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DAMIEN BG, VL AVON OU W, DAHOUN M, KAUCLEY L, AGUEMON B. [Coverage, mapping and barriers to complete vaccination for age among children under 5 years in 2021: case of Adjara-Hounvè and Ahouicodji villages in southern Benin]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.352. [PMID: 38846123 PMCID: PMC11151914 DOI: 10.48327/mtsi.v4i1.2024.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/22/2024] [Indexed: 06/09/2024]
Abstract
Background Vaccination is a protective measure against infectious diseases and remains one of the best investments in public health. Some African countries are still struggling to reach the required child immunization coverage. Several factors are responsible for limiting immunization coverage. Most of the factors considered to limit immunization coverage are related to the health system. In addition, inaccessibility to care, especially during the critical period of the Covid-19 pandemic, greatly reduced vaccination coverage rates. In Benin, several vaccines are included in the Expanded Programme on Immunization or are administered as part of routine immunization. However, cases of non-compliance with the vaccine and persistent flaccid paralysis are still recorded in the commune of Ouidah in southern Benin. The aim of this study was to investigate the coverage and factors associated with full immunization for age in children aged 0-5 years. Methods A cross-sectional survey was conducted from August to October 2021 in two villages (Adjara-Hounvè and Ahouicodji) in southern Benin. All the households were included. The survey regarded children under 5 for whom a vaccination record was presented. A couple child/mother was recruited after informed consent of the mother and her child. An univariate analysis followed by a multivariate analysis was performed by using a logistic regression model to identify the variables that influence vaccine completeness. Spatial description of vaccine completeness was performed using the kriging method using ArcGIS 10.8 mapping software. Results. Of the 414 mothers surveyed, 57.49% had an immunization card, from which information was collected. Of the 238 children recruited, 141 were in Adjara-Hounvè and 97 in Ahouicodji. Of the 238 children with an immunization card, 20.6% were fully immunized for their age. All children received Baccille Calmette Guérin vaccine at birth. Since poliomyelitis, pentavalent, pneumococcal conjugate, and rotavirus are three-dose vaccines, the percentage of children who received these vaccines decreased as the number of doses increased: 96.6%, 88.2%, 78.1% and 72.3% for the four doses of polio respectively. According to 53.4% of the respondents the reception at the vaccination site was poor, and according to 70.3% of them waiting time for vaccination sessions was long. Several reasons justified the absence of complete vaccination for the age of the children: vaccination site too far from the place of residence (59.54%), lack of financial means (29.78%) and the mother's ignorance (12.76%). Education level "primary" vs "none" (ORa = 3.32; CI95% 1.07-10.25), occupation "health staff" vs "housewife" (ORa = 21.18; CI95% 3.07-145.94), mothers' knowledge of Expanded Programme on Immunization diseases (ORa = 2, 20; CI95% 1.03-4.68) and children's age 0-2 months vs ≥ 16 months (ORa = 8.53; CI95% 2.52-28.85) and 9-15 months vs ≥ 16 months (ORa = 2.99; CI95% 1.24-7.23) increased complete immunization status for age. The homogeneity of behaviour related to age-complete immunization coverage in children under 5 years was evident at mapping. Conclusion Age-complete immunization coverage in children under 5 years of age is very low, with a spatial homogeneity in community immunization uptake behaviour. Age-complete immunization coverage is an innovative indicator that can contribute to achieving age-specific immunization targets.
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Affiliation(s)
- Barikissou Georgia DAMIEN
- Département Population et santé, Centre de formation et de recherche en matière de population, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Wenceslas VL AVON OU
- Département Population et santé, Centre de formation et de recherche en matière de population, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Marlène DAHOUN
- Département Population et santé, Centre de formation et de recherche en matière de population, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Landry KAUCLEY
- Ministère de la Santé, Agence nationale des soins de santé primaires (ANSSP), Direction de la vaccination et de la logistique, Cotonou, Bénin
| | - Badirou AGUEMON
- Département de santé publique, Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin
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Bell J, Lartey B, Fernandez M, Darrell N, Exton-Smith H, Gardner C, Richards E, Akilo A, Odongo E, Ssenkungu J, Kotchi Kouadio R, Cissé M, Rérambyah ABAI, Adou M, West R, Sharma S. A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001289. [PMID: 36989212 DOI: 10.1371/journal.pgph.0001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/23/2023] [Indexed: 03/30/2023]
Abstract
Vaccines have contributed to reductions in morbidity and mortality from preventable diseases globally, but low demand for vaccination threatens to reverse these gains. Explorations of the determinants of vaccination uptake may rely on proxy variables to describe complex phenomena and construct models without reference to underlying theories of vaccine demand. This study aimed to use the results of a formative qualitative study (described elsewhere) to construct and test a model to explain the determinants of vaccination uptake. Using the results of a survey among more than 3,000 primary caregivers of young children in Nigeria, Uganda and Guinea, factor analysis produced six explanatory factors. We then estimated the effects of each of these factors on uptake of immunization using a structural equation model. The results showed that the probability that a child is fully vaccinated increases if a caregiver has support from others to vaccinate them (B = 0.33, β = 0.21, p<0.001) and if caregivers had poor experiences with the healthcare system (B = 0.09, β = 0.09, p = 0.007). Conversely, the probability of full vaccination decreases if the caregiver's husband exerts control over her decision-making ability (B = -0.29, β = -0.20, p<0.001), or if the caregiver perceives vaccines to be of low importance (B = -0.37, β = -0.27, p<0.001). Belief in religious protection (B = -0.07, β = -0.05, p = 0.118) and a belief that vaccines are harmful (B = -0.12, β = -0.04, p = 0.320) did not have an observed effect on vaccination status. This research suggests that interventions may benefit from that including entire families and communities in their design.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rebecca West
- Ipsos Healthcare, London, United Kingdom
- Boston University School of Public Health, Boston, Massachusetts, United States of America
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Bell J, Lartey B, Spickernell G, Darrell N, Salt F, Gardner C, Richards E, Fasakin L, Egbeniyi S, Odongo E, Ssenkungu J, Kouadio RK, Cissé M, Rérambyah ABAI, Adou M, West R, Sharma S. Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531294 PMCID: PMC9748306 DOI: 10.1016/j.ssmqr.2022.100180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
Vaccines have reduced child mortality across the world, but low levels of demand for vaccination threatens to undermine progress. Existing frameworks to understand demand tend to prioritise primary caregivers' decision-making processes. We aimed to build a wider understanding of vaccine demand by applying an adapted socio-ecological model to analyse 158 interviews with primary caregivers and fathers of young children, and community influencers in Nigeria, Uganda, and Guinea. We found that several factors come together to inform a primary caregiver's demand for vaccination, including their familial and social relationships, their interactions with government and healthcare institutions, and the wider social and cultural norms in their communities. The study suggests that interventions targeted at families and communities instead of individuals could be effective. The results could be used to ensure that vaccine demand frameworks used by researchers and intervention designers are comprehensive and consider a wider range of influences on the primary caregiver.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Belinda Lartey
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | | | | | - Frances Salt
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Cassie Gardner
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Emily Richards
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
| | - Lanre Fasakin
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Shadrach Egbeniyi
- CMRG, 24A, Eric Moore Street, Wemabod Estate, Off Ajao Road, Ikeja, Lagos, Nigeria
| | - Emmanuel Odongo
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | - James Ssenkungu
- Ipsos Uganda, 3rd Floor Padre Pio House, Plot 32, Lumumba Avenue P.O. Box 21571, Kampala, Uganda
| | | | - Mamadi Cissé
- Ciblage, En Face de l’Ecole les Ecureuils, Lambanyi, Ratoma, Conakry, Guinea
| | | | - Maikol Adou
- Ciblage, Face SODECI, Imm. Hué, Porte B10, Riviera Attoban, Cocody, 09 BP 799, Abidjan 09, Cote d’Ivoire
| | - Rebecca West
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, United States
| | - Sunny Sharma
- Ipsos Healthcare, 3 Thomas More Square, London, E1W 1YW, UK
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Martinien Avahoundje E, Dossou JP, Vigan A, Gaye I, Agossou C, Boyi C, Bello K, Mikponhoue J, Faly Ba M, Faye A, Ridde V. Factors associated with COVID-19 vaccine intention in Benin in 2021: a cross-sectional study. Vaccine X 2022; 12:100237. [PMCID: PMC9632262 DOI: 10.1016/j.jvacx.2022.100237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The development of COVID-19 vaccines has brought considerable hope for the control of the pandemic. With a view to promoting good vaccine coverage, this study aimed to measure vaccine intention against COVID-19 and to understand the factors that promote it. Method In April 2021, we conducted a cross-sectional and analytical study at the national level through a telephone survey of Beninese aged 18 years or older. We used a marginal quota sampling method (n=865) according to age, gender, and department. We constructed the questionnaire using a theoretical framework of health intention. We determined the factors associated with intention to vaccinate against COVID-19 in Benin using a multinomial logistic regression at the 5% significance level. Results The intention to vaccinate was 64.7%; 10.9% of the population were hesitant, and 24.4% did not want to vaccinate. Thinking that it was important to get vaccinated (AOR=0.274; CI=0.118-0.638) or that getting vaccinated will help protect loved ones from the virus (AOR=0.399; CI=0.205-0.775) increased the intention to vaccinate. Having a high level of education (AOR=1.988; CI=1.134-3.484), thinking that the vaccine could put one's health at risk (AOR=2.259; CI=1.114-4.578), and hearing something negative about the vaccine (AOR=1.765; CI=1.059-2.941) reduced intention to vaccinate. In addition, believing that the creators of the vaccine had ensured its safety (AOR=0.209; CI=0.101-0.430), and believing that it was unlikely to be infected after vaccination (AOR=0.359; CI=0.183-0.703) decreased hesitancy in favour of the intention to vaccinate. Conclusion In April 2021, vaccine intention was high, but maintaining this high rate requires building confidence in the vaccine and combating misinformation about the vaccine.
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Affiliation(s)
- Elias Martinien Avahoundje
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin,Corresponding author at: Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Armelle Vigan
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Ibrahima Gaye
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Christian Agossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Christelle Boyi
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Kéfilath Bello
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Joël Mikponhoue
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mouhamadou Faly Ba
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Adama Faye
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal,Faculty of Medicine, Pharmacy and Odontology Cheikh Anta Diop University, Dakar, Senegal
| | - Valéry Ridde
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal,IRD, French National Research Institute for Sustainable Development and Université Paris CIté, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
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Nuwarda RF, Ramzan I, Weekes L, Kayser V. Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines (Basel) 2022; 10:vaccines10101595. [PMID: 36298459 PMCID: PMC9612044 DOI: 10.3390/vaccines10101595] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination, despite being recognized as one of the most effective primary public health measures, is viewed as unsafe and unnecessary by an increasing number of individuals. Anxiety about vaccines and vaccination programs leading to vaccine hesitancy results from a complex mix of social and political influences, cultural and religious beliefs, the availability of and ability to interpret health and scientific information, and personal and population experiences of health systems and government policies. Vaccine hesitancy is becoming a serious threat to vaccination programs, and was identified as one of the World Health Organization’s top ten global health threats in 2019. The negative impact of anti-vaccination movements is frequently cited as one of the major reasons for rising vaccine hesitancy amongst the general public world-wide. This review discusses the various issues surrounding vaccine hesitancy and the anti-vaccine movement, starting with the definitions of vaccine hesitancy and the anti-vaccine movement in their early history and in the modern era, before discussing the key drivers of vaccine hesitancy, particularly across different regions of the world, with a focus on various countries with low-, middle-, or high-income economies with different socio-economic populations. The review concludes with the impact of vaccine hesitancy on herd immunity and social, psychological, and public health measures to counter vaccine hesitancy.
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Maccaro A, Piaggio D, Oronti IB, Vignigbé M, Gbokli A, Houngnihin R, Pecchia L. Social Engagement in the Fight Against COVID-19 in the Urban and Peri-Urban Areas of Cotonou (Benin, Sub-saharan Africa): Acceptability of the Vaccination and Tracking Program. Front Med (Lausanne) 2022; 9:857890. [PMID: 35721051 PMCID: PMC9203714 DOI: 10.3389/fmed.2022.857890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction This article aims at investigating social engagement in the fight against the COVID-19 pandemic in low-resource settings (LRSs). In particular, it focuses on Benin (Sub-Saharan Africa), and reports the results of a field study that investigated the local people's acceptance of the vaccine and the tracking program. Methods This project is the product of a collaboration between the ABSPIE (Applied Biomedical and Signal Processing E-Health) Lab of the University of Warwick (UK) and the LAMA (Laboratoire d'Antropologie Medical Appliqué) of the University of Abomey Calavi (Benin). This international multidisciplinary collaboration brought together engineers, sociologists, anthropologists, and bioethicists. In light of the aims of the project, a qualitative methodology was deemed appropriate. The research team prepared two questionnaires that provided the basis for semi-structured interviews that took place between June and August 2021. Results The research team interviewed 34 Beninese respondents, comprising people aged 60+ (with multiple comorbidities), who were primarily healthcare workers and/or traditional therapists. The results of this work highlight the fact that there is widespread reticence about the vaccination program in Benin, both due to local beliefs and uncertainty about governmental management. In this study, we uncovered several local reasons interfering with the involvement of the population in the vaccination campaign against COVID-19, e.g., the existence of traditional medical practices considered as valid alternatives to vaccines, and many beliefs showing a fear of neo-colonialism hidden in the pandemic threat. Yet, another hindrance can be traced to shortcomings in the management of the vaccination campaign which resulted in obstacles to the implementation of the program. Conclusions This work does not intend to denounce any governmental effort or foster a regressive mindset, but shows how the overall confusion (defined by the World Health Organization as infodemic) linked to the pandemic and its management has caused even more dramatic consequences in LRSs. In addition, the paper proposes a specific framework for the interpretation and management of bioethical and biomedical issues in LRSs that the authors are validating in their current research.
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Affiliation(s)
- Alessia Maccaro
- Applied Biomedical Signal Processing and Intelligent e-Health Lab, School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Davide Piaggio
- Applied Biomedical Signal Processing and Intelligent e-Health Lab, School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Iyabosola Busola Oronti
- Applied Biomedical Signal Processing and Intelligent e-Health Lab, School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Marius Vignigbé
- Laboratoire d'Antropologie Médicale Appliqué, University of Abomey Calavi, Cotonou, Benin
| | - Antoinette Gbokli
- Laboratoire d'Antropologie Médicale Appliqué, University of Abomey Calavi, Cotonou, Benin
| | - Roch Houngnihin
- Laboratoire d'Antropologie Médicale Appliqué, University of Abomey Calavi, Cotonou, Benin
| | - Leandro Pecchia
- Applied Biomedical Signal Processing and Intelligent e-Health Lab, School of Engineering, University of Warwick, Coventry, United Kingdom
- School of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, Roma, Italy
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SteelFisher GK, Caporello H, McIntosh R, Muhammad Safdar R, Desomer L, Chimenya D, Abdelwahab J, Ratna J, Rutter P, O'Reilly D, Gilani BI, Williams MR, Ben-Porath EN, Blendon RJ. Preventing erosion of oral polio vaccine acceptance: A role for vaccinator visits and social norms. Vaccine 2022; 40:3752-3760. [PMID: 35599038 PMCID: PMC9119726 DOI: 10.1016/j.vaccine.2022.04.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 03/02/2022] [Accepted: 04/29/2022] [Indexed: 10/28/2022]
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SULEMANE NORDINO, ARMOCIDA BENEDETTA, VALENTE MARTINA, FORMENTI BEATRICE, BARIGAZZI SILVIA, USSAI SILVIA, MONASTA LORENZO, CASTELLI FRANCESCO, MISSONI EDUARDO. Vaccines hesitancy in Africa: how COVID-19 pandemic may affect malaria vaccination campaigns. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E1-E3. [PMID: 35647377 PMCID: PMC9121680 DOI: 10.15167/2421-4248/jpmh2022.63.1.2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Affiliation(s)
- NORDINO SULEMANE
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Correspondence: Nordino Sulemane, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy - E-mail:
| | - BENEDETTA ARMOCIDA
- Institute for maternal and child health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - MARTINA VALENTE
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - BEATRICE FORMENTI
- Department of Infectious and Tropical Diseases, University of Brescia and UNESCO Chair in “training and empowering human resources in low-income countries”, University of Brescia; Brescia, Italy
| | | | - SILVIA USSAI
- Clinical Pharmacology and Toxicology, University of Cagliari, Cagliari, Italy
| | - LORENZO MONASTA
- Institute for maternal and child health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - FRANCESCO CASTELLI
- Department of Infectious and Tropical Diseases, University of Brescia and UNESCO Chair in “training and empowering human resources in low-income countries”, University of Brescia; Brescia, Italy
| | - EDUARDO MISSONI
- Saluteglobale.it - Associazione di promozione sociale
- Centre for research on health and social care management (CERGAS), Bocconi University, Milan, Italy
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Idris IO, Tapkigen J, Kabutaulaka G, Ayeni GO, Ayomoh FI, Obwoya JG. Are children on track with their routine immunization schedule in a fragile and protracted conflict state of South Sudan? A community-based cross-sectional study. BMC Pediatr 2022; 22:147. [PMID: 35307026 PMCID: PMC8935713 DOI: 10.1186/s12887-022-03213-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The objective of this study was to assess if children aged 0–23 months in a conflict-affected state of South Sudan were on track with their immunization schedule and to identify predisposing factors that affected this study population from being on track with their routine immunization schedule. Design Community-based cross-sectional study using a semi-structured questionnaire. The binary outcome of interest was defined as being on or off track with routine vaccination schedule. Multivariable logistic regression was used to analyze for the association between the predisposing factors surveyed and being off track with one’s routine immunization schedule. Setting Rural communities in four counties (Rumbek Center, Rumbek North, Rumbek East and Wulu) of the Western Lakes state in South Sudan during January 10, 2020 to June 10, 2020. Participants We surveyed 428 children aged 0–23 months and their mothers/caregivers who lived in either of the four counties in the Western Lakes State. Participants were selected using random ballot sampling. Results More than three-quarters of the children surveyed (75.5%) were off track with their vaccination schedule. Children with an immunization card had 71% reduced odds of being off track with their immunization (AOR = 0.29; 95% CI 0.10–0.83, p-value = 0.021) compared to children without immunization cards. Children who reside near health facilities and do not require transportation to facilities had 87% reduced odds of being off track with their immunization compared to those who lived far and required transport to facilities. Giving an adequate immunization notice before conducting immunization outreach visits to communities was also associated with reduced odds (AOR = 0.27; 95% CI 0.09–0.78. p-value = 0.016) of children being off track with their immunization. Conclusion This study revealed that most children were off track with their vaccination schedule in South Sudan, which is not only influenced by maternal characteristics but mainly by community- and state-level immunization service delivery mechanisms. Policies and interventions to improve child immunization uptake should prioritize these contextual characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03213-5.
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Affiliation(s)
| | - Janet Tapkigen
- Department of Health Sciences, University of Tampere, Tampere, Finland
| | - Germaine Kabutaulaka
- Department of Epidemiology and Biostatistics, New York University, New York, USA
| | - Gabriel Omoniyi Ayeni
- Department of Field Operation and Project Coordination, Health Pooled Fund, Rumbek, South Sudan
| | | | - Justin Geno Obwoya
- Department of Field Operation and Project Coordination, Health Pooled Fund, Rumbek, South Sudan.
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Mohanty P, Jena P, Patnaik L. Vaccination against Hepatitis B: A Scoping Review. Asian Pac J Cancer Prev 2020; 21:3453-3459. [PMID: 33369439 PMCID: PMC8046310 DOI: 10.31557/apjcp.2020.21.12.3453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: Elimination of viral hepatitis by 2030 as one of the international Sustainable Development Goals puts the hepatitis B vaccination on the forefront. However, barriers to vaccination reported in various studies are of concern. This study explores the global barriers for effective uptake of Hepatitis-B vaccination. Methods: A scoping review of studies reporting hepatitis B vaccination barriers was done using PMC data base and Google scholar search engine. About 803 journal articles and reports on hepatitis B barriers were retrieved but only 36 most relevant items during last 10 years were identified, pile sorted, grouped and analyze. Results: Overall 74 barriers have been identified for effective uptake of hepatitis-B vaccines. Most studies focused on non-zero dose of hepatitis B vaccine, One-third of the barriers are related to system issues, one-fourth of the barriers were related to caregiver education or awareness, fear of side effect, migration etc., one-fifth barriers were related to service provider issues like poor out-reach, home visits, poor communication and/relation with the caregivers, failure to identify unimmunized children etc., and other barriers were social-cultural issues. The review reveals limited availability and accessibility to health-facility based immunization, lack of awareness among caregivers, poor communication by the healthcare workers and negative relationships with the beneficiaries, cost of vaccine in private sector, inconvenience time and place of vaccination etc. as the major barriers for hepatitis B vaccination. Barriers varied from country to country. Conclusion: Myriad barriers for reduced hepatitis-B vaccine uptake need to be addressed contextually as countries are at different stages of hepatitis-B vaccination implementation.
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Affiliation(s)
- Parimala Mohanty
- Department of Community Medicine, IMS & SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Pratap Jena
- School of Public Health, KIIT Deemed to be University, Bhubaneswar, India
| | - Lipilekha Patnaik
- Department of Community Medicine, IMS & SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
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Fourn L. [Modelization of recommendation framework advice for children immunization to Beninese decision makers]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2020; 32:273-278. [PMID: 32985844 DOI: 10.3917/spub.202.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The coverage of immunization against avoidable disease in the Republic of Benin as in other West African countries, is declining nowadays. To sustain the government effort, National Immunization Technical Advisory Groups (NITAG) were created technically and funded by the West African health organization (WAHO) and Preventive Medicine Agency in countries of the Economic Community of West African States (ECOWAS) including the Republic of Benin. The variation in experts’ methods of analyzing evidence sometimes results in risk error and lack of statistical power. This situation does not allow for the comparison of the scientific validity of certain recommendations made to policy makers, due to the lack of a rigorous framework. The aim of this paper is to design an improved framework to be used in the Republic of Benin in order to encourage a more harmonized approach based on evidence used by expert consultative committees. This framework shows four fundamental scientific steps including a Ministerial referral procedure, recommendation framework, evidence-based data collection, model analyses appropriate for expert advice on vaccines and child immunization, as well as three administrative steps including scientific discussion and work meetings without forgetting ethical aspects.
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Abakar MF, Seli D, Lechthaler F, Schelling E, Tran N, Zinsstag J, Muñoz DC. Vaccine hesitancy among mobile pastoralists in Chad: a qualitative study. Int J Equity Health 2018; 17:167. [PMID: 30428876 PMCID: PMC6236988 DOI: 10.1186/s12939-018-0873-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 10/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Demand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood. Although innovative approaches such as linking human and animal vaccination increase vaccination uptake among mobile pastoralist communities, vaccination coverage in these communities is still lower than for rural settled populations. We hypothesize that mobile pastoralists' communities in Chad face specific demand side barriers to access vaccination services. Understanding the factors that caregivers in these communities consider, explicitly or implicitly, in order to decide whether or not to vaccinate a child, in addition to understanding the provider's perspectives, are essential elements to tailor vaccination programmes towards increasing vaccination acceptance and uptake. METHODS We conducted a qualitative study in a rural health district in southern Chad in April 2016 with 12 key informant in-depth interviews and four focus group discussions (FGDs) including 35 male and female participants. Participants in the study included caregivers, traditional chiefs, local and religious leaders from mobile pastoralist communities, and health officials and staff. We conducted a content analysis using a pre-defined set of categories for vaccine hesitancy covering issues on harmful effects of vaccination, mistrust with vaccination programmes/services, issues with the health system and other issues. RESULTS The groups of demand side barriers reported most frequently in focus group discussions were mistrust on the expanded programme on immunization (EPI) and polio vaccination outreach services (53%, n = 94), followed by health system issues (34%, n = 94), and concerns related to potential harm of vaccines (13%, n = 94). Concerns identified by caregivers, health professionals and community leaders followed a similar pattern with issues on programme mistrust being most frequently reported and issues with harm least frequently reported. None of the health professionals reported concerns about vaccinations being potentially harmful. CONCLUSION Mobile pastoralist communities face specific demand side barriers to vaccination. Understanding these barriers is essential to reduce vaccine hesitancy and increase vaccination uptake. Local health systems must plan for the periodic presence of pastoralist communities in their zones of responsibility and create more mutual trust.
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Affiliation(s)
- Mahamat Fayiz Abakar
- Institut de Recherche en Elevage pour le Développement, PO Box 433, N'Djamena, Chad. .,Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland. .,University of Basel, PO Box CH, 4001, Basel, Switzerland.
| | - Djimet Seli
- Centre de Recherches en Anthropologie et Sciences Humaines (CRASH), PO Box 6542, N'Djamena, Chad
| | - Filippo Lechthaler
- Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland.,University of Basel, PO Box CH, 4001, Basel, Switzerland.,School of Agricultural, Forest and Food Sciences, Bern University of Applied Sciences, PO Box 3052, Zollikofen, Switzerland
| | - Esther Schelling
- Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland.,University of Basel, PO Box CH, 4001, Basel, Switzerland
| | - Nhan Tran
- School of Agricultural, Forest and Food Sciences, Bern University of Applied Sciences, PO Box 3052, Zollikofen, Switzerland.,The Alliance for Health Policy and Systems Research (AHPSR), World Health Organization, PO Box 1211, Geneva, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland.,University of Basel, PO Box CH, 4001, Basel, Switzerland
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, PO Box CH-4002, Basel, Switzerland.,University of Basel, PO Box CH, 4001, Basel, Switzerland
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Kagoné M, Yé M, Nébié E, Sié A, Müller O, Beiersmann C. Community perception regarding childhood vaccinations and its implications for effectiveness: a qualitative study in rural Burkina Faso. BMC Public Health 2018; 18:324. [PMID: 29510684 PMCID: PMC5840732 DOI: 10.1186/s12889-018-5244-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/01/2018] [Indexed: 11/28/2022] Open
Abstract
Background Vaccination has contributed to major reductions in global morbidity and mortality, but there remain significant coverage gaps. Better knowledge on the interplay between population and health systems regarding provision of vaccination information and regarding health staff organization during the immunization sessions appears to be important for improvements of vaccination effectiveness. Methods The study was conducted in the Nouna Health and Demographic Surveillance System (HDSS) area, rural Burkina Faso, from March to April 2014. We employed a combination of in-depth interviews (n = 29) and focus group discussions (n = 4) including children’s mothers, health workers, godmothers, community health workers and traditional healers. A thematic analysis was performed. All material was transcribed, translated and analyzed using the software ATLAS.ti4.2. Results There was better social mobilization in the rural areas as compared to the urban area. Most mothers know the Expanded Program of Immunization (EPI) target diseases, and the importance to immunize their children. However, the great majority of informants reported that mothers don’t know the vaccination schedule. There is awareness that some children are incompletely vaccinated. Mentioned reasons for that were migration, mothers being busy with their work, the practice of not opening vaccine vials unless a critical number of children are present, poor interaction between women and health workers during immunization sessions, potential adverse events associated with vaccination, geographic inaccessibility during rainy season, and lack of information. Conclusions Well organized vaccination programs are a key factor to improve child health and there is a clear need to consider community perceptions on program performance. In Burkina Faso, a number of factors have been identified which need attention by the EPI managers for further improvement of program effectiveness.
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Affiliation(s)
- M Kagoné
- Centre de Recherche en Santé de Nouna, Ministry of Health, PO Box 02, Nouna, Burkina Faso.
| | - M Yé
- Centre de Recherche en Santé de Nouna, Ministry of Health, PO Box 02, Nouna, Burkina Faso
| | - E Nébié
- Centre de Recherche en Santé de Nouna, Ministry of Health, PO Box 02, Nouna, Burkina Faso
| | - A Sié
- Centre de Recherche en Santé de Nouna, Ministry of Health, PO Box 02, Nouna, Burkina Faso
| | - O Müller
- Institute of Public Health, Medical School, Ruprecht-Karls-University, 69120, Heidelberg, Germany
| | - C Beiersmann
- Institute of Public Health, Medical School, Ruprecht-Karls-University, 69120, Heidelberg, Germany
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Escobar-Díaz F, Bibiana Osorio-Merchán M, De la Hoz-Restrepo F. [Reasons some children under 5 do not get vaccinated in four Colombian citiesMotivos por que não são vacinadas crianças menores de cinco anos em quatro cidades colombianas]. Rev Panam Salud Publica 2017; 41:e123. [PMID: 31391829 PMCID: PMC6660840 DOI: 10.26633/rpsp.2017.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/12/2017] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Conocer las barreras y los motivos de no vacunación en niños y niñas menores de cinco años en algunas ciudades de Colombia. Métodos. Diseño cualitativo basado en entrevistas y grupos focales a personal de salud y cuidadores en cuatro ciudades colombianas seleccionadas de acuerdo a diferentes coberturas de vacunación y densidades poblacionales Resultados. Se identificaron diferentes factores que pueden influir en el incumplimiento de los esquemas de vacunación en los dos municipios con baja cobertura, como el temor a la reacción posvacunal, las condiciones socioeconómicas, geográficas y de seguridad de la población, las condiciones laborales del personal de vacunación, los problemas administrativos y económicos y el desarrollo precario de los sistemas de información. Conclusiones. Desde el punto de vista cualitativo, los equipos de vacunación y los cuidadores destacaron aspectos sociales e institucionales que contribuyen o limitan el cumplimiento de las coberturas de vacunación en las ciudades que participaron en el estudio.
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Affiliation(s)
- Fabio Escobar-Díaz
- Grupo de Epidemiología y Evaluación en Salud Pública Universidad Nacional de Colombia Colombia Grupo de Epidemiología y Evaluación en Salud Pública, Universidad Nacional de Colombia, Colombia
| | - May Bibiana Osorio-Merchán
- Grupo de Epidemiología y Evaluación en Salud Pública Universidad Nacional de Colombia Colombia Grupo de Epidemiología y Evaluación en Salud Pública, Universidad Nacional de Colombia, Colombia
| | - Fernando De la Hoz-Restrepo
- Grupo de Epidemiología y Evaluación en Salud Pública Universidad Nacional de Colombia Colombia Grupo de Epidemiología y Evaluación en Salud Pública, Universidad Nacional de Colombia, Colombia
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SteelFisher GK, Blendon RJ, Guirguis S, Lodge W, Caporello H, Petit V, Coleman M, Williams MR, Parwiz SM, Corkum M, Gardner S, Ben-Porath EN. Understanding threats to polio vaccine commitment among caregivers in high-priority areas of Afghanistan: a polling study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1172-1179. [DOI: 10.1016/s1473-3099(17)30397-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/25/2017] [Accepted: 06/15/2017] [Indexed: 11/29/2022]
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Ames HMR, Glenton C, Lewin S. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev 2017; 2:CD011787. [PMID: 28169420 PMCID: PMC5461870 DOI: 10.1002/14651858.cd011787.pub2] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two-way, for example face-to-face discussions between parents and healthcare providers, or one-way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate. OBJECTIVES The specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents' and informal caregivers' views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents' and informal caregivers' decisions regarding childhood vaccination. SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-process and Other Non-Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search. SELECTION CRITERIA We included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, using a three-step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE-CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents' knowledge, attitudes and behaviour about childhood vaccination. MAIN RESULTS We included 38 studies, mostly from high-income countries, many of which explored mothers' perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents' needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives. AUTHORS' CONCLUSIONS We have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low- to middle-income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents' perceptions of health workers and the information provided.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- Medical Research Council of South AfricaHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
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Shapiro GK, Holding A, Perez S, Amsel R, Rosberger Z. Validation of the vaccine conspiracy beliefs scale. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2016; 2:167-172. [PMID: 29074176 PMCID: PMC5886898 DOI: 10.1016/j.pvr.2016.09.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parents' vaccine attitudes influence their decision regarding child vaccination. To date, no study has evaluated the impact of vaccine conspiracy beliefs on human papillomavirus vaccine acceptance. The authors assessed the validity of a Vaccine Conspiracy Beliefs Scale (VCBS) and determined whether this scale was associated with parents' willingness to vaccinate their son with the HPV vaccine. METHODS Canadian parents completed a 24-min online survey in 2014. Measures included socio-demographic variables, HPV knowledge, health care provider recommendation, Conspiracy Mentality Questionnaire (CMQ), the seven-item VCBS, and parents' willingness to vaccinate their son at two price points. RESULTS A total of 1427 Canadian parents completed the survey in English (61.2%) or French (38.8%). A Factor Analysis revealed the VCBS is one-dimensional and has high internal consistency (α=0.937). The construct validity of the VCBS was supported by a moderate relationship with the CMQ (r=0.44, p<0.001). Hierarchical regression analyses found the VCBS is negatively related to parents' willingness to vaccinate their son with the HPV vaccine at both price points ('free' or '$300') after controlling for gender, age, household income, education level, HPV knowledge, and health care provider recommendation. CONCLUSIONS The VCBS is a brief, valid scale that will be useful in further elucidating the correlates of vaccine hesitancy. Future research could use the VCBS to evaluate the impact of vaccine conspiracies beliefs on vaccine uptake and how concerns about vaccination may be challenged and reversed.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4.
| | - Anne Holding
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1
| | - Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4
| | - Rhonda Amsel
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, Canada H3T 1E4; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, Canada H3A 1B1
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Munyaradzi Kenneth D, Marvellous M, Stanzia M, Memory DM. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe. PLoS One 2016; 11:e0160170. [PMID: 27509018 PMCID: PMC4979998 DOI: 10.1371/journal.pone.0160170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/14/2016] [Indexed: 11/19/2022] Open
Abstract
Religion affects people's daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner.
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Affiliation(s)
| | - Mhloyi Marvellous
- Centre for Population Studies, University of Zimbabwe, Harare, Zimbabwe
| | - Moyo Stanzia
- Centre for Population Studies, University of Zimbabwe, Harare, Zimbabwe
| | - Dodzo-Masawi Memory
- Institute of Development Studies, National University of Science and Technology, Bulawayo, Zimbabwe
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Smith-Greenaway E, Madhavan S. Maternal migration and child health: An analysis of disruption and adaptation processes in Benin. SOCIAL SCIENCE RESEARCH 2015; 54:146-58. [PMID: 26463540 PMCID: PMC4833091 DOI: 10.1016/j.ssresearch.2015.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/12/2015] [Accepted: 06/08/2015] [Indexed: 05/28/2023]
Abstract
Children of migrant mothers have lower vaccination rates compared to their peers with non-migrant mothers in low-income countries. Explanations for this finding are typically grounded in the disruption and adaptation perspectives of migration. Researchers argue that migration is a disruptive process that interferes with women's economic well-being and social networks, and ultimately their health-seeking behaviors. With time, however, migrant women adapt to their new settings, and their health behaviors improve. Despite prominence in the literature, no research tests the salience of these perspectives to the relationship between maternal migration and child vaccination. We innovatively leverage Demographic and Health Survey data to test the extent to which disruption and adaptation processes underlie the relationship between maternal migration and child vaccination in the context of Benin-a West African country where migration is common and child vaccination rates have declined in recent years. By disaggregating children of migrants according to whether they were born before or after their mother's migration, we confirm that migration does not lower children's vaccination rates in Benin. In fact, children born after migration enjoy a higher likelihood of vaccination, whereas their peers born in the community from which their mother eventually migrates are less likely to be vaccinated. Although we find no support for the disruption perspective of migration, we do find evidence of adaptation: children born after migration have an increased likelihood of vaccination the longer their mother resides in the destination community prior to their birth.
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Affiliation(s)
| | - Sangeetha Madhavan
- Institute of Behavioral Science, University of Colorado Boulder, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of African and African-American Studies, University of Maryland, USA
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Exposing concerns about vaccination in low- and middle-income countries: a systematic review. Int J Public Health 2015; 60:767-80. [DOI: 10.1007/s00038-015-0715-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022] Open
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SteelFisher GK, Blendon RJ, Guirguis S, Brulé A, Lasala-Blanco N, Coleman M, Petit V, Ahmed M, Mataruse N, Corkum M, Nisar M, Ben-Porath EN, Gigli S, Sahm C. Threats to polio eradication in high-conflict areas in Pakistan and Nigeria: a polling study of caregivers of children younger than 5 years. THE LANCET. INFECTIOUS DISEASES 2015; 15:1183-1192. [PMID: 26179316 DOI: 10.1016/s1473-3099(15)00178-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/12/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Elimination of poliovirus from endemic countries is a crucial step in eradication; however, vaccination programmes in these areas face challenges, especially in regions with conflict. We analysed interviews with caregivers of children living in two polio-endemic countries to assess whether these challenges are largely operational or also driven by resistance or misinformation in the community. METHODS We designed and analysed polls based on face-to-face interviews of a random sample of parents and other caregivers of children younger than 5 years in regions of Pakistan and Nigeria at high risk for polio transmission. In both countries, the sample was drawn via a stratified multistage cluster design with random route household selection. The questionnaire covered awareness, knowledge, and attitudes about polio and oral polio vaccine (OPV), trust in vaccination efforts, and caregiver priorities for government action. We assessed experiences of caregivers in accessible higher-conflict areas and compared their knowledge and attitudes with those in lower-conflict areas. Differences were tested with two-sample t tests. FINDINGS The poll consisted of 3396 caregivers from Pakistan and 2629 from Nigeria. About a third of caregivers who responded in higher-conflict areas of Pakistan (Federally Administered Tribal Areas [FATA], 30%) and Nigeria (Borno, 33%) were unable to confirm that their child was vaccinated in the previous campaign. In FATA, 12% of caregivers reported that they were unaware of polio, and in Borno 12% of caregivers reported that vaccinators visited but their child did not receive the vaccine or they did not know whether the child was vaccinated. Additionally, caregivers in higher-conflict areas are less likely to hold beliefs about OPV that could motivate acceptance and are more likely to hold concerns than are caregivers in lower-conflict areas. INTERPRETATION Beyond the difficulties in reaching homes with OPV, challenges for vaccination programmes in higher-conflict areas extend to limited awareness, negative attitudes, and gaps in trust. Vaccination efforts might need to address underlying attitudes of caregivers through direct communications and the selection and training of local vaccinators. FUNDING Harvard T H Chan School of Public Health and UNICEF.
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Affiliation(s)
| | - Robert J Blendon
- Harvard T H Chan School of Public Health, Boston, MA, USA; John F Kennedy School of Government, Cambridge, MA, USA
| | | | - Amanda Brulé
- Harvard T H Chan School of Public Health, Boston, MA, USA
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Ganle JK. Why Muslim women in Northern Ghana do not use skilled maternal healthcare services at health facilities: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:10. [PMID: 25928326 PMCID: PMC4417257 DOI: 10.1186/s12914-015-0048-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/21/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Muslim women are one sub-population in Ghana among whom the rate of skilled maternal health services accessibility and utilisation is very low. However, there are no studies in Ghana that explore the maternity needs and care experiences of Muslim women, and why they do not utilise maternal healthcare services at health facilities. The purpose of this paper is to explore the maternity healthcare needs and care experiences of Muslim women and the barriers to accessing and using maternal health services. METHODS Qualitative research was conducted with 94 Muslim women in three communities in northern Ghana between November 2011 and May 2012. Data were analysed using the Attride-Stirling's thematic network analysis framework. RESULTS Findings suggest that although Muslim women do want to receive skilled care in a health facility, they often experience difficulties with accessing and using such services. These difficulties were often conditioned by a religious obligation to maintain bodily sanctity through modest dressing and the avoidance of unlawful bodily exposure or contact with certain people including male or alien caregivers. Other related access barriers include lack of privacy, healthcare providers' insensitivity and lack of knowledge about Muslim women's religious and cultural practices, and health information that lacked the cultural and religious specificity to meet Muslim women's maternity care needs. CONCLUSION Maternal healthcare services designed to meet the needs of mainstream non-Muslim Ghanaian women might lack the flexibility and responsiveness to meet the unique maternity care needs of Muslim women. Recommendations for change include cultural competence training for healthcare providers and cultural/religious matching to meet Muslim women's care needs and to enhance their care experience.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Geography and Rural Development, Population, Health and Gender Research Group, Faculty of Social Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
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Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Hum Vaccin Immunother 2014; 8:293-301. [DOI: 10.4161/hv.19003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Yaya Bocoum FIK, Kouanda S, Hinson L, Collymore Y, Ba-Nguz A, Bingham A. [Community perceptions of malaria vaccines : qualitative research from the sanitary districts of Kaya and Hounde in Burkina Faso]. Glob Health Promot 2014; 21:76-87. [PMID: 24496777 DOI: 10.1177/1757975913507729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Au Burkina Faso, le paludisme est la principale cause de mortalité chez les enfants de moins de 5 ans. L’un des moyens les plus efficaces de prévention des maladies reste la vaccination. Aucun vaccin antipaludique n’existe actuellement, mais la recherche pour développer un vaccin progresse. Si les résultats des essais cliniques sont concluants d’ici 2014, l’Organisation Mondiale de la Santé (OMS) pourrait recommander l’utilisation d’un vaccin anti-paludique dès 2015. C’est dans le but de guider la décision d’introduire éventuellement un vaccin contre le paludisme que cette étude a été menée. Les objectifs étaient de comprendre les perceptions et les expériences des communautés au sujet du paludisme et des vaccins et d’explorer l’acceptabilité éventuelle d’un vaccin antipaludique par ces communautés. Cette étude qualitative s’appuie sur le cadre socioécologique de L. W. Green. Elle s’est déroulée dans les districts sanitaires de Kaya et Houndé, au Burkina Faso. Au total, 30 groupes de discussions dirigées et 29 entretiens individuels ont été réalisés. Tous les participants à l’étude ont reconnu que le paludisme représente la première cause de morbidité et de mortalité au sein de leur communauté. En général, les populations de Kaya et Houndé ont eu des expériences positives avec les programmes de vaccination existant. Les effets bénéfiques que pourrait avoir un futur vaccin sont les motifs d’acceptation. L’avis du chef de ménage, l’interaction entre les prestataires de soins et les usagers des services de santé, et les effets secondaires sont des obstacles potentiels. Les résultats de cette étude fournissent des informations aux décideurs pour l’élaboration d’une stratégie de communication à l’éventuelle introduction d’un vaccin contre le paludisme. Pour surmonter les obstacles à l’introduction d’un nouveau vaccin, une stratégie de communication efficace devra formuler des messages appropriés, et identifier des canaux d’information et les publics cibles en tenant compte du contexte local.
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Cremin S, Menton JF, Canier L, Horgan M, Fanning LJ. The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts. Hum Vaccin Immunother 2012; 8:916-20. [PMID: 22777095 DOI: 10.4161/hv.20122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to determine the cervical genotype profile of females who presented to an STI Clinic with external genital warts (EGW); and to determine the potential vaccine coverage prior to the uptake of the HPV vaccines. Sixty-one cervical scrapings were taken from females aged 18-35 y who had external genital warts or a history of external genital warts. The resulting 50 samples that were positive for HPV-DNA were subjected to genotype identification. Forty-six of these samples had detectable genotypes by LIPA analysis and most (78%, 36/46) had multiple low risk (LR) and high risk (HR) genotypes on the cervix. Twenty-five of these samples (54%) had more than 1 HR genotype. Of the 36 patients who had any HR genotypes, 18 (50%) were identified to have the most oncogenic HPV genotypes, namely 16 and 18. Three of these samples had both 16 and 18 on the cervix. The presence of multiple HR genotypes on the majority of cervical samples from a self-referred population of females with EGW is presented. This study is of importance since persistent HR-HPV is the necessary risk factor in the development of precancerous and cancerous lesions of the cervix. Gardisil, the quadrivalent HPV vaccine would have been useful in the prevention of 28% (13/46) of these infections.
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Affiliation(s)
- Suzanne Cremin
- STI Clinic, Infirmary, South Victoria University Hospital, Cork, Ireland.
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Socio-cultural determinants of anticipated acceptance of an oral cholera vaccine in Western Kenya. Epidemiol Infect 2012; 141:639-50. [PMID: 22564277 PMCID: PMC3566592 DOI: 10.1017/s0950268812000829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Determinants of anticipated acceptance of an oral cholera vaccine (OCV) were studied in urban and rural communities of Western Kenya. An explanatory model interview administered to 379 community residents assessed anticipated vaccine acceptance at various prices from no cost to full-cost recovery, socio-cultural features of cholera and social characteristics. Nearly all (99%) residents indicated willingness to accept a no-cost OCV, 95% at a price of US$ 0·8, 73% at US$ 4·2 and 59% at US$ 8·4. Logistic regression models analysed socio-cultural determinants of anticipated OCV acceptance. Prominence of non-specific symptoms for cholera was negatively associated with acceptance. A cholera-specific symptom (thirst), self-help referring to prayer, income and education were positively associated. In the high-cost model, education was no longer significant and reliance on herbal treatment was a significant determinant of vaccine non-acceptance. Findings suggest high motivation for OCVs, if affordable. Socio-cultural determinants are better predictors of anticipated acceptance than socio-demographic factors alone.
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Sanou A, Kouyaté B, Bibeau G, Nguyen VK. Evaluability Assessment of an immunization improvement strategy in rural Burkina Faso: intervention theory versus reality, information need and evaluations. EVALUATION AND PROGRAM PLANNING 2011; 34:303-315. [PMID: 21168211 DOI: 10.1016/j.evalprogplan.2010.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 07/15/2010] [Accepted: 10/31/2010] [Indexed: 05/30/2023]
Abstract
An innovative immunization improvement strategy was proposed by the CRSN (Centre de Recherche en Santé de Nouna) to improve the low coverage rate for children aged 0-11 months in the health district of Nouna in Burkina Faso. This article reports on the Evaluability Assessment (EA) study that aimed to orient decisions for its evaluation in close relationship with the information needs of the stakeholders. Various methods were used, including document reviews, individual interviews, focus group discussions, meetings, literature reviews and site visits. A description of the intervention theory and philosophy is provided with its logic models and its reality documented. Lessons on the procedure include the importance of the position of the evaluability assessor, the value of replicating some steps of the assessment and the relationships between EA and process evaluation. The evaluability study concludes that the intervention had some evaluable components. To satisfy the stakeholders' needs, the initially planned community randomized controlled trial can be maintained and complemented with a process evaluation. There is a need to provide sufficient information on the cost of the intervention. This will inform decision makers on the possibility of replicating the intervention in other contexts.
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Affiliation(s)
- Aboubakary Sanou
- Université de Montréal, Department of Social and Preventive Medicine, Québec, Canada.
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Philippe D, Jean-Marie OB, Marta GD, Thomas C. Global immunization: status, progress, challenges and future. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9 Suppl 1:S2. [PMID: 19828060 PMCID: PMC2762311 DOI: 10.1186/1472-698x-9-s1-s2] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Vaccines have made a major contribution to public health, including the eradication of one deadly disease, small pox, and the near eradication of another, poliomyelitis.Through the introduction of new vaccines, such as those against rotavirus and pneumococcal diseases, and with further improvements in coverage, vaccination can significantly contribute to the achievement of the health-related United Nations Millennium Development Goals.The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes and protect as many people as possible against more diseases by expanding the reach of immunization, including new vaccines, to every eligible person.This paper briefly reviews global progress and challenges with respect to public vaccination programmes.The most striking recent achievement has been that of reduction of global measles mortality from an estimated 750,000 deaths in 2000 down to 197,000 in 2007. Global vaccination coverage trends continued to be positive. In 2007 most regions reached more than 80% of their target populations with three doses of DPT containing vaccines. However, the coverage remains well short of the 2010 goal on 90% coverage, particularly in the WHO region of Africa (estimated coverage 74%), and South-East Asia, (estimated coverage 69%). Elements that have contributed to the gain in immunization coverage include national multi-year planning, district-level planning and monitoring, re-establishment of outreach services and the establishment of national budget lines for immunization services strengthening.Remaining challenges include the need to: develop and implement strategies for reaching the difficult to reach; support evidence-based decisions to prioritize new vaccines for introduction; strengthening immunization systems to deliver new vaccines; expand vaccination to include older age groups; scale up vaccine preventable disease surveillance; improve quality of immunization coverage monitoring and use the data to improve programme performance; and explore financing options for reaching the GIVS goals, particularly in lower-middle income countries.Although introduction of new vaccines is important,this should not be at the expense of sustaining existing immunization activities. Instead the introduction of new vaccine introduction should be viewed as an opportunity to strengthen immunization systems, increase vaccine coverage and reduce inequities of access to immunization services.
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Affiliation(s)
- Duclos Philippe
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland
| | - Okwo-Bele Jean-Marie
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland
| | - Gacic-Dobo Marta
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland
| | - Cherian Thomas
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland
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Mhatre SL, Schryer-Roy AM. The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. Results from the Canadian International Immunization Initiative Phase 2 - Operational Research Grants. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9 Suppl 1:S1. [PMID: 19828053 PMCID: PMC3226229 DOI: 10.1186/1472-698x-9-s1-s1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Immunization can and does save lives. However, the presence of vaccines does not easily translate into every child being vaccinated, and this is what the studies in this journal supplement reveal. From South Asia to West Africa,the evidence presented here reveals what we are calling the fallacy of coverage, going beyond uncovering the real vaccination rates to providing evidence on the reasons for the lack of effective coverage. The evidence for the fallacy of coverage is part of an operational research program entitled the Canadian International Immunization Initiative Phase 2 (CIII2). Through a competitive peer review process, six research grants were awarded to increase access to and enhance immunization services. This journal supplement provides a forum for the presentation of the results of five of the six studies. The story of the fallacy of coverage is made up of five theme areas of evidence - timeliness of immunization, social and gender inequities, vaccine efficacy, understanding demand side issues to tailor interventions, and national data sets masking actual district level coverage rates - that reveal the discrepancies in immunization coverage rates and the reasons behind these discrepancies. As part of the story, and to turn around the fallacy of coverage, the studies also provide proof of effective and locally relevant solutions. Policies and funding, while keeping an eye on future diseases, clearly need to maintain and increase support to address existing vaccine-preventable diseases to increase coverage such that by 2015 we can achieve 90% national vaccination coverage and reach the MDG of reducing mortality rates among children under five by two-thirds.The results from the operational research grants of the CIII2 offer some answers on how to reach this goal by demonstrating how locally generated evidence can inform immunization strategies to ensure that children who need to get vaccinated will get vaccinated, and vaccinated on time.
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Affiliation(s)
- Sharmila L Mhatre
- International Development Research Centre, 150 Kent Street, Ottawa, Canada.
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