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Ahmed LQ, Adebowale AS, Palamuleni ME. Bayesian spatial analysis of incomplete vaccination among children aged 12-23 months in Nigeria. Sci Rep 2024; 14:18297. [PMID: 39112528 PMCID: PMC11306368 DOI: 10.1038/s41598-024-57345-y] [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: 11/19/2023] [Accepted: 03/18/2024] [Indexed: 08/10/2024] Open
Abstract
High childhood disease prevalence and under-five mortality rates have been consistently reported in Nigeria. Vaccination is a cost-effective preventive strategy against childhood diseases. Therefore, this study aimed to identify the determinants of Incomplete Vaccination (IV) among children aged 12-23 months in Nigeria. This cross-sectional design study utilized the 2018 Nigeria Demographic and Health Survey (NDHS) dataset. A two-stage cluster sampling technique was used to select women of reproductive age who have children (n = 5475) aged 12-23 months. The outcome variable was IV of children against childhood diseases. Data were analyzed using Integrated Nested Laplace Approximation and Bayesian binary regression models (α0.05). Visualization of incomplete vaccination was produced using the ArcGIS software. Children's mean age was 15.1 ± 3.2 months and the median number of vaccines received was four. Northern regions contributed largely to the IV. The likelihood of IV was lower among women aged 25-34 years (aOR = 0.67, 95% CI = 0.54-0.82, p < 0.05) and 35-49 years (aOR = 0.59, 95%CI = 0.46-0.77, p < 0.05) compared to younger women in the age group 15-24 years. An increasing level of education reduces the risk of odds of IV. Other predictors of IV were delivery at the health facility (aOR = 0.64, 95% CI = 053-0.76, p < 0.05), and media exposure (aOR = 0.63, 95%CI = 0.54-0.79, p < 0.05). Mothers' characteristics explained most of the variability in the IV, relatively to smaller overall contributions from the community and state-level factors (p < 0.05). The level of IV against childhood diseases was high in Nigeria. However, disparities exist across the regions and other socioeconomic segments of the population. More efforts are required to improve vaccination sensitization programs and campaigns in Nigeria.
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Affiliation(s)
- Lanre Quadri Ahmed
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Ayo S Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, North-West University, Mafikeng, South Africa
| | - Martin E Palamuleni
- Population and Health Research Entity, North-West University, Mafikeng, South Africa
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Nimpa MM, Cikomola Mwana-Wabene A, Otomba J, Mukendi JC, Danovaro-Holliday MC, Mboussou FF, Mwamba D, Kambala L, Ngwanga D, Mwanga C, Etapelong SG, Compaoré I, Yapi MD, Ishoso DK. Characterizing zero-dose and under-vaccinated children among refugees and internally displaced persons in the Democratic Republic of Congo. Trop Dis Travel Med Vaccines 2024; 10:17. [PMID: 39004758 PMCID: PMC11247746 DOI: 10.1186/s40794-024-00225-0] [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: 02/13/2024] [Accepted: 05/24/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) has one of the highest numbers of un and under-vaccinated children as well as number of refugees and internally displaced persons (IDPs) in the world. This study aims to determine and compare the proportion and characteristics of zero-dose (ZD) and under-vaccinated (UV) children among refugees and IDPs in the DRC, as well as the reasons for incomplete vaccination schedules. METHODS Data from a rolling vaccination coverage survey conducted from September 10, 2022, to July 03, 2023, among refugees and IDPs in 12 provinces of the DRC. ZD was defined as a child aged 12-23 months who had not received any dose of pentavalent vaccine DTP-Hib-Hep B (by card or recall) and UV as a child who had not received the third dose of pentavalent vaccine. The proportions of non and under-vaccination and the associated factors using a logistic regression model are presented for ZD and UV children. The reasons for non-vaccination of these children are described using the WHO-Immunization behavioral and social-drivers-conceptual framework and compared using Pearson's Chi2 test. RESULTS Of 692 children aged 12 to 23 months included in the analysis, 9.3% (95% CI: 7.2-11.7%) were ZD and 40.9% (95% CI: 95%: 37.2-44.6%) UV. The Penta1/Penta3 drop-out rate was 34.9%. After adjustment, ZD children had a significant history of home or road birth. And UV children were significantly associated with mothers/caregivers being under 40, uneducated, farmers, ranchers, employed, rural residents, as well as with home or road births. Reasons linked to people's perceptions and feelings were cited much more often for ZD (50.0%) than for UV (38.3%). Those related to social reasons were cited much more often by ZD (40.6%) than by UV (35.7%). Reasons related to "programmatic and practical issues" were cited less for ZD (90.5%) than for UV (97.1%). CONCLUSIONS ZD and UV children represent significant proportions in refugee and IDPs sites in the DRC. However, the proportion of ZD is less than for the entire country, while the proportion of UV is comparable, reflected in a very high drop-out rate. Similarly to studies in the general population in DRC, the reasons for ZD children were mainly linked to challenges in caregiver motivation to vaccinate, while for UV children, they were more often linked to pro-grammatic and practical problems of the health system.
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Affiliation(s)
| | | | - John Otomba
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of Congo
| | | | - M Carolina Danovaro-Holliday
- Immunization, Analytics and Insights (IAI), Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), Geneva, Switzerland
| | | | - Dieudonné Mwamba
- National Institute of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Leandre Kambala
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of Congo
| | - Dolla Ngwanga
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of Congo
| | - Cedric Mwanga
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of Congo
| | - Sume Gerald Etapelong
- Immunization, Vaccine-Preventable Diseases and Polio Transition (IVP) Unit, Department of Communicable Diseases (DCD), WHO Regional Office for the Eastern Mediterranean (EMRO), Cairo, Egypt
| | - Issaka Compaoré
- Associés en Management public et Développement (AMD) International, Ouagadougou, Burkina Faso
| | - Moise Désiré Yapi
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of Congo
| | - Daniel Katuashi Ishoso
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of Congo.
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
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DAMIEN BG, VL AVON OU W, DAHOUN M, KAUCLEY L, AGUEMON B. [Coverage, mapping and barriers to complete vaccination for age among children under 5 years in 2021: case of Adjara-Hounvè and Ahouicodji villages in southern Benin]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.352. [PMID: 38846123 PMCID: PMC11151914 DOI: 10.48327/mtsi.v4i1.2024.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/22/2024] [Indexed: 06/09/2024]
Abstract
Background Vaccination is a protective measure against infectious diseases and remains one of the best investments in public health. Some African countries are still struggling to reach the required child immunization coverage. Several factors are responsible for limiting immunization coverage. Most of the factors considered to limit immunization coverage are related to the health system. In addition, inaccessibility to care, especially during the critical period of the Covid-19 pandemic, greatly reduced vaccination coverage rates. In Benin, several vaccines are included in the Expanded Programme on Immunization or are administered as part of routine immunization. However, cases of non-compliance with the vaccine and persistent flaccid paralysis are still recorded in the commune of Ouidah in southern Benin. The aim of this study was to investigate the coverage and factors associated with full immunization for age in children aged 0-5 years. Methods A cross-sectional survey was conducted from August to October 2021 in two villages (Adjara-Hounvè and Ahouicodji) in southern Benin. All the households were included. The survey regarded children under 5 for whom a vaccination record was presented. A couple child/mother was recruited after informed consent of the mother and her child. An univariate analysis followed by a multivariate analysis was performed by using a logistic regression model to identify the variables that influence vaccine completeness. Spatial description of vaccine completeness was performed using the kriging method using ArcGIS 10.8 mapping software. Results. Of the 414 mothers surveyed, 57.49% had an immunization card, from which information was collected. Of the 238 children recruited, 141 were in Adjara-Hounvè and 97 in Ahouicodji. Of the 238 children with an immunization card, 20.6% were fully immunized for their age. All children received Baccille Calmette Guérin vaccine at birth. Since poliomyelitis, pentavalent, pneumococcal conjugate, and rotavirus are three-dose vaccines, the percentage of children who received these vaccines decreased as the number of doses increased: 96.6%, 88.2%, 78.1% and 72.3% for the four doses of polio respectively. According to 53.4% of the respondents the reception at the vaccination site was poor, and according to 70.3% of them waiting time for vaccination sessions was long. Several reasons justified the absence of complete vaccination for the age of the children: vaccination site too far from the place of residence (59.54%), lack of financial means (29.78%) and the mother's ignorance (12.76%). Education level "primary" vs "none" (ORa = 3.32; CI95% 1.07-10.25), occupation "health staff" vs "housewife" (ORa = 21.18; CI95% 3.07-145.94), mothers' knowledge of Expanded Programme on Immunization diseases (ORa = 2, 20; CI95% 1.03-4.68) and children's age 0-2 months vs ≥ 16 months (ORa = 8.53; CI95% 2.52-28.85) and 9-15 months vs ≥ 16 months (ORa = 2.99; CI95% 1.24-7.23) increased complete immunization status for age. The homogeneity of behaviour related to age-complete immunization coverage in children under 5 years was evident at mapping. Conclusion Age-complete immunization coverage in children under 5 years of age is very low, with a spatial homogeneity in community immunization uptake behaviour. Age-complete immunization coverage is an innovative indicator that can contribute to achieving age-specific immunization targets.
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Affiliation(s)
- Barikissou Georgia DAMIEN
- Département Population et santé, Centre de formation et de recherche en matière de population, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Wenceslas VL AVON OU
- Département Population et santé, Centre de formation et de recherche en matière de population, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Marlène DAHOUN
- Département Population et santé, Centre de formation et de recherche en matière de population, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Landry KAUCLEY
- Ministère de la Santé, Agence nationale des soins de santé primaires (ANSSP), Direction de la vaccination et de la logistique, Cotonou, Bénin
| | - Badirou AGUEMON
- Département de santé publique, Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin
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Farrenkopf BA, Zhou X, Shet A, Olayinka F, Carr K, Patenaude B, Chido-Amajuoyi OG, Wonodi C. Understanding household-level risk factors for zero dose immunization in 82 low- and middle-income countries. PLoS One 2023; 18:e0287459. [PMID: 38060516 PMCID: PMC10703331 DOI: 10.1371/journal.pone.0287459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/06/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In 2021, an estimated 18 million children did not receive a single dose of routine vaccinations and constitute the population known as zero dose children. There is growing momentum and investment in reaching zero dose children and addressing the gross inequity in the reach of immunization services. To effectively do so, there is an urgent need to characterize more deeply the population of zero dose children and the barriers they face in accessing routine immunization services. METHODS We utilized the most recent DHS and MICS data spanning 2011 to 2020 from low, lower-middle, and upper-middle income countries. Zero dose status was defined as children aged 12-23 months who had not received any doses of BCG, DTP-containing, polio, and measles-containing vaccines. We estimated the prevalence of zero-dose children in the entire study sample, by country income level, and by region, and characterized the zero dose population by household-level factors. Multivariate logistic regressions were used to determine the household-level sociodemographic and health care access factors associated with zero dose immunization status. To pool multicountry data, we adjusted the original survey weights according to the country's population of children 12-23 months of age. To contextualize our findings, we utilized United Nations Population Division birth cohort data to estimate the study population as a proportion of the global and country income group populations. RESULTS We included a total of 82 countries in our univariate analyses and 68 countries in our multivariate model. Overall, 7.5% of the study population were zero dose children. More than half (51.9%) of this population was concentrated in African countries. Zero dose children were predominantly situated in rural areas (75.8%) and in households in the lowest two wealth quintiles (62.7%) and were born to mothers who completed fewer than four antenatal care (ANC) visits (66.5%) and had home births (58.5%). Yet, surprisingly, a considerable proportion of zero dose children's mothers did receive appropriate care during pregnancy (33.5% of zero dose children have mothers who received at least 4 ANC visits). When controlled for other factors, children had three times the odds (OR = 3.00, 95% CI: 2.72, 3.30) of being zero dose if their mother had not received any tetanus injections, 2.46 times the odds (95% CI: 2.21, 2.74) of being zero dose if their mother had not received any ANC visits, and had nearly twice the odds (OR = 1.87, 95% CI: 1.70, 2.05) of being zero dose if their mother had a home delivery, compared to children of mothers who received at least 2 tetanus injections, received at least 4 ANC visits, and had a facility delivery, respectively. DISCUSSION A lack of access to maternal health care was a strong risk factor of zero dose status and highlights important opportunities to improve the quality and integration of maternal and child health programs. Additionally, because a substantial proportion of zero dose children and their mothers do receive appropriate care, approaches to reach zero dose children should incorporate mitigating missed opportunities for vaccination.
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Affiliation(s)
- Brooke Amara Farrenkopf
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Xiaobin Zhou
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Folake Olayinka
- United States Department of International Development, Immunization Team, District of Columbia, Washington, DC, United States of America
| | - Kelly Carr
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Onyema Greg Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Chizoba Wonodi
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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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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Simegn W, Diress M, Gela YY, Belay DG, Ayelign Kibret A, Chilot D, Sinamaw D, Abdu Seid M, Andualem AA, Anmut Bitew D, Eshetu HB, Mohammed Seid A. Childhood vaccination practices and associated factors among mothers/caregivers in Debre Tabor town, Northwest Ethiopia: A cross-sectional study. Front Pediatr 2023; 11:1070722. [PMID: 36793335 PMCID: PMC9922988 DOI: 10.3389/fped.2023.1070722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/02/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Incomplete immunization and non-immunization increase the risk of disease and death among children. This study aims to assess childhood vaccination practices and associated factors among mothers and caregivers in Debre Tabor town, Amhara region, Ethiopia. METHODS A community-based cross-sectional study design was conducted between February 30 and April 30, 2022. The study participants were proportionally allocated to all six kebeles found in the town. A systematic random sampling technique was used to select the study participants. The collected data were checked and coded and then entered into EpiData Version 3.1 and exported into SPSS Version 26. The results were organized using frequency tables, graphs, and charts, and bivariate and multivariable logistic regression were used to test the association of covariates with childhood vaccination practices. RESULT Approximately 422 study mothers and caregivers participated in the study, with a response rate of 100%. The mean age was 30.63 years (11.74), which ranged from 18 to 58 years. More than half of the study participants (56.4%) expressed fears about the side effects of vaccination. A majority (78.4%) of the study participants availed of counseling services about vaccination, and 71.1% of them received regular antenatal care. This study found that approximately 280 [66.4%, 95% confidence interval (CI): 61.8-70.6] mothers/caregivers had a history of good childhood vaccination practices. The factors of the fear of side effects [adjusted odds ratio (AOR) = 3.34; 95% CI: 1.72-6.49], no workload (AOR = 6.08; 95% CI: 1.74-21.22), medium workload (AOR = 4.80; 95% CI: 1.57-14.71), being a mother of child/children (AOR = 2.55; 95% CI: 1.27-5.13), positive attitude (AOR = 2.25; 95% CI: 1.32-3.82), and sound knowledge (AOR = 3.88; 95% CI: 2.26-6.68) were significantly associated with childhood vaccination practices. CONCLUSION More than half of the study participants had a history of good childhood vaccination practices. However, the rate of such practices was low among mothers and caregivers. The fear of side effects, workload, motherhood, attitude, and knowledge were all factors associated with childhood vaccination practices. Awareness creation and a consideration of the workload of mothers would be helpful in dispelling fears and increasing the rate of good practices among mothers and caregivers.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Chilot
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Debre Markos, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Human Physiology, Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre tabor, Ethiopia
| | | | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdulwase Mohammed Seid
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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8
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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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/07/2022] [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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9
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Kanma-Okafor O, Odusolu Y, Abayomi A, Shuaib F, Adeyeye M, Mustapha I, Ogboye S, Lajide D, Abdur-Razzaq H, Okafor U, Elemuwa U, Osibogun A. A qualitative analysis of the COVID-19 vaccination rollout in Lagos, Nigeria: Client and provider perspectives on the plan, the process and the progress. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000486. [PMID: 36962511 PMCID: PMC10021997 DOI: 10.1371/journal.pgph.0000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/09/2022] [Indexed: 11/10/2022]
Abstract
Mass vaccination has proven useful in the control of COVID-19, though vaccine rollout has met major challenges. The learning curve of this process has been valuable. This qualitative study aimed to assess the plan, the process and the progress of the COVID-19 vaccination rollout in Lagos, Nigeria. This study was conducted at vaccination centers in eight of the 20 Local Government Areas in Lagos State from May to July 2021 among healthcare administrators, health workers and vaccine recipients. Data were collected by conducting three key informant interviews, 24 in-depth interviews and eight focus group discussions to explore the vaccination experiences of participants and the challenges facing the vaccination plan and process. The interviews and discussions were recorded, transcribed verbatim and analyzed using the thematic approach. The four-phased plan for the vaccine rollout was clear to all the key informants because the vaccination process was preceded by training. The process was strengthened by the electronic registration system, though riddled by the frequently unstable electronic and internet data capturing. This was mitigated by a stopgap manual registration and recording of client details. Challenges in the logistics of maintaining supplies of the disposable materials required for the vaccination process were overcome by the creativity of the health professionals. Vaccine hesitancy, fueled by misinformation, myths and misconceptions about the vaccine and its side effects, played a huge role in the community response. The reported vaccine side effects were mild; fever, headaches, pain at the injection site, excessive eating and sleepiness. Though the COVID-19 vaccination process appeared to have largely made progress, the future of vaccination in Nigeria is predicated upon a bottom-up approach to programmatic planning, health education and local vaccine production. Collaborations such as public-private partnerships have the potential of boosting vaccine provision for Nigeria's large population to ensure equitable access to vaccines.
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Affiliation(s)
- Oluchi Kanma-Okafor
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yetunde Odusolu
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Moji Adeyeye
- National Agency for Food and Drug Administration and Control, Abuja, Nigeria
| | | | | | - Dayo Lajide
- Lagos State Ministry of Health, Lagos, Nigeria
| | | | - Ukamaka Okafor
- Pharmacists Council of Nigeria, Lagos Office, Lagos, Nigeria
| | - Uchenna Elemuwa
- National Agency for Food and Drug Administration and Control, Abuja, Nigeria
| | - Akin Osibogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos, Nigeria
- Lagos State Primary Health Care Board, Lagos, Nigeria
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10
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Mahachi K, Kessels J, Boateng K, Jean Baptiste AE, Mitula P, Ekeman E, Nic Lochlainn L, Rosewell A, Sodha SV, Abela-Ridder B, Gabrielli AF. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine 2022; 40:5433-5444. [PMID: 35973864 PMCID: PMC9485449 DOI: 10.1016/j.vaccine.2022.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
'Zero-dose' refers to a person who does not receive a single dose of any vaccine in the routine national immunization schedule, while 'missed dose' refers to a person who does not complete the schedule. These peopleremain vulnerable to vaccine-preventable diseases, and are often already disadvantaged due to poverty, conflict, and lack of access to basic health services. Globally, more 22.7 million children are estimated to be zero- or missed-dose, of which an estimated 3.1 million (∼14 %) reside in Nigeria.We conducted a scoping review tosynthesize recent literature on risk factors and interventions for zero- and missed-dosechildren in Nigeria. Our search identified 127 papers, including research into risk factors only (n = 66); interventions only (n = 34); both risk factors and interventions (n = 18); and publications that made recommendations only (n = 9). The most frequently reported factors influencing childhood vaccine uptake were maternal factors (n = 77), particularly maternal education (n = 22) and access to ante- and perinatal care (n = 19); heterogeneity between different types of communities - including location, region, wealth, religion, population composition, and other challenges (n = 50); access to vaccination, i.e., proximity of facilities with vaccines and vaccinators (n = 37); and awareness about immunization - including safety, efficacy, importance, and schedules (n = 18).Literature assessing implementation of interventions was more scattered, and heavily skewed towards vaccination campaigns and polio eradication efforts. Major evidence gaps exist in how to deliver effective and sustainable routine childhood immunization. Overall, further work is needed to operationalise the learnings from these studies, e.g. through applying findings to Nigeria's next review of vaccination plans, and using this summary as a basis for further investigation and specific recommendations on effective interventions.
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Affiliation(s)
- Kurayi Mahachi
- College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | | | - Kofi Boateng
- Nigeria Country Office, World Health Organization, Abuja, Nigeria
| | | | - Pamela Mitula
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Ebru Ekeman
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Laura Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Alexander Rosewell
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Bernadette Abela-Ridder
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland
| | - Albis Francesco Gabrielli
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland.
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11
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Aheto JMK, Pannell O, Dotse-Gborgbortsi W, Trimner MK, Tatem AJ, Rhoda DA, Cutts FT, Utazi CE. Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria. PLoS One 2022; 17:e0269066. [PMID: 35613138 PMCID: PMC9132327 DOI: 10.1371/journal.pone.0269066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed. Methods Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months. Results Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome. Conclusion Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.
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Affiliation(s)
- Justice Moses K. Aheto
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Oliver Pannell
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Winfred Dotse-Gborgbortsi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Mary K. Trimner
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Dale A. Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C. Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
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12
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Olutuase VO, Iwu-Jaja CJ, Akuoko CP, Adewuyi EO, Khanal V. Medicines and vaccines supply chains challenges in Nigeria: a scoping review. BMC Public Health 2022; 22:11. [PMID: 34986820 PMCID: PMC8727467 DOI: 10.1186/s12889-021-12361-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicines and vaccines supply chains represent critical systems for realising one of the major targets of the United Nations' third Sustainable Development Goals (SDGs)-access to safe, effective, quality, and affordable essential medicines and vaccines, for all. However, evidence suggests the system is confronted with several challenges in many low-medium income countries, including Nigeria. This scoping review aims to summarize the available evidence on the challenges of medicines and vaccines supply chain system in Nigeria. RESULTS We searched relevant databases including Scopus and Web of Science for studies published between January 2005 and August 2020 on the challenges associated with medicines and vaccines supply chain systems in Nigeria. Our findings implicate several factors including difficulty with medicines or vaccines selection, procurement, distribution, and inventory management. Others included poor storage infrastructure, financial constraints, insecurity, transportation challenges, inadequate human resources, weak, or poorly implemented policies. These challenges mostly resulted in stock-outs of essential medicines which notably got worsened during the current COVID-19 pandemic. CONCLUSION Our study is a wake-up call on the need to prioritise the critical sector of the supply chain systems for medicines and vaccines in Nigeria. Effective implementation of existing policies, improved security, strengthening of the health system through adequate budgetary allocations, and provision of infrastructure including regular availability of electricity are keys to surmounting the challenges and improving access to medicines or vaccines in Nigeria.
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Affiliation(s)
- Victory O. Olutuase
- Department of Clinical Pharmacy and Pharmacy Practice, University of Jos, Jos, Nigeria
| | - Chinwe J. Iwu-Jaja
- Department of Nursing & Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Cynthia P. Akuoko
- Department of Nursing, Christian Service University College, Kumasi, Ghana
| | - Emmanuel O. Adewuyi
- Collaborative Genomics and Translation Group, Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027 Australia
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13
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Eze P, Agu SA, Agu UJ, Acharya Y. Acceptability of mobile-phone reminders for routine childhood vaccination appointments in Nigeria - a systematic review and meta-analysis. BMC Health Serv Res 2021; 21:1276. [PMID: 34836531 PMCID: PMC8627092 DOI: 10.1186/s12913-021-07296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile-phone reminders have gained traction among policymakers as a way to improve childhood vaccination coverage and timeliness. However, there is limited evidence on the acceptability of mobile-phone reminders among patients and caregivers. This systematic review and meta-analysis aimed to evaluate the ownership of mobile-phone device and the willingness to receive mobile-phone reminders among mothers/caregivers utilizing routine childhood immunization services in Nigeria. METHOD MEDLINE, Scopus, CINAHL, CNKI, AJOL (African Journal Online), and Web of Science were systematically searched for studies on the acceptability of mobile-phone reminders for routine immunization appointments among mothers/caregivers in Nigeria. Studies were assessed for methodological quality using the Newcastle Ottawa Scale and JBI critical appraisal checklists. Meta-analysis was conducted using random-effects model to generate pooled estimates (proportion) of mothers who owned at least one mobile phone and proportion of mothers willing to receive mobile-phone reminders. RESULTS Sixteen studies (13 cross-sectional and three interventional) involving a total of 9923 mothers across 15 states and the Federal Capital Territory Abuja met inclusion criteria. Pooled estimates showed that the proportion of mothers who owned at least one mobile phone was 96.4% (95% CI = 94.1-98.2%; I2 = 96.3%) while the proportion of mothers willing to receive mobile-phone reminders was 86.0% (95% CI = 79.8-91.3%, I2 = 98.4%). Most mothers preferred to receive text message reminders at least 24 h before the routine immunization appointment day, and in the morning hours. Approximately 52.8% of the mothers preferred to receive reminders in English, the country's official language. CONCLUSION Current evidence suggests a high acceptability for mobile-phone reminder interventions to improve routine childhood immunization coverage and timeliness. Further studies, however, are needed to better understand unique regional preferences and assess the operational costs, long-term effects, and risks of this intervention. SYSTEMATIC REVIEW PROTOCOL REGISTRATION PROSPERO CRD42021234183.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802 USA
| | - Sergius Alex Agu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ujunwa Justina Agu
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802 USA
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Abstract
OBJECTIVES Childhood vaccination coverage in Nagaland has lagged almost all states in India for more than two decades. This study aims to find drivers and barriers of childhood vaccination in Nagaland from the perspective of demand, supply and local health governance. DESIGN A cross-sectional study was designed using a survey conducted by the Directorate of Health and Family in 2015. SETTING Households, community-based health centres and health committees were surveyed. PARTICIPANTS 285 children aged under 2 years with vaccination cards and data on households, health centres and health committees were included. OUTCOMES Variables indicating whether a child received each of bacillus calmette-guérin (BCG), diphtheria-tetanus-pertussis (DTP3), oral polio (OPV3) and measles vaccination and all of them were outcome variables. Associated factors were identified using multilevel logistic regressions. RESULTS Antenatal care at least three times was significantly associated with BCG, DTP3, OPV3 and full vaccination with adjusted ORs ranging from 2.4 (95% CI 1.1 to 5.1) to 3.3 (1.1 to 9.9). The availability of bus to health centre was slightly significant for BCG and OPV3 with the adjusted ORs of 2.0 (0.9 to 4.5) and 2.1 (0.9 to 4.8), respectively. Health committees' budget provision to health centres was significant for OPV3 and full vaccination with the respective adjusted ORs of 15.7 (1.0 to 234.1) and 15.9 (1.2 to 214.7), the wide 95% CIs of which were driven by a small sample size. Health committees' review of expenditure of health centres was significant for measles and full vaccination with the adjusted ORs of 4.0 (1.4 to 11.4) and 5.2 (1.4 to 19.4), respectively. CONCLUSION This study suggests that enhancing the utilisation of antenatal care and providing reliable transportation between villages and health centres are required to improve childhood vaccination coverage. Also, the significant association of budget administration of health committees suggests that supporting local health committees for effective financial management is important.
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Affiliation(s)
- Young Eun Kim
- Development Research Group and EAPCE Research Center, World Bank, Kuala Lumpur, Malaysia
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15
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Wagai JN, Rhoda D, Prier M, Trimmer MK, Clary CB, Oteri J, Okposen B, Adeniran A, Danovaro-Holliday C, Cutts F. Implementing WHO guidance on conducting and analysing vaccination coverage cluster surveys: Two examples from Nigeria. PLoS One 2021; 16:e0247415. [PMID: 33635913 PMCID: PMC7909665 DOI: 10.1371/journal.pone.0247415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators—VCQI) to calculate them.–The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria–one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.
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Affiliation(s)
| | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Prier
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Kay Trimmer
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Caitlin B. Clary
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Bassey Okposen
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Sato R, Fintan B. Women's understanding of immunization card and its correlation with vaccination behaviors. Hum Vaccin Immunother 2020; 16:2408-2414. [PMID: 32083511 DOI: 10.1080/21645515.2020.1726682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Despite the proven effectiveness of vaccinations, vaccination uptake is limited in Nigeria. According to the Multiple Indicator Cluster Survey (MICS), one of the main barriers is the lack of accurate knowledge of the vaccination schedule. This study evaluates caregivers' knowledge of the vaccination schedule and their ability to read the immunization card. Methods: The study evaluated the knowledge of caregivers in 11 settlements in the Jada local government area of Adamawa State in September 2019. The change in knowledge among caregivers before and after referring to the immunization card was evaluated using a simple statistical hypothesis testing (chi-square test). We also used logistic regression analysis to evaluate the determinants of vaccination knowledge, as well as the correlation between knowledge and actual vaccination behaviors. Results: More than half of the women had correct knowledge of the vaccination schedule for critical vaccines. However, the knowledge of the caregivers did not improve after referring to the immunization card which contained the information. Caregivers who brought their children to the clinic for vaccination recently were more likely to know the vaccination schedule correctly. Accurate knowledge was highly correlated with the actual vaccination behaviors. Conclusion: Reference to the immunization card did not improve the knowledge of vaccination schedule, especially among the less-educated population. To increase the demand for vaccinations, one potential policy is to target the uneducated population and help them increase their knowledge.
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Affiliation(s)
- Ryoko Sato
- Global Health and Population, Harvard T.H Chan School of Public Health , Boston, MA, USA
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17
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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: 96] [Impact Index Per Article: 24.0] [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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Sato R, Fintan B. Fear, knowledge, and vaccination behaviors among women in Northern Nigeria. Hum Vaccin Immunother 2020; 16:2438-2448. [PMID: 32083514 DOI: 10.1080/21645515.2020.1723365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Although vaccine hesitancy is a global concern, the evaluation on how fear of vaccination affects vaccination-related knowledge, behaviors, and perceptions is extremely scarce in developing countries. This study contributes to the literature by filling the knowledge gap on the fear of vaccination by focusing on Nigerian caregivers. Methods: The study evaluates the correlation between fear of vaccination and knowledge, actual behaviors, and perception among caregivers in 11 settlements in the Jada local government area of Adamawa State, northeastern Nigeria. The data were collected in September 2019. We use logistic regression analysis to evaluate the correlation. Results and Discussions: About 15% of caregivers have some form of fear regarding vaccination. However, such fear is not correlated with most of the socio-demographic characteristics among caregivers. Fear is significantly correlated with the lack of accurate vaccination knowledge, with a lower likelihood of vaccination uptake for their children, and with the lack of perceptions of vaccination importance and intention to vaccinate their children. Results from our study are consistent with findings from existing studies conducted in developed countries.
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Affiliation(s)
- Ryoko Sato
- Global Health and Population, Harvard T.H Chan School of Public Health , Boston, MA, USA
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