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Zegeye AF, Mekonen EG, Tekeba B, Alemu TG, Ali MS, Gonete AT, Kassie AT, Workneh BS, Tamir TT, Wassie M. Spatial distribution and determinants of measles vaccination dropout among under-five children in Ethiopia: A spatial and multilevel analysis of 2019 Ethiopian demographic and health survey. PLoS One 2024; 19:e0305393. [PMID: 38976660 PMCID: PMC11230542 DOI: 10.1371/journal.pone.0305393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1-2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia. METHODS Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. RESULTS In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout. CONCLUSIONS Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tsegaw TK, Alemaw HB, Wale YB, Nigatu SG, Birhan TY, Taddese AA. Incomplete immunization uptake and associated factors among children aged 12-23 months in sub-Saharan African countries; multilevel analysis evidenced from latest demography and health survey data, 2023. Ital J Pediatr 2024; 50:96. [PMID: 38735946 PMCID: PMC11089734 DOI: 10.1186/s13052-024-01642-9] [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: 01/04/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to control vaccine-preventable diseases, saving millions of lives annually. However, the coverage of basic vaccines recommended by the WHO in Africa was only 75%, which fell short of the goal of 90% by 2015. To formulate effective policies and implementation programs to reduce incomplete vaccination rates, it is important to conduct a study to determine the factors contributing to incomplete immunization among children aged 12-23 months. METHODS The study was conducted in 16 sub-Saharan African countries, using data extracted from the latest DHS data. It was a community-based cross-sectional survey that used two-stage stratified probability sampling sample designs. The vaccination coverage was assessed using vaccination cards and mother recalls. Multilevel multivariable logistic regression was used to determine the extent of incomplete immunization and the individual and community-level factors associated with partial immunization among children aged 12-23 months. Variables with a p-value less than 0.05 were considered statistically significant predictors of incomplete immunization. RESULT A total of 35, 193 weighted samples were used to determine the pooled prevalence of partial immunization. The pooled prevalence of incomplete immunization was 36.06%. In the final model factors significantly associated were: being uneducated mother(AOR:1.75;95%CI:1.48,2.05), being an unemployed mother (AOR:1.16;95%CI:1.09,1.23), no history of family planning utilization (AOR: 1.71; 95% CI: 1.61, 1.84), non-antenatal care (AOR: 1.79; 95% CI: 1.58, 2.04), non-postnatal care (AOR: 1.25; 95%CI: 1.17, 1.35), rural residence(AOR:1.50;95%CI:1.37,1.63), home delivery (AOR: 2.04; 95%CI:1.89, 2.21), having children more than five (AOR: 1.56; 95%CI: 1.13, 2.17), and non-utilization of health insurance (AOR: 1.74; 95%CI: 1.48, 2.05). CONCLUSION The pooled prevalence of incomplete immunization was found to be high in this investigation. Based on the findings of the study we recommended that policymakers and stakeholders prioritize enhancing prenatal and postnatal care, contraception, and reducing home birth rates to minimize the rate of incomplete immunization.
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Affiliation(s)
- Tigist Kifle Tsegaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helen Birhan Alemaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yordanos Bitweded Wale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Asefa Adimasu Taddese
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Aniagyei W, Mohayideen S, Sarfo-Kantanka O, Bittner S, Vivekanandan MM, Arthur JF, Boateng AO, Yeboah A, Ahor HS, Asibey SO, Owusu E, Herebian D, Huttasch M, Burkart V, Wagner R, Roden M, Adankwah E, Owusu DO, Mayatepek E, Jacobsen M, Phillips RO, Seyfarth J. BCG Vaccination-Associated Lower HbA1c and Increased CD25 Expression on CD8 + T Cells in Patients with Type 1 Diabetes in Ghana. Vaccines (Basel) 2024; 12:452. [PMID: 38793703 PMCID: PMC11125916 DOI: 10.3390/vaccines12050452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
BCG vaccination affects other diseases beyond tuberculosis by unknown-potentially immunomodulatory-mechanisms. Recent studies have shown that BCG vaccination administered during overt type 1 diabetes (T1D) improved glycemic control and affected immune and metabolic parameters. Here, we comprehensively characterized Ghanaian T1D patients with or without routine neonatal BCG vaccination to identify vaccine-associated alterations. Ghanaian long-term T1D patients (n = 108) and matched healthy controls (n = 214) were evaluated for disease-related clinical, metabolic, and immunophenotypic parameters and compared based on their neonatal BCG vaccination status. The majority of study participants were BCG-vaccinated at birth and no differences in vaccination rates were detected between the study groups. Notably, glycemic control metrics, i.e., HbA1c and IDAA1c, showed significantly lower levels in BCG-vaccinated as compared to unvaccinated patients. Immunophenotype comparisons identified higher expression of the T cell activation marker CD25 on CD8+ T cells from BCG-vaccinated T1D patients. Correlation analysis identified a negative correlation between HbA1c levels and CD25 expression on CD8+ T cells. In addition, we observed fractional increases in glycolysis metabolites (phosphoenolpyruvate and 2/3-phosphoglycerate) in BCG-vaccinated T1D patients. These results suggest that neonatal BCG vaccination is associated with better glycemic control and increased activation of CD8+ T cells in T1D patients.
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Affiliation(s)
- Wilfred Aniagyei
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | - Sumaya Mohayideen
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | - Osei Sarfo-Kantanka
- Komfo Anokye Teaching Hospital, Kumasi 00233, Ghana
- School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Sarah Bittner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Monika M. Vivekanandan
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | - Joseph F. Arthur
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | | | - Augustine Yeboah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | - Hubert S. Ahor
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | | | | | - Diran Herebian
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Maximilian Huttasch
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, 85764 Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, 85764 Neuherberg, Germany
| | - Robert Wagner
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, 85764 Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, 85764 Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Ernest Adankwah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | - Dorcas O. Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Marc Jacobsen
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Richard O. Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi 00233, Ghana (A.Y.); (D.O.O.)
- School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Julia Seyfarth
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
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Rockson Adjei M, Longsignikuu A, Saeed Iddris I, Nang Suuri T, Asamoah B, Okoye M, Vanessa Baafi J, Kubio C, Ohene SA, Grobusch MP. Trend of measles-rubella vaccination coverage and impact on measles epidemiology in the Savannah Region, Ghana; 2018-2022: A secondary data analysis. Vaccine 2024; 42:1910-1917. [PMID: 38365480 PMCID: PMC11080765 DOI: 10.1016/j.vaccine.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Ghana witnessed an outbreak of measles in 2022 following the COVID-19 pandemic, and Savannah Region was among the regions severely impacted. The objective of this study was to conduct trend analysis of measles case incidence and measles-rubella (MR) vaccination coverage in the Savannah Region to identify gaps and propose remedial actions to mitigate future outbreaks of vaccine preventable diseases (VPDs). METHODS Analysis of measles surveillance and measles-rubella vaccination data for 2018-2022 was conducted to assess relationship between immunization coverage and measles case incidence. Data were extracted from the District Health Information Management System (DHIMS) platform and loaded into Microsoft Excel 16.0 spreadsheet for analysis. Coverages for first (MR1) and second (MR2) doses of measles-rubella vaccination, dropout rates, and measles incidence (per 100,000) were calculated. RESULTS The coverage trend for both vaccine doses followed similar trajectories, increasing from 2018 to a peak in 2019, and declining sequentially thereafter to the lowest (for the study period) in 2022. Generally, MR1/MR2 dropout rate was high across all districts during the entire study period. The regional incidence of confirmed measles rose sharply from less than 1/1,000,000 in 2018-2021 to 94 in 2022. Wide variations in vaccination coverage and dropout rates were observed among the districts. There was moderate to fairly strong negative correlation between MR vaccination coverage and measles case incidence. CONCLUSIONS The MR vaccination coverage in the Savannah Region declined probably due to pre-existing weaknesses in the immunization programme accentuated by impact of the COVID-19 pandemic. The lowered population immunity likely contributed to occurrence of the measles outbreak in 2022. Pragmatic actions are needed to catch-up on missed children, restore coverage to pre-pandemic levels, and strengthen the immunization programme as part of global efforts towards achieving the Immunization Agenda 2030 (IA2030) trajectory.
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Affiliation(s)
- Michael Rockson Adjei
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Iocation AMC, University of Amsterdam, Amsterdam, the Netherlands; World Health Organization, Country Office, Accra, Ghana.
| | - Amos Longsignikuu
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | - Ibrahim Saeed Iddris
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | - Thomas Nang Suuri
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | | | | | - Janet Vanessa Baafi
- Ghana Health Service, District Health Directorate, Sunyani West, Odumase, Ghana
| | - Chrysantus Kubio
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | | | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Iocation AMC, University of Amsterdam, Amsterdam, the Netherlands; Institute of Tropical Medicine, and German Center of Infectious Diseases (DZIF), University of Tuebingen, Tuebingen, Germany; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre de Recherches Médicales En Lambaréné (CERMEL), Lambaréné, Gabon; Masanga Medical Research Unit, Masanga, Sierra Leone
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Ferede Zegeye A, Kassa Mekonnen C, Kindie H, Shetie Workneh B, Bihonegn Asmamaw D, Tarik Tamir T. Individual and community-level determinants of pentavalent vaccination dropouts among under-five children in the sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey. Vaccine X 2024; 17:100465. [PMID: 38435980 PMCID: PMC10906395 DOI: 10.1016/j.jvacx.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Globally, each year, about 3 million deaths among children are prevented by pentavalent vaccinations. However, in developing countries, particularly in Sub-Saharan Africa, pentavalent vaccination dropout rates are not well reported. Therefore, this study aimed to assess pentavalent vaccination dropout rates and their determinants among under-five children in Sub-Saharan Africa. Methods Data from the recent Demographic and Health Surveys in 33 Sub-Saharan African countries were used for analysis. The study used a total of 358,529 under-five children. The determinants of pentavalent vaccination dropout were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with pentavalent vaccination dropout were declared significant at p-values < 0.05. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. Results In Sub-Saharan Africa, one in five under-five children had pentavalent vaccination dropout rates. Factors such as Age (AOR = 1.61, 95 % CI: 1.51, 1.72), educational level (AOR = 1.30, 95 % CI: 1.22, 1.40), place of delivery (AOR = 1.65, 95 % CI: 1.57, 1.73), ANC visits (AOR = 1.34, 95 % CI: 1.23, 1.45), postnatal check-up (AOR = 1.19, 95 % CI: 1.14, 1.25), wealth status (AOR = 1.09, 95 % CI: 1.04, 1.15), distance to health facility (AOR = 1.08, 95 % CI: 1.03, 1.13), media exposure (AOR = 1.12, 95 % 1.15), and geographical region (AOR = 1.60, 95 % CI: 1.49, 1.72) had higher odds of pentavalent vaccination dropouts. Conclusions Pentavalent vaccination dropout rates in sub-Saharan Africa among under-five children were high. Both individual and community-level variables were determinants of pentavalent vaccination dropout rates. Government and ministry of health in Sub-Saharan Africa should give attention to those mothers of under-five children who reported distance as a big problem in accessing health facilities and to women who do not utilise antenatal and postnatal check-ups while designing policies and strategies in sub-Saharan Africa.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Araújo DABS, Correia LL, Lima PLGDSB, Vasconcelos SC, Farías-Antúnez S, Gomes YVC, Nogueira DL, Castro MC, Machado MMT. Coverage and determinants of childhood vaccination during the COVID-19 pandemic in Fortaleza, Northeastern Brazil: a longitudinal analysis. CAD SAUDE PUBLICA 2024; 40:e00074723. [PMID: 38324862 PMCID: PMC10841349 DOI: 10.1590/0102-311xen074723] [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: 04/22/2023] [Revised: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 02/09/2024] Open
Abstract
Brazil has seen a decrease in vaccination coverage since 2016. This study analyzes the immunization status of children born during the COVID-19 pandemic in Fortaleza, Northeastern Brazil. This is a longitudinal analysis that included vaccination data of 313 children aged 12 and 18 months. Vaccination cards were checked for dose application considering the schedule of immunization recommended by the Brazilian Ministry of Health. Factors associated with no retention of vaccination cards and incomplete immunization by 18 months were identified by Tobit regression analysis. About 73% of mothers presented their child's vaccination card. Non-availability of vaccination cards was associated with maternal age < 25 years and mothers with paid jobs. Only 33% and 45% of the children aged 12 and 18 months had all vaccines up to date, respectively. For 3-dose vaccines, the delay rate was around 10% for the first dose application, but 40% for the third dose. Despite delays, most children with available vaccine cards had coverage above 90% by 18 months of age. Adjusted factors associated with incomplete vaccination included living in a household with more than one child (p = 0.010) and monthly income of less than one minimum wage (p = 0.006). Therefore, delays in child vaccine application were high during the COVID-19 pandemic but a considerable uptake by 18 months of age was found. Poorer families with more than one child were particularly at risk of not fully immunizing their children and should be the target of public policies.
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Affiliation(s)
| | | | | | | | - Simone Farías-Antúnez
- Departamento de Ciencias da Saúde, Universidade Federal de Santa Catarina, Araranguá, Brasil
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Khan A, Hussain I, Rhoda DA, Umer M, Ansari U, Ahmed I, Clary C, Muhammad Safdar R, Bashir Soofi S. Determinants of immunization in polio super high-risk union councils of Pakistan. Vaccine 2024; 42:583-590. [PMID: 38143197 PMCID: PMC10850981 DOI: 10.1016/j.vaccine.2023.12.056] [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: 11/04/2022] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current polio epidemiology in Pakistan poses a unique challenge for global eradication as the country is affected by ongoing endemic poliovirus transmission. Across the country, 40 union councils (UCs) which serve as core reservoirs for poliovirus with continuous incidences of polio cases are categorized as super-high-risk union councils (SHRUCs). METHODOLOGY A cross-sectional survey was conducted in 39 SHRUCs using a two-stage stratified cluster sampling technique. 6,976 children aged 12-23 months were covered. A structured questionnaire was used for data collection. Data were analyzed using STATA version 17. RESULTS Based on both vaccination records and recall, 48.3% of children were fully-, 35.4 % were partially-, and 16.3% were non-vaccinated in the SHRUC districts. A child is considered fully vaccinated when h/she completed vaccination for BCG, OPV0, OPV 1-3, Penta 1-3, PCV 1-3, IPV, and MCV1. Vaccination cards were seen for over half of the children in the SHRUC districts of Khyber Pakhtunkhwa (KP) and the majority of the SHRUC districts in Sindh, except for the SHRUC district of Malir the districts of Balochistan. Results for polio vacancies show that 60.9% of children from the SHRUC districts were vaccinated with at least three doses of OPV and one dose of IPV, while 20.4% were vaccinated with any OPV doses or IPV and 18.7% of children did not receive any polio vaccines. The dropout rate between vaccine visits was higher than the WHO-recommended cutoff point of 10% for all vaccine doses in the SHRUC districts. The likelihood of being fully vaccinated was higher among the children of educated parents. Full vaccination was found significant among the children of any SHRUC districts compared to district Killa Abdullah. CONCLUSION Context-specific strategies with more focus on community engagement and targeted mobilization, along with robust monitoring mechanisms, would help address the underlying challenges of under-immunization in the SHRUCs.
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Affiliation(s)
- Ahmad Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Uzair Ansari
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | | | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan; Department of Pediatrics & Child Health, The Aga Khan University, Pakistan.
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Shiferie F, Gebremedhin S, Andargie G, Tsegaye DA, Alemayehu WA, Mekuria LA, Wondie T, Fenta TG. Vaccination dropout and wealth related inequality among children aged 12-35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey. Front Pediatr 2023; 11:1280746. [PMID: 37941975 PMCID: PMC10628708 DOI: 10.3389/fped.2023.1280746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
Background Vaccination is one of the most cost-effective public health interventions that prevents millions of deaths. Although immunization coverage is increasing globally, many children in low- and middle-income countries drop out of the vaccination continuum. This study aimed at determining vaccination dropout rates and predictors in children aged 12-35 months in remote and underserved areas of Ethiopia. Methods This study was part of a cross-sectional evaluation survey that was conducted in 2022 in Ethiopia. The study settings include pastoralist, developing & newly established regions, conflict affected areas, urban slums, internally displaced populations and refugees. A sample of 3,646 children aged 12-35 months were selected using a cluster sampling approach. Vaccination dropout was estimated as the proportion of children who did not get the subsequent vaccine among those who received the first vaccine. A generalized estimating equation was used to assess determinants of the dropout rate and findings were presented using an adjusted odds ratio with 95% confidence interval. Concentration curve and index were used to estimate wealth related inequality of vaccination dropout. Results A total of 3,646 caregivers of children participated in the study with a response rate of 97.7%. The BCG to Penta-3 (52.5%), BCG to MCV-2 (57.4%), and Penta-1 to Penta-3 (43.9%) dropouts were all high. The highest Penta-1 to Penta-3 dropout rate was found in developing regions (60.1%) and the lowest was in urban slums (11.2%). Caregivers who were working outside their homes [AOR (95% CI) = 3.67 (1.24-10.86)], who had no postnatal care follow-up visits [AOR (95%CI) = 1.66 (1.15-2.39)], who did not receive a service from a skilled birth attendant [AOR (95%CI) = 1.64 (1.21-2.27)], who were older than 45 years [AOR (95% CI) = 12.49 (3.87-40.33)], and who were less gender empowered [AOR (95%CI) = 1.63 (1.24-2.15)] had increased odds of Penta-1 to Penta-3 dropout. The odds of dropout for children from poor caregivers was nearly two times higher compared to their wealthy counterparts [AOR (95%CI) = 1.87 (1.38-2.52)]. Conclusion Vaccination dropout estimates were high among children residing in remote and underserved settings. Poor wealth quintile, advanced maternal age, low women empowerment, and limited utilization of maternity care services contributed to vaccination dropout.
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Affiliation(s)
- Fisseha Shiferie
- Project HOPE Ethiopia Country Office, Addis Ababa, Ethiopia
- School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Tamiru Wondie
- Project HOPE Ethiopia Country Office, Addis Ababa, Ethiopia
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ATEUDJIEU JEROME, TCHIO-NIGHIE KETINAHIRMA, YAKUM MARTINNDINAKIE, GOURA ANDRÉPASCAL, AMADA LAPIA, SONKOUA ISAAC, NKONTCHOU BLAISEWAKAM, KENFACK BRUNO. Innovative approach in assessing the children's immunization status when it cannot be documented. J Public Health Afr 2023; 14:2450. [PMID: 37937064 PMCID: PMC10626340 DOI: 10.4081/jphia.2023.2450] [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: 12/30/2022] [Accepted: 01/21/2023] [Indexed: 11/09/2023] Open
Abstract
During surveys, it is recommended that children immunization status should be based on immunization documents. It has been noted that in some communities, a number of children are claimed to be vaccinated but have no evidence of vaccination. This work is proposed to estimate routine immunization coverage in children based on both documented vaccination and the tracking of undocumented immunization. It was a community-based survey targeting children aged 0-59 months in which the immunization status of children was assessed based on vaccination documents and based on a questionnaire tracking immunization sites and period for children with undocumented vaccination. The vaccination coverage and completeness were estimated from data collected in immunization cards and re-estimated after tracking the immunization status of children with no immunization cards. Of 1435 children reached in households, 1430 (99.7%) were included. Of 1072 children aged 12-59 months, 194 (18.1%) received DPT-Hi+Hb 3 with evidence and 399 (37.2%) with evidence and tracking. In the same age group, the dropout rate from DPT-Hi+Hb 1 (157 doses administered) to DPT-Hi+Hb 3 (127 doses administered) with evidence was 19.1% and 42.4% with evidence and tracking. The tracking of immunization status in children with no evidence of vaccination allows to determine their immunization status and to improve the reliability of the estimated vaccination coverage. This strategy could be adopted to be part of the planning and implementation of vaccination coverage surveys of EPI vaccines.
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Affiliation(s)
| | | | - MARTIN NDINAKIE YAKUM
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - ANDRÉ PASCAL GOURA
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - LAPIA AMADA
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - ISAAC SONKOUA
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - BLAISE WAKAM NKONTCHOU
- Expanded Program of immunization, Ministry of Public Health, Yaounde
- Bill and Melinda Gates Foundation
| | - BRUNO KENFACK
- Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang
- Department of Gynecology and Obstetrics, Dschang District Hospital, Dscang, Cameroon
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Dhalaria P, Kapur S, Singh AK, Priyadarshini P, Dutta M, Arora H, Taneja G. Exploring the Pattern of Immunization Dropout among Children in India: A District-Level Comparative Analysis. Vaccines (Basel) 2023; 11:vaccines11040836. [PMID: 37112748 PMCID: PMC10143302 DOI: 10.3390/vaccines11040836] [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: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The dropout rate is one of the determinants of immunization coverage and program performance, program continuity, and follow-up. The dropout rate refers to the proportion of vaccine recipients who did not finish their vaccination schedules, and it is determined by comparing the number of infants who started the schedule to the number who completed it. It is the rate difference between the first and final dosage or the rate difference between the first vaccination and the last vaccine dropout; thus, it denotes that the first recommended dose of vaccine was received, but that the subsequently recommended dose was missed. In India, immunization coverage has shown significant improvements over the last two decades, but full immunization coverage has remained stagnant at 76.5%, of which 19.9% are partially immunized, and 3.6% are children who have been left out. In India, the Universal Immunization Programme (UIP) is challenged with cases related to dropout in immunization. Although immunization coverage in India is improving, the program is challenged by vaccination dropouts. This study provides an analysis of the determinants of vaccination dropout in India using data from two rounds of the National Family Health Survey. The finding shows that the mother's age, education, family wealth, antenatal care visit, and place of delivery were some of the variables that significantly contributed to reducing the dropout rate of immunization among children. The findings of this paper show that the dropout rate has reduced over a certain period of time. The overall improvement in the rates of dropout and increase in full immunization coverage could be attributed to various policy measures taken in the last decade in India, which brought structural changes with a positive impact on full immunization coverage and its components.
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Affiliation(s)
- Pritu Dhalaria
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Ajeet Kumar Singh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Pretty Priyadarshini
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Mili Dutta
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Gunjan Taneja
- Bill & Melinda Gates Foundation, New Delhi 110067, India
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Mezen MK, Lemlem GA, Biru YB, Yimer AM. Association of War With Vaccination Dropout Among Children Younger Than 2 Years in the North Wollo Zone, Ethiopia. JAMA Netw Open 2023; 6:e2255098. [PMID: 36749587 PMCID: PMC10408260 DOI: 10.1001/jamanetworkopen.2022.55098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE A civil war that lasted for about 6 months in the North Wollo zone of Ethiopia destroyed numerous health care facilities. However, no studies have been conducted to determine the association of the war with vaccination dropout in the area. OBJECTIVE To assess the association of war with vaccination dropout among children younger than 2 years in the North Wollo zone. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study was conducted in the North Wollo zone from April 1 to June 30, 2022. Participants included children younger than 2 years and their mothers. A multistage sampling technique was used to select the participants. MAIN OUTCOMES AND MEASURES A vaccination dropout rate (yes or no) was assessed by interviewing mothers. RESULTS The study included 449 children younger than 2 years and their mothers, 291 (64.8%) of whom were 20 to 34 years of age. Almost all of the mothers (426 [94.9%]) were married. More than half of the mothers (271 [60.4%]) had a primary level education. Seventy-one children (15.8%) in the area received all basic vaccinations. One hundred ninety-eight children (44.1%) who started vaccination prior to the war dropped out of the immunization program. Additionally, 64 children (14.3%) born during the war did not receive any vaccination. Losing a family member (adjusted odds ratio [AOR], 3.11 [95% CI, 1.63-5.93]; P = .001), not being informed about catch-up vaccination (AOR, 2.18 [95% CI, 1.39-3.43]; P < .001), being a rural resident (AOR, 2.22 [95% CI, 1.37-3.58]; P < .001), home birth (AOR, 1.75 [95% CI, 1.11-2.77]; P = .002), and length of war (AOR for 5 months, 0.51 [95% CI, 0.28-0.93; P = .04]) were associated with the outcome variable. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that nearly 60% of children in the North Wollo zone remained undervaccinated or unvaccinated. Stakeholders should make coordinated efforts to overcome the humanitarian crisis in the area and optimize the accessibility of health services.
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Affiliation(s)
| | - Getasew Assefa Lemlem
- Department of Statistics, Faculty of Natural and Computational Science, Woldia University, Woldia, Ethiopia
| | - Yemisrach Belete Biru
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abebaw Mengesha Yimer
- Department of English Language and Literature, Faculty of Social Science, Woldia University, Woldia, Ethiopia
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Gebeyehu NA, Asmare Adela G, Dagnaw Tegegne K, Birhan Assfaw B. Vaccination dropout among children in Sub-Saharan Africa: Systematic review and meta-analysis. Hum Vaccin Immunother 2022; 18:2145821. [PMID: 36459433 PMCID: PMC9762788 DOI: 10.1080/21645515.2022.2145821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Immunization is cost-effective preventive strategy for child morbidity and mortality. PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Data were extracted by Microsoft excel. Begg's rank test, and Egger's regression test was done. A pooled prevalence, Sub-group analysis, sensitivity analysis and meta-regression were conducted. A total of 12 articles were included in this study. The pooled prevalence of vaccination dropout was 26.06% (95% CI: 11.59, 30.53), I2 =91.2%. In sub-group analysis, Nigeria had the highest prevalence of immunization dropouts (33.59%). It was 18.01% and 29.25%, respectively, for published and unpublished research. Community-based studies and institutional-based studies also yield a prevalence of dropout 39.04% and 13.73% respectively. Dropout rate was 22.66% for sample sizes under 500 and 18.01% for sample sizes beyond 500. In Sub-Saharan Africa, the prevalence of vaccination dropout was high. Community education about vaccinations importance should be prioritized.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia,CONTACT Natnael Atnafu Gebeyehu Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, 02, My street, Sodo 138, Ethiopia
| | - Getachew Asmare Adela
- 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
| | - Belete Birhan Assfaw
- Department of Psychiatric Nursing, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
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Rodrigues RN, do Nascimento GLM, Arroyo LH, Arcêncio RA, de Oliveira VC, Guimarães EADA. The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps. Rev Lat Am Enfermagem 2022; 30:e3642. [PMID: 36228235 PMCID: PMC9545939 DOI: 10.1590/1518-8345.6132.3642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE to identify spatial clusters corresponding to abandonment of routine vaccines in children. METHOD an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator. RESULTS the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively. CONCLUSION in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.
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Affiliation(s)
| | | | | | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem,
Ribeirão Preto, SP, Brazil
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14
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Muluye M, Oljira L, Eyeberu A, Getachew T, Debella A, Deressa A, Dheresa M. Partial vaccination and associated factors among children aged 12-23 months in eastern Ethiopia. BMC Pediatr 2022; 22:268. [PMID: 35550040 PMCID: PMC9097114 DOI: 10.1186/s12887-022-03320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Vaccine prevents about 2–3 million deaths from vaccine-preventable diseases each year. However, immunization coverage in Ethiopia is lower than the herd immunity level required to prevent the spread of all vaccine-preventable diseases. Thus, this study aimed to assess the partial immunization and associated factors among 12–23-month-old children in Eastern Ethiopia. Method A community-based cross-sectional study design was carried out among 874 randomly selected mothers/caregivers of children aged 12–23 months. A structured questionnaire was adapted and data were collected through face-to-face interviews and review of vaccination cards. Data were coded and analyzed using the Stata version 14 software. A binary logistic regression model was utilized to identify the determinant factors. The predictor of partial immunization was presented by an adjusted odds ratio with a 95% confidence interval. A p-value of < 0.05 was used to establish statistical significance. Result The prevalence of partial immunization was 31.4% (95% CI: 28–35). The dropout rate between the first and third pentavalent vaccine was 17%. Being female child [AOR = 0.73, 95% CI: 0.52–0.95], 18–20 month child [AOR = 1.6, 95% CI: 1.1- 2.4], the child born to mothers who heard about vaccination [AOR = 3.9, 95%CI: 1.92- 8.01], a child born to mother who did not receive immunization counselling [AOR = 1.65, 95%CI: 1.15–2.36], and child whose mother walk 15–30 min, 31–60 min, and > 60 min to reach nearby health facilities [AOR = 1.94, 95% CI: 1.1–3.45], [AOR = 4.5, 95% CI: 2.47–8.15], and [AOR = 3.45, 95% CI: 1.59- 7.48] respectively were factors significantly associated with partial vaccination. Conclusions The prevalence of partial immunization is high compared to other studies. As a result, to decrease the proportion of defaulters and to increase immunization coverage, maternal health care utilization like antenatal care follow-up and mother knowledge about the importance of the vaccine need to be sought cautiously.
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Affiliation(s)
- Menberu Muluye
- Haramaya Health Office in Haramaya, East Hararge Zone, Oromia region, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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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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Deathe AR, Oyungu E, Ayaya SO, Ombitsa AR, McAteer CI, Vreeman RC, McHenry MS. Preventive Health Service Coverage Among Infants and Children at Six Maternal-Child Health Clinics in Western Kenya: A Cross-Sectional Assessment. Matern Child Health J 2022; 26:522-529. [PMID: 34714463 DOI: 10.1007/s10995-021-03271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite the substantial reduction of child mortality in recent decades, Kenya still strives to provide universal healthcare access and to meet other international benchmarks for child health. This study aimed to describe child health service coverage among children visiting six maternal and child health (MCH) clinics in western Kenya. METHODS In a cross-sectional study of Kenyan children who are under the age of 5 years presenting to MCH clinics, child health records were reviewed to determine coverage of immunizations, growth monitoring, vitamin A supplementation, and deworming. Among 78 children and their caregivers, nearly 70% of children were fully vaccinated for their age. RESULTS We found a significant disparity in full vaccination coverage by gender (p = 0.017), as males had 3.5 × higher odds of being fully vaccinated compared to females. Further, full vaccination coverage also varied across MCH clinic sites ranging from 43.8 to 92.9%. CONCLUSIONS FOR PRACTICE Health service coverage for Kenyan children in this study is consistent with national and sub-national findings; however, our study found a significant gender equity gap in coverage at these six clinics that warrants further investigation to ensure that all children receive critical preventative services.
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Affiliation(s)
- Andrew R Deathe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eren Oyungu
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Samuel O Ayaya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ananda R Ombitsa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Carole I McAteer
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel C Vreeman
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Megan S McHenry
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Division of Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5853, Indianapolis, IN, 46202, USA.
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Kayembe-Ntumba HC, Vangola F, Ansobi P, Kapour G, Bokabo E, Mandja BA, Bompangue D. Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study. Arch Public Health 2022; 80:18. [PMID: 34986887 PMCID: PMC8728983 DOI: 10.1186/s13690-021-00782-2] [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: 10/27/2020] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. Methods A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. Results Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. Conclusions Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.
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Affiliation(s)
- Harry-César Kayembe-Ntumba
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo.
| | - Felly Vangola
- Master of Ecology of Infectious Diseases, Natural Hazards and Risk Management, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Papy Ansobi
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Germain Kapour
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Eric Bokabo
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Bien-Aimé Mandja
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Didier Bompangue
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo.,Chrono-Environnement Laboratory, CNRS, UMR 6249, University of Bourgogne Franche- Comté, Besançon, France
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Rodrigues RN, Nascimento GLMD, Arroyo LH, Arcêncio RA, Oliveira VCD, Guimarães EADA. Pandemia de COVID-19 y abandono de la vacunación en niños: mapas de heterogeneidad espacial. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6132.3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resumen Objetivo: identificar grupos espaciales que abandonaron la vacunación de rutina de los niños. Método: estudio ecológico, basado en los datos de 853 municipios de un Estado brasileño. Se analizaron los registros de vacunas multidosis pentavalente, antineumocócica 10-valente y antipoliomielítica inactivada y vacuna oral contra el rotavirus humano de 781.489 niños menores de un año de edad. Se utilizó la estadística scan espacial para identificar agrupaciones espaciales y medir el riesgo relativo del indicador abandono de la vacunación. Resultados: la estadística scan espacial detectó la presencia de grupos estadísticamente significativos para el abandono de las cuatro vacunas en todos los años analizados. Sin embargo, el mayor número de grupos con estimaciones altas de riesgos relativos se identificó en 2020. Se destacan las macrorregiones del Vale do Aço y Oeste; Norte y Oeste; y Sudeste para las vacunas pentavalente, antipoliomielítica y contra el rotavirus, respectivamente. Conclusión: mientras se intentaba disminuir el impacto devastador de la pandemia de COVID-19, retrocedió el programa de inmunización. La presencia de grupos indica que es necesario implementar estrategias integradas que puedan involucrar a diferentes sectores para la búsqueda activa de niños y evitar brotes de enfermedades inmunoprevenibles en el futuro próximo.
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Miretu DG, Asfaw ZA, Addis SG. Impact of COVID-19 pandemic on vaccination coverage among children aged 15 to 23 months at Dessie town, Northeast Ethiopia, 2020. Hum Vaccin Immunother 2021; 17:2427-2436. [PMID: 33721546 DOI: 10.1080/21645515.2021.1883387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Disturbances are occurring in healthcare, trade, and travel, with countries closing off their borders due to the pandemic of coronavirus disease 2019(COVID-19) in the world. The pandemic has its impact on the delivery of important health services, including vaccinations. This study aimed to assess the impact of COVID-19 on vaccination coverage among children aged 15-23 months.Methods: A community-based cross-sectional study was conducted from July 22 to August 7, 2020, in Dessie town, Ethiopia. 633 children with their mother/caregiver were interviewed. Interviewer administered pre-tested structured questioner was used. Data was entered into EPI data and analyzed by using SPSS (Statistical Package for Social Sciences). Both binary and multivariate logistic regression analyses were tested. In multivariate analysis, a significant association was declared at a p-value of < 0.05.Result: Response rate was 96.4%. Based on the vaccination card plus recall, 350 (57.4%) of children finished all recommended vaccines. Age-eligible vaccination coverage during the COVID-19 outbreak was 12.5% lower than before the outbreak. Being a father main caregiver, mother/caregiver who can write and read, and mother/caregiver who educated from grade 1 to 8 mother/caregiver who is divorced, mother/caregiver who spend more than 30 minutes to reach health institution, and mother/caregiver who aware about the benefit of vaccination, about the campaign, and knowledge of COVID-19 each shows statistically significant association with full vaccination status of children.Conclusion: Full vaccination coverage among children aged 15-23 months remains low in Dessie town, which further decreases after the COVID-19 pandemic. Hence, measures should be taken to increase consciousness about vaccination and the COVID-19 pandemic.
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Affiliation(s)
- Debrnesh Goshiye Miretu
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zinet Abegaz Asfaw
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Gedamu Addis
- Department of Comprehensive Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Eze P, Agu UJ, Aniebo CL, Agu SA, Lawani LO, Acharya Y. Factors associated with incomplete immunisation in children aged 12-23 months at subnational level, Nigeria: a cross-sectional study. BMJ Open 2021; 11:e047445. [PMID: 34172548 PMCID: PMC8237740 DOI: 10.1136/bmjopen-2020-047445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES National immunisation coverage rate masks subnational immunisation coverage gaps at the state and local district levels. The objective of the current study was to determine the sociodemographic factors associated with incomplete immunisation in children at a sub-national level. DESIGN Cross-sectional study using the WHO sampling method (2018 Reference Manual). SETTING Fifty randomly selected clusters (wards) in four districts (two urban and two rural) in Enugu state, Nigeria. PARTICIPANTS 1254 mothers of children aged 12-23 months in July 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Fully immunised children and not fully immunised children. RESULTS Full immunisation coverage (FIC) rate in Enugu state was 78.9% (95% CI 76.5% to 81.1%). However, stark difference exists in FIC rate in urban versus rural districts. Only 55.5% of children in rural communities are fully immunised compared with 94.5% in urban communities. Significant factors associated with incomplete immunisation are: children of single mothers (aOR=5.74, 95% CI 1.45 to 22.76), children delivered without skilled birth attendant present (aOR=1.93, 95% CI 1.24 to 2.99), children of mothers who did not receive postnatal care (aOR=6.53, 95% CI 4.17 to 10.22), children of mothers with poor knowledge of routine immunisation (aOR=1.76, 95% CI 1.09 to 2.87), dwelling in rural district (aOR=7.49, 95% CI 4.84 to 11.59), low-income families (aOR=1.56, 95% CI 1.17 to 2.81) and living further than 30 min from the nearest vaccination facility (aOR=2.15, 95% CI 1.31 to 3.52). CONCLUSIONS Although the proportion of fully immunised children in Enugu state is low, it is significantly lower in rural districts. Study findings suggest the need for innovative solutions to improve geographical accessibility and reinforce the importance of reporting vaccination coverage at local district level to identify districts for more targeted interventions.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
| | - Ujunwa Justina Agu
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Chioma Lynda Aniebo
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Sergius Alex Agu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yubraj Acharya
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania, USA
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21
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Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal. Adv Prev Med 2021; 2021:1319090. [PMID: 33959398 PMCID: PMC8075685 DOI: 10.1155/2021/1319090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal. Methods The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model. Results A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant (P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55). Conclusion Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.
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22
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Cassocera M, Chissaque A, Martins MRO, Deus ND. 40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives. CAD SAUDE PUBLICA 2020; 36Suppl 2:e00038320. [PMID: 33053042 DOI: 10.1590/0102-311x00038320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022] Open
Abstract
In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.
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Affiliation(s)
- Marta Cassocera
- Instituto Nacional de Saúde, Província de Maputo, Moçambique.,Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde, Província de Maputo, Moçambique.,Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Maria R O Martins
- Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Província de Maputo, Moçambique
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Sreevatsava M, Burman AL, Wahdan A, Safdar RM, O'Leary A, Amjad R, Salam A, Quershi M, Ishaq R, Khan J, Khan J, Parker EPK, Sheikh Mahamud A, Ahmed J. Routine immunization coverage in Pakistan: a survey of children under 1 year of age in community-based vaccination areas. Vaccine 2020; 38:4399-4404. [PMID: 32402754 DOI: 10.1016/j.vaccine.2020.04.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022]
Abstract
Pakistan is one of two countries in which poliovirus remains endemic. Considering the high number of children born every year, reaching and vaccinating new birth cohorts by improving routine immunization coverage in children <1 year of age is crucial to halting virus transmission. In 2015, a community-based vaccination (CBV) strategy, using local community members to enhance vaccine acceptance and improve routine immunization service delivery, was introduced in areas of Pakistan that have never interrupted poliovirus transmission. In order to assess progress towards improving routine immunization, we performed house-to-house immunization surveys across ten CBV areas in 2017 and 2018. In each household, we determined age-appropriate routine antigen coverage for children <1 year of age based on vaccination card and caregiver recall. We surveyed 5,499 and 5,264 children in 2017 and 2018, respectively. Overall, coverage of inactivated poliovirus vaccine (IPV) at 14 weeks of age was 32% in 2017 and 39% in 2018 based on vaccination card and recall. Across the surveyed areas, coverage ranged from 7% in Killa Abdullah to 61% in Peshawar in 2018. Oral poliovirus vaccination coverage decreased with successive vaccination visits, ranging from 66% for the birth dose to 42% for the 14-week dose in 2018. No area reached the target of 80% coverage for any routine antigen. Our findings highlight the need for concerted efforts to improve routine immunization coverage in these critical areas of wild poliovirus transmission.
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Affiliation(s)
| | | | | | - Rana M Safdar
- Ministry of National Health Services, Islamabad, Pakistan
| | | | - Raabya Amjad
- United Nations Children's Fund, Islamabad, Pakistan
| | - Abdul Salam
- World Health Organization, Islamabad, Pakistan
| | | | | | - Jawed Khan
- World Health Organization, Islamabad, Pakistan
| | | | - Edward P K Parker
- The Vaccine Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jamal Ahmed
- World Health Organization, Islamabad, Pakistan
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Santos ACDS, Silva NNT, Carneiro CM, Coura-Vital W, Lima AA. Knowledge about cervical cancer and HPV immunization dropout rate among Brazilian adolescent girls and their guardians. BMC Public Health 2020; 20:301. [PMID: 32143614 PMCID: PMC7060582 DOI: 10.1186/s12889-020-8410-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 02/25/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Infections with Human Papillomavirus (HPV) are the main cause of cervical cancer. Since 2014, the HPV vaccine was introduced in the Brazilian National Vaccination Calendar. The purpose of this study was to assess the knowledge of adolescent girls and their mothers/guardians about HPV and HPV vaccine, identify the factors associated with this knowledge, and evaluate immunization dropout rate. METHODS This was a cross-sectional study involving adolescent girls and their mothers/guardians. Participants underwent an interview that addressed sociodemographic data, sexual and gynecological history, and knowledge about HPV, HPV vaccine and cervical cancer. The third quartile of the total score was established as a cutoff for assessing knowledge. Adolescents who correctly answered more than four questions and mothers/guardians who obtained more than five correct responses were categorized into high knowledge. Poisson regression analysis was performed to identify variables associated with low knowledge. Vaccination records were used to assess immunization dropout rates. Any adolescent who did not complete the two-dose vaccination schedule was considered dropout. RESULTS A total of 666 adolescent girls and 623 mothers/guardians were interviewed. Low knowledge was observed in 76.7% of adolescents and 79.8% of mothers/guardians. Most were unaware of the causal relationship between HPV and cervical cancer, signs and symptoms of HPV infection, and had limited knowledge about the HPV vaccine. Factors associated with low knowledge of adolescents were aged 12 years [IRR 1.2 (95% CI 1. 1-1.3)] or less [IRR 1.3 (95% CI (1. 2-1.4)]; household income lower than US$750 [IRR 1.7 (95% CI 1. 1-2.6)] and household income between US$751 and US$1500 [IRR 1.6 (95% CI 1.0-2.6)]. Among mothers/guardians, low knowledge was related to having completed elementary school or less [IRR 1.5 (95% CI 1. 2-2.0)]; and household income lower than US$750 [IRR 1.2 (95% CI 1.0-1.4)]. Knowledge of adolescents and mothers/guardians was not associated with vaccine uptake. HPV immunization dropout rate was considered high (32.3%). CONCLUSION Knowledge about HPV and cervical cancer as well as vaccine uptake was low. Results highlight the need for educational interventions about HPV and cervical cancer. These actions may contribute to improve adherence to HPV vaccination.
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Affiliation(s)
- Ana Carolina da Silva Santos
- Programa de Pós-graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Campus Universitário, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35.400-000, Brazil.
| | - Nayara Nascimento Toledo Silva
- Programa de Pós-graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Campus Universitário, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35.400-000, Brazil
| | - Cláudia Martins Carneiro
- Programa de Pós-graduação em Ciências Biológicas, Núcleo de Pesquisa em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Wendel Coura-Vital
- Programa de Pós-graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Campus Universitário, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35.400-000, Brazil.,Programa de Pós-graduação em Ciências Biológicas, Núcleo de Pesquisa em Ciências Biológicas (NUPEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Angélica Alves Lima
- Programa de Pós-graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Campus Universitário, Morro do Cruzeiro, Ouro Preto, Minas Gerais, 35.400-000, Brazil
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Wondimu A, Cao Q, Wilschut JC, Postma MJ. Factors associated with the uptake of newly introduced childhood vaccinations in Ethiopia: the cases of rotavirus and pneumococcal conjugate vaccines. BMC Public Health 2019; 19:1656. [PMID: 31823756 PMCID: PMC6902476 DOI: 10.1186/s12889-019-8002-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background Childhood immunization programmes have made substantial contributions to lowering the burden of disease among children in developing countries, however a large proportion of children still remain unimmunized. This study aimed to explore the determinants of rotavirus vaccine (RVV) and pneumococcal conjugate vaccine (PCV) uptake in Ethiopia. Methods The 2016 Ethiopian demographic and health survey dataset was used in this analysis. A total of 2004 children aged 12–23 months were included in the analysis. A multivariable logistic regression model was employed to identify the determinants of uptake of the complete schedules of RVV (two doses) and PCV (three doses). Crude and adjusted odds ratios with 95% confidence intervals (CIs) were calculated. Results The uptakes of the complete schedules of RVV and PCV among children aged 12–23 months were 56 and 49.1%, respectively. The likelihood of immunization with the complete schedule of RVV was significantly lower among children from the relatively poor Afar region in Ethiopia (AOR 0.16; 95%-CI 0.04–0.61). Similarly, children living in not only the Afar region (AOR 0.10; 95%-CI 0.03–0.38), but also the Gambela region (AOR 0.25; 95%-CI 0.08–0.83), were less likely to be vaccinated with PCV. On the other hand, children from more wealthy households had higher odds of vaccination with RVV (AOR 1.69; 95%-CI 1.04–2.75). Also attending antenatal care (ANC) was found to be significantly associated with uptake of the complete schedule of RVV and PCV. Conclusions The uptake of RVV and PCV is suboptimal in Ethiopia. The uptake of the vaccines were found to be associated with region, ANC use and wealth status.
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Affiliation(s)
- Abrham Wondimu
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | - Qi Cao
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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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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Wemakor A, Helegbe GK, Abdul-Mumin A, Amedoe S, Zoku JA, Dufie AI. Prevalence and factors associated with incomplete immunization of children (12-23 months) in Kwabre East District, Ashanti Region, Ghana. ACTA ACUST UNITED AC 2018; 76:67. [PMID: 30473789 PMCID: PMC6240961 DOI: 10.1186/s13690-018-0315-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022]
Abstract
Background Childhood immunization is one of the most cost effective health interventions but its rate has been declining recently in Ghana. Information on immunization coverage and determinants is needed to improve immunization programmes. The objective of this study was to determine the prevalence and factors associated with incomplete immunization of children (12-23 months) in Kwabre East District, Ghana. Methods A cross-sectional, community-based survey involving 322 children and their mothers was carried out. Data were collected on socio-demographic characteristics of mothers, childhood immunization history and mothers' knowledge and practices of immunization using a structured questionnaire. Children were classified as incompletely immunized if they failed to receive at least one of 8 vaccine doses: - one dose of Bacillus Calmette-Guérin (BCG), 3 doses each of pentavalent, 3 doses of polio and one dose of measles per WHO/UNICEF definition. Chi-square and logistic regression analyses were used to identify the factors associated with incomplete immunisation. Results The prevalence of incomplete immunization was low (15.5%) suggesting high immunisation coverage but the coverage of the second measles dose, taken at 18 months of age, was the lowest (23.9%). Most of the mothers knew the importance of immunisation (95.7%) and at least one vaccine-preventable disease or symptom (84.9%). Two factors associated with incomplete immunisation in bivariate analyses (community of residence, and mother's knowledge of number of oral polio vaccines given to children) were no longer significant in a logistic regression model. Compared to children in Aboaso, children in Gyamfi Wonoo (AOR = 1.81, 95% CI = 0.80-4.08), Mamponteng (Bonwunu) (AOR = 0.59, 95% CI = 0.24-1.48) and Mamponteng (Town) (AOR = 0.63, 95% CI = 0.26-1.55) had similar odds of incomplete immunisation. Similarly, mother's lack of knowledge of the number of doses of polio vaccine given to children had no effect on the odds of incomplete immunisation (AOR = 0.53, 95% CI = 0.22-1.26). Conclusions Immunization coverage is high in the Kwabre East district but very few children received the second measles dose. None of the maternal and child factors assessed is associated with immunisation coverage. Further research is needed to identify the determinants of immunisation coverage and the reasons for the low uptake of second measles dose in the study area.
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Affiliation(s)
- Anthony Wemakor
- 1Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Gideon Kofi Helegbe
- 2Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Alhassan Abdul-Mumin
- 3Department of Paediatrics and Child Health, Tamale Teaching Hospital/School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Shadrack Amedoe
- 1Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Jessica Adjoa Zoku
- 1Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Ahimah Ivy Dufie
- 1Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Imran W, Abbas F, Javed SA. What is causing high polio vaccine dropout among Pakistani children? Public Health 2018; 164:16-25. [PMID: 30153528 DOI: 10.1016/j.puhe.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/24/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Although the antipolio drive is undertaken across Pakistan, there are still children who have not received any oral polio vaccine or are unable to complete recommended doses of polio vaccine. This study aims at empirically analyzing the associated factors with the no oral polio vaccination (OPV) and OPV dropout groups of children in Pakistan. STUDY DESIGN This is a cross-sectional study. METHODS Data were obtained from the three waves of Pakistan Demographic and Health Survey of children aged between 12 and 23 months (1990-1991: n = 1214; 2006-2007: n = 1522; 2012-2013: n = 2074). Children who received no OPV and those who drop out of polio vaccination (OPV1-OPV3) were considered as outcome variables. The bivariate relationship of outcome variable with each socio-economic, demographic, and spatial variable is estimated with a P-value of <0.01. For both no OPV and OPV dropout children, we used logistic regression analysis separately. RESULTS The percentage of children aged 12-23 months who dropped out of OPV1-OPV3 vaccination was about 76% in the year 1990-1991; 21% in 2006-2007, and 17.5% in 2012-2013 at the national level. Among all indicators, provinces, rural versus urban residence, the mother's age at marriage, the child's birth place (home versus hospital), parental education, and household wealth status are significant predictors of no OPV and/or OPV dropout in Pakistan. Among provinces, Balochistan, Khyber Pakhtunkhwa (KPK), and Sindh are the lagging provinces. CONCLUSION Improving the socio-economic status of women helps decrease the chance of polio dropout and thus improves service delivery and program implementation.
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Affiliation(s)
- W Imran
- Idara-e-Talim-o-Aghai (ITA), Center for Education and Consciousness, Islamabad, Pakistan.
| | - F Abbas
- Courant Research Center, "Poverty, Equity and Growth in Developing and Transition Countries", Department of Economics, George August University, Goettingen, Germany.
| | - S A Javed
- Head Policy Solution Lab, Sustainable Development Policy Institute (SDPI), Islamabad, Pakistan.
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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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