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Kalbarczyk A, Brownlee N, Katz E. Of Money and Men: A Scoping Review to Map Gender Barriers to Immunization Coverage in Low- and Middle-Income Countries. Vaccines (Basel) 2024; 12:625. [PMID: 38932354 PMCID: PMC11209140 DOI: 10.3390/vaccines12060625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Among the multiple factors impeding equitable childhood immunization coverage in low- and middle-income countries (LMICs), gender barriers stand out as perhaps the most universal. Despite increasing recognition of the importance of gender considerations in immunization programming, there has not yet been a systematic assessment of the evidence on gender barriers to immunization. We conducted a scoping review to fill that gap, identifying 92 articles that described gender barriers to immunization. Studies documented a range of gender influencers across 43 countries in Africa and South Asia. The barrier to immunization coverage most frequently cited in the literature is women's lack of autonomous decision-making. Access to immunization is significantly impacted by women's time poverty; direct costs are also a barrier, particularly when female caregivers rely on family members to cover costs. Challenges with clinic readiness compound female caregiver's time constraints. Some of the most important gender barriers lie outside of the usual purview of immunization programming but other barriers can be addressed with adaptations to vaccination programming. We can only know how important these barriers are with more research that measures the impact of programming on gender barriers to immunization coverage.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Natasha Brownlee
- Global Center for Gender Equality, Washington, DC 20036, USA; (N.B.); (E.K.)
| | - Elizabeth Katz
- Global Center for Gender Equality, Washington, DC 20036, USA; (N.B.); (E.K.)
- Department of Economics, University of San Francisco, San Francisco, CA 94117, USA
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Tracey G, Olivia B, Jean M, Megan H, Sagri S. Why does gender matter for immunization? Vaccine 2024; 42 Suppl 1:S91-S97. [PMID: 36513537 DOI: 10.1016/j.vaccine.2022.11.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Attention to gender-related issues in immunization programmes goes beyond focusing on coverage discrepancies between girls and boys. There are multiple ways in which gender roles, norms and relations influence resource allocation, decision making, access, and health outcomes, including for immunization programmes. Gender impacts immunization both on the demand side through people's health seeking behaviours, and the supply side through provision of health services. To increase immunization coverage, and in particular to reach zero-dose children, it is necessary to understand and address the many ways in which gender interacts with additional socio-economic, geographic and cultural factors -- such as age, race/ethnicity, religion, marital status, education, wealth, sexual orientation and gender identity, HIV status, disability and migration status -- to influence access to and delivery of vaccines. The Immunization Agenda 2030 (IA2030) commits to addressing gender-related barriers to immunization and advancing gender equality and gender is an important cross-cutting consideration for all seven IA2030 strategic priorities. Gender-responsive strategies are particularly highlighted as an IA2030 key area of focus for Strategic Priority 3: Coverage & Equity. Gender-related barriers and gender inequality can prevent people, both male and female and those of diverse gender identities, from getting vaccinated. These operate at multiple levels from the individual and family/household to community and within institutions/systems and national policies/frameworks and are underpinned by power relations leading to different opportunities, limitations, challenges, needs and vulnerabilities, especially for women and girls. By applying knowledge about gender and taking action to design gender-responsive interventions, it is possible to implement more effective immunization programmes and increase coverage for all.
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Affiliation(s)
- Goodman Tracey
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
| | | | - Munro Jean
- Gavi the Vaccine Alliance, Geneva, Switzerland
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Williams SV, Akande T, Abbas K. Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria. PLoS One 2024; 19:e0297326. [PMID: 38446836 PMCID: PMC10917251 DOI: 10.1371/journal.pone.0297326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective. METHODS We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria. RESULTS From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12-23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29-33) among children aged 12-23 months, whilst 19% (95% CI:18-21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35-49 years compared to 15-19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039). CONCLUSIONS Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria.
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Affiliation(s)
| | - Tanimola Akande
- Department of Epidemiology & Community Health, University of Ilorin, Ilorin, Nigeria
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Olakunde BO, Itanyi IU, Onyeka TC, Paintsil E, Torpey K, Lasebikan N, Chigbu CO, Ezeanolue EE. Hepatitis B vaccine birth dose coverage among hepatitis B-exposed and hepatitis B-unexposed infants: evidence from the Healthy Beginning Initiative program in Benue State, Nigeria. Pan Afr Med J 2024; 47:67. [PMID: 38681098 PMCID: PMC11055182 DOI: 10.11604/pamj.2024.47.67.40466] [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: 05/18/2023] [Accepted: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Nigeria offers universal hepatitis B birth-dose vaccine (HepB-BD) for the prevention and control of hepatitis B (HepB). While prior studies suggest low coverage of HepB-BD in Nigeria, there is a paucity of evidence on the association between the uptake of HepB-BD and maternal HepB status. This study aimed to determine HepB-BD coverage and the associated factors among infants of HepB-positive and -negative women in Nigeria. Methods the study was a secondary analysis of data from the Healthy Beginning Initiative program conducted between June 2016 and October 2018 in Benue State, Nigeria. The analysis was restricted to data from a cohort of 6269 mothers who had HepB screening during pregnancy and completed the HepB infant immunization question in the post-delivery survey. The association between the coverage of HepB-BD and maternal HepB status, sociodemographic characteristics, and obstetric factors were determined using crude and adjusted relative risks. Results about 10% of the women tested HepB positive. The coverage of HepB-BD was 64% (63.2% among infants of HepB-positive mothers and 63.8% among HepB-negative mothers). The likelihood of infants of HepB-positive mothers receiving HepB-BD was not significantly different from infants of HepB-negative mothers (aRR=0.97, 95%CI= 0.92-1.04). Among HepB-positive mothers, infants of mothers younger than 20 years (aRR=1.49, 95%CI=1.03-2.16) or those who received antenatal care (aRR=1.41, 95%CI=1.16-1.71) were more likely to receive HepB-BD, while mothers with no previous pregnancies (aRR=0.73, 95%CI=0.59-0.91) were less likely to receive HepB-BD. Among HepB-negative mothers, infants of less-educated mothers were less likely to receive HepB-BD (aRR=0.96, 95%CI=0.92-0.99), whereas infants of mothers who received antenatal care (aRR=1.23, 95%CI=1.16-1.31) or had an institutional delivery were more likely (aRR=1.29, 95%CI=1.23-1.36) to receive HepB-BD. Conclusion: our findings highlight the need to improve HepB-BD uptake, particularly among HepB-exposed infants who are at risk of perinatal transmission of HepB.
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Affiliation(s)
- Babayemi Oluwaseun Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Tonia Chinyelu Onyeka
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Anesthesia/Pain and Palliative Care Unit, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Nwamaka Lasebikan
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chibuike Ogwuegbu Chigbu
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Nevada, USA
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Ahmed I, Ali H, Ali S, Van Woerden S, Hanna-Amodio A, Chen K, Onitolo E, Gillespie A. From digital voices to vaccine choices: increasing female vaccine acceptance in Sudan through social listening. Front Glob Womens Health 2024; 5:1288559. [PMID: 38410823 PMCID: PMC10895050 DOI: 10.3389/fgwh.2024.1288559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
The early COVID-19 vaccine rollout in Sudan experienced a gender disparity in vaccine uptake, with women accounting for less than 40% of vaccinations after four months of vaccine access. Initial analysis revealed that demand generation approaches were not sufficiently tailored to address the challenges and concerns of women. Using real-time social media monitoring, also known as social listening, to understand this inequity, we used an analytical tool called "Talkwalker" to track public sentiment and engagement regarding vaccination on social media platforms. The data captured subsequently informed a gender-responsive messaging campaign on social media that directly addressed specific concerns of Sudanese women. Within one week of the campaign's onset in September 2021, we observed a 144% increase in women's COVID-19 related social media engagement. Subsequent campaigns further enhanced women's engagement from 31% to between 35%-47%. Two subsequent campaigns in January and February/March 2022 were complemented with in-person activities, such as group meetings with community members and home visits by health promoters. Women's vaccination rates increased by 9% while the first two campaigns were live. System constraints hindered data linkages for the third campaign. These findings demonstrate the value of integrating real-time feedback with large-scale social media campaigns and the potential of linking online and offline strategies to further refine interventions, particularly in a conflict-prone and low-income country context. Our experience reinforces the notion that "one size does not fit all" when it comes to health-related communication. Responses should be tailored, contextualized, and person-centered, particularly in addressing concerns unique to women.
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Affiliation(s)
- Islam Ahmed
- UNICEF Sudan, Social and Behaviour Change, Khartoum, Sudan
| | - Hiba Ali
- UNICEF Sudan, Social and Behaviour Change, Khartoum, Sudan
| | - Sehrish Ali
- UNICEF Sudan, Social and Behaviour Change, Khartoum, Sudan
| | | | | | - Katie Chen
- The Behavioural Insights Team, London, United Kingdom
| | | | - Amaya Gillespie
- UNICEF Middle East and North Africa Regional Office, Social and Behaviour Change, Amman, Jordan
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Yeskendir A, Gusmanov A, Zhussupov B. Parental attitudes, beliefs and behaviors toward childhood and COVID-19 vaccines: A countrywide survey conducted in Kazakhstan examining vaccine refusal and hesitancy. Vaccine 2023; 41:6548-6557. [PMID: 37648608 DOI: 10.1016/j.vaccine.2023.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Vaccination rates worldwide have declined in recent years. This decrease is primarily driven by vaccine hesitancy, which remains understudied in Central Asia, including Kazakhstan. Furthermore, there is great concern about parental hesitancy toward COVID-19 vaccines, as previous studies have focused on adult vaccine hesitancy. The current study was conducted by UNICEF and funded by USAID to explore the drivers of routine and COVID-19 immunization behaviors among parents and caregivers in Kazakhstan. METHODS Using a cross-sectional methodology, researchers conducted 3081 face-to-face interviews with parents and caregivers of children aged 0-17 years across cities and villages in Kazakhstan. A tablet-based questionnaire (CAPI) was utilized, collecting participants' data on sociodemographic characteristics, childhood and COVID-19 vaccination behaviors, and potential drivers. RESULTS Total of 239 participants (7.8%) were found to previously refuse vaccination due to their own beliefs. Stronger belief that vaccines are efficacious (AdjOR = 0.47), stronger belief that childhood vaccines are safe and danger of vaccine-preventable diseases is high (AdjOR = 0.73), firmer trust in societal factors (AdjOR = 0.77) and positive attitudes of family members toward immunization (AdjOR = 0.6) were significantly associated with parental refusal of childhood vaccines. The large proportion of respondents (N = 2,634, 85.6%) missed the COVID-19 vaccination of their child or were unwilling to get vaccinated. Stronger belief that COVID-19 vaccines are safe and efficacious (AdjsOR = 0.18), lacking important information about COVID-19 vaccines (AdjOR = 1.25) and parents being unvaccinated against COVID-19 (AdjOR = 2.3) were significant predictors of vaccine hesitancy. CONCLUSION This study revealed numerous socio-demographic and behavioral factors significantly associated with parental refusal of childhood vaccines and hesitancy toward COVID-19 vaccines. Many parents not refusing vaccination possessed negative attitudes towards vaccines. Potential changes in their attitudes and beliefs of parents were observed compared to findings from pre-COVID era. Continuous monitoring of parental hesitancy, proper interventions and education of healthcare workers are suggested to reduce parental vaccine hesitancy.
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Affiliation(s)
- Alua Yeskendir
- UNICEF Kazakhstan National Consultant on COVID-19 Vaccine C4D/Demand Generation Activities, Kazakhstan.
| | - Arnur Gusmanov
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan.
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Kulkarni S, Ishizumi A, Eleeza O, Patel P, Feika M, Kamara S, Bangura J, Jalloh U, Koroma M, Sankoh Z, Sandy H, Toure M, Igbu TU, Sesay T, Fayorsey RN, Abad N. Using photovoice methodology to uncover individual-level, health systems, and contextual barriers to uptake of second dose of measles containing vaccine in Western Area Urban, Sierra Leone, 2020. Vaccine X 2023; 14:100338. [PMID: 37577263 PMCID: PMC10422676 DOI: 10.1016/j.jvacx.2023.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023] Open
Abstract
Background Vaccination coverage for the second dose of the measles-containing vaccine (MCV2) among children has remained stagnant in Sierra Leone at nearly 67% since its introduction in 2015. Identifying community-specific barriers faced by caregivers in accessing MCV2 services for their children and by health workers in delivering MCV2 is key to informing strategies to improve vaccination coverage. Methods We used Photovoice, a participatory method using photographs and narratives to understand community barriers to MCV2 uptake from March- September 2020. Six female and five male caregivers of MCV2-eligible children (15-24 months of age), and six health care workers (HCWs) in Freetown, Sierra Leone participated. After having an orientation to photovoice, they photographed barriers related to general immunization and MCV2 uptake in their community. This was followed by facilitated discussions where participants elaborated on the barriers captured in the photos. Transcripts from the six immunization-related discussions were analyzed to deduce themes through open-ended coding. A photo exhibition was held for participants to discuss the barriers and suggested solutions with decision-makers, such as the ministry of health. Results We identified and categorized nine themes into three groups: 1) individual or caregiver level barriers (e.g., caregivers' lack of knowledge on MCV2, concerns about vaccine side effects, and gender-related barriers); 2) health system barriers, such as HCWs' focus on children below one year and usage of old child health cards; and 3) contextual barriers, such as poverty, poor infrastructure, and the COVID-19 pandemic. Participants suggested the decision-makers to enhance community engagement with caregivers and HCW capacity including, increasing accountability of their work using performance-based approaches, among different strategies to improve MCV2 uptake. Conclusion Photovoice can provide nuanced understanding of community issues affecting MCV2. As a methodology, it should be integrated in broader intervention planning activities to facilitate the translation of community-suggested strategies into action.
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Affiliation(s)
- Shibani Kulkarni
- U.S. Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | | | - Palak Patel
- U.S. Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | | | | | | | | | | | | | - Mame Toure
- ICAP Sierra Leone, Freetown, Sierra Leone
| | | | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Neetu Abad
- U.S. Centers for Disease Control and Prevention, Atlanta GA, USA
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Huang J, Cheung CKM, Keung VMW, Lo ASC, Chan SC, Pang WS, Li QHY, Mui LWH, Lee A, Wong MCS. Factors Associated with Vaccination Uptake among Young Children: A Follow-Up Study of 1799 Toddlers. Vaccines (Basel) 2023; 11:vaccines11030535. [PMID: 36992119 DOI: 10.3390/vaccines11030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Childhood vaccination is crucial to protect young children from harmful infectious diseases. This study aimed to investigate the recent childhood immunization rate of recommended and additional vaccinations and identify the factors affecting the vaccination uptake of young children in Hong Kong. The self-administrated questionnaires were distributed to parents of toddlers aged 2 to 5. They were asked to provide information on (1) socioeconomic demographic factors; (2) experiences during pregnancy; and (3) the medical history of the toddler. A total of 1799 responses were collected. Children were more likely to be fully vaccinated when they were at a younger age (aOR = 0.61, 95% CI: 0.48–0.78, p < 0.001), the first child in the family (aOR second-born = 0.62, 95% CI: 0.48–0.81, p < 0.001; aOR third-born = 0.33, 95% CI: 0.19–0.55, p < 0.001), had a higher household income (aOR HKD 15,000–HKD 29,999 = 1.80, 95% CI: 1.27–2.55, p = 0.001; aOR ≥ HKD 30,000 = 3.42, 95% CI: 2.39–4.90, p < 0.001; compared with <HKD 15,000), or with mothers in older age groups (aOR 35–39 years old = 2.45, 95% CI = 1.22–4.93, p = 0.012; aOR ≥ 40 = 2.90, 95% CI = 1.24–6.77, p = 0.014; compared with ≤ age 24). The uptake of any additional vaccination was 71%. Children who were older (aOR = 1.32, 95% CI: 1.02–1.70, p = 0.036), the first child in the family (aOR second-born = 0.74, 95% CI: 0.56–0.99, p = 0.043; aOR third-born = 0.55, 95% CI: 0.32–0.96, p = 0.034), with higher household income (aOR ≥ HKD 30,000 = 1.61, 95% CI: 1.10–2.37, p = 0.016), were exposed to second-hand smoke from the father (aOR: 1.49, 95% CI: 1.08–2.07, p = 0.016), experienced hospitalization (twice or more—aOR: 1.44, 95% CI: 1.04–1.99, p = 0.027), or were fully vaccinated (aOR: 2.76, 95% CI: 2.12–3.60, p < 0.001) were associated with a higher chance of taking an additional vaccine. To encourage the vaccination rate, more attention should be given to families with more children, low-income families, and younger mothers.
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Affiliation(s)
- Junjie Huang
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Calvin K M Cheung
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Vera M W Keung
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Amelia S C Lo
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sze Chai Chan
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Sze Pang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Queenie H Y Li
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lancelot W H Mui
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Albert Lee
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The School of Public Health, Peking University, Beijing 100871, China
- The School of Public Health, The Chinese Academy of Medical Sciences and The Peking Union Medical Colleges, Beijing 100006, China
- The School of Public Health, Fudan University, Shanghai 200433, China
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Bell J, Lartey B, Spickernell G, Darrell N, Salt F, Gardner C, Richards E, Fasakin L, Egbeniyi S, Odongo E, Ssenkungu J, Kouadio RK, Cissé M, Rérambyah ABAI, Adou M, West R, Sharma S. Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531294 PMCID: PMC9748306 DOI: 10.1016/j.ssmqr.2022.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
Vaccines have reduced child mortality across the world, but low levels of demand for vaccination threatens to undermine progress. Existing frameworks to understand demand tend to prioritise primary caregivers' decision-making processes. We aimed to build a wider understanding of vaccine demand by applying an adapted socio-ecological model to analyse 158 interviews with primary caregivers and fathers of young children, and community influencers in Nigeria, Uganda, and Guinea. We found that several factors come together to inform a primary caregiver's demand for vaccination, including their familial and social relationships, their interactions with government and healthcare institutions, and the wider social and cultural norms in their communities. The study suggests that interventions targeted at families and communities instead of individuals could be effective. The results could be used to ensure that vaccine demand frameworks used by researchers and intervention designers are comprehensive and consider a wider range of influences on the primary caregiver.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Belinda Lartey
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | | | | | - Frances Salt
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Cassie Gardner
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Emily Richards
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Lanre Fasakin
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Shadrach Egbeniyi
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Emmanuel Odongo
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | - James Ssenkungu
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | | | - Mamadi Cissé
- Ciblage, En Face de l’Ecole les Ecureuils, Lambanyi, Ratoma, Conakry, Guinea
| | | | - Maikol Adou
- Ciblage, Face SODECI, Imm. Hué, Porte B10, Riviera Attoban, Cocody, 09 BP 799, Abidjan 09, Cote d’Ivoire
| | - Rebecca West
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, United States
| | - Sunny Sharma
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
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Sacre A, Bambra C, Wildman JM, Thomson K, Sowden S, Todd A. Socioeconomic Inequalities and Vaccine Uptake: An Umbrella Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11172. [PMID: 36141450 PMCID: PMC9517548 DOI: 10.3390/ijerph191811172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
The effectiveness of immunization is widely accepted: it can successfully improve health outcomes by reducing the morbidity and mortality associated with vaccine-preventable diseases. In the era of pandemics, there is a pressing need to identify and understand the factors associated with vaccine uptake amongst different socioeconomic groups. The knowledge generated from research in this area can be used to inform effective interventions aimed at increasing uptake. This umbrella systematic review aims to determine whether there is an association between socioeconomic inequalities and rate of vaccine uptake globally. Specifically, the study aims to determine whether an individual's socioeconomic status, level of education, occupation, (un)-employment, or place of residence affects the uptake rate of routine vaccines. The following databases will be searched from 2011 to the present day: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane CENTRAL, Science Citation Index (Web of Science), DARE, SCOPUS (Elsevier), and ASSIA (ProQuest). Systematic reviews will be either included or excluded based on a priori established eligibility criteria. The relevant data will then be extracted, quality appraised, and narratively synthesised. The synthesis will be guided by the theoretical framework developed for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Equity extension (PRISMA-E) guidance will be followed. This protocol has been registered on PROSPERO, ID: CRD42022334223.
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Affiliation(s)
- Amber Sacre
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle NE3 3XT, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle NE3 3XT, UK
| | - Josephine M. Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle NE3 3XT, UK
| | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle NE1 7RU, UK
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Adeyanju GC, Sprengholz P, Betsch C. Understanding drivers of vaccine hesitancy among pregnant women in Nigeria: A longitudinal study. NPJ Vaccines 2022; 7:96. [PMID: 35977958 PMCID: PMC9385635 DOI: 10.1038/s41541-022-00489-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/11/2022] [Indexed: 11/11/2022] Open
Abstract
Vaccine-preventable-diseases are major contributors to disease burden in Sub-Saharan Africa. There is dearth of knowledge on the drivers of childhood vaccine hesitancy in Nigeria and its impact on coverage. Although understudied, pregnant women are a particularly important vulnerable group and very relevant for childhood vaccination decisions. This study’s aims are to adapt Confidence, Complacency, Constraints, Calculation, and Collective Responsibility, also known as the 5C psychological antecedence scale for the Nigerian context and to measure predictors of intention to vaccinate among pregnant women (prenatal) and subsequent vaccination behavior (postnatal). It is a longitudinal study that used multi-stage sampling procedure. One healthcare facility was selected from each district in five regional clusters, from which 255 pregnant women were randomly drawn. A standardized questionnaire was used to collect relevant data, including the 5C and some additional variables. Multiple linear regression using backward elimination analysis was performed to identify intention at prenatal and behavior at postnatal. Pregnant women’s intention to vaccinate unborn children was lower if they were Muslims, had lower confidence in public health system, if husband approval was important, and if they believed in rumor. At postnatal, vaccination behavior was more likely to follow mothers’ religious beliefs, when confidence in vaccine effectiveness was high and when mothers felt responsible for the collective. However, everyday stress (constraints) related to less vaccination behavior, and intention did not predict actual vaccination behavior. The 5C scale needs revision before being widely used in Nigeria. Yet, it is a better tool for measuring vaccination behavior than intention.
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Affiliation(s)
- Gbadebo Collins Adeyanju
- Psychology and Infectious Disease Lab (PIDI), Media and Communication Science, University of Erfurt, Erfurt, Germany. .,Centre for Empirical Research in Economics and Behavioral Science (CEREB), University of Erfurt, Erfurt, Germany. .,Bernhard Nocht Institute of Tropical Medicine (BNITM), Hamburg, Germany.
| | - Philipp Sprengholz
- Psychology and Infectious Disease Lab (PIDI), Media and Communication Science, University of Erfurt, Erfurt, Germany.,Centre for Empirical Research in Economics and Behavioral Science (CEREB), University of Erfurt, Erfurt, Germany.,Bernhard Nocht Institute of Tropical Medicine (BNITM), Hamburg, Germany
| | - Cornelia Betsch
- Psychology and Infectious Disease Lab (PIDI), Media and Communication Science, University of Erfurt, Erfurt, Germany.,Centre for Empirical Research in Economics and Behavioral Science (CEREB), University of Erfurt, Erfurt, Germany.,Bernhard Nocht Institute of Tropical Medicine (BNITM), Hamburg, Germany
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12
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Shao W, Chen X, Zheng C, Wang G, Zhang B, Zhang W. Pneumococcal vaccination coverage and willingness in mainland China. Trop Med Int Health 2022; 27:864-872. [PMID: 35942809 DOI: 10.1111/tmi.13809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To estimate the coverage and willingness of pneumococcal vaccination and further explore the influencing factors of vaccination willingness among people in mainland China. METHODS Literature searches were conducted independently by two researchers in English- and Chinese-language databases from database inception to October 6, 2021. A random-effects meta-analysis model was used to derive summary vaccination coverage and willingness. Predefined subgroup analysis and meta-regression were performed to explore the sources of heterogeneity. RESULTS 97 studies were included in this meta-analysis. The summary vaccination coverage in 76 included studies was 21.7% (95% CI: 17.2 - 26.5%). Subgroup analysis shows that the summary coverage was 29.0% (95% CI, 20.4 - 39.1%) among permanent residents and 20.7% (95% CI, 12.4 - 35.9%) among floating residents. The eastern and central regions presented higher coverage than the western region. Notable differences were observed between the various study populations. 27 studies provided an estimation of vaccination willingness, with a summary willingness of 51.2% (95% CI, 40.4 - 61.9%). In subgroup analysis the summary willingness was 57.9 % (95% CI, 48.3 - 67.2%) in urban areas and 52.3 % (95% CI, 40.8 - 63.8%) in rural areas. Parents with children and people with a history of pneumonia were more willing to be vaccinated than the elderly. Recommendations by family members and physicians, previous pneumococcal and influenza vaccination, perceived vaccination effectiveness and severity of disease and a history of pneumonia contributed to vaccination willingness. CONCLUSIONS Compared to global estimates and to other countries, pneumococcal vaccination coverage and willingness are at a lower level in mainland China. Recommendations for vaccination by family members and doctors, a history of vaccination and the perception of pneumonia and vaccination are associated with greater willingness to be vaccinated. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Weihao Shao
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaorui Chen
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Caifang Zheng
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Gaili Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bowen Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weidong Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China
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13
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Analysis on vaccine hesitation and its associated factors among parents of preschool children in Songgang Street, Shenzhen. Sci Rep 2022; 12:9467. [PMID: 35676508 PMCID: PMC9176158 DOI: 10.1038/s41598-022-12530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
China has the largest number of vaccinated population around the world. However, there has been few research on the prevalence and associated factors of vaccine hesitation among parents of preschool children. Therefore, we conducted this study to evaluate the status of vaccine hesitation and its associated factors among children’s parents. A cluster random sampling method was adopted to select six community health service centers in Shenzhen, and parents of preschool children who were immunized in the vaccination outpatient department of the selected community health centers were surveyed using a structured self-administered questionnaire. Vaccine hesitation was assessed by the Parent Attitudes about Childhood Vaccines (PACV) scale. A multiple linear regression analysis was used to assess the associated factors for vaccine hesitance among children's parents. A total of 1025 parents (response rate, 93.18%) filled out the questionnaires. The average score of vaccine hesitancy was 43.37 (SD = 10.34) points. 23.61% of parents wanted children to get all the recommended shots, 53.76% of them did not believe that many of the illnesses shots prevent were severe, and 75.41% of them could not guarantee the information they receive about shots. The results of multiple linear regression showed that the number of children in the family (β = −0.93, 95% CI: −1.31 to 0.54), health status of the child (β = 0.47, 95% CI: 0.07 to 0.87), education level of the parents (Father: β = −0.84, 95%CI: −1.37 to 0.31; Mother: = −1.59, 95%CI:−2.13 to −1.05), and annual family income (β = 1.64, 95%CI: 1.13–2.16) were significantly associated with vaccine hesitation. The average score of parents' vaccine hesitation in Shenzhen was 43.37. The results showed that the number of children in the family, health status of the children, education level of the parents and annual family income were important factors associated with the parents' vaccine hesitation.
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14
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Budu E, Opoku Ahinkorah B, Okyere J, Seidu AA, Ofori Duah H. Inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana, 1993–2014. Vaccine 2022; 40:3614-3620. [DOI: 10.1016/j.vaccine.2022.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/17/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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Yibeltal K, Tsegaye S, Zelealem H, Worku W, Demissie M, Worku A, Berhane Y. Trends, projection and inequalities in full immunization coverage in Ethiopia: in the period 2000-2019. BMC Pediatr 2022; 22:193. [PMID: 35410186 PMCID: PMC8995890 DOI: 10.1186/s12887-022-03250-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization is among the most cost-effective health interventions to improve child survival. However, many countries in sub-Saharan Africa failed to achieve their national and international coverage targets repeatedly. The present study investigated trends of coverage and inequalities in coverage in Ethiopia. METHODS This study used data from five rounds of the Demographic and Health Surveys conducted in Ethiopia in 2000, 2005, 2011, 2016, and 2019. The surveys used a multistage cluster sampling procedure to obtain a nationally and sub-nationally representative data. The outcome variables included in the study were full immunization coverage and inequality. The World Health Organization's Health Equity Assessment Toolkit was used to conduct the inequality analysis. Projections for 2025 were based on smoothed averages generated using the demographic and health survey data from 2000 to 2019. RESULTS The full (basic) immunization coverage in Ethiopia has increased steadily from 14.3% in 2000 to 44.1% in 2019. Based on the average past performance, the immunization coverage is projected to reach 53.6% by 2025, which will be short of the 75% national full (basic) immunization coverage target for the year 2025. Mothers with higher levels of education are more likely to get their children all basic vaccinations than those with lower levels of education. Similarly, the inequality gaps due to wealth and residency are significant; where children in the lowest wealth strata and those living in rural areas remained disadvantaged. CONCLUSION Despite a steady increase in immunization coverage in the past two decades the country is yet to achieve its immunization target. Thus, more efforts are needed to achieve the current and future national immunization targets. A more focused intervention targeting the disadvantaged groups could be an effective strategy to achieve coverage and minimize the inequality gaps in immunization.
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Affiliation(s)
- Kalkidan Yibeltal
- Department Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
| | - Sitota Tsegaye
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hasset Zelealem
- Department of Epidemiology, Georgia State University School of Public Health, Atlanta, USA
| | - Walelegn Worku
- Department of Global health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Meaza Demissie
- Department of Global health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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16
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Women's Empowerment and Children's Complete Vaccination in the Democratic Republic of the Congo: A Cross-Sectional Analysis. Vaccines (Basel) 2021; 9:vaccines9101117. [PMID: 34696225 PMCID: PMC8540931 DOI: 10.3390/vaccines9101117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The empowerment of women contributes to better child health and wellness. This study aimed to examine the association between women’s empowerment and complete vaccination of children, as recommended in the National Expanded Program on Immunization (EPI) in the Democratic Republic of the Congo (DRC). (2) Methods: In this cross-sectional study, a principal component analysis (PCA) was conducted on data from the Multiple-Indicator Cluster Survey 6 (MICS-6) to determine the dimensions of women’s empowerment. Logistic regression analysis was used to assess the association between women’s empowerment and complete vaccination of children stratified by household wealth. In total, 3524 women with children aged 12–23 months were included in the study. (3) Results: Women’s empowerment was defined by three dimensions, namely intrinsic agency, enabling resources, and social independence. Children of women with high levels of empowerment had higher odds of complete vaccination, with values of 1.63 (p = 0.002) and 1.59 (p = 0.012) for intrinsic agency and enabling resources of the empowerment, respectively, compared to the children of women with low levels of empowerment; however, social independence failed to be associated with the vaccination status of children. After stratification by household wealth, the OR of complete vaccination was higher in women from middle-income households with high levels of intrinsic agency (OR: 2.35, p = 0.021) compared to women from poor households with high levels of intrinsic agency (OR: 1.92, p = 0.004). (4) Conclusions: Higher levels of women’s empowerment, especially intrinsic agency and enabling resources, were associated with complete vaccination in children in the DRC. Household wealth status influenced the associations. The empowerment of women is crucial in promoting the complete vaccination of children and providing equal access to vaccines.
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Olakunde BO, Adeyinka DA, Olakunde OA, Ogundipe T, Oladunni F, Ezeanolue EE. The coverage of hepatitis B birth dose vaccination in Nigeria: Does the place of delivery matter? Trans R Soc Trop Med Hyg 2021; 116:359-368. [PMID: 34453162 DOI: 10.1093/trstmh/trab129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hepatitis B birth dose (HepB-BD) vaccination coverage remains suboptimal in Nigeria. While evidence suggests that institutional delivery is associated with the uptake of HepB-BD vaccine, little is known about how the uptake differs by facility ownership (public or private). This study examined the HepB-BD vaccination coverage by place of delivery in Nigeria. METHODS This study is a secondary analysis of data on 6143 children aged 12-23 mo obtained from the 2018 Nigeria Demographic and Health Survey. We assessed the association between HepB-BD vaccination and the place of delivery using logistic regression models. RESULTS About 53% of the children received the HepB-BD vaccine. Approximately 77, 83 and 33% of those delivered at a public health facility, private health facility and at home received the HepB-BD vaccine, respectively. After controlling for child- and maternal-level factors, the odds of receiving HepB-BD vaccine were significantly lower in children delivered at a private health facility (adjusted OR [aOR]=0.77, 95% CI 0.59 to 0.99) or at home (aOR=0.48, 95% CI 0.36 to 0.63). Wealth index and region of residence were significantly associated with the receipt of HepB-BD vaccination in all three places of delivery. CONCLUSIONS Children are less likely to receive the HepB-BD vaccine if they are delivered at a private health facility or at home. There is a need for private health sector engagement for immunization service delivery and innovative community-based interventions to reach the children delivered at home.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja 900284, Nigeria.,Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu 410101, Nigeria
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon SK S7B 5E5, Canada.,Department of Public Health, National AIDS and STI Control Programme, Federal Ministry of Health, Abuja 900211, Nigeria
| | - Olubunmi A Olakunde
- Department of Disease Control and Immunization, Ondo State Primary Health Care Development Agency, Akure, Ondo 340222, Nigeria
| | - Temitayo Ogundipe
- Department of Hospital Medicine, Sentara Williamsburg Regional Medical Center, VA 23188, USA
| | - Filani Oladunni
- Department of Community and Family Medicine, Howard University Hospital, Washington, DC 20060, USA
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu 410101, Nigeria.,Healthy Sunrise Foundation, NV 89107, USA
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18
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Mutyoba JN, Surkan PJ, Makumbi F, Aizire J, Kirk GD, Ocama P, Atuyambe LM. Hepatitis B birth dose vaccination for newborns in Uganda: A qualitative inquiry on pregnant women's perceptions, barriers and preferences. J Virus Erad 2021; 7:100039. [PMID: 34026246 PMCID: PMC8122110 DOI: 10.1016/j.jve.2021.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa continues with very low hepatitis B (HBV) birth dose vaccination coverage. To guide policy on HBV vaccine for newborns, we explored perceptions, barriers and preferences of pregnant women regarding HBV and the HBV birth dose vaccination. METHODS We conducted eight focus groups discussions (FGDs) among 70 pregnant women, stratified by rural-urban residence, age and education level, using a structured focus group discussion guide to explore birth dose awareness, perceptions, barriers and preferences. Data were transcribed, coded and analysed using framework analysis. RESULTS Perceptions related to HBV and liver cancer causes and prevention were diverse; most FGD participants did not perceive illnesses as distinctly different. Older women-groups, both urban and rural, had never heard about HBV, but were aware of liver cancer, viewing the disease as fatal. No FGD participants were aware of HBV birth dose. Concerns included vaccine safety, its availability to women who deliver outside the health system and mistrust in health-care worker (HCWs) when handling newborns. Rural-dwelling groups perceived absence of HBV services, while FGDs with young participants believed vaccine side-effects hampered birth dose planning. Most women-groups preferred (i) oral to injectable vaccines; (ii) receiving birth dose education during antenatal, to media-based education; (iii) that newborns receive the birth dose immediately after delivery in the mother's presence. CONCLUSION Although the birth dose is acceptable among pregnant women, planners need to continuously engage them as key stakeholders during planning to address concerns, in order to raise confidence, maximize uptake and strengthen HBV eradication efforts.
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Affiliation(s)
- Joan Nankya Mutyoba
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Fredrick Makumbi
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Jim Aizire
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ponsiano Ocama
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lynn M. Atuyambe
- Department of Community Health & Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Olaniyan A, Isiguzo C, Hawk M. The Socioecological Model as a framework for exploring factors influencing childhood immunization uptake in Lagos state, Nigeria. BMC Public Health 2021; 21:867. [PMID: 33952252 PMCID: PMC8098781 DOI: 10.1186/s12889-021-10922-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies’ interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders’ perspectives using the Socioecological Model (SEM). Methods Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods. Results The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers’ knowledge of vaccination. Conclusions The reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria’s suboptimal immunization coverage.
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA.
| | - Chinwoke Isiguzo
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
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20
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Rapidly modifiable factors associated with full vaccination status among children in Niamey, Niger: A cross-sectional, random cluster household survey. PLoS One 2021; 16:e0249026. [PMID: 33788877 PMCID: PMC8011818 DOI: 10.1371/journal.pone.0249026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Vaccination status becomes more equitable when interventions are carried out to eliminate poverty or to improve levels in maternal education. Low-income countries need to identify interventions that would have a more immediate and equitable effect. The present study aimed to identify rapidly modifiable factors associated with full vaccination status among children in Niamey, Niger. Methods A cross-sectional, random cluster household survey was conducted in Niamey’s five health districts. Data on vaccination coverage and socioeconomic household characteristics were collected. Logistic regression analysis was conducted with data on 445 mothers and their children aged 12–23 months. Results Of 445 children, 38% were fully vaccinated. Mothers who were satisfied with their health worker’s attitude and had correct vaccination calendar knowledge (adjusted odds ratio [aOR] 5.32, 95% confidence interval [CI] 2.05–13.82) were more likely to have fully vaccinated children. Mothers who had completed secondary school (aOR 2.04, 95% CI 1.17–3.55) were also associated with having fully vaccinated children. Conclusions A higher rate of full vaccination among children could be achieved by relatively short-term modifiable factors. These modifiable factors are mothers’ satisfaction with health workers’ attitudes and knowledge of the vaccination calendar. Maternal satisfaction with health workers’ attitudes could be improved through better interpersonal communication between health workers and mothers. Specifically, mothers should be given specific information on time intervals between appointments. Strengthened communication interventions may be effective in improving both the acceptability of health services and low vaccination coverage.
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21
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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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Porth JM, Wagner AL, Moyer CA, Mutua MK, Boulton ML. Women's Empowerment and Child Vaccination in Kenya: The Modifying Role of Wealth. Am J Prev Med 2021; 60:S87-S97. [PMID: 33189504 DOI: 10.1016/j.amepre.2020.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although vaccination coverage is high in Kenya relative to other African nations, undervaccinated children remain, making it important to identify characteristics of these children and their caregivers. Potentially relevant but understudied factors are women's empowerment and early marriage. Women who marry older and have more autonomous decision-making authority may be better able to ensure their children receive health services, including immunizations. This analysis examines the relationship between early marriage and multiple dimensions of women's empowerment and child vaccination status in Kenya and explores whether these relationships are modified by wealth. METHODS Data were from the 2014 Kenya Demographic and Health Survey. The analysis was completed in 2020 using updated data made available to researchers in 2019. Logistic regressions assessed relationships among early marriage, 3 dimensions of women's empowerment (enabling conditions, intrinsic agency, and instrumental agency), and child vaccination. Analyses were stratified by wealth to explore potential effect modification. RESULTS For women in the middle wealth tertile, the odds of having a fully vaccinated child were 3.45 (95% CI=1.51, 7.91) times higher for those with higher versus lower empowerment. Further, among the wealthiest women, those with middle empowerment were 5.99 (95% CI=2.06, 17.40) times more likely to have a fully vaccinated child than women with lower empowerment. CONCLUSIONS Results suggest a threshold effect of wealth's role in the relationship between empowerment and vaccination. Enabling conditions may not influence immunization among the poorest women but exert a stronger positive influence on childhood vaccination among wealthier women. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Shenton LM, Wagner AL, Ji M, Carlson BF, Boulton ML. Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review. BMJ Open 2020; 10:e039693. [PMID: 33268412 PMCID: PMC7713201 DOI: 10.1136/bmjopen-2020-039693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status. DESIGN Scoping review. DATA SOURCES Electronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018. STUDY SELECTION All English studies with vaccination status as the outcome and the use of DHS data. DATA EXTRACTION Studies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted. RESULTS A total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1-86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO's Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child's sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition. CONCLUSIONS Researchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Dougherty L, Abdulkarim M, Ahmed A, Cherima Y, Ladan A, Abdu S, Kilgori B, Olayinka F, Garr S, Gilroy KE. Engaging traditional barbers to identify and refer newborns for routine immunization services in Sokoto, Nigeria: a mixed methods evaluation. Int J Public Health 2020; 65:1785-1795. [PMID: 33140237 PMCID: PMC7716909 DOI: 10.1007/s00038-020-01518-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study evaluates the effectiveness of an intervention that engaged traditional barbers to inform parents about the importance of vaccination and then refer newborns for vaccination services. METHODS We conducted a pre-post quasi-experimental study (n = 2639) to evaluate changes in the coverage of three birth antigens among children aged 0-5 months in response to the intervention. We also conducted in-depth interviews and focus group discussions to assess the enabling factors and challenges associated with implementation. RESULTS We found mothers who received a yellow referral card from a traditional barber were two to three times more likely to vaccinate their children with the three birth antigens. Qualitative findings indicated that the intervention influenced parent's decision to vaccinate their newborn because the barbers were considered a trusted community advisor. Challenges stemmed from the low levels of literacy among community leaders and barbers that resulted in the need for continuous training, low-literacy training materials and supervision. CONCLUSIONS Efforts to increase vaccine coverage rates in northern Nigeria should consider expanding the role of traditional barbers to encourage parents to accept vaccines.
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Affiliation(s)
- Leanne Dougherty
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA.
| | - Masduk Abdulkarim
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Aliyu Ahmed
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Yakubu Cherima
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Aliyu Ladan
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Sale Abdu
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Bello Kilgori
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Folake Olayinka
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Sani Garr
- Data Research and Mapping Consult Ltd, Lagos, Nigeria
| | - Kate E Gilroy
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
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Nda'chi Deffo R, Fomba Kamga B. Do the dynamics of vaccine programs improve the full immunization of children under the age of five in Cameroon? BMC Health Serv Res 2020; 20:953. [PMID: 33059665 PMCID: PMC7558738 DOI: 10.1186/s12913-020-05745-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Among the eight Millennium Development Goals (MDGs), three were devoted to health. Two amongst which MDG4 in relation to the reduction of infant mortality has not been achieved in Least Developed Countries (LDC). In Africa, a significant part of infant mortality is due to vaccine-preventable diseases administered free of charge by the Extended Program on Immunization (EPI). As such, in the “social equity” pillar of Sustainable Development Goals (SDG), the MDGs related to health have yet been taken into account. The achievement of these objectives requires an understanding of the immunization behavior of children under 5 years of age through an analysis of immunization dynamics between 1991 and 2011. Methods We use data from Demographic and Health Surveys (DHS) of 1991, 1998, 2004 and 2011 carried out by the National Institute of Statistics (NIS). The module concerning EPI vaccines was administered to 3350, 2317, 8125 and 25,524 under 5 in 1991, 1998, 2004 and 2011 respectively. The Immunization analysis was made from the logistic model for complete immunization and the Oaxaca’s decomposition to assess the contribution of the unexplained part, which is that of the strategies/programs implemented between 1991 and 2011 by the EPI to improve immunization. Results In general, children with vaccination card are more than 7 times likely to be fully immunized than their counterparts who do not have any. This result was higher in 1991 (approximately 57) and lowest in 2011 (5). In addition, the child’s birth order reduces his/her probability of being fully immunized and the impact increases with the latter’s birth order. On the other hand, the mother’s age as well as her level of education increase the child’s likelihood of receiving all basic vaccines. Moreover, the contributions of EPI partners in terms of immunization support as well as strategies to promote immunization through communication for development are of a particular importance in increasing immunization coverage. They significantly explain 67.62% of the 0.105 gain recorded within the 2011–2004 period and 72.46% of the 0.069 gain recorded within the 2004–1998 period. Conclusion The contribution of EPI partner organizations is fundamental for the achievement of EPI objectives. Since they contribute to increase the likelihood of fully immunized children. The link with child immunization is done through the specific characteristics to the mother.
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Affiliation(s)
- Rodrigue Nda'chi Deffo
- Faculty of Economics and Management, University of Yaounde II, Yaounde, Cameroon. .,Applied Microeconomics Research Laboratory, P.O. Box 14442, Yaounde, Cameroon.
| | - Benjamin Fomba Kamga
- Faculty of Economics and Management, University of Yaounde II, Yaounde, Cameroon.,Applied Microeconomics Research Laboratory, P.O. Box 14442, Yaounde, Cameroon.,IZA Institute of Labor Economics, Schaumburg-Lippe-Straße 5-9, 53113, Bonn, Germany
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Dougherty L, Gilroy K, Olayemi A, Ogesanmola O, Ogaga F, Nweze C, Banerjee J, Oduenyi C, Pacqué M. Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria. BMC Public Health 2020; 20:746. [PMID: 32448259 PMCID: PMC7245913 DOI: 10.1186/s12889-020-08536-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/16/2020] [Indexed: 03/18/2023] Open
Abstract
Background Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality. Methods This qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria’s Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers’ recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services. Results Parents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist. Conclusion We conclude that care-seeking decisions do not follow a linear process; that intra-household decision-making processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in care-seeking decision-making, and seeking biomedical care, is deserving of future study.
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Affiliation(s)
- Leanne Dougherty
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA.
| | - Kate Gilroy
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Abimbola Olayemi
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | | | - Felix Ogaga
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Chinwe Nweze
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | | | | | - Michel Pacqué
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
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Debie A, Lakew AM, Tamirat KS, Amare G, Tesema GA. Complete vaccination service utilization inequalities among children aged 12-23 months in Ethiopia: a multivariate decomposition analyses. Int J Equity Health 2020; 19:65. [PMID: 32398089 PMCID: PMC7218567 DOI: 10.1186/s12939-020-01166-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/18/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although World Health Organization works to make vaccination service available to everyone everywhere by 2030, majority of the world's children have been unvaccinated and unprotected from vaccine-preventable diseases. In fact, evidences on factors contributing to changes in vaccination coverage across residential areas, wealth categories and over time have not been adequate. Therefore, this study aimed at investigating inequalities in vaccination status of children aged 12-23 months owing to variations in wealth status, residential areas and over time. METHODS Maternal and child health service data were extracted from the 2011 and 2016 Ethiopian Demographic and Health Survey datasets. Then, multivariate decomposition analysis was done to identify the major factors contributing to differences in the rate of vaccination utilization across residences and time variations. Similarly, a concentration index and curve were also done to identify the concentration of child vaccination status across wealth categories. RESULTS Among children aged 12-23 months, the prevalence of complete childhood vaccination status increased from 20.7% in rural to 49.2% in urban in 2011 and from 31.7% in rural to 66.8% in urban residences in 2016. The decomposition analyses indicated that 72% in 2011 and 70.5% in 2016 of the overall difference in vaccination status was due to differences in respondent characteristics. Of the changes due to the composition of respondent characteristics, such as antenatal care and place of delivery were the major contributors to the increase in complete childhood vaccination in 2011, while respondent characteristics such as wealth index, place of delivery and media exposure were the major contributors to the increase in 2016. Of the changes due to differences in coefficients, those of low wealth status in 2016 across residences significantly contributed to the differences in complete childhood vaccination. On top of that, from 2011 to 2016, there was a significant increment in complete childhood vaccination status and a 59.8% of the overall increment between the surveys was explained by the difference in composition of respondents. With regard to the change in composition, the differences in composition of ANC visit, wealth status, place of delivery, residence, maternal education and media exposure across the surveys were significant predictors for the increase in complete child vaccination over time. On the other hand, the wealth-related inequalities in the utilization of childhood vaccination status were the pro-rich distribution of health services with a concentration index of CI = 0.2479 (P-value < 0.0001) in 2011 and [CI = 0.1987; P-value < 0.0001] in 2016. CONCLUSION A significant rural-urban differentials was observed in the probability of a child receiving the required childhood vaccines. Children in urban households were specifically more likely to have completed the required number of vaccines compared to the rural areas in both surveys. The effect of household wealth status on the probability of a child receiving the required number of vaccines are similar in the 2011 and 2016 surveys, and the vaccination status was high in households with high wealth status. The health policies aimed at reducing wealth related inequalities in childhood vaccination in Ethiopia need to adjust focus and increasingly target vulnerable children in rural areas. It is of great value to policy-makers to understand and design a compensation mechanism for the costs incurred by poor households. Special attention should also be given to rural communities through improving their access to the media. The findings highlight the importance of women empowerment, for example, through education to enhance childhood vaccination services in Ethiopia.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Obanewa OA, Newell ML. The role of place of residency in childhood immunisation coverage in Nigeria: analysis of data from three DHS rounds 2003-2013. BMC Public Health 2020; 20:123. [PMID: 31996184 PMCID: PMC6988360 DOI: 10.1186/s12889-020-8170-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background In 2017, about 20% of the world’s children under 1 year of age with incomplete DPT vaccination lived in Nigeria. Fully-immunised child coverage (FIC), which is the percentage of children aged 12–23 months who received all doses of routine infant vaccines in their first year of life in Nigeria is low. We explored the associations between child, household, community and health system level factors and FIC, in particular focussing on urban formal and slum, and rural residence, using representative Nigeria Demographic Health Survey (NDHS) data from 2003, 2008 and 2013. Method Multilevel logistic regression models were applied for quantitative analyses of NDHS 2003, 2008 and 2013 data, singly, pooled overall and stratified by rural/urban, and within urban by formal and slum. We also quantify Population Attributable Risk (PAR) of FIC. Results FIC for rural, urban formal and slum rose from 7.4, 25.6 and 24.9% respectively in 2003 to 15.8, 45.5 and 38.5% in 2013, and varied across sociodemographics. In pooled NDHS analysis, overall and stratified, final FIC adjusted odds (aOR) were: 1. Total population - delivery place (health facility vs home, aOR = 1.13, 95% CI = 0.73–1.73), maternal education (higher vs no education, aOR = 3.92, 95% CI = 1.79–8.59) and place of residence (urban vs rural, aOR = 1.69, 95% CI = 0.89–3.22). 2. Rural, urban formal and slum stratified: A.Rural – delivery place (aOR = 1.47, 95% CI = 1.12–1.94), maternal education (aOR = 4.99, 95% CI = 2.48–10.06). B.Urban formal - delivery place (aOR = 2.62, 95% CI = 1.43–4.79), maternal education level (aOR = 9.18, 95% CI = 3.05–27.64). C.Slums - delivery place (aOR = 5.39, 95% CI = 2.18–13.33), maternal education (aOR = 5.03, 95% CI = 1.52–16.65). The PAR revealed the highest percentage point increase in FIC would be achieved in all places of residence by maternal higher education: rural-38.15, urban formal-22.88 and slum 23.76, while non-attendance of antenatal care was estimated to lead to the largest reduction in FIC. Conclusion Although low FIC in rural areas may be largely due to lack of health facilities and immunisation education, the intra-urban disparity is mostly unexplained, and requires further qualitative and interventional research. We show the FIC point increase that can be achieved if specific sociodemographic variable (risk) are addressed in the various communities, thus informing prioritisation of interventions.
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Affiliation(s)
- Olayinka Aderopo Obanewa
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Marie Louise Newell
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Santoso MV, Kerr RB, Hoddinott J, Garigipati P, Olmos S, Young SL. Role of Women's Empowerment in Child Nutrition Outcomes: A Systematic Review. Adv Nutr 2019; 10:1138-1151. [PMID: 31298299 PMCID: PMC6855975 DOI: 10.1093/advances/nmz056] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/26/2019] [Indexed: 01/20/2023] Open
Abstract
Women's empowerment has gained attention as critical for child nutrition during the first 1000 days of life. However, the ways in which various women's empowerment measures are applied and the evidence for how they are differentially related to child nutrition is unclear. In this systematic review, therefore, we 1) systematically parse the many ways in which women's empowerment has been quantitatively measured in the context of child nutrition through the use of a theoretically driven application of dimensions and domains of empowerment; 2) summarize evidence for each of the various pathways between women's empowerment and child nutrition, based on dimensions and domains of empowerment; and 3) offer suggestions for future research to better articulate the relationship between women's empowerment and child nutrition. A search of evidence yielded 62 quantitative studies that used 200 unique indicators of women's empowerment, tested in 1316 associations with various child nutrition outcomes. Despite the large number of unique indicators, indicators for time resource allocation and reproductive decisions and indicators for men's engagement in child care and nutrition, all pertinent to child nutrition, were missing. Overall, the findings indicated an inconclusive relationship between women's empowerment and child nutrition: 379 out of 461 (82% weighted) and 217 out of 258 (84% weighted) associations found with stunting and wasting outcomes, respectively, were not significant. The current lack of evidence is likely not due to the absence of an underlying relationship between women's empowerment and child nutrition, but rather limitations in study design. Future research should carefully select women's empowerment indicators in context-specific ways, aggregate them meaningfully, and use a longitudinal study design to conduct pathway and lifecycle analysis in appropriate populations to clarify the relationship between women's empowerment and child nutrition.
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Affiliation(s)
| | - Rachel Bezner Kerr
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Priya Garigipati
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Sophia Olmos
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA,Institute of Policy Research, Northwestern University, Evanston, IL, USA,Address correspondence to SLY (e-mail: )
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Limaye RJ, Sara AB, Siddique AR, Vivas C, Malik S, Omonoju K. Interpersonal and community influences affecting childhood vaccination decision-making among Nigerian caregivers: Perceptions among frontline workers in Nigeria. J Child Health Care 2019; 23:403-414. [PMID: 31122059 DOI: 10.1177/1367493519852457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although routine immunization has contributed to a substantial reduction in mortality from vaccine-preventable diseases globally, vaccine-preventable diseases are attributable for 22% of childhood deaths in Nigeria. Individual and structural level factors that influence vaccination uptake in Nigeria have been well documented. However, there is limited information about the role of interpersonal and community level factors. Frontline workers play a crucial role in delivering life-saving vaccines in Nigeria, as they are tasked with ensuring that all children are vaccinated, within the health system as well as traveling to underserved areas, where health systems are not able to reach. This qualitative study conducted focus groups to examine frontline workers' perceptions of influences affecting caregivers' vaccine-related decision-making. Community- and facility-based frontline workers (n = 47) identified village and community chiefs, as well as religious leaders as influential within the context of immunization uptake because of their trusted role within communities. Male partners and husbands were identified as also holding an enormous level of influence over childhood vaccination, and the credibility of frontline workers influenced vaccination coverage. Immunization programs should target not only caregivers but also key influencers-such as interpersonal and community sources-to make progress in reaching vaccination coverage goals.
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Affiliation(s)
- Rupali J Limaye
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Ballard Sara
- 2 Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | | | | | - Kanayo Omonoju
- 5 Centre for Communication and Social Impact, Abuja, Nigeria
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Sibeudu FT, Uzochukwu BS, Onwujekwe OE. Rural-urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria. SAGE Open Med 2019; 7:2050312118823893. [PMID: 30719291 PMCID: PMC6348577 DOI: 10.1177/2050312118823893] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives: The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas. Method: The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses. Result: Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05). Conclusion: Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.
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Affiliation(s)
- Florence Tochukwu Sibeudu
- Department of Nursing Science, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Benjamin Sc Uzochukwu
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna E Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
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Hu Y, Liang H, Wang Y, Chen Y. Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092000. [PMID: 30217080 PMCID: PMC6164817 DOI: 10.3390/ijerph15092000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/20/2022]
Abstract
Objective: The objectives of this study were to determine the degree and risk factors of the inequity in the childhood coverage of full primary immunization (FPI) in Zhejiang province. Method: We used data from two rounds of vaccination coverage surveys among children aged 24–35 months conducted in 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality, and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in the coverage of FPI. Results: The coverage rates of FPI were 80.6%, with a CI value of 0.12028 for the 2014 survey, while the coverage rates of FPI were 85.2%, with a CI value of 0.10129 for the 2017 survey. The results of decomposition analysis suggested that 68.2% and 67.1% of the socioeconomic inequality in the coverage of FPI could be explained by the mother’s education level for the 2014 and 2017 survey, respectively. Other risk factors including birth order, ethnic group, mother’s age, maternal employment status, residence, immigration status, GDP per-capita, and the percentage of the total health spending allocated to public health could also explain this inequality. Conclusion: The socioeconomic inequity in the coverage of FPI still remained, although this gap was reduced between 2014 and 2017. Policy recommendations for health interventions on reducing the inequality in the coverage of FPI should be focused on eliminating poverty and women’s illiteracy.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou 310000, China.
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Shenton LM, Wagner AL, Carlson BF, Mubarak MY, Boulton ML. Vaccination status of children aged 1-4 years in Afghanistan and associated factors, 2015. Vaccine 2018; 36:5141-5149. [PMID: 30026033 DOI: 10.1016/j.vaccine.2018.07.020] [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: 03/14/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Childhood mortality in Afghanistan fell by half between 1990 and 2015, due in part to the government's commitment to improving pediatric immunization services. Although progress has been made, immunization coverage has nonetheless remained low with only 65% of children receiving the third dose of Diphtheria-Pertussis-Tetanus (DPT3) based on WHO estimates. This study aims to calculate the proportion of Afghan children aged 1-4 years who were fully vaccinated, under-vaccinated, or non-vaccinated with government-recommended Expanded Program on Immunization vaccines and identify predictors related to the family's sociodemographic status and maternal autonomy. METHODS Data from the 2015 Afghanistan Demographic and Health Survey was used to calculate the proportion of children who were fully vaccinated (i.e. received all recommended vaccines), under-vaccinated (i.e. received some, but not all), and non-vaccinated (i.e. did not receive any vaccines) according to WHO guidelines. A multivariable multinomial logistic regression model generated odds ratios for under-vaccination and non-vaccination versus full vaccination, and examined associations between independent factors and full vaccination status. RESULTS We found 40.6% of Afghan children age 1-4 were fully vaccinated, 42.4% under-vaccinated, and 17% non-vaccinated. Large disparities characterized immunization coverage among provinces and between urban and rural regions. Birthing in a government institution (vs. non-institutional setting), a higher number of antenatal care visits, and a visit to a health facility in the past 12 months were all associated with increased odds of full immunization. Factors related to maternal autonomy including maternal decision-making and maternal attitudes towards beating were also significantly associated with vaccination status. CONCLUSION Approximately 60% of children in Afghanistan are under-vaccinated or non-vaccinated, leaving millions of children unnecessarily at risk for vaccine-preventable diseases. Engagement with community and religious leaders to create programs that increase women's autonomy and expand access to institutional delivery could lead to downstream increases in childhood vaccination coverage.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Mohammad Yousuf Mubarak
- Department of Microbiology, Kabul University of Medical Science, Jamal Mina, 3rd District, Next to Ali Abad Teaching Hospital, Kabul, Afghanistan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Asuman D, Ackah CG, Enemark U. Inequalities in child immunization coverage in Ghana: evidence from a decomposition analysis. HEALTH ECONOMICS REVIEW 2018; 8:9. [PMID: 29644503 PMCID: PMC5895562 DOI: 10.1186/s13561-018-0193-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/25/2018] [Indexed: 05/14/2023]
Abstract
Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant inequalities in achieving universal coverage of child vaccination among and within countries. In this paper, we examine rural-urban inequalities in child immunizations in Ghana. Using data from the recent two waves of the Ghana Demographic and Health Survey, we examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas. We find significant child-specific, maternal and household characteristics on a child's immunization status. The results show that children in rural areas are more likely to complete the required vaccinations. The direction and sources of inequalities in child immunizations have changed between the two survey waves. We find a pro-urban advantage in 2008 arising from differences in observed characteristics whilst a pro-rural advantage emerges in 2014 dominated by the differences in coefficients. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas, to maintain focus on women empowerment and pay attention to children from high socio-economic households in less favourable economic times.
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Affiliation(s)
- Derek Asuman
- Institute of Statistical, Social and Economic Research, University of Ghana, E.N. Omaboe Building, P. O. Box LG 74, Legon, Ghana
| | - Charles Godfred Ackah
- Institute of Statistical, Social and Economic Research, University of Ghana, E.N. Omaboe Building, P. O. Box LG 74, Legon, Ghana
| | - Ulrika Enemark
- Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
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Shafiq Y, Khowaja AR, Yousafzai MT, Ali SA, Zaidi A, Saleem AF. Knowledge, attitudes and practices related to tetanus toxoid vaccination in women of childbearing age: A cross-sectional study in peri-urban settlements of Karachi, Pakistan. J Infect Prev 2018; 18:232-241. [PMID: 29317900 DOI: 10.1177/1757177416689722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022] Open
Abstract
Backgound A higher incidence of neonatal tetanus implies failure of the vaccination program in Pakistan. Objectives The objective of this study was to assess knowledge, attitudes and practices related to tetanus toxoid (TT) vaccine in women of childbearing age. Methods We performed a cross-sectional survey in peri-urban Karachi, Pakistan, among women of childbearing age, stratified into three mutually exclusive groups as: married pregnant; married non-pregnant; and unmarried. Descriptive and inferential analyses were performed to estimate vaccine coverage and knowledge attributes. Results A total of 450 women participated, of which the largest proportion were married and non-pregnant (n = 185/450, 41%). Over 50% of women (n = 258/450) had not received TT vaccine. Most unmarried women (n = 139, 97%) were unvaccinated. Non-vaccination predictors included: women aged <25 years without any formal education (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0-4.4), lack of knowledge about free vaccination (adjusted OR, 4.0; 95% CI, 1.64-10.20), poor knowledge of tetanus disease/vaccination (adjusted OR, 4.6; 95%, 2.2-9.6), living with extended family (adjusted OR, 2.0; 95% CI, 1.04-3.96); family non-supporting vaccination (adjusted OR, 5.7; 95% CI, 2.3-13.9); and husband/other family member deciding upon issues related to women's health (adjusted OR, 2.9; 95% CI, 1.3-6.6). Conclusion Low coverage of TT vaccine is largely influenced by poor knowledge, family structure and family decision-making in the local communities of Pakistan.
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Affiliation(s)
- Yasir Shafiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Asif Raza Khowaja
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Syed Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Faisal Saleem
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Forshaw J, Gerver SM, Gill M, Cooper E, Manikam L, Ward H. The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis. BMC Infect Dis 2017; 17:801. [PMID: 29281990 PMCID: PMC5745980 DOI: 10.1186/s12879-017-2890-y] [Citation(s) in RCA: 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: 02/21/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background There is an established correlation between maternal education and reduction in childhood mortality. One proposed link is that an increase in maternal education will lead to an increase in health care access and vaccine uptake. Vaccinations are a central preventative child health tool, therefore demonstrating the importance of understanding factors that can improve coverage. This review aims to establish if there is a correlation between increasing maternal education and vaccine uptake and if this varies between continents, setting and time. Methods An electronic database search was conducted using Medline Ovid, Embase and The Cochrane Library using a combination of keywords and appropriate MeSH terms for maternal education and child vaccination. Bibliographies were also hand searched. Data was extracted and entered onto a Microsoft Excel spreadsheet and analysed using STATA 13.0 software. The primary outcome of effect size of maternal education on completion of childhood vaccinations was analysed at different levels. Secondary outcomes were explored using subgroup analyses of differences between continents, rural or urban settings, and dates. Results The online search yielded 3430 papers, 37 were included in this study. The analysis showed increasing child vaccination uptake with increasing maternal education. Overall, analysis showed that the odds of full childhood vaccination were 2.3 times greater in children whose mother received secondary or higher education when compared to children whose mother had no education. There was large variability in the effect size between the studies included. Conclusions Improving maternal education is important for increasing childhood vaccination uptake and coverage. Further research is needed in higher income countries. Trial registration PROSPERO Registration No: CRD42016042409.
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Affiliation(s)
- Jennifer Forshaw
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Sarah M Gerver
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Moneet Gill
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Emily Cooper
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Logan Manikam
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Helen Ward
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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Uthman OA, Adedokun ST, Olukade T, Watson S, Adetokunboh O, Adeniran A, Oyetoyan SA, Gidado S, Lawoko S, Wiysonge CS. Children who have received no routine polio vaccines in Nigeria: Who are they and where do they live? Hum Vaccin Immunother 2017; 13:2111-2122. [PMID: 28665749 DOI: 10.1080/21645515.2017.1336590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nigeria has made remarkable progress against polio, but 2 wild polio virus cases were reported in August 2016; putting an end to 2 y without reported cases. We examined the extent of geographical disparities in childhren not vaccinated against polio and examined individual- and community-level predictors of non-vaccination in Nigeria. We applied multilevel logistic regression models to the recent Nigeria Demographic and Health Survey. The percentage of children not routinely vaccinated against polio in Nigeria varied greatly and clustered geographically, mainly in north-eastern states, with a great risk of spread of transmission within these states and potential exportation to neighboring states and countries. Only about one-third had received all recommended 4 routine oral polio vaccine doses. Non-vaccinated children tended to have a mother who had no formal education and who was currently not working, live in poorer households and were from neighborhoods with higher maternal illiteracy rates.
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Affiliation(s)
- Olalekan A Uthman
- a Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences , University of Warwick Medical School , Coventry , UK.,b Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Sulaimon T Adedokun
- a Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences , University of Warwick Medical School , Coventry , UK.,c Department of Demography and Social Statistics , Obafemi Awolowo University , Ile-Ife , Nigeria
| | - Tawa Olukade
- d Center for Evidence-Based Global Health , Ilorin , Kwara State , Nigeria
| | - Samuel Watson
- a Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences , University of Warwick Medical School , Coventry , UK
| | - Olatunji Adetokunboh
- e Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa
| | - Adeyinka Adeniran
- f Department of Community Health & Primary Healthcare , Lagos State University College of Medicine , Lagos , Nigeria
| | | | - Saheed Gidado
- h Lagos Mainland Local Government, Ebute Meta, Lagos, Nigeria ; Nigeria Field Epidemiology and Laboratory Training Programme , Abuja , Nigeria
| | - Stephen Lawoko
- i Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,j Faculty of Health Sciences , Victoria University , Kampala , Uganda
| | - Charles S Wiysonge
- b Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,k Cochrane South Africa , South African Medical Research Council , Cape Town , South Africa
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Oleribe O, Kumar V, Awosika-Olumo A, Taylor-Robinson SD. Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria. Pan Afr Med J 2017; 26:220. [PMID: 28690734 PMCID: PMC5491752 DOI: 10.11604/pamj.2017.26.220.11453] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/30/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Immunization is the world's most successful and cost-effective public health intervention as it prevents over 2 million deaths annually. However, over 2 million deaths still occur yearly from Vaccine preventable diseases, the majority of which occur in sub-Saharan Africa. Nigeria is a major contributor of global childhood deaths from VPDs. Till date, Nigeria still has wild polio virus in circulation. The objective of this study was to identify the individual and socioeconomic factors associated with immunization coverage in Nigeria through a secondary dataset analysis of Nigeria Demographic and Health Survey (NDHS), 2013. METHODS A quantitative analysis of the 2013 NDHS dataset was performed. Ethical approvals were obtained from Walden University IRB and the National Health Research Ethics Committee of Nigeria. The dataset was downloaded, validated for completeness and analyzed using univariate, bivariate and multivariate statistics. RESULTS Of 27,571 children aged 0 to 59 months, 22.1% had full vaccination, and 29% never received any vaccination. Immunization coverage was significantly associated with childbirth order, delivery place, child number, and presence or absence of a child health card. Maternal age, geographical location, education, religion, literacy, wealth index, marital status, and occupation were significantly associated with immunization coverage. Paternal education, occupation, and age were also significantly associated with coverage. Respondent's age, educational attainment and wealth index remained significantly related to immunization coverage at 95% confidence interval in multivariate analysis. CONCLUSION The study highlights child, parental and socioeconomic barriers to successful immunization programs in Nigeria. These findings need urgent attention, given the re-emergence of wild poliovirus in Nigeria. An effective, efficient, sustainable, accessible, and acceptable immunization program for children should be designed, developed and undertaken in Nigeria with adequate strategies put in place to implement them.
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Affiliation(s)
- Obinna Oleribe
- Excellence and Friends Management Care Centre (EFMC), Dutse Abuja FCT, Nigeria.,Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London
| | - Vibha Kumar
- Walden University, 100 Washington Ave S #900, Minneapolis, Minnesota, USA
| | - Adebowale Awosika-Olumo
- Walden University, 100 Washington Ave S #900, Minneapolis, Minnesota, USA.,GHMIGROUP INC, 3845 Cypress Creek Parkway #305, Houston, Tx 77068
| | - Simon David Taylor-Robinson
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London.,Faculty of Medicine, Imperial College London, St Mary's Hospital Campus, Norfolk Place, London W2 1PG, United Kingdom
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Ghosh A, Laxminarayan R. Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India. Vaccine 2017; 35:1087-1093. [PMID: 28081971 PMCID: PMC5297340 DOI: 10.1016/j.vaccine.2016.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette-Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3. METHODS We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007-08). RESULTS Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres. CONCLUSIONS Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals' background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.
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Affiliation(s)
- Arpita Ghosh
- Public Health Foundation of India, Gurgaon, Haryana, India.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton University, Princeton, NJ, USA.
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Landoh DE, Ouro-Kavalah F, Yaya I, Kahn AL, Wasswa P, Lacle A, Nassoury DI, Gitta SN, Soura AB. Predictors of incomplete immunization coverage among one to five years old children in Togo. BMC Public Health 2016; 16:968. [PMID: 27618851 PMCID: PMC5020474 DOI: 10.1186/s12889-016-3625-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incompleteness of vaccination coverage among children is a major public health concern because itcontinues to sustain a high prevalence of vaccine-preventable diseases in some countries. In Togo, very few data on the factors associated with incomplete vaccination coverage among children have been published. We determined the prevalence of incomplete immunization coverage in children aged one to five years in Togo and associated factors. METHODS This was a cross-sectional study using secondary data from the 2010 Multiple Indicator Cluster Surveys (MICS4) conducted in 2010 among children aged 1 to 5 years in Togo. This survey was conducted over a period of two months from September to November, 2010. RESULTS During Togo'sMICS4 survey, 2067 children met the inclusion criteria for our study. Female children accounted for 50.9 % (1051/2067) of the sample and 1372 (66.4 %) lived in rural areas. The majority of children (92.2 %; 1905/2067) lived with both parents and 30 % of the head of households interviewed were not schooled (620/2067). At the time of the survey, 36.2 % (750/2067) of the children had not received all vaccines recommended by Expanded Program on Immunization (EPI). In multivariate analysis, factors associated with incompleteness of immunization at 1 year were: health region of residences (Maritime aOR = 0.650; p = 0.043; Savanes: aOR = 0.324; p <0.001), non-schooled mother (aOR = 1.725; p = 0.002),standard of living (poor: aOR = 1.668; p = 0.013; medium: aOR = 1.393; p = 0.090) and the following characteristics of the household heads: sex (aOR = 1.465; p = 0.034), marital status (aOR = 1.591; p = 0.032), education level(non-educated: aOR = 1.435; p = 0.027. CONCLUSION The incomplete immunization coverage among children in Togo remains high. It is necessary to strengthen health promotion among the population in order to improve the use of immunization services that are essential to reduce morbidity and mortality among under five years old children.
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Affiliation(s)
| | | | - Issifou Yaya
- Aix-Marseille Université INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé &Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.,Unité de Recherche Démographique (URD) Université, Lomé, Togo
| | - Anna-Lea Kahn
- World Health Organization, Headquarters, Genève, Switzerland
| | - Peter Wasswa
- African Field Epidemiology Network (AFENET), Kampala, Uganda
| | - Anani Lacle
- Division de l'épidémiologie, Ministère de la Santé du Togo, Lomé, Togo
| | | | | | - Abdramane Bassiahi Soura
- Institut supérieur des sciences de la population (ISSP), ISSP, Université de Ouagadougou, Ouagadougou, Burkina Faso
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Shrestha S, Shrestha M, Wagle RR, Bhandari G. Predictors of incompletion of immunization among children residing in the slums of Kathmandu valley, Nepal: a case-control study. BMC Public Health 2016; 16:970. [PMID: 27619349 PMCID: PMC5020516 DOI: 10.1186/s12889-016-3651-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Immunization is one of the most effective health interventions averting an estimated 2–3 million deaths every year. In Nepal, as in most low-income countries, infants are immunized with standard WHO recommended vaccines. However, 16.4 % of children did not receive complete immunization by 12 months of age in Nepal in 2011. Studies from different parts of the world showed that incomplete immunization is even higher in slums. The objective of this study was to identify the predictors of incompletion of immunization among children aged 12–23 months living in the slums of Kathmandu Valley, Nepal. Methods The unmatched case-control study was conducted in 22 randomly selected slums of Kathmandu Valley. The sampling frame was first identified by complete enumeration of entire households of the study area from which 59 incompletely immunized children as cases and 177 completely immunized children as controls were chosen randomly in 1:3 ratio. Data were collected from the primary caretakers of the children. Backward logistic regression with 95 % confidence interval and adjusted odds ratio (AOR) were applied to assess the factors independently associated with incomplete immunization. Result Twenty-six percent of the children were incompletely vaccinated. The coverage of BCG vaccine was 95.0 % while it was 80.5 % for measles vaccine. The significant predictors of incomplete immunization were the home delivery of a child, the family residing on rent, a primary caretaker with poor knowledge about the schedule of vaccination and negative perception towards vaccinating a sick child, conflicting priorities, and development of abscess following immunization. Conclusion Reduction of abscess formation rate can be a potential way to improve immunization rates. Community health volunteers should increase their follow-up on children born at home and those living in rent. Health institutions and volunteers should be influential in creating awareness about immunization, its schedule, and post-vaccination side effects.
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Affiliation(s)
- Sumina Shrestha
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Monika Shrestha
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rajendra Raj Wagle
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Gita Bhandari
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Olorunsaiye CZ, Degge H. Variations in the Uptake of Routine Immunization in Nigeria: Examining Determinants of Inequitable Access. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23762004.2016.1206780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Comfort Z. Olorunsaiye
- College of Health and Human Services, University of North Carolina Charlotte, Charlotte, North Carolina, USA
| | - Hannah Degge
- Faculty of Health and Social Care, University of Hull, Hull, UK
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Kriss JL, Goodson J, Machekanyanga Z, Shibeshi ME, Daniel F, Masresha B, Kaiser R. Vaccine receipt and vaccine card availability among children of the apostolic faith: analysis from the 2010-2011 Zimbabwe demographic and health survey. Pan Afr Med J 2016; 24:47. [PMID: 27642388 PMCID: PMC5012723 DOI: 10.11604/pamj.2016.24.47.8663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/09/2016] [Indexed: 01/21/2023] Open
Abstract
Introduction Vaccine hesitancy and refusal continue to be a global challenge to reaching immunization targets, especially among those in traditional or fundamentalist religions. The apostolic faith in Zimbabwe has been historically associated with objection to most medical interventions, including immunization. Methods We conducted a descriptive analysis of socio-demographic characteristics and vaccine coverage among apostolic and non-apostolic adults aged 15-49 years and children aged 12-23 months using the Demographic and Health Survey conducted in Zimbabwe during 2010-2011. We used logistic regression models to estimate associations between the apostolic religion and receipt of all four basic childhood vaccinations in the Expanded Program on Immunization, receipt of no vaccinations, and availability of child vaccination card. Results Among children aged 12-23 months, 64% had received all doses of the four basic vaccinations, and 12% had received none of the recommended vaccines. A vaccination card was available for 68% of children. There was no significant association between Apostolic faith and completion of all basic vaccinations (aOR = 0.90, 95% CI: 0.69-1.17), but apostolic children were almost twice as likely to have received no basic vaccinations (aOR = 1.83, 95% CI: 1.22-2.77) than non-Apostolic children, and they were 32% less likely to have a vaccination card that was available and seen by the interviewer (aOR = 0.68, 95% CI: 0.52-0.89). Conclusion Disparities in childhood vaccination coverage and availability of vaccination cards persist for apostolic in Zimbabwe. Continued collaboration with apostolic leaders and additional research to better understand vaccine hesitancy and refine interventions and messaging strategies are needed.
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Affiliation(s)
- Jennifer Lara Kriss
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Goodson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zorodzai Machekanyanga
- InterCountry Support Team East and Southern Africa, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Messeret Eshetu Shibeshi
- InterCountry Support Team East and Southern Africa, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Fussum Daniel
- InterCountry Support Team East and Southern Africa, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Balcha Masresha
- Immunization and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Brazzaville, Republic of the Congo
| | - Reinhard Kaiser
- InterCountry Support Team East and Southern Africa, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
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The Influence of Women’s Empowerment on Child Immunization Coverage in Low, Lower-Middle, and Upper-Middle Income Countries: A Systematic Review of the Literature. Matern Child Health J 2015; 20:172-186. [DOI: 10.1007/s10995-015-1817-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Amugsi DA, Aborigo RA, Oduro AR, Asoala V, Awine T, Amenga-Etego L. Socio-demographic and environmental determinants of infectious disease morbidity in children under 5 years in Ghana. Glob Health Action 2015; 8:29349. [PMID: 26455493 PMCID: PMC4600709 DOI: 10.3402/gha.v8.29349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globally, diarrhoea and acute respiratory infections (ARIs) have been identified as major threats to child survival. In Ghana, the two conditions are among the top three causes of morbidity and mortality among children under 5 years. An in-depth analysis of the factors associated with these two diseases is warranted, because of their high degree of fatality and also it provides a basis for intervention planning. OBJECTIVES To investigate socio-demographic and environmental factors associated with infectious disease morbidity in children under 5 years old in Ghana. DESIGN Population-based cross-sectional survey. The study sample comprised 2,790 children aged 0-59 months, drawn from the Ghana Demographic and Health Surveys. The mothers reported whether their children under age 5 had been ill with a cough accompanied by short, rapid breathing (ARI), or diarrhoea with the presence of blood or mucus in the stool, in the 2 weeks preceding the survey. RESULTS Children in the 6-11, 12-23, and 24-59 months age groups had, respectively, 3.48 (95% CI=2.23, 5.44), 4.57 (95% CI=3.03, 6.90), and 1.93 (95% CI=1.30, 2.87) increased odds of getting diarrhoea infection compared to those in the youngest age category (0-5). Similarly, children in the 6-11, 12-23, and 24-59 months age brackets were, respectively, 2.64 (95% CI=1.76, 3.97), 2.63 (95% CI=1.81, 3.83), and 1.83 (95% CI=1.29, 2.59) times more likely to have cough compared to children in 0-5 months age brackets. Children who were not breastfeeding had higher odds of childhood diarrhoea (OR=1.33, 95% CI=1.03, 1.73) compared to those who were breastfeeding. Compared to children who were living in households without co-wives, children who were living in households with co-wives had 1.74 increased odds of diarrhoea (95% CI=1.33, 2.27). A unit increase in maternal opinion regarding wife beating was associated with 14% reduced odds of diarrhoea (OR=0.86, 95% CI=0.80, 0.91), while a unit change in the women's attitude towards sex index was associated with 14% reduced odds of childhood cough (OR=0.86, 95% CI=0.77, 0.97). CONCLUSIONS Our results show that breastfeeding, polygamous marriage, and maternal decision-making autonomy are significant predictors of child morbidity. Therefore, implementing effective educational programmes that aim at promoting breastfeeding, empowering women, and discouraging polygamous marriages could help save many children from infectious disease morbidity in Ghana.
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Affiliation(s)
- Dickson A Amugsi
- African Population and Health Research Centre, Nairobi, Kenya
- Navrongo Health Research Centre, Navrongo, Ghana;
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Morhason-Bello IO, Wallis S, Adedokun BO, Adewole IF. Willingness of reproductive-aged women in a Nigerian community to accept human papillomavirus vaccination for their children. J Obstet Gynaecol Res 2015; 41:1621-9. [DOI: 10.1111/jog.12775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/08/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Imran O. Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine; University of Ibadan/University College Hospital; Ibadan Nigeria
| | - Selina Wallis
- Liverpool School of Tropical Medicine; University of Liverpool; Liverpool United Kingdom
| | - Babatunde O. Adedokun
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine; University of Ibadan; Ibadan Nigeria
| | - Isaac F. Adewole
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine; University of Ibadan/University College Hospital; Ibadan Nigeria
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Tsawe M, Moto A, Netshivhera T, Ralesego L, Nyathi C, Susuman AS. Factors influencing the use of maternal healthcare services and childhood immunization in Swaziland. Int J Equity Health 2015; 14:32. [PMID: 25889973 PMCID: PMC4391603 DOI: 10.1186/s12939-015-0162-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and child healthcare services are very important for the health outcomes of the mother and that of the child and in ensuring that both maternal and child deaths are prevented. Studying these services is necessary in developing countries where infrastructure (which is meant to deal with these health services) is minimal or lacking. The objective of the study is to examine the factors that influence the use of maternal healthcare services and childhood immunization in Swaziland. METHODS Our study used secondary data from the Swaziland Demographic and Health Survey 2006-07. This is an explorative and descriptive study which used pre-selected variables to study factors influencing the use of maternal and child healthcare services in Swaziland. We ran three different types of analyses: univariate, bivariate and multivariate. For the multivariate analysis, a logistic regression was run to investigate the relationship between the dependent and independent variables. FINDINGS The study findings showed a high use rate of antenatal care (97.3%) and delivery care (74.0%) and a low rate of postnatal care use (20.5%). The uptake of childhood immunization is also high in the country, averaging more than 80.0%. Certain factors which were found to be influencing the use of maternal healthcare and childhood immunization include: woman's age, parity, media exposure, maternal education, wealth quintile, and residence. The findings also revealed that these factors affect the use of maternal and child health services differently. CONCLUSION It is important to study factors related to maternal and child health uptake to inform relevant stakeholders about possible areas of improvement. Programs to educate families about the importance of maternal and child healthcare services should be implemented. In addition, interventions should focus on: (a) age differentials in use of maternal and child health services, (b) women with higher parities, (c) women in rural areas, and (d) women from the poor quintile. We recommend that possible future studies could use the qualitative approach to study issues associated with the low use of postnatal services.
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Affiliation(s)
- Mluleki Tsawe
- Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa.
| | - Amos Moto
- Population Statistics Division, Statistics South Africa (StatsSA), Pretoria, South Africa.
| | | | - Lesego Ralesego
- Department of Demography & Population Studies, University of the Witwatersrand, Johannesburg, South Africa.
| | - Cassandra Nyathi
- Department of Demography & Population Studies, University of the Witwatersrand, Johannesburg, South Africa.
| | - A Sathiya Susuman
- Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa.
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Sociodemographic influences on immunization of children with chronic neurological disorders in Enugu, Nigeria. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.trivac.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Women's autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua. Public Health Nutr 2014; 18:1979-90. [PMID: 25409706 DOI: 10.1017/s1368980014002468] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the associations of women's autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua. DESIGN Cross-sectional study. Feeding practices and children's nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women's autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women's social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles. SETTING Los Cuatro Santos area, rural Nicaragua. SUBJECTS A total of 1371 children 0-35 months of age. RESULTS Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller. CONCLUSIONS While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.
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