Understanding multilevel barriers to childhood vaccination uptake among Internally Displaced Populations (IDPs) in Mogadishu, Somalia: a qualitative study

Prevalence and factors contributing to missed opportunities for vaccination in Mogadishu, Somalia

Objectives

Vaccination is a critical public health intervention that significantly reduces morbidity and mortality from vaccine-preventable diseases. Despite the proven benefits of vaccines, missed opportunities for vaccination (MOVs) remain a significant challenge in many low-income countries, including Somalia. This study aimed to determine the prevalence and identify the factors contributing to MOVs in Mogadishu, Somalia.

Methods

A cross-sectional study was conducted at various health care facilities in Mogadishu, Somalia from January to March 2024. A total of 234 caregivers of children under 5 years of age were interviewed using a structured questionnaire. Data on sociodemographic characteristics, health service utilization, and reasons for missed vaccinations were collected. Logistic regression analysis was used to identify factors associated with MOVs.

Results

The prevalence of MOVs in Mogadishu was 26%. The key factors contributing to MOVs included low socioeconomic status, lack of caregiver awareness about vaccination schedules, logistical challenges within the health care system, and misconceptions about vaccine safety and efficacy. Knowledge and beliefs of mothers about vaccination significantly affected the MOVs in children. Not knowing whether all children should be vaccinated is associated with higher probability of (MOVs) (adjusted odds ratio = 13.006, 95% confidence interval = 1.175-143.924, P = 0.003).

Conclusions

The study highlighted a significant prevalence of MOVs in Mogadishu, Somalia. Addressing these missed opportunities requires a multifaceted approach, including enhancing public awareness about the importance of vaccination, improving health care infrastructure, and ensuring consistent vaccine supply and proper storage.

Childhood Vaccinations and Associated Factors in 35 Sub-Saharan African Countries: Secondary Analysis of Demographic and Health Surveys Data from 358 949 Under-5 Children

Objective. We examined childhood vaccinations coverage and its associated factors in sub-Saharan Africa (SSA) countries. Methods. We used demographic and health surveys (DHSs) data collected between 2008 and 2022 from 35 SSA countries. A sample of 358 949 under-5 children was analyzed. Percentage and multivariable binary logistic regression analyses were conducted. A 5% significance level was set. Results. Rwanda (7461/8092; 92.2%), Burundi (10 792/13 192; 81.8%), Gambia (6548/8362; 78.3%), Kenya (14 570/19 530; 74.6%), and Burkina Faso (8739/12 343; 70.8%) had the leading coverage of under-5 children who received all basic vaccinations in the first year of life. For every unit increase in the age of a child, there was 72% increase in the odds of vaccination. Children from older mothers had higher odds of vaccination, when compared with children with mothers aged 15 to 19 years. There was a 6% reduction in the odds of vaccination among children from rural residence, when compared with their urban counterparts. Children with educated mothers had over two times higher odds of vaccination, when compared with those from mothers with no formal education. Children from rich households had higher odds of vaccination, when compared with children from poorest household. There was a 13% increase in the odds of vaccination among children covered by health insurance, when compared with those not covered by health insurance. Conclusion. Vaccination uptake for children under-5 in SSA was found to be sub-optimal and associated with several factors. A health educational intervention for pregnant women could potentially increase the uptake of vaccines among children.

Vaccination card loss and associated factors in Ethiopia: A multilevel analysis using Ethiopia Mini Demographic and Health Survey 2019 data

BACKGROUND

The loss of vaccination cards is a momentous public health challenge in the prevention of vaccine-preventable diseases in most developing countries. There is a paucity of studies on the magnitude of vaccination card losses and associated factors in Ethiopia. Therefore, the aim of the current study was to assess the level of vaccination card loss and associated factors in Ethiopia.

METHODS

Data were extracted from the 2019 Ethiopia Mini Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years with children aged 0-35 months. Data from a total of 3208 mother-child pairs was extracted for the study. A multilevel logistic regression model with random effect analysis techniques was used to identify individual and regional-level determinants of vaccination card loss. We checked the model's fitness by using Akaike Information Criteria and Bayesian Information Criteria. Odds ratios with a 95% Confidence intervals were used to declare statistical significance.

RESULTS

A total of 3208 mother-child pairs from nine regions and two city administrations were included in the analysis. The result revealed that 1933 (60.26%) mother-child pairs did not have vaccination cards during home visits. illiterate mother 2.239 (95% CI: 1.297, 3.864), lowest wealth index category 2.089 (95% CI: 1.432, 3.048), ANC non-user 2.047 (95% CI: 1.605, 2.609), children living with their caretaker 6.749 (95% CI: 1.425, 13.654), having no access to television 1.384 (95% CI: 1.150, 1.664), longer birth interval 1.325 (95% CI: 1.027,1.710), giving birth at home and private health facilities 1.985 (95% CI: 1.579, 2.497), 1.696 (1.086, 2.648), contraceptive non-users 1.295 (95% CI: (1.042,1.609) and children aged 12-23 months and 24-35 months 1.577 (95% CI: 1.252, 1.985) and 2.282 (1.803, 2.889) were associated with vaccination card loss.

CONCLUSIONS

Overall vaccination card loss among mothers of 0-35-month-old children is considerably high. To enhance maternal awareness regarding the significance of vaccination cards, promote antenatal care and public health facility delivery, and future researchers have to explore how to enhance vaccination card retention in Ethiopia.

Barriers to child vaccination: The role of international sanctions

International sanctions are often imposed with the aim of influencing the political behavior of target states, but they may have unintended consequences on public health. This study empirically examines the impact of international sanctions on child immunization rates in developing countries. Utilizing panel data from 76 developing countries between 2000 and 2019, the analysis explores how different types of sanctions, including those from the US, EU, and UN, as well as economic and unilateral sanctions, affect the immunization rates for DPT, Hepatitis B, and Measles vaccines. The findings indicate that sanctions, particularly those imposed by the US and EU, significantly reduce vaccination rates, with economic and unilateral sanctions showing the most substantial negative impact. Additionally, the study highlights the moderating role of health spending, revealing that increased healthcare investment can mitigate some of the adverse effects of sanctions. Poorer developing countries are disproportionately affected compared to their more affluent counterparts. The results underscore the need for policymakers to consider the broader public health implications of sanctions and for international efforts to ensure that essential medical resources remain accessible in sanctioned countries. This study contributes to the literature by providing comprehensive empirical evidence on the detrimental effects of international sanctions on child immunization, advocating for a balanced approach that protects public health while achieving geopolitical objectives.

Maternal Satisfaction With Children's Vaccination and Its Contributing Factors in Ethiopia: A Systematic Review and Meta-Analysis

Background: Various initiatives are underway to improve maternal satisfaction with the vaccination of children in developing nations. Governments, international organizations, and nongovernmental organizations are actively working to improve healthcare infrastructure, expand service accessibility, improve communication, and foster community engagement. However, despite these efforts, maternal satisfaction with child vaccination services continues to be a significant issue. Objective: This systematic review and meta-analysis is aimed at assessing the pooled prevalence of maternal satisfaction with the child's vaccination service and its predictors in Ethiopia. Methods: Scopus, Embase, Web of Science, Google Scholar, PubMed, African Journals Online, and Semantic Scholar were searched to access the included articles. A weighted inverse-variance random effect model was used to estimate the prevalence of maternal satisfaction with vaccination of children. Variations in pooled prevalence estimates were adjusted by subgroup analysis according to the specific region where the study was conducted. Funnel plot and Egger's regression test were used to check publication bias. STATA version 14 statistical software was used for meta-analysis. Results: The combined prevalence of maternal satisfaction with vaccination of children was found to be 73% (95% CI: 72-75; I 2 = 0.00%, p value < 0.001). Based on the subgroup analysis, the result revealed that the prevalence of maternal satisfaction with vaccination of children was 63% in SNNPR, 79% in Oromia, and 74% in Amhara. Conclusions: A meta-analysis of mothers' satisfaction with vaccination services for their children in Ethiopia found a low level of satisfaction. Therefore, provide regular training and capacity-building programs for healthcare workers involved in the delivery of vaccination services.

COVID-19 Vaccine Uptake and Factors Associated Among Pregnant Women in Mogadishu, Somalia

Background

Pregnant women exhibit COVID-19 vaccine hesitancy due to concerns regarding potential risks to their babies, doubts about vaccine efficacy, and limited access to information. Therefore, this study aims to estimate COVID-19 vaccine uptake and factors associated with pregnant women in Mogadishu, Somalia.

Methods

A cross-sectional study was conducted on pregnant women using a questionnaire covering socio-demographic information, pregnancy-related characteristics, perceptions about the COVID-19 vaccine, and vaccination status. Univariable and multivariable logistic regression analyses were utilized to identify factors associated with the outcome variable.

Results

Among the 400 pregnant women who participated in this study, 26.8% had received a COVID-19 vaccine dose, with only 14.9% receiving it during pregnancy. Reasons for not receiving the vaccine included a lack of information about the vaccine (47.4%), concerns about its adverse effects on personal health (33.8%), misconceptions regarding impacts on fertility or menstrual cycles (14.3%), belief in the vaccine's inefficacy (3.4%), and fears about adverse effects on their fetus. In multivariable logistic regression, pregnant women with a history of chronic diseases (AOR=3.27, 95% CI=1.992-6.145), those who perceived themselves at risk of contracting COVID-19 (AOR=3.81, 95% CI=2.11-5.10), those who believed that the vaccine was accessible to them (AOR=4.34, 95% CI=2.915-6.165), and those who discussed the COVID-19 vaccine with their healthcare provider (AOR=3.91, 95% CI=2.123-7.878) were more likely to receive the COVID-19 vaccine compared to their counterparts.

Conclusion

Pregnant women in Mogadishu, Somalia, face challenges with sub-optimal covid-19 vaccine uptake. Implementations should improve awareness of COVID-19 risks and facilitate discussions between healthcare providers and pregnant women. In addition, efforts to provide reliable information about the vaccine, alleviate concerns about its adverse effects, and dispel misconceptions about fertility, menstrual cycles, efficacy, and foetal impact are crucial.

Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia

Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff (n = 17), and with vaccinators and community members (n = 52). The data were analyzed using the GAVI Vaccine Alliance IRMMA framework. Nomadic populations, internally displaced persons, and populations living in remote and Al-shabaab-controlled areas are three vulnerable and neglected populations with a high proportion of zero-dose children. Despite the contextual heterogeneity of these population groups, the lack of targeted, population-specific strategies and meaningful engagement of local communities in the planning and implementation of immunization services is problematic in effectively reaching zero-dose children. This is, to our knowledge, the first study that examines vaccination strategies for zero-dose and under-vaccinated populations in the fragile context of Somalia. Evidence on populations at risk of vaccine-preventable diseases and barriers to vital vaccination services remain critical and urgent, especially in a country like Somalia with complex health system challenges.