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Immurana M, Abdul Rahman AM. The Effect of Economic Growth on the Utilisation of Childhood Immunisation: New Evidence From 50 African Countries. Health Serv Insights 2024; 17:11786329241261990. [PMID: 39049962 PMCID: PMC11268013 DOI: 10.1177/11786329241261990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/27/2024] Open
Abstract
Africa bears the greatest brunt of under-five mortality in the world. Among the major approaches used in tackling under-five deaths is childhood immunisation. While income is regarded as a major determinant of demand for child health inputs including immunisation, the existing studies are microlevel analyses, which do not provide a bigger picture of how an enhancement in economic growth (aggregate income) contributes to the utilisation of childhood immunisation in an economy as a whole. Since Africa has experienced economic growth in the recent decades, this study aims to fill this gap in the literature by examining the contribution of economic growth to the utilisation of childhood immunisation in selected African countries. The study uses a panel design involving data on 50 African countries over the period, 2002 to 2019. Utilisation of DPT (diphtheria, pertussis (or whooping cough) and tetanus) and measles immunisation are used as proxies for childhood immunisation while the system Generalised Method of Moments (GMM) regression is used as the estimation technique. We find economic growth to have a positive significant effect on the utilisation of childhood immunisation. Thus, it is imperative to intensify the enablers of economic growth in Africa in order to increase the utilisation of childhood immunisation.
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Affiliation(s)
- Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Bantie B, Atnafu Gebeyehu N, Adella GA, Ambaw Kassie G, Mengstie MA, Abebe EC, Abdu Seid M, Gesese MM, Tegegne KD, Zemene MA, Anley DT, Dessie AM, Fenta Feleke S, Dejenie TA, Chanie ES, Kebede SD, Bayih WA, Moges N, Kebede YS. Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis. Front Public Health 2024; 12:1339539. [PMID: 38912271 PMCID: PMC11193363 DOI: 10.3389/fpubh.2024.1339539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Background Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia. Methods A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi* hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization. Results Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, p-value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization. Conclusion and recommendation In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Adisu MA, Bogale WA, Alemu TG. Second dose of measles-containing vaccine coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023. Front Public Health 2024; 12:1364865. [PMID: 38756896 PMCID: PMC11097900 DOI: 10.3389/fpubh.2024.1364865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background Measles caused 207,000 deaths worldwide in 2019. Ethiopia ranks among the top 10 countries in the world with the highest number of measles cases. However, the coverage of the second dose of measles-containing vaccine (MCV2) remains low. To increase coverage, the government of Ethiopia launched a nationwide measles vaccination campaign. Despite this intervention, the coverage is still below target, and there is scarce information in the study area. Therefore, this study aimed to assess MCV2 coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023. Methods A community-based cross-sectional study was conducted among 621 children aged 24-36 months using a systematic random sampling technique from 25 April to 25 May. A pre-tested, interviewer-administered, and structured questionnaire was used and collected using Kobo Toolbox and then transferred to Stata version 17 for further analysis. The binary logistic regression model was used to identify factors, and the presence of an association was declared using a p-value of <0.05. Similarly, an adjusted odds ratio with a 95% confidence interval was used to interpret the direction and strength of an association. Results A total of 621 children, with a response rate of 98.1%, participated in the study. The coverage of the second dose of MCV was 75.68% (95% CI: 72.1-78.9). The following factors were significantly associated with measles-containing vaccine second dose (MCV2) coverage: father as the household head (AOR: 3.06, 95% CI: 1.43-6.44), first birth order (AOR: 4.45, 95% CI: 1.21-16.3), four and above antenatal care (ANC) follow-ups (AOR: 5.18, 95% CI:1.62-16.5), postnatal care (PNC) service utilization (AOR: 2.57, 95% CI:1.27-5.15), at least two doses of vitamin A uptake (AOR: 6.39, 95% CI: 2.67-15.2), mothers having high awareness (AOR: 1.97, 95% CI:1.15-3.4), and good perception (AOR: 3.6, 95% CI: 2-6.47) about measles vaccination. Conclusion and recommendations The coverage of MCV2 in the study area is lower than the national and global target of above 95%. Head of household, birth order, ANC follow-up, PNC service utilization, vitamin A uptake, awareness, and perception of mothers about measles vaccination were significant factors for MCV2 coverage. Creating awareness, increasing the perception of mothers about measles vaccination, and strengthening the ANC and PNC services will increase the coverage.
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Affiliation(s)
- Molalign Aligaz Adisu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Worknesh Akanaw Bogale
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Akanpaabadai EA, Adiak AA, Nukpezah RN, Adokiya MN, Adjei SE, Boah M. Population-based cross-sectional study of factors influencing full vaccination status of children aged 12- 23 months in a rural district of the Upper East Region, Ghana. BMC Pediatr 2024; 24:168. [PMID: 38459467 PMCID: PMC10921601 DOI: 10.1186/s12887-024-04662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Achieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 - 23 months in a rural district of the Upper East Region of Ghana. METHODS A population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children's health record books and carers' recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0. RESULTS The results showed that 76.9% (95% CI: 72.3 - 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20-5.63) and tertiary (aOR = 3.98, 95% CI: 1.34-11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03-4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21-0.80). CONCLUSIONS Our study found that nearly one-quarter of children aged 12-23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12-23 months, and improving accessibility to vaccination services.
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Affiliation(s)
| | | | - Ruth Nimota Nukpezah
- School of Nursing and Midwifery University for Development Studies, Northern Region, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana.
- Center for Population Health, Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda.
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Wassenaar M, Fombah AE, Chen H, Owusu-Kyei K, Williams J, Sunders JHC, Llach M, Quinto L, Sesay T, Samai M, Menéndez C, González R. Immunisation coverage and factors associated with incomplete immunisation in children under two during the COVID-19 pandemic in Sierra Leone. BMC Public Health 2024; 24:143. [PMID: 38200476 PMCID: PMC10777622 DOI: 10.1186/s12889-023-17534-2] [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: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Routine childhood immunisation is one of the most important life-saving public health interventions. However, many children still have inadequate access to these vaccines and millions remain (partially) unvaccinated globally. As the COVID-19 pandemic disrupted health systems worldwide, its effects on immunisation have become apparent. This study aimed to estimate routine immunisation coverage among children under two in Sierra Leone and to identify factors associated with incomplete immunisation during the COVID-19 pandemic. METHODS A cross-sectional household survey was conducted in three districts in Sierra Leone: Bombali, Tonkolili and Port Loko. A three-stage cluster sampling method was followed to enrol children aged 10-23 months. Information regarding immunisation status was based on vaccination cards or caretaker's recall. Using WHO's definition, a fully immunised child received one BCG dose, three oral polio vaccine doses, three pentavalent vaccine doses and one measles-containing vaccine dose. Following the national schedule, full immunisation status can be achieved at 9 months of age. Data were weighted to reflect the survey's sampling design. Associations between incomplete immunisation and sociodemographic characteristics were assessed through multivariable logistic regression. RESULTS A total of 720 children were enrolled between November and December 2021. Full vaccination coverage was estimated at 65.8% (95% CI 60.3%-71.0%). Coverage estimates were highest for vaccines administered at birth and decreased with doses administered subsequently. Adjusting for age, the lowest estimated coverage was 40.7% (95% CI 34.5%-47.2%) for the second dose of the measles-containing vaccine. Factors found to be associated with incomplete immunisation status were: living in Port Loko district (aOR = 3.47, 95% CI = 2.00-6.06; p-value < 0.001), the interviewed caretaker being Muslim (aOR = 1.94, 95% CI = 1.25-3.02; p-value = 0.015) and the interviewed caretaker being male (aOR = 1.93, 95% CI = 1.03-3.59, p-value = 0.039). CONCLUSION Though full immunisation coverage at district level improved compared with pre-pandemic district estimates from 2019, around one in three surveyed children had missed at least one basic routine vaccination and over half of eligible children had not received the recommended two doses of a measles-containing vaccine. These findings highlight the need to strengthen health systems to improve vaccination uptake in Sierra Leone, and to further explore barriers that may jeopardise equitable access to these life-saving interventions.
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Affiliation(s)
- Myrte Wassenaar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Augustin E Fombah
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
- Ministry of Health, Freetown, Sierra Leone.
| | - Haily Chen
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Julian Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joe-Henry C Sunders
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mireia Llach
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quinto
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Tom Sesay
- Directorate of Reproductive Child Health, Ministry of Health, Freetown, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Directorate of Research and Training, Ministry of Health, Freetown, Sierra Leone
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
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Fadl N, Abdelmoneim SA, Gebreal A, Youssef N, Ghazy RM. Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy. Public Health 2024; 226:66-73. [PMID: 38007843 DOI: 10.1016/j.puhe.2023.10.049] [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: 06/15/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries. STUDY DESIGN A cross-sectional study was conducted from November 1 to December 15, 2022. METHODS Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed. RESULTS Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168). CONCLUSIONS Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.
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Affiliation(s)
- N Fadl
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | - S A Abdelmoneim
- Clinical Research Administration, Directorate of Health Affairs, Egyptian Ministry of Health, Alexandria, Egypt.
| | - A Gebreal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - N Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Saudi Arabia.
| | - R M Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
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Amoah A, Issaka J, Ayebeng C, Okyere J. Influence of women empowerment on childhood (12-23 months) immunization coverage: Recent evidence from 17 sub-Saharan African countries. Trop Med Health 2023; 51:63. [PMID: 37957779 PMCID: PMC10644494 DOI: 10.1186/s41182-023-00556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND There is a global consensus that child immunization plays an important role in promoting the health and well-being of children. Despite the quintessential role of immunization, not all children receive full immunization coverage. We examined the association between women empowerment and childhood immunization coverage in sub-Saharan Africa (SSA). METHODS The most recent Demographic and Health Survey data of 17 SSA countries were used for the analysis, with a sample of 19,223. The outcome and exposure variables were full immunization coverage and women empowerment, respectively. Full immunization was computed from percentage of children between the ages of 12 and 23 months who had received the following vaccines at any point in time: one dose of Bacille Calmette-Guérin, three doses of the vaccine protecting against diphtheria, pertussis, and tetanus or the tetravalent/pentavalent vaccine, three doses of the polio vaccine, and one dose of the measles vaccine (either as a standalone measles vaccine or as part of a combination with other immunogens). Women's empowerment was an index of labour participation, acceptance towards spousal violence, decision-making capacity and general knowledge level. Descriptive analysis and multilevel logistic regression were performed. Results were reported in adjusted odds ratio with a corresponding 95% confidence interval. RESULTS The study found that 56.6% of children were fully immunized. Children of employed mothers were 1.16 times more likely to be fully immunized. Children of mothers with higher acceptance toward violence were less likely to be fully immunized [aOR = 0.90, CI 0.81, 0.99]. The odds of full immunization were higher among children born to mothers with high [aOR = 1.11, CI 1.01, 1.22] decision-making capacity. Higher odds of full immunization were found among children born to mothers with medium [aOR = 1.24, CI 1.13, 1.36] to high [aOR = 1.44, CI 1.27, 1.63] general knowledge level. CONCLUSIONS We conclude that empowering women through livelihood empowerment interventions can increase their decision-making capacity and foster their resolve to ensure the full immunization of their children. This can be achieved by consciously investing in initiatives such as vocational training programs, job placement services, or support for entrepreneurship initiatives to encourage and support women's workforce participation.
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Affiliation(s)
- Abigail Amoah
- Department of Science, Jasikan College of Education, Jasikan-Buem, Ghana
| | - Jacob Issaka
- Department of Science, Jasikan College of Education, Jasikan-Buem, Ghana
| | - Castro Ayebeng
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- Department of Research and Advocacy, Challenging Heights, Winneba, Ghana
| | - Joshua Okyere
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.
- Department of Research and Advocacy, Challenging Heights, Winneba, Ghana.
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Abdilahi MM, Mohamed AI, Jonah KM, Ismail AS. Prevalence and factors associated with immunization coverage among children under five years in Mohamed Mooge health center, Hargeisa, Somaliland: a cross-sectional study. BMC Pediatr 2023; 23:545. [PMID: 37904092 PMCID: PMC10614313 DOI: 10.1186/s12887-023-04371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Routine immunization contributes greatly to reduction in mortality from vaccine preventable diseases among children. The Somaliland Demographic and Health survey, 2020 revealed that only 13.7% of children in Marodijeh (Hargeisa) region had received all recommended vaccines, which is far below the World Health Organization (WHO) target of 80%. We therefore, assessed factors associated with immunization coverage among children under five years at Mohamed Mooge Health Center in Hargeisa, Somaliland. METHODS Institutional based cross-sectional study was conducted on 174 systematically sampled, consented mothers that visited Mohamed Mooge Health Center for antenatal care during December 2022 to May 2023. Data was collected using a structured questionnaire. Data was analysed using SPSS and the relationship between dependent and independent variables was checked chi-square test at p ≤ 0.05. Finally, candidate variables were tested by using multivariate logistic regression in order to control potential confounders and the result was presented using AOR and 95% confidence interval. Model fitness was checked using Hosmer-Lemeshaw goodness of fit test with P > 0.05 for fitness. Multicollinearity between variables was checked using correlation coefficients at 0.80 or higher. RESULT: Among 174 study participants, the prevalence of overall vaccine completion in this study was 55.3%. Women who had being aware about childhood immunization on BCG vaccination (AOR = 3.887; 95% CI: 1.275, 6.844), pentavalent (AOR = 11.385; 95% CI: 5.424-14.464), and measles (AOR = 3.074; 95% CI: 1.822-6.130) had higher odds of having immunized their children. Mothers who had employment had higher odds of having their children immunized against measles (AOR = 4.069; 95% CI: 1.822-6.130) compared to those who had not. CONCLUSIONS Full immunization coverage was lower than the target set by the World Health Organization in this study area. The current study revealed that, the mother's awareness of childhood vaccinations on BCG, pentavalent, measles and employment status of mothers were positively associated with immunization coverage. To promote vaccination coverage, the government should implement a national awareness campaign on childhood immunization and increase the number of outreach services.
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Affiliation(s)
| | - Ahmed Ismail Mohamed
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
| | - Kiruja M Jonah
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
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Muhoza P, Shah MP, Gao H, Amponsa-Achiano K, Quaye P, Opare W, Okae C, Aboyinga PN, Opare KL, Wardle MT, Wallace AS. Predictors for Uptake of Vaccines Offered during the Second Year of Life: Second Dose of Measles-Containing Vaccine and Meningococcal Serogroup A-Containing Vaccine, Ghana, 2020. Vaccines (Basel) 2023; 11:1515. [PMID: 37896919 PMCID: PMC10611024 DOI: 10.3390/vaccines11101515] [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: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Understanding the drivers of coverage for vaccines offered in the second year of life (2YL) is a critical focus area for Ghana's life course approach to vaccination. This study characterizes the predictors of vaccine receipt for 2YL vaccines-meningococcal serogroup A conjugate vaccine (MACV) and the second dose of measles-containing vaccine (MCV2)-in Ghana. METHODS 1522 children aged 18-35 months were randomly sampled through household surveys in the Greater Accra Region (GAR), Northern Region (NR), and Volta Region (VR). The association between predictors and vaccination status was modeled using logistic regression with backwards elimination procedures. Predictors included child, caregiver, and household characteristics. RESULTS Coverage was high for infant vaccines (>85%) but lower for 2YL vaccines (ranging from 60.2% for MACV in GAR to 82.8% for MCV2 in VR). Predictors of vaccination status varied by region. Generally, older, first-born children, those living in rural settlements and those who received their recommended infant vaccines by their first birthday were the most likely to have received 2YL vaccines. Uptake was higher among those with older mothers and children whose caregivers were aware of the vaccination schedule. CONCLUSIONS Improving infant immunization uptake through increased community awareness and targeted strategies, such as parental reminders about vaccination visits, may improve 2YL vaccination coverage.
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Affiliation(s)
- Pierre Muhoza
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Monica P. Shah
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Hongjiang Gao
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kwame Amponsa-Achiano
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Pamela Quaye
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - William Opare
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Charlotte Okae
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Philip-Neri Aboyinga
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Kwadwo L. Opare
- Neglected Tropical Diseases Control Programme, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra 00233, Ghana
| | - Melissa T. Wardle
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Aaron S. Wallace
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Asresie MB, Fekadu GA, Dagnew GW. Urban-rural disparities in immunization coverage among children aged 12-23 months in Ethiopia: multivariate decomposition analysis. BMC Health Serv Res 2023; 23:969. [PMID: 37679707 PMCID: PMC10485935 DOI: 10.1186/s12913-023-09940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia. METHODS We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. RESULTS The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity. CONCLUSIONS There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Gedefaw Abeje Fekadu
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Kamal A, Waseem A, Siddiqa M, Ijaz M, Shakeel A, Iftikhar S. Contextual factors influencing incomplete immunization and investigation of its geospatial heterogeneity in Pakistan: a cross-sectional study based on PDHS (2017-18). BMC Public Health 2023; 23:1620. [PMID: 37620868 PMCID: PMC10463638 DOI: 10.1186/s12889-023-16508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Immunization is one of the most effective public health initiatives, saving millions of lives and lowering the risk of diseases such as diphtheria, tetanus, influenza, and measles. Immunization saves an estimated 2-3 million lives per year. A study of the regional variations in incomplete immunization will be useful in identifying gaps in the performance of immunization programs that are not noticed by standard vaccination programs monitoring. The primary goal of this study was to identify factors influencing child immunization status and to examine regional variations in incomplete immunization among children aged 12 to 23 months in Pakistan. METHODS For the current study, the data were taken from the Demographic and Health Survey for Pakistan (PDHS 2017-2018). Ever-married women who had children aged 12-23 months were included in this study. The immunization status of children was used as an outcome variable. In order to determine the effects of different factors on incomplete immunization, multilevel logistic model was used. To study the geographical variation of incomplete immunization, hotspot analysis was done using ArcGIS 10.7 and SaTScan software and to identify significant predictors of incomplete immunization, GWR 4 software was used. RESULTS Place of delivery, gender of child, mother's educational level and region were identified as significant determinants of incomplete immunization of children in Pakistan. Chances of incomplete immunization of children were found significantly lower for educated mothers (AOR = 0.52, 95% CI 0.34-0.79) and mothers who had delivered children in the health facilities (AOR = 0.51, 95% CI 0.32-0.83). Female children were more likely (AOR = 1.44, 1.95% CI 1.04-1.99) to be incompletely immunized as compared to male children. FATA (AOR = 11.19, 95% CI 4.89-25.6), and Balochistan (AOR = 10.94, 95% CI 5.08-23.58) were found at the highest risk of incomplete immunization of children as compared to Punjab. The significant spatial heterogeneity of incomplete immunization was found across Pakistan. The spatial distribution of incomplete immunization was clustered all over Pakistan. The high prevalence of incomplete immunization was observed in Balochistan, South Sindh, North Sindh, South KPK, South FATA, Gilgit Baltistan, Azad Jammu Kashmir, South and East Punjab. Drang and Harcho were identified as hotspot areas of incomplete immunization in Gilgit Baltistan. Secondary clusters with a high risk of incomplete immunization were found in regions Balochistan, Sindh and FATA. CONCLUSION Gender biasedness towards female children, regarding complete immunization of children prevailed in Pakistan. Spatial heterogeneity was also found for incomplete immunization of children. To overcome the problem access to health facilities is the foremost step. Government should target hotspot areas of incomplete immunization of children to provide primary health care facilities by opening health care units in these areas. The government in collaboration with the media should launch awareness campaigns in those areas to convince people that complete immunization is the right of every child regardless of gender.
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Affiliation(s)
- Asifa Kamal
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Ayesha Waseem
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Maryam Siddiqa
- Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan
| | - Muhammad Ijaz
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan.
| | - Abeera Shakeel
- Department of Statistics, Lahore College for Women, University, Lahore, Pakistan
| | - Soofia Iftikhar
- Department of Statistics, Shaheed Benazir Bhutto Women University Peshawar, Peshawar, Pakistan
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Aoki A, Mochida K, Kuramata M, Sadamori T, Sapalalo P, Tchicondingosse L, Balogun OO, Aiga H, Francisco KR, Takehara K. Association between the quality of care and continuous maternal and child health service utilisation in Angola: Longitudinal data analysis. J Glob Health 2023; 13:04073. [PMID: 37565413 PMCID: PMC10416139 DOI: 10.7189/jogh.13.04073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Background Many low- and middle-income countries (LMICs) prioritise minimising maternal, neonatal, and infant mortality. To improve maternal and child health, various evidence-based interventions have been introduced. Quality of care is pertinent while strengthening service utilisations. Achieving optimal-quality care is often marred with difficulties, such as inadequate skills and knowledge of health workers, poor fidelity to protocols, and poor user acceptance. Angola is a LMIC facing these problems. This study aimed to demonstrate the influence of health facilities' quality of care at antenatal care (ANC) on subsequent maternal, newborn and child health (MNCH) service utilisation in Angolan pregnant women. Methods Population-based cohort data from the Maternal and Child Health Handbook (MCH-HB) effectiveness study were analysed. The original study was conducted among women who became pregnant between March and April 2019 in Benguela Province, Angola. Socioeconomic and MNCH service utilisation indicators were collected through interviewer-administered structured questionnaires. The indicator of quality of care was a composite measure that assessed the implementation of the MCH-HB based on the RE-AIM framework, mostly consisted of common factors related to delivery and management of MNCH services. A multivariate logistic regression analysis was performed between quality of care, socioeconomic factors, and service utilisation indicators among the intervention group participants who had at least one ANC visit. Results Of the 3351 pregnant women who visited ANC at least once, 2911 without missing values among explanatory or dependent variables were included in the analysis. Among them, 2032 (69.8%) were exposed to optimal-quality ANC, and 2058 (70.7%), 1573 (54.0%), and 941 (32.3%) achieved ANC target, facility delivery, and vaccination target for six-month-old infants, respectively. Exposure to suboptimal-quality care at ANC was associated with lower odds for facility delivery (adjusted odds ratio (AOR) = 0.60, 95% CI = 0.49-0.73) and the achievement of the vaccination target (AOR = 0.43, 95% CI = 0.33-0.55). A low socioeconomic status was inversely associated with health service utilisation indicators. Conclusions Health facilities' quality of care influences subsequent MNCH service utilisation. Therefore, simultaneous efforts to improve quality of care and the mobilisation of pregnant women and communities are essential for enhancing maternal and child health.
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Affiliation(s)
- Ai Aoki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Keiji Mochida
- TA Networking Corp., Tokyo, Japan
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | | | | | - Pedro Sapalalo
- Domus Custodius (SU) Lda. Tchikos Agency, Luanda, Angola
| | | | | | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Human Development Department, Japan International Cooperation Agency, Tokyo, Japan
| | | | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Runge M, Stahlfeld A, Ambrose M, Toh KB, Rahman S, Omoniwa OF, Bever CA, Oresanya O, Uhomoibhi P, Galatas B, Tibenderana JK, Gerardin J. Perennial malaria chemoprevention with and without malaria vaccination to reduce malaria burden in young children: a modelling analysis. Malar J 2023; 22:133. [PMID: 37095480 PMCID: PMC10124689 DOI: 10.1186/s12936-023-04564-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND A recent WHO recommendation for perennial malaria chemoprevention (PMC) encourages countries to adapt dose timing and number to local conditions. However, knowledge gaps on the epidemiological impact of PMC and possible combination with the malaria vaccine RTS,S hinder informed policy decisions in countries where malaria burden in young children remains high. METHODS The EMOD malaria model was used to predict the impact of PMC with and without RTS,S on clinical and severe malaria cases in children under the age of two years (U2). PMC and RTS,S effect sizes were fit to trial data. PMC was simulated with three to seven doses (PMC-3-7) before the age of eighteen months and RTS,S with three doses, shown to be effective at nine months. Simulations were run for transmission intensities of one to 128 infectious bites per person per year, corresponding to incidences of < 1 to 5500 cases per 1000 population U2. Intervention coverage was either set to 80% or based on 2018 household survey data for Southern Nigeria as a sample use case. The protective efficacy (PE) for clinical and severe cases in children U2 was calculated in comparison to no PMC and no RTS,S. RESULTS The projected impact of PMC or RTS,S was greater at moderate to high transmission than at low or very high transmission. Across the simulated transmission levels, PE estimates of PMC-3 at 80% coverage ranged from 5.7 to 8.8% for clinical, and from 6.1 to 13.6% for severe malaria (PE of RTS,S 10-32% and 24.6-27.5% for clinical and severe malaria, respectively. In children U2, PMC with seven doses nearly averted as many cases as RTS,S, while the combination of both was more impactful than either intervention alone. When operational coverage, as seen in Southern Nigeria, increased to a hypothetical target of 80%, cases were reduced beyond the relative increase in coverage. CONCLUSIONS PMC can substantially reduce clinical and severe cases in the first two years of life in areas with high malaria burden and perennial transmission. A better understanding of the malaria risk profile by age in early childhood and on feasible coverage by age, is needed for selecting an appropriate PMC schedule in a given setting.
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Affiliation(s)
- Manuela Runge
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
| | - Anne Stahlfeld
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
| | - Monique Ambrose
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, USA
| | - Kok Ben Toh
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
| | - Semiu Rahman
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT Nigeria
| | - Omowunmi F. Omoniwa
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT Nigeria
| | - Caitlin A. Bever
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, USA
| | - Olusola Oresanya
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT Nigeria
| | - Perpetua Uhomoibhi
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Beatriz Galatas
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | - Jaline Gerardin
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
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Budu E, Ahinkorah BO, Guets W, Ameyaw EK, Essuman MA, Yaya S. Socioeconomic and residence-based related inequality in childhood vaccination in Sub-Saharan Africa: Evidence from Benin. Health Sci Rep 2023; 6:e1198. [PMID: 37091357 PMCID: PMC10117389 DOI: 10.1002/hsr2.1198] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Aims Childhood vaccination remains a cost-effective strategy that has expedited the control and elimination of numerous diseases. Although coverage of new vaccines in low- and middle-income countries increased exponentially in the last two decades, progress on expanding routine vaccination services to reach all children remains low, and coverage levels in many countries remains inadequate. This study aimed to examine the pattern of wealth and residence-based related inequality in vaccination coverage through an equity lens. Methods We used data from the 2017-2018 Benin Demographic and Health Survey. Statistical and econometrics modeling were used to investigate factors associated with childhood vaccination. The Wagstaff decomposition analysis was used to disentangle the concentration index. Results A total of 1993 children were included, with 17% in the wealthiest quintile and 63% were living in rural areas. Findings showed that wealth is positively and significantly associated with vaccination coverage, particularly, for middle-wealth households. A secondary or higher education level of women and partners increased the odds of vaccination compared to no education (p < 0.05). Women with more antenatal care visits, with multiple births, attending postnatal care and delivery in a health facility had increased vaccination coverage (p < 0.01). Inequalities in vaccination coverage are more prominent in rural areas; and are explained by wealth, education, and antenatal care visits. Conclusion Inequality in child vaccination varies according to socioeconomic and sociodemographic characteristics and is of interest to health policy. To mitigate inequalities in child vaccination coverage, policymakers should strengthen the availability and accessibility of vaccination and implement educational programs dedicated to vulnerable groups in rural areas.
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Affiliation(s)
| | - Bright O. Ahinkorah
- School of Public Health, Faculty of HealthUniversity of Technology SydneySydneyAustralia
- REMS Consult LimitedSekondi‐TakoradiGhana
| | - Wilfried Guets
- Health, Nutrition, and Population Unit, The World BankParisFrance
| | - Edward K. Ameyaw
- Institute of Policy Studies and School of Graduate StudiesLingnan UniversityLingnanHong Kong
- L & E Research Consult LtdWaGhana
| | - Mainprice A. Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied SciencesUniversity of Cape CoastCape CoastGhana
| | - Sanni Yaya
- School of International Development and Global StudiesUniversity of OttawaOttawaCanada
- The George Institute for Global Health, Imperial College LondonLondonUK
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Sako S, Gilano G, Hailegebreal S. Determinants of childhood vaccination among children aged 12-23 months in Ethiopia: a community-based cross-sectional study. BMJ Open 2023; 13:e069278. [PMID: 36889833 PMCID: PMC10008449 DOI: 10.1136/bmjopen-2022-069278] [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] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE Childhood vaccination is a cost-effective, essential service to reach a larger population globally. Due to unclear reasons, new emergence and resurgence of vaccine-preventable diseases increase. Thus, the aim of this study is to identify prevalence and determinants of childhood vaccination in Ethiopia. DESIGN Community-based cross-sectional study. SETTING We used data from 2019 Ethiopia Mini Demographic and Health Survey. The survey included all the nine regional states and two city administrations of Ethiopia. PARTICIPANTS A weighted sample of 1008 children 12-23 months of age was included in the analysis. MAIN OUTCOME MEASURES A multilevel proportional odds model was fitted to identify determinants of childhood vaccination status. In the final model, variables with a p value of less than 5% and an adjusted OR (AOR) with a 95% CI were reported. RESULT The full childhood vaccination coverage of Ethiopia was 39.09% (95% CI: 36.06%-42.28%). Mothers who attended primary (AOR=2.16; 95% CI: 1.43-3.26), secondary (AOR=2.02; 95% CI: 1.07-3.79) and higher education (AOR=2.67; 95% CI: 1.25-5.71); being in union (AOR=2.21; 95% CI: 1.06-4.58); kept vaccination cards (AOR=26.18; 95% CI: 15.75-43.53); children receiving vitamin A1 (AOR=4.14; 95% CI: 2.9-5.9); living in Afar (AOR=0.14; 95% CI: 0.04-0.45), Somali (AOR=0.19; 95% CI: 0.06-0.60), Gambela (AOR=0.22; 95% CI: 0.06-0.77), Harari (AOR=0.14; 95% CI: 0.04-0.52) and Dire Dawa (AOR=0.23; 95% CI: 0.06-0.79) regions; and rural residents (AOR=0.53; 95% CI: 0.30-0.93) were factors significantly associated with childhood vaccination. CONCLUSION The full childhood vaccination coverage in Ethiopia was low and remained unchanged since 2016. The study identified that both the individual-level and community-level factors affected the vaccination status. Accordingly, public health interventions targeted to these identified factors can increase childhood full vaccination status.
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Affiliation(s)
- Sewunet Sako
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Girma Gilano
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Samuel Hailegebreal
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Lerm BR, Silva Y, Cata-Preta BO, Giugliani C. Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case. CAD SAUDE PUBLICA 2023; 39:e00102922. [PMID: 36651377 DOI: 10.1590/0102-311xen102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023] Open
Abstract
Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast, inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.
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Affiliation(s)
| | - Yanick Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Tesfa GA, Yehualashet DE, Getnet A, Bimer KB, Seboka BT. Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. A spatial and multilevel analysis. PLoS One 2023; 18:e0279399. [PMID: 36608032 PMCID: PMC9821487 DOI: 10.1371/journal.pone.0279399] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Complete childhood vaccination considerably aids in the reduction of morbidity and mortality from vaccine-preventable childhood diseases. Understanding the geographical disparity of complete basic childhood vaccination and Identifying associated factors is vital to designing appropriate interventions. This study aimed to assess the spatial distribution and associated factors of complete basic childhood vaccination among children aged 12-23 months in Ethiopia. METHODS A two-stage stratified sampling technique was used based on the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,028 children was included in the analysis. ArcGIS version 10.8 software was used to visualize the spatial distribution of complete basic childhood vaccination. The Bernoulli-based model was used to detect significant clusters of areas using SaTScan version 9.6 software. To identify associated factors, multilevel logistic regression analyses were used, and all variables with a p-value less than 0.05 were reported as statistically significant predictors. RESULTS Complete basic childhood vaccination among children aged 12-23 months had a significant variation in Ethiopia (Moran's I = 0.276, p<0.001). The spatial scan analysis identified the most likely significant primary clusters with low complete basic childhood vaccination coverage in the Somali region's Afder, Liben, Shabelle, and Nogobe zones; the Southern Nation Nationality and Peoples Region's (SNNPR) Gedeo and Sidama zones; and the Oromia region's Bale and Guji zones. The second significant cluster was found in the Afar region's zones 1, 4, and 5, as well as the northern Somali region's Siti zone. In the multivariable multilevel analysis, maternal age 20-24, 25-29, 35-39, and 40-44 years, delivery at a health facility, four or more antenatal care (ANC) visits, orthodox religion fellowship, maternal primary education, Muslim religion fellowship, living in the Afar, Somalia, and Oromia regions, and living in rural areas were all found to be significantly associated with complete basic childhood vaccination. CONCLUSION A geographically significant variation of complete basic childhood vaccination was observed. Maternal age, maternal education, religion, place of delivery, ANC visit, region, and residence were significantly associated with complete basic childhood vaccination. Developing immunization campaigns targeting areas that had low basic vaccination coverage and designing healthcare programs that can motivate facility-based delivery and ANC follow-up is recommended.
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Affiliation(s)
- Getanew Aschalew Tesfa
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | | | - Addisu Getnet
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kirubel Biweta Bimer
- Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Guye AH, Nigussie T, Tesema M, Shambi DB, Diriba BS, Tefera EM, Girma Y. Exploring barriers of childhood full vaccination among children living in Siraro District, West Arsi Zone, Oromia region, Ethiopia: A qualitative study. Front Pediatr 2023; 11:1083358. [PMID: 36937956 PMCID: PMC10020180 DOI: 10.3389/fped.2023.1083358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background Childhood immunization is one of the most effective global public health interventions to reduce childhood morbidity and mortality. However, some children remain not fully vaccinated in developing countries due to defaulting from full vaccination, which can put them at risk of acquiring vaccine-preventable disease outbreaks. The barriers to full vaccination were well explored in Ethiopia using a qualitative approach. The study aimed to explore barriers to full childhood vaccination in Siraro District, West Arsi Zone, Oromia, Ethiopia. Methods A qualitative study was conducted in Siraro District through 15 key informant health workers interviews and 6 in-depth interviews with children's mothers from April 20 to May 15, 2022. Data were collected by semi-structured questionnaires and captured using audio tape recorders and field note-taking. A heterogeneous purposive sampling technique was used to select representative study participants. Data transcription and translation were done according to the respondents' verbatim from the local language to English. Data coding and key categories were identified and analyzed using thematic analysis. Finally, data were presented in narrative forms using respondents' own words as an illustration. Result Twenty-one study participants were interviewed and included in this study. Of the explored barriers to full childhood vaccination, the evidence from the respondents was integrated from subcategories and presented as a whole within each thematic area. Five thematic areas emerged from interviews of the participants through thematic analysis of the data. The identified barriers were forgetting the next vaccination schedule, migration of parents, work overload, lack of knowledge and awareness, rumors, and misinformation. Additionally, vaccination service delivery-related barriers such as vaccine vials not being opened for a few children, fear of vaccine side effects, closed health posts during visits by mothers for vaccination, and absence of health extension workers at health posts were the key barriers to full childhood vaccination. Conclusion Forgetting vaccination schedule, migration of parents, work overload, rumors, and misinformation, fear of vaccine side effects, vaccine vial not opened for few children, closed health posts during visiting by mothers, absence of health extension workers from health posts were the key barriers to the full vaccination status of children. Thus, the district health office should work on barriers to full vaccination by strengthening vaccination service delivery and improving vaccination awareness through a health extension program.
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Affiliation(s)
- Ararso Hordofa Guye
- Department of Public Health, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Mengistu Tesema
- Department of Pediatrics and Child Health, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Dame Banti Shambi
- Department of Public Health, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Berhanu Senbeta Diriba
- Department of Public Health, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Esayas Mekonen Tefera
- Department of Public Health, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Yeabsira Girma
- Department of Maternal and Child Health, Center for Family Service Organization, Addis Ababa, Ethiopia
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Asmare G, Madalicho M, Sorsa A. Disparities in full immunization coverage among urban and rural children aged 12-23 months in southwest Ethiopia: A comparative cross-sectional study. Hum Vaccin Immunother 2022; 18:2101316. [PMID: 36054825 DOI: 10.1080/21645515.2022.2101316] [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] [Indexed: 12/15/2022] Open
Abstract
Vaccination coverage worldwide fell from 86% in 2019 to 83% in 2020. The purpose of this research was to determine the level of full immunization coverage among children aged 12 to 23 months in both urban and rural Southwest Ethiopia. A comparative cross-sectional study of sampled 644 children aged 12 to 23 months was conducted in the community (296 from urban areas and 348 from rural areas). Chi-square testing was used to determine whether there was a significant difference in full immunization coverage between urban and rural children, and binary logistic regression was used to identify predictors of full immunization. This study included 635 caregivers of children aged 12-23 months (292 from urban areas and 343 from rural areas), yielding a 98.4% response rate. The overall, full immunization coverage among the whole children was 66.1%. There was a significant difference in fully immunization coverage between urban 74.3% and rural 59.2% of children (χ2 = 16.126, P = .000). Residence, wealth index, ANC follow up and fear of COVID 19 infection at health institutions were predictor variables for overall full vaccination. Knowledge and place of delivery were predictor variables for full vaccination in the urban area whereas distance and male partner involvement in the rural area. Vaccination coverage was higher in urban compared to rural areas but it is still far below the WHO recommended target. Promoting male involvement, health education, and communication are crucial for alleviating poor knowledge about child immunization.
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Affiliation(s)
- Getachew Asmare
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Merkine Madalicho
- Department of Expanded Program of Immunization, Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
| | - Abebe Sorsa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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20
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Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J, Gaythorpe KAM. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health 2022; 21:82. [PMID: 35701823 PMCID: PMC9194352 DOI: 10.1186/s12939-022-01678-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION Prospero, CRD42021261927.
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Affiliation(s)
- Huda Ahmed Ali
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Anna-Maria Hartner
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | | | - Jeremy Roth
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Xiang Li
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- grid.38142.3c000000041936754XCenter for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | - Emilia Vynnycky
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - Kim Woodruff
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Neil M Ferguson
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Jaspreet Toor
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Katy AM Gaythorpe
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
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21
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Eryurt MA, Yalçin SS. Zero-dose children in Turkey: regional comparison of pooled data for the period 1990 to 2018. BMC Infect Dis 2022; 22:421. [PMID: 35501702 PMCID: PMC9063378 DOI: 10.1186/s12879-022-07416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization plays a vital role in child health and survival. Zero-dose children are coming increasingly into focus as part of the global Immunization Agenda 2030. Although the percentage of zero-dose children has decreased in Turkey over time, regional/socioeconomic inequalities persist. This study aims to analyze the trend in zero-dose children and the factors associated with this problem in Turkey in light of regional inequalities. METHODS Six data sets (1993, 1998, 2003, 2008, 2013, and 2018) were pooled from the last six Turkey Demographic and Health Surveys (TDHSs). The vaccination module for children aged 12-35 months and variables related to household characteristics, socio-economic, cultural characteristics of parents, bio-demographic/health-related factors were taken from the DHS data. Binary logistic regression analyses were carried out by taking into account the complex sample design of surveys for Turkey in general, the East region, and other regions. RESULTS Significant progress has been made in reducing the number of zero-dose children in Turkey over the last three decades, as it has dropped from 3.2 to 0.9%. The results of multivariate analyses revealed that survey year, household wealth, the mother's level of education, payment of bride price, mother's native language, place of delivery, and the number of antenatal care visits are associated with zero-dose children. Factors associated with zero-dose children also differ between the East region, and other regions. CONCLUSION Public health programs targeting uneducated parents, poor households, lack of social security, Kurdish-speaking mothers, older mothers and those without antenatal care should be implemented to promote childhood immunization.
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Affiliation(s)
- Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Siddika Songül Yalçin
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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22
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Tariku A, Berhane Y, Worku A, Biks GA, Persson LÅ, Okwaraji YB. Health postservice readiness and use of preventive and curative services for suspected childhood pneumonia in Ethiopia: a cross-sectional study. BMJ Open 2022; 12:e058055. [PMID: 35477882 PMCID: PMC9047705 DOI: 10.1136/bmjopen-2021-058055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/08/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Pneumonia is the single-leading cause of infectious disease deaths in children under-5. Despite this challenge, the utilisation of preventive and curative child health services remains low in Ethiopia. We investigated the association between health post service readiness and caregivers' awareness of pneumonia services, care-seeking and utilisation of pneumonia-relevant immunisation in four Ethiopian regions. DESIGN AND SETTING This cross-sectional study was conducted in 52 districts of four regions of Ethiopia from December 2018 to February 2019. The health posts preparedness for sick child care was assessed using the WHO Health Service Availability and Readiness Assessment tool. Multilevel analyses were employed to examine the associations between health post readiness and household-level awareness and utilisation of services. PARTICIPANTS We included 165 health posts, 274 health extension workers (community health workers) and 4729 caregivers with 5787 children 2-59 months. OUTCOME MEASURES Awareness of pneumonia treatment, care-seeking behaviour and coverage of pentavalent-3 immunisation. RESULTS Only 62.8% of health posts were ready to provide sick child care services. One-quarter of caregivers were aware of pneumonia services, and 56.8% sought an appropriate care provider for suspected pneumonia. Nearly half (49.3%) of children (12-23 months) had received pentavalent-3 immunisation. General health post readiness was not associated with caregivers' awareness of pneumonia treatment (adjusted OR, AOR 0.9, 95% CI 0.7 to 1.1) and utilisation of pentavalent-3 immunisation (AOR=1.2, 95% CI 0.8 to 1.6), but negatively associated with care-seeking for childhood illnesses (AOR=0.6, 95% CI 0.4 to 0.8). CONCLUSION We found no association between facility readiness and awareness or utilisation of child health services. There were significant deficiencies in health post preparedness for services. Caregivers had low awareness and utilisation of pneumonia-related services. The results underline the importance of enhancing facility preparedness, providing high-quality care and intensifying demand generation efforts to prevent and treat pneumonia.
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Affiliation(s)
- Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
- Department of Epidemiology and Biostatistics and Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics and Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics and Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lars Åke Persson
- London School of Hygiene and Tropical Medicine, London, UK
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yemisrach Behailu Okwaraji
- London School of Hygiene and Tropical Medicine, London, UK
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Ali A, Zar A, Wadood A. Factors associated with incomplete child immunization in Pakistan: findings from Demographic and Health Survey 2017-18. Public Health 2022; 204:43-48. [DOI: 10.1016/j.puhe.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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24
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Setiawan MS, Wijayanto AW. Determinants of immunization status of children under two years old in Sumatera, Indonesia: A multilevel analysis of the 2020 Indonesia National Socio-Economic Survey. Vaccine 2022; 40:1821-1828. [DOI: 10.1016/j.vaccine.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 11/29/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
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25
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Ndayizigiye M, Allan-Blitz LT, Dally E, Abebe S, Andom A, Tlali R, Gingras E, Mokoena M, Msuya M, Nkundanyirazo P, Mohlouoa T, Mosebo F, Motsamai S, Mabathoana J, Chetane P, Ntlamelle L, Curtain J, Whelley C, Birru E, McBain R, Andrea DM, Schwarz D, Mukherjee JS. Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000985. [PMID: 36962564 PMCID: PMC10021396 DOI: 10.1371/journal.pgph.0000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.
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Affiliation(s)
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Emily Dally
- Partners In Health, Boston, Massachusetts, United States of America
| | | | - Afom Andom
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | | | - Meba Msuya
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | | | - Joel Curtain
- Partners In Health, Boston, Massachusetts, United States of America
| | - Collin Whelley
- Homebase Center for Common Concerns, San Francisco, California, United States of America
| | - Ermyas Birru
- University of Washington, Seattle, Washington, United States of America
| | - Ryan McBain
- RAND Corporation, Boston, Massachusetts, United States of America
| | - Di Miceli Andrea
- Analysis Group Inc., Boston, Massachusetts, United States of America
| | - Dan Schwarz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Ariadne Labs, Boston, Massachusetts, United States of America
| | - Joia S Mukherjee
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
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Alghamdi S. The role of vaccines in combating antimicrobial resistance (AMR) bacteria. Saudi J Biol Sci 2021; 28:7505-7510. [PMID: 34867055 PMCID: PMC8626314 DOI: 10.1016/j.sjbs.2021.08.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 12/24/2022] Open
Abstract
Most pathogens have developed an intrinsic capacity to thrive by developing resistance to antimicrobial compounds utilized in treatment. Antimicrobial resistance arises when microbial agents such as bacteria, viruses, fungi, and parasites alter their behaviour to make current conventional medicines inefficient. Vaccination is one of the most effective strategies to fight antimicrobial resistance. Vaccines, unlike drugs, are less likely to produce resistance since they are precise to their target illnesses. Vaccines against infectious agents such as Streptococcus pneumoniae and Haemophilus influenzae have already been shown to reduce tolerance to antimicrobial medications; however, vaccines against some antimicrobial-resistant pathogens such as Vibrio cholerae, Salmonella typhi, Escherichia coli, nosocomial infections, and pulmonary and diarrheal disease viruses require more research and development. This paper describes vaccine roles in combatting antimicrobial resistance, quantifies the overall advantages of vaccination as an anti-antimicrobial resistance approach, analyzes existing antimicrobial vaccines and those currently under development, and emphasizes some of the obstacles and prospects of vaccine research and development.
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Affiliation(s)
- Saad Alghamdi
- Laboratory Medicne Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
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27
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Dheresa M, Dessie Y, Negash B, Balis B, Getachew T, Mamo Ayana G, Merga BT, Regassa LD. Child Vaccination Coverage, Trends and Predictors in Eastern Ethiopia: Implication for Sustainable Development Goals. J Multidiscip Healthc 2021; 14:2657-2667. [PMID: 34584421 PMCID: PMC8464587 DOI: 10.2147/jmdh.s325705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Every year, immunization prevents about 4–5 million child fatalities from vaccine preventable morbidities. Conversely, in Ethiopia, achieving full coverage of vaccination has continued to be challenging. Socio-demographic, caregivers and child related factors determine vaccination coverage. Therefore, this study aimed to find out recent coverage, trends in coverage, and its predictors in eastern Ethiopia. Methods A population-based longitudinal study design was conducted among 14,246 children aged 12–24 months from 2017 to 2021 in Kersa Health and Demographic Surveillance System site (KHDSS). The data were collected from caregivers of the child by face to face interview. Multinomial logistic regressions were used to identify predictors of vaccination. The association between vaccination coverage and its predictors was presented by adjusted odds ratio with 95% confidence interval. A p-value of <0.05 was used to establish statistical significance. Results From the 14,198 included children, only 39% of children were fully vaccinated, with highest proportion in 2020 (45%) and lowest proportion in 2019 (32%). In comparison to fully vaccinated, being partially vaccinated was positively associated with older maternal age, rural residence, unemployment, rich wealth index, no antenatal care, facility delivery, and birth order whereas negatively associated with semi-urban residence. In compared to fully vaccinated, being not vaccinated was positively associated with older maternal age, rural residence, maternal education, unemployment, and no antenatal care whereas negatively associated with semi-urban residence, poor wealth index, multipara, grand multipara, and facility delivery. Conclusion Less than two-fifths of children aged 12 to 24 months were fully vaccinated. Socio-demographic factors and maternity care utilization were found to be predictors of vaccination coverage. Therefore, strategies that emphasize women’s empowerment in terms of education, economy, and employment status, and enhancing maternal healthcare utilization may improve vaccination coverage.
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Affiliation(s)
- Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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28
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Gebremeskel TG, Hagos MG, Kassahun SS, Gebrezgiher BH. Magnitude and associated factors of delayed vaccination among children aged 11-23 months in, Tigray, Ethiopia, 2018. Hum Vaccin Immunother 2021; 17:3831-3837. [PMID: 34292123 DOI: 10.1080/21645515.2021.1934356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Delay in receiving the vaccination is a major public health problem that has been associated with vaccine-preventable disease epidemics. In Ethiopia, many children have not received the benefits of age-appropriate vaccination; thus more than 90% of child deaths are largely due to preventable communicable diseases. OBJECTIVE The present study assessed the magnitude and associated factors of delayed vaccination among 12-23 months old children in Tigray, Ethiopia. METHODS A community-based cross-sectional study was carried out among 393, 12-23 months old children from July 1 to 30, 2018. Data were collected using a structured interviewer-administered questionnaire. The questionnaire includes socio-demographic, economic factors, Maternal/caregiver factors, Child's factors, and Service-related factors. We applied bivariable and multivariable logistic regression to determine predictors for delayed Vaccination. The odds ratio with 95% CI was computed to evaluate the strength of the association. RESULTS 393 participants were involved in the study. The magnitude of delayed vaccination was 29.5% (95% CI 26.7-45). Mothers who attend tertiary (University/college) education (AOR 0.169, 95% CI 0.032-0.882), and secondary education (AOR 0.269, 95% CI 0.114-0.636) had the protective effect of delayed vaccination. But the sickness of a child (AOR = 11.8, 95% CI 6.16-22.65) was a risk for delayed vaccination. CONCLUSIONS The magnitude of delayed vaccination was high, particularly among participants with Mother's education, and Mother's consideration in the child's wellness to take the vaccine. This implies that it is important to give emphasis, especially for the mothers who have an uneducated and sick child to increase awareness about the advantage of vaccination, which will improve on-time vaccination.
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Affiliation(s)
- Teferi Gebru Gebremeskel
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | | | - Selam Shushay Kassahun
- Department of Midwifery, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
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