Reasons why children miss vaccinations in Western Kenya; A step in a five-point plan to improve routine immunization

"Are we ready to transition from the Global Alliance for Vaccines and Immunization support?" Perceptions from 15 Kenyan counties

Introduction

Gavi, the Vaccine Alliance, defined a transition roadmap for countries receiving funding support based on their income status projections. According to the latest projections, Kenya will complete their transition from vaccine funding in 2029. While eligible countries are kept informed and supported for a smooth transition process, the extent to which countries understand the significant implications of a complete end of GAVI support on immunization service delivery varies. Furthermore, whereas studies have been conducted to assess national preparedness for transition, there is a paucity of data on the understanding of subnational authorities of this process. In this study, we explored the perspectives of county-level stakeholders on Kenya's preparedness for GAVI transition.

Methods

using purposive sampling, 77 senior county officials from 15 counties were selected for in-depth interviews. Data were collected using a semi-structured interview guide, transcribed, and thematically analysed. Ethical approval for the study was granted by Moi University Institutional Ethics and Research Committee.

Results

findings reveal a consensus among respondents that both national and county governments are not fully prepared for the end of the Gavi Alliance. Concerns were highlighted around a lack of knowledge about vaccine costs, post-transition funding sources, and potential disruptions in immunization services. Respondents advocated for a phased transition, continued donor support, clear funding allocation, and legislative measures to ensure financial sustainability. Moreover, advocacy and awareness efforts, capacity building, and a robust legal framework were emphasized as essential for a smooth transition.

Conclusion

after the end of the financial support provided by Gavi Alliance, Kenya's immunization bill is expected to be significant. This study underscores the importance of effectively engaging the subnational (county) level authorities. Successful transition from Gavi's support requires a strategy that promotes awareness and improves communication regarding the expected impact of the impending transition from Gavi on sustainable immunization financing in Kenya.

Immunization programs to support primary health care and achieve universal health coverage

Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course.

A Practical Guide to Pilot Testing Community-Based Vaccination Coverage Surveys

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.

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign in Southern province, Zambia

INTRODUCTION

Despite gains in global coverage of childhood vaccines, many children remain undervaccinated. Although mass vaccination campaigns are commonly conducted to reach these children their effectiveness is unclear. We evaluated the effectiveness of a mass vaccination campaign in reaching zero-dose children.

METHODS

We conducted a prospective study in 10 health centre catchment areas in Southern province, Zambia in November 2020. About 2 months before a national mass measles and rubella vaccination campaign conducted by the Ministry of Health, we used aerial satellite maps to identify built structures. These structures were visited and diphtheria-tetanus-pertussis (DTP) and measles zero-dose children were identified (children who had not received any DTP or measles-containing vaccines, respectively). After the campaign, households where measles zero-dose children were previously identified were targeted for mop-up vaccination and to assess if these children were vaccinated during the campaign. A Bayesian geospatial model was used to identify factors associated with zero-dose status and measles zero-dose children being reached during the campaign. We also produced fine-scale zero-dose prevalence maps and identified optimal locations for additional vaccination sites.

RESULTS

Before the vaccination campaign, 17.3% of children under 9 months were DTP zero-dose and 4.3% of children 9-60 months were measles zero-dose. Of the 461 measles zero-dose children identified before the vaccination campaign, 338 (73.3%) were vaccinated during the campaign and 118 (25.6%) were reached by a targeted mop-up activity. The presence of other children in the household, younger age, greater travel time to health facilities and living between health facility catchment areas were associated with zero-dose status. Mapping zero-dose prevalence revealed substantial heterogeneity within and between catchment areas. Several potential locations were identified for additional vaccination sites.

CONCLUSION

Fine-scale variation in zero-dose prevalence and the impact of accessibility to healthcare facilities on vaccination coverage were identified. Geospatial modelling can aid targeted vaccination activities.

Factors affecting non-coverage of measles-rubella vaccination among children aged 9-59 months in Tanzania

Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan that set a target to eliminate Measles-Rubella (MR) in five of the six World Health Organization (WHO) regions by 2020. This was cross-sectional study employed both quantitative and qualitative research methods. The sample size was calculated to provide overall, age- and sex-specific coverage estimates for MR vaccine among children aged between 9 and 59 months at the national level. Using desired precision of ±5% with an expected coverage of 95%, a total of 15,235 households were required. The age of children, a child who had received the MR vaccine before the campaign, household wealth quintile, the age of caregivers, and their marital status were associated with non-coverage of MR vaccination among children aged 9-59 months in Tanzania. Nationally, an estimated 88.2% (95% CI: 87.3-89%) of children aged 9-59 months received the MR campaign dose, as assessed by caregivers' recall. These estimates revealed slightly higher coverage in Zanzibar 89.6% (95% CI: 84.7-93%) compared to Mainland Tanzania 88.1% (95% CI 87.2-88.9%). These associated factors revealed causes of unvaccinated children and may be some of the reasons for Tanzania's failure to meet the MR campaign target of 95 percent vaccination coverage. Thus, vaccine development must increase programmatic oversight in order to improve immunization activities and communication strategies in Tanzanian areas with low MR coverage.