepted: 05/19/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Childhood immunization averts 2.5 million annual child deaths globally. However, poor monitoring, possibly due to a lack of locally available data on immunization, might affect full protection of vaccines from Vaccine Preventable Diseases. This study was aimed at bringing data about immunization service coverage and its associated factors from Sekota Zuria district, which is one of the hard-to-reach areas in Amhara Region, Ethiopia. Methods A community-based cross-sectional study was conducted from September 20 to October 28, 2017, among 620 children aged 12-23 months in seven randomly selected rural kebeles of Sekota Zuria district. Socio-demographic child conditions and vaccine-related data were collected using a pretested interviewer-administered questionnaire. Multivariable logistic regression analysis was carried out to identify factors associated with immunization coverage at a p-value ≤ 0.05. Crude and Adjusted Odds Ratio (AOR) with their confidence interval were reported. Results 77.4% (95%CI: 74.0%-80.6%) of children aged 12-23 months were fully immunized. Having antenatal care visit (AOR=2.75, 95%CI: 1.52-5.0), higher level of maternal education (AOR=2.39, 95%CI: 1.06-5.36), mothers' good knowledge on immunization (AOR=3.70, 95%CI: 2.37-5.79), short distance to health facility (AOR=2.65, 95%CI: 1.61-4.36), and being born in health institutions (AOR=2.58, 95%CI: 1.66-3.99) had increased the odds of full immunization coverage while having five and more family size reduced the odds of children's vaccine uptake (AOR=0.62, 95%CI: 0.38-0.99). Conclusion Full immunization coverage of the district was lower than the target set by the World Health Organization. Improving mother's health seeking behavior toward pregnancy follow-up and enhancing mothers' knowledge on child immunization, strengthening outreach services, community engagement, and actively working with local community-based health agents are recommended to increase number of children to be vaccinated.
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Nozaki I, Hachiya M, Kitamura T. Factors influencing basic vaccination coverage in Myanmar: secondary analysis of 2015 Myanmar demographic and health survey data. BMC Public Health 2019; 19:242. [PMID: 30819127 PMCID: PMC6394082 DOI: 10.1186/s12889-019-6548-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization is one of the most effective measures for preventing disease when vaccination coverage is sufficient. Although vaccination coverage is known to be influenced by social and cultural barriers, the determinants of childhood immunization in Myanmar remain poorly understood. This study analyzed factors that influenced complete vaccination status (one dose each for Bacillus Calmette-Guérin and measles and three doses each for diphtheria-pertussis and polio) using 2015 data from the Myanmar Demographic Health and Survey. METHODS Data from 12 to 23-month-old children and their mothers were extracted from the nationally representative survey results. Bivariate and multivariate analyses with survey-weighted logistic regression were performed to examine the relationships between vaccination status and various sociodemographic and medical factors. The independent variables for the analyses included area of residence, economic status, maternal age, marital status, education, literacy, employment status, antenatal care attendance, tetanus vaccination, place of delivery, postnatal evaluations, child's sex, number of children, previous child death, decision maker(s) regarding child's health, frequency of healthcare visits, paternal education, and paternal occupation. RESULTS A representative sample of 904 cases were extracted for the analysis. The overall complete vaccination rate was 55.4%. In the multivariate analysis with backward step-wise selection, complete vaccination was independently associated with middle or high economic status (adjusted odds ratio [AOR]: 2.64, 95% confidence interval [CI]: 1.85-3.78), older maternal age (AOR: 2.87, 95% CI: 1.62-5.10), ≥4 antenatal care visits (AOR: 1.87, 95% CI: 1.28-2.73), and maternal tetanus vaccination before delivery (AOR: 3.26, 95% CI: 1.82-5.85). CONCLUSION The first Demographic and Health Survey in Myanmar revealed that only approximately one-half of 12-23-year-old children had received complete vaccination, which was lower than the estimated rate from routine administrative coverage. Our results indicate that incomplete immunization status was associated with low economic status, younger maternal age, fewer antenatal care visits, and no maternal tetanus vaccination. These findings may help improve the targeting and strategic implementation of the Expanded Programme on Immunization.
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Affiliation(s)
- Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan. .,Ministry of Health, Naypyidaw, Myanmar.
| | - Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Tomomi Kitamura
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
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Abstract
OBJECTIVE The objective of this study is to assess the determinants of BCG vaccination in Ethiopia from 2016 Ethiopia Demographic and Health Survey (EDHS). SETTING Since Ethiopia has nine regional states and two administrative cities, sample was taken from all the divisions. The population-based sample was intended to provide estimates of key indicators for the country. PARTICIPANT The sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census. From 15 683 women recorded in EDHS dataset, women with no child (n=10 379) were excluded from the study. Therefore, the total sample size for this study was 5304 women. The outcome variable was BCG immunisation status of children. RESULT Out of the study participants (n=5304), the majority were in between 20 and 34 years of age (73.8%). The median age of the respondents was 28.4 (SD=±6.5) years old. Prevalence of BCG vaccination was 63.6% (n=3373) and BCG vaccination coverage in urban residents was higher (88%) than rural residents (57.3%). Mothers' age between 20 up to 34 (Adjusted odds ratio (AOR)=1.48; 95% CI: 1.13 to 1.93) and between 35 up to 49 (AOR=1.83; 95% CI: 1.35 to 2.46) were more likely to vaccinate their child's than those mothers' age less than 20. Mothers settled in urban areas were two times more likely to vaccinate their child's than those living in rural areas (AOR=1.94; 95% CI: 1.45 to 2.60). Mothers with greater antenatal visits show higher BCG vaccination, Antenatal Care (ANC) 4 and above (AOR=3.48; 95% CI: 2.91 to 4.15). BCG vaccination is higher for mothers delivered at non-governmental organisation health facility than home (AOR=2.9; 95% CI: 1.69 to 4.96). Maternal occupation and wealth index also had a significant association with BCG vaccination. CONCLUSION BCG vaccination coverage, in this study, was lower and determinant factors for BCG vaccination were residence, mother's age, place of delivery, mother's antenatal visit, wealth index and mother's occupation.
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Affiliation(s)
| | - Getasew Tadesse Worku
- Department of Health System and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
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Phillips DE, Dieleman JL, Shearer JC, Lim SS. Childhood vaccines in Uganda and Zambia: Determinants and barriers to vaccine coverage. Vaccine 2018; 36:4236-4244. [DOI: 10.1016/j.vaccine.2018.05.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/04/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
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Bukusuba J, Kaaya AN, Atukwase A. Modelling the impact of stunting on child survival in a rural Ugandan setting. BMC Nutr 2018; 4:13. [PMID: 32153877 PMCID: PMC7050845 DOI: 10.1186/s40795-018-0220-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting. This study was conducted to model the impact of stunting on child mortality in the southwest region of Uganda where the prevalence of stunting and child mortality are of great public health concern. METHODS The study was conducted in Buhweju district in the southwest region of Uganda. The study was cross-sectional involving use of a structured household questionnaire, focus group discussions and interviews with key informants in order to gather relevant information on infant and young child feeding (IYCF) and coverage of antenatal care (ANC) and vaccination programs. The survey of stunting, vaccination and ANC services covered 221 children aged 6-59 months while the assessment of IYCF practices covered 83 children aged 0-23. The Lives Saved Tool (LiST) was used to estimate the impact of stunting on child mortality and cases of stunting averted. RESULTS The study findings indicated that only 33% of the mothers had knowledge of optimal IYCF and 39% of the sampled children were exclusively breastfed. The majority of the mothers (57%) breastfed their children for less than 2 years and only 31% of the mothers practiced appropriate introduction of complementary foods at 6 months. Only 17% of the 0-23-month-olds received a good standard of IYCF. Only 37% of the mothers reportedly attended ANC 4 times or more during pregnancy and among children aged 6-59 months, only 28% were fully vaccinated. The high impact LiST model estimated that 1297 children under 5 years would be saved and 24,850 cases of stunting averted in the study district. CONCLUSIONS The study concludes that IYCF practices and coverage of expanded programme on immunization (EPI) and ANC in the study population are sub-optimal thus the high prevalence of stunting and child mortality in the region. LiST demonstrated that prevention of stunting would reduce child mortality in rural Uganda. Therefore, increased investment in cost-effective child survival interventions targeting rural areas of Uganda would have a significant impact on stunting and child mortality.
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Affiliation(s)
- John Bukusuba
- School of Food Technology, Nutrition and Bio-engineering, Makerere University, Kampala, Uganda
| | - Archileo N Kaaya
- School of Food Technology, Nutrition and Bio-engineering, Makerere University, Kampala, Uganda
| | - Abel Atukwase
- School of Food Technology, Nutrition and Bio-engineering, Makerere University, Kampala, Uganda
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Forshaw J, Gerver SM, Gill M, Cooper E, Manikam L, Ward H. The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis. BMC Infect Dis 2017; 17:801. [PMID: 29281990 PMCID: PMC5745980 DOI: 10.1186/s12879-017-2890-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background There is an established correlation between maternal education and reduction in childhood mortality. One proposed link is that an increase in maternal education will lead to an increase in health care access and vaccine uptake. Vaccinations are a central preventative child health tool, therefore demonstrating the importance of understanding factors that can improve coverage. This review aims to establish if there is a correlation between increasing maternal education and vaccine uptake and if this varies between continents, setting and time. Methods An electronic database search was conducted using Medline Ovid, Embase and The Cochrane Library using a combination of keywords and appropriate MeSH terms for maternal education and child vaccination. Bibliographies were also hand searched. Data was extracted and entered onto a Microsoft Excel spreadsheet and analysed using STATA 13.0 software. The primary outcome of effect size of maternal education on completion of childhood vaccinations was analysed at different levels. Secondary outcomes were explored using subgroup analyses of differences between continents, rural or urban settings, and dates. Results The online search yielded 3430 papers, 37 were included in this study. The analysis showed increasing child vaccination uptake with increasing maternal education. Overall, analysis showed that the odds of full childhood vaccination were 2.3 times greater in children whose mother received secondary or higher education when compared to children whose mother had no education. There was large variability in the effect size between the studies included. Conclusions Improving maternal education is important for increasing childhood vaccination uptake and coverage. Further research is needed in higher income countries. Trial registration PROSPERO Registration No: CRD42016042409.
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Affiliation(s)
- Jennifer Forshaw
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Sarah M Gerver
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Moneet Gill
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Emily Cooper
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Logan Manikam
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Helen Ward
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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