Exploring Strategies to Improve Adherence to Immunization Schedule: A Study among Children Attending Maternal and Child Health Clinic at Kenyatta National Hospital, Nairobi, Kenya

Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey

Effective spontaneous AEFI reporting is the first step to ensuring vaccine safety. Half of the global population lives in countries with weak vaccine safety monitoring systems, especially in the African, Eastern Mediterranean, and Western Pacific regions. Further, Immunisation services have been upscaled without commensurate effective AEFI surveillance systems. Hence, this study aims to comprehensively investigate the impediments to an effective AEFI surveillance system. Given the programmatic and regulatory implications, understanding these impediments would facilitate the development and implementation of policies and strategies to strengthen the AEFI surveillance system in Nigeria. A qualitative research design (using a grounded theory approach) was employed by conducting ten key informant interviews and two Focus Group Discussion sessions among the study population to identify the barriers impeding optimal AEFI surveillance and documentation in Nigeria. This study found that the AEFI surveillance system is in place in Nigeria. However, its functionality is sub-optimal, and the potential capacity is yet to be fully harnessed due to health systems and socio-ecological impediments. The identified impediments are human-resource-related issues- knowledge gaps; limited training; lack of designated officers for AEFI; excessive workload; poor supportive supervision and attitudinal issues; caregiver's factor; governance and leadership- moribund AEFI committee; lack of quality supervisory visit and oversight and weak implementation of AEFI policy guidance. Others include funding and logistics issues- no dedicated budget provision and weak referral mechanism; insecurity; socio-economic and infrastructural deficits- poverty, geographical barriers, limited ICT skills, and infrastructure; and poor feedback and weak community engagement by the health workers. Findings from this study provide empirical evidence and serve as an advocacy tool for vaccine pharmacovigilance strengthening in Nigeria. Addressing the impediments requires health system strengthening and a whole-of-the-society approach to improve vaccine safety surveillance, restore public confidence and promote vaccine demand, strengthen PHC services, and contribute to attaining UHC and SDGs.

Determinants of defaulter to full vaccination among children aged 12-23 months in Siraro district, West Arsi zone, Oromia, Ethiopia: a case-control study

BACKGROUND

Vaccination is one of the most cost-effective global public health interventions to reduce childhood morbidity and mortality. Defaulters to full vaccination can put children at greater risk of acquiring vaccine-preventable disease outbreaks. The reason for not receiving full vaccination is not well explored, and hence, there is limited evidence about defaulters of vaccination in Ethiopia.

OBJECTIVES

To identify determinants of defaulter to full vaccination among children aged 12-23 months in Siraro District, West Arsi Zone, Oromia Region, Ethiopia.

METHODS

A community-based unmatched case-control study was conducted among children aged 12-23 months from March 20 to April 30, 2022, with a total sample size of 444 (148 cases and 296 controls). Cases were children aged 12-23 months who had missed at least one routine vaccination dose, while controls were children who had received all of the recommended routine vaccinations. Consecutive sampling and simple random sampling techniques were used to select representative cases and controls respectively. Data were collected using a structured questionnaire, entered into Epi-data version 4.6, and exported to Statistical Package for Social Sciences version 26 for analysis. Logistic regression was used to identify determinants of the defaulter to full vaccination and the variables with p-value < 0.25 were recruited for multivariable analysis, and an adjusted odds ratio with a 95% confidence interval and a p-value of ≤ 0.05 was used to declare the statistical significance of the association.

RESULT

Of the assessed determinants of the defaulter to full vaccination; inadequate knowledge of mothers/caretakers (AOR = 4.32, 95% CI:2.78-6.70), educational status of a father unable to read and write (AOR = 3.66, 95% CI:1.29-10.39), time to reach health facility ≥ 30 minutes (AOR = 2.45, 95% CI:1.51-3.97), not told about the type of vaccine received (AOR = 2.37, 95% CI;1.27-4.45), no parents discussion on vaccination (AOR = 2.16, 95% CI:1.24-3.79), home delivery (AOR = 2.43, 95% CI:1.39-4.25) and not participated in pregnant mother conference (AOR = 2.47, 95% CI = 1.35-4.49) were the identified determinants of the defaulter to full vaccination.

CONCLUSION

Mother's' knowledge, father's education, place of delivery, time to reach a health facility, health workers who told the type of vaccine received, participation in pregnant mother conference, and parents' discussion on vaccination were the determinants of the defaulter to full vaccination status. Thus, the district health office should work on defaulters of vaccination by strengthening immunization service delivery and improving maternal knowledge on vaccination through pregnant mother conference participation.

Exploring barriers of childhood full vaccination among children living in Siraro District, West Arsi Zone, Oromia region, Ethiopia: A qualitative study

Background

Childhood immunization is one of the most effective global public health interventions to reduce childhood morbidity and mortality. However, some children remain not fully vaccinated in developing countries due to defaulting from full vaccination, which can put them at risk of acquiring vaccine-preventable disease outbreaks. The barriers to full vaccination were well explored in Ethiopia using a qualitative approach. The study aimed to explore barriers to full childhood vaccination in Siraro District, West Arsi Zone, Oromia, Ethiopia.

Methods

A qualitative study was conducted in Siraro District through 15 key informant health workers interviews and 6 in-depth interviews with children's mothers from April 20 to May 15, 2022. Data were collected by semi-structured questionnaires and captured using audio tape recorders and field note-taking. A heterogeneous purposive sampling technique was used to select representative study participants. Data transcription and translation were done according to the respondents' verbatim from the local language to English. Data coding and key categories were identified and analyzed using thematic analysis. Finally, data were presented in narrative forms using respondents' own words as an illustration.

Result

Twenty-one study participants were interviewed and included in this study. Of the explored barriers to full childhood vaccination, the evidence from the respondents was integrated from subcategories and presented as a whole within each thematic area. Five thematic areas emerged from interviews of the participants through thematic analysis of the data. The identified barriers were forgetting the next vaccination schedule, migration of parents, work overload, lack of knowledge and awareness, rumors, and misinformation. Additionally, vaccination service delivery-related barriers such as vaccine vials not being opened for a few children, fear of vaccine side effects, closed health posts during visits by mothers for vaccination, and absence of health extension workers at health posts were the key barriers to full childhood vaccination.

Conclusion

Forgetting vaccination schedule, migration of parents, work overload, rumors, and misinformation, fear of vaccine side effects, vaccine vial not opened for few children, closed health posts during visiting by mothers, absence of health extension workers from health posts were the key barriers to the full vaccination status of children. Thus, the district health office should work on barriers to full vaccination by strengthening vaccination service delivery and improving vaccination awareness through a health extension program.

Predictors of Adherence to Routine Immunization Schedule Among Caretakers of Children Aged 10 to 18 Months in Lira City, Uganda

Background

Although the majority of nations have routine immunization programs in place as a public health strategy, more than 1.5 million children under the age of 5 die yearly worldwide due to inadequate vaccination coverage. This study investigated the predictors of adherence to routine immunization schedules in Lira city.

Methods

This was a cross-sectional study among 420 caretakers of children aged 10 to 18 months. Bivariate and multiple regression analyses were conducted to assess the predictors of adherence to the full immunization schedule. A P-value > .05 was considered statistically significant at 95% CI.

Results

The study result indicated that the majority, 237 (56.4%) of caretakers were aged 25 to 34 years, 205 (48.8%) had attained primary level education, and 284 (67.6%) were married. The results showed that 365 (87.0%) had their children fully immunized. The predictors of adherence to full immunization schedule were knowledge on when to start vaccination (AOR:5.65; 95% CI:1.82-17.55; P = .003), maternal outcome expectations (AOR:3.45; 95% CI:1.16-10.29; P = .03) and maternal knowledge (AOR:2.15; 95% CI:1.18-3.90; P = .01).

Conclusion

The study findings show that 9 in 10 of the caregivers adhered to the immunization schedule. The significant predictors of adherence to full immunization were flexible clinical hours, maternal outcome expectations and maternal knowledge. Based on the conclusions we recommend that government and service providers be flexible in clinic hours and continue health education to women of childbearing age at an early stage, especially during antenatal care visits, delivery and the postnatal period on childhood vaccination to maintain adherence to the routine immunization schedule.

Awareness and Perception of Parents Regarding Well Baby Clinic in Primary Health Care Centres in Abha City, Southwestern Saudi Arabia

Background:

Well-baby clinic (WBC) service is implemented in all primary health care centers and is provided based on international standards to all children under 5 years in Saudi Arabia. It is a comprehensive package of health promotion and curative care to improve and maintain the health status and well-being of this age group.

Aim:

The main aim is to assess parents’ awareness and perception regarding WBC in primary health care centers in Abha sector, Kingdom of Saudi Arabia (KSA).

Methodology:

A descriptive cross-sectional approach was used in the current study. The study targeted all babies’ caregivers attending WBCs in primary health care centers in Abha city. The children's parents were included using three stages cluster sample technique. The questionnaire included participants’ demographic data such as age, gender, relation to the baby, educational level, work, and monthly income. Awareness regarding the WBC was assessed using two main items covering hearing about the clinic provided services.

Results:

The study included 1593 participants whose ages ranged from 19 to 55 years old with a mean age of 34.6 ± 11.8 years. About 64% of the respondents knew about the WBC, which was significantly higher among the females than males (P = .003). Also, 71.2% of respondents aged 25–34 years knew about well-baby clinic (WBC) compared to 35% of parents aged less than 25 years (P = .001). Exact 57.1% of the respondents went to the nearest governmental health office at vaccination times. About 46% of the respondents reported that the clinic nurse was the main person who dealt with them. Regarding services provided by a nurse at the vaccination clinic, registering child vaccination was the most reported (66.2%), followed by helping the mother make the child calm (56.8%).

Conclusions:

In conclusion, the study revealed that proper care is vital for a child's survival as well as optimal physical and mental development. Adequately cared child has proper well-being and happiness. Mothers and children caregivers had adequate awareness and acceptable attitude towards WBCs and provided services. Some barriers were declared including lack of available WBCs within the residence range, not all WBCs usually working, and more information should be provided about WBCs.

Usability and Acceptability of a Mobile App for Behavior Change and to Improve Immunization Coverage among Children in Pakistan: A Mixed-Methods Study

Background: Pakistan’s immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience. Objective: The aim of this study was to learn about caregivers’ attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan. Methods: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent’s attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews. Results: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization. Conclusion: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents’ experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions.

Using participatory action research to improve immunization utilization in areas with pockets of unimmunized children in Nigeria

BACKGROUND

In 2005, Nigeria adopted the Reaching Every Ward strategy to improve vaccination coverage for children 0-23 months of age. By 2015, Ogun state had full coverage (100%) in 12 of its 20 local government areas, but eight had pockets of unimmunized children, with the highest burden (37%) in Remo North. A participatory action research (PAR) approach was used to facilitate implementation of local solutions to contextual barriers to immunization in Remo North. This article assesses and seeks to explain the outcomes of the PAR implemented in Remo North to understand whether and possibly how it improved immunization utilization.

METHODS

The PAR intervention took place from 2016 to 2017. It involved two (4-month) cycles of dialogue and action between community members, frontline health workers and local government officials in two wards of Remo North, facilitated by the research team. The PAR was assessed using a pre/post-intervention-only design with mixed methods. These included household surveys of caregivers of 215 and 213 children, respectively, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community members. Data were analysed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy framework.

RESULTS

Collaboration among the three stakeholder groups enabled the development and implementation of solutions to identified problems related to access to and use of immunization services. At endline, assessment by card for children older than 9 months revealed a significant increase in those fully immunized, from 60.7% at baseline to 90.9% (p < .05). A significantly greater number of caregivers visited fixed government health facilities for routine immunization at endline (83.2%) than at baseline (54.2%) (p < .05). The reasons reported by caregivers for improved utilization of routine immunization services were increased community mobilization activities and improved responsiveness of the health workers. Spillover effects into maternal health services enhanced the use of immunization services by caregivers. Spontaneous scale-up of actions occurred across Remo North due to the involvement of local government officials.

CONCLUSION

The PAR approach achieved contextual solutions to problems identified by communities. Collection and integration of evidence into discussions/dialogues with stakeholders can lead to change. Leveraging existing structures and resources enhanced effectiveness.