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Bantie B, Atnafu Gebeyehu N, Adella GA, Ambaw Kassie G, Mengstie MA, Abebe EC, Abdu Seid M, Gesese MM, Tegegne KD, Zemene MA, Anley DT, Dessie AM, Fenta Feleke S, Dejenie TA, Chanie ES, Kebede SD, Bayih WA, Moges N, Kebede YS. Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis. Front Public Health 2024; 12:1339539. [PMID: 38912271 PMCID: PMC11193363 DOI: 10.3389/fpubh.2024.1339539] [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: 11/21/2023] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Background Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia. Methods A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi* hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization. Results Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, p-value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization. Conclusion and recommendation In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Tadese ZB, Nigatu AM, Yehuala TZ, Sebastian Y. Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach. Sci Rep 2024; 14:11529. [PMID: 38773175 PMCID: PMC11109113 DOI: 10.1038/s41598-024-62641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 05/20/2024] [Indexed: 05/23/2024] Open
Abstract
The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12-35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers' occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.
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Affiliation(s)
- Zinabu Bekele Tadese
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia.
| | - Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tirualem Zeleke Yehuala
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yakub Sebastian
- Department of Information Technology, Faculty of Science and Technology, Charles Darwin University, Darwin, Australia
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Habchy P, Tahan L, Moussi C, Barakat MA, Ghanem L, Kattan O, Njeim A, Abou Habib L, El Bitar W, El Asmar B, Chahine MN. Referrals and Determinant Factors of a National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old. CHILDREN (BASEL, SWITZERLAND) 2024; 11:175. [PMID: 38397287 PMCID: PMC10886849 DOI: 10.3390/children11020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
In this extensive study examining the health of 7184 school children aged 3 to 12 in 27 Lebanese schools, screenings involved medical evaluation and interviews, complemented by phone interviews with 3880 parents. Notably, one in two students received a medical referral, revealing prevalent issues such as dental cavities (33%), under-vaccination (25%), undetected vision problems (13%), abnormal growth (6%), underweight (27%), and overweight (33%). Additional concerns encompassed abnormal vital signs (3%), abuse signs (0.6%), infectious skin lesions (1.6%), scoliosis (1.7%), abnormal auscultation (heart 1.1%, lungs 1.2%), ear problems (3.3%), precocious puberty (0.7%), and neurologic signs (0.6%). Mental health challenges affected 20-25% of students. Public schools and Beirut exhibited higher referral rates, with girls, older children, overweight students, those lacking regular pediatrician visits, and children of self-employed or less educated parents facing elevated referral rates. In contrast, children of healthcare workers experienced fewer referrals. Against this backdrop, the study emphasizes the imperative for targeted health initiatives, particularly in marginalized areas and for socioeconomically disadvantaged students. Priority areas include dental care, weight issues, mental health, vaccination compliance, and addressing vision problems to enhance learning outcomes.
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Affiliation(s)
- Peter Habchy
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Léa Tahan
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Charbel Moussi
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Muhammad A. Barakat
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Laura Ghanem
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Ogarite Kattan
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Alain Njeim
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
| | - Leila Abou Habib
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
| | - Wassim El Bitar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Department of Pediatrics, Bellevue Medical Center University Hospital, Mansourieh P.O. Box 295, Lebanon
| | - Béchara El Asmar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Faculty of Medicine, Saint Joseph University, Beirut P.O. Box 17-5208, Lebanon
- Department of Cardiology, Hotel-Dieu de France Hospital, Achrafieh, Beirut 1100, Lebanon
| | - Mirna N. Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon; (P.H.); (L.T.); (C.M.); (M.A.B.); (L.G.); (O.K.); (A.N.)
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath 1519, Lebanon
- Foundation-Medical Research Institutes (F-MRI), Achrafieh, Beirut 1100, Lebanon
- Foundation-Medical Research Institutes (F-MRI), 1211 Geneva, Switzerland
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Melis T, Mose A, Fikadu Y, Haile K, Habte A, Jofiro G. Predictors for low coverage of uptake of second dose of measles vaccine among children in sub-Saharan Africa, 2023: a systematic review and meta-analysis. J Pharm Policy Pract 2023; 17:2285507. [PMID: 38205190 PMCID: PMC10775641 DOI: 10.1080/20523211.2023.2285507] [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] [Indexed: 01/12/2024] Open
Abstract
Background Measles became a public health important disease in sub-Saharan Africa. World Health Organization recommended measles-containing vaccine dose 2 (MCV2) through routine service delivery. This study aims to determine coverage of second-dose measles vaccination uptake and its predictors among children aged 24-35 months in sub-Saharan Africa. Methods and materials We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature. Results The overall uptake of the second dose of measles vaccine uptake was 41% (95% CI: 28.90-53.47). Caregiver's awareness of the importance of the second dose of measles (2.51, 95% CI 1.77, 3.25), educational status of mothers (1.30, 95% CI 1.16, 1.45), distance from vaccination site (1.22, 95% CI 1.12, 1.32), and attending four and above ANC visit (2.72, 95% CI 2.29, 3.15) were determinants for second dose measles vaccine uptake. Conclusion Coverage of the second dose of measles uptake in Sub-Saharan Africa was low (41%) which is lower than the recommendation from WHO. Therefore policymakers and stakeholders should increase mother's awareness. Also, special strategies should be developed for those who are far from the vaccination site. Abbreviation and acronyms ANC: Ante Natal Care; JBI: Joanna Briggs Institute; MCV1: Measles containing vaccine dose 1; MCV2: Measles containing vaccine dose 2; WHO: World Health Organization.
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Affiliation(s)
- Tamirat Melis
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Yohannes Fikadu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Kassahun Haile
- Department of medical laboratory, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Aklilu Habte
- Department of Public Health, College of Medicine and Health Science, Wachamo University, Hosanna, Ethiopia
| | - Gemechu Jofiro
- Department of Nurse, College of Medicine and Health Science, Arsi University, Asela, Ethiopia
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Lawal TV, Atoloye KA, Adebowale AS, Fagbamigbe AF. Spatio-temporal analysis of childhood vaccine uptake in Nigeria: a hierarchical Bayesian Zero-inflated Poisson approach. BMC Pediatr 2023; 23:493. [PMID: 37773112 PMCID: PMC10540393 DOI: 10.1186/s12887-023-04300-x] [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: 04/14/2022] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Globally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of doses of childhood vaccines taken is limited in the literature. We used a Bayesian zero-inflated Poisson regression model with spatio-temporal components to assess the number of doses of childhood vaccines taken among children aged 12-23 months and their associated factors. METHODS Data of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of doses of childhood vaccines taken using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS. RESULTS The prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of doses of childhood vaccines taken include maternal age (adjusted Incidence "risk" Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03-1.07) for 25-34 years and (aIRR = 1.07; 95% CrI = 1.05-1.10) for 35-49 years and education: (aIRR = 1.11, 95% CrI = 1.09-1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13-1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendants, religion, mother's desire for the child, community poverty rate, community illiteracy, and community unemployment. CONCLUSION Although full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving the uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria.
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Affiliation(s)
- Temitayo Victor Lawal
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, FCT Nigeria
| | - Kehinde Adebola Atoloye
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- Viable Knowledge Masters, Abuja, FCT Nigeria
- Viable Helpers Development Organization, Abuja, FCT Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- Division of Population and Behavioural Science, School of Medicine, Health Data Science Unit, University of St Andrews, St Andrews, UK
- Institute of Applied Health Sciences, School of Medicine, Medicinal Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
- Research Methods and Evaluation Unit, Institute for Health & Wellbeing, Coventry University, Coventry, UK
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Danso SE, Frimpong A, Seneadza NAH, Ofori MF. Knowledge, attitudes, and practices of caregivers on childhood immunization in Okaikoi sub-metro of Accra, Ghana. Front Public Health 2023; 11:1230492. [PMID: 37780451 PMCID: PMC10540614 DOI: 10.3389/fpubh.2023.1230492] [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: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Immunization remains one of the most cost-effective health interventions. However, there are still issues of vaccine hesitancy especially in caregivers who are required to protect their children from vaccine-preventable diseases. This thwarts the overall vaccine coverage in disease-endemic areas such as sub-Saharan Africa. Therefore, to determine the factors that promote vaccine hesitancy in caregivers, this study sought to assess the knowledge, attitude, and practices of caregivers on childhood immunization in Okaikoi, a sub-metro of Accra in Ghana. Methods A cross-sectional study on childhood immunization was conducted to determine the knowledge, attitudes, and practices of caregivers. A total of 120 caregivers with infants aged 12 months to 23 months were interviewed with a structured questionnaire containing open-ended and closed-ended queries. Results From the community, infants whose caregivers had adhered completely to immunization constituted 53.3% while the rest were partially immunized. The two main deterrents to complete immunization were time constraints (25.8%) and forgetfulness (17.5%). It was observed that vaccination uptake and maternal level of education, as well as vaccination adverse reaction, did not impact the completion of the EPI program by these caregivers. Unfortunately, it was noted that caregivers with higher education levels were unable to complete their vaccination schedules due to their busy work schedules. Nonetheless, the main deterrent to adhering to complete childhood immunization was poor maternal knowledge (58%). Conclusion The study revealed that, the caregivers in the community had poor knowledge on vaccination and its benefits, and therefore, with no strict adherence to vaccination schedules. This promoted the incomplete immunization of children in the community by their caregivers. Also, since the main source of information with regard to immunization in the sub-metro was through the antenatal and postnatal child welfare clinics and the media, we recommend that the health workers collaborate with media personnel to ensure that standardized information is disseminated.
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Affiliation(s)
- Samuel E. Danso
- Department of Community Health, University of Ghana Medical and Dental School, College of Health Science, Accra, Ghana
- GA East Hospital, Accra, Ghana
| | - Augustina Frimpong
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Nana A. H. Seneadza
- Department of Community Health, University of Ghana Medical and Dental School, College of Health Science, Accra, Ghana
| | - Michael F. Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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Kamal A, Waseem A, Siddiqa M, Ijaz M, Shakeel A, Iftikhar S. Contextual factors influencing incomplete immunization and investigation of its geospatial heterogeneity in Pakistan: a cross-sectional study based on PDHS (2017-18). BMC Public Health 2023; 23:1620. [PMID: 37620868 PMCID: PMC10463638 DOI: 10.1186/s12889-023-16508-8] [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: 02/28/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Immunization is one of the most effective public health initiatives, saving millions of lives and lowering the risk of diseases such as diphtheria, tetanus, influenza, and measles. Immunization saves an estimated 2-3 million lives per year. A study of the regional variations in incomplete immunization will be useful in identifying gaps in the performance of immunization programs that are not noticed by standard vaccination programs monitoring. The primary goal of this study was to identify factors influencing child immunization status and to examine regional variations in incomplete immunization among children aged 12 to 23 months in Pakistan. METHODS For the current study, the data were taken from the Demographic and Health Survey for Pakistan (PDHS 2017-2018). Ever-married women who had children aged 12-23 months were included in this study. The immunization status of children was used as an outcome variable. In order to determine the effects of different factors on incomplete immunization, multilevel logistic model was used. To study the geographical variation of incomplete immunization, hotspot analysis was done using ArcGIS 10.7 and SaTScan software and to identify significant predictors of incomplete immunization, GWR 4 software was used. RESULTS Place of delivery, gender of child, mother's educational level and region were identified as significant determinants of incomplete immunization of children in Pakistan. Chances of incomplete immunization of children were found significantly lower for educated mothers (AOR = 0.52, 95% CI 0.34-0.79) and mothers who had delivered children in the health facilities (AOR = 0.51, 95% CI 0.32-0.83). Female children were more likely (AOR = 1.44, 1.95% CI 1.04-1.99) to be incompletely immunized as compared to male children. FATA (AOR = 11.19, 95% CI 4.89-25.6), and Balochistan (AOR = 10.94, 95% CI 5.08-23.58) were found at the highest risk of incomplete immunization of children as compared to Punjab. The significant spatial heterogeneity of incomplete immunization was found across Pakistan. The spatial distribution of incomplete immunization was clustered all over Pakistan. The high prevalence of incomplete immunization was observed in Balochistan, South Sindh, North Sindh, South KPK, South FATA, Gilgit Baltistan, Azad Jammu Kashmir, South and East Punjab. Drang and Harcho were identified as hotspot areas of incomplete immunization in Gilgit Baltistan. Secondary clusters with a high risk of incomplete immunization were found in regions Balochistan, Sindh and FATA. CONCLUSION Gender biasedness towards female children, regarding complete immunization of children prevailed in Pakistan. Spatial heterogeneity was also found for incomplete immunization of children. To overcome the problem access to health facilities is the foremost step. Government should target hotspot areas of incomplete immunization of children to provide primary health care facilities by opening health care units in these areas. The government in collaboration with the media should launch awareness campaigns in those areas to convince people that complete immunization is the right of every child regardless of gender.
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Affiliation(s)
- Asifa Kamal
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Ayesha Waseem
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Maryam Siddiqa
- Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan
| | - Muhammad Ijaz
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan.
| | - Abeera Shakeel
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Soofia Iftikhar
- Department of Statistics, Shaheed Benazir Bhutto Women University Peshawar, Peshawar, Pakistan
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Fagbamigbe AF, Lawal TV, Atoloye KA. Evaluating the performance of different Bayesian count models in modelling childhood vaccine uptake among children aged 12-23 months in Nigeria. BMC Public Health 2023; 23:1197. [PMID: 37344872 DOI: 10.1186/s12889-023-16155-z] [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: 11/22/2022] [Accepted: 06/20/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Choosing appropriate models for count health outcomes remains a challenge to public health researchers and the validity of the findings thereof. For count data, the mean-variance relationship and proportion of zeros is a major determinant of model choice. This study aims to compare and identify the best Bayesian count modelling technique for the number of childhood vaccine uptake in Nigeria. METHODS We explored the performances of Poisson, negative binomial and their zero-inflated forms in the Bayesian framework using cross-sectional data pooled from the Nigeria Demographic and Health Survey conducted between 2003 and 2018. In multivariable analysis, these Bayesian models were used to identify factors associated with the number of vaccine uptake among children. Model selection was based on the -2 Log-Likelihood (-2 Log LL), Leave-One-Out Cross-Validation Information Criterion (LOOIC) and Watanabe-Akaike/Widely Applicable Information Criterion (WAIC). RESULTS Exploratory analysis showed the presence of excess zeros and overdispersion with a mean of 4.36 and a variance of 12.86. Observably, there was a significant increase in vaccine uptake over time. Significant factors included the mother's age, level of education, religion, occupation, desire for last-child, place of delivery, exposure to media, birth order of the child, wealth status, number of antenatal care visits, postnatal attendance, healthcare decision maker, community poverty, community illiteracy, community unemployment, rural proportion and number of health facilities per 100,000. The zero-inflated negative binomial model was best fit with -2Log LL of -27171.47, LOOIC of 54464.2, and WAIC of 54588.0. CONCLUSION The Bayesian zero-inflated negative binomial model was most appropriate to identify factors associated with the number of childhood vaccines received in Nigeria due to the presence of excess zeros and overdispersion. Improving vaccine uptake by addressing the associated risk factors should be promptly embraced.
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Affiliation(s)
- A F Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - T V Lawal
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria.
| | - K A Atoloye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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9
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Dlamini TN, Bhat LD, Kodali NK, Philip NE. Prevalence and factors associated with incomplete immunization among children aged 12 to 35 months in Eswatini: analysis of the Eswatini multiple indicator cluster survey. Pan Afr Med J 2023; 45:51. [PMID: 37637393 PMCID: PMC10460101 DOI: 10.11604/pamj.2023.45.51.38643] [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: 12/28/2022] [Accepted: 04/30/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction incomplete childhood immunization is a significant public health challenge as children continue to succumb to vaccine-preventable diseases in most developing countries. Studies on childhood immunization conducted in Eswatini are sparse. Therefore, the present study assessed the prevalence of incomplete childhood immunization in Eswatini and further explored associated factors among children aged 12 to 35 months. Methods using data from Eswatini multiple indicator cluster survey 5 (EMICS5), a cross-sectional analysis with 978 children aged 12 to 35 months was conducted. This is the latest available data in the public domain. The survey was conducted from July 2014 to October 2014. The primary outcome variable was incomplete immunization. Univariate and multivariate logistic regressions were used to examine the association between selected variables and incomplete immunization. Results the mean age of the children was 23.45±6.92 months, 50.2% were boys, and 74.1% lived in rural areas. The prevalence of incomplete immunization was 31.5%. Increased child´s age, being a girl, increased caregiver´s age, and increased number of children under-five years in the household and residing in the Manzini or Hhohho region were significantly associated with incomplete immunization. Conclusion the EMICS 5 revealed a high prevalence of incomplete immunization in Eswatini. Health promotion activities such as empowering women and caregivers of children through health education about child health should be emphasized. Where feasible, outreach services and door-to-door immunization should be strengthened to improve immunization coverage in the country and cover dropouts.
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Affiliation(s)
- Thatho Nolwazi Dlamini
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
| | - Lekha Divakara Bhat
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
| | - Neena Elezebeth Philip
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Tamil Nadu, India
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10
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Atnafu Gebeyehu N, Abebe Gelaw K, Asmare Adella G, Dagnaw Tegegne K, Adie Admass B, Mesele Gesese M. Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis. Hum Vaccin Immunother 2023:2202125. [PMID: 37144686 DOI: 10.1080/21645515.2023.2202125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Immunization is one of the most cost-effective measures to prevent morbidity and mortality in children. Therefore, the purpose of this systematic review and meta-analysis was to determine the pooled prevalence of incomplete immunization among children in Africa as well as its determinants. PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Studies published within English language, with full text available for searching, and studies conducted in Africa were included in this meta-analysis. A pooled prevalence, Sub-group analysis, sensitivity analysis and meta-regression were conducted. Out of 1305 studies assessed, 26 met our criteria and were included in this study. The pooled prevalence of incomplete immunization was 35.5% (95% CI: 24.4, 42.7), I2 = 92.1%). Home birth (AOR=2.7; 95% CI: 1.5-4.9), rural residence (AOR = 4.6; 95% CI: 1.1-20.1), lack of antenatal care visit (AOR = 2.6; 95% CI: 1.4-5.1), lack of knowledge of immunizations (AOR=2.4; 95% CI: 1.3-4.6), and maternal illiteracy (AOR = 1.7: 95%CI: 1.3-2.0) were associated with incomplete immunization. In Africa, the prevalence of incomplete immunization is high. It is important to promote urban residency, knowledge of immunization and antenatal follow up care.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kelemu Abebe Gelaw
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Biruk Adie Admass
- Department of Anesthesia, College of Medicine and Health Science, Gondar University, Gondar, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
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11
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Lerm BR, Silva Y, Cata-Preta BO, Giugliani C. Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case. CAD SAUDE PUBLICA 2023; 39:e00102922. [PMID: 36651377 DOI: 10.1590/0102-311xen102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023] Open
Abstract
Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast, inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.
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Affiliation(s)
| | - Yanick Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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12
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Chilot D, Belay DG, Shitu K, Gela YY, Getnet M, Mulat B, Muluneh AG, Merid MW, Bitew DA, Alem AZ. Measles second dose vaccine utilization and associated factors among children aged 24–35 months in Sub-Saharan Africa, a multi-level analysis from recent DHS surveys. BMC Public Health 2022; 22:2070. [PMID: 36371164 PMCID: PMC9655865 DOI: 10.1186/s12889-022-14478-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a safe and effective vaccine is available, measles remains an important cause of mortality and morbidity among young children in Sub-Saharan Africa (SSA). The WHO and UNICEF recommended measles-containing vaccine dose 2 (MCV2) in addition to measles-containing vaccine dose 1 (MCV1) through routine services strategies. Many factors could contribute to the routine dose of MCV2 coverage remaining far below targets in many countries of this region. This study aimed to assess the prevalence of MCV2 utilization among children aged 24–35 months and analyze factors associated with it by using recent nationally representative surveys of SSA countries. Methods Secondary data analysis was done based on recent Demographic and Health Surveys (DHS) data from eight Sub-Saharan African countries. In this region, only eight countries have a record of routine doses of measles-containing vaccine dose 2 in their DHS dataset. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from each of the eight country’s KR files. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with measles-containing vaccine dose 2 utilization. Result The pooled prevalence of MCV2 utilization in SSA was 44.77% (95% CI: 27.10–62.43%). In the multilevel analysis, mothers aged 25–34 years [AOR = 1.15,95% CI (1.05–1.26), mothers aged 35 years and above [AOR = 1.26, 95% CI (1.14–1.41)], maternal secondary education and above [AOR = 1.27, 95% CI (1.13–1.43)], not big problem to access health facilities [AOR = 1.21, 95% CI (1.12–1.31)], four and above ANC visit [AOR = 2.75, 95% CI (2.35–3.24)], PNC visit [AOR = 1.13, 95% CI (1.04–1.23)], health facility delivery [AOR = 2.24, 95% CI (2.04–2.46)], were positively associated with MCV2 utilization. In contrast, multiple twin [AOR = 0.70, 95% CI (0.53–0.95)], rural residence [AOR = 0.69, 95% CI (0.57–0.82)] and high community poverty [AOR = 0.66, 95% CI (0.54–0.80)] were found to be negatively associated with MCV2 utilization. Conclusions and recommendations Measles-containing vaccine doses 2 utilization in Sub-Saharan Africa was relatively low. Individual-level factors and community-level factors were significantly associated with low measles-containing vaccine dose 2 utilization. The MCV2 utilization could be improved through public health intervention by targeting rural residents, children of uneducated mothers, economically poor women, and other significant factors this study revealed.
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13
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Lai YA, Chen X, Kunasekaran M, Rahman B, MacIntyre CR. Global epidemiology of vaccine-derived poliovirus 2016-2021: A descriptive analysis and retrospective case-control study. EClinicalMedicine 2022; 50:101508. [PMID: 35784443 PMCID: PMC9240990 DOI: 10.1016/j.eclinm.2022.101508] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaccine derived poliovirus (VDPV) remains a major barrier to polio eradication, and recent growing emergences are concerning. This paper presents the global epidemiology of circulating VDPV (cVDPV) by exploring associations between demographic and socioeconomic factors with its recent rise. METHODS Data on reported cVDPV cases and isolates between January 1 2016 and June 30 2021 were compiled from EPIWATCH, an open-source observatory for outbreak scanning and analysis, the World Health Organisation (WHO) and ProMed, and analysed descriptively. Reports containing cVDPV case information were included while duplicates and defective links were excluded. Data collection occurred from April 5 2021 to July 16 2021. To identify factors associated with cVDPV, a retrospective case-control study comparing socioeconomic profiles of countries which reported cVDPV with those that did not was undertaken with weighted logistic regression analysis. FINDINGS cVDPV caused by serotype 2 poliovirus was the predominant strain (95%) of 1818 total human cVDPV cases reported. Of 40 countries reporting cVDPV cases or isolates, 22 (55%) had polio vaccination coverages below 80%. Low vaccination coverage (Adjusted OR = 83·41, 95% CI: [5·01, 1387·71], p = 0·0020) was found to be associated with increased odds of reporting cVDPV after adjusting for confounding effects of GDP per capita, female adult literacy rates, maternal mortality rate, and Global Peace Index. INTERPRETATION Our findings reinforce the importance of maintaining high levels of vaccination, as risk of re-emergence rises when immunity wanes. Interventions to increase vaccination and standards of living in developing countries, coupled with robust surveillance are required if humanity hopes to eradicate polio in the near future. FUNDING This research was supported by the MRFF 2021 Frontier Health and Medical Research Grant (ID RFRHPI000280), Department of Health, the Australian Government.
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Affiliation(s)
- Yi An Lai
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Corresponding author at: Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Xin Chen
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bayzidur Rahman
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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14
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Budu E, Opoku Ahinkorah B, Okyere J, Seidu AA, Ofori Duah H. Inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana, 1993–2014. Vaccine 2022; 40:3614-3620. [DOI: 10.1016/j.vaccine.2022.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/17/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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Determinants of pentavalent and measles vaccination dropouts among children aged 12-23 months in The Gambia. BMC Public Health 2022; 22:520. [PMID: 35296298 PMCID: PMC8926885 DOI: 10.1186/s12889-022-12914-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Every year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12–23 months in The Gambia. Methods The study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019–20 (GDHS). The percentage of children aged 12–23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout. Results Approximately 7.0% and 4.0% of the 1,302 children aged 12–23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout. Conclusion Tailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.
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16
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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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Islam T, Mandal S, Chouhan P. Influence of socio-demographic factors on coverage of full vaccination among children aged 12-23 months: a study in Indian context (2015-2016). Hum Vaccin Immunother 2021; 17:5226-5234. [PMID: 34613872 DOI: 10.1080/21645515.2021.1977056] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vaccine-preventable diseases (VPDs) are one of the key public health concerns in low and middle-income countries due to incomplete vaccination coverage. Nearly three million children up to 5 years of age die due to VPDs each year. Vaccination plays a significant role in reducing child mortality and morbidity from VPDs. Globally, full vaccination coverage efficiently saves two to three million children's lives from life-threatening VPDs. OBJECTIVE This study intends to inspect the influence of socio-demographic factors on full vaccination coverage of children aged 12-23 months in India. METHODS A cross-sectional observational study was carried out using the NFHS-4, 2015-2016 data of India. A total of 44,771 children aged 12-23 months born to the mothers aged 15-49 years in the last 5 years preceding the survey were used for this study. For the analyses of the data, Bivariate and Multivariate analyses were performed. RESULTS The prevalence of full vaccination coverage of children aged 12-23 months in India was 62%. The result of the study indicated that maternal educational attainment, household wealth status, child size at birth, and maternal health-care services are the main significant predictors of full vaccination coverage. Other socio-demographic factors include maternal age, sex of the household head, exposure to mass media, child birth order, social category, religion, place of residence and region also play significant role in the coverage of full vaccination. CONCLUSION The study found that socio-demographic factors play a significant role in full vaccination coverage children in India. Therefore, policymaker and administrators should accentuate the inventive approach for the development of women education, improvement of family income, and easy accessibility of maternal and child healthcare services to surmount the impediment of children full vaccination coverage, which eventually reduce the risk of child morbidity and mortality.
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Affiliation(s)
- Tarikul Islam
- Department of Geography, University of Gour Banga, Malda, India
| | - Salim Mandal
- Darjeeling Government College & Department of Geography, University of Gour Banga, Malda, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, India
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Feldstein LR, Sutton R, Jalloh MF, Parmley L, Lahuerta M, Akinjeji A, Mansaray A, Eleeza O, Sesay T, Kulkarni S, Conklin L, Wallace AS. Access, demand, and utilization of childhood immunization services: A cross-sectional household survey in Western Area Urban district, Sierra Leone, 2019. J Glob Health 2021; 10:010420. [PMID: 32509292 PMCID: PMC7243070 DOI: 10.7189/jogh.10.010420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Urban childhood immunization programs face unique challenges in access, utilization, and demand due to frequent population movement between and within localities, sprawling informal settlements, and population heterogeneity. We conducted a cross-sectional household survey in the Western Area Urban district, Sierra Leone, stratified by slums and non-slums as defined by the United Nations Development Program. Methods Based on data from child vaccination cards, weighted vaccination coverage was estimated from 450 children aged 12-36 months (household response rate = 83%). Interviews with 444 caregivers identified factors related to accessing routine immunization services. Factors associated with coverage in bivariate analyses were examined in multivariate models using backward stepwise procedure. Results Coverage was similar in slums and non-slums for 3-doses of diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine (86%, 92%) and second dose of measles vaccine (33%, 29%). In a multivariate logistic regression model, incomplete pentavalent vaccine coverage was associated with being second or later birth order (adjusted odds ratio (aOR) = 4.5 (95% confidence interval (CI) = 1.4-14.9), a household member not approving of childhood vaccinations (aOR = 7.55, 95% CI = 1.52-37.38), self-reported delay of child receiving recommended vaccinations (aOR = 4.8, 95% CI = 1.0-22.1), and living in a household made of natural or rudimentary materials (aOR = 3.5, 95% CI = 1.2-10.6). Overall, the majority (>70%) of caregivers reported occupation as petty trader and <50% reported receiving vaccination information via preferred communication sources. Conclusions Although vaccination coverage in slums was similar to non-slums, study findings support the need for targeted interventions to improve coverage, especially for the second dose of measles vaccine to avoid large scale measles outbreaks. Strategies should focus on educating household members via preferred communication channels regarding the importance of receiving childhood vaccinations on time for all offspring, not just the first born. Vaccination coverage could be further improved by increasing accessibility through innovative strategies such as increasing the number of vaccination days and modifying hours.
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Affiliation(s)
- Leora R Feldstein
- Global Immunization Division (GID), Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roberta Sutton
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Mohamed F Jalloh
- Global Immunization Division (GID), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Parmley
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
| | - Adewale Akinjeji
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Anthony Mansaray
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Oliver Eleeza
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Tom Sesay
- Child Health/EPI Program, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Shibani Kulkarni
- Global Immunization Division (GID), Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Evaluation Fellow (Oak Ridge Institute for Science and Education), GID, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Conklin
- Global Immunization Division (GID), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron S Wallace
- Global Immunization Division (GID), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Huang Y, Danovaro-Holliday MC. Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006-2018. BMC Public Health 2021; 21:351. [PMID: 33581740 PMCID: PMC7880859 DOI: 10.1186/s12889-021-10364-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. METHODS We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. RESULTS Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. CONCLUSION Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.
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Affiliation(s)
- Yue Huang
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland
- Present affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - M Carolina Danovaro-Holliday
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland.
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Silva FDS, Queiroz RCDS, Branco MDRFC, Simões VMF, Barbosa YC, Rodrigues MAFRDA, Barbieri MA, Bettiol H, Saraiva MDCP, Scorzafave LG, Habenschus MIAT, Silva AAMD. Bolsa Família program and incomplete childhood vaccination in two Brazilian cohorts. Rev Saude Publica 2020; 54:98. [PMID: 33175031 PMCID: PMC7575218 DOI: 10.11606/s1518-8787.2020054001774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE: To estimate the effect of being a beneficiary of the Bolsa Família Program (BFP) in the vaccination of children aged 13 to 35 months. METHODS: Our study was based on all birth records of residents of Ribeirão Preto (SP) and probabilistic sampling with 1/3 of the births of residents of São Luís (MA), selecting low-income children, born in 2010, belonging to the cohorts Brazilian Ribeirão Preto and São Luís Birth Cohort Studies and eligible for the Bolsa Família program. The information of Cadastro Único (CadÚnico – Single Registry) was used to categorize the receipt of benefit from the BFP (yes or no). The final sample consisted of 532 children in Ribeirão Preto and 1,229 in São Luís. The outcome variable was a childhood vaccine regimen, constructed with BCG, tetravalent, triple viral, hepatitis B, poliomyelitis, rotavirus and yellow fever vaccines. The adjustment variables were: economic class, mother's schooling and mother's skin color. Children with monthly per capita family income of up to R$ 280.00 and/or economic class D/E were considered eligible for the benefit of the BFP. A theoretical model was constructed using a directed acyclic graph to estimate the effect of being a beneficiary of the BFP in the vaccination of low-income children. In the statistical analyses, weighing was used by the inverse of the probability of exposure and pairing by propensity score. RESULTS: Considering a monthly per capita family income of up to R$ 280.00, being a beneficiary of the BFP had no effect on the childhood vaccination schedule, according to weighing by the inverse of the probability of exposure (SL-coefficient: −0.01; 95%CI −0.07 to 0.04; p = 0.725 and RP-coefficient: 0.04; 95%CI −0.02 to 0.10; p = 0.244) and pairing by propensity score (SL-coefficient: −0.01; 95%CI −0.07 to 0.05; p = 0.744 and RP-coefficient: 0.04; 95%CI −0.02 to 0.10; p = 0.231). CONCLUSIONS: The receipt of the benefit of the BFP did not influence childhood vaccination, which is one of the conditionalities of the program. This may indicate that this conditionality is not being adequately monitored.
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Affiliation(s)
| | - Rejane Christine de Sousa Queiroz
- Universidade Federal do Maranhão. Departamento de Saúde Pública. Programa de Pós-Graduação em Saúde Coletiva. São Luís, Maranhão, MA, Brasil
| | | | - Vanda Maria Ferreira Simões
- Universidade Federal do Maranhão. Departamento de Saúde Pública. Programa de Pós-Graduação em Saúde Coletiva. São Luís, Maranhão, MA, Brasil
| | - Yonna Costa Barbosa
- Universidade Federal do Maranhão. Hospital Universitário Presidente Dutra. São Luís, Maranhão, MA, Brasil
| | | | - Marco Antonio Barbieri
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Programa de Pós-Graduação em Saúde da Criança e do Adolescente. Ribeirão Preto, São Paulo, Brasil
| | - Heloísa Bettiol
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Programa de Pós-Graduação em Saúde da Criança e do Adolescente. Ribeirão Preto, São Paulo, Brasil
| | - Maria da Conceição Pereira Saraiva
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Programa de Pós-Graduação em Saúde da Criança e do Adolescente. Ribeirão Preto, São Paulo, Brasil
| | - Luiz Guilherme Scorzafave
- Universidade de São Paulo. Faculdade de Economia. Departamento de Economia. Programa de Pós-Graduação em Economia Aplicada. Ribeirão Preto, São Paulo, Brasil
| | | | - Antônio Augusto Moura da Silva
- Universidade Federal do Maranhão. Departamento de Saúde Pública. Programa de Pós-Graduação em Saúde Coletiva. São Luís, Maranhão, MA, Brasil
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Melaku MS, Nigatu AM, Mewosha WZ. Spatial distribution of incomplete immunization among under-five children in Ethiopia: evidence from 2005, 2011, and 2016 Ethiopian Demographic and health survey data. BMC Public Health 2020; 20:1362. [PMID: 32891120 PMCID: PMC7487875 DOI: 10.1186/s12889-020-09461-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An estimate of 2-3 million children under 5 die in the world annually due to vaccine-preventable disease. In Ethiopia, incomplete immunization accounts for nearly 16% of under-five mortality, and there is spatial variation for vaccination of children in Ethiopia. Spatial variation of vaccination can create hotspot of under vaccination and delay control and elimination of vaccine preventable disease. Thus, this study aims to assess the spatial distribution of incomplete immunization among children in Ethiopia from the three consecutive Ethiopia demographic and health survey data. METHOD A cross-sectional study was employed from Ethiopia demographic and health survey (2005, 2011and 2016) data. In total, 7901mothers who have children aged (12-35) months were included in this study. ArcGIS 10.5 Software was used for global and local statistics analysis and mapping. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of incomplete immunization. GWR version 4 Software was used to model spatial relationships. RESULT The proportion of incomplete immunization was 74.6% in 2005, 71.4% in 2011, and 55.1% in 2016. The spatial distribution of incomplete immunization was clustered in all the study periods (2005, 2011, and 2016) with global Moran's I of 0.3629, 1.0700, and 0.8796 respectively. Getis-Ord analysis pointed out high-risk regions for incomplete immunization: In 2005, hot spot (high risk) regions were detected in Kefa, Gamogofa, KembataTemibaro, and Hadya zones of SNNPR region, Jimma zone of Oromiya region. Similarly, Kefa, Gamogofa, Kembatatemibaro, Dawuro, and Hadya zones of SNNPR region; Jimma and West Arsi zones of Oromiya region were hot spot regions. In 2016, Afder, Gode, Korahe, Warder Zones of Somali region were hot spot regions. Geographically weighted regression identified different significant variables; being not educated and poor wealth index were the two common for incomplete immunization in different parts of the country in all the three surveys. CONCLUSION Incomplete immunization was reduced overtime across the study periods. The spatial distribution of incomplete immunization was clustered and High-risk areas were identified in all the study periods. Predictors of incomplete immunization were identified in the three consecutive surveys.
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Affiliation(s)
- Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, Wollo University, Dessie, Ethiopia
| | - Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health 2020; 20:1108. [PMID: 32664849 PMCID: PMC7362649 DOI: 10.1186/s12889-020-09169-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker’ barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, lifestyle, migration, occupation and parent’s forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.
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Affiliation(s)
- Joseph Benjamin Bangura
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China. .,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Feiyun Ouyang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lei Chen
- Department of Pediatrics, Faculty, Global Health Initiative, Yale University School of Medicine, New Haven, USA
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Shibre G, Zegeye B, Idriss-Wheeler D, Yaya S. Inequalities in measles immunization coverage in Ethiopia: a cross-sectional analysis of demographic and health surveys 2000-2016. BMC Infect Dis 2020; 20:481. [PMID: 32635891 PMCID: PMC7341655 DOI: 10.1186/s12879-020-05201-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia has low measles immunization coverage and little is known about the disparities surrounding what coverage is provided. This study assessed disparities in measles immunization and its change over time using the four Ethiopia Demographic and Health Surveys conducted between 2000 and 2016. Methods This is a cross-sectional analysis of data using Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to present the inequalities. Four measures of inequality were calculated: Difference (D), Ratio (R), Population Attributable Fraction (PAF) and Population Attributable Risk (PAR). The results were disaggregated by wealth, education, residence, sex and sub-national regions and 95% Uncertainty Intervals (UIs) were computed for each point estimate to boost confidence of the findings. Results Measles immunization coverage was higher among the richest and secondary and above schools’ subgroup by nearly 30 to 31 percentage points based on point estimates (D = 31%; 95% CI; 19.48, 42.66) and 29.8 percentage points (D = 29.8%; 95% CI; 16.57, 43.06) as compared to the poorest and no education subgroup respectively in the 2016 survey. Still, in the 2016 survey, substantial economic status (PAF = 36.73; 95%CI: 29.78, 43.68), (R = 1.71; 95%CI: 1.35, 2.08), education status (PAF = 45.07; 95% CI: 41.95, 48.18), (R = 1.60; 95% CI: 1.30, 1.90), place of residence (PAF = 39.84, 95% CI: 38.40, 41.27), (R = 1.47, 95% CI: 1.20, 1. 74) and regional (PAF = 71.35, 95% CI: 31.76, 110.95), (R = 3.09, 95%CI: 2.01, 4.17) inequality were observed with both simple and complex measures. There was no statistically significant difference in the prevalence of measles immunization between male and female children in all the studied years, as indicated, for instance, by measures of PAF in 2000 (PAF = 0; 95%CI: − 6.79, 6.79), 2005 (PAF = 0; 95%CI: − 6.04, 6.04), 2011(PAF = 0; 95%CI: − 3.79, 3.79) and 2016 (PAF = 2.66; − 1.67; 6.99). Overall, the inequality of measles immunization narrowed significantly by at least some of the measures between the first and the last survey periods across all the studied subgroups. Conclusions National, regional and district levels of government should make a pledge to reduce inequalities in coverage of measles immunization. Equity-sensitive strategies, sufficient human and financial resources as well as continued research and monitoring of immunization coverage inequalities are necessary to achieve related sustainable development goals.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betregiorgis Zegeye
- Shewarobit Field Office, HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada. .,The George Institute for Global Health, The University of Oxford, Oxford, UK.
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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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Debie A, Lakew AM, Tamirat KS, Amare G, Tesema GA. Complete vaccination service utilization inequalities among children aged 12-23 months in Ethiopia: a multivariate decomposition analyses. Int J Equity Health 2020; 19:65. [PMID: 32398089 PMCID: PMC7218567 DOI: 10.1186/s12939-020-01166-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/18/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although World Health Organization works to make vaccination service available to everyone everywhere by 2030, majority of the world's children have been unvaccinated and unprotected from vaccine-preventable diseases. In fact, evidences on factors contributing to changes in vaccination coverage across residential areas, wealth categories and over time have not been adequate. Therefore, this study aimed at investigating inequalities in vaccination status of children aged 12-23 months owing to variations in wealth status, residential areas and over time. METHODS Maternal and child health service data were extracted from the 2011 and 2016 Ethiopian Demographic and Health Survey datasets. Then, multivariate decomposition analysis was done to identify the major factors contributing to differences in the rate of vaccination utilization across residences and time variations. Similarly, a concentration index and curve were also done to identify the concentration of child vaccination status across wealth categories. RESULTS Among children aged 12-23 months, the prevalence of complete childhood vaccination status increased from 20.7% in rural to 49.2% in urban in 2011 and from 31.7% in rural to 66.8% in urban residences in 2016. The decomposition analyses indicated that 72% in 2011 and 70.5% in 2016 of the overall difference in vaccination status was due to differences in respondent characteristics. Of the changes due to the composition of respondent characteristics, such as antenatal care and place of delivery were the major contributors to the increase in complete childhood vaccination in 2011, while respondent characteristics such as wealth index, place of delivery and media exposure were the major contributors to the increase in 2016. Of the changes due to differences in coefficients, those of low wealth status in 2016 across residences significantly contributed to the differences in complete childhood vaccination. On top of that, from 2011 to 2016, there was a significant increment in complete childhood vaccination status and a 59.8% of the overall increment between the surveys was explained by the difference in composition of respondents. With regard to the change in composition, the differences in composition of ANC visit, wealth status, place of delivery, residence, maternal education and media exposure across the surveys were significant predictors for the increase in complete child vaccination over time. On the other hand, the wealth-related inequalities in the utilization of childhood vaccination status were the pro-rich distribution of health services with a concentration index of CI = 0.2479 (P-value < 0.0001) in 2011 and [CI = 0.1987; P-value < 0.0001] in 2016. CONCLUSION A significant rural-urban differentials was observed in the probability of a child receiving the required childhood vaccines. Children in urban households were specifically more likely to have completed the required number of vaccines compared to the rural areas in both surveys. The effect of household wealth status on the probability of a child receiving the required number of vaccines are similar in the 2011 and 2016 surveys, and the vaccination status was high in households with high wealth status. The health policies aimed at reducing wealth related inequalities in childhood vaccination in Ethiopia need to adjust focus and increasingly target vulnerable children in rural areas. It is of great value to policy-makers to understand and design a compensation mechanism for the costs incurred by poor households. Special attention should also be given to rural communities through improving their access to the media. The findings highlight the importance of women empowerment, for example, through education to enhance childhood vaccination services in Ethiopia.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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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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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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Nordhagen S, Bauck A, Doledec D. Gender Equity and Vitamin A Supplementation: Moving Beyond Equal Coverage. Food Nutr Bull 2019; 41:38-49. [DOI: 10.1177/0379572119860310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Vitamin A supplementation (VAS) is currently implemented in over 80 countries worldwide, but little attention has been paid to gender equity in the design or implementation of these programs. Objective: This article describes the ways in which gender equity can impact or be impacted by VAS programs and suggests ways to ensure these programs better support gender equity in the future. Methods: We undertook a desk review of research on gender equity in health services and extrapolated findings to VAS, highlighting gender equity issues throughout the VAS implementation process and across delivery platform types. We also amassed secondary data on VAS coverage from 45 surveys in 13 countries and analyzed it to examine differences in VAS coverage between boys and girls. Results: Despite few significant differences in coverage between boys and girls, we identify numerous ways in which gender equity can impact or be impacted by VAS programs, including through the choice of VAS distributors and the communication materials used to promote VAS campaigns. Examining these different entry points reveals that there are several missed opportunities for better integration of gender within VAS. Conclusions: VAS program implementers and policymakers should revisit VAS approaches to identify opportunities for advancing gender equity through this wide-reaching platform.
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Affiliation(s)
- Stella Nordhagen
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - Aubrey Bauck
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - David Doledec
- Africa Regional Office, Helen Keller International, Nairobi, Kenya
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Tamirat KS, Sisay MM. Full immunization coverage and its associated factors among children aged 12-23 months in Ethiopia: further analysis from the 2016 Ethiopia demographic and health survey. BMC Public Health 2019; 19:1019. [PMID: 31362790 PMCID: PMC6668097 DOI: 10.1186/s12889-019-7356-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination is one of the cost effective strategies reducing childhood morbidity and mortality. Further improvement of immunization coverage would halt about 1.5 million additional deaths globally. Understanding the level of immunization among children is vital to design appropriate interventions. Therefore, this study aimed to assess full immunization coverage and its determinants among children aged 12-23 months in Ethiopia. METHODS The study was based on secondary data analysis from the 2016 Ethiopia Demographic and Health Survey (EDHS). Information about 1,909 babies aged 12-23 months was extracted from children dataset. Both bivariate and multivariable logistic regression models were utilized to assess the status and factors associated with full immunization. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed. Variables with less than 0.05 p-values in the multivariable logistic regression model were considered as statistically and significantly associated with the outcome variable. RESULTS The overall full immunization coverage was 38.3% (95% CI: 36.7, 41.2). Rural residence (AOR = 0.60, 95% CI: 0.43, 0.84), employed (AOR = 1.62, 95% CI: 1.31, 2.0), female household head (AOR = 0.58, 95% CI: 0.44, 0.76), wealth index [middle (AOR = 1.44, 95% CI: 1.07, 1.94) and richness (AOR = 1.65, 95% CI: 1.25,2.19)], primary school maternal education (AOR = 1.38,95% CI: 1.07, 1.78), secondary school maternal education (AOR = 2.19, 95% CI: 1.43, 3.36), diploma graduated mothers (AOR = 1.99, 95% CI: 1.09, 3.61), ANC follow ups (AOR = 2.79, 95% CI:2.17 3.59), and delivery at health facilities (AOR = 1.76, 95% CI: 1.36, 2.24) were significantly associated factors with full immunization. CONCLUSION Full immunization coverage in Ethiopia was significantly lower than the global target. Female household head and rural dwellings were negatively associated with full immunization. In contrast higher maternal education, employment, middle and rich economic status, ANC follow up, and delivery at health facility were positively associated with full immunization among 12-23 months old children. This suggests that improved health education and service expansion to remote areas are necessary to step immunization access.
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Affiliation(s)
- Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Adegbosin AE, Zhou H, Wang S, Stantic B, Sun J. Systematic review and meta-analysis of the association between dimensions of inequality and a selection of indicators of Reproductive, Maternal, Newborn and Child Health (RMNCH). J Glob Health 2019; 9:010429. [PMID: 31131102 PMCID: PMC6513502 DOI: 10.7189/jogh.09.010429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Globally, progress in Maternal and Child Health (MCH) has been inconsistent, with several evidence showing both between and within country disparities in several RMNCH outcome measures. In this study, we aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators. METHODS We searched PubMed, Embase, Scopus databases and grey literatures from the WHO, UNICEF and World Bank publications. Using the PRISMA guidelines, we identified and reviewed studies from low and middle-income countries, that explored the effects of inequalities on RMNCH, with focus on studies that utilised data from a nationally representative survey. The review protocol was registered at the PROSPERO international prospective register of systematic reviews. RESULTS A total of 28 studies were included in the meta-analysis. Results revealed the existence of marked inequality based on income levels, education and place of residence. The most significant level of disparity was with regards to unmet need for contraception and antenatal coverage. For both respective indicators, those with secondary or higher education were 6 times more likely to have better coverage, than those with lesser level of education; (odds ratio (OR) = 6.25 (95% confidence interval (CI) = 1.68-23.23; I2 = 98%, P = 0.006) and (OR = 6.17 (95% CI = 3.03-12.56; I2 = 97%, P < 0.00001) respectively. In contrast, the lowest inequality was in the completion of 3 doses of diphtheria, pertussis and tetanus vaccines (DPT3), those with primary or no education, were equally as likely as those with secondary or higher education to have received DPT3; (OR = 1.21, 95% CI = 0.34-4.27; I2 = 96%, P = 0.77). CONCLUSIONS In developing countries, maternal and child health coverage remains highly inequitable and assess to maternal and child health services are governed by factors such as income, level of education, and place of residence.
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Affiliation(s)
| | | | - Sen Wang
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - Bela Stantic
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Yismaw AE, Assimamaw NT, Bayu NH, Mekonen SS. Incomplete childhood vaccination and associated factors among children aged 12-23 months in Gondar city administration, Northwest, Ethiopia 2018. BMC Res Notes 2019; 12:241. [PMID: 31036071 PMCID: PMC6489187 DOI: 10.1186/s13104-019-4276-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Despite the fact that immunization services are offered free of charge in Ethiopia but the coverage of complete vaccination is still low. The aim of the study is to determine incomplete vaccination and associated factors among children aged 12–23 months in Gondar city administration, Northwest Ethiopia, 2018. Result The proportion of incomplete vaccination among children aged 12–23 months in Gondar city adminstration was 24.3% (95% CI 19.3, 29.2). Knowledge about the benefits of vaccination (AOR = 6.1 (95% CI 1.3, 28.9), the age at which the child begins vaccination (AOR = 2.4 (95% CI 1.09, 8.4) time taken to reach nearby health facility and means of transportation to nearby health facility (AOR = 0.22 95% CI 0.06, 0.9) have statistically significant association with incomplete vaccination. In the current study the proportion of incomplete vaccination was found to be high. Increasing the awareness about vaccination for child care givers and further improve caregiver’s knowledge towards the benefit of vaccination is important.
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Affiliation(s)
- Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia.
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanent Habetie Bayu
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet Mekonen
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zida-Compaore WIC, Ekouevi DK, Gbeasor-Komlanvi FA, Sewu EK, Blatome T, Gbadoe AD, Agbèrè DA, Atakouma Y. Immunization coverage and factors associated with incomplete vaccination in children aged 12 to 59 months in health structures in Lomé. BMC Res Notes 2019; 12:84. [PMID: 30764874 PMCID: PMC6376666 DOI: 10.1186/s13104-019-4115-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/06/2019] [Indexed: 11/11/2022] Open
Abstract
Objective To estimate the immunization coverage among children admitted for consultation or hospitalization in health structures of Lomé. Results A total of 797 respondent–child couples were included and 31.1% of them had their immunization cards. Complete immunization coverage was 69.3%, 95% confidence interval (65.9–72.5) and per antigen, it ranged from 83.1% for measles to 95.7% for BCG. Factors associated with incomplete immunization were the absence of immunization card (p < 0.001), respondents’ sex (p < 0.001), level of education (p < 0.001), marital status (p < 0.001) and the level of the health structure in the organization of the Togolese health system (p < 0.001). Obstacles to immunization were mainly the lack of money to pay for immunization fees (38.4%) and forgetting the immunization appointment (28.1%).
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Affiliation(s)
- Wendpouiré I C Zida-Compaore
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Didier K Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, 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.
| | | | - Essèboè K Sewu
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Tetouyaba Blatome
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Adama D Gbadoe
- Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Hôpital de Bè, Lomé, Togo
| | - Diparidè A Agbèrè
- Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Centre Hospitalier Régional de Lomé-Commune, Lomé, Togo
| | - Yawo Atakouma
- Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo
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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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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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Asuman D, Ackah CG, Enemark U. Inequalities in child immunization coverage in Ghana: evidence from a decomposition analysis. HEALTH ECONOMICS REVIEW 2018; 8:9. [PMID: 29644503 PMCID: PMC5895562 DOI: 10.1186/s13561-018-0193-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/25/2018] [Indexed: 05/14/2023]
Abstract
Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant inequalities in achieving universal coverage of child vaccination among and within countries. In this paper, we examine rural-urban inequalities in child immunizations in Ghana. Using data from the recent two waves of the Ghana Demographic and Health Survey, we examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas. We find significant child-specific, maternal and household characteristics on a child's immunization status. The results show that children in rural areas are more likely to complete the required vaccinations. The direction and sources of inequalities in child immunizations have changed between the two survey waves. We find a pro-urban advantage in 2008 arising from differences in observed characteristics whilst a pro-rural advantage emerges in 2014 dominated by the differences in coefficients. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas, to maintain focus on women empowerment and pay attention to children from high socio-economic households in less favourable economic times.
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Affiliation(s)
- Derek Asuman
- Institute of Statistical, Social and Economic Research, University of Ghana, E.N. Omaboe Building, P. O. Box LG 74, Legon, Ghana
| | - Charles Godfred Ackah
- Institute of Statistical, Social and Economic Research, University of Ghana, E.N. Omaboe Building, P. O. Box LG 74, Legon, Ghana
| | - Ulrika Enemark
- Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
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Samiak L, Emeto TI. Vaccination and nutritional status of children in Karawari, East Sepik Province, Papua New Guinea. PLoS One 2017; 12:e0187796. [PMID: 29121088 PMCID: PMC5679557 DOI: 10.1371/journal.pone.0187796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022] Open
Abstract
Delivery of health care services to rural and remote populations in Papua New Guinea (PNG) is problematic. This is mainly due to difficulties with transportation and communication. Hence, the children in this region of PNG are likely to be at risk of malnutrition compounded by inadequate vaccination that may predispose them to preventable diseases. This study was conducted to determine the vaccination and nutritional status of children less than 5 years old in the remote and rural Karawari area of PNG. 105 children were included in the study, of whom 55% were male and 45% female. The mean age of children included in the study was 32.6 months. Their age, height, and weight by gender was not significantly different. Overall, 85% of children had incomplete vaccination. However, children above the median age of 32 months (34%) were more likely to be fully vaccinated for their age, χ2 (1) = 23.294, p < 0.005. In addition, 25% of children were below the -1 SD (Z-scores) for weight-for—height, 33% below the -1 SD for weight-for-age, and 25.5% below the -1 SD for height-for-age compared to WHO standards. A large proportion of children had poor nutrition status and lack protection from vaccine preventable diseases. This study recommends that the government should introduce a surveillance system for detecting issues of importance to the rural majority. We also recommend that the PNG government reopen the nearby health centre, and/ or establish new facilities within the region, with adequately trained and compensated staff.
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Affiliation(s)
- Louis Samiak
- Department of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Theophilus I. Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- * E-mail:
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Landoh DE, Kahn AL, Lacle A, Adjeoda K, Saka B, Yaya I, Nassoury DI, Kalao A, Makawa MS, Biey NMJ, Bita A, Toke YT, Dörte P, Imboua L, Ronveaux O. [Impact of Controlled Temperature Chain (CTC) approach on immunization coverage achieved during the preventive vaccination campaign against meningitis A using MenAfriVac in Togo in 2014]. Pan Afr Med J 2017; 27:38. [PMID: 28761614 PMCID: PMC5516651 DOI: 10.11604/pamj.2017.27.38.11873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/06/2017] [Indexed: 11/11/2022] Open
Abstract
METHOD We conducted a survey from 9 to 14 March 2015 (for approximately 3 months) after the end of the vaccination campaign in these four regions. Interviewees were selected using two stages cluster sampling stratified according to the regions. MenAfriVac vaccine in Controlled Temperature Chain (CTC) was used in 10 districts, in Togo. RESULTS A total of 2707 households were surveyed and 9082 people aged 1-29 years were interviewed. The average age of the individuals surveyed was 11.8±7.7 years and sex-ratio (H/F) was 1.01. The average number of individuals per household was 5.7 and that of persons aged 1-29 years targeted in the campaign was 3.4. Out of 9082 people surveyed 8889 (98%) were vaccinated. Multivariate analysis showed that the factors associated with immunization coverage using MenAfrivac vaccine were: habitual residence in the area at the time of the campaign (AOR = 4.52; 95%CI = [4.07 - 4.97]) and level of information about the campaign before it starts (AOR=2.42; 95%CI = [2.05 - 2.80]). By contrast, there were no differences in vaccination coverage between the areas based on whether the CTC approach was used or not (AOR=0.09; 95%CI = [-0.27 - 0.45]). Two hundred and seven respondents (2.3%) reported that they had Adverse Event Following Immunisation (AEFI) after the administration of the vaccine. These were usually minor AEFI involving fever, abscesses and swelling at the injection site. CONCLUSION Survey results show that the use of CTC in a country with limited resources such as Togo doesn't have a negative impact on immunization coverage. Indeed, there was no difference between immunization coverage in CTC and non-CTC areas. It is important to capitalize on the experience gained in order to use vaccines by Expanded Program of Immunization in CTC approach especially in countries with limited resources in terms of cold chain availability.
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Affiliation(s)
| | - Anna-Léa Kahn
- World Health Organization, Headquarters, Genève, Switzerland
| | - Anani Lacle
- Division de l'Immunisation, Ministère de la Santé du Togo, Lomé, Togo
| | - Kodjovi Adjeoda
- Division de l'Immunisation, Ministère de la Santé du Togo, Lomé, Togo
| | - Bayaki Saka
- Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, Lomé, Togo
| | - Issifou Yaya
- Laboratoire de Santé Publique (EA 3279), Aix-Marseille Université, Marseille, France
| | | | - Assima Kalao
- Direction Préfectorale de la Santé Golfe, Ministère de la santé, Lomé, Togo
| | - Makawa-Sy Makawa
- Fonds des Nations Unies pour l'Enfance (UNICEF), Bureau Togo, Lomé, Togo
| | | | - Andre Bita
- World Health Organization, IST/WA, Ouagadougou , Burkina Faso
| | | | - Petit Dörte
- World Health Organization, Headquarters, Genève, Switzerland
| | - Lucile Imboua
- World Health Organization, Country Office, Lomé, Togo
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Hu Y, Chen Y, Wang Y, Song Q, Li Q. Prenatal vaccination education intervention improves both the mothers' knowledge and children's vaccination coverage: Evidence from randomized controlled trial from eastern China. Hum Vaccin Immunother 2017; 13:1-8. [PMID: 28319453 DOI: 10.1080/21645515.2017.1285476] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To verify the effectiveness of prenatal vaccination education intervention on improving mother's vaccination knowledge and child's vaccination status in Zhejiang province, eastern China. METHODS Pregnant women with ≥ 12 gestational weeks were recruited and randomly assigned into the intervention group and the control group. The intervention group were given a vaccination education session while the control group were not. Two round surveys were performed before and 3 months after the intervention. The vaccination status of child was extracted at 12 months of age from immunization information system. The differences of the vaccination knowledge, the coverage, the completeness and the timeliness of vaccination between 2 groups were evaluated. The effectiveness of vaccination education intervention was assessed, under the control of the other demographic variables. RESULTS Among the 1252 participants, 851 subjects replied to the post-survey. Significant improvements of vaccination knowledge between the pre- and the post- survey in the intervention group were observed (Mean ± S.D:1.8 ± 1.1 vs. 3.7 ± 1.2 for vaccines score and 2.7 ± 1.5 vs. 4.8 ± 1.0 for vaccine policy score, respectively). The coverage of fully vaccination was significantly higher in the intervention group (90.0% vs. 82.9%, P<0.01). The timeliness of fully vaccination was significantly higher in the intervention group (51.9% vs. 33.0%, P<0.01). In the intervention group, pregnant women were more likely to be with high score of knowledge (OR = 5.2, 95%CI: 2.6-8.8), and children were more likely to complete the full series of vaccination (OR = 3.4, 95%CI: 2.1-4.8), and children were more likely to complete the full series of vaccination in a timely manner (OR = 2.3, 95%CI: 1.6-3.5). CONCLUSIONS Vaccination education in the pregnant women can effectively improve the knowledge regarding immunization and increase the coverage, the completeness and the timeliness of childhood vaccination. Strong partnership needs to be established between the obstetricians and the vaccination staff to improve the performance of NIP.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Quanwei Song
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Qian Li
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
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