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Rhoda DA, Cutts FT, Agócs M, Brustrom J, Trimner MK, Clary CB, Clark K, Koffi D, Manibaruta JC, Sowe A, Gunnala R, Ogbuanu IU, Gacic-Dobo M, Danovaro-Holliday MC. A Practical Guide to Pilot Testing Community-Based Vaccination Coverage Surveys. Vaccines (Basel) 2023; 11:1773. [PMID: 38140178 PMCID: PMC10748182 DOI: 10.3390/vaccines11121773] [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: 10/05/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023] Open
Abstract
Pilot testing is crucial when preparing any community-based vaccination coverage survey. In this paper, we use the term pilot test to mean informative work conducted before a survey protocol has been finalized for the purpose of guiding decisions about how the work will be conducted. We summarize findings from seven pilot tests and provide practical guidance for piloting similar studies. We selected these particular pilots because they are excellent models of preliminary efforts that informed the refinement of data collection protocols and instruments. We recommend survey coordinators devote time and budget to identify aspects of the protocol where testing could mitigate project risk and ensure timely assessment yields, credible estimates of vaccination coverage and related indicators. We list specific items that may benefit from pilot work and provide guidance on how to prioritize what to pilot test when resources are limited.
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Affiliation(s)
- Dale A. Rhoda
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary Agócs
- American Red Cross, 431 18th Street NW, Washington, DC 20006, USA
| | - Jennifer Brustrom
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Mary Kay Trimner
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Caitlin B. Clary
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Kathleen Clark
- American Red Cross, 431 18th Street NW, Washington, DC 20006, USA
| | - David Koffi
- Cabinet d’Appui au Développement Sanitaire, Abidjan, Côte d’Ivoire
| | - Jean Claude Manibaruta
- Burundi Country Office, World Health Organization, Boulevard de I’Uprona-Rohero II, Bujumbura P.O. Box 1450, Burundi
| | - Alieu Sowe
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia
| | - Rajni Gunnala
- US Indian Health Services Area Office, Indian Health Service, 40 N Central Ave #600, Phoenix, AZ 85004, USA
| | - Ikechukwu U. Ogbuanu
- Child Health and Mortality Prevention Surveillance (CHAMPS) Network, Crown Agents in Sierra Leone, 28 Bathurst Street, Freetown, Sierra Leone
| | - Marta Gacic-Dobo
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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Ji WY, Liu DL, Yu R, Miao L, Yuan QL, Suo LD, Yu JP. Vaccination coverage survey of children aged 1-3 years in Beijing, China, 2005-2021. Vaccine 2023; 41:6444-6452. [PMID: 37709591 DOI: 10.1016/j.vaccine.2023.08.015] [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: 04/21/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The routine immunization program for children is a primary strategy and a core part of vaccination. Achieving and maintaining high level of vaccination coverage are important to reduce morbidity and mortality caused by vaccine-preventable diseases. In Beijing, annual coverage surveys have been conducted since 2005. It is necessary and possible to assess the level and trend of routine vaccination coverage of children in Beijing as well as the disruption of coronavirus disease 2019 (COVID-19) pandemic and provide the reference for the further improve the vaccination coverage. METHODS The data of 61,521 children aged 1-3 years in the vaccination coverage surveys during 2005-2021 were analyzed by Beijing Center for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the data and the difference of vaccination coverage within the time period. RESULTS More than 99 % of participants had immunization cards and electronic immunization records. The concordance rate of both records were also over 99 %. During 2011-2019, the rates of on-time and in-time vaccination of each routine vaccine reached 96 % or more and increased significantly (all P values <0.05), compared with that of 2005-2010. All rates of the investigated vaccine, except for Bacillus Calmette-Guérin vaccine (BCG) and the first dose of hepatitis B vaccine (HepB), decreased in 2020-2021 significantly (all P values <0.05). For the causes of failing to vaccinate on time, delayed vaccination accounted for 47.82 %. The top two vaccines to be missed were the first dose of hepatitis A vaccine and the 4th dose of diphtheria-tetanus-acellular pertussis vaccine, accounting for 21.41 % and 20.79 %, respectively. The main reason for zero-dose/drop-out vaccination was "Guardians regarded the immunization service time as inappropriate", accounting for 72.27 %. CONCLUSION The coverage level and service quality of routine immunization in Beijing were relatively high. However, as influenced by COVID-19 epidemics, both on-time and in-time vaccination rates decreased significantly, except for BCG and HepB. Under the background of COVID-19 pandemic, the keys to maintain high level of vaccination coverage include flexible immunization service time to ensure the guardians bringing their children for vaccination timely, and more attention from providers to the doses after children's first birthday.
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Affiliation(s)
- Wen-Yan Ji
- Institute of Immunization, Beijing Center for Disease Control and Prevention, Beijing, PR China
| | - Dong-Lei Liu
- Department of Vaccines Management and Supply, Beijing Center for Disease Control and Prevention, Beijing 100013, PR China
| | - Rui Yu
- Institute of Immunization, Beijing Center for Disease Control and Prevention, Beijing, PR China
| | - Liang Miao
- Institute of Immunization, Beijing Center for Disease Control and Prevention, Beijing, PR China
| | - Qian-Li Yuan
- Institute of Immunization, Beijing Center for Disease Control and Prevention, Beijing, PR China
| | - Luo-Dan Suo
- Institute of Immunization, Beijing Center for Disease Control and Prevention, Beijing, PR China
| | - Jian-Ping Yu
- Office of Beijing Center for Disease Control and Prevention, Beijing 10013, PR China.
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Ishoso DK, Danovaro-Holliday MC, Cikomola AMW, Lungayo CL, Mukendi JC, Mwamba D, Ngandu C, Mafuta E, Lusamba Dikassa PS, Lulebo A, Manirakiza D, Mboussou FF, Yapi MD, Ngabo GF, Riziki RB, Mwanga C, Otomba J, Nimpa MM. "Zero Dose" Children in the Democratic Republic of the Congo: How Many and Who Are They? Vaccines (Basel) 2023; 11:900. [PMID: 37243004 PMCID: PMC10224070 DOI: 10.3390/vaccines11050900] [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: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: The Democratic Republic of the Congo (DRC) is one of the countries with the highest number of never vaccinated or "zero-dose" (ZD) children in the world. This study was conducted to examine the proportion of ZD children and associated factors in the DRC. (2) Methods: Child and household data from a provincial-level vaccination coverage survey conducted between November 2021-February 2021 and 2022 were used. ZD was defined as a child aged 12 to 23 months who had not received any dose of pentavalent (diphtheria-tetanus-pertussis-Haemophilus influenzae type b (Hib)-Hepatitis B) vaccine (by card or recall). The proportion of ZD children was calculated and associated factors were explored using logistic regression, taking into account the complex sampling approach. (3) Results: The study included 51,054 children. The proportion of ZD children was 19.1% (95%CI: 19.0-19.2%); ZD ranged from 62.4% in Tshopo to 2.4% in Haut Lomami. After adjustment, being ZD was associated with low level of maternal education and having a young mother/guardian (aged ≤ 19 years); religious affiliation (willful failure to disclose religious affiliation as the highest associated factor compared to being Catholic, followed by Muslims, revival/independent church, Kimbanguist, Protestant); proxies for wealth such as not having a telephone or a radio; having to pay for a vaccination card or for another immunization-related service; not being able to name any vaccine-preventable disease. A child's lack of civil registration was also associated with being ZD. (4) Conclusions: In 2021, one in five children aged 12-23 months in DRC had never been vaccinated. The factors associated with being a ZD child suggest inequalities in vaccination that must be further explored to better target appropriate interventions.
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Affiliation(s)
- Daniel Katuashi Ishoso
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - M. Carolina Danovaro-Holliday
- Immunization, Analytics and Insights (IAI), Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 1202 Geneva, Switzerland
| | | | | | | | - Dieudonné Mwamba
- National Institute of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Christian Ngandu
- National Institute of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Aimée Lulebo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Deo Manirakiza
- United Nations Children’s Fund (UNICEF) Country Office, Kinshasa, Democratic Republic of the Congo
| | - Franck-Fortune Mboussou
- World Health Organization African Regional Office, Brazzaville, Democratic Republic of the Congo
| | - Moise Désiré Yapi
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of the Congo
| | - Gaga Fidele Ngabo
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of the Congo
| | - Richard Bahizire Riziki
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of the Congo
- Higher Institute of Medical Techniques of Nyangezi, Public Health Section, Sud-Kivu, Democratic Republic of the Congo
| | - Cedric Mwanga
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of the Congo
| | - John Otomba
- World Health Organization (WHO) Country Office, Kinshasa, Democratic Republic of the Congo
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Use of catch-up vaccinations in the second year of life (2YL) platform to close immunity gaps: A secondary DHS analysis in Pakistan, Philippines, and South Africa. Vaccine 2023; 41:61-67. [PMID: 36396512 PMCID: PMC9662756 DOI: 10.1016/j.vaccine.2022.10.040] [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: 07/24/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immunity gaps caused by COVID-19-related disruptions highlight the importance of catch-up vaccination. Number of countries offering vaccines in second year of life (2YL) has increased, but use of 2YL for catch-up vaccination has been variable. We assessed pre-pandemic use of 2YL for catch-up vaccination in three countries (Pakistan, the Philippines, and South Africa), based on existence of a 2YL platform (demonstrated by offering second dose of measles-containing vaccine (MCV2) in 2YL), proportion of card availability, and geographical variety. METHODS We conducted a secondary data analysis of immunization data from Demographic and Health Surveys (DHS) in Pakistan (2017-2018), the Philippines (2017), and South Africa (2016). We conducted time-to-event analyses for pentavalent vaccine (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenzae type b [Hib]) and MCV and calculated use of 2YL and MCV visits for catch-up vaccination. RESULTS Among 24-35-month-olds with documented dates, coverage of third dose of pentavalent vaccine increased in 2YL by 2%, 3%, and 1% in Pakistan, Philippines, and South Africa, respectively. MCV1 coverage increased in 2YL by 5% in Pakistan, 10% in the Philippines, and 3% in South Africa. In Pakistan, among 124 children eligible for catch-up vaccination of pentavalent vaccine at time of a documented MCV visit, 45% received a catch-up dose. In the Philippines, among 381 eligible children, 38% received a pentavalent dose during an MCV visit. In South Africa, 50 children were eligible for a pentavalent vaccine dose before their MCV1 visit, but only 20% received it; none with MCV2. CONCLUSION Small to modest vaccine coverage improvements occurred in all three countries through catch-up vaccination in 2YL but many missed opportunities for vaccination continue to occur. Using the 2YL platform can increase coverage and close immunity gaps, but immunization programmes need to change policies, practices, and monitor catch-up vaccination to maximize the potential.
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Eze P, Aniebo CL, Agu UJ, Agu SA, Acharya Y. Validity of maternal recall for estimating childhood vaccination coverage - Evidence from Nigeria. Vaccine 2022; 40:28-36. [PMID: 34863616 DOI: 10.1016/j.vaccine.2021.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vaccination coverage surveys in low- and middle-income countries typically estimate vaccination coverage using data from vaccination cards, parental recall, or a combination of the two. However, these surveys are often complicated by the pervasive absence of vaccination cards, forcing researchers to rely on parental recall. We assessed the validity of mothers' recall against home-based vaccination cards using data from a community-based household survey in Nigeria. METHODS A cross-sectional survey of 1,254 mothers of children aged 12-23 months was performed in Enugu State, Nigeria in July 2020. Data on vaccination status for BCG, OPV, DPT, Measles, Yellow fever, and Vitamin A supplement were collected using two data sources: home-based vaccination cards and mothers' recall. We evaluated the level of agreement between the two data sources; estimated the sensitivity and specificity of mothers' recalls; and computed multivariable regression models to identify socio-demographic factors associated with mothers' recall bias. RESULTS Out of 1,254 mothers interviewed, 578 (46.1%) mothers with vaccination cards were included in this analysis. Vaccination coverage levels were generally similar across data sources, though recall-based data generally underestimated the coverage. The level of agreement between the two data sources was high (≥91.0% for all vaccine types) with recall bias due to under-reporting generally higher than recall bias due to over-reporting. The sensitivity of parental recalls was high for all vaccine types, while the specificity was low across vaccine types. Across all vaccines, mothers recall bias was significantly associated with the rural residence and not receiving postnatal care. CONCLUSION In the absence of vaccination cards, mothers' recall of their children' vaccination status for BCG, OPV, DPT, Measles, Yellow fever and Vitamin A is a valid instrument for estimating childhood vaccination coverage in this setting in Nigeria. However, additional research is needed to confirm these findings at higher sub-national and national levels.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA.
| | - Chioma Lynda Aniebo
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Ujunwa Justina Agu
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Sergius Alex Agu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA.
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Joseph L, Lavis A, Greenfield S, Boban D, Jose P, Jeemon P, Manaseki-Holland S. A systematic review of home-based records in maternal and child health for improving informational continuity, health outcomes, and perceived usefulness in low and middle-income countries. PLoS One 2022; 17:e0267192. [PMID: 35925923 PMCID: PMC9352021 DOI: 10.1371/journal.pone.0267192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Evidence shows that a gap in the documentation of patients' past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. METHODS The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection criteria- studies explaining the use of HBRs in LMIC for maternal and child health care. The included study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results from all study designs were summarised narratively. RESULTS In total, 41 papers were included in the review from 4514 potential studies. Included studies represented various study designs and 16 countries. The least evaluated function of HBR was information continuity across health care facilities (n = 6). Overall, there were limited data on the usefulness of HBRs to providers and mothers/families. Home-based records were mostly available for providers during health care visits. However, the documentation in HBRs varied. The use of HBRs is likely to lead to improved antenatal visits and immunisation uptake, and skilled birth delivery in some settings. Mothers' knowledge of breastfeeding practices and danger signs in pregnancy improved with the use of HBRs. One randomised trial found the use of HBRs reduced the risk of cognitive development delay in children and another reported on trial lessened the risk of underweight and stunted growth in children. CONCLUSION There is limited literature from LMICs on the usefulness of HBRs and for improving information transfer across healthcare facilities, or their use by women at home. Current HBRs from LMICs are sub-optimally documented leading to poor informational availability that defeats the point of them as a source of information for future providers.
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Affiliation(s)
- Linju Joseph
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Anna Lavis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Dona Boban
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
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Rhoda DA, Prier ML, Clary CB, Trimner MK, Velandia-Gonzalez M, Danovaro-Holliday MC, Cutts FT. Using Household Surveys to Assess Missed Opportunities for Simultaneous Vaccination: Longitudinal Examples from Colombia and Nigeria. Vaccines (Basel) 2021; 9:vaccines9070795. [PMID: 34358211 PMCID: PMC8310031 DOI: 10.3390/vaccines9070795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
One important strategy to increase vaccination coverage is to minimize missed opportunities for vaccination. Missed opportunities for simultaneous vaccination (MOSV) occur when a child receives one or more vaccines but not all those for which they are eligible at a given visit. Household surveys that record children’s vaccination dates can be used to quantify occurrence of MOSVs and their impact on achievable vaccination coverage. We recently automated some MOSV analyses in the World Health Organization’s freely available software: Vaccination Coverage Quality Indicators (VCQI) making it straightforward to study MOSVs for any Demographic & Health Survey (DHS), Multi-Indicator Cluster Survey (MICS), or Expanded Programme on Immunization (EPI) survey. This paper uses VCQI to analyze MOSVs for basic vaccine doses among children aged 12–23 months in four rounds of DHS in Colombia (1995, 2000, 2005, and 2010) and five rounds of DHS in Nigeria (1999, 2003, 2008, 2013, and 2018). Outcomes include percent of vaccination visits MOSVs occurred, percent of children who experienced MOSVs, percent of MOSVs that remained uncorrected (that is, the missed vaccine had still not been received at the time of the survey), and the distribution of time-to-correction for children who received the MOSV dose at a later visit.
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Affiliation(s)
- Dale A. Rhoda
- Biostat Global Consulting, Worthington, OH 43085, USA; (M.L.P.); (C.B.C.); (M.K.T.)
- Correspondence:
| | - Mary L. Prier
- Biostat Global Consulting, Worthington, OH 43085, USA; (M.L.P.); (C.B.C.); (M.K.T.)
| | - Caitlin B. Clary
- Biostat Global Consulting, Worthington, OH 43085, USA; (M.L.P.); (C.B.C.); (M.K.T.)
| | - Mary Kay Trimner
- Biostat Global Consulting, Worthington, OH 43085, USA; (M.L.P.); (C.B.C.); (M.K.T.)
| | - Martha Velandia-Gonzalez
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC 20037, USA;
| | | | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Brown DW, Danovaro-Holliday MC, Rhoda DA. Pairs of independent nationally representative vaccination coverage surveys conducted within one year of each other: A global overview covering 2000-2019. Vaccine X 2021; 7:100085. [PMID: 33644743 PMCID: PMC7887424 DOI: 10.1016/j.jvacx.2021.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Population-based surveys play an important role in measuring vaccination coverage. Surveys measuring vaccination coverage may be commissioned by the Expanded Programme on Immunization (EPI surveys) or part of multi-domain non-EPI surveys such as Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). Surveys conducted too close in time to each other may not only be an inefficient use of resources but may also create problems for programme staff when results suggest inconsistent patterns of programme performance for similar time periods. Objective To summarize the occurrence of vaccination coverage surveys conducted close in time during 2000–2019 and compare results of EPI and non-EPI coverage surveys when the surveys were conducted within one year of each other. Methods Using a database of published national-level vaccination coverage survey results compiled by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), the authors abstracted information on survey field work dates, sample size, percentage of children with documented history of vaccination and the percent coverage, as well as published uncertainty intervals from DHS and MICS, for the first and third doses of diphtheria-tetanus toxoid-pertussis containing vaccine (DTP1, DTP3) and first dose of measles containing vaccine (MCV1). Survey results of EPI and non-EPI surveys were compared. Results The authors identified 646 surveys with final reports and estimates of national-level vaccination coverage for DTP1, DTP3, or MCV1 from a total of 687 surveys with data collection start date from 2000 to 2019. Of the 140 countries with at least one vaccination coverage survey, a median of four surveys was observed. Most countries were Gavi-eligible and located in the WHO Africa Region. Sixty-six survey dyads were identified where an EPI survey occurred within one year of a non-EPI survey. For the 66 dyads, in 49 of 59 with information available, EPI surveys reported higher proportion of documented evidence of vaccination and EPI survey results tended to suggest higher levels of vaccination coverage compared to the non-EPI surveys; quite often, differences were substantial. Surveys that found higher proportions of children with documented vaccination evidence tended to also find higher proportions of children who had been vaccinated. Summary Opportunities exist to improve overall planning of vaccination coverage measurement in population-based household surveys so that both EPI and non-EPI surveys are more comparable and survey coverage estimates are more appropriately spaced in time. When surveys occur too close in time, careful attention is warranted to ensure comparability and assess sources of documented evidence of vaccination and related coverage differences.
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Affiliation(s)
- David W. Brown
- BCGI LLC/pivot-23.5°, Cornelius, NC, USA
- Corresponding author at: BCGI LLC/pivot-23.5°, 19701 Bethel Church Road, Ste 103-168, Cornelius, NC 28031, USA.
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Kaboré L, Meda B, Médah I, Shendale S, Nic Lochlainn L, Sanderson C, Ouattara M, Kaboré WMF, Betsem E, Ogbuanu IU. Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization's revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage. Vaccine 2020; 38:7603-7611. [PMID: 33077298 PMCID: PMC7604568 DOI: 10.1016/j.vaccine.2020.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
We assessed reasons for missed opportunities for vaccination (MOV) in Burkina Faso. We found the prevalence of MOV was 76% among all eligible children. The prevalence of MOV was 97% among children attending for a non-vaccination visit. Health workers’ knowledge, attitude and practices were insufficient to minimize MOV. Reducing MOV can result in increases to both vaccine coverage and equity.
Background Despite the remarkable achievements of the Expanded Programme on Immunization (EPI) in Burkina Faso, numerous challenges remain, including missed opportunities for vaccination (MOV) which occur when people visit a health facility with at least one vaccine due according to the national immunization schedule, are free of contraindications, and leave without receiving all due vaccine doses. In 2016, we used the revised World Health Organization’s (WHO) MOV strategy to assess the extent of and reasons for MOV in Burkina Faso. Methods We purposively selected 27 primary health facilities (PHFs) from the eight health districts with the highest absolute numbers of children who missed the first dose of measles-rubella (MR1) in 2015. We conducted exit interviews with caregivers of children aged 0–23 months, and requested health workers to complete a self-administered knowledge, attitudes and practices (KAP) questionnaire. Results A total of 489 caregivers were interviewed, of which 411 were eligible for inclusion in our analysis. Medical consultation (35%) and vaccination (24.5%) were the most frequent reasons for visiting PHFs. Among the 73% of children eligible for vaccination, 76% of vaccination opportunities were missed. Among eligible children, the percentage with MOV was significantly higher in those aged ≥12 months and also in those attending for a reason other than vaccination. A total of 248 health workers completed the KAP questionnaire. Of these, 70% (n = 168/239) considered their knowledge on immunization to be insufficient or outdated; 83% failed to correctly identify valid contraindications to vaccination. Conclusion Addressing MOV offers the potential for substantial increases in vaccine coverage and equity, and ultimately reducing the burden of vaccine-preventable diseases (VPDs). This will require the implementation of a series of interventions aimed at improving community knowledge and practices, raising health workers’ awareness, and fostering the integration of immunization with other health services.
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Affiliation(s)
- Lassané Kaboré
- Agence de Médecine Préventive (AMP), Ouagadougou, Burkina Faso.
| | - Bertrand Meda
- Agence de Médecine Préventive (AMP), Ouagadougou, Burkina Faso
| | - Isaie Médah
- Ministry of Health, Direction de la Prévention par les Vaccinations (DPV), Ouagadougou, Burkina Faso
| | - Stephanie Shendale
- 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
| | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mâ Ouattara
- World Health Organization, Country Office, Ouagadougou, Burkina Faso
| | - William M F Kaboré
- Ministry of Health, Direction de la Prévention par les Vaccinations (DPV), Ouagadougou, Burkina Faso
| | - Edouard Betsem
- Agence de Médecine Préventive (AMP), Ouagadougou, Burkina Faso; Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso
| | - Ikechukwu U Ogbuanu
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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