Programmatic and beneficiary-related factors for low vaccination coverage in Papum Pare district, Arunachal Pradesh, India

Trends in Urban Immunization Coverage in India: A Meta-Analysis and Meta-Regression

OBJECTIVES

To assess the gaps and trends in child immunization coverage among urban and rural areas in India, and compare the success of immunisation program in each.

METHODS

PubMed, Scopus, and Crossref, and Google Scholar electronic databases were searched on October 9, 2019, and March 21, 2020, for studies that measured and reported immunization coverage indicators in India. Random-effects meta-analyses and meta-regressions were conducted.

RESULTS

The authors' search identified 545 studies, and 2 were obtained by expert suggestion. Among these 68 studies and 6 surveys were included. They found that full immunization coverage has grown yearly at 2.65% and 0.82% in rural and urban areas, respectively whereas partial immunization coverage declined by -2.44% and -0.69%, respectively. Percentage of nonimmunized children did not show a statistically significant trend in either.

CONCLUSION

While rural immunization coverage has seen a large increase over the past two decades, the progress in urban areas is weak and negligible. This was largely attributable to a focus on minimizing dropouts in rural areas. However, a lack of significant reduction in unimmunized children may indicate left-out children or pockets in both rural and urban areas. The poor performance of immunization programs in urban areas, coupled with a larger impact of COVID-19, warrants that India urgently adopts urban-sensitive and urban-focused policies and programs.

Childhood vaccination uptake and associated factors among children 12-23 months in rural settings of the Gambia: a community-based cross-sectional study

Background

Globally, immunization prevents 2–3 million deaths annually from vaccine-preventable diseases such as diphtheria, tetanus, pertussis, influenza, and measles. In developing countries, several immunization programs have made progress, but the coverage remains a standstill in some areas. In order to inform policies and practices, the present study aimed at assessing vaccination uptake and contextual-associated factors among children aged 12–23 months in rural Gambia.

Methods

A community-based triangulated cross-sectional design was conducted in January 2020, with 200 caregivers with children aged 12–23 months in selected households in rural communities across Upper River Region of the Gambia using multistage sampling technique were recruited. A structured interview questionnaire was developed and Infant Welfare Cards were assessed to elicit information regarding contextual household characteristics towards childhood immunization uptake. Percentages, chi-square/fisher exact test for variables with p-value ≤0.15 were considered for inclusion into logistic regression model. The significance level was set at p < 0.05. The adjusted Odds Ratio (aOR) with 95% Confidence Interval (CI) were reported to declare significance.

Results

The proportion of children who received all the required vaccines was 66%. At the level of antigen-specific coverage, about 88.5% received BCG, 71% received OPV 3, 82.5% received Penta 3, while 72 and 71% received Measles-Rubella and yellow fever, respectively. Caregivers who had primary education level 88.8% (aOR = 0.112; 95% CI = 0.029–0.434), secondary & above 87.2% (aOR = 0.128; 95% CI = 0.029, 0. 561) and arabic/madrassa 95.7% (aOR = 0.043; 95% CI = 0.008–1.227) were less likely to be fully vaccinated when compared to those who have never been to school. Farmers are less likely by 88.9% (aOR = 0.111; 95% CI 0.020, 0.635) while children from family size of more than 20 members had reduced odds (aOR = 0.420; 95% CI = 0.197, 0.894) for their children to complete their vaccination schedule as compared to those with at most 20 household members.

Conclusion

There is moderately a burden of incomplete vaccination in rural Gambia. Vaccination programs should be constantly monitored and evaluated by the Ministry of Health, especially in rural areas. To increase societal awareness and vaccine acceptance, a robust community-based health education efforts are desperately needed as part of initiatives to increase vaccine service utilization for these high-risk classes.

Measles vaccination coverage, determinants of delayed vaccination and reasons for non-vaccination among children aged 24-35 months in Zhejiang province, China

Background

This study was aimed to assess the coverage of two doses of measles vaccine and identify the determinants of the delayed vaccination.

Methods

A cluster survey among 1386 children aged 24–35 months was conducted. Characteristics on demographic and socio-economic and vaccination records was collected. The overall coverage was defined as the proportion of children receiving the first dose of measles vaccination and the second dose of measles vaccination by 24 months of age. The age-appropriate coverage was defined as the proportion of children receiving the measles vaccine doses within one month after its relevant due date. Timeliness was evaluated with the Kaplan-Meier analysis. Cox proportional hazard regression was adopted to identify determinants of the delayed vaccination.

Results

The overall coverage was 96.9% for the first dose of measles vaccine and 93.9% for the second dose of measles vaccine. The age-appropriate coverage of the first and the second dose of measles vaccine was 76.6 and 68.2%, respectively. Household having more than one child, non-local children were associated with the delayed vaccination for the first and the second dose of measles vaccine. Children delivered at home, younger mothers, low maternal education background, mothers with a fixed job, and low household income were associated with the delayed vaccination for the second dose of measles vaccine.

Conclusions

The coverage of measles vaccine had been improved for both the first and the second dose, while the timeliness still needed improvement. We suggested the policy-makers pay more attention to the reasons for non-vaccination and determinants of delayed vaccination when planning efforts to ensure the high age-appropriate coverage of measles vaccination.

Analysis of the effects of individual- and community- level predictors on migrant children's primary immunization in Yiwu city, east China

BACKGROUND

To evaluate the effects of a wide range of individual- and community-level factors on migrant children's primary immunization.

METHODS

Migrant children aged 13-24 months (born from 1 June 2013 to 31 May 2014) were surveyed in Yiwu city, in June 2015. Social-demographic factors and vaccination records were collected. Five factors at community-level including community wealth, distance to the nearest immunization clinic, maternal education, antenatal clinic (ANC) visits, and hospital delivery were constructed. The relationship between individual- and community-level factors and a child's vaccination status for Chinese primary immunization were evaluated by logistic regression model and the adjusted odds ratio (AOR) with the p-values and 95% confidence interval (CI) were calculated.

RESULTS

The community wealth (aOR:1.4; 95% CI:1.1-2.7), the community maternal education (aOR:1.8; 95% CI:1.4-4.5), the community ANC visits (aOR:1.8; 95% CI:1.3-2.8), and the community hospital delivery (aOR:2.2; 95% CI:1.6-4.8) were positively associated with the completeness of primary immunization, while community distance to the nearest immunization clinic was negatively associated with the completeness of primary immunization (aOR:0.7; 95% CI:0.5-0.9). The coverage of completeness of primary immunization was higher among children living in rural areas than those living in urban areas (aOR:1.7; 95% CI: 1.3-3.1).

CONCLUSIONS

In order to achieve better vaccination coverage among migrant children in Yiwu, as well as to close the gaps and disparities of acceptability and accessibility in childhood vaccination in urban areas, policy makers should design interventions based on the factors addressed in this study.

Timeliness of Childhood Primary Immunization and Risk Factors Related with Delays: Evidence from the 2014 Zhejiang Provincial Vaccination Coverage Survey

Background: this study aimed to assess both immunization coverage and timeliness, as well as reasons for non-vaccination, and identity the risk factors of delayed immunization, for the vaccines scheduled during the first year of life, in Zhejiang province, east China. Methods: A cluster survey among children aged 24-35 months was conducted. Demographic information and socio-economic characteristics of the selected child, the mother, and the household were collected. Immunization data were transcribed from immunization cards. Timeliness was assessed with Kaplan-Meier analysis for each vaccine given before 12 months of age, based on the time frame stipulated by the expanded program on immunization of China. Cox proportional hazard regression was applied to identify risk factors of delayed immunization. Results: A total of 2772 eligible children were surveyed. The age-appropriate coverage ranged from 25.4% (95% CI: 23.7-27.0%) for Bacillus Calmette-Guerin (BCG) to 91.3% (95% CI: 90.2-92.3%) for the first dose of oral poliomyelitis vaccine (OPV1). The most frequent reason for non-vaccination was parent's fear of adverse events of immunization. Delayed immunizations were associated with mother having a lower education level, mother having a job, delivery at home, increasing number of children per household, and having a lower household income. Conclusions: Although the timeliness of immunization has improved since 2011, necessary steps are still needed to achieve further improvement. Timeliness of immunization should be considered as another important indicator of expanded program on immunization (EPI) performance. Future interventions on vaccination coverage should take into consideration demographic and socio-economic risk factors identified in this study. The importance of adhering to the recommended schedule should be explained to parents.

Risk factors for delay in age-appropriate vaccinations among Gambian children

BACKGROUND

Vaccination has been shown to reduce mortality and morbidity due to vaccine-preventable diseases. However, these diseases are still responsible for majority of childhood deaths worldwide especially in the developing countries. This may be due to low vaccine coverage or delay in receipt of age-appropriate vaccines. We studied the timeliness of routine vaccinations among children aged 12-59 months attending infant welfare clinics in semi-urban areas of The Gambia, a country with high vaccine coverage.

METHODS

A cross-sectional survey was conducted in four health centres in the Western Region of the Gambia. Vaccination dates were obtained from health cards and timeliness assessed based on the recommended age ranges for BCG (birth-8 weeks), Diphtheria-Pertussis-Tetanus (6 weeks-4 months; 10 weeks-5 months; 14 weeks-6 months) and measles vaccines (38 weeks-12 months). Risk factors for delay in age-appropriate vaccinations were determined using logistic regression. Analysis was limited to BCG, third dose of Diphtheria-Pertussis -Tetanus (DPT3) and measles vaccines.

RESULTS

Vaccination records of 1154 children were studied. Overall, 63.3% (95 % CI 60.6-66.1%) of the children had a delay in the recommended time to receiving at least one of the studied vaccines. The proportion of children with delayed vaccinations increased from BCG [5.8% (95 % CI 4.5-7.0%)] to DPT3 [60.4% (95 % CI 57.9%-63.0%)] but was comparatively low for the measles vaccine [10.8% (95 % CI 9.1%-12.5%)]. Mothers of affected children gave reasons for the delay, and their profile correlated with type of occupation, place of birth and mode of transportation to the health facilities.

CONCLUSION

Despite high vaccination coverage reported in The Gambia, a significant proportion of the children's vaccines were delayed for reasons related to health services as well as profile of mothers. These findings are likely to obtain in several countries and should be addressed by programme managers in order to improve and optimize the impact of the immunization coverage rates.

Timeliness of childhood vaccinations in Kampala Uganda: a community-based cross-sectional study

BACKGROUND

Child survival is dependent on several factors including high vaccination coverage. Timely receipt of vaccines ensures optimal immune response to the vaccines. Yet timeliness is not usually emphasized in estimating population immunity. In addition to examining timeliness of the recommended Expanded Programme for Immunisation (EPI) vaccines, this paper identifies predictors of untimely vaccination among children aged 10 to 23 months in Kampala.

METHODS

In addition to the household survey interview questions, additional data sources for variables included data collection of child's weight and length. Vaccination dates were obtained from child health cards. Timeliness of vaccinations were assessed with Kaplan-Meier time-to-event analysis for each vaccine based on the following time ranges (lowest-highest target age): BCG (birth-8 weeks), polio 0 (birth-4 weeks), three polio and three pentavalent vaccines (4 weeks-2 months; 8 weeks-4 months; 12 weeks-6 months) and measles vaccine (38 weeks-12 months). Cox regression analysis was used to identify factors associated with vaccination timeliness.

RESULTS

About half of 821 children received all vaccines within the recommended time ranges (45.6%; 95% CI 39.8-51.2). Timely receipt of vaccinations was lowest for measles (67.5%; 95% CI 60.5-73.8) and highest for BCG vaccine (92.7%: 95% CI 88.1-95.6). For measles, 10.7% (95% CI 6.8-16.4) of the vaccinations were administered earlier than the recommended time. Vaccinations that were not received within the recommended age ranges were associated with increasing number of children per woman (adjusted hazard ratio (AHR); 1.84, 95% CI 1.29-2.64), non-delivery at health facilities (AHR 1.58, 95% CI 1.02-2.46), being unmarried (AHR 1.49, 95% CI 1.15-1.94) or being in the lowest wealth quintile (AHR 1.38, 95% CI 1.11-1.72).

CONCLUSIONS

Strategies to improve vaccination practices among the poorest, single, multiparous women and among mothers who do not deliver at health facilities are necessary to improve timeliness of vaccinations.