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Rahimi BA, Ishaq N, Mudaser GM, Taylor WR. Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study. PLoS One 2022; 17:e0265487. [PMID: 35404980 PMCID: PMC9000062 DOI: 10.1371/journal.pone.0265487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality in children but there are no published data on the treatment outcomes of ABM in Afghanistan. METHODS We conducted a prospective observational cohort study over one year, February 2020 to January 2021 in a tertiary care hospital in Kandahar, Afghanistan. AMB was diagnosed clinically and on lumbar puncture findings. Binary logistic regression assessed factors for death. RESULTS A total of 393 ABM children of mean age 4.8 years were recruited. Most were males [231 (58.8%)], living in rural areas [267 (67.9%)] and in households of >10 inhabitants [294 (74.8%)]. Only 96 (24.4%) had received against both Haemophilus influenzae type b (Hib) or pneumococcal (PCV) vaccines. Children were treated with combination of ceftriaxone and ampicillin and 169/321 (52.6%) received dexamethasone. Of the 321 children with a known outcome, 69 (21.5%) died. Death was significantly associated with: not receiving dexamethasone [adjusted odds ratio (AOR) 4.9 (95% CI 2.6-9.5, p <0.001)], coma on admission [AOR 4.6 (I 2.3-9.5, p <0.001)], no PCV [AOR 2.8 (1.2-6.6, p = 0.019)] or Hib vaccine [AOR 2.8 (1.2-6.6, p = 0.019)], and being male [AOR 2.7 (1.4-5.5, p = 0.005). CONCLUSIONS ABM causes significant morbidity and mortality in Afghan children that may be improved by greater use of PCV and Hib vaccines. Adjunct dexamethasone should be evaluated formally in our setting.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Research Unit of Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Niamatullah Ishaq
- Department of Radiology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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Wondimu A, Cao Q, Wilschut JC, Postma MJ. Factors associated with the uptake of newly introduced childhood vaccinations in Ethiopia: the cases of rotavirus and pneumococcal conjugate vaccines. BMC Public Health 2019; 19:1656. [PMID: 31823756 PMCID: PMC6902476 DOI: 10.1186/s12889-019-8002-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background Childhood immunization programmes have made substantial contributions to lowering the burden of disease among children in developing countries, however a large proportion of children still remain unimmunized. This study aimed to explore the determinants of rotavirus vaccine (RVV) and pneumococcal conjugate vaccine (PCV) uptake in Ethiopia. Methods The 2016 Ethiopian demographic and health survey dataset was used in this analysis. A total of 2004 children aged 12–23 months were included in the analysis. A multivariable logistic regression model was employed to identify the determinants of uptake of the complete schedules of RVV (two doses) and PCV (three doses). Crude and adjusted odds ratios with 95% confidence intervals (CIs) were calculated. Results The uptakes of the complete schedules of RVV and PCV among children aged 12–23 months were 56 and 49.1%, respectively. The likelihood of immunization with the complete schedule of RVV was significantly lower among children from the relatively poor Afar region in Ethiopia (AOR 0.16; 95%-CI 0.04–0.61). Similarly, children living in not only the Afar region (AOR 0.10; 95%-CI 0.03–0.38), but also the Gambela region (AOR 0.25; 95%-CI 0.08–0.83), were less likely to be vaccinated with PCV. On the other hand, children from more wealthy households had higher odds of vaccination with RVV (AOR 1.69; 95%-CI 1.04–2.75). Also attending antenatal care (ANC) was found to be significantly associated with uptake of the complete schedule of RVV and PCV. Conclusions The uptake of RVV and PCV is suboptimal in Ethiopia. The uptake of the vaccines were found to be associated with region, ANC use and wealth status.
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Affiliation(s)
- Abrham Wondimu
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | - Qi Cao
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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Rivadeneira MF, Bassanesi SL, Fuchs SC. Role of health determinants in a measles outbreak in Ecuador: a case-control study with aggregated data. BMC Public Health 2018; 18:269. [PMID: 29458349 PMCID: PMC5819223 DOI: 10.1186/s12889-018-5163-9] [Citation(s) in RCA: 6] [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: 12/08/2016] [Accepted: 02/07/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In 2011-2012, an outbreak of measles occurred in Ecuador. This study sought to ascertain which population characteristics were associated. METHODS Case-control study of aggregate data. The unit of analysis was the parish (smallest geographic division). The national communicable disease surveillance database was used to identify 52 case parishes (with at least one confirmed case of measles) and 972 control parishes (no cases of measles). A hierarchical model was used to determine the association of measles with population characteristics and access to health care. RESULTS Case parishes were mostly urban and had a higher proportion of children under 1 year of age, heads of household with higher educational attainment, larger indigenous population, lower rates of measles immunization, and lower rates of antenatal care visit attendance. On multivariate analysis, associations were found with educational attainment of head of household ≥8 years (OR: 0.29; 95%CI 0.15-0.57) and ≥1.4% indigenous population (OR: 3.29; 95%CI 1.63-6.68). Antenatal care visit attendance had a protective effect against measles (OR: 0.98; 95%CI 0.97-0.99). Measles vaccination was protective of the outbreak (OR: 0.97; 95%CI 0.95-0.98). The magnitude of these associations was modest, but represents the effect of single protective factors, capable of acting at the population level regardless of socioeconomic, biological, and environmental confounding factors. CONCLUSION In Ecuador, the parishes with the highest percentage of indigenous populations and those with the lowest vaccination coverage were the most vulnerable during the measles outbreak.
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Affiliation(s)
- María F. Rivadeneira
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Av. 12 de octubre 1076 y Roca, Quito, Ecuador
| | - Sérgio L. Bassanesi
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandra C. Fuchs
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Complete immunization coverage and its determinants among children in Malaysia: findings from the National Health and Morbidity Survey (NHMS) 2016. Public Health 2017; 153:52-57. [DOI: 10.1016/j.puhe.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
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Wagner AL, Mubarak MY, Johnson LE, Porth JM, Yousif JE, Boulton ML. Trends of vaccine-preventable diseases in Afghanistan from the Disease Early Warning System, 2009-2015. PLoS One 2017; 12:e0178677. [PMID: 28570694 PMCID: PMC5453561 DOI: 10.1371/journal.pone.0178677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Afghanistan's public health system was neglected during decades of military and civil conflict, and trends in infectious disease occurrence remain poorly characterized. This study examines cyclical and long-term trends of six vaccine-preventable diseases: pneumonia, diarrhea, meningitis, typhoid, measles, and acute viral hepatitis. METHODS Using weekly data collected between 2009 and 2015 through Afghanistan's Disease Early Warning System, we calculated monthly case counts, and fit a Poisson regression with a Fourier transformation for seasonal cycles and dummy variables for year. RESULTS We found the greatest incidence of diarrhea and typhoid in the summer, pneumonia in the winter, and measles in the late spring. Meningitis and acute viral hepatitis did not demonstrate substantial seasonality. Rates of pneumonia and diarrhea were constant across years whereas rates of meningitis, typhoid, and acute viral hepatitis decreased. Measles incidence increased in 2015. CONCLUSIONS Communicable disease reporting systems can guide public health operations-such as the implementation of new vaccines, and permit evaluation of health interventions. For example, measles supplementary immunization activities in Afghanistan have not slowed long-term transmission of the disease, but decreases in typhoid fever and acute viral hepatitis are probably tied to improvements in sanitation in the country.
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Affiliation(s)
- Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
| | | | - Laura E. Johnson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, United States of America
| | - Julia M. Porth
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
| | - Jenna E. Yousif
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
| | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, United States of America
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Onsomu EO, Abuya BA, Okech IN, Moore D, Collins-McNeil J. Maternal Education and Immunization Status Among Children in Kenya. Matern Child Health J 2016; 19:1724-33. [PMID: 25636652 DOI: 10.1007/s10995-015-1686-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Child morbidity and mortality due to infectious diseases continues to be a major threat and public health concern worldwide. Although global vaccination coverage reached 90 % for diphtheria, tetanus and pertussis (DTP3) across 129 countries, Kenya and other sub-Saharan countries continue to experience under-vaccination. The purpose of this study was to examine the association between maternal education and child immunization (12-23 months) in Kenya. This study used retrospective cross-sectional data from the 2008-2009 Kenya Demographic and Health Survey for women aged 15-49, who had children aged 12-23 months, and who answered questions about vaccination in the survey (n = 1,707). The majority of the children had received vaccinations, with 77 % for poliomyelitis, 74 % for measles, 94 % for tuberculosis, and 91 % for diphtheria, whooping cough (pertussis), and tetanus. After adjusting for other covariates, women with primary, secondary, and college/university education were between 2.21 (p < 0.01) and 9.10 (p < 0.001) times more likely to immunize their children than those who had less than a primary education. Maternal education is clearly crucial in ensuring good health outcomes among children, and integrating immunization knowledge with maternal and child health services is imperative. More research is needed to identify factors influencing immunization decisions among less-educated women in Kenya.
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Affiliation(s)
- Elijah O Onsomu
- Division of Nursing, Winston-Salem State University, 601 S. Martin Luther King Jr. Drive, Winston-Salem, NC 27110, USA,
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Branco FLCC, Pereira TM, Delfino BM, Braña AM, Oliart-Guzmán H, Mantovani SAS, Martins AC, Oliveira CSDM, Ramalho AA, Codeço CT, da Silva-Nunes M. Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil. Int J Equity Health 2014; 13:118. [PMID: 25428334 PMCID: PMC4256802 DOI: 10.1186/s12939-014-0118-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Vaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination. Methods A census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes. Results Only 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95). Conclusions This study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.
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Affiliation(s)
| | | | - Breno Matos Delfino
- Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil.
| | - Athos Muniz Braña
- Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil.
| | | | | | | | | | | | - Claudia Torres Codeço
- Scientific Computing Program, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, Brazil.
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Wado YD, Afework MF, Hindin MJ. Childhood vaccination in rural southwestern Ethiopia: the nexus with demographic factors and women's autonomy. Pan Afr Med J 2014; 17 Suppl 1:9. [PMID: 24624243 PMCID: PMC3946289 DOI: 10.11694/pamj.supp.2014.17.1.3135] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/24/2013] [Indexed: 11/14/2022] Open
Abstract
Introduction Vaccination can reduce child mortality significantly and is a cost effective way to improve child health.Worldwide, more than 22 million children do not receive the basic recommended vaccinations.Vaccination coverage in Ethiopia remains low. Research on child health has focused on socio-economic factors such as maternal education and access to health care, but little attention has been given to demographic factors and women's autonomy within the household. The purpose of this study was to examine the influences of demographic factors and women's autonomy on the completion of childhood vaccination in rural Ethiopia. Methods A cross-sectional community-based study was conducted in a Health and Demographic Survelliance System (HDSS) in southwestern Ethiopia. Data were drawn from a random sample of women with children aged 12-24 months (n = 889). Information on maternal socio-demographic characteristics and household variables were collected using an interviewer-administered structured questionnaire. Vaccination data were obtained from vaccination cards or mother's recall. Multivariate logistic regression was used to assess the association of independent variables with completion of childhood vaccination. Results Of 889 children aged 12-24 months, 690 (78%) had received at least one vaccination. Only 37% (95% CI, 33.5-39.9) were fully vaccinated. Women's decision making autonomy, number of under-five children in the household, mother's education, use of antenatal care services and proximity to health facility were the main factors associated with full vaccination status. Conclusion Completion of basic vaccination series is very low in the study area. Initiatives that enhance women's autonomy within the household and that promote healthy timing and spacing of pregnancies may help in improving child health through vaccination.
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Affiliation(s)
- Yohannes Dibaba Wado
- Department of Population & Family Health, College of Health Sciences, Jimma University, Ethiopia
| | | | - Michelle J Hindin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, USA
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Moyer CA, Tadesse L, Fisseha S. The relationship between facility delivery and infant immunization in Ethiopia. Int J Gynaecol Obstet 2013; 123:217-20. [DOI: 10.1016/j.ijgo.2013.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/18/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
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Kim D, Lauria DT, Poulos C, Dong B, Whittington D. Effect of travel distance on household demand for typhoid vaccines: implications for planning. Int J Health Plann Manage 2013; 29:e261-76. [DOI: 10.1002/hpm.2172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/23/2013] [Accepted: 01/27/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dohyeong Kim
- School of Economic, Political and Policy Sciences; University of Texas at Dallas, Richardson; Texas USA
| | - Donald T. Lauria
- Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Christine Poulos
- Research Triangle Institute; Research Triangle Park North Carolina USA
| | - Baiqing Dong
- Guangxi Center for Disease Control and Prevention; Nanning China
| | - Dale Whittington
- Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
- Manchester Business School; University of Manchester; Manchester UK
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Mutua MK, Kimani-Murage E, Ettarh RR. Childhood vaccination in informal urban settlements in Nairobi, Kenya: who gets vaccinated? BMC Public Health 2011; 11:6. [PMID: 21205306 PMCID: PMC3024932 DOI: 10.1186/1471-2458-11-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 01/04/2011] [Indexed: 11/23/2022] Open
Abstract
Background Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of undervaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination. Methods The study was carried out as part of a longitudinal Maternal and Child Health study undertaken in Korogocho and Viwandani slums of Nairobi. These slums host the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) run by the African Population and Health Research Centre (APHRC). All women from the NUHDSS area who gave birth since September 2006 were enrolled in the project and administered a questionnaire which asked about the vaccination history of their children. For the purpose of this study, we used data from 1848 children aged 12-23 months who were expected to have received all the WHO-recommended vaccinations. The vaccination details were collected during the first visit about four months after birth with follow-up visits repeated thereafter at four month intervals. Full vaccination was defined as receiving all the basic childhood vaccinations by the end of 24 months of life, whereas up-to-date (UTD) vaccination referred to receipt of BCG, OPV 1-3, DTP 1-3, and measles vaccinations within the first 12 months of life. All vaccination data were obtained from vaccination cards which were sighted during the household visit as well as by recall from mothers. Multivariate models were used to identify the risk factors associated with incomplete vaccination. Results Measles coverage was substantially lower than that for the other vaccines when determined using only vaccination cards or in addition to maternal recall. Up-to-date (UTD) coverage with all vaccinations at 12 months was 41.3% and 51.8% with and without the birth dose of OPV, respectively. Full vaccination coverage (57.5%) was higher than up-to-date coverage (51.8%) at 12 months overall, and in both slum settlements, using data from cards. Multivariate analysis showed that household assets and expenditure, ethnicity, place of delivery, mother's level of education, age and parity were all predictors of full vaccination among children living in the slums. Conclusions The findings show the extent to which children resident in slums are underserved with vaccination and indicate that service delivery of immunization services in the urban slums needs to be reassessed to ensure that all children are reached.
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Affiliation(s)
- Martin K Mutua
- African Population and Health Research Center, Shelter Afrique Center, Longonot Road, Upper Hill, Nairobi, Kenya
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Immunization status and risk factors of migrant children in densely populated areas of Beijing, China. Vaccine 2009; 28:1264-74. [PMID: 19941996 DOI: 10.1016/j.vaccine.2009.11.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 11/06/2009] [Accepted: 11/08/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To properly evaluate the immunization status and determine risk factors of migrant children in 23 densely populated towns and townships in Beijing. METHODS A household cluster sampling survey was implemented and standard face-to-face interviews were conducted with 1820 migrant children aged 12-35 months. Demographic characteristics of the child and primary caregiver, the child's migrant characteristics, the primary caregiver's knowledge and attitude toward immunization, information about immunization services provided by the local clinic, and the child's immunization history were obtained. Weighted up-to-date (UTD) and age-appropriate immunization rates for the following four vaccines were assessed: three doses of diphtheria, tetanus and pertussis combined vaccine (DTP); three doses of oral poliomyelitis vaccine (OPV); three doses of hepatitis B vaccine (HepB); and one dose of Measles-containing vaccine (MCV). Weighted UTD and age-appropriate immunization rates for the overall series of these four vaccines (the 3:3:3:1 immunization series) were also estimated. Risk factors for not being UTD, being invalid and being delayed for the 3:3:3:1 immunization series were explored using both single-level and multi-level multinomial logistic regression models. RESULTS For each antigen, the weighted UTD immunization rate was above 83%, but the age-appropriate immunization coverages for HepB, OPV, DPT, and MCV were only 45.6%, 49.6%, 50.8% and 54.7%, respectively. The 1st dose was most likely to be invalid or delayed within HepB, OPV and DPT series. For the 3:3:3:1 immunization series, the weighted UTD and age-appropriate immunization rates were 78.1% and 20.5%, respectively. Immunization status of migrant children tended to be homogenous within a village and therefore, multi-level model was more appropriate for assessing risk factors. Besides demographic characteristics, several other factors were significantly associated with age-appropriate immunization coverage. These factors included: the child's migrant characteristics; the primary caregiver's awareness of the importance of vaccination, and outreach services provided by immunization clinics including notification services and supplementary immunization activities (SIAs). The frequency and duration of clinical immunization sessions significantly influenced the UTD immunization rate but not the age-appropriate immunization rate. The degree of the primary caregiver's satisfaction with clinic services and convenience to vaccination clinic had no impact on the child's immunization status. CONCLUSION Alarmingly low age-appropriate immunization coverage of migrant children in densely populated areas demanded immediate intervention. Community context was an important factor to a migrant child's vaccination status and should be considered when taking measures. Strategies to strengthen outreach immunization service need to be developed to effectively improve the age-appropriate immunization coverage of migrant children.
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