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Bekele G, Darega J, Mulu E, Tsegaw M. Determinants of immunization defaulters among children aged 12-23 months in Ambo town, Oromia, Ethiopia: A case-control study. Hum Vaccin Immunother 2024; 20:2338952. [PMID: 38606820 PMCID: PMC11018067 DOI: 10.1080/21645515.2024.2338952] [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: 12/22/2023] [Accepted: 04/01/2024] [Indexed: 04/13/2024] Open
Abstract
Immunization is a public health intervention to reduce morbidity and mortality among children. However, vaccination becomes more effective if the child can receive the full course of recommended vaccination doses according to the schedule. Many children fail to complete the full course of vaccination. To identify the determinants of immunization defaulters among children aged 12-23 months in Ambo town, Oromia, Ethiopia. A community-based, unmatched, case-control study was done from October 1 to 25, 2021. A simple random sampling was used to select 317 (106 cases and 211 controls). Data were collected by using a pretested and structured questionnaire. Data were coded and entered to Epi-data version 3.1 and then transported to SPSS version 21.0 for statistical analysis. Descriptive analysis like frequency, mean, and percentage was calculated. Binary and multivariable logistic regression analysis was done. Finally, variables with a p value < .05 were considered statistically significant. Urban residences (AOR = 0.288, 95% CI, 0.146, 570), government employee (AOR = 0.179, 95% CI, 0.057, 0.565), number of family members more than four (AOR = 2.696, 95% CI, 1.143, 6.358), higher income (AOR = 0.250, 95% CI, 0.099, 0.628), attending ANC (AOR = 0..237, 95% CI, 0.107, 0.525), and good awareness (AOR = 0.070, 95% CI, 0.005, 308) were significant predictors of immunization defaulters. This study has found that urban residences, government employee by occupation, number of family members more than four, higher monthly income, and attending ANC were identified as determinants of childhood immunization defaulters. Social Behavior Change intervention programs should focus on providing health information about the importance of the vaccine and vaccine schedule. Due attention should be given for rural residents and farmers who had limited access to information and are more prone to defaulting. Policy-makers should consider those identified factors while designing intervention programs to enhance vaccination coverage.
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Affiliation(s)
| | - Jiregna Darega
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Erimiyas Mulu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Menen Tsegaw
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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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 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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Johns NE, Blumenberg C, Kirkby K, Allorant A, Costa FDS, Danovaro-Holliday MC, Lyons C, Yusuf N, Barros AJD, Hosseinpoor AR. Comparison of Wealth-Related Inequality in Tetanus Vaccination Coverage before and during Pregnancy: A Cross-Sectional Analysis of 72 Low- and Middle-Income Countries. Vaccines (Basel) 2024; 12:431. [PMID: 38675813 PMCID: PMC11054082 DOI: 10.3390/vaccines12040431] [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: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Immunization of pregnant women against tetanus is a key strategy for reducing tetanus morbidity and mortality while also achieving the goal of maternal and neonatal tetanus elimination. Despite substantial progress in improving newborn protection from tetanus at birth through maternal immunization, umbilical cord practices and sterilized and safe deliveries, inequitable gaps in protection remain. Notably, an infant's tetanus protection at birth is comprised of immunization received by the mother during and before the pregnancy (e.g., through childhood vaccination, booster doses, mass vaccination campaigns, or during prior pregnancies). In this work, we examine wealth-related inequalities in maternal tetanus toxoid containing vaccination coverage before pregnancy, during pregnancy, and at birth for 72 low- and middle-income countries with a recent Demographic and Health Survey or Multiple Indicator Cluster Survey (between 2013 and 2022). We summarize coverage levels and absolute and relative inequalities at each time point; compare the relative contributions of inequalities before and during pregnancy to inequalities at birth; and examine associations between inequalities and coverage levels. We present the findings for countries individually and on aggregate, by World Bank country income grouping, as well as by maternal and neonatal tetanus elimination status, finding that most of the inequality in tetanus immunization coverage at birth is introduced during pregnancy. Inequalities in coverage during pregnancy are most pronounced in low- and lower-middle-income countries, and even more so in countries which have not achieved maternal and neonatal tetanus elimination. These findings suggest that pregnancy is a key time of opportunity for equity-oriented interventions to improve maternal tetanus immunization coverage.
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Affiliation(s)
- Nicole E. Johns
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
- Causale Consulting, Avenida Adolfo Fetter 4331, Pelotas 96090-840, Brazil
| | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Adrien Allorant
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Francine Dos Santos Costa
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Carrie Lyons
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Nasir Yusuf
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
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Nnaji CA, Wiysonge CS, Cooper S, Mayeye A, Luphondo L, Mabuya T, Kalui N, Lesosky M, Ndwandwe D. Contextualising missed opportunities for children's vaccination: A theory-informed qualitative study in primary care settings in Cape Town, South Africa. Hum Vaccin Immunother 2023; 19:2162771. [PMID: 36601915 PMCID: PMC9980502 DOI: 10.1080/21645515.2022.2162771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study aimed to explore the contextual factors that may be associated with missed opportunities for vaccination (MOV) from the perspectives of healthcare providers and caregivers attending primary healthcare facilities in the Cape Town Metro Health District, South Africa. The ultimate goal of the assessment was to help inform the design and implementation of a contextually appropriate quality improvement programme targeted at reducing MOV in primary healthcare settings. We used a theory-informed exploratory qualitative research design involving focus group discussions with caregivers of children aged 0-23 months; and in-depth interviews of facility staff. A thematic template analysis approach, integrating the theoretical domains framework (TDF) and the capability, opportunity and motivation model of behavior (COM-B) was used to code and analyze the data. Three focus group sessions were conducted, each consisting of 5-8 caregivers and five in-depth interviews involving facility staff. Capability factors comprised caregivers' knowledge, attitude and behavior toward children's immunization. Opportunity factors included the organization of immunization services, long waiting time, vaccine stock out, staff shortage and health workers' attitude, knowledge and capability to assess children's immunization status and needs. Motivation factors included optimism and beliefs about immunization, fear of vaccine-preventable diseases and immunization safety concerns. This study identified important caregiver-, provider- and health system-related factors, which influence immunization outcomes; offering useful contextual insights for informing quality improvement strategies for reducing MOV at primary healthcare level.
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Affiliation(s)
- Chukwudi A. Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,CONTACT Chukwudi A. Nnaji, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, 1 Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Charles S. Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,Division of Social & Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lucy Luphondo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Thobile Mabuya
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntomboxolo Kalui
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Birhanu F, Yitbarek K. Wealth-based inequity in full child vaccination coverage: An experience from Mali, Bangladesh, and South Africa. A multilevel poison regression. PLoS One 2023; 18:e0293522. [PMID: 38117824 PMCID: PMC10732374 DOI: 10.1371/journal.pone.0293522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/15/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Every child around the globe should get routine childhood vaccination, which is mostly affected by the country's economic capacity besides the socioeconomic differences. However, how well countries with different economic capacities address equitable child vaccination remains unanswered. METHODS Cross-sectional data from the latest Demographic and Health Survey (DHS) database of Mali, Bangladesh, and South Africa was used for this study. The dependent variable was full child vaccination, and wealth-based inequality was assessed using rate-ratio, concentration curve, and concentration index. A multilevel Poisson regression analysis was used to determine the predictors of inequalities. A risk ratio (RR) with a p-value of 0.05 was used to declare statistical significance. All analysis was weighted. RESULTS Full child vaccination status was 30.15%, 62.18%, and 46.94% in Mali, Bangladesh, and South Africa respectively. Even if the disparity is higher in Mali, the full vaccination favors the better-off family both in Mali, and Bangladesh respectively [CInd: 0.05, 95% CI: 0.01, 0.09], [CInd: 0.02, 95% CI: 0.001, 0.03], wealth status did not have an effect in South Africa. The multilevel poison regression indicated maternal age, occupation, wealth of household, and frequency of watching television to positively affect full vaccination, whereas the number of children in the house negatively affected full vaccination. CONCLUSION Wealth-based inequality in child vaccination was higher in Mali followed by Bangladesh. There was no observable significant equity gap in South Africa. Wealth status, maternal occupation, maternal age, frequency of watching television, and number of children were predictors of full child vaccination.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, Mizan Aman, Southwest Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Ndwandwe D, Ndlovu M, Mayeye A, Luphondo N, Muvhulawa N, Ntamo Y, Dludla PV, Wiysonge CS. Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa. Vaccines (Basel) 2023; 11:1782. [PMID: 38140186 PMCID: PMC10747087 DOI: 10.3390/vaccines11121782] [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: 10/01/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. METHODS Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. RESULTS AND DISCUSSION The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. CONCLUSIONS The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Musawenkosi Ndlovu
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Nomahlubi Luphondo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | - Yonela Ntamo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Phiwayinkosi V. Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Empangeni 3886, South Africa
| | - Charles S. Wiysonge
- Vaccine Preventable Diseases Programme, Universal Health Coverage/Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo;
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Dlamini TN, Bhat LD, Kodali NK, Philip NE. Prevalence and factors associated with incomplete immunization among children aged 12 to 35 months in Eswatini: analysis of the Eswatini multiple indicator cluster survey. Pan Afr Med J 2023; 45:51. [PMID: 37637393 PMCID: PMC10460101 DOI: 10.11604/pamj.2023.45.51.38643] [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: 12/28/2022] [Accepted: 04/30/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction incomplete childhood immunization is a significant public health challenge as children continue to succumb to vaccine-preventable diseases in most developing countries. Studies on childhood immunization conducted in Eswatini are sparse. Therefore, the present study assessed the prevalence of incomplete childhood immunization in Eswatini and further explored associated factors among children aged 12 to 35 months. Methods using data from Eswatini multiple indicator cluster survey 5 (EMICS5), a cross-sectional analysis with 978 children aged 12 to 35 months was conducted. This is the latest available data in the public domain. The survey was conducted from July 2014 to October 2014. The primary outcome variable was incomplete immunization. Univariate and multivariate logistic regressions were used to examine the association between selected variables and incomplete immunization. Results the mean age of the children was 23.45±6.92 months, 50.2% were boys, and 74.1% lived in rural areas. The prevalence of incomplete immunization was 31.5%. Increased child´s age, being a girl, increased caregiver´s age, and increased number of children under-five years in the household and residing in the Manzini or Hhohho region were significantly associated with incomplete immunization. Conclusion the EMICS 5 revealed a high prevalence of incomplete immunization in Eswatini. Health promotion activities such as empowering women and caregivers of children through health education about child health should be emphasized. Where feasible, outreach services and door-to-door immunization should be strengthened to improve immunization coverage in the country and cover dropouts.
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Affiliation(s)
- Thatho Nolwazi Dlamini
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
| | - Lekha Divakara Bhat
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
| | - Neena Elezebeth Philip
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
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Atnafu Gebeyehu N, Abebe Gelaw K, Asmare Adella G, Dagnaw Tegegne K, Adie Admass B, Mesele Gesese M. Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis. Hum Vaccin Immunother 2023:2202125. [PMID: 37144686 DOI: 10.1080/21645515.2023.2202125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Immunization is one of the most cost-effective measures to prevent morbidity and mortality in children. Therefore, the purpose of this systematic review and meta-analysis was to determine the pooled prevalence of incomplete immunization among children in Africa as well as its determinants. PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Studies published within English language, with full text available for searching, and studies conducted in Africa were included in this meta-analysis. A pooled prevalence, Sub-group analysis, sensitivity analysis and meta-regression were conducted. Out of 1305 studies assessed, 26 met our criteria and were included in this study. The pooled prevalence of incomplete immunization was 35.5% (95% CI: 24.4, 42.7), I2 = 92.1%). Home birth (AOR=2.7; 95% CI: 1.5-4.9), rural residence (AOR = 4.6; 95% CI: 1.1-20.1), lack of antenatal care visit (AOR = 2.6; 95% CI: 1.4-5.1), lack of knowledge of immunizations (AOR=2.4; 95% CI: 1.3-4.6), and maternal illiteracy (AOR = 1.7: 95%CI: 1.3-2.0) were associated with incomplete immunization. In Africa, the prevalence of incomplete immunization is high. It is important to promote urban residency, knowledge of immunization and antenatal follow up care.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kelemu Abebe Gelaw
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Biruk Adie Admass
- Department of Anesthesia, College of Medicine and Health Science, Gondar University, Gondar, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
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Determinants of Parents Taking Their Children for Scheduled Vaccinations during COVID-19 Pandemic in South Africa. Vaccines (Basel) 2023; 11:vaccines11020389. [PMID: 36851266 PMCID: PMC9963815 DOI: 10.3390/vaccines11020389] [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: 01/09/2023] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Scheduled or routine childhood vaccinations are known for their effectiveness in eradicating fear for many life-threatening and disabling diseases and saving lives globally. This paper is aimed at assessing determinants of parents taking their children for scheduled vaccinations during the COVID-19 pandemic in South Africa. Data used for this paper were obtained from the Human Sciences Research Council's (HSRC) COVID-19 Online Survey titled "One Year Later Survey", which was conducted between 25 June and 11 October 2021 in South Africa. Multivariate logistic regression analysis was performed to achieve this study goal. Findings showed that just over half of parents (56.7%) reported taking their children for scheduled vaccinations across the country. Males were significantly less likely (aOR = 0.53 95% CI [0.45-0.61], p < 0.001) to have taken their children for scheduled vaccinations than females. Parents' experiences and views were among key determinants of parents having taken their children for scheduled vaccinations in South Africa. Parents who had never taken influenza (flu) vaccines were significantly less likely (aOR = 0.33 [0.28-039], p < 0.001) to have taken their children for scheduled vaccinations than those who had taken flu vaccines. Parents who did not know anyone who had personally experienced serious side effects to any vaccine were significantly less likely (aOR = 0.77 [0.66-0.90], p = 0.001) to have taken their children for scheduled vaccinations than those who knew anyone who had experienced them. Parents who did not think vaccines were a good way to protect communities from disease were significantly less likely (aOR = 0.50 [0.33-0.77], p = 0.001) to have taken their children for scheduled vaccinations than those who thought vaccines were a good way to protect communities from disease. These findings are of significance especially during the time when the country is still struggling to reach a substantial proportion of its population vaccinated for COVID-19. Thus, these findings may be relevant in determining parents' intentions to have their children receive the South African Department of Health recommended vaccines for their respective age group.
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Iwu-Jaja CJ, Jordan P, Ngcobo N, Jaca A, Iwu CD, Mulenga M, Wiysonge C. Improving the availability of vaccines in primary healthcare facilities in South Africa: is the time right for a system redesign process? Hum Vaccin Immunother 2022; 18:1926184. [PMID: 35349379 PMCID: PMC9009956 DOI: 10.1080/21645515.2021.1926184] [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] [Indexed: 11/15/2022] Open
Abstract
An uninterrupted supply of vaccines at different supply chain levels is a basic component of a functional immunization programme and care service. There can be no progress toward achieving universal health coverage and sustainable development without continuous availability of essential medicines and vaccines in healthcare facilities. Shortages of vaccines, particularly at health facility level is an issue of grave concern that requires urgent attention in South Africa. The causes of vaccine stock-outs are multifactorial and may be linked to a broader systems issue. These factors include challenges at higher levels such as delays in the delivery of stock from the pharmaceutical depot; health facility level factors, which include a lack of commitment from healthcare workers and managers; human resource factors, such as, staff shortages, and lack of skilled personnel. Therefore, there is a compelling need to address the factors associated with shortages of vaccines in health facilities. This paper highlights the challenges of vaccine availability in South Africa, the associated factors, the available interventions, and recommended interventions for the expanded programme on immunization in South Africa. We propose a system redesign approach as a potentially useful intervention.
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Affiliation(s)
- Chinwe Juliana Iwu-Jaja
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Portia Jordan
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Chidozie Declan Iwu
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Modest Mulenga
- Department of Public Health, Michael Chilifa Sata School of Medicine, Copperbelt University, Kitwe, Zambia
| | - Charles Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J, Gaythorpe KAM. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health 2022; 21:82. [PMID: 35701823 PMCID: PMC9194352 DOI: 10.1186/s12939-022-01678-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION Prospero, CRD42021261927.
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Affiliation(s)
- Huda Ahmed Ali
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Anna-Maria Hartner
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | | | - Jeremy Roth
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Xiang Li
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- grid.38142.3c000000041936754XCenter for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | - Emilia Vynnycky
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - Kim Woodruff
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Neil M Ferguson
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Jaspreet Toor
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Katy AM Gaythorpe
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
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Missed Opportunities for Vaccination and Associated Factors among Children Attending Primary Health Care Facilities in Cape Town, South Africa: A Pre-Intervention Multilevel Analysis. Vaccines (Basel) 2022; 10:vaccines10050785. [PMID: 35632542 PMCID: PMC9144782 DOI: 10.3390/vaccines10050785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0–23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0–23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers’ low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13–11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25–0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07–0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06–0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.
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COVID-19 and the Gaping Wounds of South Africa's Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination. Vaccines (Basel) 2021; 9:vaccines9070691. [PMID: 34201684 PMCID: PMC8310047 DOI: 10.3390/vaccines9070691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Despite South Africa's substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.
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Budu E, Ahinkorah BO, Aboagye RG, Armah-Ansah EK, Seidu AA, Adu C, Ameyaw EK, Yaya S. Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys. BMJ Open 2021; 11:e045992. [PMID: 33986059 PMCID: PMC8126284 DOI: 10.1136/bmjopen-2020-045992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa. DESIGN Our study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa. PARTICIPANTS A total of 60 964 mothers of children aged 11-23 months were included in the study. OUTCOME VARIABLES The main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC). RESULTS The average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended. CONCLUSION The study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Collins Adu
- Department of Health Promotion, and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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