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Howard B, Gorman G. Worth a Shot: Experience and Lessons From an Unsuccessful Pediatric Immunization Quality Improvement Effort in a Large Health System During the COVID-19 Pandemic. Mil Med 2024; 189:e2284-e2289. [PMID: 38935398 DOI: 10.1093/milmed/usae323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project. MATERIALS AND METHODS Measles, mumps, and rubella immunization rates served as proxy outcome measures for routine immunization rates tracked by the Center for Disease Control multi-immunization combination measures. The tracked measure was the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2, respectively. Various countermeasures were implemented throughout the study period, and standard quality improvement analyses informed the effect of countermeasures. RESULTS By January 2023, the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2 was 85% and 91%, respectively, with no positive shift in immunization rates despite various countermeasures introduced during the study period. For reference, the MMR immunization rates of commercial health maintenance organization and commercial preferred provider organization for 24-month-old populations were 92% and 90.3%, respectively. On chart review, the most common cause for under-immunization (55%) was vaccine abandonment. MMR #1 rates rose to 92% in 24-month olds. CONCLUSIONS Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers.
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Affiliation(s)
- Bailey Howard
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Gregory Gorman
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Vereen RJ, Aden JK, Drumm CM. Newborn medication adherence and childhood under-immunization in military beneficiaries. Vaccine 2023; 41:2887-2892. [PMID: 37005102 DOI: 10.1016/j.vaccine.2023.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/03/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The American Academy of Pediatrics recommends birth doses of vitamin K, erythromycin ointment, and the hepatitis B vaccine, but the relationship between birth medication administration and childhood immunization compliance is understudied. The objective of this study is to evaluate rates of newborn medication administration, and risk factors for refusal in military beneficiaries and determine the relationship between medication refusal and under-immunization at 15 months. METHODS A retrospective chart review was completed for all term and late preterm infants born at Brooke Army Medical Center, San Antonio, TX, from January 1, 2016, to December 31, 2019. The electronic medical record was queried for birth medication administration, maternal age, active-duty status, rank, and birth order. Childhood immunization records were extracted for all patients who continued care at our facility. A patient was considered completely immunized if they had received at least 22 vaccines by 15 months: three doses of the hepatitis B vaccine [PediarixTM], two doses of the rotavirus vaccine [RotarixTM], four doses of the DTAP vaccine [PediarixTM and Acel-ImmuneTM], three doses of Haemophilus influenza B vaccine [PedvaxhibTM], four doses of pneumococcal [Prevnar 13TM], three doses of IPV [PediarixTM], one dose of measles, mumps, and rubella [MMRTM], one dose of varicella [VarivaxTM] and one dose of hepatitis A vaccine [HarvixTM]. RESULTS Seven thousand one hundred and forty infants were included; 99.3% received vitamin K, 98.8% received erythromycin ointment, and 93.8% received the hepatitis B vaccine. Refusal of the erythromycin ointment and hepatitis B vaccine was associated with older maternal age and higher birth order. Childhood immunization records were available for 607 infants; 7.2% (n = 44) were under-immunized by 15 months, with no infants being non-immunized. Refusal of the hepatitis B vaccine (RR: 2.9 (CI 1.16-7.31)) only at birth was associated with a higher risk of being under-immunized. CONCLUSIONS Refusal of the hepatitis B vaccine in the nursery is associated with a risk of being under-immunized in childhood. Obstetric and pediatric providers should be aware of this association for appropriate family counseling.
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Shrivastwa N, Wagner AL, Boulton ML. Analysis of State-Specific Differences in Childhood Vaccination Coverage in Rural India. Vaccines (Basel) 2019; 7:E24. [PMID: 30813481 PMCID: PMC6466023 DOI: 10.3390/vaccines7010024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/20/2022] Open
Abstract
There is little research on state-level differences in child health outcomes in India. The aim of this study was to identify state-level characteristics that relate to childhood immunizations. Most state-level characteristics came from the 2011 Indian Census. Individual-level data and other state-level characteristics were obtained from the 2007⁻2008 District Level Household and Facility Survey. Predictors of full vaccination were assessed with logistic regression models. Among 86,882 children 12⁻36 months, 53.2% were fully vaccinated. Children living in bigger households (≥7 members), born in non-institutional settings, and female had lower odds of complete vaccination. Individuals living in states in the mid-range of poverty had lower odds of full vaccination compared to those in lower or higher poverty states (3rd vs. 1st quintile: odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.30, 0.42). Greater average population per primary health center was associated with decreased odds of full vaccination (5th vs. 1st quintile: OR: 0.37, 95% CI: 0.30, 0.47). Vaccination coverage in India can be explained by a complex interplay of individual- and state-level factors. Solutions to increasing vaccination must be multisectoral and acknowledge the cultural and socio-economic diversity that influences an individual child's vaccination coverage along with within-state disparities.
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Affiliation(s)
- Nijika Shrivastwa
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Matthew L Boulton
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA.
- Department of Internal Medicine, Division of Infectious Disease, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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Neighbourhood influence on the fourth dose of diphtheria-tetanus-pertussis vaccination. Public Health 2019; 167:41-49. [PMID: 30639802 DOI: 10.1016/j.puhe.2018.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/22/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Using 542,159 vaccination records from children born between April 1, 2007, and March 31, 2012, in the Michigan Care Improvement Registry and data from the American Community Survey, we determine if neighbourhood-level characteristics at the Census tract level and block level are associated with low uptake of the fourth dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP4). STUDY DESIGN This study was a cross-sectional study. METHODS We used exploratory factor analysis to determine important socio-economic factors at the Census block level and tract level. We then used generalised estimating equations to test the relationship between block- and tract-level socio-economic factors and DTaP4 uptake. RESULTS DTaP4 coverage was 88.6% (95% confidence interval [CI]: 88.4%-88.7%) in Michigan. At the Census tract level, two factors surfaced as important for DTaP4 vaccination: 'affluence' (Cronbach's alpha = 0.88) and 'socio-economic disadvantage' (Cronbach's alpha = 0.89). At the Census block level, one factor was important: 'affluence' (Cronbach's alpha = 0.90). Affluence may relate to knowledge about medical exemptions and antivaccination sentiment, while socio-economic disadvantage may indicate limited access to healthcare resources. Children in high-affluence tracts had 1.08% lower vaccination coverage (95% CI: -1.62% to -0.55%) than children in low affluence tracts. Children in low socio-economic disadvantage tracts had 2.92% higher coverage than children in high socio-economic disadvantage tracts (95% CI: 2.58%-3.26%). CONCLUSIONS This study articulates the need to further understand the contribution of neighbourhood-level characteristics, from both affluent and socioeconomically disadvantaged areas to low vaccination rates. Developing a better understanding of these social environmental factors will help determine useful community-level interventions to improve vaccination rates and reduce disease burden.
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Chien AT, Newhouse JP, Iezzoni LI, Petty CR, Normand SLT, Schuster MA. Socioeconomic Background and Commercial Health Plan Spending. Pediatrics 2017; 140:peds.2017-1640. [PMID: 28974535 PMCID: PMC5654394 DOI: 10.1542/peds.2017-1640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Risk-adjustment algorithms typically incorporate demographic and clinical variables to equalize compensation to insurers for enrollees who vary in expected cost, but including information about enrollees' socioeconomic background is controversial. METHODS We studied 1 182 847 continuously insured 0 to 19-year-olds using 2008-2012 Blue Cross Blue Shield of Massachusetts and American Community Survey data. We characterized enrollees' socioeconomic background using the validated area-based socioeconomic measure and calculated annual plan payments using paid claims. We evaluated the relationship between annual plan payments and geocoded socioeconomic background using generalized estimating equations (γ distribution and log link). We expressed outcomes as the percentage difference in spending and utilization between enrollees with high and low socioeconomic backgrounds. RESULTS Geocoded socioeconomic background had a significant, positive association with annual plan payments after applying standard adjusters. Every 1 SD increase in socioeconomic background was associated with a 7.8% (95% confidence interval, 7.2% to 8.3%; P < .001) increase in spending. High socioeconomic background enrollees used higher-priced outpatient and pharmacy services more frequently than their counterparts from low socioeconomic backgrounds (eg, 25% more outpatient encounters annually; 8% higher price per encounter; P < .001), which outweighed greater emergency department spending among low socioeconomic background enrollees. CONCLUSIONS Higher socioeconomic background is associated with greater levels of pediatric health care spending in commercially insured children. Including socioeconomic information in risk-adjustment algorithms may address concerns about adverse selection from an economic perspective, but it would direct funds away from those caring for children and adolescents from lower socioeconomic backgrounds who are at greater risk of poor health.
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Affiliation(s)
- Alyna T. Chien
- Division of General Pediatrics, Department of Medicine and,Departments of Pediatrics
| | - Joseph P. Newhouse
- Health Care Policy, and,Departments of Health Policy and Management and,John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts;,National Bureau of Economic Research, Cambridge, Massachusetts; and
| | - Lisa I. Iezzoni
- Medicine, Harvard Medical School,,Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Carter R. Petty
- Clinical Research Center, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine and,Departments of Pediatrics
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Wu JN, Li DJ, Zhou Y, Du MR, Piao HL. Relationship between receipt of substitutable for-fee vaccines and completion of the expanded programme on immunisation: a cross-sectional study in Fujian, China. BMJ Open 2017; 7:e015666. [PMID: 28729316 PMCID: PMC5642657 DOI: 10.1136/bmjopen-2016-015666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between receipt of the substitutable-for-fee vaccines (SFV) and completion of the expanded programme on immunisation (EPI). DESIGN AND SETTINGS A cross-sectional study was conducted in Fujian province, China. PARTICIPANTS Children who were born from 1 September 2009 to 31 August 2011, and who had been residing in the township for at least 3 months, were randomly recruited from 34 townships. MAIN OUTCOMES MEASURES Outcomes were completion rate of the EPI and coverage rate of the SFV. RESULTS The study included 1428 children, of whom 1350 (94.5%) finished the EPI and 282 (19.7%) received at least one dose of the SFV. Administration of the SFV was associated with an increased likelihood of completing the EPI (OR=3.2, 95% CI 1.3 to 7.6 in the total sample and OR=4.0, 95% CI 1.7 to 9.6 in the subsample of children in regions with the SFV accessibility). The impact of the SFV administration on completion of the EPI was larger among children whose parents have junior school education or less (97.8% and 97.9% vs 92.5% and 91.9%, both p<0.001) and among those with a timely hepatitis B vaccine first dose (98.5% vs 94.0%, p<0.001). CONCLUSIONS Receipt of SFV is associated with increased likelihood of completion of the EPI in Fujian, China.
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Affiliation(s)
- Jiang-Nan Wu
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Da-Jin Li
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yong Zhou
- Department of Expanded Programme on Immunization, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Mei-Rong Du
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hai-Lan Piao
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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On-time Measles and Pneumococcal Vaccination of Shanghai Children: The Impact of Individual-level and Neighborhood-level Factors. Pediatr Infect Dis J 2016; 35:e311-7. [PMID: 27294307 DOI: 10.1097/inf.0000000000001267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measles-containing vaccines (MCVs) and pneumococcal conjugate vaccines (PCVs) can prevent a large proportion of infant deaths and are recommended by international organizations for inclusion in pediatric immunization schedules. In China, MCV but not PCV is publically funded and access to vaccination may be limited among nonlocals, who are rural migrants to cities. In this study, we estimate the proportion of Shanghai children with on-time MCV and PCV administration, compare vaccination in nonlocals versus locals and assess the impact of township-level characteristics on vaccination outcomes. METHODS Data from children in the Shanghai Immunization Program Information System were linked to township-level data from the 2010 China Census. We used generalized estimating equations with logistic regression models to assess the impact of residency and township-level predictors on on-time MCV and PCV administration. RESULTS Nonlocals had lower vaccination levels than locals. Compared with locals, nonlocals had 0.50 times the odds of MCV dose 1 by 9 months [95% confidence interval (CI): 0.47, 0.53], 0.42 times the odds of MCV dose 2 by 24 months (95% CI: 0.39, 0.45), 0.37 times the odds of PCV by 9 months of age (95% CI: 0.33, 0.42) and 0.41 times the odds of PCV by 24 months of age (95% CI: 0.37, 0.45). Overall, children had less on-time MCV and PCV administration in nonlocal-majority than local-majority townships. CONCLUSIONS Late vaccination negatively impacts disease control efforts in Shanghai. Nonlocals, particularly those living in nonlocal-majority townships, should especially be targeted for vaccination in order to improve disease control efforts in Shanghai.
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Thompson KM, Logan GE. Characterization of Heterogeneity in Childhood Immunization Coverage in Central Florida Using Immunization Registry Data. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1418-1426. [PMID: 26033542 DOI: 10.1111/risa.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/17/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
Despite high vaccine coverage in the United States in general, and in the State of Florida specifically, some children miss scheduled vaccines due to health system failures or vaccine refusal by their parents. Recent experiences with outbreaks in the United States suggest that geographic clustering of un(der)vaccinated populations represent a threat to the elimination status of some vaccine-preventable diseases. Immunization registries continue to expand and play an important role in efforts to track vaccine coverage and use. Using nearly 700,000 de-identified immunization records from the Florida Department of Health immunization information system (Florida SHOTS™) for children born during 2003-2014, we explored heterogeneity and potential clustering of un(der)vaccinated children in six counties in central Florida-Brevard, Lake, Orange, Oseola, Polk, and Seminole-that represent a high-risk area for importation due to family tourist attractions in the area. By zip code, we mapped the population density, the percent of children with religious exemptions, the percent of children on track or overdue for each vaccine series without and with exemptions, and the numbers of children with no recorded dose of each vaccine. Overall, we found some heterogeneity in coverage among the counties and zip codes, but relatively consistent and high coverage. We found that some children with an exemption in the system received the vaccines we analyzed, but exemption represents a clear risk factor for un(der)immunization. We identified many challenges associated with using immunization registry data for spatial analysis and potential opportunities to improve registries to better support future analyses.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Grace E Logan
- University of Central Florida, College of Medicine, Orlando, FL, USA
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Jones MN, Brown CM, Widener MJ, Sucharew HJ, Beck AF. Area-Level Socioeconomic Factors Are Associated With Noncompletion of Pediatric Preventive Services. J Prim Care Community Health 2016; 7:143-8. [PMID: 26883436 DOI: 10.1177/2150131916632361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined 4872 infants born consecutively, 2011-2012, and seen at 3 primary care centers to determine whether area-based socioeconomic measures were associated with noncompletion of common preventive services within the first 15 months. Addresses were geocoded and linked to census tract poverty, adult educational attainment, and household vehicle ownership rates. The quartile of patients in the highest poverty (adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.01-1.54) and lowest vehicle ownership tracts (aOR 1.32; 95% CI 1.07-1.63) had significantly increased odds of service noncompletion. There were significant spatial clusters of low completion in Cincinnati's urban core. These findings have implications for preventive service delivery.
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Affiliation(s)
- Margaret N Jones
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Courtney M Brown
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Heidi J Sucharew
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Crawford NW, Clothier H, Hodgson K, Selvaraj G, Easton ML, Buttery JP. Active surveillance for adverse events following immunization. Expert Rev Vaccines 2013; 13:265-76. [DOI: 10.1586/14760584.2014.866895] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Kattan JA, Kudish KS, Cadwell BL, Soto K, Hadler JL. Effect of vaccination coordinators on socioeconomic disparities in immunization among the 2006 Connecticut birth cohort. Am J Public Health 2013; 104:e74-81. [PMID: 24228642 DOI: 10.2105/ajph.2013.301418] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan-funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months. METHODS We examined predictors of underimmunization among the 2006 birth cohort (n = 34,568) in the state's Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses. RESULTS Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization. CONCLUSIONS SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities.
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Affiliation(s)
- Jessica A Kattan
- At the time of the study, Jessica A. Kattan was an Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention (CDC), assigned to the Infectious Diseases Section, Connecticut Department of Public Health, Hartford. Kathy S. Kudish is with the Immunization Program and Kristen Soto is with the Infectious Diseases Section, Connecticut Department of Public Health. Betsy L. Cadwell is with the Office of Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, GA. James L. Hadler is a consultant for the Connecticut Emerging Infections Program, New Haven
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Monguno AK. Socio Cultural and Geographical Determinants of Child Immunisation in Borno State, Nigeria. J Public Health Afr 2013; 4:e10. [PMID: 28299099 PMCID: PMC5345420 DOI: 10.4081/jphia.2013.e10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 02/18/2013] [Accepted: 04/06/2013] [Indexed: 11/30/2022] Open
Abstract
Immunisation has been an important strategy for disease prevention globally. Despite proven successes in other settings, child immunisation has continued to be problematic in developing countries including Nigeria. In addressing the problems, policy in Nigeria is largely directed at overcoming socio cultural issues surrounding parents’ rejection of vaccines. However, determinants of immunisation have geographical implications as well. A cross sectional survey was used to select 484 mothers/caregivers through a multi stage cluster sampling technique from the three senatorial districts of Borno State, Nigeria. Mothers or caregivers of children 12–23 months were interviewed using a structured questionnaire adapted from the Nigeria Demographic and Health Survey (2008). Socio cultural factors measured include mother’s education, religion, husband’s permission and sex of child while spatial variables include location i.e. whether rural or urban, and distance measured in terms of physical distance, cost and perception of physical distance. Descriptive statistics, univariate and multivariate logistic regressions were used to analyse the results. Data indicate that only 10.5% of children were fully immunised. Though immunisation uptake differed between the senatorial districts, this was not significant (P=0.1). In the bivariate analysis, mothers living in urban areas, <1 km to immunisation centre, their perception of travel distance and travel cost were the spatial predictors of immunisation while literacy and husband’s permission were the socio-cultural factors of significance. However, in the multivariate regression only two geographical factors i.e. living in an urban area [odds ratio (OR) 3.42, confidence interval (CI) 1.40–8.33] and mothers’ perception of distance (OR 4.52, CI 2.14–9.55) were protective against under immunisation while mother’s education was the only socio cultural variable of significance (OR 0.10, CI 0.03–0.41). It was concluded that while it is important to address socio cultural issues, policies directed at overcoming the friction of distance especially mobile clinics in rural areas are required to significantly improve immunisation uptake in the state.
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Gold R, Naleway A, Riedlinger K. Factors predicting completion of the human papillomavirus vaccine series. J Adolesc Health 2013; 52:427-32. [PMID: 23298984 DOI: 10.1016/j.jadohealth.2012.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/12/2012] [Accepted: 09/14/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE This study identified factors associated with completion of the three dose quadrivalent human papillomavirus vaccine (HPV4) series by female adolescents. METHODS Between February and September 2008, we prospectively surveyed 11- to 26-year-old female members of an integrated managed care organization shortly after their first HPV4 dose to identify factors that predicted series completion. We used regression analyses to assess whether self-reported experiences at the index visit, knowledge/attitudes about HPV and HPV4, and medical record data on adverse events, demographic characteristics, care-utilization frequency, and visit characteristics, were associated with vaccine series completion within one year of the first HPV4 dose. RESULTS Of 899 survey respondents (27% of 3347 survey recipients), 786 (87%) maintained continuous enrollment in the health plan in the year following the first HPV4 dose. Fifty percent (n = 393) completed the vaccine series within that year. In multivariate analyses of survey respondents, only respondents' ability to correctly identify the number of shots required for series completion was significantly associated with series completion. Reported bruising was associated with decreased likelihood of completion, and the clinician stating that future shots were required was associated with increased likelihood, but both were of borderline significance. Females ages 16-20 had the lowest series completion. CONCLUSIONS Improving HPV4 completion will require targeted efforts. Our results suggest that providers may help by stressing the need for additional doses of vaccine, and confirming that patients understand this information. Special attention should be given to females ages 16-20. Future randomized trials should assess the effect on vaccine completion of these simple, low-cost interventions.
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Affiliation(s)
- Rachel Gold
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR 97227, USA.
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14
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Birth order and private voluntary immunization—A study of 110,902 children. Vaccine 2012; 30:442-7. [DOI: 10.1016/j.vaccine.2011.10.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 10/06/2011] [Accepted: 10/24/2011] [Indexed: 11/18/2022]
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Burton DC, Flannery B, Bennett NM, Farley MM, Gershman K, Harrison LH, Lynfield R, Petit S, Reingold AL, Schaffner W, Thomas A, Plikaytis BD, Rose CE, Whitney CG, Schuchat A. Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults. Am J Public Health 2010; 100:1904-11. [PMID: 20724687 PMCID: PMC2936986 DOI: 10.2105/ajph.2009.181313] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults. METHODS We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs). RESULTS During 2003 to 2004, the average annual incidence of bacteremic pneumonia was 24.2 episodes per 100 000 Black adults versus 10.1 per 100 000 White adults (RR = 2.40; 95% CI = 2.24, 2.57). Incidence among Black residents of census tracts with 20% or more of persons in poverty (most impoverished) was 4.4 times the incidence among White residents of census tracts with less than 5% of persons in poverty (least impoverished). Racial disparities in incidence were reduced but remained significant in models that controlled for age, census tract poverty level, and state. CONCLUSIONS Adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts.
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Affiliation(s)
- Deron C Burton
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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16
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Patronek GJ. Mapping and measuring disparities in welfare for cats across neighborhoods in a large US city. Am J Vet Res 2010; 71:161-8. [PMID: 20113223 DOI: 10.2460/ajvr.71.2.161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether disparities in health and welfare among cats are present within neighborhoods and across census tracts in a large US city, and to compare results with area-level human data. SAMPLE POPULATION 17,587 cat intake records from 2 animal sheltering organizations serving Boston, and summary data from city animal control authorities for a 5-year period (2004 through 2008). PROCEDURES Geocoded addresses (n = 15,285) were spatially joined to neighborhood and census tract polygons. Cat intakes and deaths were calculated per capita and compared with human demographic and death data. Poisson mixed-effects models were used to smooth mortality rates and calculate relative risks. RESULTS Data from geocoded records indicated that annual rates of cat intakes and deaths ranged widely (0.85 to 10.3 cats/1,000 persons and 0.27 to 3.9 cats/1,000 persons, respectively) within 16 neighborhoods of Boston. The disparity across 156 census tracts that comprised these neighborhoods was even greater (0.10 to 22.1 cats/1,000 persons and 0.15 to 6.47 cats/1,000 persons for intakes and deaths, respectively). Cat deaths were significantly correlated with human premature deaths at the neighborhood level (R2 = 0.77). Overall, annual per capita city-wide shelter-associated mortality rate for cats (estimated at approx 2.6 cats/1,000 persons) was similar to rates in other progressive communities. CONCLUSIONS AND CLINICAL RELEVANCE By use of geospatial techniques, 14- to 40-fold gradients in cat deaths were detected across Boston neighborhoods and census tracts. Cat deaths were associated with human premature deaths and socioeconomic indicators reflecting deprivation. Targeted interventions may be effective in resolving these disparities.
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Affiliation(s)
- Gary J Patronek
- Animal Rescue League of Boston, 10 Chandler St, Boston, MA 02116, USA.
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Choi BK, Manning ML. The immunization status of home-schooled children in America. J Pediatr Health Care 2010; 24:42-7. [PMID: 20122477 DOI: 10.1016/j.pedhc.2009.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/27/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
Abstract
The immunization of children against a vast number of life-threatening infectious agents has been hailed as one of the greatest public health interventions of the twentieth century. In America, the morbidity and mortality associated with many common childhood infectious diseases has all but vanished. State-based school entry vaccination laws play a significant role in achieving high immunization rates among children and adolescents. Alarmingly, there is no consistent regulation in place to monitor the immunization status of the ever-growing home-schooled population. It is widely unknown whether the nearly 2 million home-schooled children are adequately immunized. As the home schooling movement continues to gain ground in the United States, pediatric nurse practitioners in the primary care setting will play an important role in protecting the health of these children, as well as the public's health.
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Affiliation(s)
- Bonnie K Choi
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Neubrand TPL, Breitkopf CR, Rupp R, Breitkopf D, Rosenthal SL. Factors associated with completion of the human papillomavirus vaccine series. Clin Pediatr (Phila) 2009; 48:966-9. [PMID: 19483128 DOI: 10.1177/0009922809337534] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tara P L Neubrand
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
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