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Towett G, Snead RS, Marczika J, Prada I. Discursive framework for a multi-disease digital health passport in Africa: a perspective. Global Health 2024; 20:64. [PMID: 39164710 PMCID: PMC11337601 DOI: 10.1186/s12992-024-01067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024] Open
Abstract
Africa's dual burden of rising incidence of infectious diseases and increasing prevalence of non-communicable diseases (NCDs), such as cardiovascular diseases and diabetes, demands innovative approaches to disease surveillance, response, and cross-border health management in response to growing economic integration and global connectivity. In this context, we propose a discursive framework for the development and implementation of a multi-disease digital health passport (MDDHP) in Africa. The MDDHP would serve as a secure platform for storing and sharing individual health data, offering a comprehensive solution to track and respond to infectious diseases, facilitate the management of NCDs, and improve healthcare access across borders. Empowering individuals to proactively manage their health and improve overall outcomes is a key aspect of the MDDHP. In the paper, we examine the key elements necessary to effectively implement MDDHP, focusing on minimizing risks, maintaining efficacy, and driving its adoption while also taking into consideration the unique contexts of the continent. The paper is intended to provide an understanding of the key principles involved and contribute to the discussion on the development and successful implementation of MDDHP in Africa.
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Affiliation(s)
- Gideon Towett
- The Self Research Institute, Broken Arrow, Oklahoma, USA.
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya.
| | | | - Julia Marczika
- The Self Research Institute, Broken Arrow, Oklahoma, USA
| | - Isaac Prada
- The Self Research Institute, Broken Arrow, Oklahoma, USA
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Bardak F, Kocoglu-Tanyer D. Vaccination status among children in an urban area and its association with risk factors and some parent health practices: A cross-sectional study. Public Health Nurs 2024. [PMID: 38804032 DOI: 10.1111/phn.13343] [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: 12/15/2023] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The study aims to determine the vaccination status of children and evaluate the relationship between vaccination rates, vaccine attitudes, and some parental health practices. DESIGN AND METHODS This cross-sectional study was conducted with 674 mothers. Data were collected using a survey evaluating vaccine characteristics, some infant health practices, and The Public Attitude Toward Vaccination Scale-Health Belief Model. Chi-square test, independent samples t-test, and logistic regression analysis were used. RESULTS 80.2% of children were fully vaccinated. The rate of non or under-vaccination was higher in the group that did not regularly undergo follow-up for 0-2-year-old children, did not fully have health screenings, did not use vitamin D and iron supplements, and used alternative medicine. Moreover, the duration of breast milk feeding, the transition to supplementary food, and the duration of vitamin D use in the non-fully vaccinated group were lower than in the fully vaccinated group (p < .05). The increase in maternal education period and severity and benefit attitude scores of vaccine attitude were the factors that decreased the rate of non-fully vaccination. The increase in barrier scores toward vaccines increased the rate of non or under-vaccination. CONCLUSION Mothers who have negative attitudes toward vaccination have negative behaviors in health practices and screenings on infant/child health.
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Affiliation(s)
- Feyza Bardak
- Faculty of Health Sciences, Nursing Department, Suleyman Demirel University, Isparta, Turkey
| | - Deniz Kocoglu-Tanyer
- Faculty of Nursing, Department of Public Health Nursing, Selcuk University, Konya, Turkey
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Konlan MY, Mahama F, Abubakari BB, Konka P, Appiah BO, Yeboah MO, Kwarteng PG, Apea PO, Adjei MR, Adokiya MN, Boadum O, Abiwu HAK. Predictors of vaccination card retention in Tamale Metropolis, Ghana. PLoS One 2024; 19:e0292765. [PMID: 38408074 PMCID: PMC10896499 DOI: 10.1371/journal.pone.0292765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. METHODS We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0-59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0-59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. RESULTS A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15-0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29-0.90) sub-Metro areas and being caregivers of children aged 24-59 months (AOR = 0.39; 95% CI = 0.22-0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95-8.95) was a positive predictor of vaccination card retention. CONCLUSION In this study, vaccination card retention among children aged 0-59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention.
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Affiliation(s)
- Matthew Y. Konlan
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Fuseini Mahama
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | | | - Paul Konka
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Benedict O. Appiah
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Maxwell O. Yeboah
- Department of Nursing, Northern Regional Hospital, Ghana Health Service, Tamale, Ghana
| | | | | | | | - Martin N. Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Oheneba Boadum
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, MS, United States of America
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Araújo DABS, Correia LL, Lima PLGDSB, Vasconcelos SC, Farías-Antúnez S, Gomes YVC, Nogueira DL, Castro MC, Machado MMT. Coverage and determinants of childhood vaccination during the COVID-19 pandemic in Fortaleza, Northeastern Brazil: a longitudinal analysis. CAD SAUDE PUBLICA 2024; 40:e00074723. [PMID: 38324862 PMCID: PMC10841349 DOI: 10.1590/0102-311xen074723] [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: 04/22/2023] [Revised: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 02/09/2024] Open
Abstract
Brazil has seen a decrease in vaccination coverage since 2016. This study analyzes the immunization status of children born during the COVID-19 pandemic in Fortaleza, Northeastern Brazil. This is a longitudinal analysis that included vaccination data of 313 children aged 12 and 18 months. Vaccination cards were checked for dose application considering the schedule of immunization recommended by the Brazilian Ministry of Health. Factors associated with no retention of vaccination cards and incomplete immunization by 18 months were identified by Tobit regression analysis. About 73% of mothers presented their child's vaccination card. Non-availability of vaccination cards was associated with maternal age < 25 years and mothers with paid jobs. Only 33% and 45% of the children aged 12 and 18 months had all vaccines up to date, respectively. For 3-dose vaccines, the delay rate was around 10% for the first dose application, but 40% for the third dose. Despite delays, most children with available vaccine cards had coverage above 90% by 18 months of age. Adjusted factors associated with incomplete vaccination included living in a household with more than one child (p = 0.010) and monthly income of less than one minimum wage (p = 0.006). Therefore, delays in child vaccine application were high during the COVID-19 pandemic but a considerable uptake by 18 months of age was found. Poorer families with more than one child were particularly at risk of not fully immunizing their children and should be the target of public policies.
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Affiliation(s)
| | | | | | | | - Simone Farías-Antúnez
- Departamento de Ciencias da Saúde, Universidade Federal de Santa Catarina, Araranguá, Brasil
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Khan A, Hussain I, Rhoda DA, Umer M, Ansari U, Ahmed I, Clary C, Muhammad Safdar R, Bashir Soofi S. Determinants of immunization in polio super high-risk union councils of Pakistan. Vaccine 2024; 42:583-590. [PMID: 38143197 PMCID: PMC10850981 DOI: 10.1016/j.vaccine.2023.12.056] [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: 11/04/2022] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current polio epidemiology in Pakistan poses a unique challenge for global eradication as the country is affected by ongoing endemic poliovirus transmission. Across the country, 40 union councils (UCs) which serve as core reservoirs for poliovirus with continuous incidences of polio cases are categorized as super-high-risk union councils (SHRUCs). METHODOLOGY A cross-sectional survey was conducted in 39 SHRUCs using a two-stage stratified cluster sampling technique. 6,976 children aged 12-23 months were covered. A structured questionnaire was used for data collection. Data were analyzed using STATA version 17. RESULTS Based on both vaccination records and recall, 48.3% of children were fully-, 35.4 % were partially-, and 16.3% were non-vaccinated in the SHRUC districts. A child is considered fully vaccinated when h/she completed vaccination for BCG, OPV0, OPV 1-3, Penta 1-3, PCV 1-3, IPV, and MCV1. Vaccination cards were seen for over half of the children in the SHRUC districts of Khyber Pakhtunkhwa (KP) and the majority of the SHRUC districts in Sindh, except for the SHRUC district of Malir the districts of Balochistan. Results for polio vacancies show that 60.9% of children from the SHRUC districts were vaccinated with at least three doses of OPV and one dose of IPV, while 20.4% were vaccinated with any OPV doses or IPV and 18.7% of children did not receive any polio vaccines. The dropout rate between vaccine visits was higher than the WHO-recommended cutoff point of 10% for all vaccine doses in the SHRUC districts. The likelihood of being fully vaccinated was higher among the children of educated parents. Full vaccination was found significant among the children of any SHRUC districts compared to district Killa Abdullah. CONCLUSION Context-specific strategies with more focus on community engagement and targeted mobilization, along with robust monitoring mechanisms, would help address the underlying challenges of under-immunization in the SHRUCs.
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Affiliation(s)
- Ahmad Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Uzair Ansari
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | | | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan; Department of Pediatrics & Child Health, The Aga Khan University, Pakistan.
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Hussain I, Khan A, Rhoda DA, Ahmed I, Umer M, Ansari U, Shah MA, Yunus S, Brustrom J, Oelrichs R, Soofi SB, Bhutta ZA. Routine Immunization Coverage and Immunization Card Retention in Pakistan: Results From a Cross-sectional National Survey. Pediatr Infect Dis J 2023; 42:260-270. [PMID: 36728580 PMCID: PMC9935567 DOI: 10.1097/inf.0000000000003804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Immunization is one of the most successful public health interventions available, saving millions of lives from death and disability each year. Therefore, improving immunization coverage is a high priority for the Government of Pakistan and essential to progress toward universal health coverage. This survey reports the national and provincial/regional coverage and determinants of fully, partially, and not-vaccinated children 12-23 months of age, antigen-wise coverage, percentage of home-based vaccination records (HBR) retention, and reasons for nonretention; dropout, timeliness, and prevalence of missed opportunities for simultaneous vaccination (MOSV). METHODS The survey was a descriptive cross-sectional national household survey carried out across Pakistan. The survey included 110,790 children 12-23 months old and their caregivers. A World Health Organization (WHO)-Expanded Program on Immunization (EPI) Survey questionnaire was adapted to collect information. Data were analyzed using the WHO Vaccination Coverage Quality Indicators (VCQI) software and Stata version 17. RESULTS Nationally excluding Azad Jammu and Kashmir (AJK) and Gilgit Baltistan (GB), the coverage of fully vaccinated children was 76.5%. The likelihood of being fully vaccinated was higher among children of educated parents who belonged to higher wealth quintiles and resided in any province/region other than Balochistan. The main reasons for unimmunization were no faith in immunization, rumors about vaccines, and distance to the facility. About two-thirds (66.2%) of the children had their HBR available, and the main reasons for not having a card were never visiting a health facility and having no awareness about the importance of a card. Dropout was discernible for later doses of vaccines compared with earlier ones. Higher proportions of children received the last doses late by more than two months. Of the 218,002 vaccination visits documented on HBR in the provinces, MOSVs occurred in 17.6% of the visits. CONCLUSION The immunization coverage rates provide a direction to strategize the progress to improve the vaccination rates in Pakistan. The country needs to outline the immediate and long-term actions to combat vaccine-preventable diseases, such as escalating integrated immunization campaigns and outreach activities, provision of mobility support, and deploying behavioral interventions as a cross-cutting strategy to improve awareness and reduce misconceptions.
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Affiliation(s)
- Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Ahmad Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Uzair Ansari
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | | | | | | | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
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Sharma R, Dwivedi LK, Jana S, Banerjee K, Mishra R, Mahapatra B, Sahu D, Singh S. Survey implementation process and interviewer effects on skipping sequence of maternal and child health indicators from National Family Health Survey: An application of cross-classified multilevel model. SSM Popul Health 2022; 19:101252. [PMID: 36268137 PMCID: PMC9576585 DOI: 10.1016/j.ssmph.2022.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/28/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
Implementing a large-scale survey involves a string of intricate procedures exposed to numerous types of survey errors. Uniform and systematic training protocols, comprehensive survey manuals, and multilayer supervision during survey implementation help reduce survey errors, providing a consistent fieldwork environment that should not result in any variation in the quality of data collected across interviewers and teams. With this background, the present study attempts to delineate the effect of field investigator (FI) teams and survey implementation design on the selected outcomes. Data on four of the bigger Empowered Action Group (EAG) states of India, namely Uttar Pradesh, Madhya Pradesh, Bihar, and Rajasthan, were obtained from the fourth round of the National Family Health Survey (NFHS-4) for analysis. A fixed-effect binary logistic regression model was used to assess the effect of FI teams and survey implementation design on the selected outcomes. To study the variation in the outcome variables at the interviewer level, a cross-classified multilevel model was used. Since one interviewer had worked in more than one primary sampling unit (PSU) & district and did not follow a perfect hierarchical structure, the cross-classified multilevel model was deemed suitable. In addition, since NFHS-4 used a two-stage stratified sampling design, two-level weights were adjusted for the models to compute unbiased estimates. This study demonstrated the presence of interviewer-level variation in the selected outcomes at both inter- and intra-field agencies across the selected states. The interviewer-level intra-class correlation coefficient (ICC) for women who had not availed antenatal care (ANC) was the highest for eastern Madhya Pradesh (0.23) and central Uttar Pradesh (0.20). For ‘immunisation card not seen’, Rajasthan (0.16) and western Uttar Pradesh (0.13) had higher interviewer-level ICC. Interviewer-level variations were insignificant for women who gave birth at home across all regions of Uttar Pradesh. Eastern Madhya Pradesh, Rajasthan, and Bihar showed higher interviewer-level variation across the selected outcomes, underlining the critical role of agencies and skilled interviewers in different survey implementation designs. The analysis highlights non-uniform adherence to survey protocols, which implies that not all interviewers and agencies performed in a similar manner in the field. This study recommends a refined mechanism for field implementation and supervision, including focused training on the challenges faced by FIs, random vigilance, and morale building. In addition, examining interviewer-level characteristics, field challenges, and field agency effects may also highlight the roots of interviewer-level variation in the data. However, based on the interviewer's performance in the field, the present study offers an intriguing insight into interviewer-level variations in the quality of data. With uniform survey implementation strategies, the interviewer should not have any effect in explaining the maternal and child health variables. Skipping of selected maternal and child health indicators curtails informativeness of the survey. Results confirms that information on vaccination card, antenatal care, maternal policy information, delivery cost and postnatal checkups have been skipped with negative response to opening questions. Cross-classified multilevel model confirms the presence of interviewer-level variation. The interviewer-level intra-class correlation coefficient (ICC) for ‘immunization card not seen’ was found to be highest in Rajasthan and western Uttar Pradesh. Interviewer-level variations were found to be not significant for women who gave birth at home across all the regions of Uttar Pradesh whereas the interviewer-level variations for women who had not availed ANC was found to be highest for eastern Madhya Pradesh central Uttar Pradesh. Results emphasizes that not all interviewers and agencies performed in a similar manner in the field. The study recommends a refined mechanism for field implementation and supervision, including focused training on challenges faced by field investigators, random vigilance, and morale building.
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Key Words
- ANC, antenatal care
- CAPI, computer-assisted personal interviewing
- Cross-classified multilevel model
- EAG, empowered action group
- FA, field agencies
- FI, field investigator
- ICC, intra-class correlation coefficient
- Interviewer effect
- Level weights
- MP, Madhya Pradesh
- Maternal and child health
- NFHS, National Family Health Survey
- PSU, primary sampling unit
- SDGs, Sustainable Development Goals
- Survey design
- Survey implementation
- Team level variation
- UP, Uttar Pradesh
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Affiliation(s)
- Radhika Sharma
- International Institute for Population Sciences, Mumbai, India
| | - Laxmi Kant Dwivedi
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
- Corresponding author.
| | - Somnath Jana
- International Institute for Population Sciences, Mumbai, India
| | - Kajori Banerjee
- SVKM's Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, India
| | | | | | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - S.K. Singh
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
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Yakum MN, Funwie AD, Ajong AB, Tsafack M, Ze LEE, Ekukole ESR, Shah Z. Factors associated with routine vaccination card retention among children aged 0–59 months in Yaounde-Cameroon: A cross-sectional survey. PLoS One 2022; 17:e0273515. [PMID: 36026433 PMCID: PMC9416987 DOI: 10.1371/journal.pone.0273515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The routine vaccination card is an important health record for children, but recent findings suggest that vaccination card retention in Cameroon is low, varying from 29%-53%. The aim of this study was to assess factors associated with children’s routine vaccination card retention in Cameroon.
Methods
This cross-sectional survey was conducted in Yaoundé in November 2021, targeting children aged 0–59 months. Participants were selected using a 2-stage systematic cluster sampling in which households were selected by a restricted sampling technique. Data were collected by interviewing the children’s parents/guardians, and a vaccination card was said to be retained if it was presented to the interviewer by the interviewees. Data were analysed using multiple logistics regression with R version 4.1.0 (2021-05-18).
Findings
A total of 529 households were assessed with 361 children aged 0–59 months enrolled: 51% girls and 49% boys. Children aged 0–11 months represented 24.4% of all participants, and children aged 12–59 months were 74.6%. Vaccination card retention was 24% (87), and positive predictors of card retention included: girl child (adjusted Odds Ratio = 1.34, p-value = 0.0269), the respondent being one of the biological parents of the child: mother (adjusted Odds Ratio = 5.97, p-value = 0.0034) or father(adjusted Odds Ratio = 4.69, p-value = 0.0067), and living in a richer household (adjusted Odds Ratio = 1.56, p-value = 0.038). On the other hand, negative predictors of card retention were: child aged 12–23 months (adjusted Odds Ratio = 0.44, p-value = 0.0209) or aged 24-59months (adjusted Odds Ratio = 0.13, p-value = 0.0000), and having an employed mother (adjusted Odds Ratio = 0.34, p-value = 0.0066).
Conclusion
Vaccination card retention in children aged 0–59 months in Yaoundé is low when compared with findings reported by studies from other locations in Cameroon. Besides, the poor and older children have lower odds of keeping routine vaccination cards. There is a need to design interventions to improve vaccination card retention, which considers household wealth and the age of the child.
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Affiliation(s)
- Martin Ndinakie Yakum
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Cameroon
- * E-mail:
| | - Atanga D. Funwie
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Cameroon
| | - Atem Bethel Ajong
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Marcellin Tsafack
- Medical Department, Doctors Without Borders (MSF-OCG), Yaoundé, Cameroon
| | - Linda Evans Eba Ze
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Ekome Serge Raoul Ekukole
- Contract Development and Verification Agency (CDVA)-Performance-based Financing (PBF) for the South West region, Cameroon
| | - Zahir Shah
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Cameroon
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Rajaonarifara E, Bonds MH, Miller AC, Ihantamalala FA, Cordier L, Razafinjato B, Rafenoarimalala FH, Finnegan KE, Rakotonanahary RJL, Cowley G, Ratsimbazafy B, Razafimamonjy F, Randriamanambintsoa M, Raza-Fanomezanjanahary EM, Randrianambinina A, Metcalf CJ, Roche B, Garchitorena A. Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar. BMJ Glob Health 2022; 7:bmjgh-2021-006824. [PMID: 35012969 PMCID: PMC8753401 DOI: 10.1136/bmjgh-2021-006824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background To reach global immunisation goals, national programmes need to balance routine immunisation at health facilities with vaccination campaigns and other outreach activities (eg, vaccination weeks), which boost coverage at particular times and help reduce geographical inequalities. However, where routine immunisation is weak, an over-reliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunisation and outreach activities to reach immunisation goals in rural Madagascar. Methods We obtained data from health centres in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, diphtheria, tetanus and pertussis (DTP) and polio) delivered to children, during 2014–2018. We also analysed data from a district-representative cohort carried out every 2 years in over 1500 households in 2014–2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographical and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions. Results The HSS intervention was associated with a significant increase in immunisation rates (OR between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunisation rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (OR between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographical coverage, which prevented achieving international coverage targets. Conclusion Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunisations.
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Affiliation(s)
- Elinambinina Rajaonarifara
- Sciences & Ingénierie, Sorbonne Universite, Paris, France .,UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,NGO PIVOT, Ranomafana, Madagascar
| | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Karen E Finnegan
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - C Jessica Metcalf
- Dept of Ecology and Evol. Biology, Princeton University, Princeton, New Jersey, USA
| | - Benjamin Roche
- UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,Universidad Nacional Autónoma de México, Coyoacan, Distrito Federal, Mexico
| | - Andres Garchitorena
- UMR 224 MIVEGEC, Univ. Montpellier-CNRS-IRD, Montpellier, France.,NGO PIVOT, Ranomafana, Madagascar
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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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Wagner AL, Tefera YA, Gillespie BW, Carlson BF, Boulton ML. Vaccine coverage, timeliness and delay estimated from regional and national cross-sectional surveys in Ethiopia, 2016. Pan Afr Med J 2021; 39:205. [PMID: 34603586 PMCID: PMC8464200 DOI: 10.11604/pamj.2021.39.205.22777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction measures of vaccine timing require data on vaccination dates, which may be unavailable. This study compares estimates of vaccine coverage and timing; and compares regression techniques that model these measures in the presence of incomplete data. Methods this cross-sectional study used the 2016 Ethiopian Demographic and Health Survey (DHS), and a 2016 survey from Worabe, Ethiopia. Three measures of vaccine uptake were calculated: coverage (regardless of timing), timeliness (within 1 week of recommended administration), and delay (the number of days between the recommended and actual date of vaccination). Vaccine coverage and timeliness were modeled with logistic regressions. After excluding those without dates, vaccine delay was estimated using linear regression or survival analysis. Vaccine delay was also estimated using accelerated failure time (AFT) models. Results the DHS survey included 3819 children aged 12-60 months and the Worabe survey included 484 children aged 12-23 months. In the Worabe survey, vaccine coverage for pentavalent vaccine dose 3 was 87.4%, with 8.6% receiving it within 1 week, and 71.7% within 4 weeks; the median delay was 19 days. Predictors of outcomes were similar in both the Worabe survey and Ethiopian DHS, with the largest numbers of significant associations seen in models with vaccine coverage or delays (with AFT models) as the outcomes. Conclusion estimates of coverage may miss a substantial proportion of infants who have delayed vaccination. Accelerated failure time (AFT) models are useful to estimate vaccine delay because they include information from all respondents (those with full and partial data on vaccination dates) and are agnostic about an age limit for timely vaccination.
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Affiliation(s)
- Abram Luther Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Yemesrach Abeje Tefera
- Department of Public Health, St. Paul´s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Brenda Wilson Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley Frederick Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Lester Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Emerging technologies and COVID-19 digital vaccination certificates and passports. PUBLIC HEALTH IN PRACTICE 2021; 2:100136. [PMID: 33977281 PMCID: PMC8103710 DOI: 10.1016/j.puhip.2021.100136] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
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Shenton LM, Wagner AL, Ji M, Carlson BF, Boulton ML. Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review. BMJ Open 2020; 10:e039693. [PMID: 33268412 PMCID: PMC7713201 DOI: 10.1136/bmjopen-2020-039693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status. DESIGN Scoping review. DATA SOURCES Electronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018. STUDY SELECTION All English studies with vaccination status as the outcome and the use of DHS data. DATA EXTRACTION Studies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted. RESULTS A total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1-86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO's Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child's sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition. CONCLUSIONS Researchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Socioeconomic characteristics associated with the introduction of new vaccines and full childhood vaccination in Ghana, 2014. Vaccine 2020; 38:2937-2942. [PMID: 32139314 DOI: 10.1016/j.vaccine.2020.02.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/31/2020] [Accepted: 02/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Childhood vaccination in Ghana has historically been high, but the impact of recently introduced vaccines on coverage is unknown. We calculate vaccine coverage of Ghanaian children- contrasting newly introduced vaccines and those long available - and describe associations between sociodemographic indicators and full vaccination. METHODS Data from the 2014 Ghana Demographic and Health Survey was used to calculate full vaccination, defined as receipt of one dose bacillus Calmette-Guérin (BCG); two doses of rotavirus vaccine; 3 doses of pentavalent vaccine, oral polio vaccine (OPV), and pneumococcal conjugate vaccine (PCV); and one dose of measles-rubella vaccine and yellow fever vaccine, among children age 12-24 months. Logistic regression with survey procedures was used to estimate odds ratios for socioeconomic factors' association with full vaccination. RESULTS The sample comprised a total of 1107 children 12-24 months. Full vaccination coverage was 70.8%. Vaccination coverage was higher for vaccines administered at younger ages (e.g., birth dose of BCG was 97.0%) than at older ages (e.g., yellow fever at 9 months was 88.2%). Newly introduced vaccines had lower coverage: at 10 weeks, pentavalent 2 was 95.4%, versus 91.2% for PCV 2 and 88.8% for rotavirus 2. Living outside of Greater Accra, home delivery, younger maternal age, urban residence, and more than one child under five in the home were all associated with decreased odds of full vaccination in the adjusted analysis whereas sex of the child, wealth, religion, and maternal education were not associated with full vaccination status. CONCLUSION Ghana has high overall vaccination rates although disparities in full vaccination by sociodemographic status exist. As vaccine recommendations are revised, it will be important to insure equitable access to vaccination for all children regardless of demographic and socioeconomic background.
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