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Sharma A, Jain RB, Satija J, Sharma A, Sharma A, Shekhawat S. Cluster sampling methodology to evaluate immunization coverage. World J Methodol 2024; 14:92344. [DOI: 10.5662/wjm.v14.i3.92344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Immunization is a key component of primary health care and an indisputable human right. Vaccines are critical to the prevention and control of infectious disease outbreaks. The coronavirus disease 2019 (COVID-19) pandemic and associated disruptions over the past two years have strained the health systems, with many children missing out on essential childhood vaccines.
AIM To evaluate the immunization coverage among 12-23-month-old children in the rural areas of Community Health Centre (CHC) Dighal and to determine the factors influencing the existing immunization coverage.
METHODS A coverage evaluation survey was conducted according to the 30-cluster sampling technique, which is the standard methodology for such surveys devised by World Health Organization. A total of 300 children aged 12-23 months were included, whose immunization details were noted from their immunization cards.
RESULTS Full immunization rate was noted in 86.7% of the children, with partial and non-immunized children accounting for 9% and 4.3% respectively. The full immunization dropout rate was 4.2%. The common reasons for partial or non-immunization were family problem including illness of mother, vaccine not being available and child being ill. Place of birth (P = 0.014) and availability of immunization card (P < 0.001) were significant predictors of the immunization status. Since the study was conducted in 2020/2021, health services were disrupted due to the COVID-19 lockdown.
CONCLUSION Due to the coverage being higher than the national average, it was concluded that the immunization coverage was optimal and not affected by the COVID-19 pandemic.
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Affiliation(s)
- Aishwarya Sharma
- Department of Community Medicine, School of Medical Sciences & Research, Sharda University, Greater Noida 201306, UP, India
| | - RB Jain
- Department of Community Medicine, World College of Medical Sciences & Research, Jhajjar 124103, Haryana, India
| | - Jitesh Satija
- Department of Community Medicine, ESIC Medical College & Hospital, Faridabad 121012, Haryana, India
| | - Aditi Sharma
- Department of Community Medicine, Hamdard Institute of Medical Sciences & Research, New Delhi 110062, India
| | - Avani Sharma
- Department of Community Medicine, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
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Hailegebireal AH, Hailegebreal S, Tirore LL, Wolde BB. Spatial variation and predictors of incomplete pneumococcal conjugate vaccine (PCV) uptake among children aged 12-35 months in Ethiopia: spatial and multilevel analyses. Front Public Health 2024; 12:1344089. [PMID: 38864011 PMCID: PMC11165216 DOI: 10.3389/fpubh.2024.1344089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
Background Despite the Ethiopian government included the Pneumococcal Conjugate Vaccine (PCV) in the national expanded program for immunization in 2011, only 56% of children aged 12-23 months received the full dose of PCV. Despite some studies on PCV uptake in Ethiopia, there was a dearth of information on the geographical distribution and multilevel factors of incomplete PCV uptake. Hence, this study aimed to identify the spatial variations and predictors of incomplete PCV uptake among children aged 12-35 months in Ethiopia. Methods The study was based on an in-depth analysis of 2016 Ethiopia Demographic Health Survey data, using a weighted sample of 3,340 women having children aged 12-35 months. Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used for the spatial analysis. To explore spatial variation and locate spatial clusters of incomplete PCV, the Global Moran's I statistic and Bernoulli-based spatial scan (SaTScan) analysis were carried out, respectively. A multilevel mixed-effect multivariable logistic regression was done by STATA version 16. Adjusted odds ratio (AOR) with its corresponding 95% CI was used as a measure of association, and variables with a p < 0.05 were deemed as significant determinants of incomplete PCV. Results The overall prevalence of incomplete PCV in Ethiopia was found to be 54.0% (95% CI: 52.31, 55.69), with significant spatial variation across regions (Moran's I = 0.509, p < 0.001) and nine most likely significant SaTScan clusters. The vast majority of Somali, southeast Afar, and eastern Gambela regions were statistically significant hot spots for incomplete PCV. Lacking ANC visits (AOR = 2.76, 95% CI: 1.91, 4.00), not getting pre-birth Tetanus injections (AOR = 1.84, 95% CI: 1.29, 2.74), home birth (AOR = 1.72, 95% CI: 1.23, 2.34), not having a mobile phone (AOR = 1.64, 95% CI: 1.38, 1.93), and residing in a peripheral region (AOR = 4.63; 95% CI: 2.34, 9.15) were identified as statistically significant predictors of incomplete PCV. Conclusion The level of incomplete PCV uptake was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the federal and regional governments should collaborate with NGOs to improve vaccination coverage and design strategies to trace those children with incomplete PCV in peripheral regions. Policymakers and maternal and child health program planners should work together to boost access to maternal health services like antenatal care and skilled delivery services to increase immunization coverage.
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Affiliation(s)
| | - Samuel Hailegebreal
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Wachemo University, Hosaina, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lire Lemma Tirore
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Biruk Bogale Wolde
- School of Public Health, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
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Osman MA, Waits A, Chien LY. Factors Associated with Vaccination Coverage among 0-59-Month-Old Children: A Multilevel Analysis of the 2020 Somaliland Demographic and Health Survey. Vaccines (Basel) 2024; 12:509. [PMID: 38793760 PMCID: PMC11125891 DOI: 10.3390/vaccines12050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15-49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women's literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake.
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Affiliation(s)
- Mohamed Abdalle Osman
- International Health Program, Yang-Ming Campus, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan;
- Faculty of Health Sciences, Sanaag University, Erigavo, Somaliland
| | - Alexander Waits
- Institute of Public Health, Yang-Ming Campus, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan;
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, Yang-Ming Campus, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan
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Simbeye AJ, Kumwenda S, Cohee LM, Omondi D, Masibo PK, Wao H, Awandu SS. Factors associated with malaria vaccine uptake in Nsanje district, Malawi. Malar J 2024; 23:105. [PMID: 38627704 PMCID: PMC11022426 DOI: 10.1186/s12936-024-04938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Malaria remains a significant global health burden affecting millions of people, children under 5 years and pregnant women being most vulnerable. In 2019, the World Health Organization (WHO) endorsed the introduction of RTS,S/AS01 malaria vaccine as Phase IV implementation evaluation in three countries: Malawi, Kenya and Ghana. Acceptability and factors influencing vaccination coverage in implementing areas is relatively unknown. In Malawi, only 60% of children were fully immunized with malaria vaccine in Nsanje district in 2021, which is below 80% WHO target. This study aimed at exploring factors influencing uptake of malaria vaccine and identify approaches to increase vaccination. METHODS In a cross-sectional study conducted in April-May, 2023, 410 mothers/caregivers with children aged 24-36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine. RESULTS Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08-6.51 and OR: 1.89, 95%CI 1.18-3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06-0.25 and OR: 0.30, 95%CI 0.03-0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive. CONCLUSION Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities' education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa.
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Affiliation(s)
- Atusaye J Simbeye
- Department of Biomedical Sciences, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, P. O. Box 210-40601, Bondo, Kenya.
| | - Save Kumwenda
- Department of Public and Environmental Health Sciences, School of Science and Technology, Malawi University of Business and Applied Sciences, Chichiri, Private Bag 303, Blantyre, Malawi
| | - Lauren M Cohee
- Department of Pediatrics, Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 655 B Baltimore St S, Baltimore, MD, 21201, USA
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Dickens Omondi
- Department of Biomedical Sciences, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, P. O. Box 210-40601, Bondo, Kenya
| | - Peninah K Masibo
- School of Public Health, Amref International University, P. O. Box 27691-00506, Nairobi, Kenya
| | - Hesborn Wao
- African Population and Health Research Centre (APHRC), P. O. Box 10787-00100, Nairobi, Kenya
| | - Shehu S Awandu
- Department of Biomedical Sciences, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, P. O. Box 210-40601, Bondo, Kenya
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Williams SV, Akande T, Abbas K. Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria. PLoS One 2024; 19:e0297326. [PMID: 38446836 PMCID: PMC10917251 DOI: 10.1371/journal.pone.0297326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective. METHODS We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria. RESULTS From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12-23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29-33) among children aged 12-23 months, whilst 19% (95% CI:18-21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35-49 years compared to 15-19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039). CONCLUSIONS Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria.
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Affiliation(s)
| | - Tanimola Akande
- Department of Epidemiology & Community Health, University of Ilorin, Ilorin, Nigeria
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Konlan MY, Mahama F, Abubakari BB, Konka P, Appiah BO, Yeboah MO, Kwarteng PG, Apea PO, Adjei MR, Adokiya MN, Boadum O, Abiwu HAK. Predictors of vaccination card retention in Tamale Metropolis, Ghana. PLoS One 2024; 19:e0292765. [PMID: 38408074 PMCID: PMC10896499 DOI: 10.1371/journal.pone.0292765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. METHODS We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0-59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0-59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. RESULTS A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15-0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29-0.90) sub-Metro areas and being caregivers of children aged 24-59 months (AOR = 0.39; 95% CI = 0.22-0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95-8.95) was a positive predictor of vaccination card retention. CONCLUSION In this study, vaccination card retention among children aged 0-59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention.
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Affiliation(s)
- Matthew Y. Konlan
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Fuseini Mahama
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | | | - Paul Konka
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Benedict O. Appiah
- Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
| | - Maxwell O. Yeboah
- Department of Nursing, Northern Regional Hospital, Ghana Health Service, Tamale, Ghana
| | | | | | | | - Martin N. Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Oheneba Boadum
- Department of Advanced Biomedical Education, University of Mississippi Medical Center, Jackson, MS, United States of America
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Matthew Ayodele A, Fasasi MI, Rejoice Uche O, Gideon Ikemdinachi N, Henry Ugochukwu U. Factors associated with full childhood vaccination coverage among young mothers in Northern Nigeria. Pan Afr Med J 2024; 47:4. [PMID: 38371647 PMCID: PMC10870161 DOI: 10.11604/pamj.2024.47.4.37517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/12/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction wide regional variation in immunization coverage still persists in Nigeria. Full Immunization Coverage (FIC) for more than 80% of all states in the northern region is lower than 40% relative to their southern counterpart. Studies focusing on young women in the north remain sparse, despite the high prevalence of early marriage and poor health-seeking behavior. This study examines FIC among young women in northern Nigeria. Methods we performed a secondary analysis of the 2013 and 2018 Nigeria Demographic and Health Survey on 1,198 women of children aged 12-23 months in 2013 and 405 in the 2018 dataset. Analysis was limited to young women 15-24 years, residing in Northern Nigeria. We used logistics regression to predict factors associated with FIC. Results the proportion of fully immunized children was low, at 11% in 2013 and 18% in 2018. The coverage for most vaccines was low, except for the oral polio vaccine. The children of mothers who had health card [(aOR=18.1,95% C.I (8.1-40.7)], in 2013 and 2018 [(aOR=12.7, 95% C.I (5.9-27.1)], attended ANC [(aOR=8.6, 95% C.I (2.4-30.9)] in 2013 and had facility delivery [(aOR=2.0, 95% C.I (1.0-4.1)] in 2018 were more likely to be fully immunized. Conclusion the study found FIC among children of young women in Northern Nigeria was abysmally low. Ownership of health care, antenatal attendance, and facility delivery significantly predicted the odds of FIC. These findings suggest the need for approaches that remove barriers to good health-seeking behavior, especially among young mothers in Northern Nigeria.
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Affiliation(s)
| | | | - Obiora Rejoice Uche
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
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Abdilahi MM, Mohamed AI, Jonah KM, Ismail AS. Prevalence and factors associated with immunization coverage among children under five years in Mohamed Mooge health center, Hargeisa, Somaliland: a cross-sectional study. BMC Pediatr 2023; 23:545. [PMID: 37904092 PMCID: PMC10614313 DOI: 10.1186/s12887-023-04371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Routine immunization contributes greatly to reduction in mortality from vaccine preventable diseases among children. The Somaliland Demographic and Health survey, 2020 revealed that only 13.7% of children in Marodijeh (Hargeisa) region had received all recommended vaccines, which is far below the World Health Organization (WHO) target of 80%. We therefore, assessed factors associated with immunization coverage among children under five years at Mohamed Mooge Health Center in Hargeisa, Somaliland. METHODS Institutional based cross-sectional study was conducted on 174 systematically sampled, consented mothers that visited Mohamed Mooge Health Center for antenatal care during December 2022 to May 2023. Data was collected using a structured questionnaire. Data was analysed using SPSS and the relationship between dependent and independent variables was checked chi-square test at p ≤ 0.05. Finally, candidate variables were tested by using multivariate logistic regression in order to control potential confounders and the result was presented using AOR and 95% confidence interval. Model fitness was checked using Hosmer-Lemeshaw goodness of fit test with P > 0.05 for fitness. Multicollinearity between variables was checked using correlation coefficients at 0.80 or higher. RESULT: Among 174 study participants, the prevalence of overall vaccine completion in this study was 55.3%. Women who had being aware about childhood immunization on BCG vaccination (AOR = 3.887; 95% CI: 1.275, 6.844), pentavalent (AOR = 11.385; 95% CI: 5.424-14.464), and measles (AOR = 3.074; 95% CI: 1.822-6.130) had higher odds of having immunized their children. Mothers who had employment had higher odds of having their children immunized against measles (AOR = 4.069; 95% CI: 1.822-6.130) compared to those who had not. CONCLUSIONS Full immunization coverage was lower than the target set by the World Health Organization in this study area. The current study revealed that, the mother's awareness of childhood vaccinations on BCG, pentavalent, measles and employment status of mothers were positively associated with immunization coverage. To promote vaccination coverage, the government should implement a national awareness campaign on childhood immunization and increase the number of outreach services.
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Affiliation(s)
| | - Ahmed Ismail Mohamed
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
| | - Kiruja M Jonah
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
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Gelagay AA, Worku AG, Bashah DT, Tebeje NB, Gebrie MH, Yeshita HY, Cherkose EA, Ayana BA, Lakew AM, Bitew DA, Asmamaw DB, Negash WD, Belachew TB, Fentie EA. Complete childhood vaccination and associated factors among children aged 12-23 months in Dabat demographic and health survey site, Ethiopia, 2022. BMC Public Health 2023; 23:802. [PMID: 37131146 PMCID: PMC10152426 DOI: 10.1186/s12889-023-15681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/15/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Childhood immunization is one of the most cost-effective public health strategies to prevent children's mortality and morbidity from infectious diseases, but the Covid-19 pandemic and associated disruptions have strained health systems, and worldwide 25 million children missing out on vaccination in 2021. Of the 25 million, more than 60% of these children live in 10 countries including Ethiopia. Therefore, this study aimed to assess complete childhood vaccination coverage and associated factors in the Dabat district. METHOD A community-based cross-sectional study was conducted from December 10/2020 to January 10/2021Gregorian Calendar. The data for this study was extracted from information collected for the assessment of maternal, Neonatal, and Child Health and health services utilization in the Dabat demographic and health survey site. Vaccine-related data were collected using an interviewer-administered questionnaire. An adjusted odds ratio with a 95% confidence interval was used to identify the presence and the direction of the association. RESULTS Based on vaccination cards and mothers/caretakers' recall 30.9% (95%CI: 27.9-34.1%) of children aged 12-23 months in the Dabat district were completely immunized. Urban residency [AOR 1.813, 95% CI: (1.143, 2.878)], delivered in the health facility [AOR = 5.925, 95% CI: (3.680, 9.540)], ANC follow-up during their pregnancy [AOR 2.023, 95% CI: (1.352, 3.027)], rich wealth index [AOR = 2.392, 95% CI: (1.296, 4.415)], and parity [AOR 2.737, 95% CI: (1.664, 4.500)] were significantly associated with complete child vaccination. RECOMMENDATION AND CONCLUSION Complete vaccination coverage among children aged 12-23 months in the Dabat district was lower than the Global vaccine plan and Ethiopian ministry of health goal in 2020. Therefore, Health care providers and other stakeholders should mobilize the community to improve mothers' health-seeking behavior toward pregnancy follow-up and health facility delivery to improve childhood vaccination. Besides, expanding the service to remote areas are necessary to increase the immunization access.
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Affiliation(s)
- Abebaw Addis Gelagay
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu Worku
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debrework Tesgera Bashah
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nigusie Birhan Tebeje
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mignote Hailu Gebrie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hedija Yenus Yeshita
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endeshaw Adimasu Cherkose
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanu Abera Ayana
- Department of Obstetrics and Gynecology, Zewuditu Memorial Hospital, Addis Ababa, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Galadima AN, Mohd Zulkefli NA, Said SM, Ahmad N, Garba SN. Theory-based immunisation health education intervention in improving child immunisation uptake among antenatal mothers attending federal medical centre in Nigeria: A study protocol for a randomized controlled trial. PLoS One 2022; 17:e0263436. [PMID: 36480545 PMCID: PMC9731461 DOI: 10.1371/journal.pone.0263436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Childhood immunisation coverage is very low in Nigeria (31%) with Zamfara State being amongst the states with the poorest coverage (<10%). Lack of maternal knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions of religious regulations of antenatal mothers towards childhood immunisation are the contributory factors to poor childhood immunisation uptake. This study aims is to develop, implement and evaluate the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunization uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. METHODOLOGY The study will be a single-blind parallel-group randomised controlled trial, where baseline data will be collected from 392 estimated antenatal mothers, after that they will be evenly randomised using randomly generated permuted block sizes (each containing two intervention and two control assignments). The study participants will be antenatal mothers of ages 18 years and above who are in third trimesters and attending Federal Medical Centre Gusau, Zamfara State, Nigeria; during the study period and fulfilled all the inclusion and exclusion criteria. The intervention group will undergo five-health education sessions on immunisation, which will be strictly guided by Social Cognitive Theory-based intervention module: while the control group will receive usual care (standard care). Follow-up data will be collected using the same questionnaire at 6-weeks post-delivery, 10-weeks post-delivery and 14-weeks post-delivery. The generalized linear mixed model will be carried-out to determine the overall effect of the intervention after controlling for 14 potential confounding variables. An intention to treat analysis will also be carried-out. Childhood immunisation uptake is the primary outcome while the secondary outcomes are: improved knowledge scores, attitude scores, outcomes expectation, self-efficacy scores, cultural beliefs scores and assumptions on religious regulations scores. DISCUSSION The study will be a randomised controlled trial, that focuses on the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunisation uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR202006722055635. Protocol registered on 09 June 2020.
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Affiliation(s)
- Abubakar Nasiru Galadima
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
- * E-mail:
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Saleh Ngaski Garba
- Department of Nursing Sciences, Faculty of Allied Health Sciences, Ahmad Bello University, Zaria, Nigeria
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Mebrate M, Workicho A, Alemu S, Gelan E. Vaccination Status and Its Determinants Among Children Aged 12 to 23 Months in Mettu and Sinana Districts, Oromia Region, Ethiopia: A Comparative Cross Sectional Study. Pediatric Health Med Ther 2022; 13:335-348. [PMID: 36176346 PMCID: PMC9514263 DOI: 10.2147/phmt.s380303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Globally, more than 19 million children have not received all of their vaccination benefits, resulting in an estimated one million deaths worldwide each year. Vaccine-preventable diseases are becoming more common in Ethiopia, despite the fact that official vaccination coverage is sufficient to develop herd immunity locally for some diseases such as measles. This mistrust of the official report prompted us to conduct a community survey and compare it to other areas where there have been no reports of vaccine-preventable disease. Methods A community-based comparative cross-sectional study was conducted from 20/01–20/02/2021 in Sinana and Mettu districts. Probability proportional to estimate size was used to select 23 clusters. We recruited 228 from Mettu and 436 from Sinana by systematic random sampling. We used a structured questionnaire to collected data from mother–child pair using card and history. We conducted independent t-tests to test coverage differences between districts. We identified determinants of full vaccination status by multivariate logistic regression analysis after bivariate candidate selection. Results Fully vaccinated children accounted for 62.7% in Sinana and 91.6% in Mettu, demonstrating a significant coverage difference (p<0.001). Being a resident of Mettu (AOR: 3.5, 95% CI [1.5, 6.9]), intended pregnancy (AOR 5.9, 95% CI [2.4, 11.3]), 4 or more antenatal care visits (AOR: 2.09, 95% CI [1.4, 3]), having postnatal care (AOR: 3.5, 95% CI [1.6, 7.9]), younger child age (AOR: 0.87, 95% CI [0.8, 0.9]), having up to three children (AOR 3, 95% CI [1.13, 8]) and good knowledge of vaccine schedule (AOR: 2.4, 95% CI [1.4, 4]) were associated positively with full vaccination status. Conclusion Full vaccination status was 91.6% in Mettu and 62.7% in Sinana district. Place of residence, ANC, PNC, pregnancy intention, child number, age of child and knowledge of vaccination schedule were significantly associated with vaccination status of the children.
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Affiliation(s)
| | - Abdulhalik Workicho
- Department of Epidemiology, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Soresa Alemu
- Mettu Health Science College, Mettu, Ethiopia
- Correspondence: Soresa Alemu, Mettu, Oromia, Ethiopia, Tel +251 917273506, Email
| | - Ebsa Gelan
- Departement of Statistics, College of Natural Science, Mettu University, Mettu, Ethiopia
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Mahachi K, Kessels J, Boateng K, Jean Baptiste Achoribo AE, Mitula P, Ekeman E, Nic Lochlainn L, Rosewell A, Sodha SV, Abela-Ridder B, Gabrielli AF. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine 2022; 40:5433-5444. [PMID: 35973864 PMCID: PMC9485449 DOI: 10.1016/j.vaccine.2022.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
Comprehensive review of recent literature on zero- or missed-dose children in Nigeria. Risk factors are well-known and widely studied. Literature on interventions was scattered, and focussed on campaigns and polio. Gaps exist in investigating how to deliver sustainable immunization programs. Further work is needed to operationalise findings of this review.
'Zero-dose' refers to a person who does not receive a single dose of any vaccine in the routine national immunization schedule, while ‘missed dose’ refers to a person who does not complete the schedule. These people remain vulnerable to vaccine-preventable diseases, and are often already disadvantaged due to poverty, conflict, and lack of access to basic health services. Globally, more 22.7 million children are estimated to be zero- or missed-dose, of which an estimated 3.1 million (∼14 %) reside in Nigeria. We conducted a scoping review to synthesize recent literature on risk factors and interventions for zero- and missed-dose children in Nigeria. Our search identified 127 papers, including research into risk factors only (n = 66); interventions only (n = 34); both risk factors and interventions (n = 18); and publications that made recommendations only (n = 9). The most frequently reported factors influencing childhood vaccine uptake were maternal factors (n = 77), particularly maternal education (n = 22) and access to ante- and perinatal care (n = 19); heterogeneity between different types of communities – including location, region, wealth, religion, population composition, and other challenges (n = 50); access to vaccination, i.e., proximity of facilities with vaccines and vaccinators (n = 37); and awareness about immunization – including safety, efficacy, importance, and schedules (n = 18). Literature assessing implementation of interventions was more scattered, and heavily skewed towards vaccination campaigns and polio eradication efforts. Major evidence gaps exist in how to deliver effective and sustainable routine childhood immunization. Overall, further work is needed to operationalise the learnings from these studies, e.g. through applying findings to Nigeria’s next review of vaccination plans, and using this summary as a basis for further investigation and specific recommendations on effective interventions.
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Affiliation(s)
- Kurayi Mahachi
- College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | | | - Kofi Boateng
- Nigeria Country Office, World Health Organization, Abuja, Nigeria
| | | | - Pamela Mitula
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Ebru Ekeman
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Laura Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Alexander Rosewell
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Bernadette Abela-Ridder
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland
| | - Albis Francesco Gabrielli
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland.
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Hailu C, Fisseha G, Gebreyesus A. Determinants of measles vaccination dropout among 12 − 23 months aged children in pastoralist community of Afar, Ethiopia. BMC Infect Dis 2022; 22:376. [PMID: 35421952 PMCID: PMC9008940 DOI: 10.1186/s12879-022-07350-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Measles is a viral disease and a leading vaccine-preventable childhood killer. More than 95% of measles deaths occur in countries with low incomes and weak health infrastructures. In response to this, Ethiopia prepared a measles elimination strategic plan to achieve by 2020. However, based on the Mini-Ethiopian demographic health survey 2019 the full coverage of immunization is 43% at the country level and it is lowest (20%) in the Afar region where this study was conducted. Therefore, this study aimed to identify the determinants of the measles vaccine dropout rate in Afar regional state which is one of the pastoralist communities in Ethiopia.
Methods
Community based unmatched case-control study design was used. The study was conducted in Awash district of Afar regional state, Ethiopia from June 1st -30th 2018. Data were collected from a study unit of 12–23 months old children. For this study, a sample of 166 cases and 331controls were selected by simple random sampling methods and the total sample size was 497. Data were collected using a pretested structured questionnaire by health workers using the local language. Data were entered into Epi-info − 7 and analyzed by SPSS version 20 software and logistic regression was used to assess the determinants measles dropout rate.
Results
A total of 487 children participated in this study with a response rate of 97.9%. More than half of the children were female (53.3%) and 113 (35.2%) children mothers’ were not attended formal education. Mother who had antenatal care ≤ 2 visits [AOR:=5.7(3.2–10.14)], being in the birth order of 1 − 3 [AOR = 4.47(1.63–12.29)], long waiting time > 60 min at nearby health facility for vaccine [AOR = 2.37(1.36–4.15)], households visit by health extension workers [AOR = 2.03(1.12–3.66)], pregnant women not participating with women development army [AOR = 3.5(1.94–6.18)], and poor maternal knowledge on vaccination [AOR = 3.30(1.9–5.73)] were significant determinants with measles vaccination dropout rate.
Conclusions
Health facility and mother characteristics were the determinants of the measles vaccine dropout rate. Therefore, tracing and strict follow up by the health extension works using home visits and women development army at the pastoralist community is necessary to reach them.
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Darebo TD, Oshe BB, Diro CW. Full vaccination coverage and associated factors among children aged 12 to 23 months in remote rural area of Demba Gofa District, Southern Ethiopia. PeerJ 2022; 10:e13081. [PMID: 35310168 PMCID: PMC8929168 DOI: 10.7717/peerj.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/16/2022] [Indexed: 01/12/2023] Open
Abstract
Background Full vaccination refers to the administration of vaccines/antigens recommended for children in the first year of life. However, little is known about full vaccination in remote, rural Ethiopia. This study aimed to measure full vaccination coverage and associated factors among children aged 12 to 23 months in Demba Gofa District, Southern Ethiopia. Methods A community-based cross-sectional study was conducted in April and May 2019 using a multistage sampling technique to select 677 mothers with children 12-23 months of age. Data was collected using a pre-tested structured questionnaire, and data were edited, coded, entered, and cleaned using Epi Info v3.1 and analyzed using SPSS v20. Bivariate and multivariable logistic regression was used to understand associations between dependent and independent variables. Results Three-hundred and nine children (47.0%) were fully vaccinated, 274 (41.7%) were partially vaccinated, and 74 (11.3%) were not vaccinated at all. Children were more likely to be vaccinated if decisions were made jointly with husbands (AOR = 1.88, 95% CI [1.06-3.34]), were made by mothers (AOR = 4.03, 95% CI [1.66-9.78]), followed postnatal care (AOR = 5.02, 95% CI [2.28-11.05]), if the child's age for completing vaccination was known (AOR = 2.54, 95% CI [1.04-6.23]), and if vaccinations did not make the child sick (AOR = 0.32, 95% CI [0.16-0.64]). Conclusion Full vaccination coverage was less than average in the study district and far below the governmental target (90%) necessary for sustained control of vaccine-preventable diseases. Interventions targeted towards maternal healthcare decision-making, postnatal care, knowledge on vaccination timing, and importance should be prioritized to improve full vaccination coverage. A continuous supply of vaccination cards needs to be ensured to improve vaccination conditions.
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Affiliation(s)
- Tadele Dana Darebo
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, SouthEthiopia
| | - Bahru Belachew Oshe
- Maternal and Child Health Department, Gofa Zone Health Office, Gofa, SouthEthiopia
| | - Chala Wegi Diro
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, SouthEthiopia
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Setiawan MS, Wijayanto AW. Determinants of immunization status of children under two years old in Sumatera, Indonesia: A multilevel analysis of the 2020 Indonesia National Socio-Economic Survey. Vaccine 2022; 40:1821-1828. [DOI: 10.1016/j.vaccine.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 11/29/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
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Joseph L, Lavis A, Greenfield S, Boban D, Jose P, Jeemon P, Manaseki-Holland S. A systematic review of home-based records in maternal and child health for improving informational continuity, health outcomes, and perceived usefulness in low and middle-income countries. PLoS One 2022; 17:e0267192. [PMID: 35925923 PMCID: PMC9352021 DOI: 10.1371/journal.pone.0267192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Evidence shows that a gap in the documentation of patients' past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. METHODS The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection criteria- studies explaining the use of HBRs in LMIC for maternal and child health care. The included study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results from all study designs were summarised narratively. RESULTS In total, 41 papers were included in the review from 4514 potential studies. Included studies represented various study designs and 16 countries. The least evaluated function of HBR was information continuity across health care facilities (n = 6). Overall, there were limited data on the usefulness of HBRs to providers and mothers/families. Home-based records were mostly available for providers during health care visits. However, the documentation in HBRs varied. The use of HBRs is likely to lead to improved antenatal visits and immunisation uptake, and skilled birth delivery in some settings. Mothers' knowledge of breastfeeding practices and danger signs in pregnancy improved with the use of HBRs. One randomised trial found the use of HBRs reduced the risk of cognitive development delay in children and another reported on trial lessened the risk of underweight and stunted growth in children. CONCLUSION There is limited literature from LMICs on the usefulness of HBRs and for improving information transfer across healthcare facilities, or their use by women at home. Current HBRs from LMICs are sub-optimally documented leading to poor informational availability that defeats the point of them as a source of information for future providers.
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Affiliation(s)
- Linju Joseph
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Anna Lavis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Dona Boban
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
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Sangaré S, Sangho O, Doumbia L, Marker H, Sarro YDS, Dolo H, Telly N, Zakour IB, Ndiaye HM, Sanogo M, Sangho F, Diarra NH, Sangho A, Traoré FB, Diallo B, Coulibaly CA, Ongoiba S, Diakité L, Doumbia S. Concordance of vaccination status and associated factors with incomplete vaccination: a household survey in the health district of Segou, Mali, 2019. Pan Afr Med J 2021; 40:102. [PMID: 34887977 PMCID: PMC8627150 DOI: 10.11604/pamj.2021.40.102.29976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction the region of Segou recorded 36.8% of children were incompletely vaccinated in 2018. In 2019, the district of Segou was one of the districts with the lowest vaccination coverage in the region, with 85.1% coverage for the three doses of the pentavalent vaccine and 85.4% for the measles vaccine. This study was initiated to better understand this low vaccination coverage, in the absence of specific studies on vaccination coverage in the district of Segou. Methods a prospective cross-sectional study was conducted from May to August 2020 with 30 clusters. We performed Kappa coefficient, bivariate, and multiple logistic regression analysis. Results findings showed that 18.46% (101/547) [15.44-21.93] of children were incompletely vaccinated. Mothers correctly reported the vaccination status of their children in 67.30% of cases (Kappa coefficient). Uneducated (OR[IC95%]=2.13[1.30-3.50]), living in rural area (OR[IC95%]=2.07[1.23-3.47]), lack of knowledge of Expanded Program on Immunization (EPI) target diseases (OR[IC95%]=2.37[1.52-3.68]), lack of knowledge of vaccination schedule (OR[IC95%]=3.33[1.90-5.81]) and lack of knowledge of the importance of vaccination (OR[IC95%]=3.6[2.35-6.32]) were associated with incomplete vaccination. In multivariate analysis, uneducated (ORa[IC95%>]=1.68[1.004-2.810]) and lack of knowledge of the importance of vaccination were associated with incomplete vaccination (ORa[IC95%]=3.40[2.049-5.649]). Conclusion findings showed a good concordance of the vaccination status. Living in a rural area, no education, lack of the knowledge of EPI target diseases, lack of the knowledge of vaccination schedule and lack of knowledge of the importance of vaccination were associated with incomplete vaccination.
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Affiliation(s)
| | - Oumar Sangho
- Department of Education and Research of Biological and Medical Sciences, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.,Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lancina Doumbia
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hannah Marker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yeya Dit Sadio Sarro
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Housseini Dolo
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nouhoum Telly
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | - Moussa Sanogo
- Regional Directorate of Health and Public Hygiene, Kidal, Mali
| | - Fanta Sangho
- Department of Education and Research of Biological and Medical Sciences, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.,Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Niélé Hawa Diarra
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Aboubacar Sangho
- Department of Education and Research of Pharmaceutical Sciences, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Baba Diallo
- University Hospital Center for Odonto-Stomatology (CHU-CNOS), Bamako, Mali
| | - Cheick Abou Coulibaly
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | - Seydou Doumbia
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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van Heemskerken PG, Decouttere CJ, Broekhuizen H, Vandaele NJ. Understanding the complexity of demand-side determinants on vaccine uptake in sub-Saharan Africa. Health Policy Plan 2021; 37:281-291. [PMID: 34918093 DOI: 10.1093/heapol/czab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/28/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA.
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Affiliation(s)
- Phylisha G van Heemskerken
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | | | - Henk Broekhuizen
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.,Department of Health and Society, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen 3000, The Netherlands
| | - Nico J Vandaele
- Access-To-Medicines Research Center, KU Leuven, Naamsestraat 69, Leuven, Belgium
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Adedire EB, Ajumobi O, Bolu O, Nguku P, Ajayi I. Maternal knowledge, attitude, and perception about childhood routine immunization program in Atakumosa-west Local Government Area, Osun State, Southwestern Nigeria. Pan Afr Med J 2021; 40:8. [PMID: 36157559 PMCID: PMC9474928 DOI: 10.11604/pamj.supp.2021.40.1.30876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Routine Immunization (RI) is a key strategy in prevention of vaccine-preventable diseases (VPD). The Nigerian Demographic and Health survey 2013 showed that only 55% of children were fully immunized in Osun State. Historically, efforts to improve uptake of RI focused on health system factors with little attention on maternal related factors. This study assessed mothers´ knowledge, attitude, and perception towards the RI program in Atakumosa West Local Government Area (LGA) of Osun State. Methods A total of 750 mothers were enrolled in a household survey using WHO cluster sampling in Atakumosa West LGA. Semi-structured questionnaires were used to obtain data on sociodemographic characteristics, knowledge on RI, attitudes, and perception of mothers towards RI program. Knowledge scores of ≥ 4 points based on six-point domain questions were regarded as good. Results The mean (±SD) age of the mothers was 27.9 (± 6.1) years; 76% (571/750) had good knowledge of RI and VPD and a majority demonstrated a positive attitude towards the RI program. Antenatal care (ANC) attendance [OR 3.7; 95% CI (2.0 - 6.7)] health facility delivery [OR 1.7 (1.2 - 2.7)]; higher level of education [OR 1.9; 95% CI (1.4 - 2.5)], and mothers´ tetanus toxoid immunization status [OR 4.0 (2.3 - 7.2)] were significantly associated with having good knowledge of the RI program. Conclusion A high proportion of mothers in Atakumosa West LGA of Osun State have good knowledge on childhood RI program. Current efforts at health education in ANC should be sustained and other strategies to improve knowledge on immunization need to be identified.
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Affiliation(s)
- Elizabeth B. Adedire
- African Field Epidemiology Network, Abuja, Nigeria,,Corresponding author: Elizabeth B. Adedire, African Field Epidemiology Network, Abuja, Nigeria.
| | - Olufemi Ajumobi
- School of Community Health Sciences, University of Nevada, Reno, USA
| | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ikeoluwapo Ajayi
- Epidemiology and Medical Statistics Department, College of Medicine, University of Ibadan, Oduduwa Road, 200132, Ibadan, Nigeria
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20
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Ignis IO, Tomini S. Vaccination Coverage: Vaccine-Related Determinants & Anthropometric Measures in Children Resident in a Rural Community in Nigeria. Curr Drug Saf 2021; 17:199-210. [PMID: 34719376 DOI: 10.2174/1574886316666211029153212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/28/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vaccination of children has played a significant role in reducing early childhood morbidity and mortality from vaccine-preventable diseases; however, some factors act as deterrents in achieving adequate coverage in this susceptible population. AIMS & OBJECTIVES The study, therefore, aimed to identify vaccine-related determinants of childhood vaccination as well as determine the relationship between childhood vaccination status and body weight, height, and a child's body mass index (BMI). METHODS The study was conducted using a cross-sectional design in which 608 caregiver-child pair was recruited sequentially by using a two-stage sampling technique. Structured questionnaires based on the SAGE vaccine hesitancy model were used to interview the participants. Elicited data was analyzed and categorical variables were presented in tables and charts as frequencies, while a chi-square test was used to test the association between the independent and dependent variables. Pearson's correlation analysis was also done to determine the correlation between vaccination status and weight, height, and BMI of children. RESULT The study showed that vaccination coverage was suboptimal (70.56%) in children and was below the expected target of 80%. Although a few (183, 30.10%) of the respondents claimed they would prevent the vaccination of their children due to the fear of needles, the majority (87.50%) will be willing to accept more vaccine doses for their children if there were no pain. While factors such as the experience of adverse reaction (X2 = 13.22, df = 2, p<0.001), crying from pain (X2 = 11.33, df = 2, p<0.001) and the scientific evidence of safety (X2 = 34.63, df = 2, p<0.001) were significantly associated with a complete vaccination status, vaccination status was positively correlated with the weight (r=0.160, p<0.001), height (r=0.081, p=0.023) and BMI (r=0.214, p<0.001) of children in the rural community. CONCLUSION Vaccination uptake and coverage can be significantly improved in children by designing and implementing interventional programs that target pharmaceutical and vaccine-specific factors acting as barriers in these rural communities.
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Affiliation(s)
- Iribhogbe Osede Ignis
- Department of Pharmacology & Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, Ambrose Alli University Ekpoma, Edo State. Nigeria
| | - Sonila Tomini
- Public Health, University of Roehampton, London. United Kingdom
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21
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Dheresa M, Dessie Y, Negash B, Balis B, Getachew T, Mamo Ayana G, Merga BT, Regassa LD. Child Vaccination Coverage, Trends and Predictors in Eastern Ethiopia: Implication for Sustainable Development Goals. J Multidiscip Healthc 2021; 14:2657-2667. [PMID: 34584421 PMCID: PMC8464587 DOI: 10.2147/jmdh.s325705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Every year, immunization prevents about 4–5 million child fatalities from vaccine preventable morbidities. Conversely, in Ethiopia, achieving full coverage of vaccination has continued to be challenging. Socio-demographic, caregivers and child related factors determine vaccination coverage. Therefore, this study aimed to find out recent coverage, trends in coverage, and its predictors in eastern Ethiopia. Methods A population-based longitudinal study design was conducted among 14,246 children aged 12–24 months from 2017 to 2021 in Kersa Health and Demographic Surveillance System site (KHDSS). The data were collected from caregivers of the child by face to face interview. Multinomial logistic regressions were used to identify predictors of vaccination. The association between vaccination coverage and its predictors was presented by adjusted odds ratio with 95% confidence interval. A p-value of <0.05 was used to establish statistical significance. Results From the 14,198 included children, only 39% of children were fully vaccinated, with highest proportion in 2020 (45%) and lowest proportion in 2019 (32%). In comparison to fully vaccinated, being partially vaccinated was positively associated with older maternal age, rural residence, unemployment, rich wealth index, no antenatal care, facility delivery, and birth order whereas negatively associated with semi-urban residence. In compared to fully vaccinated, being not vaccinated was positively associated with older maternal age, rural residence, maternal education, unemployment, and no antenatal care whereas negatively associated with semi-urban residence, poor wealth index, multipara, grand multipara, and facility delivery. Conclusion Less than two-fifths of children aged 12 to 24 months were fully vaccinated. Socio-demographic factors and maternity care utilization were found to be predictors of vaccination coverage. Therefore, strategies that emphasize women’s empowerment in terms of education, economy, and employment status, and enhancing maternal healthcare utilization may improve vaccination coverage.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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22
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Olakunde BO, Adeyinka DA, Olakunde OA, Ogundipe T, Oladunni F, Ezeanolue EE. The coverage of hepatitis B birth dose vaccination in Nigeria: Does the place of delivery matter? Trans R Soc Trop Med Hyg 2021; 116:359-368. [PMID: 34453162 DOI: 10.1093/trstmh/trab129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/09/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hepatitis B birth dose (HepB-BD) vaccination coverage remains suboptimal in Nigeria. While evidence suggests that institutional delivery is associated with the uptake of HepB-BD vaccine, little is known about how the uptake differs by facility ownership (public or private). This study examined the HepB-BD vaccination coverage by place of delivery in Nigeria. METHODS This study is a secondary analysis of data on 6143 children aged 12-23 mo obtained from the 2018 Nigeria Demographic and Health Survey. We assessed the association between HepB-BD vaccination and the place of delivery using logistic regression models. RESULTS About 53% of the children received the HepB-BD vaccine. Approximately 77, 83 and 33% of those delivered at a public health facility, private health facility and at home received the HepB-BD vaccine, respectively. After controlling for child- and maternal-level factors, the odds of receiving HepB-BD vaccine were significantly lower in children delivered at a private health facility (adjusted OR [aOR]=0.77, 95% CI 0.59 to 0.99) or at home (aOR=0.48, 95% CI 0.36 to 0.63). Wealth index and region of residence were significantly associated with the receipt of HepB-BD vaccination in all three places of delivery. CONCLUSIONS Children are less likely to receive the HepB-BD vaccine if they are delivered at a private health facility or at home. There is a need for private health sector engagement for immunization service delivery and innovative community-based interventions to reach the children delivered at home.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja 900284, Nigeria.,Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu 410101, Nigeria
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon SK S7B 5E5, Canada.,Department of Public Health, National AIDS and STI Control Programme, Federal Ministry of Health, Abuja 900211, Nigeria
| | - Olubunmi A Olakunde
- Department of Disease Control and Immunization, Ondo State Primary Health Care Development Agency, Akure, Ondo 340222, Nigeria
| | - Temitayo Ogundipe
- Department of Hospital Medicine, Sentara Williamsburg Regional Medical Center, VA 23188, USA
| | - Filani Oladunni
- Department of Community and Family Medicine, Howard University Hospital, Washington, DC 20060, USA
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu 410101, Nigeria.,Healthy Sunrise Foundation, NV 89107, USA
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23
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Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health 2021; 21:1475. [PMID: 34320942 PMCID: PMC8320032 DOI: 10.1186/s12889-021-11466-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1–59 months were due to vaccine preventable diseases. Despite the benefits of childhood immunisation, routine vaccination coverage for all recommended Expanded Programme on Immunization vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa, as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake. Methods We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords and searching multiple databases (Medline, PubMed, CINAHL and Psychology & Behavioral Sciences Collection) dating back from inception to 2020. Results Out of 18,708 recorded citations retrieved, 10,396 titles were filtered and 324 titles remained. These 324 abstracts were screened leading to 51 included studies. Statistically significant factors found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further categorised into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation, whereas non-modifiable factors were sociodemographic factors of parent and child, logistic and administration factors. Conclusion Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women, focusing on the significant findings from this systematic review, would hopefully improve childhood immunisation uptake in African countries with poor coverage rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11466-5.
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Affiliation(s)
- Abubakar Nasiru Galadima
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
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24
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Tabiri D, Ouédraogo JCRP, Nortey PA. Factors associated with malaria vaccine uptake in Sunyani Municipality, Ghana. Malar J 2021; 20:325. [PMID: 34315489 PMCID: PMC8314499 DOI: 10.1186/s12936-021-03857-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Malaria continues to be a major disease of public health concern affecting several million people worldwide. The World Health Organization (WHO) started a pilot study on a malaria vaccine (RTS,S) in Ghana and two other countries in 2019. This study aimed at assessing the factors associated with uptake of the vaccine in the Sunyani Municipality of Ghana. Methods The study was a cross-sectional study employing a quantitative approach. Stratified sampling technique was used to select respondents. A structured questionnaire was administered to parents/caregivers with children eligible to have taken the first three doses of the malaria vaccine by December 2019. The Child Welfare Clinic (CWC) cards of the eligible children were also inspected. Ordinal logistic regression analysis was done to determine the association between the independent variables and full vaccine uptake. Results Uptake of RTS,S 1 was 94.1%. However, this figure reduced to 90.6% for RTS,S 2, and 78.1% for RTS,S 3. Children with a parent who had been educated up to the tertiary level had 4.72 (AOR: 4.72, 95% CI 1.27–17.55) increased odds of full uptake as compared to those who completed secondary education. Parents whose children had experienced fever as an adverse reaction were more likely to send their children for the malaria vaccine as compared to those whose children had ever suffered abscess as an adverse reaction (AOR: 2.27, 95% CI 1.13–5.10). Children with parents who thought vaccines were becoming too many for children had 71% (AOR: 0.29, 95% CI 0.14–0.61) reduced odds of full uptake as compared to those who thought otherwise. Conclusion Uptake of RTS,S 1 and RTS,S 2 in Sunyani Municipality meets the WHO’s target coverage for vaccines, however, RTS,S 3 uptake does not. Furthermore, there is a growing perception amongst parents/caregivers that vaccines are becoming too many for children which negatively affects uptake.
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Affiliation(s)
- Dennis Tabiri
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana.
| | | | - Priscilla Awo Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
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25
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Eze P, Agu UJ, Aniebo CL, Agu SA, Lawani LO, Acharya Y. Factors associated with incomplete immunisation in children aged 12-23 months at subnational level, Nigeria: a cross-sectional study. BMJ Open 2021; 11:e047445. [PMID: 34172548 PMCID: PMC8237740 DOI: 10.1136/bmjopen-2020-047445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES National immunisation coverage rate masks subnational immunisation coverage gaps at the state and local district levels. The objective of the current study was to determine the sociodemographic factors associated with incomplete immunisation in children at a sub-national level. DESIGN Cross-sectional study using the WHO sampling method (2018 Reference Manual). SETTING Fifty randomly selected clusters (wards) in four districts (two urban and two rural) in Enugu state, Nigeria. PARTICIPANTS 1254 mothers of children aged 12-23 months in July 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Fully immunised children and not fully immunised children. RESULTS Full immunisation coverage (FIC) rate in Enugu state was 78.9% (95% CI 76.5% to 81.1%). However, stark difference exists in FIC rate in urban versus rural districts. Only 55.5% of children in rural communities are fully immunised compared with 94.5% in urban communities. Significant factors associated with incomplete immunisation are: children of single mothers (aOR=5.74, 95% CI 1.45 to 22.76), children delivered without skilled birth attendant present (aOR=1.93, 95% CI 1.24 to 2.99), children of mothers who did not receive postnatal care (aOR=6.53, 95% CI 4.17 to 10.22), children of mothers with poor knowledge of routine immunisation (aOR=1.76, 95% CI 1.09 to 2.87), dwelling in rural district (aOR=7.49, 95% CI 4.84 to 11.59), low-income families (aOR=1.56, 95% CI 1.17 to 2.81) and living further than 30 min from the nearest vaccination facility (aOR=2.15, 95% CI 1.31 to 3.52). CONCLUSIONS Although the proportion of fully immunised children in Enugu state is low, it is significantly lower in rural districts. Study findings suggest the need for innovative solutions to improve geographical accessibility and reinforce the importance of reporting vaccination coverage at local district level to identify districts for more targeted interventions.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
| | - Ujunwa Justina Agu
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chioma Lynda Aniebo
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Sergius Alex Agu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yubraj Acharya
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
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26
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Iribhogbe OI, Tomini S. Vaccination coverage in children resident in a rural community in Nigeria: socio-ecological and contextual determinants. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
The national vaccination coverage rate and the coverage rate in rural communities in Nigeria are below the global vaccine action target of 80%; hence, evaluation of factors that determine vaccination status and determine the proportion of children aged 12–59 months who are fully immunised in the rural community should be conducted.
Methods
A cross-sectional study was conducted using an interview-structured questionnaire that was pilot tested before being administered. In the study, a two-stage sampling technique was used and the sample size was determined using the EPI-Info, version 7, software.
Key Findings
Of the 608 caregiver–child pairs that was assessed, the majority (525, 86.35%) were mothers. Assessment of immunisation status showed that the majority of the children (429, 70.56%) were completely vaccinated while 179 (29.44%) were incompletely vaccinated. Educational status (χ 2 = 59.85, df = 4, P < 0.001), the level of knowledge about vaccination (χ 2 = 77.62, df = 2, P < 0.001), family setting (χ 2 = 27.70, df = 3, P < 0.001), maternal ANC visits (χ 2 = 85.37, df = 2, P < 0.001), type of birth (χ 2 = 7.27, df = 2, P = 0.03) and child’s breastfeeding status (χ 2 = 80.75, df = 2, P < 0.001) were all significantly associated with the vaccination status of the child.
Conclusion
The study has shown that immunisation coverage in the rural community surveyed is still below the expected target; thus, public health intervention should still focus on individual, community, socio-cultural and healthcare-related factors as this will improve the immunisation status of children in rural communities.
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Affiliation(s)
- Osede Ignis Iribhogbe
- Department of Pharmacology & Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine Ambrose Alli University Ekpoma, Edo State, Nigeria
| | - Sonila Tomini
- Department of Public Health University of Roehampton, UK
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27
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Budu E, Seidu AA, Agbaglo E, Armah-Ansah EK, Dickson KS, Hormenu T, Hagan JE, Adu C, Ahinkorah BO. Maternal healthcare utilization and full immunization coverage among 12-23 months children in Benin: a cross sectional study using population-based data. ACTA ACUST UNITED AC 2021; 79:34. [PMID: 33726859 PMCID: PMC7962345 DOI: 10.1186/s13690-021-00554-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/01/2021] [Indexed: 01/24/2023]
Abstract
Background Maternal and child health are important issues for global health policy, and the past three decades have seen a significant progress in maternal and child healthcare worldwide. Immunization is a critical, efficient, and cost-effective public health intervention for newborns. However, studies on these health-promoting indicators in low-income and middle-income countries, especially in sub-Sahara Africa are sparse. We investigated the association between maternal healthcare utilization and complete vaccination in the Republic of Benin. Methods We analysed data from the 2018 Benin Demographic and Health Survey (BDHS). Specifically, the children’s recode file was used for the study. The outcome variable used was complete vaccination. Number of antenatal care visits, assistance during delivery, and postnatal check-up visits were the key explanatory variables. Bivariate and multilevel logistic regression analyses were carried out. The results were presented as unadjusted odds ratios (uOR) and adjusted odds ratios (aOR), with their corresponding 95% confidence intervals (CIs) signifying their level of precision. Statistical significance was declared at p < 0.05. Results The prevalence of full immunization coverage in Benin was 85.4%. The likelihood of full immunization was lower among children whose mothers had no antenatal care visits, compared to those whose mothers had 1–3 visits [aOR = 0.11, 95% CI: 0.08–0.15], those who got assistance from Traditional Birth Attendants/other during delivery, compared to those who had assistance from Skilled Birth Attendants/health professionals [aOR = 0.55, 95% CI: 0.40–0.77], and mothers who had no postnatal care check-up visit, compared to those who had postnatal care check-up < 24 h after delivery [aOR = 0.49, 95% CI: 0.36–0.67]. With the covariates, religion, partner’s level of education, parity, wealth quintile, and place of residence also showed significant associations with full immunization. Conclusion The study has demonstrated strong association between full immunization and antenatal care, skilled attendance at birth, and postnatal care check-up visit. We found that full immunization decreases among women with no antenatal care visits, those who receive assistance from Traditional Birth Attendants during delivery, and those who do not go for postnatal care visits. To help achieve full immunization, it is prudent that the government of Benin collaborates with international organisations such as WHO and UNICEF to provide education to pregnant women on the importance of immunization after delivery. Such education can be embedded in the antenatal care, delivery and postnatal care services offered to pregnant women during pregnancy, delivery, and after delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00554-y.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Kwesi Armah-Ansah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Hormenu
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana.,Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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28
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Umoke PCI, Umoke M, Nwalieji CA, Igwe FO, Umoke UG, Onwe RN, Nwazunku AA, Nwafor IE, Chukwu OJ, Eyo N, Ugwu A, Ogbonnaya K, Okeke E, Eke DO. Investigating Factors Associated with Immunization Incompletion of Children Under Five in Ebonyi State, Southeast Nigeria: Implication for Policy Dialogue. Glob Pediatr Health 2021; 8:2333794X21991008. [PMID: 33614848 PMCID: PMC7868489 DOI: 10.1177/2333794x21991008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/10/2020] [Accepted: 01/08/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose. To investigate factors associated with immunization incompletion of children under 5 years in Ebonyi state, Southeastern part of Nigeria. Method. A cross-sectional and a cluster sampling design were implemented; 400 women of childbearing age in families with children between 0 to 59 months of age were interviewed in Ebonyi state. Demographic characteristics of the child and mother, the child’s immunization history, and reasons for partial immunization were obtained with the use of a self-administered questionnaire. Data were analyzed using descriptive statistics of mean, standard deviation, t-test and ANOVA with SPSS version 23 and hypothesis tested at P < .05. Results. Findings revealed that 180 (48.1%) females, and 194 (51.9%) males’ children were immunized; Less than half 155 (41.9%) of the children had 1 missed dose, considered as partial immunization cases indicating low coverage. Of the reasons given for incomplete immunization mothers, mothers agreed that immunization centers are far from home (x̄ = 2.55 ± 0.92). This reason significantly affects mothers who were young (≤20 years) (x = 2.86 ± 0.94; P = .018), single (x = 2.84 ± 1.05; 0.037), had secondary education (x = 2.65 ± 1.08;0.000), students (2.89 ± 1.08; P = .000), poor (x = 2.63 ± 1.05; P = .009), and primiparous (x = 2.50 ± 1.08; P = .036) are more affected and they agreed (grand mean >2.50). Conclusion. Immunization coverage was low, and far location from health facility was indicted thus policy implementers should locate health facilities close to homes. also health education on the importance of immunization should be given to mothers especially those who are young and has low socio-economic status.
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Affiliation(s)
| | - MaryJoy Umoke
- Ebonyi State Ministry of Health, Abakaliki, Ebonyi State, Nigeria
| | | | | | | | | | | | | | - Obinna Jude Chukwu
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria
| | - Nora Eyo
- WHO Office, Ebonyi State, Nigeria
| | | | - Kalu Ogbonnaya
- Ebonyi State Ministry of Health, Abakaliki, Ebonyi State, Nigeria
| | | | - David Onyemaechi Eke
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria
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29
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Prevalence and predictors of vaccine hesitancy among expectant mothers in Enugu metropolis, South-east Nigeria. J Public Health Policy 2021; 42:222-235. [PMID: 33568746 DOI: 10.1057/s41271-020-00273-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/21/2022]
Abstract
Vaccine hesitancy, defined as delay in acceptance or refusal of vaccines despite availability of vaccinations services, constrains control of vaccine-preventable diseases. This study determined the prevalence and correlates of vaccine hesitancy among pregnant women attending a university teaching hospital in Enugu metropolis, South-east Nigeria using cross-sectional survey and parent attitudes about childhood vaccines (PACV) questionnaire. We dichotomised the 256 expectant mother participants into hesitant and non-hesitant categories using median PACV and sub-scale scores. Overall, 31.6% of participants were hesitant. About 17.6%, 14.8%, and 30.9% of mothers were hesitant due to their vaccination behaviour, beliefs about vaccine safety and efficacy, and general attitudes and trust of service providers, respectively. Mothers aged less than 30 years were three times more likely to be vaccine hesitant than older ones. Public health practitioners should target young, expectant mothers by developing and conducting vaccine hesitancy screening, focused health education, and information campaigns. The prevalence of childhood vaccine hesitancy among expectant mothers is high. Younger expectant mothers are more likely to be vaccine hesitant than older ones. Involvement of maternal health service workers to provide vaccine literacy and to support expectant mothers to make informed decision about childhood vaccination might be helpful in reducing vaccine hesitancy.
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30
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Mohamud Hayir TM, Magan MA, Mohamed LM, Mohamud MA, Muse AA. Barriers for full immunization coverage among under 5 years children in Mogadishu, Somalia. J Family Med Prim Care 2020; 9:2664-2669. [PMID: 32984104 PMCID: PMC7491846 DOI: 10.4103/jfmpc.jfmpc_119_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Immunization is amongst the most cost-effective public health interventions for reducing childhood morbidity and mortality. However, globally 9 million deaths of children occur as a result of vaccine-preventable diseases in which 4.4 million are from the sub-Saharan region. Therefore, this study aimed to assess barriers for complete vaccination coverage among under five years children in Mogadishu, Somalia. Methods: A community-based cross-sectional study was conducted between April to July 2019 in Mogadishu-Somalia. Two-stage cluster sampling with systematic random sampling was used to select a sample of 820 households. Data was collected through a structured, interviewer administrator questionnaire. In case more eligible children found at a single selected household, one child was randomly selected and the information related to immunization was interviewed from his/her caregiver. Results: The overall, fully vaccinated under 5 years children were found to be 45.2%. Immunization was found to be increased by being a younger caregiver (β=-0.024, P-Value=0.019) being father with secondary and above education (AOR = 1.755, 95% CI = 1.161–2.655, P-Value = 0.008), being a young child (β = −0.018, P-value = 0.011), being children from birth order of fifth and above (AOR = 1.539, 95% CI = 1.011–2.343, P-value = 0.044), being a married caregiver (AOR = 4.101, 95% CI=1.062-15.835, P-Value = 0.041), increased monthly family income (β =0.003, P-value = 0.000), availability of vaccine at the time of visit (AOR = 6.147, 95% CI = 1.943–19.441, P-value = 0.002), cost affordability of vaccine (AOR = 1.951, 95% CI = 1.238–3.076, P-value = 0.004), being born at health facility (AOR = 1.517, 95% CI = 1.104–2.086, P-value = 0.010), having good knowledge on immunization (AOR = 1.125, 95% CI = 1.070–1.181, P-value = 0.001), having good practice on immunization (AOR = 2.756, 95% CI = 2.233–3.402, P-value = 0.001) and having good perception on vaccine (AOR = 4.976, 95% CI = 2.183–11.340, P-value = 0.001). Conclusion: The result of this study has revealed that the proportion of fully immunized under-5 children in Mogadishu is very low. Several factors were found to the barriers achieving full immunization coverage. Steps to promote health education and vaccine availability should be lounged.
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Affiliation(s)
| | - Mohamed A Magan
- Faculty of Medicine and Surgery, Jazeera University, Mogadishu, Somalia
| | - Lul M Mohamed
- Faculty of Medicine and Surgery, Jazeera University, Mogadishu, Somalia
| | - Mohamed A Mohamud
- Faculty of Medicine and Surgery, Jazeera University, Mogadishu, Somalia
| | - Abdishakur A Muse
- Faculty of Medicine and Surgery, Jazeera University, Mogadishu, Somalia
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Puri P, Khan J, Shil A, Ali M. A cross-sectional study on selected child health outcomes in India: Quantifying the spatial variations and identification of the parental risk factors. Sci Rep 2020; 10:6645. [PMID: 32313048 PMCID: PMC7170851 DOI: 10.1038/s41598-020-63210-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/26/2020] [Indexed: 12/02/2022] Open
Abstract
This study examined association between selected child health indicators- anaemia, stunting and no/incomplete immunization by inter-linking maternal characteristics at district level and parental characteristics at individual level. A spatial analysis and a binary logit model estimation were employed to draw inferences using the data from the fourth round of National Family Health Survey, 2015-16 of India. Significant spatial clustering of the selected child health outcomes was observed in the country. Mother's educational attainment explained significant district level differential in the selected child health outcomes. At the individual level, parents who are very young, not-educated, socially excluded, belong to poor class were found to be significantly associated with the poor child health outcomes. This study indicates that parental characteristics, such as age, educational attainment and employment substantially determine child health in India, suggesting that an intervention by targeting the households where children are vulnerable is important to improve child health in the country.
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Affiliation(s)
- Parul Puri
- Doctoral Fellow, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Junaid Khan
- Doctoral Fellow, International Institute for Population Sciences, Govandi Station Road, Mumbai, 400088, Maharashtra, India.
| | - Apurba Shil
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
- Doctoral Fellow, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Mohammad Ali
- Senior Scientist, Department of International Health, Johns Hopkins University, Baltimore, Maryland, 21205, United States of America
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Dansereau E, Brown D, Stashko L, Danovaro-Holliday MC. A systematic review of the agreement of recall, home-based records, facility records, BCG scar, and serology for ascertaining vaccination status in low and middle-income countries. Gates Open Res 2020; 3:923. [PMID: 32270134 DOI: 10.12688/gatesopenres.12916.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Household survey data are frequently used to estimate vaccination coverage - a key indicator for monitoring and guiding immunization programs - in low and middle-income countries. Surveys typically rely on documented evidence from home-based records (HBR) and/or maternal recall to determine a child's vaccination history, and may also include health facility sources, BCG scars, and/or serological data. However, there is no gold standard source for vaccination history and the accuracy of existing sources has been called into question. Methods and Findings: We conducted a systematic review of literature published January 1, 1975 through December 11, 2017 that compared vaccination status at the child-level from at least two sources of vaccination history. 27 articles met inclusion criteria. The percentage point difference in coverage estimates varied substantially when comparing caregiver recall to HBRs (median: +1, range: -43 to +17), to health facility records (median: +5, range: -29 to +34) and to serology (median: -20, range: -32 to +2). Ranges were also wide comparing HBRs to facility-based records (median: +17, range: -61 to +21) and to serology (median: +2, range: -38 to +36). Across 10 studies comparing recall to HBRs, Kappa values exceeded 0.60 in 45% of comparisons; across 7 studies comparing recall to facility-based records, Kappa never reached 0.60. Agreement varied depending on study setting, coverage level, antigen type, number of doses, and child age. Conclusions: Recall and HBR provide relatively concordant vaccination histories in some settings, but both have poor agreement with facility-based records and serology. Long-term, improving clinical decision making and vaccination coverage estimates will depend on strengthening administrative systems and record keeping practices. Short-term, there must be greater recognition of imperfections across available vaccination history sources and explicit clarity regarding survey goals and the level of precision, potential biases, and associated resources needed to achieve these goals.
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Affiliation(s)
- Emily Dansereau
- Strategic Information Group, Expanded Program on Immunization (EPI), Department of Immunizaztion, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - David Brown
- Brown Consulting Group Int'l LLC, Cornelius, NC, USA
| | - Lena Stashko
- Strategic Information Group, Expanded Program on Immunization (EPI), Department of Immunizaztion, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - M Carolina Danovaro-Holliday
- Strategic Information Group, Expanded Program on Immunization (EPI), Department of Immunizaztion, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Debie A, Lakew AM. Factors associated with the access and continuum of vaccination services among children aged 12-23 months in the emerging regions of Ethiopia: evidence from the 2016 Ethiopian demography and health survey. Ital J Pediatr 2020; 46:28. [PMID: 32131868 PMCID: PMC7057504 DOI: 10.1186/s13052-020-0793-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Child vaccination is an instrument for saving millions of lives. Only one in twenty children has access to childhood vaccination in hard to reach areas in developing countries. Although studies have been done on childhood vaccination, factors associated with access and continuum were not considered in Ethiopia. Therefore, this study aimed to identify the factors associated with the access and continuum of childhood vaccination in the emerging regions of Ethiopia based on the 2016 EDHS datasets. Methods The two-stage stratified sampling technique was used for the survey carried out on 642 mothers of children aged 12–23 months. Access is the provision of services in shorter waiting times and flexibly at all times and alternative methods of communication. Accordingly, continuum of care reflects the extent to which a series of discrete health care events are being experienced by people coherently and interconnected over time. As a result, access and continuum of childhood vaccination are determined using pentavalent-1 and measles vaccination status of children, respectively. A binary logistic regression model was fitted to identify the factors associated with access and continuum of the vaccination. Results Overall, 25.1% of children aged 12–23 months received all of the recommended childhood vaccines. Sixty-two percent of children accessed and 46.9% had continuum of childhood vaccination in the emerging regions of Ethiopia. Pentavalent_1 to 3 and BCG to measles dropout rates were 33.42 and 17.53%, respectively. Mothers’ formal education (AOR = 1.99; 95%CI: 1.20, 3.31), ANC (AOR = 4.13; 95%CI: 2.75,6.19), health facility delivery of last birth (AOR = 1.58; 95%CI: 1.19, 2.82), rich wealth (AOR = 1.57; 95%CI: 1.19, 3.14) and average child birth weight (AOR = 1.67; 95%CI: 1.03, 2.72) were positively associated with childhood access to vaccination. On the other hand, mothers’ ANC attendance (AOR = 3.68; 95%CI: 2.48, 5.47) and rich wealth (AOR = 2.07; 95%CI: 1.15, 3.71) were positively associated with the continuum of the services. On the contrary, children with rural resident mothers (AOR = 0.33; 95%CI: 0.14, 0.76) and small birth weight (AOR = 0.51; 95%CI: 0.33, 0.81) were negatively associated to the access and continuum of childhood vaccination, respectively. Conclusion Childhood vaccination status was low in the emerging regions of Ethiopia. Variables such as maternal education, birth weight of children, ANC, health facility delivery and wealth were associated with the access and continuum of the vaccination. Therefore, empowering women with education and strengthening maternal healthcare services might enhance childhood vaccination. In addition, the government needs to design a compensation mechanism for the cost relating to childhood vaccination to improve the access and continuum of the service.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Health Policy, Institute of Public Health, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Dansereau E, Brown D, Stashko L, Danovaro-Holliday MC. A systematic review of the agreement of recall, home-based records, facility records, BCG scar, and serology for ascertaining vaccination status in low and middle-income countries. Gates Open Res 2020; 3:923. [PMID: 32270134 PMCID: PMC7110941 DOI: 10.12688/gatesopenres.12916.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Household survey data are frequently used to estimate vaccination coverage - a key indicator for monitoring and guiding immunization programs - in low and middle-income countries. Surveys typically rely on documented evidence from home-based records (HBR) and/or maternal recall to determine a child’s vaccination history, and may also include health facility sources, BCG scars, and/or serological data. However, there is no gold standard source for vaccination history and the accuracy of existing sources has been called into question. Methods and Findings: We conducted a systematic review of literature published January 1, 1975 through December 11, 2017 that compared vaccination status at the child-level from at least two sources of vaccination history. 27 articles met inclusion criteria. The percentage point difference in coverage estimates varied substantially when comparing caregiver recall to HBRs (median: +1, range: -43 to +17), to health facility records (median: +5, range: -29 to +34) and to serology (median: -20, range: -32 to +2). Ranges were also wide comparing HBRs to facility-based records (median: +17, range: -61 to +21) and to serology (median: +2, range: -38 to +36). Across 10 studies comparing recall to HBRs, Kappa values exceeded 0.60 in 45% of comparisons; across 7 studies comparing recall to facility-based records, Kappa never reached 0.60. Agreement varied depending on study setting, coverage level, antigen type, number of doses, and child age. Conclusions: Recall and HBR provide relatively concordant vaccination histories in some settings, but both have poor agreement with facility-based records and serology. Long-term, improving clinical decision making and vaccination coverage estimates will depend on strengthening administrative systems and record keeping practices. Short-term, there must be greater recognition of imperfections across available vaccination history sources and explicit clarity regarding survey goals and the level of precision, potential biases, and associated resources needed to achieve these goals.
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Affiliation(s)
- Emily Dansereau
- Strategic Information Group, Expanded Program on Immunization (EPI), Department of Immunizaztion, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - David Brown
- Brown Consulting Group Int'l LLC, Cornelius, NC, USA
| | - Lena Stashko
- Strategic Information Group, Expanded Program on Immunization (EPI), Department of Immunizaztion, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - M Carolina Danovaro-Holliday
- Strategic Information Group, Expanded Program on Immunization (EPI), Department of Immunizaztion, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Okenwa UJ, Dairo MD, Bamgboye E, Ajumobi O. Maternal knowledge and infant uptake of valid hepatitis B vaccine birth dose at routine immunization clinics in Enugu State - Nigeria. Vaccine 2020; 38:2734-2740. [PMID: 32007294 DOI: 10.1016/j.vaccine.2020.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/14/2019] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND World Health Organization recommends hepatitis B vaccine birth dose for all infants within 24 hours of birth as the most cost-effective measure to prevent perinatal hepatitis B virus infection (HBV). We assessed and identified the predictors of maternal knowledge and infants' uptake of valid hepatitis B vaccine birth dose (HepB-BD). METHODS We conducted a hospital-based cross-sectional survey among 366 mother-infant attendees of routine immunization clinics selected by multi-stage sampling technique in Enugu State, Nigeria. We collected data on socio-demographic characteristics, delivery history, maternal knowledge and infant's receipt of valid HepB-BD with interviewer-administered questionnaire. Maternal knowledge was assessed using nine domain questions. Overall, good knowledge was defined as a score of ≥50%. Only infants who received first hepatitis B dose within 24 hours were considered to have received valid BD. We calculated frequencies, performed Chi square test and logistic regression. RESULTS One hundred and two (29.7%) mothers knew HBV can be transmitted from mother to child; 119 (34.6%) and 156 (45.3%) knew their infant should receive valid HepB-BD and four doses for full immunization of HepB respectively. Overall, 114 (31.1%) mothers had good knowledge of HBV and 88 (26.9%) of 327 who delivered at the health facilities had valid HepB-BD. Predictors of maternal knowledge were attainment of tertiary education (adjusted Odds Ratio (aOR): 2.1, 95%CI: 1.3-3.5) and living in rural areas (aOR: 0.5, 95%CI: 0.3-0.9). Predictors of valid HepB-BD uptake were maternal knowledge (aOR: 2.4, 95%CI: 1.4-4.0) and delivery at facilities offering routine immunization services (aOR: 5.4, 95%CI: 2.5-11.9). CONCLUSION Knowledge and uptake of valid HepB-BD were low. Health education on benefits of valid HepB-BD was given to mothers after administration of questionnaires. We disseminated findings to the State Ministry of Health and recommended integration of child delivery and immunization services for birth dose vaccines especially valid HepB-BD.
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Affiliation(s)
- Uchechukwu Joel Okenwa
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; Enugu State Ministry of Health, Enugu, Nigeria.
| | - Magbagbeola David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Eniola Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; School of Community Health Sciences, University of Nevada, Reno, United States; Federal Ministry of Health, Abuja, Nigeria
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Jillian O, Kizito O. Socio-Cultural Factors Associated with Incomplete Routine Immunization of Children _ Amach Sub-County, Uganda. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1848755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Meshram P, Ratta A. Study of determinants of immunization status among under-five children attending OPD in a rural health center of the tertiary health care institute. J Family Med Prim Care 2020; 9:2724-2729. [PMID: 32984115 PMCID: PMC7491797 DOI: 10.4103/jfmpc.jfmpc_387_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 11/04/2022] Open
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Maternal reasons for non-receipt of valid Hepatitis B birth dose among mother-infant pairs attending routine immunization clinics, South-east, Nigeria. Vaccine 2019; 37:6894-6899. [PMID: 31562005 DOI: 10.1016/j.vaccine.2019.09.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hepatitis B vaccine (HepB) is an effective tool in prevention of hepatitis B virus (HBV) infection. When administered at birth, it prevents mother-to-child transmission of acute and chronic HBV infection. However, despite a decade and half of implementation of HepB birth dose (HepB-BD), uptake has remained persistently low in Enugu State, Nigeria. We assessed the uptake of valid HepB-BD and the reasons given by mothers of infants for not receiving the HepB-BD in Enugu State, South-east Nigeria. METHODS An hospital-based cross-sectional survey was conducted among mother-infant pairs attending immunization clinics at randomly selected health facilities in Enugu State, Nigeria. Overall, 344 mothers and their infant children in this study were interviewed using structured questionnaire. Data on maternal reasons for non-receipt of valid HepB-BD by their infants and their recommendations on ways to improve valid HepB-BD uptake, were collected. We defined valid birth dose as the receipt of first dose of HepB within 24 h of birth. RESULTS Overall, 254 (73.8%) infants did not receive valid HepB-BD. Major reasons for its non-receipt were vaccine not available at place of delivery (91.3%, n = 232), delivery did not take place on immunization day (75.6%, n = 192), lack of awareness on timing of valid HepB-BD (72.8%, n = 185), long distance from the health facility (5.1%, n = 13) and fee payment for immunization (6.3%, n = 16). Of the 384 maternal recommendations, 143 (37.2%) emphasized female literacy while 87 (22.7%) indicated pre-positioning the vaccines at labor rooms to improve valid HepB-BD uptake. CONCLUSION The low receipt of valid HepB-BD among infants attending routine immunization clinics, found in this study were attributed to lack of maternal awareness on timing of HepB-BD and poor integration of child delivery and immunization services. We recommend educating mothers on benefits of a timely HepB-BD and pre-positioning the vaccines at the labor rooms.
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Ntenda PAM, Nkoka O, Nana AW, Majoni P, Mhone TG, Tizifa T, Mwenyenkulu ET, Kazambwe JF, Putthanachote N, Motsa MPS. Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015-16 Malawi demographic and health survey. Trans R Soc Trop Med Hyg 2019; 113:534-544. [PMID: 31034078 DOI: 10.1093/trstmh/trz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 2010 and 2015, the percentage of children 12-23 months of age who received full immunization in Malawi decreased from 81% to 76%, prompting us to investigate the factors associated with completion of childhood immunization in Malawi. METHODS Using data from the 2015-16 Malawi Demographic and Health Survey, generalized linear mixed models were applied on 3145 children 12-23 months of age nested within 850 communities. Complete immunization was defined as the child having received a Bacillus Calmette-Guerin, three doses of pentavalent vaccine, four doses of oral polio vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine and one dose of measles vaccine before their first birthday. RESULTS Adjusted multilevel regression showed that children born to mothers with either none or one antenatal care visit (adjusted odds ratio [aOR] 0.56 [95% confidence interval {CI} 0.32 to 0.93]) and whose mothers had no card or no longer had a vaccination card (aOR 0.06 [95% CI 0.04 to 0.07]) were less likely to receive complete immunization. In addition, children from the poorest households (aOR 0.60 [95% CI 0.40 to 0.92]) and who resided in communities with a medium (aOR 0.73 [95% CI 0.53 to 0.98]) or high percentage (aOR 0.73 [95% CI 0.53 to 0.99]) of households that perceived the distance to the nearest health facility as a big problem had reduced odds of achieving complete immunization. Furthermore, the findings showed evidence of clustering effects of childhood complete immunization at the community level. CONCLUSIONS Our findings show that a series of sociodemographic, health and contextual factors are associated with the completion of childhood vaccination. Therefore interventions that aim at increasing the completion of childhood immunization in Malawi should not only address individual needs, but should also consider contextual factors and the communities addressed in this study.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | | | - Precious Majoni
- Department of Computer Science, Chancellor College, University of Malawi, Zomba, Malawi
| | - Thomas Gabriel Mhone
- Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, No. 100, Shiquan 1st Road, Sanmin District, Kaohsiung City, Taiwan
| | - Tinashe Tizifa
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Edward Tisungane Mwenyenkulu
- School of International Education, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, Guangdong, People's Republic of China
| | - Jane Flora Kazambwe
- NBS, House Corner Chipembere Highway & Johnstone Roads Ginnery Corner Blantyre, Chichiri, Blantyre, Malawi
| | - Nuntiput Putthanachote
- Roi Et Hospital, 111 Ronnachaicharnyut Soi 13, Tambon Nai Mueang, Amphoe Mueang Roi Et, Roi Et Province, Thailand
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Limaye RJ, Sara AB, Siddique AR, Vivas C, Malik S, Omonoju K. Interpersonal and community influences affecting childhood vaccination decision-making among Nigerian caregivers: Perceptions among frontline workers in Nigeria. J Child Health Care 2019; 23:403-414. [PMID: 31122059 DOI: 10.1177/1367493519852457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although routine immunization has contributed to a substantial reduction in mortality from vaccine-preventable diseases globally, vaccine-preventable diseases are attributable for 22% of childhood deaths in Nigeria. Individual and structural level factors that influence vaccination uptake in Nigeria have been well documented. However, there is limited information about the role of interpersonal and community level factors. Frontline workers play a crucial role in delivering life-saving vaccines in Nigeria, as they are tasked with ensuring that all children are vaccinated, within the health system as well as traveling to underserved areas, where health systems are not able to reach. This qualitative study conducted focus groups to examine frontline workers' perceptions of influences affecting caregivers' vaccine-related decision-making. Community- and facility-based frontline workers (n = 47) identified village and community chiefs, as well as religious leaders as influential within the context of immunization uptake because of their trusted role within communities. Male partners and husbands were identified as also holding an enormous level of influence over childhood vaccination, and the credibility of frontline workers influenced vaccination coverage. Immunization programs should target not only caregivers but also key influencers-such as interpersonal and community sources-to make progress in reaching vaccination coverage goals.
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Affiliation(s)
- Rupali J Limaye
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Ballard Sara
- 2 Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | | | | | - Kanayo Omonoju
- 5 Centre for Communication and Social Impact, Abuja, Nigeria
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Hailu S, Astatkie A, Johansson KA, Lindtjørn B. Low immunization coverage in Wonago district, southern Ethiopia: A community-based cross-sectional study. PLoS One 2019; 14:e0220144. [PMID: 31339939 PMCID: PMC6655723 DOI: 10.1371/journal.pone.0220144] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Immunization is a cost-effective intervention that prevented more than 5 million deaths worldwide from 2010 to 2015. Despite increased vaccination coverage over the past four decades in many African countries, including Ethiopia, universal coverage has not yet been reached. Only 39% of children aged 12-23 months received full vaccinations in Ethiopia, according to the 2016 Ethiopian Demographic Health Survey. This study aimed to evaluate immunization coverage and identify individual and community factors that explain incomplete vaccination coverage among children aged 6-36 months in the Wonago district of southern Ethiopia. METHODS We conducted a community-based, cross-sectional study in three randomly selected kebeles in the Wonago district from June to July 2017. Our nested sample of 1,116 children aged 6-36 months included 923 child-mother pairs (level 1) within kebeles (level 2). We conducted multilevel regression analysis using STATA software. RESULTS Among participants, 85.0% of children aged 12-36 months received at least one vaccine, and 52.4% had complete immunization coverage. After controlling for several individual and community variables, we identified six significant predictor variables for complete immunization: Older mothers' age (AOR = 1.05, 95% CI: 1.00-1.09), higher utilization of antenatal care (AOR = 1.36, 95% CI: 1.14-1.62), one or more tetanus-toxoid vaccination during pregnancy (AOR = 2.64, 95% CI: 1.43-4.86), mothers knowing the age at which to complete child's vaccinations (AOR = 2.00, 95% CI: 1.25-3.20), being a female (AOR = 0.64, 95% CI: 0.43-0.95), and child receiving vitamin A supplementation within the last 6 months (AOR = 2.79, 95% CI: 1.59-4.90). We observed a clustering effect at the individual and community levels with an intra-cluster correlation coefficient of 48.1%. CONCLUSIONS We found low immunization coverage among children in the Wonago district of southern Ethiopia, with significant differences across communities. Promoting maternal health care and community service could enhance immunization coverage.
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Affiliation(s)
- Samrawit Hailu
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.,School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Ayalew Astatkie
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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Anichukwu OI, Asamoah BO. The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria: a cross-sectional study. BMJ Open 2019; 9:e026324. [PMID: 31221876 PMCID: PMC6588997 DOI: 10.1136/bmjopen-2018-026324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria. DESIGN Individual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the association between MHC utilisation and routine immunisation coverage of children. SETTING Nigeria Demographic and Health Survey 2013. PARTICIPANTS 5506 women aged 15-49 years with children aged 12-23 months born in the 5 years preceding the survey. PRIMARY OUTCOME MEASURES Fully immunised children and not fully immunised children. RESULTS The percentage of children fully immunised with basic routine childhood vaccines by the age of 12 months was 25.8%. Antenatal care (ANC) attendance irrespective of the number of visits (adjusted OR (AOR)1-3 visits 2.4, 95% CI 1.79 to 3.27; AOR4-7 visits 3.2, 95% CI 2.52 to 4.13; AOR≥ 8 visits 3.5, 95% CI 2.64 to 4.50), skilled birth attendance (SBA) (AOR 1.9, 95% CI 1.65 to 2.35); and maternal postnatal care (PNC) (AOR 1.7, 95% CI 1.46 to 2.06) had positive effects on the child being fully immunised after adjusting for covariates (except for each other, ie, ANC, SBA and PNC). Further analyses (adjusting stepwise for each MHC service) showed a mediation effect that led to the effect of PNC not being significant. CONCLUSIONS The percentage of fully immunised children in Nigeria was very low. ANC attendance, SBA and maternal PNC attendance had positive impact on the child being fully immunised. The findings suggest that strategies aimed at maximising MHC utilisation in Nigeria could be effective in achieving the national coverage target of at least 80% for routine immunisation of children.
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Affiliation(s)
- Onyekachi Ibenelo Anichukwu
- International Masters Programme in Public Health, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Benedict Oppong Asamoah
- Department of Clinical Sciences, Malmo, Social Medicine and Global Health, Lund University, Lund, Sweden
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43
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Full Immunization Coverage and Associated Factors among Children Aged 12-23 Months in a Hard-to-Reach Areas of Ethiopia. Int J Pediatr 2019; 2019:1924941. [PMID: 31263502 PMCID: PMC6556785 DOI: 10.1155/2019/1924941] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/20/2019] [Accepted: 05/19/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Childhood immunization averts 2.5 million annual child deaths globally. However, poor monitoring, possibly due to a lack of locally available data on immunization, might affect full protection of vaccines from Vaccine Preventable Diseases. This study was aimed at bringing data about immunization service coverage and its associated factors from Sekota Zuria district, which is one of the hard-to-reach areas in Amhara Region, Ethiopia. Methods A community-based cross-sectional study was conducted from September 20 to October 28, 2017, among 620 children aged 12-23 months in seven randomly selected rural kebeles of Sekota Zuria district. Socio-demographic child conditions and vaccine-related data were collected using a pretested interviewer-administered questionnaire. Multivariable logistic regression analysis was carried out to identify factors associated with immunization coverage at a p-value ≤ 0.05. Crude and Adjusted Odds Ratio (AOR) with their confidence interval were reported. Results 77.4% (95%CI: 74.0%-80.6%) of children aged 12-23 months were fully immunized. Having antenatal care visit (AOR=2.75, 95%CI: 1.52-5.0), higher level of maternal education (AOR=2.39, 95%CI: 1.06-5.36), mothers' good knowledge on immunization (AOR=3.70, 95%CI: 2.37-5.79), short distance to health facility (AOR=2.65, 95%CI: 1.61-4.36), and being born in health institutions (AOR=2.58, 95%CI: 1.66-3.99) had increased the odds of full immunization coverage while having five and more family size reduced the odds of children's vaccine uptake (AOR=0.62, 95%CI: 0.38-0.99). Conclusion Full immunization coverage of the district was lower than the target set by the World Health Organization. Improving mother's health seeking behavior toward pregnancy follow-up and enhancing mothers' knowledge on child immunization, strengthening outreach services, community engagement, and actively working with local community-based health agents are recommended to increase number of children to be vaccinated.
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44
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Utazi CE, Thorley J, Alegana VA, Ferrari MJ, Takahashi S, Metcalf CJE, Lessler J, Cutts FT, Tatem AJ. Mapping vaccination coverage to explore the effects of delivery mechanisms and inform vaccination strategies. Nat Commun 2019; 10:1633. [PMID: 30967543 PMCID: PMC6456602 DOI: 10.1038/s41467-019-09611-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/21/2019] [Indexed: 12/02/2022] Open
Abstract
The success of vaccination programs depends largely on the mechanisms used in vaccine delivery. National immunization programs offer childhood vaccines through fixed and outreach services within the health system and often, additional supplementary immunization activities (SIAs) are undertaken to fill gaps and boost coverage. Here, we map predicted coverage at 1 × 1 km spatial resolution in five low- and middle-income countries to identify areas that are under-vaccinated via each delivery method using Demographic and Health Surveys data. We compare estimates of the coverage of the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3), which is typically delivered through routine immunization (RI), with those of measles-containing vaccine (MCV) for which SIAs are also undertaken. We find that SIAs have boosted MCV coverage in some places, but not in others, particularly where RI had been deficient, as depicted by DTP coverage. The modelling approaches outlined here can help to guide geographical prioritization and strategy design.
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Affiliation(s)
- C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK.
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Julia Thorley
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
| | - Victor A Alegana
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
- Flowminder Foundation, Stockholm SE, 11355, Sweden
| | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, PA, 16802, USA
| | - Saki Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, 08544, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, 08544, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK
- Flowminder Foundation, Stockholm SE, 11355, Sweden
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45
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Nozaki I, Hachiya M, Kitamura T. Factors influencing basic vaccination coverage in Myanmar: secondary analysis of 2015 Myanmar demographic and health survey data. BMC Public Health 2019; 19:242. [PMID: 30819127 PMCID: PMC6394082 DOI: 10.1186/s12889-019-6548-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization is one of the most effective measures for preventing disease when vaccination coverage is sufficient. Although vaccination coverage is known to be influenced by social and cultural barriers, the determinants of childhood immunization in Myanmar remain poorly understood. This study analyzed factors that influenced complete vaccination status (one dose each for Bacillus Calmette-Guérin and measles and three doses each for diphtheria-pertussis and polio) using 2015 data from the Myanmar Demographic Health and Survey. METHODS Data from 12 to 23-month-old children and their mothers were extracted from the nationally representative survey results. Bivariate and multivariate analyses with survey-weighted logistic regression were performed to examine the relationships between vaccination status and various sociodemographic and medical factors. The independent variables for the analyses included area of residence, economic status, maternal age, marital status, education, literacy, employment status, antenatal care attendance, tetanus vaccination, place of delivery, postnatal evaluations, child's sex, number of children, previous child death, decision maker(s) regarding child's health, frequency of healthcare visits, paternal education, and paternal occupation. RESULTS A representative sample of 904 cases were extracted for the analysis. The overall complete vaccination rate was 55.4%. In the multivariate analysis with backward step-wise selection, complete vaccination was independently associated with middle or high economic status (adjusted odds ratio [AOR]: 2.64, 95% confidence interval [CI]: 1.85-3.78), older maternal age (AOR: 2.87, 95% CI: 1.62-5.10), ≥4 antenatal care visits (AOR: 1.87, 95% CI: 1.28-2.73), and maternal tetanus vaccination before delivery (AOR: 3.26, 95% CI: 1.82-5.85). CONCLUSION The first Demographic and Health Survey in Myanmar revealed that only approximately one-half of 12-23-year-old children had received complete vaccination, which was lower than the estimated rate from routine administrative coverage. Our results indicate that incomplete immunization status was associated with low economic status, younger maternal age, fewer antenatal care visits, and no maternal tetanus vaccination. These findings may help improve the targeting and strategic implementation of the Expanded Programme on Immunization.
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Affiliation(s)
- Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan. .,Ministry of Health, Naypyidaw, Myanmar.
| | - Masahiko Hachiya
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Tomomi Kitamura
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan
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46
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Sibeudu FT, Uzochukwu BS, Onwujekwe OE. Rural-urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria. SAGE Open Med 2019; 7:2050312118823893. [PMID: 30719291 PMCID: PMC6348577 DOI: 10.1177/2050312118823893] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives: The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas. Method: The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses. Result: Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05). Conclusion: Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.
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Affiliation(s)
- Florence Tochukwu Sibeudu
- Department of Nursing Science, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Benjamin Sc Uzochukwu
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna E Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
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47
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Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaoundé. Vaccine 2018; 36:7549-7555. [DOI: 10.1016/j.vaccine.2018.10.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
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48
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Larson Williams A, Mitrovich R, Mwananyanda L, Gill C. Maternal vaccine knowledge in low- and middle-income countries-and why it matters. Hum Vaccin Immunother 2018; 15:283-286. [PMID: 30252609 PMCID: PMC6422451 DOI: 10.1080/21645515.2018.1526589] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/13/2018] [Indexed: 11/26/2022] Open
Abstract
Maternal vaccines have the potential to reduce the global burden of neonatal morbidity and mortality by accessing the infant immune system before a vaccine administered in childhood would be effective. Maternal vaccines for influenza, tetanus, and pertussis have been shown to reduce neonatal disease and mortality, and other candidate vaccines for group B streptococcus and respiratory syncytial virus are being developed to continue this trend. However, safe and effective maternal vaccines will only successfully reduce neonatal illness if mothers decide to receive them. Maternal knowledge, attitudes, and beliefs around vaccines are key determinants to vaccine acceptance or vaccine hesitancy, and yet this issue is often understudied in low and middle-income country settings. A deeper understanding of these factors and how they influence maternal decision-making will allow public health practitioners and global and national policymakers to design more effective interventions. Addressing barriers to immunization at the policy and programmatic levels such as mothers' knowledge, attitudes, and beliefs of maternal vaccines is essential to increasing vaccination rates at a global scale and reducing global vaccine-preventable neonatal deaths.
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Affiliation(s)
- Anna Larson Williams
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rachel Mitrovich
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Chris Gill
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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49
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Tesfaye TD, Temesgen WA, Kasa AS. Vaccination coverage and associated factors among children aged 12 - 23 months in Northwest Ethiopia. Hum Vaccin Immunother 2018; 14:2348-2354. [PMID: 30118398 DOI: 10.1080/21645515.2018.1502528] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Full vaccination coverage has been identified as the foundation for the prevention of morbidity and mortality from the childhood illnesses. However, a significant number of children do not get recommended vaccinations. The problem is much worse in low-income countries with varied figures and evidence gap. Therefore, this study was conducted to assess vaccination coverage and its predicting factors in one of the low-income country Ethiopia, particularly in northwest Ethiopia. METHODS A community-based cross-sectional study was conducted in Northwest Ethiopia in 2016 on 846 children aged 12 to 23 completed months. Cluster sampling method was used. Mothers or caretakers were interviewed. SPSS version 20 was used for analysis. RESULTS In Northwest Ethiopia, full-vaccination coverage for the children aged 12-23 months was 58.4%, while 17% and 24.6% were partially vaccinated and not vaccinated at all respectively. Child full vaccination status has a positive association with urban residence, having antenatal care visit, institutional delivery for the study child, vaccination site at health institutions, mothers who knows vaccination schedule of a catchment area, and mothers taking a child for vaccination even if the child is sick. However, mothers who ever-married and their travel time to the nearest vaccination site ≤ 30 minutes were negatively associated with child full-vaccination status. CONCLUSION Vaccination coverage in Northwest Ethiopia, East Gojam, is better than the national coverage. Yet, it is far below the plan. Encouraging antenatal care utilization, delivery at health institutions, and providing adequate information on child vaccination (including when to start, return and finish) for mothers would increase full-vaccination coverage.
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Affiliation(s)
- Tadesse Dagget Tesfaye
- a College of Medicine and Health Sciences, Department of Adult Health Nursing , Bahir Dar University , Bahir Dar , Ethiopia
| | - Worku Animaw Temesgen
- a College of Medicine and Health Sciences, Department of Adult Health Nursing , Bahir Dar University , Bahir Dar , Ethiopia
| | - Ayele Semachew Kasa
- a College of Medicine and Health Sciences, Department of Adult Health Nursing , Bahir Dar University , Bahir Dar , Ethiopia
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50
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Ekouevi DK, Gbeasor-Komlanvi FA, Yaya I, Zida-Compaore WI, Boko A, Sewu E, Lacle A, Ndibu N, Toke Y, Landoh DE. Incomplete immunization among children aged 12-23 months in Togo: a multilevel analysis of individual and contextual factors. BMC Public Health 2018; 18:952. [PMID: 30071824 PMCID: PMC6090752 DOI: 10.1186/s12889-018-5881-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/24/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Inadequate immunization coverage remains a public health problem in Africa. In Togo, only 62% of children under one year of age were fully immunized in 2013. This study aimed to estimate the immunization coverage among children aged 12-23 months, and to identify factors associated with incomplete immunization status in Togo. METHODS A cross-sectional survey was conducted in the six health regions of Togo. Children aged 12 to 23 months who were living with one of their parents or guardians from selected households were recruited for the study. Data was collected using a pre-tested questionnaire through face-to-face interviews. Multilevel logistic regression analyses were performed to assess factors associated with incomplete immunization coverage. RESULTS A total of 1261 households were included. Respondents were predominantly women (91.9%) and 22.8% had secondary or higher education level. Immunization cards were available for 85.3% of children. Complete immunization coverage was 72.3%, 95% confidence interval (CI): [69.7-74.8]). After controlling for both individual and contextual level variables, children whose mothers attended secondary school or above were 33% (adjusted Odds Ratio (aOR) = 0.67, CI [0.47-0.94]) less likely to have an incomplete immunization coverage compared to those with no education. The likelihood of incomplete immunization in children decreased with the increase in household's income (aOR = 0.73, 95% CI [0.58-0.93]), children who did not have an immunization card (aOR = 13.41, 95% CI [9.19-19.57]) and those whose parents did not know that children immunization was free of charge (aOR = 1.82, 95% CI [1.00-3.30]) were more likely to have an incomplete immunization. Finally, children whose parents had to walk half an hour to one hour to reach a healthcare center were 57% (aOR = 1.57, 95% CI [1.15-2.13]) more likely to have an incomplete immunization coverage than those whose parents had to walk less than half an hour. CONCLUSION The goal of 90% coverage at the national level has not been achieved in 2017. Innovative strategies such as using electronic cards and strengthening sensitization activities must be initiated in order to attain a complete immunization coverage in Togo.
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Affiliation(s)
- Didier K. Ekouevi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | - Fifonsi A. Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Issifou Yaya
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale (SESSTIM), Aix Marseille Université, Marseille, France
| | | | - Amevegbé Boko
- Programme Elargi de Vaccination, Ministère de la Santé et de la Protection Sociale, Lomé, Togo
| | - Essèboe Sewu
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Anani Lacle
- Programme Elargi de Vaccination, Ministère de la Santé et de la Protection Sociale, Lomé, Togo
| | | | - Yaovi Toke
- UNICEF, country office of Togo, Lomé, Togo
| | - Dadja E. Landoh
- World Health Organization, country office of Togo, Lomé, Togo
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