Paternal education status significantly influences infants' measles vaccination uptake, independent of maternal education status

Factors influencing the first dose of measles vaccination uptake in 42 low- and middle-income countries

OBJECTIVES

Vaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children.

STUDY DESIGN

This was a cross-sectional study.

METHODS

This study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI).

RESULTS

The prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children.

CONCLUSION

The first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished.

Do maternal and paternal education protect against developmental delays?

BACKGROUND

Parental education is linked to child development and wellbeing, but unique and combined contributions of maternal and paternal education have rarely been studied.

AIMS

This study assessed the individual and joint associations of maternal and paternal education on children's odds of a probable developmental delay.

METHODS AND PROCEDURES

Mothers (N = 3566) from the Upstate KIDS cohort study reported on theirs and the father's highest level of education and completed the Ages and Stages Questionnaires up to 7 times when the child was 4- to 36-months-old. A nonparametric constrained inference technique assessed the association between education and probable developmental delays.

OUTCOMES AND RESULTS

Higher levels of maternal and paternal education were protective against child probable developmental delays in years 2 (18, 24 months; p-trends<.001) and 3 (30, 36 months; p-trends<.001), but not year 1 (4, 8, 12 months; p-trend=.486-.832). Trends held adjusting for parental age and race. When adjusting for the other parent's education, only maternal education had unique associations with delays. Among parents with the same or similar education levels, when both parents had one level higher education it was also protective.

CONCLUSIONS AND IMPLICATIONS

Both maternal and paternal education may protect against children's developmental delays in toddlerhood, but maternal education may be particularly important.

Continuum of care in maternal and child health in Indonesia

AIM

This paper aims to empirically analyze the socioeconomic and demographic correlates of maternal and child health (MCH) care utilization in Indonesia using the continuum of care (CoC) concept.

BACKGROUND

The concept of CoC has emerged as an important guiding principle in reproductive, maternal, newborn, and child health. Indonesia's maternal mortality rate, neonatal mortality, and under-five mortality rates are among the highest in the Southeast Asian region.

METHODS

Using pooled data from four successive waves of the nationally representative Indonesian Demographic and Health Survey (IDHS) conducted in the years 2002, 2007, 2012, and 2017, we use multivariate regression models to analyze care across four components of the continuum: antenatal care (ANC), institutional delivery, postnatal care for children, and full immunization (IM).

FINDINGS

CoC at each stage of MCH care has improved continuously over the period 2002-2017 in Indonesia. Despite this, just less than one out of two children receive all four components of the CoC. The overall coverage of CoC from its second stage (four or more ANC visits) to the final stage (full child IM) is driven by the dropouts at the ANC visit stage, followed by the loss of postnatal checkups and child IM. We find that the probability of a child receiving CoC at each of the four stages is significantly associated with maternal age and education, the household's socioeconomic and demographic characteristics, and economic status.

CONCLUSION

Complete CoC with improved, affordable, and accessible MCH care services has the potential to accelerate the progress of Sustainable Development Goal 3 by reducing maternal and childhood mortality risks. Our findings show that in Indonesia, the CoC continuously declines as women proceed from ANC to other MCH services, with a sharp decline observed after four ANC visits. Our study has identified key socioeconomic characteristics of women and children that increase their probability of failing to access care.

Oral and Inactivated Polio Vaccine Coverage and Determinants of Coverage Inequality Among the Most At-Risk Populations in Ethiopia

Combining oral (OPV) and inactivated (IPV) poliovirus vaccines prevents importation of poliovirus and emergence of circulating vaccine-derived poliovirus. We measured the coverage with IPV and third dose of OPV (OPV-3) and identified determinants of coverage inequality in the most at-risk populations in Ethiopia. A national survey representing 10 partly overlapping underserved populations-pastoralists, conflict-affected areas, urban slums, hard-to-reach settings, developing regions, newly formed regions, internally displaced people (IDPs), refugees, and districts neighboring international and interregional boundaries-was conducted among children 12 to 35 months old (N = 3,646). Socioeconomic inequality was measured using the concentration index (CIX) and decomposed using a regression-based approach. One-third (95% CI: 31.5-34.0%) of the children received OPV-3 and IPV. The dual coverage was below 50% in developing regions (19.2%), pastoralists (22.0%), IDPs (22.3%), districts neighboring international (24.1%) and interregional (33.3%) boundaries, refugees (27.0%), conflict-affected areas (29.3%), newly formed regions (33.5%), and hard-to-reach areas (38.9%). Conversely, coverage was better in urban slums (78%). Children from poorest households, living in villages that do not have health posts, and having limited health facility access had increased odds of not receiving the vaccines. Low paternal education, dissatisfaction with vaccination service, fear of vaccine side effects, living in female-headed households, having employed and less empowered mothers were also risk factors. IPV-OPV3 coverage favored the rich (CIX = -0.161, P < 0.001), and causes of inequality were: inaccessibility of health facilities (13.3%), dissatisfaction with vaccination service (12.8%), and maternal (4.9%) and paternal (4.9%) illiteracy. Polio vaccination coverage in the most at-risk populations in Ethiopia is suboptimal, threatening the polio eradication initiative.

Uptake and determinants of childhood vaccination status among children aged 0-12 months in three West African countries

BACKGROUND

Vaccination has long been recognized as one of the most effective ways to reduce child mortality. It has played a significant role, particularly for children, and is considered a major achievement and relevant in preventing childhood diseases worldwide. This study looks at the uptake and determinants of childhood vaccination status among children under the age of one year, for Gambia, Sierra Leon, and Liberia.

METHOD

Data from 2019 to 20 Demographic and Health Survey (DHS) data from Gambia, Sierra Leone, and Liberia were pooled for the analysis used in this study. Data were obtained from a total weighted sample of 5,368 children aged 0-12 months through a stratified two-stage cluster sampling approach. A multivariable logistic regression model was used to assess the predictors of childhood vaccination uptake at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs).

RESULTS

The weighted sample pooled prevalence of full vaccination among children under 12 months of age was 15.1% for males and 15.0% for females. After controlling for confounders in the regression model, factors that were found to be associated with vaccination status include children whose mothers attended postnatal care (PNC) visits had higher odds of being fully vaccinated (aOR = 1.23, 95% CI = 1.03-1.46), while children whose fathers had primary education (aOR = 0.67, 95% CI = 0.48-0.96), children whose households never watched TV (aOR = 0.68, 95% CI = 0.56-0.82) and children whose mothers attended 1-3 antenatal care (ANC) visits (aOR = 0.59, 95% CI = 0.45-0.79) had lower odds of being fully vaccinated.

CONCLUSION

Childhood vaccination uptake was low among children under 12 months of age in these countries. Hence, there is a need to promote the uptake of vaccination across these three West African countries especially among rural dwellers.

Willingness to COVID-19 vaccination: Empirical evidence from EU

The unforgettable COVID-19 shock is most likely to be reversed by a viable vaccination strategy. In this paper, we investigate willingness to be vaccinated (WTV) against the COVID-19. Current trends suggest that only around 73% of EU inhabitants (15 and +) were immunized, with more than 104 million people still warranted to be immunized. Vaccine reluctance is a key impediment to conducting immunization programs in the setting of a pandemic. We provide first of its kind empirical evidence on the citizens (N = 11,932) of the EU-27 by employing the recent data from the European Commission. Based on the survey responses, controlling for the correlations in the error terms, we utilize a simulated multivariate probit regression model. Our results show that amongst all the statistically significant drivers of the WTV, the positive perception (vaccination works and has no side effects); R&D information (clarity on how vaccination is developed, tested, authorized) has the largest impact on the WTV. We find that the group of variables on social feedback (Positive perception; social adoption and pressure), and on trustworthy sources of information (R&D info; medical advice) are to be considered for WTV policy. The counteracting policy gaps that act against WTV include vaccination governance dissatisfaction, perception of long-term side effects, growing mistrust in information sources, uncertainty between safety and efficacy, education level, and risky age group. Strategies based on the outcomes of this study are needed to address public acceptance and willingness to vaccinate during a pandemic. This research is novel and offers authorities in-depth insights into the challenges and solutions regarding the COVID-19 pandemic and thus to its end via stimulation of the WTV.

Parental willingness to have children vaccinated against COVID-19 in Geneva, Switzerland: a cross-sectional population-based study

OBJECTIVE

We aimed to examine factors associated with parental willingness to vaccinate their children against COVID-19.

METHODS

We surveyed adults included in a digital longitudinal cohort study composed of participants in previous SARS-CoV-2 serosurveys conducted in Geneva, Switzerland. In February 2022, an online questionnaire collected information on COVID-19 vaccination acceptance, parental willingness to vaccinate their children aged ≥5 years and reasons for vaccination preference. We used multivariable logistic regression to assess the demographic, socioeconomic and health-related factors associated with being vaccinated and with parental intention to vaccinate their children.

RESULTS

We included 1,383 participants (56.8% women; 69.3% aged 35-49 years). Parental willingness to vaccinate their children increased markedly with the child's age: 84.0%, 60.9% and 21.2%, respectively, for parents of adolescents aged 16-17 years, 12-15 years and 5-12 years. For all child age groups, unvaccinated parents more frequently indicated not intending to vaccinate their children than vaccinated parents. Refusal to vaccine children was associated with having a secondary education (1.73; 1.18-2.47) relative to a tertiary education and with middle (1.75; 1.18-2.60) and low (1.96; 1.20-3.22) household income relative to high income. Refusal to vaccine their children was also associated with only having children aged 12-15 years (3.08; 1.61-5.91), aged 5-11 years (19.77; 10.27-38.05), or in multiple age groups (6.05; 3.22-11.37), relative to only having children aged 16-17 years.

CONCLUSION

Willingness to vaccinate children was high for parents of adolescents aged 16-17 years but decreased significantly with decreasing child age. Unvaccinated, socioeconomically disadvantaged parents and those with younger children were less likely to be willing to vaccinate their children. These results are important for vaccination programs and developing communication strategies to reach vaccine-hesitant groups, both in the context of COVID-19 and in the prevention of other diseases and future pandemics.

Association Between Parental Education and Simultaneous Malnutrition Among Parents and Children in 45 Low- and Middle-Income Countries

IMPORTANCE

Parental education is known to be associated with the health status of parents and their offspring. However, the association between parental education and the simultaneous manifestation of multiple forms of malnutrition within households remains underinvestigated globally.

OBJECTIVE

To assess the association between parental education and the simultaneous manifestation of malnutrition of both parent and child (either overnutrition or undernutrition)-referred to as the double burden of malnutrition (DBM)-at the household level in mother-child and father-child pairs in low- and middle-income countries (LMICs).

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from the US Agency for International Development Demographic and Health Surveys (January 1, 2010, to December 31, 2021) to identify mother-child pairs and father-child pairs from LMICs. The eligibility criteria were as follows: (1) children aged 0 to 59 months; (2) nonpregnant mothers at the time of the survey in the sample of mother-child pairs; and (3) valid measures of the weight, height, and hemoglobin level for the child and at least 1 of their parents.

EXPOSURES

Highest level of parental education obtained and number of years of education completed.

MAIN OUTCOMES AND MEASURES

Four sets of multivariable logistic regression models were constructed to assess the association between parental education and DBM, and analysis was performed between March 10 and May 15, 2022.

RESULTS

This study included 423 340 mother-child pairs from 45 LMICs and 56 720 father-child pairs from 16 LMICs. The mean (SD) age of the mother-child pairs was 28.2 (6.1) and 1.9 (1.4) years, respectively; 48.8% of the children were female. We observed that 49.0% of mother-child pairs experienced DBM. Compared with mother-child pairs with no maternal education, higher maternal education was associated with a lower risk of DBM. For example, the odds ratio (OR) for tertiary maternal education was 0.71 (95% CI, 0.67-0.74). However, the association differed by DBM subtypes: higher maternal education was associated with a lower risk of both mothers and children being undernourished but with a higher risk of almost all DBM subtypes involving overnutrition. For example, compared with mother-child pairs with no maternal education, those with secondary education were less likely to develop simultaneous maternal and child undernutrition (OR, 0.83 [95% CI, 0.80-0.86]) but were more likely to experience simultaneous maternal and child overnutrition (OR, 2.20 [95% CI, 1.61-3.00]); similar results were observed for pairs with primary and tertiary education. The results in mother-child pairs remained consistent after controlling for paternal education. Among the father-child pairs, 26.5% had DBM, with fathers with tertiary education significantly more likely to experience simultaneous paternal overnutrition and child undernutrition (OR, 1.55 [95% CI, 1.23-1.95]) compared with pairs with no paternal education; they were also less likely to have both paternal and child undernutrition (OR, 0.70 [95% CI, 0.59-0.84]).

CONCLUSIONS AND RELEVANCE

In this study, maternal education and paternal education were independently associated with DBM, and the associations differed by DBM subtypes. These findings suggest that the different risks of malnutrition faced by households with various levels of education should thus be considered in policy evaluation.

Factors affecting childhood immunization: Thematic analysis of parents and healthcare workers' perceptions

Immunization against common childhood diseases is an important strategy as it is critical for reducing the global child morbidity and mortality. This review explores the perceptions of parents and HCWs toward childhood immunization. The PRISMA guideline was used to search and include the studies. Relevant electronic databases were systemically searched for the years ranging from 2000 to 2021 to identify studies reported in English. Themes were then identified using thematic analysis. A total of 44 studies met the review criteria and were summarized and categorized into 4 themes: barriers to immunization, parental knowledge, attitude and behavior (KAB), health system factors and HCWs' KAB. This review found that immunization decision-making is a complex process. Parental KAB leads to immunization decisions. HCWs were also noted to be the trusted sources of immunization information. Further research can be conducted on how to improve parents' perceptions of immunization and immunization practices.

Childhood immunization and age-appropriate vaccinations in Indonesia

Background

Childhood immunization is a cost-effective way to protect individuals against communicable diseases. However, although there is a large literature on childhood immunization in Indonesia, there is a paucity of research on the age-appropriateness on measles and DTwP-3 vaccination, and the inequities in immunization coverage across Indonesia.

Methods

In this paper, using seven waves of data from the nationally representative Indonesia Demographic and Health Surveys (DHS) covering the period 1991- 2017, we empirically analyse the socio-economic and demographic factors influencing the uptake of four routine vaccines (BCG, Polio-3, DTwP-3, and Measles). Specifically, using multivariate regression analysis, we identify the socio-economic and demographic factors influencing childhood immunization coverage. We further analyse the socio-economic and demographic correlates of the age-appropriateness of the measles and DTwP-3 vaccination coverage.

Results

Our findings show that parental education and use of healthcare services are strong predictors of full immunization and age-appropriate vaccinations. This study also finds evidence of spatial heterogeneity in both full immunization rates and age-appropriate vaccinations for measles and DTwP-3 vaccines.

Conclusions

Our analysis finds that despite an improvement in the timing of vaccinations over the last two decades, a significant proportion of children continue to receive their measles and DTwP vaccinations age inappropriately. In particular, we find that maternal education and maternal engagement with healthcare services are critical in improving age appropriateness of vaccinations. From a policy perspective, these results call for concerted efforts by policy makers to address regional gaps in access to health services and immunization coverage, as well as to improve the age-appropriateness of vaccination.

Determinants of default from full completion of vaccination among children between 12 and 23 months old in Yilmana Densa district, west Gojam zone, Ethiopia, 2019

Background

Vaccination is one of the best cost-effective public health interventions to safeguard children from vaccine-preventable diseases. In Ethiopia, the prevalence of default to the full completion of child immunization is high. However, the determinants of default to full completion have not been thoroughly investigated in this study area. Therefore, this study assessed the determinants of default to the full compilation of vaccination among children between 12 and 23 months old in Yilmana Densa District, west Gojam, northwest Ethiopia.

Methods

A community-based unmatched case-control study design was employed in the Yilmana Densa district among 343 (111 cases and 232 controls) randomly selected 12-23 months old children. Face-to-face interviews were used to collect data using a multistage sampling method. For analysis, data were entered into epidata version 3.1 and exported to SPSS 23 software. Descriptive analysis followed by binary and multivariable logistic regression analysis was conducted. The statistical significance was declared at a p-value of 0.05.

Result

This study identified that mothers who had not attended ANC follow-up [AOR = 5.55, 95% CI: (1.789-17.217)], mothers who had not gotten information about vaccinations [AOR = 8.589, 95% CI: (4.414-16.714)], and mothers whose time taken to reach vaccination site is more than 39 min were at higher risk to default from completion of vaccination [AOR = 3.252, 95% CI: (1.952-5.417)]. Furthermore, maternal waiting time (>45 min) for child vaccination [AOR = 2.674, 95% CI: (1.517-4.714)] and home delivery [AOR 3.19, 95% CI: (1.751-5.814)] were risk factors to default child from full completion of vaccination.

Conclusion

Mothers delivered at home, mothers not attending ANC follow-up, mothers who did not get health information about the vaccine, mothers taking longer time to reach the vaccination site, and staying longer time for child vaccination are causes of default. Motivated institutional delivery services utilization is recommended. The district office should consider the distribution of vaccination sites by the opening of new outreach site to reduce the waiting time of mothers.

Socioeconomic Inequalities and Vaccine Uptake: An Umbrella Review Protocol

The effectiveness of immunization is widely accepted: it can successfully improve health outcomes by reducing the morbidity and mortality associated with vaccine-preventable diseases. In the era of pandemics, there is a pressing need to identify and understand the factors associated with vaccine uptake amongst different socioeconomic groups. The knowledge generated from research in this area can be used to inform effective interventions aimed at increasing uptake. This umbrella systematic review aims to determine whether there is an association between socioeconomic inequalities and rate of vaccine uptake globally. Specifically, the study aims to determine whether an individual's socioeconomic status, level of education, occupation, (un)-employment, or place of residence affects the uptake rate of routine vaccines. The following databases will be searched from 2011 to the present day: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane CENTRAL, Science Citation Index (Web of Science), DARE, SCOPUS (Elsevier), and ASSIA (ProQuest). Systematic reviews will be either included or excluded based on a priori established eligibility criteria. The relevant data will then be extracted, quality appraised, and narratively synthesised. The synthesis will be guided by the theoretical framework developed for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Equity extension (PRISMA-E) guidance will be followed. This protocol has been registered on PROSPERO, ID: CRD42022334223.

Analysis on vaccine hesitation and its associated factors among parents of preschool children in Songgang Street, Shenzhen

China has the largest number of vaccinated population around the world. However, there has been few research on the prevalence and associated factors of vaccine hesitation among parents of preschool children. Therefore, we conducted this study to evaluate the status of vaccine hesitation and its associated factors among children’s parents. A cluster random sampling method was adopted to select six community health service centers in Shenzhen, and parents of preschool children who were immunized in the vaccination outpatient department of the selected community health centers were surveyed using a structured self-administered questionnaire. Vaccine hesitation was assessed by the Parent Attitudes about Childhood Vaccines (PACV) scale. A multiple linear regression analysis was used to assess the associated factors for vaccine hesitance among children's parents. A total of 1025 parents (response rate, 93.18%) filled out the questionnaires. The average score of vaccine hesitancy was 43.37 (SD = 10.34) points. 23.61% of parents wanted children to get all the recommended shots, 53.76% of them did not believe that many of the illnesses shots prevent were severe, and 75.41% of them could not guarantee the information they receive about shots. The results of multiple linear regression showed that the number of children in the family (β = −0.93, 95% CI: −1.31 to 0.54), health status of the child (β = 0.47, 95% CI: 0.07 to 0.87), education level of the parents (Father: β = −0.84, 95%CI: −1.37 to 0.31; Mother: = −1.59, 95%CI:−2.13 to −1.05), and annual family income (β = 1.64, 95%CI: 1.13–2.16) were significantly associated with vaccine hesitation. The average score of parents' vaccine hesitation in Shenzhen was 43.37. The results showed that the number of children in the family, health status of the children, education level of the parents and annual family income were important factors associated with the parents' vaccine hesitation.

Mother’s Media Use and Children’s Vaccination Status in Indonesia: A Community-Based Cross-Sectional Study

Exposing appropriate information to mothers is a key factor for children’s immunization status. This study aims to assess the influence of mothers’ media use on their children’s vaccination status in Indonesia, using the 2017 Indonesia Demographic Health Survey data. A multilevel multinomial logistic regression model was employed. Mothers who used media irregularly and regularly had higher odds of having partially vaccinated children (vs unvaccinated) than mothers who never used media with adjusted odds ratio (aOR): 1.74; 95% Confidence interval (95% CI): 1.06-2.85 and aOR: 1.48; 95% CI: 1.02-2.16, respectively. Furthermore, they had higher odds of having a fully vaccinated child (vs unvaccinated) (aOR: 1.86; 95% CI: 1.12-3.08 for irregular media use and aOR: 2.41; 95% CI: 1.64-3.53 for regular media use vs. no media use). Our findings suggest that mothers’ media use could positively affect their children’s vaccination status by increasing mothers’ knowledge about children’s vaccination.

Role of Information Sources in Vaccination Uptake: Insights From a Cross-Sectional Household Survey in Sierra Leone, 2019

Our findings suggest that health workers and faith leaders are important sources of information to deliver vaccination messages, given their strong association with vaccination confidence and uptake. In this context, vaccination promotion efforts that integrate faith leaders and health workers may help increase vaccination uptake.

Introduction:

There is limited understanding of the potential impact of information sources on vaccination attitudes and behaviors in low-income countries. We examined how exposure to immunization information sources may be associated with vaccination uptake in Sierra Leone.

Methods:

In 2019, a household survey was conducted using multistage cluster sampling to randomly select 621 caregivers of children aged 12–23 months in 4 districts in Sierra Leone. We measured exposure to various sources of immunization information and 2 outcomes: (1) vaccination confidence using an aggregate score (from 12 Likert items, informed by previously validated scale) that was dichotomized into a binary variable; (2) uptake of the third dose of diphtheria-pertussis-tetanus-hepatitis B-Haemophilus influenzae type-b-pentavalent vaccine (penta-3) based on card record or through caregiver recall when card was unavailable. Associations between information sources and the outcomes were examined using modified Poisson regression with robust variance estimator.

Results:

Weighted estimate for penta-3 uptake was 81% (75.2%–85.5%). The likelihood of uptake of penta-3 was significantly greater when caregiver received information from health facilities (adjusted prevalence ratio [aPR]=1.26, 95% confidence interval [CI]=1.1, 1.5), faith leaders (aPR=1.16, 95% CI=1.1, 1.3), and community health workers (aPR=1.13, 95% CI=1.003, 1.3). Exposure to greater number of information sources was associated with high penta-3 uptake (aPR=1.05, 95% CI=1.02, 1.1).

Discussion:

Immunization information received during health facility visits and through engagement with religious leaders may enhance vaccination uptake. Assessments to understand context-specific information dynamics should be prioritized in optimizing immunization outcomes.

Awareness of Vaccination against Respiratory Tract Diseases, Including Pneumonia, Influenza, and COVID-19 in Patients with Diabetes Mellitus

Patients with diabetes have an increased risk of severe acute respiratory infections, and vaccination is their life-saving option. This study aimed to investigate the interest and knowledge of patients about influenza, pneumonia, and COVID-19(coronavirus disease 2019) vaccines. Materials. We handed out a questionnaire to patients with diabetes who were admitted to the endocrinology clinic between April and August 2021. The questionnaire collected information on demographic data, knowledge about respiratory tract disease vaccines, and hesitancy about vaccines. Results. Four hundred twenty-four patients (female = 256, male = 168) enrolled in the study. In this study, 148 (34.9%) participants were vaccinated against pneumonia, 155 (36.6%) against flu, and 312 (73.6%) against COVID-19. In addition, antivaccination sentiment was recorded in 8.7% of patients with diabetes. We found that participants in the study primarily rely on doctors as the source of information about vaccines (doctor (46.7%), nurse (1.2%), television (8.7%), friend/neighbour (8.7%), and others (2.6%)). The rate of vaccination was statistically higher than the presence of comorbid diseases. Conclusions. We examined the vaccine awareness of patients with diabetes and investigated factors affecting it. İt was determined that vaccination awareness is affected by many factors, especially comorbid diseases and educational status. The study showed that patients primarily relied on doctors as their source of information for vaccination. Doctor-centered vaccination promotion programmes can increase the rate of vaccination.

Impact of the first phase of COVID-19 pandemic on childhood routine immunisation services in Nepal: a qualitative study on the perspectives of service providers and users

Background

The COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services in Nepal during the COVID-19 pandemic.

Methods

Semi-structured qualitative interviews were conducted with childhood immunisation service providers and users (i.e., parents of children) from Kathmandu valley, Nepal. All interviews were conducted through phone or internet-based tools, such as Zoom, WhatsApp, and messenger. All interviews were audio-recorded, transcribed verbatim, and analysed using theme-based content analysis in an Excel spreadsheet.

Results

A total of 15 participants (n = 7 service providers and n = 8 service users) participated. Six themes were identified, namely: (1) impact of COVID-19 and lockdown on childhood immunisation services; (2) motivation and resilience for childhood immunisation; (3) Biosafety practices and Personal Protective Equipment (PPE) availability during the COVID-19 pandemic; (4) service adjustments and guidelines during pandemic; (5) availability of vaccines; and (6) immunisation program resilience in view of COVID-19. Service providers mentioned facing disruptions in services and some parents had decided to delay scheduled immunisation. However, most service providers showed determinations to deliver the services with high morale, while most service users reported taking their children for immunisation. Families migrating from urban to rural areas during the pandemic led to service providers having no means to confirm complete immunisation of migrating children. Service providers also experienced lack of adequate guidance to deal with the pandemic and personal protective equipment to protect themselves and service users.

Conclusion

Despite experiencing disruptions in childhood immunisation service due to the COVID-19 pandemic, service users and providers were determined to vaccinate the children. There is an urgent need for effective preparedness plans to be in place to address the observed barriers and to ensure resilient immunisation services during ongoing and future pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-021-00366-z.

Disparities in infant mortality from all-infectious, vaccine-preventable, and non-vaccine preventable diseases in relation to parental education

BACKGROUND

The burden of infectious diseases in infants is substantial. Parental education has been considered as a critical factor for predicting infant mortality. However, even though some studies have been done about relationship between infectious disease and parent's education level, no researches have been conducted specifically about vaccine-preventable and non-vaccine-preventable disease mortality by parent's educational level.

PURPOSE

This study aimed to compare infant mortality rates from all-infectious diseases, vaccine-preventable and non-vaccine-preventable diseases by mother's and father's education levels.

METHODS

We used 2017 US Linked Birth and Infant Death Data from National Center for Health Statistics, which included 3,153,574 live births and 13,870 deaths. To identify the association between each mother's and father's education level and all-infectious disease, vaccine-preventable disease, and non-vaccine-preventable disease infant mortality, logistic regression analyses were conducted by using educational level 1 as the reference. All-infectious diseases, vaccine-preventable and non-vaccine-preventable diseases were identified by vaccination recommendation of 2017 CDC guideline. Education levels were classified into four groups: level 1, through 12th grade with no diploma; Level 2, high school graduate or GED completed; Level 3, some college credit but no degree or associate degree; and Level 4, bachelor's degree, master's degree, doctorate or professional degree.

RESULTS

Higher parents' education level was appreciably associated with lower infant mortality from all-cause, all-infectious diseases, vaccine-preventable diseases, and non-vaccine-preventable diseases. Moreover, each mother's and father's education level was correlated to infant mortality due to vaccine-preventable diseases on the whole education level, while all-infectious disease and non-vaccine-preventable disease mortality is related with parent's education level only if their education level is fairly high. In other words, the adjusted odds for vaccine-preventable disease mortality were significantly lower than that for all-infectious and non-vaccine-preventable disease mortality at education level 2 and 3 and still smaller at education level 4.

CONCLUSION

These finding implies that each mother's and father's higher education level was associated with lower infant mortality rate from all-infectious diseases, vaccine-preventable diseases, and non-vaccine-preventable diseases. Furthermore, each level of mother's and father's education was more likely to be related to infant mortality by vaccine-preventable diseases than that of infant mortality by all-infectious diseases, and non-vaccine-preventable diseases.

Deworming Coverage and its Predictors among Ethiopian Children Aged 24 to 59 Months: Further Analysis of EDHS 2016 Data Set

Intestinal parasitic infections are the major public health problem globally, mostly in developing countries. World Health Organization recommends deworming to all at-risk people living in endemic areas as a prevention or intervention strategy. Therefore this study aimed to assess the deworming coverage and its predictors among Ethiopian children aged 24-59 months. The study analyzed retrospectively cross-sectional data on a weighted sample of 5,948 children aged 24-59 months nested within 645 clusters after extracting from the Ethiopian Demographic health survey. Bivariable and multivariable logistic regression was employed to assess the association of variables. Predictors at p-value < 0.25 were entered into the multivariable logistic regression model, and statistical significance was declared at P-value < 0.05. In this study, the prevalence of maternal reported deworming supplements among children aged 24-59 months was 15.1%. Predictive variables significantly associated with deworming supplementation include maternal media exposure, maternal control of household healthcare decisions, institutional healthcare delivery, and child vitamin-A supplementation. Having history of a diarrheal disease, maternal and paternal education, and family size were also statistically significant predictors of deworming supplements. Therefore, deworming supplementation among children is low. Maternal education and employment, paternal education, family size, decision-making process, maternal media exposure, place of delivery, vitamin-A supplementation, and a having history of diarrhea were predictors of deworming supplements. Multifaceted interventions aimed at those predictors should be given emphasis.

Age-appropriate vaccination practice and associated factors among mothers of children aged less than one year in the pastoral community of Afar region, Ethiopia

Achieving and maintaining high-level immunization coverage is the priority of the health-care delivery system. However, any delay in receiving the vaccine leaves youngsters inadequately protected. Timely vaccination has scarcely been reported and given little attention in developing nations like Ethiopia, which hinders effective interventions. Therefore, this study aimed to assess age-appropriate vaccination practice and associated factors among mothers of children aged less than one year in the pastoral community. A community-based cross-sectional study has conducted among 340 mothers/caregivers of children aged less than one year in Samara-logia city administration. A systematic random sampling technique was employed to identify and enroll mothers-child paired. The logistic regression analysis had done to identify the factors associated with age-appropriate vaccination practice. The statistical association had measured, and a p-value < 0.05 was considered statistically significant. In this study, a total of 331 mothers/caregivers-child pairs participated with a response rate of 97.3%. The age-appropriate vaccination practice was 43.7% (95% CI, 38%, 49.5%). Mothers who had higher educational level (Adjusted odds ratio (AOR)) = AOR = 2.89, 95% CI (1.14, 7.3), antenatal care follow-up (AOR = 2.1, 95% CI (1.04, 4.1)), and had good knowledge on vaccination (AOR = 3.1, 95% CI (1.4, 6.78)) were associated with increased odds of age-appropriate vaccination practice.

Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal

Background

Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal.

Methods

The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model.

Results

A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant (P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55).

Conclusion

Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.

Mothers' Opinions on Vaccinations and Penal Responsibility for Vaccination Avoidance in Nine Selected European Countries: Findings from a Cross-Sectional Survey

Aim

Relations between penal responsibility and vaccination obligation can be essential for raising the vaccination rate. Social media play a vital role in distributing information. The attitude towards vaccination consists of many factors, including the criminal law situation in the field of vaccination in a given country. The aim of the study was to assess the impact of criminal law liability and other social factors such as age and education on mothers’ desire to vaccinate their children.

Methods

Survey target: mothers from nine European countries (Poland, Germany, Slovakia, France, Norway, Serbia, Romania, Greece, Italy). Response count: 2205. Questionnaire content: adjusted to country-specific legal regulations concerning vaccinations - considering whether vaccines are mandatory, recommended, additional, and how to cover costs. The way of dissemination of the questionnaire: general parental groups on Facebook.

Results

The respondents: Poles (30%), Italians, Germans, Slovaks, Greeks (10% each), Norwegians, Frenchwomen, Romanians, Serbians (5% each). The average respondent age: highest: Norway (38.14±10.08) and Italy (37.35±8.12), lowest: Slovakia (30.22±6.19). Respondents with higher, secondary, vocational, primary education represent 58%, 27%, 12%, 3%, respectively, of the group. Countries with above 90% rate of answers that they vaccinate their children: Greece, Norway, Slovakia, France. The lowest rate (55%) recorded for Romania. Sixty-seven percent aware of the existence of anti-vaccination movements. High rates were recorded for Norway (88%), Romania (82%), Poland (78%), Serbia (71%), Greece (67%), Germany (66%). The lowest rate for France (31%). Countries without vaccination at all (Germany, Norway, Romania, Greece), the rest of the countries mentioned above – have some mandatory, recommended and additional vaccinations.

Conclusion

In countries with mandatory vaccinations parents have their children vaccinated less willingly than in countries with voluntary vaccinations. The rising level of education and providing information about complications following infectious diseases appear to increase the vaccination rate.

Factors associated with measles vaccination status in children under the age of three years in a post-soviet context: a cross-sectional study using the DHS VII in Armenia

BACKGROUND

The resurgence of measles globally and the increasing number of unvaccinated clusters call for studies exploring factors that influence measles vaccination uptake. Armenia is a middle-income post-Soviet country with an officially high vaccination coverage. However, concerns about vaccine safety are common. The purpose of this study was to measure the prevalence of measles vaccination coverage in children under three years of age and to identify factors that are associated with measles vaccination in Armenia by using nationally representative data.

METHODS

Cross-sectional analysis using self-report data from the most recent Armenian Demographic Health Survey (ADHS VII 2015/16) was conducted. Among 588 eligible women with a last-born child aged 12-35 months, 63 women were excluded due to unknown status of measles vaccination, resulting in 525 women included in the final analyses. We used logistic regression models in order to identify factors associated with vaccination status in the final sample. Complex sample analyses were used to account for the study design.

RESULTS

In the studied population 79.6% of the children were vaccinated against measles. After adjusting for potential confounders, regression models showed that the increasing age of the child (AOR 1.07, 95% CI: 1.03-1.12), secondary education of the mothers (AOR 3.38, 95% CI: 1.17-9.76) and attendance at postnatal check-up within two months after birth (AOR 2.71, 95% CI: 1.17-6.30) were significantly associated with the vaccination status of the child.

CONCLUSIONS

The measles vaccination coverage among the children was lower than the recommended percentage. The study confirmed the importance of maternal education and attending postnatal care visits. However, the study also showed that there might be potential risks for future measles outbreaks because of delayed vaccinations and a large group of children with an unknown vaccination status.

Understanding inequalities in child immunization in India: a decomposition approach

The importance of childhood immunization for healthy child growth and development is well recognized and is considered to be the best and most cost-effective lifesaver. Low socioeconomic status has been shown to be associated with low child immunization and health care utilization, but the inequalities in immunization coverage due to social and economic factors are poorly understood. This study aimed to explore the association between child immunization coverage and various socioeconomic factors and to quantify their contributions to generating inequalities in immunization coverage in India. The study data are from the National Family Health Survey-4 conducted in 2015-16. The association between socioeconomic determinants and child full immunization coverage was estimated using the χ2 test and binary logistic regression. Concentration indices were estimated to measure the magnitude of inequality, and these were further decomposed to explain the contribution of different socioeconomic factors to the total disparity in full immunization coverage. The results showed that the uptake of immunization in 2015-16 was highly associated with mother's educational status and household wealth. The concentration index decomposition revealed that inequality (immunization disadvantage) was highest among poorer economic groups and among children whose mothers were illiterate. The overall concentration index value indicates that the weaker socioeconomic groups in India are more disadvantaged in terms of immunization interventions. The results offer insight into the dynamics of the variation in immunization coverage in India and help identify vulnerable populations that should be targeted to decrease socioeconomic inequalities in the country.

Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006-2018

BACKGROUND

Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases.

METHODS

We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines.

RESULTS

Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned.

CONCLUSION

Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.

Breaking Barriers to Healthcare Access: A Multilevel Analysis of Individual- and Community-Level Factors Affecting Women's Access to Healthcare Services in Benin

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its associated factors. Methods: We utilized data from the 2017–2018 Benin Demographic and Health Survey (n = 15,928). We examined the associations between the demographic and socioeconomic characteristics of women using multilevel logistic regression. The outcome variable for the study was problem of access to healthcare service. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were estimated. Results: Overall, 60.4% of surveyed women had problems in accessing healthcare services. Partner’s education (AOR = 0.70; 95% CI; 0.55–0.89), economic status (AOR = 0.59; 95% CI; 0.47–0.73), marital status (AOR = 0.44; 95% CI; 0.39–0.51), and parity (AOR = 1.85; 95% CI; 1.45–2.35) were significant individual-level factors associated with problem of access to healthcare. Region (AOR = 5.24; 95% CI; 3.18–8.64) and community literacy level (AOR = 0.69; 95% CI; 0.51–0.94) were the main community-level risk factors. Conclusions: Enhancing husband education through adult education programs, economic empowerment of women, enhancing national education coverage, and providing priority for unmarried and multipara women need to be considered. Additionally, there is the need to ensure equity-based access to healthcare services across regions.

Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review

OBJECTIVE

To characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status.

DESIGN

Scoping review.

DATA SOURCES

Electronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018.

STUDY SELECTION

All English studies with vaccination status as the outcome and the use of DHS data.

DATA EXTRACTION

Studies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted.

RESULTS

A total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1-86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO's Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child's sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition.

CONCLUSIONS

Researchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.

Complete basic childhood vaccination and associated factors among children aged 12-23 months in East Africa: a multilevel analysis of recent demographic and health surveys

Background

Complete childhood vaccination remains poor in Sub-Saharan Africa, despite major improvement in childhood vaccination coverage worldwide. Globally, an estimated 2.5 million children die annually from vaccine-preventable diseases. While studies are being conducted in different East African countries, there is limited evidence of complete basic childhood vaccinations and associated factors in East Africa among children aged 12–23 months. Therefore, this study aimed to investigate complete basic childhood vaccinations and associated factors among children aged 12–23 months in East Africa.

Methods

Based on the Demographic and Health Surveys (DHSs) of 12 East African countries (Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Mozambique, Madagascar, Zimbabwe, Kenya, Zambia, and Malawi), secondary data analysis was performed. The study included a total weighted sample of 18,811 children aged 12–23 months. The basic childhood vaccination coverage was presented using a bar graph. Multilevel binary logistic regression analysis was fitted for identifying significantly associated factors because the DHS has a hierarchical nature. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (−2LLR) were used for checking model fitness, and for model comparison. Variable with p-value ≤0.2 in the bi-variable multilevel analysis were considered for the multivariable analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the significance and strength of association with full vaccination.

Results

Complete basic childhood vaccination in East Africa was 69.21% (95% CI, 69.20, 69.21%). In the multivariable multilevel analysis; Mothers aged 25–34 years (AOR = 1.21, 95% CI: 1.10, 1.32), mothers aged 35 years and above (AOR = 1.50, 95% CI: 1.31, 1.71), maternal primary education (AOR = 1.26, 95% CI: 1.15, 1.38), maternal secondary education and above (AOR = 1.54, 95% CI: 1.36, 1.75), husband primary education (AOR = 1.25, 95% CI: 1.13, 1.39), husband secondary education and above (AOR = 1.24, 95% CI: 1.11, 1.40), media exposure (AOR = 1.23, 95% CI: 1.13, 1.33), birth interval of 24–48 months (AOR = 1.28, 95% CI: 1.15, 1.42), birth interval greater than 48 months (AOR = 1.35, 95% CI: 1.21, 1.50), having 1–3 ANC visit (AOR = 3.24, 95% CI: 2.78, 3.77), four and above ANC visit (AOR = 3.68, 95% CI: 3.17, 4.28), PNC visit (AOR = 1.34, 95% CI: 1.23, 1.47), health facility delivery (AOR = 1.48, 95% CI: 1.35, 1.62), large size at birth 1.09 (AOR = 1.09, 95% CI: 1.01, 1.19), being 4–6 births (AOR = 0.83, 95% CI: 0.75, 0.91), being above the sixth birth (AOR = 0.60, 95% CI: 0.52, 0.70), middle wealth index (AOR = 1.16, 95% CI: 1.06, 1.28), rich wealth index (AOR = 1.20, 95% CI: 1.09, 1.33), community poverty (AOR = 1.21, 95% CI: 1.11, 1.32) and country were significantly associated with complete childhood vaccination.

Conclusions

In East Africa, full basic childhood vaccine coverage remains a major public health concern with substantial differences across countries. Complete basic childhood vaccination was significantly associated with maternal age, maternal education, husband education, media exposure, preceding birth interval, number of ANC visits, PNC visits, place of delivery, child-size at birth, parity, wealth index, country, and community poverty. Public health interventions should therefore target children born to uneducated mothers and fathers, poor families, and those who have not used maternal health services to enhance full childhood vaccination to reduce the incidence of child mortality from vaccine-preventable diseases.

Impact of the COVID-19 Pandemic on Routine Childhood Immunization in Saudi Arabia

The COVID-19 pandemic is impacting national and international public health. Routine childhood immunization may be adversely affected by COVID-19 mitigation measures. We aimed to identify the prevalence of delayed immunization and explore the reasons and barriers for delayed immunization during the COVID-19 pandemic in the Qassim region, Saudi Arabia. We conducted a cross-sectional study using an online self-administered questionnaire for parents of children under two years of age during the period from 1 May to 30 June 2020. Most of the 749 participants (82.6%) were mothers, with 31 to 40 years being the most common age group (49.8%). Nearly three-quarters (73.2%) of the parents had appointments scheduled for their child’s vaccination during the pandemic, and approximately 23.4% of the parents reported a delay of more than one month in the immunization of their child. The most common reason for the delay was the fear of being infected by COVID-19 (60.9%). Large household size and lack of insurance were risk factors for immunization delay. The COVID-19 pandemic has affected the timeliness of routine childhood immunization in Saudi Arabia. Childhood immunization should be prioritized, as well as the implementation of focused strategies to achieve significant and sustainable vaccination rates during pandemics.

Socio-demographic correlates of first dose of measles (MCV1) vaccination coverage in India

Background

Between 2010 and 2018, measles-related mortality had halved in India mainly with effective measles vaccination campaigns and widespread coverage across the states and population subgroups. Despite the commendable vaccination coverage, 2.9 million children in India missed the first dose of measles vaccine (MCV1) in 2017, and many of those vaccinated were not vaccinated at the recommended age (i.e. between 9 and 12 months). This study analyzed pattern and correlates of MCV1 coverage and MCV1 administration at recommended age among children aged 12–23 months in India.

Methods

We used the official data from the recent round of National Family Health Survey (NFHS-4), a nationally representative cross-sectional household survey in India conducted in 2015–16. Descriptive statistics and logistic regression analysis were applied to ascertain the influence of specified socio-demographic variables affecting measles vaccination coverage in India.

Results

The study revealed the distinct variations in coverage of MCV1 between the districts of India. There were also major challenges with age recommended vaccination, with about 15% of eligible children not vaccinated within the recommended age range, attributable to several socio-demographic factors. Significantly, antenatal care utilization of mothers strongly influenced MCV1 coverage and age recommended MCV1 coverage in India. The study also identified that children who missed MCV1 had one or more adverse health risks such as malnutrition, anemia and diarrhea disease.

Conclusions

A socio-economic gradient exists in India’s MCV1 coverage, mediated by antenatal visits, education of mothers, and highlighted socio-demographic factors. Infection with measles was significantly correlated with greater anthropometric deficits among the study cohort, indicating a wider range of benefits from preventing measles infection. Eliminating morbidity and mortality from measles in India is feasible, although it will require efficient expanded program on immunization management, enhanced health literacy among mothers, continuing commitment from central state and district political authorities.

Influence of parental education on child mortality in Bangladesh: repeated cross-sectional surveys

Reducing the mortality of children under-5 (U5) is an essential part of the Sustainable Development Goal (SDG). Although Bangladesh has made progress in reducing child mortality, there remain inequalities among different sociodemographic groups. Education is one particular key factor with a multidimensional impact on child health and survival. This study assessed the association between parental education and U5 mortality using repeated cross-sectional Bangladesh Demographic and Health Survey data. The risk of child death was substantially low among educated parents. Children of secondary or higher educated mother and father were about 30% (hazard ratio [HR] = 0.697, 95% confidence interval [CI] 0.596 to 0.815, p< .001) and 26% (HR = 0.738, 95% CI 0.635 to 0.858, p < .001), respectively, less likely to die early. Children from wealthier households and born to mothers with long birth spacings were less likely to face an early death. The study findings emphasize on imparting education to parents as an intervention strategy to continue the reduction of child mortality rate in Bangladesh, which could be a policy direction toward achieving the SDGs.

Community perspectives: An exploration of potential barriers to men's involvement in maternity care in a central Tanzanian community

Background

Male involvement in maternal health has been linked to positive health outcomes for women and children, as they control household resources and make significant decisions, which influence maternal health. Despite of the important role they have in maternal health care, their actual involvement remains low. The objective of this study was to explore community perspectives on potential barriers to men’s involvement in maternity care in central Tanzania.

Methods

Qualitative research methods were used in data collection. We conducted 32 focus group discussions (16 FGDs with men and 16 FGDs with women) and 34 in-depth interviews with community leaders, village health workers and health care providers. Interview guides were used to guide the focus group discussions and in-depth interviews. The interviews and discussions were audio recorded, transcribed and translated into English and imported into QSR NVivo 9 software for thematic analysis. Three themes emerged from the data; men’s maternity care involvement indicators, benefits of men’s involvement in maternity health care services and barriers to men’s involvement in maternity health care services.

Results

Both men and women participants acknowledged the importance of men’s involvement in maternity health care services, even though few men actually got involved. Identified benefits of men’s involvement in maternity health care services include: Learning any risk factors directly from the health care providers and getting prepared in addressing them; and reinforcing adherence to instruction received from the health care provider as family protectors and guardians. Barriers to men’s involvement in maternity health care services are systemic; starting from the family, health care and culture-specific gender norms for maternity related behaviour as well as healthcare facilities structural constrains inhibiting implementation of couple-friendly maternity health care services.

Conclusions

Men’s involvement in maternity care is influenced by culture-specific maternity-related gender norms. This situation is compounded by the conditions of deprivation that deny women access to resources with which they could find alternative support during pregnancy. Moreover, structures meant for maternal health care services lack privacy, thus inhibiting male partners’ presence in the delivery room. Intervention to increase men’s involvement in maternity care should address individual and systemic barriers to men’s involvement.

Willingness-to-pay for a hypothetical Ebola vaccine in Indonesia: A cross-sectional study in Aceh

Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia.

Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients’ family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP.

Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP.

Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.

Willingness-to-pay for a hypothetical Ebola vaccine in Indonesia: A cross-sectional study in Aceh

Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients' family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.

Willingness-to-pay for a hypothetical Ebola vaccine in Indonesia: A cross-sectional study in Aceh

Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients' family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.

Rubella Vaccination Coverage Among Women of Childbearing Age in Vietnam

Despite the availability of effective and safe rubella vaccines for women of childbearing age, prevention and control of congenital rubella syndrome in children remains challenging in Vietnam. In order to examine this issue, we conducted a cross-sectional study, examining the current coverage of rubella vaccination before pregnancy among 807 pregnant women and women with children under 12 months of age in urban and rural districts, Dong Da and Ba Vi, in Hanoi, Vietnam. In this population, we observed an alarming non-compliance rate with rubella vaccination before pregnancy in both localities. Among the 82.0% of participants who remained unvaccinated against this contagious viral infection, 95.8% of them were in Ba Vi district, compared to 68.0% in Dong Da district (p < 0.001). Besides the differences in age, number of children, education levels, primary occupations and monthly incomes among the participants between the two districts, other reasons for noncompliance with rubella vaccination includeddisinterest in rubella vaccination, the high cost and long distance to vaccination sites as well as unawareness of vaccination locations. In addition to addressing the unique socio-economicchallenges behind one’s accessibility to vaccination services in urban and rural areas, our study supports a continued effort in ensuring proper access to and education about pre-pregnancy vaccines and vaccination among women of childbearing age in order to achieve and sustain sufficient immunization coverage of rubella and other vaccine-preventable diseases in both settings.

Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon

Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016. Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan-Meier curves and logistic regression to identify the predictors of age-appropriate immunization. Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination. Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon.

Mandatory and recommended vaccinations in Poland in the views of parents

Background: Vaccinations are currently the key element in the prevention of the spread of infectious diseases. We studied parents' opinions about mandatory and recommended preventive vaccinations in Poland. Methods: A diagnostic survey using an original questionnaire was done in a group of 300 parents. Results: A total of 3.7% of parents did not vaccinate their children. 90% were aware of the threat potentially posed by infectious diseases, and 73.7% knew that breastfeeding alone does not ensure sufficient protection against them. 28% believed that it is necessary to vaccinate a child against all diseases, 51.7% that the number of vaccinations is insufficient, and 62.7% that vaccine use is safe. 40.7% thought that unvaccinated children should not be able to attend nurseries and kindergartens, as they pose a threat to other children. Postvaccinal adverse events occurred in 21.3% of children, mainly (71.9%) an increase in body temperature above 38°C. 88.3% were informed about possible vaccine-induced complications, most often by nurses (79.7%). 88% of the respondents were aware of the possibility to switch to an alternative immunization program, 92% were informed on the possible administration of recommended vaccines, and 53% took advantage of combined vaccines. Conclusions: Views on vaccinations were mostly varied, depending on the age, sex, education, and financial situation of the respondents. Most of the parents who did not vaccinate their children believed that immunity can be acquired by infection. They were in favor of a limited number of vaccinations, were more critical of the vaccination program in Poland, considered the vaccines used in Poland to be unsafe, and blamed vaccines for multiple developmental defects and autism in children. Parents whose children experienced vaccine-induced adverse reactions were more likely to have doubts before the next vaccination.

An Overview of Coverage of BCG Vaccination and Its Determinants Based on Data from the Coverage Survey in Zhejiang Province

To assess the Bacille Calmette-Guérin (BCG) vaccination coverage in Zhejiang province and to investigate predictors of the BCG vaccination, we used data from the 2017 Zhejiang provincial coverage survey. Demographic and immunization data on the selected children, their mothers, and their families were also collected by using a pre-tested questionnaire. BCG scars were verified among children who were available at the moment of survey. Coverage of BCG and other expanded program on immunization (EPI) vaccines scheduled before the first year of life was calculated. BCG coverage through the scar assessment and timeliness of BCG were also presented. Multivariate analyses of the predictors associated with the BCG vaccination and its timeliness were conducted separately. In total, 1393 children agreed to participate in the survey and presented the immunization cards. Of them, the coverage of BCG was 92.0% and 88.3% received the BCG within the first 28 days after birth. Besides this, 1282 out of the 1393 children were screened for the BCG scars and 97.1% of them had developed the scars. The multivariable logistic regression analyses indicated that hospital delivery, higher maternal education, a mother with no job, and a resident child were positively associated with the higher BCG vaccination coverage and its timely administrations. BCG coverage was optimal and it was administered in a timely manner. The majority of children vaccinated with BCG developed scars. Tailored interventions should be more greatly focused on and targeted to children with the risk factors identified in this study.

Sociodemographic predictors are associated with compliance to a vaccination-reminder in 9692 girls age 14, Denmark 2014-2015

We aimed to identify sociodemographic predictors of compliance after receiving a personalised reminder on lacking vaccinations against MMR (Measles, Mumps, Rubella) and/or HPV (Human Papilloma Virus) among parents of Danish adolescent girls. A nationwide register-based study, including all 14-year-old girls (15 May 2014-14 May 2015) lacking either MMR, HPV-vaccination or both. Vaccination-compliance following a postal reminder was modelled using multivariable logistic regression and included the following socio-demographic predictors: maternal age, education, employment and ethnicity. Birth order, number of siblings, family-structure, location of residence, and household income. The parents of 9692 girls received a reminder. Out of 4940 exclusively lacking an HPV-vaccine, 15.3% were subsequently vaccinated. Among 2026 only lacking an MMR vaccination, 8.5% were vaccinated. Among 2726 girls lacking both, 5% received an HPV, 4.4% an MMR and 5.4% received both vaccinations. We identified sociodemographic differences between reminderletter-compliers and non-compliers, also according to vaccination types. Non-western descendants were more likely to receive HPV-vaccination, although the association was only significant for those who only lacked HPV (OR 2.02, 95% 1.57-2.59). For girls only lacking an MMR, regional differences were identified. Among girls lacking both vaccines, girls of mothers with intermediate (OR 0.63, 0.42-0.95) or basic education (OR 0.43, 0.24-0.75) were less likely to be vaccinated compared to girls of higher educated mothers. Reminders were in particular effective in increasing HPV uptake among immigrants of non-Western ethnicity. We found reminders to be less effective among less educated mothers whose daughters lacked both vaccines. To increase the coverage in this group, additional interventions are needed.

Factors Associated with Undernutrition in Children under the Age of Two Years: Secondary Data Analysis Based on the Pakistan Demographic and Health Survey 2012⁻2013

In Pakistan, 96% of the children under the age of two years do not receive an adequate diet. The main aim of this paper is to identify the sociodemographic, nutritional, and health-related factors associated with stunting, wasting, and underweight in children under the age of two years in Pakistan. Secondary data analysis was performed based on the Pakistan Demographic and Health Survey, 2012⁻2013. The analysis was limited to children under the age of two years (n = 984). Analysis was done using bivariate and multivariable binary logistic regression. The incidence of stunting, wasting, and underweight in children was 28.3%, 12.1%, and 27.9%, respectively. The odds of stunting, wasting, and underweight increased with the child's age. The odds of stunting and underweight increased with the mother's low body mass index, low access to information, high birth order of child, consanguineous marriages, father's low education, rural settlement, poor toilet facilities, and low vitamin A consumption. The odds of wasting increased in children who were not being breastfed, but no significant relation was seen with stunting and underweight. There is a need to improve child nutritional status in Pakistan by addressing issues such as poverty, low parental education, low micronutrient intake, and targeting provinces where undernutrition was found to be higher.

The role of parental education in child disability in China from 1987 to 2006

This paper aimed to investigate the role of parental education in child disability in China. We used nationally representative data from China’s National Sample Survey on Disability, iterated twice, in 1987 and 2006, with data of 764,718 children aged 0–14 years. Logit models were used for statistical analysis. Results showed that the prevalence of child disability was significantly associated with each parent’s education. Maternal education was more important than paternal education in child disability in both surveys. The analysis of marginal effect indicated a one-year increase in maternal and paternal schooling led to an average decrease of 0.121% and 0.091% in the probability of child disability in 1987, and 19 years later, these figures had dwindled to 0.091% and 0.072%, respectively.

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.

Determination of factors affecting the vaccination status of children aged 12-35 months in Lao People's Democratic Republic

Vaccines are one of the most important achievements in public health, and a major contributor to this success is the Expanded Programme on Immunization. The utilisation of vaccination services and completion of the recommended schedule are determined by numerous factors. In Lao People’s Democratic Republic (Lao PDR), the overall immunisation coverage has been improving. However, notwithstanding the improvement in immunisation coverage and the supplementary immunisation activities, there have been measles, diphtheria, and polio outbreaks in the country. The recent multicounty study of household health surveys revealed that the within-country economic-related inequality in the delivery of a vaccine was still high in Lao PDR.

Our previous work evaluated the factors associated with vaccination status among the children aged 5–9 years old, which was older age group for this type of study. This study evaluated factors that affect vaccination status among children aged between 12 and 35 months. It is a nationwide population-based cross-sectional study that used data obtained through multistage cluster sampling. We found that the proportion of infants who were fully immunised was lower than the national target and that “maternal ethnicity” (odds ratio (OR) 0.34, 95% confidence interval [CI]: 0.20–0.60), “paternal education” (OR 1.87, 95% CI: 1.12–3.10), and “source of information about vaccination date by medical staff” (OR 1.65, 95% CI: 1.01–2.71) were significantly associated with the children’s vaccination status. Numerous factors are associated with the completion of the recommended vaccine schedule, and some factors are location-specific. Identification of these factors should lead to actions for facilitating the optimal use of vaccination services by all the children in Lao PDR.

Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India

BACKGROUND

Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette-Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3.

METHODS

We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007-08).

RESULTS

Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres.

CONCLUSIONS

Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals' background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.

Effective role of lady health workers in immunization of children in Pakistan

Objective:

To determine the association of Lady Health Worker’s role with immunization of children in Pakistan.

Methods:

Secondary analysis was conducted on data obtained from Pakistan’s Demographic and Health Survey. Children who did not receive all doses of vaccines were considered incompletely immunized or vice versa. The association between determinants was assessed by simple and multivariable binary logistic regression.

Results:

The mothers and fathers had a mean age of 32.7 (SD+8.6) years and 37.9 (SD +10.1) years, respectively. Age of mother greater than 35 (OR=0.93; 95% CI:0.70-1.25); born in Baluchistan (OR=3.47,95% CI:2.21-5.49); rural area dwellers (OR=2.04; 95% CI:1.65-2.51); female gender (OR=1.06; 95% CI:0.87-1.29); birth order (of last born child) greater than 7 (OR=2.21, 95% CI:1.60-3.06); delivered at home (OR=2.20, 95% CI:1.76-2.74); long distance to health care facility (OR=2.66, 95% CI:2.16-3.28); and no LHW visit in last 12 months (OR=1.91, CI:1.48-2.47) were significantly associated with incomplete immunization in bivariate analysis. In final model of multinomial regression analysis the absence of visit by LHW in last 12 months was the most significant factor when all risk factors were analyzed in last model

Conclusions:

This study has concluded that visit of LHW in last 12 months was significantly associated with immunization.

Risk stratification model to detect early pulmonary disease in infants with cystic fibrosis diagnosed by newborn screening

OBJECTIVE

The clinical benefit of newborn screening (NBS) for cystic fibrosis (CF) has been primarily nutritional, with less overt respiratory impact. Identification of risk factors for infant CF lung disease could facilitate targeted interventions to improve pulmonary outcomes.

METHODS

This retrospective study evaluated socioeconomic information, clinical data, and results from routine infant pulmonary function testing (iPFT) of infants diagnosed with CF through NBS (N = 43) at a single CF center over a 4-year period (2008-2012). A five-item composite clinical score was developed and combined with socioeconomic indicators to facilitate identification of CF infants at increased risk of early-onset respiratory impairment.

RESULTS

Paternal education was positively associated with lung function (P = 0.02). Clinical score <7 (on a scale of 0-10) predicted diminished pulmonary measure (P < 0.005). Retrospective risk stratification by clinical score and paternal education identified CF infants at low, intermediate, or high risk of pulmonary disease. Forced expiratory volume (FEV_0.5 %, mean ± SD) averaged 115 ± 19% in the low-risk group, 97 ± 17% in the intermediate-risk group, and 90 ± 8% in the high-risk group (P < 0.005). Results were similar for mid-expiratory flows (FEF_25-75 %). Multiple regression analysis confirmed the predictive value of this risk stratification model of CF infant pulmonary health.

CONCLUSION

We combined socioeconomic and clinical data to risk-stratify CF infants for early-onset lung disease as quantified by iPFT. Our model showed significant differences in infant pulmonary function across risk groups. The developed tool offers an easily available, inexpensive, and non-invasive way to assess risk of respiratory decline in CF infants and identify those meriting targeted therapeutic attention. Pediatr Pulmonol. 2016;51:1168-1176. © 2016 Wiley Periodicals, Inc.

Modifiable determinants of attitude towards dengue vaccination among healthy inhabitants of Aceh, Indonesia: Findings from a community-based survey

OBJECTIVE

To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh (northern Sumatra Island, Indonesia), the region that was most severely affected by the earthquake and tsunami of 26 December 2004.

METHODS

A community-based, cross-sectional study was conducted among 535 healthy inhabitants in nine regencies (Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015. A set of validated, pre-tested, structured questionnaires was used to guide the interviews. The questionnaires covered a range of explanatory variables and one outcome variable (attitude to dengue vaccination). Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.

RESULTS

More than 70% of the participants had a poor attitude towards dengue vaccination. Modifiable determinants associated with poor attitude to dengue vaccination were low education level, working as farmers and traditional market traders, low socioeconomic status and poor knowledge, attitude and practice regarding dengue fever (P < 0.05). The KAP domain scores were correlated strongly with attitude to dengue vaccination, rs = 0.25, rs = 0.67 and rs = 0.20, respectively (P < 0.001). Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever (P < 0.001).

CONCLUSIONS

This study reveals that low KAP regarding dengue fever, low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination. Therefore, inhabitants of suburbs who are working as farmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.