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Odero CO, Othero D, Were VO, Ouma C. Trends of non-vaccination, under-vaccination and missed opportunities for vaccination (2003-2014) amongst children 0-23 months in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002906. [PMID: 38319922 PMCID: PMC10846728 DOI: 10.1371/journal.pgph.0002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Abstract
Vaccines are effective and cost-effective. Non-vaccination, under-vaccination, and missed opportunities for vaccination (MOV), have contributed to incomplete vaccination coverage in Kenya. Analyzing their trends is essential for targeting interventions and improvement strategies. This study aimed to assess trends of non-vaccination, under-vaccination, and MOV among children aged 0-23 months in Kenya using data obtained from the Kenya Demographic and Health Surveys (KDHS) conducted in 2003, 2008/09, and 2014. A two-stage, multi-stage, and stratified sampling technique was used. Weighted analysis was conducted to ensure generalizability to the full population. Using the KDHS sample size estimation process, the sample size was estimated for each indicator, with varying standard error estimates, level of coverage and estimated response rates. Final sample size was 2380 (2003), 2237 (2008/09) and 7380 (2014). To determine the level of non-vaccination, under-vaccination and MOV among children aged 0-23 months, a weighted descriptive analysis was used to estimate their prevalence, with 95% confidence intervals (CI) for each year. MOV was defined using an algorithm as a binary variable. Data coding and recoding were done using Stata (version 14; College Station, TX: StataCorp LP). Trends in proportions of non-vaccination, under-vaccination and MOV were compared between 2003, 2008/09, and 2014 using the Cochrane-Armitage trend test. All results with P≤0.05 were considered statistically significant. Trends in proportion of non-vaccination among children aged 0-23 months in Kenya was 13.2%, 6.1% and 3.2% in 2003, 2008/09 and 2014, respectively (P = 0.0001). Trends in proportion of under-vaccination among children aged 0-23 months in Kenya was 54.3%, 50% and 51.3% in 2003, 2008/09 and 2014, respectively (P = 0.0109). The trends in proportion of children who experienced MOV was 22.7% in 2003, 31.9% in 2008/09 and 37.6% in 2014 (P = 0.0001). In the study duration, non-vaccination decreased by 10%, under-vaccination remained relatively stable, and MOV increased by ~15%. There is need for the Government and partners to implement initiatives that improve vaccine access and coverage, particularly in regions with low coverage rates, and to address missed opportunities for vaccination.
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Affiliation(s)
| | - Doreen Othero
- Department of Public Health, Maseno University, Kisumu, Kenya
| | - Vincent Omondi Were
- KEMRI Wellcome-Trust Research Program, Health Economics Research Unit, Kilifi, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya
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Mwinnyaa G, Peters MA, Shapira G, Neill R, Sadat H, Yuma S, Akilimali P, Hossain S, Wendrad N, Atiwoto WK, Ofosu AA, Alfred JP, Kiarie H, Wesseh CS, Isokpunwu C, Kangbai DM, Mohamed AA, Sidibe K, Drouard S, Fernandez PA, Azais V, Hashemi T, Hansen PM, Ahmed T. Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries. Vaccines (Basel) 2023; 11:1415. [PMID: 37766092 PMCID: PMC10536121 DOI: 10.3390/vaccines11091415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/31/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3. METHODS After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries. RESULTS Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022. CONCLUSIONS At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.
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Affiliation(s)
- George Mwinnyaa
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | | | - Gil Shapira
- The World Bank, Washington, DC 20433, USA (G.S.)
| | - Rachel Neill
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Husnia Sadat
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Sylvain Yuma
- Ministe’re de la Sante, Kinshasa 4310, Democratic Republic of the Congo
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | | | | | | | | | - Jean Patrick Alfred
- Ministère de la Sante Publique et de la Population, Port-au-Prince HT6123, Haiti
| | - Helen Kiarie
- Ministry of Health, Nairobi P.O. Box 30016-00100, Kenya
| | | | | | | | | | - Kadidja Sidibe
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | | | | | - Viviane Azais
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Tawab Hashemi
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Peter M. Hansen
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA
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Ishoso DK, Mafuta E, Danovaro-Holliday MC, Ngandu C, Menning L, Cikomola AMW, Lungayo CL, Mukendi JC, Mwamba D, Mboussou FF, Manirakiza D, Yapi MD, Ngabo GF, Riziki RB, Aluma ADL, Tsobeng BN, Mwanga C, Otomba J, Lulebo A, Lusamba P, Nimpa MM. Reasons for Being "Zero-Dose and Under-Vaccinated" among Children Aged 12-23 Months in the Democratic Republic of the Congo. Vaccines (Basel) 2023; 11:1370. [PMID: 37631938 PMCID: PMC10459103 DOI: 10.3390/vaccines11081370] [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: 06/12/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12-23 months not having received any pentavalent vaccine (diphtheria-tetanus-pertussis-Hemophilus influenzae type b (Hib)-Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao-Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12-23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people's thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p < 0.001). Regarding intentions to vaccinate their children, 82.15% of the parents/guardians of the ZD children said they wanted their children to receive "none" of the recommended vaccines, which was significantly higher than for the under-vaccinated children. In contrast, "practical issues" were cited for 35.60% of the ZD children, compared to 55.60% for the under-vaccinated children (p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions.
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Affiliation(s)
- Daniel Katuashi Ishoso
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
- Kinshasa School of Public Health (KSPH), University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo; (E.M.); (A.L.); (P.L.)
| | - Eric Mafuta
- Kinshasa School of Public Health (KSPH), University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo; (E.M.); (A.L.); (P.L.)
| | - M. Carolina Danovaro-Holliday
- Immunization, Analytics and Insights (IAI), Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211 Geneva, Switzerland; (M.C.D.-H.); (L.M.)
| | - Christian Ngandu
- National Institute of Public Health, Kinshasa 01209, Democratic Republic of the Congo; (C.N.); (D.M.)
| | - Lisa Menning
- Immunization, Analytics and Insights (IAI), Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211 Geneva, Switzerland; (M.C.D.-H.); (L.M.)
| | - Aimé Mwana-Wabene Cikomola
- Expanded Program of Immunization, Kinshasa 01208, Democratic Republic of the Congo; (A.M.-W.C.); (C.L.L.); (J.-C.M.)
| | - Christophe Luhata Lungayo
- Expanded Program of Immunization, Kinshasa 01208, Democratic Republic of the Congo; (A.M.-W.C.); (C.L.L.); (J.-C.M.)
| | - Jean-Crispin Mukendi
- Expanded Program of Immunization, Kinshasa 01208, Democratic Republic of the Congo; (A.M.-W.C.); (C.L.L.); (J.-C.M.)
| | - Dieudonné Mwamba
- National Institute of Public Health, Kinshasa 01209, Democratic Republic of the Congo; (C.N.); (D.M.)
| | - Franck-Fortune Mboussou
- Communicable and Noncommunicable Diseases Cluster, World Health Organization Inter-Country Support Teams Central Africa, Libreville BP 820, Gabon;
| | - Deo Manirakiza
- United Nations Children’s Fund (UNICEF) Country Office, Kinshasa 01204, Democratic Republic of the Congo;
| | - Moise Désiré Yapi
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
| | - Gaga Fidele Ngabo
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
| | - Richard Bahizire Riziki
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
- Public Health Section, Higher Institute of Medical Techniques of Nyangezi, Sud-Kivu 11213, Democratic Republic of the Congo
| | | | - Bienvenu Nguejio Tsobeng
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
| | - Cedric Mwanga
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
| | - John Otomba
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
| | - Aimée Lulebo
- Kinshasa School of Public Health (KSPH), University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo; (E.M.); (A.L.); (P.L.)
| | - Paul Lusamba
- Kinshasa School of Public Health (KSPH), University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo; (E.M.); (A.L.); (P.L.)
| | - Marcellin Mengouo Nimpa
- Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo; (M.D.Y.); (G.F.N.); (R.B.R.); (B.N.T.); (C.M.); (J.O.); (M.M.N.)
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Kamya C, Namugaya F, Opio C, Katamba P, Carnahan E, Katahoire A, Nankabirwa J, Okiring J, Waiswa P. Coverage and Drivers to Reaching the Last Child With Vaccination in Urban Settings: A Mixed-Methods Study in Kampala, Uganda. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100663. [PMID: 36041847 PMCID: PMC9426991 DOI: 10.9745/ghsp-d-21-00663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Limited evidence exists regarding the drivers of vaccination coverage and equity in Kampala city, despite frequent measles outbreaks, inequities in vaccination coverage, and the decline in vaccination coverage rates. This study was designed to determine vaccine coverage among children aged 12-36 months and to understand its demand-side drivers. METHODS We utilized a mixed-methods parallel convergent study design. A household survey was conducted to quantify the drivers of vaccine coverage among households with children aged 12-36 months. We employed a multistage sampling approach to select households, using a primary sampling unit of an enumeration area. We conducted 30 key informant interviews, 7 focus group discussions, and 6 in-depth interviews with representatives from the immunization program, health workers, and parents residing in areas with low vaccine coverage. RESULTS Of the 590 enrolled children, 340 (57.6%) were partially vaccinated, 244 (41.4%) were fully vaccinated and had received all the recommended vaccinations, and 6 (1.0%) had never received any vaccine. Of the 244 with all recommended vaccinations, only 65 (26.6%) received their vaccines on time. Access to vaccination services was high (first dose of diphtheria, pertussis, and tetanus [DPT1] coverage of 96%), but utilization decreased over time, as shown by a dropout rate of 17.3% from the first to third dose of DPT. The main driver of complete vaccination was the parents' appreciation of the benefits of vaccination. Among partially vaccinated children, the barriers to vaccination were inadequate information about vaccination (its benefits and schedule), vaccine stock-outs, long waiting times to receive vaccination services, and hidden vaccination costs. CONCLUSION Vaccination needs to be targeted to all children irrespective of whether they reside in slum areas or nonslum areas, as most are under-vaccinated. Social mobilization and communication efforts should be tailored to the complexities of urban settings characterized by transient and diverse populations with different cultures.
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Affiliation(s)
- Carol Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Faith Namugaya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Charles Opio
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Paul Katamba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Waiswa
- Makerere University, Kampala, Uganda
- Uganda and Global Health Division, Karolinska Institutet, Solna, Sweden
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Mapping BCG vaccination coverage in Ethiopia between 2000 and 2019. BMC Infect Dis 2022; 22:569. [PMID: 35739462 PMCID: PMC9219134 DOI: 10.1186/s12879-022-07547-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/16/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction The Bacille-Calmette–Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia. Method Bacille-Calmette–Guerin immunization coverage and geographical information data were obtained from five different Demographic and Health Surveys, conducted in Ethiopia between 2000 and 2019. Data for independent variables were obtained from publicly available sources. Bayesian geostatistical models were used to predict the spatial distribution of BCG vaccination coverage in Ethiopia. Result The overall national BCG vaccination coverage between 2000 and 2019 was 65.5%. The BCG vaccine coverage was 53.5% in 2000, 56.9% in 2005, 64.4% in 2011, 79.6% in 2016, and 79.0% in 2019. BCG vaccination coverage increased by 47.6% in Ethiopia from 2000 to 2019, but substantial geographical inequalities in BCG coverage remained at sub-national and local levels. High vaccination coverage was observed in northern, western, and central parts of Ethiopia. Climatic and demographic factors such as temperature, altitude, and population density were positively associated with BCG vaccination coverage. Whereas, healthcare access factors such as distance to health facilities and travel time to the nearest cities were negatively associated with BCG vaccine coverage in Ethiopia. Conclusion Despite substantial progress in national BCG vaccination coverage, marked spatial variation in BCG coverage persists throughout the country at sub-national and local levels. Healthcare access and climatic and demographic factors determined the spatial distribution of BCG vaccination coverage. Maintaining a high level of vaccination coverage across geographical areas is important to prevent TB in Ethiopia. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07547-4.
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Périères L, Séror V, Boyer S, Sokhna C, Peretti-Watel P. Reasons given for non-vaccination and under-vaccination of children and adolescents in sub-Saharan Africa: A systematic review. Hum Vaccin Immunother 2022; 18:2076524. [PMID: 35709342 PMCID: PMC9481092 DOI: 10.1080/21645515.2022.2076524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To achieve the full benefits of vaccination, it is key to understand the underlying causes of low vaccination by researching the barriers to vaccination at a local level. This systematic literature review aims to identify the reasons given by community members for the non-vaccination and under-vaccination of children and adolescents in sub-Saharan Africa. PubMed, Web of Science, PsycINFO, African Index Medicus, and African Journals Online databases were searched to identify articles published between 2010 and 2020. A total of 37 articles were included. As 17 studies did not report the reasons for non-vaccination and under-vaccination separately, we considered these two outcomes as “incomplete vaccination”. The most common reasons for incomplete vaccination were related to caregiver’s time constraints, lack of knowledge regarding vaccination, the unavailability of vaccines/personnel in healthcare facilities, missed opportunities for vaccination, caregiver’s fear of minor side effects, poor access to vaccination services, and caregiver’s vaccination beliefs.
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Affiliation(s)
| | - Valérie Séror
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Sylvie Boyer
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Cheikh Sokhna
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Asmare Atalell K, Asmare Techane M, Adugna Wubneh C, Tezera Assimamaw N, Mulualem Belay G, Tarik Tamir T, Bilal Muhye A, Guadie Kassie D, Wondim A, Terefe B, Tigabu Tarekegn B, Seid Ali M, Fentie B, Tefera Gonete A, Tekeba B, Fisiha Kassa S, Kassahun Desta B, Tilahun Dessie M, Getaneh Alemu T. Spatiotemporal distributions of immunization coverage in Ethiopia from 2000 to 2019. Vaccine 2022; 40:1413-1420. [PMID: 35125222 DOI: 10.1016/j.vaccine.2022.01.053] [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: 11/13/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vaccination is the most important mechanism to improve childhood survival. However, immunization coverage is very low and unevenly distributed throughout the country. Therefore, this study was aimed to investigate the spatiotemporal distribution of immunization coverage in Ethiopia. METHOD Immunization coverage data and geospatial covariates data were obtained from EDHS 2000 to 2019 and different publicly available sources. A Bayesian geostatistic model was used to estimate the national immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages. RESULT The overall immunization coverage in Ethiopia was 38.7%, 36.55%, 51.8%, 67.1% and 66.9% for 2000, 2005, 2011, 2016 and 2019 respectively. Spatial clustering of low immunization coverage was observed in Eastern, Southern, Southwestern, Southeastern and Northeastern parts of Ethiopia in EDHSs. The altitude of the area was positively associated with immunization coverage in 2000, 2005 and 2019 EDHS. The population density was positively associated with immunization coverage in 2000, 2005, 2011 and 2016. Precipitation is also positively associated with immunization coverage in 2016. Moreover, mean annual temperature was positively associated with immunization coverage in 2000, 2005 and 2019 EDHSs. Travel time to the nearest city is negatively associated with immunization coverage in 2000, 2005, 2011 and 2016. Likewise, distance to health facilities was negatively associated with immunization coverage in all the five EDHSs. CONCLUSION This study found that immunization coverage in Ethiopia substantially varied across the subnational and local levels. Spatial clustering of low immunization coverage was observed in Southern, Southeastern, Southwestern, Northeastern, and Eastern parts of the country. Altitude, population density, precipitation, temperature, travel time to the nearest city in minutes, and distance to the health facilities were factors that affect the spatial clustering of immunizations coverage. These findings can guide policymakers in Ethiopia to design geographically targeted interventions to increase programs to achieve maximum immunization coverage.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addis Bilal Muhye
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaye Guadie Kassie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Selam Fisiha Kassa
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bogale Kassahun Desta
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ngwa CH, Doungtsop BCK, Bihnwi R, Ngo NV, Yang NM. Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon. Hum Vaccin Immunother 2021; 18:1939620. [PMID: 34197271 PMCID: PMC8920166 DOI: 10.1080/21645515.2021.1939620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The discovery and development of vaccines remain one of the major successes of global health with millions of lives saved every year through routine vaccination. Although vaccines provide a safe and cost-effective solution to vaccine-preventable diseases (VPDs), VPDs are still a serious public health problem in most parts of the world, especially in sub-Saharan Africa (SSA) and Asia. In this review, we discuss the burden of VPDs and vaccine coverage several decades after the introduction of the Expanded Program on Immunization (EPI) in Cameroon. We also discuss how different factors affect the implementation of the EPI, highlighting context-specific factors such as the ongoing civil conflict in Cameroon, and the presence of other infectious diseases like COVID-19.
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Affiliation(s)
- Che Henry Ngwa
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Languages and Literature, Lund University, Lund, Sweden
| | | | | | - Ngo Valery Ngo
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niendum Mediatrice Yang
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Matos CCDSA, Gonçalves BA, Couto MT. Vaccine hesitancy in the global south: Towards a critical perspective on global health. Glob Public Health 2021; 17:1087-1098. [PMID: 33843459 DOI: 10.1080/17441692.2021.1912138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The complex phenomenon of vaccine hesitancy has been causing increasing global concern. This systematic review aims at analysing the state of art of scientific literature concerning vaccine hesitancy in Latin America and Africa, observing if: (i) they use the same research trends as the global North; and (ii) the parameters recommended by the World Health Organization (WHO) and taken from the experience of the global North are adequate to the Global South's context. This review analyses empirical, qualitative, quantitative, or mixed-study publications, from 2015 to 2020, available at five different databases. The studies produced in the Global South bring up important context-specific issues, such as issues of access (that are not included in the WHO's definition of vaccine hesitancy), cultural and religious issues, reactions to governments, reactions to recent episodes of vaccine tests on populations, and reactions to past of colonial violence. Initiatives to understand the phenomenon based on methodological and conceptual frameworks from the global North alone can cause wrongful conclusions.
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Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health 2020; 20:1108. [PMID: 32664849 PMCID: PMC7362649 DOI: 10.1186/s12889-020-09169-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker’ barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, lifestyle, migration, occupation and parent’s forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.
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Affiliation(s)
- Joseph Benjamin Bangura
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China. .,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Feiyun Ouyang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lei Chen
- Department of Pediatrics, Faculty, Global Health Initiative, Yale University School of Medicine, New Haven, USA
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Li AJ, Tabu C, Shendale S, Okoth PO, Sergon K, Maree E, Mugoya IK, Machekanyanga Z, Onuekwusi IU, Ogbuanu IU. Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities. PLoS One 2020; 15:e0230783. [PMID: 32226039 PMCID: PMC7105087 DOI: 10.1371/journal.pone.0230783] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background In 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)—when eligible children have contact with the health system but are not fully vaccinated—to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment. Methods Using the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children <24 months of age visiting the selected health facilities on the day of the assessment were requested to participate in focus group discussions. Health workers were purposively sampled to capture a broad range of perspectives. Key informants were selected based on their perceived insight on immunization services at the county, sub-county, or health facility level. Results Six focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies. Conclusions Identified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.
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Affiliation(s)
- Anyie J. Li
- ASPPH/CDC Allan Rosenfield Global Health Fellowship and PHI/CDC Global Health Fellowship, Atlanta, GA, United States of America
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
| | | | - Kibet Sergon
- World Health Organization Kenya Country Office, Nairobi, Kenya
| | - Ephantus Maree
- National Vaccines and Immunization Program, Ministry of Health Kenya, Nairobi, Kenya
| | | | - Zorodzai Machekanyanga
- Inter-Country Support Team (IST)–East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | | | - Ikechukwu Udo Ogbuanu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Headquarters, Geneva, Switzerland
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