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Karlsson O, Rajpal S, Johri M, Kim R, Subramanian SV. Prevalence and Trends of Not Receiving a Dose of DPT-Containing Vaccine Among Children 12-35 Months: An Analysis of 81 Low- And Middle-Income Countries. J Epidemiol Glob Health 2024:10.1007/s44197-024-00294-6. [PMID: 39298110 DOI: 10.1007/s44197-024-00294-6] [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: 02/05/2024] [Accepted: 08/29/2024] [Indexed: 09/21/2024] Open
Abstract
Not receiving a DPT-containing vaccine in early childhood indicates an absence of routine immunization, which puts children at an elevated risk of mortality, morbidity, and worse human development over the life course. We estimated the percentage of children 12-35 months who did not receive a dose of DPT-containing vaccine (termed zero-dose children) using household surveys from 81 low- and middle-income countries conducted between 2014 and 2023. For 68 countries with more than one survey (with the earlier survey conducted 2000-2013), we estimated the average annual percentage point change in prevalence of zero-dose children between the earliest and latest surveys. We also explored the association of zero-dose prevalence with postneonatal and child mortality, health expenditure, and Gavi-eligibility. Overall, 16% of children in our pooled sample had not received a dose of DPT-containing vaccine. There was a 0.8% point decline in zero-dose prevalence per year on average across the period studied. A single percentage point average annual decline in zero-dose prevalence was associated with an average annual decrease of 1.4 deaths in the postneonatal and childhood period per 1000 live births. Gavi-eligible countries had a much faster decline in zero-dose prevalence than other countries. Large gains have been made in reducing the percentage of children who did not receive a DPT-containing vaccine. Efforts to reduce the number of zero-dose children should focus on countries with high prevalence to achieve the Immunization Agenda 2030. Healthcare spending could be prioritized so that the prevalence of zero-dose children is reduced.
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Affiliation(s)
- Omar Karlsson
- Duke University Population Research Institute, Duke University, 140 Science Dr, Durham, NC, 27710, USA
- Centre for Economic Demography, School of Economics and Management, Lund University, P.O. Box 7083, Lund, 220 07, Sweden
| | - Sunil Rajpal
- Department of Economics, FLAME University, Pune, India
| | - Mira Johri
- Carrefour de l'Innovation, Centre de Recherche du Centre Hospitalier de l Universite, de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Gestion, d'Évaluation, École de Santé Publique, et de Politique de Santé, Université de Montréal (ÉSPUM), Montréal, QC, Canada
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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Tamir TT, Zegeye AF, Mekonen EG, Tekeba B, Ali MS, Gonete AT, Kassie AT, Workneh BS, Wassie M, Alemu TG. Prevalence, spatial variation and determinants of zero-dose children in Ethiopia: Spatial and multilevel analyses. Public Health 2024; 236:365-372. [PMID: 39303624 DOI: 10.1016/j.puhe.2024.09.011] [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: 03/18/2024] [Revised: 07/16/2024] [Accepted: 09/11/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES Vaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. STUDY DESIGN A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. METHODS The study included a total of 1334 children aged 12-35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. RESULTS The prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples' Region) regions had high zero-dose proportions. Maternal age 15-19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. CONCLUSIONS The prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of emergency and critical care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mak J, Patenaude BN, Mutembo S, Pilewskie ME, Winter AK, Moss WJ, Carcelen AC. Modeling the Cost of Vaccinating a Measles Zero-Dose Child in Zambia Using Three Vaccination Strategies. Am J Trop Med Hyg 2024; 111:121-128. [PMID: 38772386 PMCID: PMC11229634 DOI: 10.4269/ajtmh.23-0412] [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: 06/22/2023] [Accepted: 02/10/2024] [Indexed: 05/23/2024] Open
Abstract
Countries with moderate to high measles-containing vaccine coverage face challenges in reaching the remaining measles zero-dose children. There is growing interest in targeted vaccination activities to reach these children. We developed a framework for prioritizing districts for targeted measles and rubella supplementary immunization activities (SIAs) for Zambia in 2020, incorporating the use of the WHO's Measles Risk Assessment Tool (MRAT) and serosurveys. This framework was used to build a model comparing the cost of vaccinating one zero-dose child under three vaccination scenarios: standard nationwide SIA, targeted subnational SIA informed by MRAT, and targeted subnational SIA informed by both MRAT and measles seroprevalence data. In the last scenario, measles seroprevalence data are acquired via either a community-based serosurvey, residual blood samples from health facilities, or community-based IgG point-of-contact rapid diagnostic testing. The deterministic model found that the standard nationwide SIA is the least cost-efficient strategy at 13.75 USD per zero-dose child vaccinated. Targeted SIA informed by MRAT was the most cost-efficient at 7.63 USD per zero-dose child, assuming that routine immunization is just as effective as subnational SIA in reaching zero-dose children. Under similar conditions, a targeted subnational SIA informed by both MRAT and seroprevalence data resulted in 8.17-8.35 USD per zero-dose child vaccinated, suggesting that use of seroprevalence to inform SIA planning may not be as cost prohibitive as previously thought. Further refinement to the decision framework incorporating additional data may yield strategies to better target the zero-dose population in a financially feasible manner.
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Affiliation(s)
- Joshua Mak
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bryan N Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Simon Mutembo
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monica E Pilewskie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy K Winter
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea C Carcelen
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ravi SJ, Vecino-Ortiz AI, Potter CM, Merritt MW, Patenaude BN. Group-based trajectory models of integrated vaccine delivery and equity in low- and middle-income countries. Int J Equity Health 2024; 23:5. [PMID: 38195588 PMCID: PMC10775446 DOI: 10.1186/s12939-023-02088-x] [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: 10/18/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Integrated vaccine delivery - the linkage of routine vaccination with provision of other essential health services - is a hallmark of robust primary care systems that has been linked to equitable improvements in population health outcomes. METHODS We gathered longitudinal data relating to routine immunization coverage and vaccination equity in 78 low- and middle-income countries that have ever received support from Gavi, the Vaccine Alliance, using multiple imputation to handle missing values. We then estimated several group-based trajectory models to describe the relationship between integrated vaccine delivery and vaccination equity in these countries. Finally, we used multinomial logistic regression to identify predictors of group membership. RESULTS We identified five distinct trajectories of geographic vaccination equity across both the imputed and non-imputed datasets, along with two and four trajectories of socioeconomic vaccination equity in the imputed and non-imputed datasets, respectively. Integration was associated with reductions in the slope index of inequality of measles vaccination in the countries analyzed. Integration was also associated with an increase in the percentage of districts reporting high measles vaccination coverage. CONCLUSIONS Integrated vaccine delivery is most strongly associated with improvements in vaccination equity in settings with high baseline levels of inequity. Continued scholarship is needed to further characterize the relationship between integration and health equity, as well as to improve measurement of vaccination coverage and integration.
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Affiliation(s)
- Sanjana J Ravi
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 700 East Pratt Street, Suite 900, Baltimore, MD, 21202, USA.
| | - Andrés I Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
| | - Christina M Potter
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 700 East Pratt Street, Suite 900, Baltimore, MD, 21202, USA
| | - Maria W Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, 5th Floor, Baltimore, MD, 21231, USA
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Saidu Y, Agbor VN, Di Mattei P, Nchinjoh SC, Edwidge NN, Njoh AA, Muteh NJ, Prescott M, Wiwa O, Diack D, Flegere J, Montomoli E, Costa Clemens SA, Clemens R. Development of a composite scoring system to rank communities at high risk of zero-dose children in Cameroon: A geospatial analysis. J Glob Health 2023; 13:04136. [PMID: 37971948 PMCID: PMC10653342 DOI: 10.7189/jogh.13.04136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background Despite growing efforts to improve access to vaccination, millions of children, especially in developing countries, have not received a single dose of diphtheria, tetanus, and pertussis (DTP) vaccine. Consequently, they are often called zero-dose children (ZDC). With limited health resources, prioritising communities for rapid and mass zero-dose catch-up vaccination in missed communities to avert epidemic outbreaks is complicated by unreliable denominators used to compute vaccination coverages. Incorporating other indicators of access and utilisation of vaccination services can help with identifying and ranking missed communities based on the likelihood of finding ZDC. We described the process of generating a scoring method to rank health areas in Cameroon based on their likelihood of containing ZDC. Methods We used geospatial analysis to compute and aggregate health area characteristics, including hard-to-reach (HTR) areas (defined as areas of settlement above a one- (for urban areas) or 15-kilometre radius (for rural areas) beyond a vaccinating health facility), amount of area covered by slums and new area settlement, and percentage of children unvaccinated for DTP-1. We attributed a weight based on the ability to limit accessibility or utilisation of vaccination services to each characteristic and computed the score as a weighted average of health area characteristics. The health area score ranged from 0 to 1, with higher scores representing a higher likelihood of containing ZDC. We stratified the analysis by rural and urban health areas. Results We observed substantial district and regional variations in health area scores, with hotspots health areas (administrative level 4) observed in the Far North (0.83), North (0.81), Adamawa (0.80), East (0.75), and South West (0.67) regions. The Adamawa region had the highest percentage of health areas with the highest score (78%), followed by the East (50%), West (48%), and North (46%) regions. For most regions (Far North, South, South West, Littoral, West, and North West), DTP-1 contributed the most to the score. However, HTR settlement areas within a health area contributed substantially to the overall score in the East, North, and Adamawa regions. Conclusions We found substantial variations in health area scores with hotspots in the Far North, North, Adamawa, East, and South West regions. Although DTP-1 could be used as an indicator to identify health areas with ZDC for most communities, HTR settlement area was a valuable indicator in ranking priority health areas in the East, North, and Adamawa regions, further emphasising the need to consider other indicators before prioritisation.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc., Yaoundé, Cameroon
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Valirie N Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Andreas A Njoh
- Expanded Program on Immunization, Cameroon Ministry of Public Health, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
| | | | - Marta Prescott
- Global Analytics and Implementation Research Team, Clinton Health Access Initiative Inc., Boston, USA
| | - Owens Wiwa
- Clinton Health Access Initiative Inc., Yaoundé, Cameroon
| | - Demba Diack
- Gavi, the Vaccine Alliance, Geneva, Switzerland
| | | | - Emanuele Montomoli
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi srl, Siena, Italy
| | - Sue A Costa Clemens
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- Department of Pediatrics, University of Oxford, Oxford, UK
| | - Ralf Clemens
- Institute for Global Health, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- International Vaccine Institute, IVI, Seoul, Republic of Korea
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Ingle EA, Shrestha P, Seth A, Lalika MS, Azie JI, Patel RC. Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis. Viruses 2023; 15:2092. [PMID: 37896868 PMCID: PMC10612020 DOI: 10.3390/v15102092] [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: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Zero-dose children, or children who have not received any routine vaccination, are a priority population for global health policy makers as these children are at high risk of mortality from vaccine-preventable illnesses. We conducted a narrative review to identify potential interventions, both within and outside of the health sector, to reach zero-dose children. We reviewed the peer-reviewed and grey literature and identified 27 relevant resources. Additionally, we interviewed six key informants to enhance the synthesis of our findings. Data were organized into three priority settings: (1) urban slums, (2) remote or rural communities, and (3) conflict settings. We found that zero-dose children in the three priority settings face differing barriers to vaccination and, therefore, require context-specific interventions, such as leveraging slum health committees for urban slums or integrating with existing humanitarian response services for conflict settings. Three predominant themes emerged for grouping the various interventions: (1) community engagement, (2) health systems' strengthening and integration, and (3) technological innovations. The barriers to reaching zero-dose children are multifaceted and nuanced to each setting, therefore, no one intervention is enough. Technological interventions especially must be coupled with community engagement and health systems' strengthening efforts. Evaluations of the suggested interventions are needed to guide scale-up, as the evidence base around these interventions is relatively small.
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Affiliation(s)
- Erin A. Ingle
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Priyanka Shrestha
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Aparna Seth
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Mathias S. Lalika
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Jacinta I. Azie
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
| | - Rena C. Patel
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA 98195, USA; (P.S.); (A.S.); (M.S.L.); (J.I.A.); (R.C.P.)
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Siddique M, Iftikhar S, Dharma VK, Shah MT, Siddiqi DA, Malik AA, Chandir S. Using geographic information system to track children and optimize immunization coverage and equity in Karachi, Pakistan. Vaccine 2023; 41:2922-2931. [PMID: 37012115 DOI: 10.1016/j.vaccine.2023.03.051] [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: 09/21/2022] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Despite the potential of geospatial technologies to track and monitor coverage, they are underutilized for guiding immunization program strategy and implementation, especially in low-and-middle-income countries. We conducted geospatial analysis to explore the geographic and temporal trends of immunization coverage, and examined the pattern of immunization service access (outreach and facility based) by children. METHODOLOGY We extracted data to analyze coverage rates across different dimensions (by enrolment year, birth year and vaccination year) from 2018 till 2020 in Karachi, Pakistan using the Sindh Electronic Immunization Registry (SEIR). We conducted geospatial analysis to assess variation in coverage rates of BCG, Pentavalent (Penta)-1, Penta-3, and Measles-1 vaccines using Government targets. We also analyzed the proportion of children receiving their routine vaccinations at fixed centers and outreach and examined whether children received vaccinations at the same or multiple immunization centers. RESULTS A total of 1,298,555 children were born, enrolled or vaccinated from 2018 till 2020. At the district level, analysis by enrollment and birth year showed coverage increased between 2018 and 2019 and declined in 2020, while analysis by vaccination year showed consistent increase in coverage. However, micro-geographic analysis revealed pockets where coverage persistently declined. Notably 27/168, 39/168 and 3/156 Union councils showed consistently declining coverage when analyzing by enrollment, birth and vaccination year respectively. More than half (52.2%, 678,280/1,298,555) of the children received all their vaccinations exclusively through fixed centers and, 71.7% (499,391/696,701) received all vaccinations from the same centers. CONCLUSION Despite overall improving vaccination coverage between 2018 and 2020, certain geographic areas have consistently declining coverage rates, which is detrimental for equity. Making immunization inequities visible through geospatial analysis is the first step to ensure resources are allocated optimally. Our study provides impetus for immunization programs to develop and invest in geospatial technologies, harnessing its potential for improved coverage and equity.
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Affiliation(s)
- Muhammad Siddique
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Sundus Iftikhar
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Vijay Kumar Dharma
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Mubarak Taighoon Shah
- IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore
| | - Danya Arif Siddiqi
- IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore.
| | - Amyn A Malik
- IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore
| | - Subhash Chandir
- Maternal & Child Health, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan; IRD Global, 16 Raffles Quay, #16-02, Hong Leong Building, Singapore 048581, Singapore
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Yang Y, Kostandova N, Mwansa FD, Nakazwe C, Namukoko H, Sakala C, Bobo P, Masumbu PK, Nachinga B, Ngula D, Carcelen AC, Prosperi C, Winter AK, Moss WJ, Mutembo S. Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles-Rubella Supplementary Immunization Activity during the COVID-19 Pandemic. Vaccines (Basel) 2023; 11:608. [PMID: 36992192 PMCID: PMC10059977 DOI: 10.3390/vaccines11030608] [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: 02/14/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Measles-rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey in Zambia to measure the proportion of measles zero-dose and under-immunized children who were reached by the 2020 MR-SIA and identified reasons associated with persistent inequalities following the MR-SIA. METHODS Children between 9 and 59 months were enrolled in a nationally representative, cross-sectional, multistage stratified cluster survey in October 2021 to estimate vaccination coverage during the November 2020 MR-SIA. Vaccination status was determined by immunization card or through caregivers' recall. MR-SIA coverage and the proportion of measles zero-dose and under-immunized children reached by MR-SIA were estimated. Log-binomial models were used to assess risk factors for missing the MR-SIA dose. RESULTS Overall, 4640 children were enrolled in the nationwide coverage survey. Only 68.6% (95% CI: 66.7%, 70.6%) received MCV during the MR-SIA. The MR-SIA provided MCV1 to 4.2% (95% CI: 0.9%, 4.6%) and MCV2 to 6.3% (95% CI: 5.6%, 7.1%) of enrolled children, but 58.1% (95% CI: 59.8%, 62.8%) of children receiving the MR-SIA dose had received at least two prior MCV doses. Furthermore, 27.8% of measles zero-dose children were vaccinated through the MR-SIA. The MR-SIA reduced the proportion of measles zero-dose children from 15.1% (95% CI: 13.6%, 16.7%) to 10.9% (95% CI: 9.7%, 12.3%). Zero-dose and under-immunized children were more likely to miss MR-SIA doses (prevalence ratio (PR): 2.81; 95% CI: 1.80, 4.41 and 2.22; 95% CI: 1.21 and 4.07) compared to fully vaccinated children. CONCLUSIONS The MR-SIA reached more under-immunized children with MCV2 than measles zero-dose children with MCV1. However, improvement is needed to reach the remaining measles zero-dose children after SIA. One possible solution to address the inequalities in vaccination is to transition from nationwide non-selective SIAs to more targeted and selective strategies.
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Affiliation(s)
- Yangyupei Yang
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Natalya Kostandova
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Francis Dien Mwansa
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | | | | | - Constance Sakala
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | - Patricia Bobo
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | | | | | - David Ngula
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | - Andrea C. Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Amy K. Winter
- Department of Epidemiology, University of Georgia, Athens, GA 30602, USA
| | - William J. Moss
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
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Bazant E, McPhillips-Tangum C, Shrestha SD, G S P, Khera A, Nic Lochlainn L, Habtamu E, Patel VI, Muhire G, Saarlas KN. Promising practices for the collaborative planning of integrated health campaigns from a synthesis of case studies. BMJ Glob Health 2022; 7:bmjgh-2022-010321. [PMID: 36517112 PMCID: PMC9756207 DOI: 10.1136/bmjgh-2022-010321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
A combination of public health campaigns and routine primary healthcare services are used in many countries to maximise the number of people reached with interventions to prevent, control, eliminate or eradicate diseases. Health campaigns have historically been organised within vertical (disease-specific) programmes, which are often funded, planned and implemented independently from one another and from routinely offered primary healthcare services. Global health agencies have voiced support for enhancing campaign effectiveness, including campaign efficiency and equity, through collaboration among vertical programmes. However, limited guidance is available to country-level campaign planners and implementers about how to effectively integrate campaigns. Planning is critical to the implementation of effective health campaigns, including those related to neglected tropical diseases, malaria, vitamin A supplementation and vaccine-preventable diseases, including polio, measles and meningitis. However, promising approaches to planning integrated health campaigns have not been sufficiently documented. This manuscript highlights promising practices for the collaborative planning of integrated health campaigns that emerged from the experiences of eight project teams working in three WHO regions. Adoption of the promising practices described in this paper could lead to enhanced collaboration among campaign stakeholders, increased agreement about the need for and anticipated benefits of campaign integration, and enhanced understanding of effective planning of integrated health campaigns.
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Affiliation(s)
- Eva Bazant
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - Preetha G S
- International Institute of Health Management Research, Delhi, India
| | | | - Laura Nic Lochlainn
- Department of Immunization, Vaccines & Biologicals (IVB), World Health Organization, Geneve, Switzerland
| | - Esmael Habtamu
- International Centre for Eye Health (ICEH), London School of Hygiene & Tropical Medicine, London, UK
| | - Vivek I Patel
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
| | | | - Kristin N Saarlas
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
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Ozigbu CE, Olatosi B, Li Z, Hardin JW, Hair NL. Correlates of Zero-Dose Vaccination Status among Children Aged 12-59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors. Vaccines (Basel) 2022; 10:1052. [PMID: 35891216 PMCID: PMC9322920 DOI: 10.3390/vaccines10071052] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12-59 months sampled between 2010 and 2020 in 33 SSA countries. Associations of zero-dose status with individual and contextual factors were assessed using multilevel logistic regression. 16.5% of children had not received any vaccines. Individual level factors associated lower odds of zero-dose status included mother's primary school or high school education, employment, use of antenatal care services and household wealth. Compared to children in countries with lower GDP, children in countries with relatively high GDP had nearly four times greater odds of being unvaccinated. Both individual and contextual factors are correlated with zero-dose status in SSA. Our results can inform efforts to identify and reach children who have not received any vaccines.
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Affiliation(s)
- Chamberline E. Ozigbu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC 29208, USA
| | - Zhenlong Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC 29208, USA
- Geoinformation and Big Data Research Laboratory, University of South Carolina, Columbia, SC 29208, USA
| | - James W. Hardin
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Nicole L. Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
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11
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Wendt A, Santos TM, Cata-Preta BO, Costa JC, Mengistu T, Hogan DR, Victora CG, Barros AJD. Children of more empowered women are less likely to be left without vaccination in low- and middle-income countries: A global analysis of 50 DHS surveys. J Glob Health 2022; 12:04022. [PMID: 35356658 PMCID: PMC8943525 DOI: 10.7189/jogh.12.04022] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To help provide a global understanding of the role of gender-related barriers to vaccination, we have used a broad measure of women’s empowerment and explored its association with the prevalence of zero-dose children aged 12-23 months across many low- and middle-income countries, using data from standardized national household surveys. Methods We used data from Demographic and Health Surveys (DHS) of 50 countries with information on both women’s empowerment and child immunisation. Zero-dose was operationally defined as the proportion of children who failed to receive any doses of the diphtheria, pertussis, and tetanus containing vaccines (DPT). We measured women’s empowerment using the SWPER Global, an individual-level indicator estimated for women aged 15-49 years who are married or in union and with three domains: social independence, decision-making and attitude towards violence. We estimated two summary measures of inequality, the slope index of inequality (SII) and the concentration index (CIX). Results were presented for individual and pooled countries. Results In the country-level (ecological) analyses we found that the higher the proportion of women with high empowerment, the lower the zero-dose prevalence. In the individual level analyses, overall, children with highly-empowered mothers presented lower prevalence of zero-dose than those with less-empowered mothers. The social independence domain presented more consistent associations with zero-dose. In 42 countries, the lowest zero-dose prevalence was found in the high empowerment groups, with the slope index of inequality showing significant results in 28 countries. When we pooled all countries using a multilevel Poisson model, children from mothers in the low and medium levels of the social independence domain had respectively 3.3 (95% confidence interval (CI) = 2.3, 4.7) and 1.8 (95% CI = 1.5, 2.1) times higher prevalence of zero-dose compared to those in the high level. Conclusions Our country-level and individual-level analyses support the importance of women’s empowerment for child vaccination, especially in countries with weaker routine immunisation programs.
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Affiliation(s)
- Andrea Wendt
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bianca O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Janaína C Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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