Immunization coverage and factors associated with incomplete vaccination in children aged 12 to 59 months in health structures in Lomé

Population-based cross-sectional study of factors influencing full vaccination status of children aged 12- 23 months in a rural district of the Upper East Region, Ghana

BACKGROUND

Achieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 - 23 months in a rural district of the Upper East Region of Ghana.

METHODS

A population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children's health record books and carers' recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0.

RESULTS

The results showed that 76.9% (95% CI: 72.3 - 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20-5.63) and tertiary (aOR = 3.98, 95% CI: 1.34-11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03-4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21-0.80).

CONCLUSIONS

Our study found that nearly one-quarter of children aged 12-23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12-23 months, and improving accessibility to vaccination services.

Urban-rural disparities in immunization coverage among children aged 12-23 months in Ethiopia: multivariate decomposition analysis

BACKGROUND

Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia.

METHODS

We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.

RESULTS

The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity.

CONCLUSIONS

There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.

Rates of Seroprotection against Vaccine-Preventable Infectious Diseases in HIV-Exposed and -Unexposed Malawian Infants

BACKGROUND

The evaluation of seroprotection rates against vaccine-preventable infectious diseases allows for the identification of risk populations. HIV-exposed infants, even if not infected with HIV, have higher morbidity and mortality in comparison to unexposed counterparts. The aim of this study was to compare the specific IgG levels against Haemophilus influenzae type-B (HiB), Hepatitis-B (HBV), and Streptococcus pneumoniae (Spn) in two groups of infants (HIV-exposed and HIV-unexposed) living in Malawi.

METHODS

Blood samples from 62 infants, 49 HIV-exposed, uninfected (HEU), and born to women living with HIV and 13 HIV-unexposed and uninfected (HUU), were collected at 6 months, and specific IgG levels were determined using ELISA tests.

RESULTS

The antibody levels against HiB, HBV, and Spn were similar in the two groups. At six months, all HUU infants and 81.6% of HEU infants showed seroprotective levels against HiB, while a percentage of protection varying from 80.6 to 84.6% was observed for HBV and Spn regardless of HIV exposure. Only 59.2% of HEU and 69.2% of HUU infants showed antibody protection against all three pathogens.

CONCLUSIONS

These results indicate similar rates of seroprotection among HEU and HUU infants but also suggest that a consistent fraction of infants received incomplete vaccinations. Strategies to enforce participation in immunization programs in Malawi should be a health priority.

Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis

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.

Determinants of childhood vaccination among children aged 12-23 months in Ethiopia: a community-based cross-sectional study

OBJECTIVE

Childhood vaccination is a cost-effective, essential service to reach a larger population globally. Due to unclear reasons, new emergence and resurgence of vaccine-preventable diseases increase. Thus, the aim of this study is to identify prevalence and determinants of childhood vaccination in Ethiopia.

DESIGN

Community-based cross-sectional study.

SETTING

We used data from 2019 Ethiopia Mini Demographic and Health Survey. The survey included all the nine regional states and two city administrations of Ethiopia.

PARTICIPANTS

A weighted sample of 1008 children 12-23 months of age was included in the analysis.

MAIN OUTCOME MEASURES

A multilevel proportional odds model was fitted to identify determinants of childhood vaccination status. In the final model, variables with a p value of less than 5% and an adjusted OR (AOR) with a 95% CI were reported.

RESULT

The full childhood vaccination coverage of Ethiopia was 39.09% (95% CI: 36.06%-42.28%). Mothers who attended primary (AOR=2.16; 95% CI: 1.43-3.26), secondary (AOR=2.02; 95% CI: 1.07-3.79) and higher education (AOR=2.67; 95% CI: 1.25-5.71); being in union (AOR=2.21; 95% CI: 1.06-4.58); kept vaccination cards (AOR=26.18; 95% CI: 15.75-43.53); children receiving vitamin A₁ (AOR=4.14; 95% CI: 2.9-5.9); living in Afar (AOR=0.14; 95% CI: 0.04-0.45), Somali (AOR=0.19; 95% CI: 0.06-0.60), Gambela (AOR=0.22; 95% CI: 0.06-0.77), Harari (AOR=0.14; 95% CI: 0.04-0.52) and Dire Dawa (AOR=0.23; 95% CI: 0.06-0.79) regions; and rural residents (AOR=0.53; 95% CI: 0.30-0.93) were factors significantly associated with childhood vaccination.

CONCLUSION

The full childhood vaccination coverage in Ethiopia was low and remained unchanged since 2016. The study identified that both the individual-level and community-level factors affected the vaccination status. Accordingly, public health interventions targeted to these identified factors can increase childhood full vaccination status.

Spatial distribution of rotavirus immunization coverage in Ethiopia: a geospatial analysis using the Bayesian approach

Introduction

Rotavirus causes substantial morbidity and mortality every year, particularly among under-five children. Despite Rotavirus immunization preventing severe diarrheal disease in children, the vaccination coverage remains inadequate in many African countries including Ethiopia. Measuring rotavirus immunization coverage in a lower geographic area can provide information for designing and implementing a targeted immunization campaign. This study aimed to investigate the spatial distributions of rotavirus immunization coverage in Ethiopia.

Methods

Rotavirus immunization coverage data were obtained from the recent Ethiopian Demographic and Health Survey (EDHS 2019). Covariate data were assembled from different publicly available sources. A Bayesian geostatistics model was used to estimate the national rotavirus immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages.

Result

The national rotavirus immunization coverage in Ethiopia was 52.3% (95% CI: 50.3, 54.3). The immunization coverage varied substantially at the sub-national level with spatial clustering of low immunization coverage observed in the Eastern, Southeastern, and Northeastern parts of Ethiopia. The spatial clustering of the rotavirus immunization coverage was positively associated with altitude of the area [mean regression coefficient (β): 0.38; 95% credible interval (95% CrI): 0.18, 0.58] and negatively associated with travel time to the nearest cities in minutes [mean regression coefficient (β): − 0.45; 95% credible interval (95% CrI): (− 0.73, − 0.18)] and distance to the nearest health facilities [mean regression coefficient (β): − 0.71908; 95% credible interval (95% CrI): (− 1.07, − 0.37)].

Conclusions

This study found that the rotavirus immunization coverage varied substantially at sub-national and local levels in Ethiopia. The spatial clustering of rotavirus immunization coverage was associated with geographic and healthcare access factors such as altitude, distance to health facilities, and travel time to the nearest cities. The immunization program should be strengthened in Ethiopia, especially in the Eastern, Southeastern, and Northeastern parts of the Country. Outreach immunization services should be also implemented in areas with low coverage.

Missed Opportunities for Vaccination and Associated Factors among Children Attending Primary Health Care Facilities in Cape Town, South Africa: A Pre-Intervention Multilevel Analysis

Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0–23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0–23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers’ low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13–11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25–0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07–0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06–0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.

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

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

Introduction:

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

Methods:

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

Results:

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

Discussion:

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

Concordance of vaccination status and associated factors with incomplete vaccination: a household survey in the health district of Segou, Mali, 2019

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.

COVID-19 and the Gaping Wounds of South Africa's Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination

Despite South Africa's substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.

Incomplete vaccination and associated factors among children aged 12-23 months in South Africa: an analysis of the South African demographic and health survey 2016

Background

Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa. Despite substantial efforts at ensuring universal access to vaccines, many children remain under-vaccinated in the country. This study aimed to assess the prevalence and factors associated with incomplete vaccination in the first year of life, among children aged 12–23 months in South Africa.

Methods

The study is a secondary analysis of the 2016 South African Demographic and Health Survey. A multivariable logistic regression model was applied to the data on 708 children aged 12–23 months. The study outcome, vaccination completeness, was assessed using a composite assessment of nine doses of four vaccines; Bacillus Calmette–Guérin (BCG) (one dose), Polio (four doses), diphtheria-tetanus-pertussis containing vaccines (DTP) (three doses) and measles-containing vaccines (MCV) (one dose). Children who received all the nine doses were categorized as completely vaccinated. Independent variables included child, maternal, and demographic characteristics. Variables were included in the model based on literature findings. Bivariate analyses were used to examine the crude association between each independent variable and incomplete vaccination, while the multivariable logistic regression model was used to examine the adjusted association after controlling for other variables. Measures of association were presented as odds ratios (OR) with their 95% confidence intervals (CI).

Results

About two-fifths (40.8%) of the children were incompletely vaccinated. The prevalence of incomplete vaccination was significantly high among children whose mothers did not receive antenatal care (ANC) during pregnancy (57.5%), and children living in Gauteng Province (52.2%). From the bivariate analyses, the odds of being incompletely vaccinated were three times higher in children whose mothers did not attend ANC compared with children whose mothers attended ANC (crude OR = 2.93; 95% CI 1.42–6.03). The odds were about three times higher in children living in Mpumalanga province (OR = 2.58; 95% CI 1.27–5.25) and in those living in Gauteng province (OR = 2.76; 95% CI 1.30–5.91), compared with those living in Free State province. Conversely, the odds were 32% lower in children from rich households, compared with those from poor households (OR = 0.68; 95% CI 0.47–0.98). In the adjusted model, the higher odds of incomplete vaccination in children whose mothers did not attend ANC were maintained in both magnitude and direction (adjusted OR [aOR] = 2.87; 95% CI 1.31–6.25). Similarly, compared with children living in Free State province, the higher odds of a child being incompletely vaccinated in Mpumalanga (aOR = 2.30; 95% CI 1.03–5.14) and in Gauteng (aOR = 3.10; 95% CI 1.35–7.15) provinces were maintained in both magnitude and direction.

Conclusions

There is a substantial burden of incomplete childhood vaccination in South Africa. Maternal ANC attendance during pregnancy and area of residence significantly influences this burden. Interventions that promote broader health service utilization, such as ANC attendance, can help improve the awareness and uptake of routine childhood vaccination. It is also imperative to take into consideration the provincial disparities in childhood vaccination completeness, in planning and implementing interventions to improve vaccination coverage in the country.

Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis

BACKGROUND

Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia.

METHOD

This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted odds ratio (AOR) with their 95% confidence intervals (CIs).

RESULTS

Of the 774 children included for analysis, 498 (64.3%) were fully vaccinated while 247 (31.9%) were fully vaccinated on-time. Caregivers who had secondary education and above (AOR = 2.391; 95% CI: 1.317-4.343), from richest households (AOR = 2.381; 95% CI: 1.502-3.773), children whose mother attended four or more ante natal care visits (AOR = 2.844; 95% CI: 1.310-6.174) and whose mother had two or more post natal care visits (AOR = 2.054; 95%CI:1.377-3.063) were positively associated with on-time full vaccination. In contrary, caregivers aged above 35 years (AOR = 0.469; 95 % CI: 0.253-0.869], being vaccinated at health post (AOR = 0.144; 95%CI: 0.048-0.428) and travelling more than 30 min to the vaccination site (AOR = 0.158; 95%CI: 0.033-0.739) were negatively associated with on-time full vaccination. The random effects indicated that 26% of the variability in on-time full vaccination was attributable to differences between communities.

CONCLUSION

In this study, untimely vaccination was found to be high. Different individual and contextual factors were found to be associated with on-time full vaccination. Therefore, tailored strategies have to be designed and implemented to address people and the communities where they live. Moreover, timeliness of vaccination should be considered as important indicator of the immunization program performance in Ethiopia.

Poor maternal health service utilization associated with incomplete vaccination among children aged 12-23 months in Ethiopia

Complete vaccination, meaning the administration of all doses in a vaccination regimen, is one of the most cost-effective interventions to reduce under-age-five-years mortality and morbidity. However, only a few studies have investigated the magnitude and predictors of incomplete vaccination. This study aimed to identify those factors associated with incomplete vaccination among children aged 12-23 months in Kutaber District, south Wollo zone, Ethiopia. A community-based cross-sectional study was conducted in Kutaber District from August to September 2017. A total of 480 participants were selected using the stratified multi-stage sampling technique. A structured, pre-tested and interviewer-administered questionnaire was used to collect the data. A logistic regression model was fitted to identify factors associated with incomplete vaccination. The prevalence of incomplete vaccination in this population was found to be 7.7%. The factors home delivery (Adjusted Odds Ratio (AOR) = 3.21), children from mothers with no history of Tetanus Toxoid (TT) vaccination (AOR = 5.26), living near the health post (AOR = 5.65), caregivers aged 19-26 years (AOR = 9.59), mothers/caregivers with no education (AOR = 3.71), and children from mothers with no Antenatal Care (ANC) follow-ups (AOR = 9.41) were found to be significantly associated with incomplete vaccination. The rate of incomplete vaccination was low as compared to the Ethiopian national report. Educational status of mother/caregiver, TT vaccination of mother, ANC follow-ups, place of delivery, and living near health facilities were significantly associated with incomplete vaccination. In light of these findings, the Ethiopian zonal health office and health care professionals should strengthen maternal health services to decrease the rate of defaulters from complete vaccination.