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Dang TTH, Carnahan E, Nguyen L, Mvundura M, Dao S, Duong TH, Nguyen T, Nguyen D, Nguyen T, Werner L, Ryman TK, Nguyen N. Outcomes and Costs of the Transition From a Paper-Based Immunization System to a Digital Immunization System in Vietnam: Mixed Methods Study. J Med Internet Res 2024; 26:e45070. [PMID: 38498020 PMCID: PMC10985597 DOI: 10.2196/45070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/28/2023] [Accepted: 01/26/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits. OBJECTIVE This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system. METHODS This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective. RESULTS NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8% (202/580) in Hanoi and 29.4% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS. CONCLUSIONS The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs.
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Affiliation(s)
- Thi Thanh Huyen Dang
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | - Thi Hong Duong
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Trung Nguyen
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Doan Nguyen
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Tove K Ryman
- Bill & Melinda Gates Foundation, Seattle, WA, United States
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Zemariam AB, Abebe GK, Kassa MA, Alamaw AW, Molla RW, Abate BB, Tilahun BD, Wondie WT, Shimelash RA, Fentanew M. Immunization coverage and its associated factors among children aged 12-23 months in Ethiopia: An umbrella review of systematic review and meta-analysis studies. PLoS One 2024; 19:e0299384. [PMID: 38451961 PMCID: PMC10919590 DOI: 10.1371/journal.pone.0299384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Immunization estimated to prevent 2 to 3 million children deaths every year from vaccine preventable disease. In Ethiopia, limited and inconclusive studies have been conducted on immunization coverage so far. Therefore, this umbrella review was intended to estimate the pooled national immunization coverage and its associated factors among children age 12-23 months in Ethiopia. METHODS This umbrella review included five systematic reviews and meta-analyses through literature search from PubMed, Science direct, and web of science, CINHALE, and data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and Prospero, the International Prospective Register of Systematic Reviews from May 1 to 30/ 2023. Only systematic reviews and meta-analyses published in English from inception to May 1, 2023, were included. The quality of each study was assessed using Assessment of Multiple Systematic Reviews. Data were extracted using Microsoft excel 2016 and analyzed using STATA 17.0 statistical software. Heterogeneity among studies was assessed using the Cochran Q statistics and I2 test. The pooled effect sizes were determined using pooled proportion for the full vaccination coverage and odds ratios for the associated factors with the corresponding 95% confidence interval were used to declare statically significance. RESULTS Five studies with 77,161 children aged 12-23 months were included. The overall pooled full vaccination coverage was 57.72% (95% CI 50.17, 65.28). Institutional delivery (OR: 2.12, 95% CI: 1.78-2.52), travel to vaccination site for <2 hours (OR: 2.43, 95%CI: 1.97-3.00), received at least one antenatal (ANC) visit (OR: 3.2, 95%CI: 2.46-4.1), good maternal knowledge of immunization (OR: 3.63, 95%CI: 2.82-4.67), being informed on immunization schedule (OR: 2.54, 95%CI: 2.02-3.2), living in urban areas (OR: 2, 95% CI: 1.54-2.6), and a household visit by health-care providers (HCP) during the postnatal period (OR: 2.23, 95%CI: 1.22-4.09) were the independent predictors of immunization coverage. CONCLUSION This study showed the full immunization coverage in Ethiopia was lower compared to the WHO-recommended level. Besides, the current umbrella review identifies several factors that contribute to higher immunization coverage. These includes; institutional delivery, near to vaccination site, having ANC visit, being urban residence, household visited by HCP, having good knowledge and informed on immunization schedule. Thus, the government should intensify the growth of immunization services by emphasizing outreach initiatives to reach remote areas and professionals must combine child immunization service with other medical services offered by health institutions.
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Affiliation(s)
- Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Mulat Awoke Kassa
- Department of Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Addis Wondemagegn Alamaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Rediet Woldesenbet Molla
- Department of Midwifery, School of Midwifery, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Befekad Deresse Tilahun
- Department of Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Wubet Tazeb Wondie
- Departments of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Rahel Asres Shimelash
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, DebreMarkos University, DebreMarkos, Ethiopia
| | - Molla Fentanew
- Departments of Physiotherapy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Le TV, Nguyen VTT, Nguyen QH, Nguyen TTT, Duong TTN, Ly TTT, Pham TN, Nguyen VL, Vien CC. The evaluation of anti-diphtheria toxoid antibodies in healthy population in Kon Tum, Vietnam: a population-based study. IJID REGIONS 2022; 3:171-176. [PMID: 35755469 PMCID: PMC9216714 DOI: 10.1016/j.ijregi.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
The risk of diphtheria remains high in Kon Tum given the low seroprevalence. One third of community in Kon Tum have no protective antibodies to diphtheria. The antibodies from previous childhood vaccination gradually wane over time. A booster dose (5-7 years) is recommended for adolescents and adults in Vietnam.
Background Despite diphtheria immunization are to apply an effective primary immunization in childhood and to maintain immunity throughout life. Cases of diphtheria have been reported in Viet Nam in recent years. The aim of this study was to evaluate the seroprevalence of IgG antibodies to diphtheria toxoid among healthy person population in Kon Tum, Viet Nam. Methods Blood samples were obtained from 2225 healthy persons aged 2-98 years collected in 2019 and 2020. Samples were tested for diphtheria toxoid antibodies by commercial Anti-Diphtheria Toxoid IgG Enzyme-Linked Immunosorbent Assay (ELISA). Results An antibody level of <0.01 IU/mL (susceptibility) was found in 802 (36.0%) of the 2225 subjects, 136 (6.1%) had antibody levels of 0.01–0.099 IU/mL (basic protection), and 1287 (57.8%) had antibody levels ≥0.1 IU/mL (full protection). The full protection level increased significantly in persons aged above 60 years with antibody levels of 70.6%. No significant difference in seroprotection prevalence was found according to gender, ethnicity, residence, education and occupation. The results also demonstrated that people with vaccination against diphtheria during past 10 years were found to have a high immunity (83.8%) compared to 54.8% (OR: 4.7; 95%CI: 3.8-6.5) and 60.7% (OR: 3.8; 95%CI: 2.6-5.7) in persons with no and unknown vaccination (p <0.0001). Conclusions The level of anti-diphtheria toxoid antibodies among children and adults in Kon Tum was low. The high risk of diphtheria outbreaks may occur among individuals lacking basic immunity against diphtheria.
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Affiliation(s)
- Tuan Van Le
- Department of Microbiology and Immunology, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | - Van Thi Tuyet Nguyen
- Department of Microbiology and Immunology, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | - Quan Hoang Nguyen
- Department of Microbiology and Immunology, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | - Tram Thi Thu Nguyen
- Department of Microbiology and Immunology, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | - Thuy Thi Ngoc Duong
- Department of Microbiology and Immunology, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | - Trang Thi Thuy Ly
- Communicable Disease Control Department, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | - Thanh Ngoc Pham
- Communicable Disease Control Department, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
| | | | - Chien Chinh Vien
- Communicable Disease Control Department, Tay Nguyen Institute of Hygiene and Epidemiology, Buon Ma Thuot, Vietnam
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Knowledge, Attitudes and Practices toward Hepatitis B Virus Infection among Students of Medicine in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137081. [PMID: 34281017 PMCID: PMC8296898 DOI: 10.3390/ijerph18137081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/21/2023]
Abstract
Background: Building capacity in hepatitis B virus prevention and management for medical students and health professionals is one of the pillars of the national viral hepatitis control strategy. Methods: A cross-sectional study was conducted at eight medical universities from the northern, central and southern regions of the country between May and November 2020 using a systematic random sampling technique. Results: Among 2000 participants, 84.2% reported they had been tested for hepatitis B and 83.9% had received the hepatitis B vaccine. The mean knowledge, attitude, practice score was 40.2 out of 54 (74.4%) with only 19.9% of the study participants obtaining a good score. In multivariate analysis, fifth year students, students from central universities, students who had tested positive for hepatitis B and students who had received hepatitis B vaccine or had encountered patients with chronic hepatitis B had significantly higher knowledge score (p < 0.05). The study showed lack of trust in the hepatitis B vaccine safety and lack of confidence in providing counselling, testing and management of patients with chronic hepatitis B. Conclusion: Findings from our research emphasized an immediate need to improve the medical schools’ training curriculum in Vietnam to enable students’ readiness in hepatitis B prevention and management.
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Mekonnen ZA, Gelaye KA, Were M, Tilahun B. Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia. JMIR Mhealth Uhealth 2021; 9:e27603. [PMID: 34128813 PMCID: PMC8277338 DOI: 10.2196/27603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message-based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. OBJECTIVE This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. METHODS A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. RESULTS A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. CONCLUSIONS Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, United States
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Hu Y, Chen Y, Wang Y, Liang H, Lv H. The trends of socioeconomic inequities in full vaccination coverage among children aged 12-23 months from 2000 to 2017: evidence for mitigating disparities in vaccination service in Zhejiang province. Hum Vaccin Immunother 2021; 17:810-817. [PMID: 32730179 DOI: 10.1080/21645515.2020.1790907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the trends and changes in inequities in the completeness of the primary vaccination (CPV) scheduled before the first year of age among children aged 12-23 months, from 2000 to 2017. Methods: Data were extracted from five rounds of the provincial vaccination coverage survey (PVCS) in 2000, 2004, 2008, 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequity analysis. The concentration index (CI) was used to quantify the degree of inequity, and the decomposition approach was applied to quantify the contributions from independent factors to inequity in the CPV. Results: The CPV was significantly improved from 2000 to 2017, with 67.0% for the 2000 PVCS and 86.0% for the 2017 PCVS. The CI value decreased from 0.29839 for the 2000 round to 0.03601 for the 2017 round. The decomposition analysis indicated that independent variables such as birth order, ethnic group, mother's education, maternal employment status, residence, immigration status and the percentage of the total health spending allocated to public health could explain the inequity in the CPV in varying degrees. Conclusions: A sharp reduction in socioeconomic inequity in the CPV was observed from 2000 to 2017. Policy recommendations to reduce the inequality in the CPV should focus on children with the risk factors found in this study, for better outcome in full vaccination and long-lasting herd immunity.
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Affiliation(s)
- Yu Hu
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Liang
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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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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Hefele L, Syphan S, Xayavong D, Homsana A, Kleine D, Chanthavilay P, Nouanthong P, Xaydalasouk K, Phathammavong O, Billamay S, Xeuatvongsa A, Reinharz D, Black AP, Muller CP. Timeliness of immunisation with the pentavalent vaccine at different levels of the health care system in the Lao People's Democratic Republic: A cross-sectional study. PLoS One 2020; 15:e0242502. [PMID: 33290386 PMCID: PMC7723256 DOI: 10.1371/journal.pone.0242502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background The timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People’s Democratic Republic. We also investigated factors associated with delayed immunization. Methods 1162 children aged 8–28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses. Results Several discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination. Conclusion We observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.
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Affiliation(s)
- Lisa Hefele
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
- * E-mail:
| | | | | | - Anousin Homsana
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
| | - Daria Kleine
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | | | | | | | | | | | - Anonh Xeuatvongsa
- Expanded Programme on Immunisation, Vientiane, Lao People’s Democratic Republic
| | - Daniel Reinharz
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Antony P. Black
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
| | - Claude P. Muller
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
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Nour TY, Farah AM, Ali OM, Osman MO, Aden MA, Abate KH. Predictors of immunization coverage among 12-23 month old children in Ethiopia: systematic review and meta-analysis. BMC Public Health 2020; 20:1803. [PMID: 33243208 PMCID: PMC7689978 DOI: 10.1186/s12889-020-09890-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Immunization is one of modern medicine’s greatest achievements in the last three decades. Annually it can prevent nearly 2 to 3 million deaths. Understanding the determinants of effective immunization coverage is a critical undertaking. Accordingly, we set out to check the best available evidence of outstanding predictors of immunization coverage among children aged 12–23 months in Ethiopia. Method Electronic databases including PubMed, Google Scholar, HINARI, and SCOPUS, Web of Science, African Journals Online, Ethiopian Medical Journals were searched. The search process, study selection, critical appraisal, and data extraction were done independently by two reviewers using Joanna Briggs Institute Meta-analysis for Review Instrument (JBI-MAStARI). The difference between reviewers was resolved with a third person. The risk of bias was assessed by the Newcastle Ottawa Tool for observational studies. Data were extracted using the Microsoft Excel checklist and exported to STATA 13. Heterogeneity was assessed using I2, Funnel plot and Egger’s test was used to check for publication bias. Results We identified 26 studies with 15,042 children with mothers/caretakers to assess factors associated with immunization coverage and significant factors were: maternal formal education, (OR = 2.45; 95% CI: 1.62–3.72), paternal formal education, (OR = 1.01; 95% CI: 0.27–3.77), residence, (OR = 2.11; 95% CI: 1.00–4.45), birth at health facility (OR = 1.86; 95% CI: 0.99–3.49), family size less than four, (OR = 1.81; 95% CI: 1.16–2.84), knowledge on age of immunization to be completed (OR = 6.18;95% CI: 3.07–12.43), knowledge on immunization schedule (OR = 2.49; 95% CI: 1.35–4.59), time to travel to health faculties, (OR = 1.74; 95% CI: 0.62–4.89), antennal care, (OR = 3.11; 95% CI: 1.64–5.88), and tetanus toxoid vaccination, (OR = 4.82; 95% CI: 2.99–7.75). Conclusion Our findings showed that literacy, residence, awareness, family size, maternal health services use, and proximity of the health facilities were factors associated with full immunization. This implies that there is a need for primary health service expansion and health education to “hard to reach areas” to improve immunization coverage for children aged 12–23 months.
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Affiliation(s)
- Tahir Yousuf Nour
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia.
| | - Alinoor Mohamed Farah
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Omer Moelin Ali
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Mowlid Akil Aden
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
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Ndwandwe D, Nnaji CA, Mashunye T, Uthman OA, Wiysonge CS. Incomplete vaccination and associated factors among children aged 12-23 months in South Africa: an analysis of the South African demographic and health survey 2016. Hum Vaccin Immunother 2020; 17:247-254. [PMID: 32703070 PMCID: PMC7872074 DOI: 10.1080/21645515.2020.1791509] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa. Despite substantial efforts at ensuring universal access to vaccines, many children remain under-vaccinated in the country. This study aimed to assess the prevalence and factors associated with incomplete vaccination in the first year of life, among children aged 12–23 months in South Africa. Methods The study is a secondary analysis of the 2016 South African Demographic and Health Survey. A multivariable logistic regression model was applied to the data on 708 children aged 12–23 months. The study outcome, vaccination completeness, was assessed using a composite assessment of nine doses of four vaccines; Bacillus Calmette–Guérin (BCG) (one dose), Polio (four doses), diphtheria-tetanus-pertussis containing vaccines (DTP) (three doses) and measles-containing vaccines (MCV) (one dose). Children who received all the nine doses were categorized as completely vaccinated. Independent variables included child, maternal, and demographic characteristics. Variables were included in the model based on literature findings. Bivariate analyses were used to examine the crude association between each independent variable and incomplete vaccination, while the multivariable logistic regression model was used to examine the adjusted association after controlling for other variables. Measures of association were presented as odds ratios (OR) with their 95% confidence intervals (CI). Results About two-fifths (40.8%) of the children were incompletely vaccinated. The prevalence of incomplete vaccination was significantly high among children whose mothers did not receive antenatal care (ANC) during pregnancy (57.5%), and children living in Gauteng Province (52.2%). From the bivariate analyses, the odds of being incompletely vaccinated were three times higher in children whose mothers did not attend ANC compared with children whose mothers attended ANC (crude OR = 2.93; 95% CI 1.42–6.03). The odds were about three times higher in children living in Mpumalanga province (OR = 2.58; 95% CI 1.27–5.25) and in those living in Gauteng province (OR = 2.76; 95% CI 1.30–5.91), compared with those living in Free State province. Conversely, the odds were 32% lower in children from rich households, compared with those from poor households (OR = 0.68; 95% CI 0.47–0.98). In the adjusted model, the higher odds of incomplete vaccination in children whose mothers did not attend ANC were maintained in both magnitude and direction (adjusted OR [aOR] = 2.87; 95% CI 1.31–6.25). Similarly, compared with children living in Free State province, the higher odds of a child being incompletely vaccinated in Mpumalanga (aOR = 2.30; 95% CI 1.03–5.14) and in Gauteng (aOR = 3.10; 95% CI 1.35–7.15) provinces were maintained in both magnitude and direction. Conclusions There is a substantial burden of incomplete childhood vaccination in South Africa. Maternal ANC attendance during pregnancy and area of residence significantly influences this burden. Interventions that promote broader health service utilization, such as ANC attendance, can help improve the awareness and uptake of routine childhood vaccination. It is also imperative to take into consideration the provincial disparities in childhood vaccination completeness, in planning and implementing interventions to improve vaccination coverage in the country.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Thandiwe Mashunye
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick Medical School , Coventry, UK.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University , Cape Town, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University , Cape Town, South Africa
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11
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Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis. BMC Public Health 2020; 20:908. [PMID: 32527248 PMCID: PMC7291496 DOI: 10.1186/s12889-020-08935-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia. METHOD This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted odds ratio (AOR) with their 95% confidence intervals (CIs). RESULTS Of the 774 children included for analysis, 498 (64.3%) were fully vaccinated while 247 (31.9%) were fully vaccinated on-time. Caregivers who had secondary education and above (AOR = 2.391; 95% CI: 1.317-4.343), from richest households (AOR = 2.381; 95% CI: 1.502-3.773), children whose mother attended four or more ante natal care visits (AOR = 2.844; 95% CI: 1.310-6.174) and whose mother had two or more post natal care visits (AOR = 2.054; 95%CI:1.377-3.063) were positively associated with on-time full vaccination. In contrary, caregivers aged above 35 years (AOR = 0.469; 95 % CI: 0.253-0.869], being vaccinated at health post (AOR = 0.144; 95%CI: 0.048-0.428) and travelling more than 30 min to the vaccination site (AOR = 0.158; 95%CI: 0.033-0.739) were negatively associated with on-time full vaccination. The random effects indicated that 26% of the variability in on-time full vaccination was attributable to differences between communities. CONCLUSION In this study, untimely vaccination was found to be high. Different individual and contextual factors were found to be associated with on-time full vaccination. Therefore, tailored strategies have to be designed and implemented to address people and the communities where they live. Moreover, timeliness of vaccination should be considered as important indicator of the immunization program performance in Ethiopia.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia. .,Health System Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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12
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Heo J, Kim SY, Yi J, Yu SY, Jung DE, Lee S, Jung JY, Kim H, Do N, Lee HY, Nam YS, Hoang VM, Luu NH, Lee JK, Tran TGH, Oh J. Maternal, neonatal, and child health systems under rapid urbanization: a qualitative study in a suburban district in Vietnam. BMC Health Serv Res 2020; 20:90. [PMID: 32024537 PMCID: PMC7003413 DOI: 10.1186/s12913-019-4874-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/24/2019] [Indexed: 12/01/2022] Open
Abstract
Abstract Background Vietnam has been successful in increasing access to maternal, neonatal, and child health (MNCH) services during last decades; however, little is known about whether the primary MNCH service utilization has been properly utilized under the recent rapid urbanization. We aimed to examine current MNCH service utilization patterns at a district level. Methods The study was conducted qualitatively in a rural district named Quốc Oai. Women who gave a birth within a year and medical staff at various levels participated through 43 individual in-depth interviews and 3 focus group interviews. Results Primary MNCH services were underutilized due to a failure to meet increased quality needs. Most of the mothers preferred private clinics for antenatal care and the district hospital for delivery due to the better service quality of these facilities compared to that of the commune health stations (CHSs). Mothers had few sociocultural barriers to acquiring service information or utilizing services based on their improved standard of living. A financial burden for some services, including caesarian section, still existed for uninsured mothers, while their insured counterparts had relatively few difficulties. Conclusions For the improved macro-efficiency of MNCH systems, the government needs to rearrange human resources and/or merge some CHSs to achieve economies of scale and align with service volume distribution across the different levels.
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Affiliation(s)
- Jongho Heo
- National Assembly Futures Institute, Seoul, Republic of Korea.,JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Yun Kim
- UNICEF Kenya Country Office, United Nations Children's Fund, Nairobi, Kenya
| | - Jinseon Yi
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Soo-Young Yu
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | | | - Sangmi Lee
- Korea International Cooperation Agency, Seongnam-si, Republic of Korea
| | - Ju Youn Jung
- Department of Biomedical Science, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon-si, Republic of Korea
| | - Ngan Do
- Sphere Institute, Burlingame, CA, USA
| | - Hwa-Young Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Takemi Program in International Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - You-Seon Nam
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Juhwan Oh
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, USA.
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13
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Vo HL, Huynh LTB, Nguyen Si Anh H, Do DA, Doan TNH, Nguyen THT, Nguyen Van H. Trends in Socioeconomic Inequalities in Full Vaccination Coverage among Vietnamese Children aged 12-23 Months, 2000-2014: Evidence for Mitigating Disparities in Vaccination. Vaccines (Basel) 2019; 7:vaccines7040188. [PMID: 31752228 PMCID: PMC6963749 DOI: 10.3390/vaccines7040188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/02/2022] Open
Abstract
There has been no report on the situation of socioeconomic inequalities in the full vaccination coverage among Vietnamese children. This study aims to assess the trends and changes in the socioeconomic inequalities in the full vaccination coverage among Vietnamese children aged 12–23 months from 2000 to 2014. Data were drawn from Multiple Indicator Cluster Surveys (2000, 2006, 2011, and 2014). Concentration index (CCI) and concentration curve (CC) were applied to quantify the degree of the socioeconomic inequalities in full immunization coverage. The prevalence of children fully receiving recommended vaccines was significantly improved during 2000–2014, yet, was still not being covered. The total CCI of full vaccination coverage gradually decreased from 2000 to 2014 (CCI: from 0.241 to 0.009). The CC increasingly became close to the equality line through the survey period, indicating the increasingly narrow gap in child full immunization amongst the poor and the rich. Vietnam witnessed a sharp decrease in socioeconomic inequality in the full vaccination coverage for over a decade. The next policies towards children from vulnerable populations (ethnic minority groups, living in rural areas, and having a mother with low education) belonging to lower socioeconomic groups may mitigate socioeconomic inequalities in full vaccination coverage.
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Affiliation(s)
- Hoang-Long Vo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (H.N.S.A.); (T.-N.-H.D.)
- Correspondence: or (H.-L.V.); or (L.-T.-B.H.); or (H.N.V.)
| | - Le-Thai-Bao Huynh
- Faculty of Medicine, Duy Tan University, Danang 550000, Vietnam
- Correspondence: or (H.-L.V.); or (L.-T.-B.H.); or (H.N.V.)
| | - Hao Nguyen Si Anh
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (H.N.S.A.); (T.-N.-H.D.)
| | - Dang-An Do
- Department of International Cooperation, Ministry of Health, Hanoi 100000, Vietnam;
| | - Thi-Ngoc-Ha Doan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (H.N.S.A.); (T.-N.-H.D.)
| | | | - Huy Nguyen Van
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (H.N.S.A.); (T.-N.-H.D.)
- Graduate School of Public Health, St. Luke’s International University, Tokyo 104-0044, Japan
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA
- Correspondence: or (H.-L.V.); or (L.-T.-B.H.); or (H.N.V.)
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14
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Mekonnen ZA, Tilahun B, Alemu K, Were M. Effect of mobile phone text message reminders on improving completeness and timeliness of routine childhood vaccinations in North-West, Ethiopia: a study protocol for randomised controlled trial. BMJ Open 2019; 9:e031254. [PMID: 31694849 PMCID: PMC6858152 DOI: 10.1136/bmjopen-2019-031254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Non-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia. METHODS AND ANALYSIS A two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother-infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother-infant pairs with 1:1 allocation ratio. Mothers assigned to the intervention group will receive text message reminder 1 day before the scheduled vaccination visit at 6 weeks, 10 weeks, 14 weeks and at 9 months. Initially, descriptive statistics will be computed. For the primary outcome log-binomial regression model will be used to identify associated factors, and relative risk with 95% CI will be reported. Primarily, iIntention-to-treat analysis principle will be applied. STATA V.14 software will be used for the analysis. ETHICS AND DISSEMINATION This study obtained ethical approval from the University of Gondar Institutional Ethical Review Board. The trial findings on the effectiveness of mobile text message reminders in improving vaccination uptake will help to inform decision makers on the use of mobile health interventions in developing countries like Ethiopia. The scientific findings of the trial will also be published in reputable journals. TRIAL REGISTRATION NUMBER PACTR201901533237287.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Health Informatics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Binyam Tilahun
- Health Informatics, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Institute of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Mekonnen ZA, Hussien FN, Tilahun B, Gelaye KA, Mamuye A. Development of automated text-message reminder system to improve uptake of child vaccination in Ethiopia. Online J Public Health Inform 2019; 11:e15. [PMID: 31632609 PMCID: PMC6788892 DOI: 10.5210/ojphi.v11i2.10244] [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] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is forgetfulness of caretakers to show up in vaccination schedules. This necessitates developing an automated reminder system with integration of mobile technologies. OBJECTIVES This paper aimed to develop and test an automated mobile text message reminder system in the local context of Ethiopia. METHODS This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Requirement gathering was done before development of the system. Front end application was developed using java technologies while back end applications were developed with oracle database. Finally, pilot testing of the automated reminder system was done on 30 participants. RESULTS The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2. SMS application for automatic SMS text messaging. In the pilot testing, all the text messages (100%) were dispatched from the automated system to the respective participants. Finally, the system has shown a notification that the text messages have been sent successfully. CONCLUSION Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message based mHealth interventions should be carefully designed, developed, tested and refined before actual implementation.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of health informatics, Institute of Public Health, University of
Gondar, Gondar, Ethiopia
| | | | - Binyam Tilahun
- Department of health informatics, Institute of Public Health, University of
Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics,
Institute of Public Health, University of Gondar, Gondar,
Ethiopia
| | - Adane Mamuye
- Department of computer science, Faculty of
Informatics, University of Gondar, Gondar, Ethiopia
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16
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Parents' Attitude about Hepatitis B Disease and Practice of Hepatitis B Vaccination among Children in Ho Chi Minh City, Vietnam. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9323814. [PMID: 31355286 PMCID: PMC6634122 DOI: 10.1155/2019/9323814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/26/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022]
Abstract
Introduction The Expanded Program on Immunization (EPI) in Vietnam for hepatitis B (HepB) among infants has been implemented since 2003. The rates of the birth dose (babies receiving HepB immunization injection within 24 hours after birth) and the later three-dose series were low in 2013-2014. Objective This article evaluated attitudes about the hepatitis B disease and vaccine in relation to the correct practice of vaccination among mothers of 12-24-month-old children in Ho Chi Minh City. Material and Methods The parents of 768 children aged 12 to 24 months, in Ho Chi Minh City, were interviewed and reviewed their vaccination cards from February 2016 to July 2017. Results A total of 768 children had parents of a mean age of 30.8 years, approximately 34% of the children with a mean age of 16.8 months completed all four doses of the hepatitis B vaccine in a timely manner according to the EPI, and only 45.2% of children received the birth dose on schedule within 24 hours. The mother's fears of HepB risk in the community, living in rural areas, and receiving vaccination information from health workers increased the odds of complete and timely HepB vaccination (all p<0.05). Conclusions A high rate of children did not receive a complete and timely HepB vaccination in the EPI. Health information strategies should be designed to target urban people and focus on safety of the vaccine, by health workers, to increase the correct practices of hepatitis B vaccination, including the birth dose, and provide education programs that emphasize the high risk for getting hepatitis B.
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17
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Nandi A, Shet A, Behrman JR, Black MM, Bloom DE, Laxminarayan R. Anthropometric, cognitive, and schooling benefits of measles vaccination: Longitudinal cohort analysis in Ethiopia, India, and Vietnam. Vaccine 2019; 37:4336-4343. [PMID: 31227354 PMCID: PMC6620502 DOI: 10.1016/j.vaccine.2019.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/28/2019] [Accepted: 06/13/2019] [Indexed: 12/20/2022]
Abstract
Objective To estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam. Methods Longitudinal survey data from Young Lives were used to compare outcomes at ages 7–8 and 11–12 years between children who reported receipt or non-receipt of measles vaccine at 6–18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children. Findings Using age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7–8 years, and 0.2 higher BMIZ at age 11–12 years in Vietnam. At ages 7–8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11–12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2–0.3 additional schooling grades across all ages and countries. Conclusion Our findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences which extend beyond early childhood.
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Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St. NW, Suite 500, Washington, DC 20005, USA.
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD 21231, USA.
| | - Jere R Behrman
- Economics Department, Perelman Center for Political Science and Economics, University of Pennsylvania, 133 South 36th Street, Philadelphia, PA 19104-6297, USA.
| | - Maureen M Black
- RTI International, Research Triangle Park, NC 27709, USA; Department of Pediatrics, University of Maryland School of Medicine, 737 W. Lombard Street, Suite 161, Baltimore, MD 21201, USA.
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building I 12th Floor, Suite 1202, Boston, MA 02115, USA.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, B-25, Lajpat Nagar II, New Delhi, Delhi 110024, India; Princeton Environmental Institute, Princeton University, Princeton, NJ 08544, USA.
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18
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Hepatitis B Birth Dose Vaccination among Vietnamese Children: Implications for the Expanded Program on Immunization. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3453105. [PMID: 31317025 PMCID: PMC6601501 DOI: 10.1155/2019/3453105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/22/2019] [Indexed: 12/11/2022]
Abstract
Background This study assesses the prevalence of Vietnamese children receiving the hepatitis B (HepB) vaccine birth dose and explores its associated socioeconomic factors. Methods We used the data of the Multiple Indicator Cluster Survey, 2014. We estimated the overall percentage of HepB birth dose vaccination among 0–23-month-old children and its percentages according to selected characteristics. Multiple logistic regression was applied. Results 62.8% of children received the HepB vaccine birth dose. The prevalence rates by selected factors ranged from 35.3% to 76.7%. The categories with the lowest prevalence rates were children who had low birth weight (41.6%), had a mother aged less than 20 years (35.3%), had a mother with primary or less education (42.7%), belonged to ethnic minorities (30.3%), resided in rural areas (59.9%), and were in the 1st quintile of mother's socioeconomic status (38.6%). Receiving HepB vaccine birth dose was associated with child's birth weight, mother's age, mother's education, socioeconomic status, and ethnicity. Conclusions This study identified vulnerable groups, upon which policy-makers should focus their efforts to equitably and sustainably tackle birth dose HepB vaccine coverage as well as the full vaccination coverage, thereby promoting long-lasting herd immunity in this country.
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19
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Do TTT, Nguyen AN, Le XTT, Pongsakul A, Nguyen QN, Nguyen TV, Nguyen TH, Do TM, Le HT, Nguyen HLT, Truong NT, Hoang CL, Vu GT, Tran TT, Tran TH, Tran BX, Latkin CA, Ho CS, Ho RC. Rubella Vaccination Coverage Among Women of Childbearing Age in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101741. [PMID: 31100981 PMCID: PMC6572083 DOI: 10.3390/ijerph16101741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022]
Abstract
Despite the availability of effective and safe rubella vaccines for women of childbearing age, prevention and control of congenital rubella syndrome in children remains challenging in Vietnam. In order to examine this issue, we conducted a cross-sectional study, examining the current coverage of rubella vaccination before pregnancy among 807 pregnant women and women with children under 12 months of age in urban and rural districts, Dong Da and Ba Vi, in Hanoi, Vietnam. In this population, we observed an alarming non-compliance rate with rubella vaccination before pregnancy in both localities. Among the 82.0% of participants who remained unvaccinated against this contagious viral infection, 95.8% of them were in Ba Vi district, compared to 68.0% in Dong Da district (p < 0.001). Besides the differences in age, number of children, education levels, primary occupations and monthly incomes among the participants between the two districts, other reasons for noncompliance with rubella vaccination includeddisinterest in rubella vaccination, the high cost and long distance to vaccination sites as well as unawareness of vaccination locations. In addition to addressing the unique socio-economicchallenges behind one’s accessibility to vaccination services in urban and rural areas, our study supports a continued effort in ensuring proper access to and education about pre-pregnancy vaccines and vaccination among women of childbearing age in order to achieve and sustain sufficient immunization coverage of rubella and other vaccine-preventable diseases in both settings.
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Affiliation(s)
- Toan Thanh Thi Do
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Anh Ngoc Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Xuan Thanh Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Ann Pongsakul
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA.
| | - Quang Nhat Nguyen
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.
- Institute for Global Health Innovations, Duy Tan University, Da Nang 55000, Vietnam.
| | - Thanh Van Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Thang Huu Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Tri Minh Do
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 55000, Vietnam.
| | - Nu Thi Truong
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh 70000, Vietnam.
| | - Chi Linh Hoang
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh 70000, Vietnam.
| | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh 70000, Vietnam.
| | - Tung Thanh Tran
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh 70000, Vietnam.
| | - Tung Hoang Tran
- Department of Lower Limb Surgery, Vietnam-Germany Hospital, Hanoi 100000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Cyrus Sh Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Roger Cm Ho
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh 70000, Vietnam.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
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20
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Wagner AL, Shenton LM, Gillespie BW, Mathew JL, Boulton ML. Assessing the timeliness of vaccine administration in children under five years in India, 2013. Vaccine 2018; 37:558-564. [PMID: 30595345 DOI: 10.1016/j.vaccine.2018.12.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022]
Abstract
Morbidity from vaccine-preventable diseases is high in India, but precise estimates of vaccination timeliness are difficult to compute because many children lack records of vaccination dates. This study assessed vaccination timeliness after accounting for right and left censoring of data. This cross-sectional study used the 2012-2013 District Level Household and Facility Survey in India. The outcome was vaccination timeliness for 9 vaccine doses: 1 dose Bacillus Calmette-Guérin (BCG), 4 doses oral polio vaccine, 3 doses diphtheria-pertussis-tetanus vaccine (DPT), and 1 dose measles-containing vaccine. Age-specific probabilities of vaccination were calculated using Turnbull estimators: children not yet vaccinated were right censored, and children vaccinated but without a recorded date were left censored. Data from 108,783 children under 5 years were available. For children 25-60 months, maternal recall was a more common source of information than a vaccination record with dates. At one month past the recommended vaccination age, estimated coverage ranged from 35% for DPT-3 to 55% for BCG. Accounting for censored data improved vaccination timeliness measures, and demonstrated little increase in vaccination coverage after age one. Efforts to reduce morbidity from vaccine-preventable diseases in India should focus on eliminating missed opportunities for vaccination and instituting special vaccination programs for older children.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
| | - Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA; Consulting for Statistics Computing and Analytics Research, University of Michigan, 915 E Washington St, Ann Arbor, MI, USA
| | | | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Disease, Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, MI, USA
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21
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Coverage, Timelines, and Determinants of Incomplete Immunization in Bangladesh. Trop Med Infect Dis 2018; 3:tropicalmed3030072. [PMID: 30274468 PMCID: PMC6160906 DOI: 10.3390/tropicalmed3030072] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
Immunization has become one of the major contributors to public health globally as it prevents communicable disease, particularly in children. The objective of this study was to estimate the extent of timely immunization coverage and to investigate the determinants of incomplete and untimely vaccination. Methods: The study used data from the latest Bangladesh Demographic Health Survey (BDHS) 2014. A total sample of 1631 children aged 12–23 months who had an Expanded Program on Immunization (EPI) card and immunization history were analyzed. Multivariable logistic regression models were used to determine the significant influencing factors on untimely vaccination (BCG, pentavalent vaccine/OPV, and measles) and incomplete vaccination. The results were presented in terms of adjusted odds ratio (AOR) with a 95% confidence interval and a significance level p < 0.05. Results: The proportions of children who received timely vaccinations were 24% for BCG, 46% for pentavalent 3, and 53% for measles, whereas 76%, 51%, and 36% children failed to receive the BCG, pentavalent 3, and measles vaccines, respectively, in a timely manner. The proportion of early vaccination was 3% for pentavalent 3 and 12% for measles. Several significant influencing factors including age, maternal education and working status, awareness of community clinics, socioeconomic status, and geographic variation significantly contributed to untimely and incomplete vaccination of children in Bangladesh. Conclusions: The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh. The findings will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control strategies with respect to delayed and early vaccination in Bangladesh.
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Tran BX, Nguyen QN, Dang AK, Vu GT, Hoang VQ, La PV, Hoang DA, Van Dam N, Vuong TT, Nguyen LH, Le HT, Latkin CA, Ho CS, Ho RC. Acceptability of and willingness to pay for using a smartphone-based vaccination application in a Vietnamese cohort. Patient Prefer Adherence 2018; 12:2583-2591. [PMID: 30584282 PMCID: PMC6287420 DOI: 10.2147/ppa.s185129] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The increasing accessibility of smartphone in Vietnam shows potential in using smartphone applications for vaccination management to improve compliance. However, the acceptability and financial feasibility of using this application in Vietnam have not yet been understood. This study measured the general perception of and willingness to pay (WTP) for using smartphone-based vaccination management applications and their associated factors in Vietnam. SUBJECTS AND METHODS A cross-sectional study was conducted between March and April 2016 in an urban vaccination clinic at the Hanoi Medical University in Vietnam. Convenience sampling was used to recruit 429 adult participants who had received vaccinations or whose children were vaccinated. Sociodemographic characteristics and the acceptability of and WTP for using smartphone-based vaccination management applications were evaluated. RESULTS Among participants who used smartphone applications, 5% were aware of existing vaccination management applications, of whom 57.9% had previously used the applications. About 69.6% of participants believed that the applications were necessary, 93.7% of them were also willing to use the applications, and 79.1% were willing to pay 92.7 thousand Vietnamese dong (VND) for the applications on average. Participants who were older, unemployed, earned more household income, and having knowledge about functions and benefits of vaccination were less likely to use the vaccination applications. Participants who brought their children to get vaccinated at younger age and with higher level of education were willing to pay more for vaccination applications. CONCLUSION High levels of acceptability of, willingness to use, and WTP for smartphone-based vaccination management applications among Vietnamese participants are reported. Increased education and awareness about the benefits of vaccination and vaccination management applications through community health workers might increase the feasibility of implementing such applications and perception toward their usage among young adult smartphone users. In addition, building a stronger relationship with health care providers at hospitals might improve the application's visibility and adoption.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Quang N Nguyen
- Université Claude Bernard Lyon 1, Villeurbanne 69100, France
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Vuong Quan Hoang
- Centre for Interdisciplinary Social Research, Thanh Tay University, Hanoi, Vietnam
| | | | | | - Nhue Van Dam
- Faculty of Graduate Studies, National Economics University, Hanoi, Vietnam
| | | | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Cyrus Sh Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore
| | - Roger Cm Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore
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23
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Kamimura A, Trinh HN, Weaver S, Chernenko A, Wright L, Stoddard M, Nourian MM, Nguyen H. Knowledge and beliefs about HPV among college students in Vietnam and the United States. J Infect Public Health 2017; 11:120-125. [PMID: 28668657 DOI: 10.1016/j.jiph.2017.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/07/2017] [Accepted: 06/09/2017] [Indexed: 12/19/2022] Open
Abstract
Any sexually active person has the possibility of contracting the human papillomavirus (HPV) sometime in their lifetime. HPV vaccines are effective in preventing HPV if obtained prior to viral exposure. Research on knowledge and beliefs of HPV and HPV vaccination among college students in Vietnam is significantly scarce. The purpose of this study is to examine the knowledge and beliefs about HPV among college students in Vietnam compared to college students in the US. This cross-cultural comparison will fill a void in current research on this subject. Over 900 college students (N=932: n=495 in Vietnam and n=437 in the US) participated in a self-administered survey on the knowledge and beliefs about HPV in September and October 2016. Vietnamese participants reported lower levels of knowledge and experiences with the HPV virus and vaccines (p<0.01). Additionally, Vietnamese participants also exhibited more barriers in obtaining the vaccination, as well as, HPV risk denial (p<0.01). The level of knowledge is an important predictor of barriers (p<0.01; ηp2=0.022) and risk denial (p<0.01; ηp2=0.116). On average, both Vietnamese and US participants could correctly answer less than half of the survey questions regarding HPV knowledge. Additionally, provider recommendations are potentially more important than informal connections (e.g. friends, family) to reduce barriers to HPV vaccination (p<0.01; ηp2=0.035) and denial of HPV risks (p<0.05; ηp2=0.008). The increase of knowledge about HPV prevention, including and vaccination, has the potential to be improved through provider interventions. Vietnam could take action toward promoting HPV vaccinations not only at an individual level but also at a national or local level. Further research may examine the effects of a lack of knowledge on HPV-related health outcomes.
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Affiliation(s)
| | - Ha N Trinh
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | | | | | | | - Hanh Nguyen
- Vietnam National University, Ho Chi Minh City, Vietnam
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24
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Adedokun ST, Uthman OA, Adekanmbi VT, Wiysonge CS. Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors. BMC Public Health 2017; 17:236. [PMID: 28270125 PMCID: PMC5341359 DOI: 10.1186/s12889-017-4137-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 02/15/2017] [Indexed: 12/03/2022] Open
Abstract
Background Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live. Methods The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12–23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3). Results More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15–24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39–0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51–0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50–0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02–1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60–4.71) and states (aOR = 2.69; 955 CrI =1.37–4.73) were more likely to be incompletely immunized. Conclusions This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.
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Affiliation(s)
- Sulaimon T Adedokun
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK. .,Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK.,Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Victor T Adekanmbi
- NIHR Collaboration for Leadership in Applied Health Research and Care, West Midlands (CLAHRC WM), University of Warwick Medical School, Coventry, UK
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
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25
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Kien VD, Van Minh H, Giang KB, Mai VQ, Tuan NT, Quam MB. Trends in childhood measles vaccination highlight socioeconomic inequalities in Vietnam. Int J Public Health 2017; 62:41-49. [PMID: 27695901 PMCID: PMC5348557 DOI: 10.1007/s00038-016-0899-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe trends in measles vaccine coverage rates and their association with socioeconomic characteristics among children from age 12 to 23 months in Vietnam from the year 2000 to 2014. METHODS Data were drawn from the Vietnam Multiple Indicator Cluster Surveys in years 2000, 2006, 2011, and 2014. Concentration indices were used to determine the magnitude of socioeconomic inequalities in measles vaccine coverage. Associations between measles vaccine coverage and relevant social factors were assessed using logistic regression. RESULTS Socioeconomic inequalities in measles vaccine coverage rates decreased during 2000-2014. Children belonging to ethnic minority groups, having mothers with lower education, and belonging to the poorest group were less likely to receive measles vaccine; although, their vaccine coverage rates did increase with time. Measles vaccine coverage declined among children of mothers with more education and belonging to the wealthiest socioeconomic group. CONCLUSIONS Understanding the social factors influencing adherence to recommend childhood vaccination protocols is essential. Attempts to regain and retain herd immunity must be guided by an understanding of these social factors if they are to succeed.
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Affiliation(s)
- Vu Duy Kien
- Center for Population Health Sciences, Hanoi School of Public Health, No. 138, Giang Vo Street, Dong Da, Hanoi, Vietnam
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi School of Public Health, No. 138, Giang Vo Street, Dong Da, Hanoi, Vietnam
| | - Kim Bao Giang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Vu Quynh Mai
- Center for Population Health Sciences, Hanoi School of Public Health, No. 138, Giang Vo Street, Dong Da, Hanoi, Vietnam
| | - Ngo Tri Tuan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Mikkel B. Quam
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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26
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Phuong NT, Hoang TT, Foster K, Roberts CL, Marais BJ. Exploring pneumonia risk factors in Vietnamese infants: a survey of new mothers. BMJ Paediatr Open 2017; 1:e000155. [PMID: 29637159 PMCID: PMC5862220 DOI: 10.1136/bmjpo-2017-000155] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To understand the prevalence of pneumonia risk factors and perceived barriers to risk factor reduction among Vietnamese infants. METHODS We conducted a cross-sectional survey of mothers in the postnatal wards of Da Nang Hospital for Women and Children in central Vietnam from 10 February 2017 to 24 February 2017. RESULTS Of 286 mothers surveyed, 259 (91%) initiated breast feeding and 207 (72%) intended to continue exclusive breast feeding for 6 months. No mother smoked cigarettes, but 42% of fathers did. Mothers' decision not to smoke was motivated by concerns for their own health and that of their baby. Households rarely used wood or coal for cooking (6%). Mothers indicated near universal (99%) uptake of the National Expanded Program of Immunization vaccinations. Few (64; 22%) mothers knew about the pneumococcal conjugate vaccine; 56/64 (88%) indicated that they would purchase it for their infants. Family members rarely influenced mothers' decisions about breast feeding or vaccination, except in two instances where fathers were concerned about vaccine-related adverse effects. CONCLUSION Modifiable pneumonia risk factors were uncommon among newborn babies in central Vietnam, apart from paternal cigarette smoke exposure. Successful local implementation of the WHO Essential Newborn Care package as well as high levels of maternal education and decision autonomy was observed.
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Affiliation(s)
- Nguyen Tk Phuong
- Discipline of Paediatrics and Adolescent Medicine, The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia.,Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Tran T Hoang
- Da Nang Hospital for Women and Children, Da Nang, Vietnam.,Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Kirsty Foster
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Medical Education, Northern Clinical School & Kolling Institute, Sydney, Australia
| | - Christine L Roberts
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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27
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Van Minh H, Oh J, Hoat LN, Lee JK, Williams JS. Millennium Development Goals in Vietnam: Taking Multi-sectoral Action to Improve Health and Address the Social Determinants. Glob Health Action 2016; 9:31271. [PMID: 26950569 PMCID: PMC4780116 DOI: 10.3402/gha.v9.31271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Juhwan Oh
- Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;
| | | | - Jong-Koo Lee
- Seoul National University College of Medicine, Seoul, South Korea
| | - Jennifer Stewart Williams
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
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