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Kurkuri SN, Subramanian M. Immunization Status of Children 12-36 Months Age of Migrant Workers and Factors Associated with it in Urban Areas of Bangalore East. Indian J Community Med 2024; 49:104-109. [PMID: 38425974 PMCID: PMC10900454 DOI: 10.4103/ijcm.ijcm_42_23] [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: 01/23/2023] [Accepted: 10/31/2023] [Indexed: 03/02/2024] Open
Abstract
Background Immunization is a cost-effective weapon against vaccine preventable diseases. Children of migrant workers suffer from lack of immunization because of frequent shift of places, poor knowledge, and low socioeconomic status. To assess the immunization status of children 12-36 months of age of migrant workers and factors associated it. To identify the reasons for non-immunization or partial immunization among these children. Material and Methods A cross-sectional study was conducted among 500 migrant workers' children aged 12-36 months residing in Urban Bangalore east from February 2019 to August 2020. A cluster sampling method was incorporated. The data were collected using pre-tested semi-structured questionnaire. Data were analyzed using Epi-info™ Version 7.2.1 and SPSS version-21. Data were summarized in percentages, mean, standard deviation, and logistic regression. Results The mean age of the children was 25.2340 ± 8.42 months. Out of 500 children, 88.60% were fully immunized, 11.40% were partially immunized, and no child was unimmunized. Significant predictors of immunization status of children were education of father and immunization card. Common reasons for dropout were inconvenient time (80.70%), unaware of need (77.19%), and busy schedule of parents (75.44%). The dropout rate of BCG to MR-1, Penta-1 to Penta-3, and Penta1to MR-1 was 6.49%, 0.85%, and 2.12%, respectively. Conclusions Immunization coverage in the present study was 88.60%. Inconvenient time was the main reason behind partial immunization.
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Affiliation(s)
- Shweta Neminath Kurkuri
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Mangala Subramanian
- Department of Community Medicine, Vydehi Institute of Medical Sciences and Research Centre Bangalore, Karnataka, India
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2
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Sarder MA, Lee KY, Keramat SA, Hashmi R, Ahammed B. A multilevel analysis of individual and community-level factors associated with childhood immunisation in Bangladesh: Evidence from a pooled cross-sectional survey. Vaccine X 2023; 14:100285. [PMID: 37063304 PMCID: PMC10090204 DOI: 10.1016/j.jvacx.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Previous studies on childhood vaccinations in Bangladesh relied on single-level analyses and ignored the clustering and hierarchical structure of data collected from people living in different geographical units. This study, therefore, aimed to investigate the association between individual and community-level factors of full childhood immunisation with an improved analytical approach. Methods Participants were 13,752 children aged 12-59 months. Data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, and 2017-18. A two-level multilevel logistic regression method was used to analyse the data. Results Approximately 87% of the children were fully immunised. In the fully adjusted model, at the individual level, mothers who had primary and above education (Adjusted odds ratio [AOR] = 1.78; 95% Confidence Interval [CI]: 1.57, 2.01), mass media exposure (AOR = 1.14; 95% CI: 1.00, 1.30), having vaccination cards (AOR = 3.65; 95% CI: 3.23, 4.14), and having at least 4 antenatal care (ANC) visits (AOR = 1.24; 95% CI: 1.06, 1.44) were strongly associated with full childhood immunisation. At community-level, rural residency (AOR = 1.25; 95% CI: 1.08, 1.44), community women's education (AOR = 1.24; 95% CI: 1.07, 1.43), and community ANC utilisation (AOR = 1.38; 95% CI: 1.19, 1.61) were significantly associated with full childhood immunisation. Conclusion Along with individual-level factors, community-level factors have a significant effect on childhood immunisation. Policymakers should target improving community-level characteristics, such as community poverty, education levels, and the number of community-level ANC visits, to increase the national level of childhood immunisation. Public health intervention programs aiming at increasing awareness of childhood immunisation should include elements at both individual and community levels.
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Affiliation(s)
- Md. Alamgir Sarder
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna 9208, Bangladesh
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Corresponding author at: Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh
- School of Business, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Rubayyat Hashmi
- School of Business, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Benojir Ahammed
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna 9208, Bangladesh
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Nwachukwu BC, Alatishe-Muhammad BW, Ibizugbe S, Alake DI, Bolarinwa OA. Low Immunization Completion among Under-Five Children: Are Underserved Nomadic and Farming Communities in a North Central State of Nigeria doing Better? Niger J Clin Pract 2023; 26:709-719. [PMID: 37470643 DOI: 10.4103/njcp.njcp_652_22] [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] [Indexed: 07/21/2023]
Abstract
Background The recent drop in immunization coverage in Nigeria has left more than 3.25 million children unimmunized and has risen concern over immunization completion among the under-five children. More so among underserved communities of pastoralist nomads and farmers that were isolated from immunization services because of operational and sociocultural factors. Materials and Methods A cross-sectional analytical (comparative analysis) study was carried out among 550 eligible caregivers of under-five children in nomadic and farming communities in Niger State, Nigeria. The mothers and caregivers paired with under-five children were recruited into the study using a multistage sampling technique. Data was collected using a validated interviewer-administered questionnaire. Data was analyzed with the statistical software package (version 23). Results More than half of the under-five children studied were males in both the nomadic (57.5%) and farming (52.0%) communities. The aggregated score of immunization knowledge was significantly (P < 0.001) better (Good 44.4%; Fair 49.8%) among farmers compared to their nomads' counterpart (Good 21.1%; Fair 43.6%). Conversely, almost all the respondents (98.2%) in nomadic community significantly had a good overall perception of childhood immunization compared to 77.1% in the farming community. More farmers' children (99.6%) had received immunization compared to 92.4% of the nomads' children. About 87.3% of farmers compared to 76% of the nomads' (76.0%) children reported immunization completion. About 50.5% of the farmers' and 41.4% of the nomads' children have achieved immunization on card inspection. Conclusion This study revealed that average immunization completion reported among under-five children in both farming and nomadic communities is higher than the national average. It is recommended that more strategies are needed to intensify immunization campaigns targeted at populations in Nigeria.
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Affiliation(s)
- B C Nwachukwu
- Assistant Public Health Officer, World Health Organization, Kebbi State Field Office, Ilorin, Nigeria
| | - B W Alatishe-Muhammad
- FMCPH, Directorate of Planning, Research and Statistics Kwara State Ministry of Health, Ilorin, Nigeria
| | - S Ibizugbe
- Data Manger/Analyst, Clinton Health Access Initiative, Abuja, Nigeria
| | - D I Alake
- Strategic Information Optimiser, Center for Clinical Care and Clinical Research, Ilorin, Nigeria
| | - O A Bolarinwa
- FWACP, Ph.D. Department of Epidemiology and Community Health University of Ilorin/UITH, Ilorin, Nigeria
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Xu J, Tang W, Qiu W, Yao Y, Yao N, Zhong J, Zhu X, Wang Q. Effects of mobile APP for immunization on vaccination compliance of migrant children in southwest China: A community trial study. Hum Vaccin Immunother 2022; 18:2135853. [PMID: 36469711 PMCID: PMC9762749 DOI: 10.1080/21645515.2022.2135853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
With the advancement of the "internet plus" action plan in China, the electronic information system and the mobile phone applications (APPs) are widely used in the management of expanding national program of immunization (EPI). To estimate the use of childhood vaccination APP to improve migrants' vaccination knowledge, attitude and practice (KAP), a community trial toward migrant children was carried out in Chongqing, China. Migrant children were divided into two groups, one group was provided with health education and vaccination reminders in manual way and the other group was provided with online health education and vaccination reminders by mobile APP. After seven-month interventions, a total of 196 guardians of migrant children aged 2 months to 2 y participated in the questionnaire survey. There were significant differences between two groups in the awareness of vaccine policy, disposal of adverse reaction and attitude toward vaccination. Few significant differences in vaccination coverage of children ≤12 months between two groups, except 2ndbOPV and 2ndMenA. The timely vaccination rate of children >6 months in the APP group ranged from 37.5% to 68.2%, that was from 0% to 30.5% in the non-APP group (P < .05). Most migrant children above 6 months had vaccination within a month after due day in the APP group, while that was at least 3 months after due day in the non-APP group. The vaccination APP greatly improved migrants' KAP on vaccination. Continuous and systematic intervention by vaccination APP would play a more critical role in the vaccination behaviors of older migrant children.
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Affiliation(s)
- Jiawei Xu
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Wenge Tang
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Wei Qiu
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Yuan Yao
- EPI Department, Jiulongpo District Center for Disease Control and Prevention, Chongqing, China
| | - Ning Yao
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Jianghong Zhong
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Xiang Zhu
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Qing Wang
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China,CONTACT Qing Wang EPI Department, Chongqing Municipal Center for Disease Control and Prevention, Chongqing
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Xiong Y, Xue Y, Jiao G, Xie J, Cheng J. Comparative Analysis of the Status and Influencing Factors of Immunization Among Children Between Registered and Floating Population. Front Public Health 2022; 10:872342. [PMID: 35757635 PMCID: PMC9218952 DOI: 10.3389/fpubh.2022.872342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background A vaccine is an effective tool to reduce the gap between the rich and the poor and improve health equity, through which a number of serious childhood diseases can be successfully prevented or eradicated. This study is aimed to compare the current situation of vaccination and related factors among children in China's registered residents and floating population, to provide a reference for achieving the 100% vaccination rate in China. Methods The data used for this study are from the 2017 National Migrants Dynamic Monitoring Special Survey data. A self-designed questionnaire was used to collect information, such as socio-demographics, vaccination status of children, and so on, on the registered population and floating population. Descriptive statistics and a chi-square independence test were used to describe the information and to compare the vaccination status of children under different sociodemographic characteristics. Binary logistic regression was employed to analyze influencing factors associated with vaccination of children. Results The findings showed that 94.39% of children in registered residence were completely vaccinated, which was significantly higher than that of the floating children (91.68%, p < 0.001). The region, parents' education level, and marital status were found to be significant risk factors for complete vaccination of children regardless of the registered or floating population. In addition, ethnicity and length of time to the nearest medical institution were unique risk factors for complete vaccination of children in registered residence. And, health record was an independent influencing factor for vaccination of children of floating population. Conclusion Compared with registered population, floating population was at a disadvantage in using basic public health services, especially in children's vaccination. To achieve 100% vaccination for children, particular interventions should be taken for different populations.
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Affiliation(s)
- Yan Xiong
- School of Public Health, Shanxi Medical University, Taiyuan, China.,School of Management, Shanxi Medical University, Taiyuan, China
| | - Yaqing Xue
- School of Public Health, Southern Medical University, Guangzhou, China.,School of Health Management, Southern Medical University, Guangzhou, China
| | - Guojin Jiao
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Jun Xie
- School of Basic Medicine, Shanxi Medical University, Taiyuan, China
| | - Jingmin Cheng
- School of Management, Shanxi Medical University, Taiyuan, China
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Jing Z, Zhang S, Zhang N, Sun M, Zhou C. The Effect of Parental Social Integration on the Physical Examination Utilization for Young Migrant Children: A National Cross-Sectional Study in China. Front Public Health 2022; 9:755726. [PMID: 35096735 PMCID: PMC8790474 DOI: 10.3389/fpubh.2021.755726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Physical examination is a key component of child health management. Migrant children are a vulnerable group with lower healthcare service utilization, and this study aims to explore the effect of parental social integration on the physical examination service utilization for young migrant children under 6 years old in China. Method: This study conducted a secondary data analysis of the 2014 National Internal Migrant Dynamic Monitoring Survey in China. A total of 2,620 participants were included in this study. A total of 22 indicators were selected to measure social integration. Multivariate logistic regression was used to explore the association between parental social integration and physical examination use of young migrant children. Results: More than half (66.4%) of the migrant children aged 0-6 years had used free physical examination. Parental social integration, especially structural integration, was associated with the physical examination utilization of migrant children. Specifically, those migrant children's parents who had medical insurance (P < 0.05; OR = 1.29), who had participated in local activities (P < 0.001; OR = 1.98), who had registered local residents as neighbors (P < 0.05; OR = 1.34), and who had a deep sense of self-identity (P < 0.05; OR = 1.09) were more likely to take children to use physical examination. Conclusions: This study provided evidence that parental social integration was associated with migrant children's physical examination utilization, and this association was multifaceted, lying in the dimensions of economic, structural, and psychological integration. Improving the social integration of migrant parents would be effective to enhance the migrant children's healthcare service utilization.
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Affiliation(s)
- Zhengyue Jing
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China.,Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shiya Zhang
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China
| | - Nan Zhang
- Social Statistics, Manchester Institute for Collaborative Research on Ageing, University of Manchester, Manchester, United Kingdom
| | - Mei Sun
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,National Health Commission of the PRC (NHC) Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Chengchao Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission of the PRC (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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7
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Hu Y, Liang H, Chen F, Shen L, Pan X, Wang Y, Chen Y, Lv H. Evaluating the vaccination coverage: validity of household-hold vaccination booklet and caregiver's recall. Hum Vaccin Immunother 2021; 17:3034-3041. [PMID: 33825657 DOI: 10.1080/21645515.2021.1906151] [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: 10/21/2022] Open
Abstract
BACKGROUND We compared results from household data sources to medical record sources by using data from a vaccination coverage survey. METHODS Vaccination coverage (VC) was calculated based on parental recall, household vaccination booklet, and Zhejiang provincial immunization information system (ZJIIS). We evaluated the accuracy of VC based on household sources (vaccination booklet and recall) assuming the medical record was accurate. Concordance, sensitivity, specificity, positive predictive value, and negative predictive value were estimated as well as the Kappa statistic was also used to evaluate the agreement between data sources. RESULTS Among the 1,800 children identified in the household survey, all were registered in ZJIIS. VC estimated using the vaccination booklet alone was substantially lower than that based on medical records (net bias 3.4-16.7% in different age groups). VC based on parental recall ranged from 2.5% below (among children aged 1 year) to 16.7% points above (among children aged 6 years) than those based on medical records. Concordance was lowest for card estimates (32.5-45.5%). Sensitivity was <60% for all household sources, except for recall source. Specificity was lowest for recall estimates (14.5-42.6%). Positive predictive value was >75%, while negative predictive value was <50%, for all household sources. Kappa statistics generally indicated poor agreement between household and medical record sources. CONCLUSIONS Household-retained vaccination booklets and parental recall were insufficient sources for evaluating the VC. Our findings emphasized the importance of taking interventions to make the vaccination booklet more consistent with the records from medical resource.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Fuxing Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Linzhi Shen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xuejiao Pan
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Hu Y, Chen Y, Wang Y, Liang H, Lv H. The association between the density of vaccination workers and immunization coverage in Zhejiang province, East China. Hum Vaccin Immunother 2021; 17:2319-2325. [PMID: 33545020 DOI: 10.1080/21645515.2020.1865045] [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: 10/22/2022] Open
Abstract
Background: We aimed to evaluate whether the density of vaccination workers was associated with the immunization coverage in Zhejiang province.Methods: The immunization coverage of measles-containing vaccine (MCV), the third dose of diphtheria, tetanus, and pertussis combined vaccine (DTP3), and the third dose of poliomyelitis vaccine (PV3) was selected as the dependent variables. Immunization coverage data of children aged 13-23 months were taken from the Zhejiang immunization information system (ZJIIS). The aggregate density of vaccination workers was an independent variable in one set of regressions, while the full-time and part-time vaccination workers were adopted separately in other sets.Results: The density of total vaccination workers was positively and significantly associated with the immunization coverage (MCV: AOR = 3.36; DTP3: AOR = 2.68; PV3: AOR = 2.37). However, when the effects of full-time vaccination workers and part-time vaccination workers were assessed separately, we only found that the density of full-time vaccination workers was positively and significantly associated with the immunization coverage (MCV: AOR = 5.59; DTP3: AOR = 4.13; PV3: AOR = 3.28). The proportion of migrant children < 7 years and Land area were found as negative and significant factors for immunization coverage.Conclusions: A higher density of vaccination workers could improve the availability of vaccination services and immunization coverage. We recommended that government or other non-government organization should, apart from vaccine-related assistance, focus their efforts on human resources for vaccination.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Apuleni G, Jacobs C, Musonda P. Predictors of Health Seeking Behaviours for Common Childhood Illnesses in Poor Resource Settings in Zambia, A Community Cross Sectional Study. Front Public Health 2021; 9:569569. [PMID: 34095039 PMCID: PMC8170042 DOI: 10.3389/fpubh.2021.569569] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Developing countries, including Zambia, account for larger share of child morbidities and mortalities due to common childhood illnesses. Studies on wider determinants of behaviour pertaining to treatment seeking for childhood febrile illnesses in poor resource settings are limited. This study investigated health seeking behaviours of mothers in poor resource settings of Zambia and identified associated factors. Methods: Secondary data from a community cross sectional study design from the Health for the Poorest Population (HPP) Project was analysed between March and May 2019. Data was collected between May and August, 2013. It was collected by means of administering a structured questionnaire from the mothers of under-five children. The survey took place in Samfya and Chiengi of Luapula province while in Northern Province, Luwingu and Mungwi were settled for. A total of 1 653 mothers of under 5 years who had an episode of diarrhoea, malaria, pneumonia or a combination of any of them not more than 14 days before the interview were included in the study. A sample size was arrived at using A Lot Quality Assurance Sampling (LQAS) method. In order to determine the associations between respondent's demographic characteristics and health seeking behaviour, chi square test of independence was carried out. Multivariable logistic regression was also done to identify predictors of health seeking behaviours for common childhood illnesses in children aged <5 years old in poor resource settings. Results: Among the mothers interviewed, 64.6% were married while 35.4% were unmarried. Their mean age was 32 years. Mothers who took their sick children to the health facilities for the purpose of seeking health care for their child for either of the illnesses accounted for 75.2%, [95% CI: 0.62–0.96], while 24.8% did not seek health care for their sick child. Factors typically associated with health seeking behaviours were mothers' marital status [aOR = 0.74; 95% CI: 0.58–0.94], and mothers ‘education level [aOR = 1.47; 95% CI: 1.13–1.92]. Conclusion: It was established in this study that health care seeking behaviours for these common childhood illnesses in poor resource settings was relatively high and could be predicted by mother's education level and mothers' marital status. Integrating interventions targeted at increasing utilisation of maternal and child health services with basic education to women and moral support counselling to families may potentially maximise health seeking behaviours in marginalised communities.
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Affiliation(s)
- Golden Apuleni
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Musonda
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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10
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Hu Y, Chen Y, Wang Y, Liang H, Lv H. The trends of socioeconomic inequities in full vaccination coverage among children aged 12-23 months from 2000 to 2017: evidence for mitigating disparities in vaccination service in Zhejiang province. Hum Vaccin Immunother 2021; 17:810-817. [PMID: 32730179 DOI: 10.1080/21645515.2020.1790907] [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: 10/23/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the trends and changes in inequities in the completeness of the primary vaccination (CPV) scheduled before the first year of age among children aged 12-23 months, from 2000 to 2017. Methods: Data were extracted from five rounds of the provincial vaccination coverage survey (PVCS) in 2000, 2004, 2008, 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequity analysis. The concentration index (CI) was used to quantify the degree of inequity, and the decomposition approach was applied to quantify the contributions from independent factors to inequity in the CPV. Results: The CPV was significantly improved from 2000 to 2017, with 67.0% for the 2000 PVCS and 86.0% for the 2017 PCVS. The CI value decreased from 0.29839 for the 2000 round to 0.03601 for the 2017 round. The decomposition analysis indicated that independent variables such as birth order, ethnic group, mother's education, maternal employment status, residence, immigration status and the percentage of the total health spending allocated to public health could explain the inequity in the CPV in varying degrees. Conclusions: A sharp reduction in socioeconomic inequity in the CPV was observed from 2000 to 2017. Policy recommendations to reduce the inequality in the CPV should focus on children with the risk factors found in this study, for better outcome in full vaccination and long-lasting herd immunity.
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Affiliation(s)
- Yu Hu
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Liang
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Department of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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11
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Prevalence and predictors of vaccine hesitancy among expectant mothers in Enugu metropolis, South-east Nigeria. J Public Health Policy 2021; 42:222-235. [PMID: 33568746 DOI: 10.1057/s41271-020-00273-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/21/2022]
Abstract
Vaccine hesitancy, defined as delay in acceptance or refusal of vaccines despite availability of vaccinations services, constrains control of vaccine-preventable diseases. This study determined the prevalence and correlates of vaccine hesitancy among pregnant women attending a university teaching hospital in Enugu metropolis, South-east Nigeria using cross-sectional survey and parent attitudes about childhood vaccines (PACV) questionnaire. We dichotomised the 256 expectant mother participants into hesitant and non-hesitant categories using median PACV and sub-scale scores. Overall, 31.6% of participants were hesitant. About 17.6%, 14.8%, and 30.9% of mothers were hesitant due to their vaccination behaviour, beliefs about vaccine safety and efficacy, and general attitudes and trust of service providers, respectively. Mothers aged less than 30 years were three times more likely to be vaccine hesitant than older ones. Public health practitioners should target young, expectant mothers by developing and conducting vaccine hesitancy screening, focused health education, and information campaigns. The prevalence of childhood vaccine hesitancy among expectant mothers is high. Younger expectant mothers are more likely to be vaccine hesitant than older ones. Involvement of maternal health service workers to provide vaccine literacy and to support expectant mothers to make informed decision about childhood vaccination might be helpful in reducing vaccine hesitancy.
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12
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Li J, Yu W, Zhao Z, Zhang L, Gong Q. Measles vaccination among children in border areas of Yunnan Province, Southwest China. PLoS One 2020; 15:e0240733. [PMID: 33085692 PMCID: PMC7577443 DOI: 10.1371/journal.pone.0240733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Border areas are at high risk of measles epidemics. This study aimed to evaluate the effectiveness of the implementation of the routine two-dose measles containing vaccine (MCV) program in border counties of Southwest China. METHODS Data used in the study were derived from a cross-sectional survey among 1,467 children aged 8 to 84 months from five border counties of Yunnan Province, Southwest China in 2016. The participants were recruited using a multistage sampling method. Primary guardians of the children were interviewed to collect information on vaccination history, socio-economic status, and knowledge about immunization. Both coverage and timely coverage for the first (MCV1) and the second (MCV2) dose of MCV were calculated. The Kaplan-Meier method was performed to estimate the cumulative coverage of MCV, and Log-rank tests were adopted to compare the differences across counties and birth cohorts. Univariate and multivariate logistic regression models were used to investigate the predictors of delayed MCV1 vaccination. RESULTS The coverage for MCV1 and MCV2 were 97.5% and 93.4%, respectively. However, only 63.8% and 84.0% of the children received MCV1 or MCV2 on time. Significant differences in the cumulative coverage were detected across counties and birth cohorts. Results of the multivariate logistic regression analysis indicated that children whose primary guardian knew the schedule of MCV were less likely to receive MCV1 late (OR = 0.63, P<0.01). For the guardians, doctors at vaccination units were the primary and also the most desired source of vaccination information. CONCLUSIONS Although the coverage for MCV is high in border areas of Southwest China, the timeliness of MCV vaccination seems suboptimal. Tailored information from local health professionals may help to reduce untimely vaccination.
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Affiliation(s)
- Jiangrong Li
- Expanded Program on Immunization Department, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhixian Zhao
- Expanded Program on Immunization Department, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Lei Zhang
- Zhaotong Vocational College of Health, Zhaotong, China
| | - Qiongyu Gong
- Expanded Program on Immunization Department, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
- * E-mail:
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Budu E, Darteh EKM, Ahinkorah BO, Seidu AA, Dickson KS. Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys. PLoS One 2020; 15:e0239754. [PMID: 33002092 PMCID: PMC7529274 DOI: 10.1371/journal.pone.0239754] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Vaccination is proven to be one of the most cost-effective measures adopted to improve the health of children globally. Adhering to vaccines for children has the propensity to prevent about 1.5 million annual child deaths globally. This study sought to assess the trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana. MATERIALS AND METHODS The study was based on data from four rounds of the Ghana Demographic and Health Survey (GDHS 1998, 2003, 2008, and 2014). Information on 5,119 children aged 12-23 months were extracted from the children's files. Both bivariate and multivariate analyses were conducted to assess the factors associated with complete vaccination and statistical significance was pegged at p<0.05. RESULTS We found that complete vaccination coverage increased from 85.1% in 1998 to 95.2% in 2014. Children whose mothers were in rural areas [aOR = 0.45; CI = 0.33-0.60] had lower odds of getting complete vaccination, compared to those whose mothers were in urban areas. Also, children whose mothers had a secondary level of education [aOR = 1.87; CI = 1.39-2.50] had higher odds of receiving complete vaccination, compared to those whose mothers had no formal education. Children whose mothers were either Traditionalists [aOR = 0.60; CI = 0.42-0.84] or had no religion [aOR = 0.58, CI = 0.43-0.79] had lower odds of receiving complete vaccination, compared to children whose mothers were Christians. CONCLUSION The study revealed that there has been an increase in the coverage of complete vaccination from 1998 to 2014 in Ghana. Mother's place of residence, education, and religious affiliation were significantly associated with full childhood vaccination. Although there was an increase in complete childhood vaccination, it is imperative to improve health education and expand maternal and child health services to rural areas and among women with no formal education to further increase complete vaccination coverage in Ghana.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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14
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Liu X, Yang C, Qu X, Li N, Huang X, Yang Y, Zhao Y, Wang Y, Zhou H. Vaccination coverage and its determinants of live attenuated hepatitis A vaccine among children aged 24-59 months in 20 rural counties of 10 provinces of China in 2016. Hum Vaccin Immunother 2020; 16:1574-1578. [PMID: 31746666 DOI: 10.1080/21645515.2019.1688034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To understand one single dose coverage of live attenuated hepatitis A vaccine and its determinants among children aged 24-59 months in 20 rural counties of 10 provinces of China in 2016. METHODS In 20 counties, using three-stage probability proportion to size sampling, 1979 children aged 24-59 months with a vaccination card were selected from 20 rural counties in 2016. Socio-demographic and socio-economic characteristics of children and their caregivers were acquired from face-to-face questionnaire survey and copies of the vaccination cards. We used multivariate logistic regression models to identify the determinants of one single dose coverage of live attenuated hepatitis A vaccine. RESULTS In 2016, the overall one single dose coverage of live attenuated hepatitis A vaccine among children aged 24-59 months in rural areas of China was 77.1%. The adjusted analysis showed that being in second birth order (adjusted OR: 1.40; 95%CI: 1.03-1.90), being in third birth order or more (adjusted OR: 2.10; 95%CI: 1.26-3.51), being born at home (adjusted OR: 2.01; 95%CI: 1.04-3.88) and having the lowest per capita income of household (adjusted OR: 2.36; 95%CI: 1.11-4.99) were significantly related to being unvaccinated one single dose coverage of live attenuated hepatitis A vaccine against hepatitis A virus. CONCLUSION one single dose coverage of live attenuated hepatitis A vaccine was still at a low level in 20 rural counties of 10 provinces in China. To improve the coverage of live attenuated hepatitis A vaccine, the government should pay more attention to the disadvantaged groups, especially the children who were in second birth order or higher, or delivered at home, or who have the lowest per capita income of household.
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Affiliation(s)
- Xiaoli Liu
- Research Center of Clinical Epidemiology, Peking University Third Hospital , Beijing, China
| | - Chenlu Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University , Beijing, China
| | - Xueqi Qu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital , Beijing, China
| | | | | | - Yiming Zhao
- Research Center of Clinical Epidemiology, Peking University Third Hospital , Beijing, China
| | - Yan Wang
- Department of Maternal and Child Health, School of Public Health, Peking University , Beijing, China
| | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University , Beijing, China
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15
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Bierhoff M, Pinyopornpanish K, Pinyopornpanish K, Tongprasert F, Keereevijit A, Rijken M, Chu CS, Nosten F, Perfetto J, van Vugt M, Mcgready R, Angkurawaranon C. Retrospective Review of Documentation Practices of Hepatitis B Immunoglobulin, Birth Dose, and Vaccination at the Hospital of Birth, in Thai Nationals and Migrants in Northern Thailand. Open Forum Infect Dis 2019; 6:ofz518. [PMID: 31890723 PMCID: PMC6934156 DOI: 10.1093/ofid/ofz518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/06/2019] [Indexed: 12/18/2022] Open
Abstract
Background Vaccination remains the mainstay of prevention of hepatitis B virus (HBV) including birth dose and hepatitis B immunoglobulins (HBIGs). National estimates of vaccination coverage exclude migrants. The objective of this study is to investigate documentation practices of HBV-related infant vaccinations in Northern Thailand including migrants. Methods This is a retrospective review of hospital records of women who birthed infants in 2015 at Maharaj Nakorn Hospital, Chiang Mai (CM) or on the Thailand-Myanmar border, Tak. Results Of 2522 women, 987 were from CM (861 Thai nationals, 126 migrants) and 1535 were from Tak (651 Thai residence and 884 Myanmar residence). In CM, documentation for the birth dose vaccine (999 of 999, 100%) and HBIG was complete. In Tak, documentation was 1441 of 1549 (93%) for birth dose and 26 of 34 (76.5%) for HBIG, with missed opportunities including home delivery, delay in obtaining hepatitis B e-antigen status, and limitations of the records. Expanded Program of Immunization (EPI) documentation of 3 follow-up vaccinations dwindled with subsequent doses and distance, and complete documentation of 3 HBV EPI vaccines at the hospital of birth was low, 41.5% (1056 of 2547), but equitable for Thai or migrant status. Conclusions This review provides strong support for excellent documentation of HBIG and birth dose vaccination in urban and rural settings, and in migrants, consistent with Thailand's vaccination policy and practice. Documentation of the 3 HBV EPI at the hospital of birth decreases with sequential doses, especially in families further away. Innovative data linkage is required to prove coverage and identify gaps.
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Affiliation(s)
- M Bierhoff
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Kanokwan Pinyopornpanish
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - F Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arunrot Keereevijit
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - M Rijken
- Utrecht University Medical Centre and Julius Centre Global Health, Utrecht, The Netherlands
| | - C S Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - J Perfetto
- New York University School of Medicine, New York, New York, USA
| | - M van Vugt
- Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Mcgready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - C Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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16
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Kinfe Y, Gebre H, Bekele A. Factors associated with full immunization of children 12-23 months of age in Ethiopia: A multilevel analysis using 2016 Ethiopia Demographic and Health Survey. PLoS One 2019; 14:e0225639. [PMID: 31774859 PMCID: PMC6881024 DOI: 10.1371/journal.pone.0225639] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Only 40% of World Health Assembly member states achieved 90% national full vaccination coverage in 2015. In the African region, 79% of the countries had not achieved the target in 2015. In Ethiopia, only 39% of children 12-23 months of age were fully vaccinated. Though different studies were conducted in Ethiopia, they were limited in scope and used single level analysis. Therefore, this study aimed to assess individual and community level factors associated with full immunization among children 12-23 months of age in Ethiopia. METHODS The data was obtained from Ethiopia Demographic and Health Survey 2016, conducted from January 2016 to June 2016. The sample was taken using two stage stratified sampling. In stage one, 645 Enumeration Areas and in stage two 28 households per Enumeration Area were selected systematically. Weighted sample of 1929 children 12-23 months of age were included in the study. Data was extracted from http://www.DHSprogram.com. Multilevel logistic regression was employed. Akaike Information Criteria was used to select best fit model. RESULTS Mother's education, husband employment, mother's religion, mother's antenatal care visit, presence of vaccination document, region and community antenatal care utilization were significantly associated with children full vaccination. The odds of full vaccination were 2.5 [AOR = 2.48 95% CI: 1.35, 4.56] and 1.6 [AOR = 1.58 95% CI: 1.1, 2.28] times higher in children of mothers with secondary or higher and primary education respectively than children of mothers with no education. CONCLUSION This study showed that children full vaccination is affected both by the individual and community level factors. Therefore, efforts to increase children full vaccination status need to target both at individual and community level.
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Affiliation(s)
- Yohannes Kinfe
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail:
| | - Hagazi Gebre
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Abate Bekele
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Hu Y, Wang Y, Chen Y, Liang H. Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224575. [PMID: 31752311 PMCID: PMC6887931 DOI: 10.3390/ijerph16224575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/30/2022]
Abstract
Objectives: Exploring determinants underlying disparities in full vaccination coverage (FVC) can contribute to improved immunization interventions. FVC and its risk factors in Zhejiang province have been studied, yet the determinants explaining the rural-urban disparity in FVC have not been studied. This study aimed to disentangle the factors explaining rural-urban disparities in FVC of vaccine doses scheduled during the first year of life in Zhejiang province. Methods: We used data from a vaccination coverage survey among children aged 24-35 months conducted in 2016. The outcome measure was full vaccination status, and the grouping variable was the area of residence. Descriptive statistics were used to analyze the FVC and rural-urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the FVC disparity. Results: There were 847 children included in this study, of which 49.6% lived in a rural area. FVC was 94% in rural areas and 85% in urban areas. A disparity of 9% to the advantage of the rural areas and the exposure variables explained 81.1% of the disparity. Maternal factors explained 49.7% of the explained disparity with education, occupation, and ethnicity being the significant contributors to the explained disparity. Children's birth order and immigration status contributed somewhat to the explained inequality. Conclusion: There was a significant disparity in FVC in Zhejiang province, a disadvantage to the urban areas. Policy recommendations or health interventions to reduce the inequality should be focused on eliminating poverty and women's illiteracy, targeted at migrant children or children from minority ethnicities.
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Yismaw AE, Assimamaw NT, Bayu NH, Mekonen SS. Incomplete childhood vaccination and associated factors among children aged 12-23 months in Gondar city administration, Northwest, Ethiopia 2018. BMC Res Notes 2019; 12:241. [PMID: 31036071 PMCID: PMC6489187 DOI: 10.1186/s13104-019-4276-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Despite the fact that immunization services are offered free of charge in Ethiopia but the coverage of complete vaccination is still low. The aim of the study is to determine incomplete vaccination and associated factors among children aged 12–23 months in Gondar city administration, Northwest Ethiopia, 2018. Result The proportion of incomplete vaccination among children aged 12–23 months in Gondar city adminstration was 24.3% (95% CI 19.3, 29.2). Knowledge about the benefits of vaccination (AOR = 6.1 (95% CI 1.3, 28.9), the age at which the child begins vaccination (AOR = 2.4 (95% CI 1.09, 8.4) time taken to reach nearby health facility and means of transportation to nearby health facility (AOR = 0.22 95% CI 0.06, 0.9) have statistically significant association with incomplete vaccination. In the current study the proportion of incomplete vaccination was found to be high. Increasing the awareness about vaccination for child care givers and further improve caregiver’s knowledge towards the benefit of vaccination is important.
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Affiliation(s)
- Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia.
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanent Habetie Bayu
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet Mekonen
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Coverage of Haemophilus influenzae Type b Conjugate Vaccine for Children in Mainland China: Systematic Review and Meta-analysis. Pediatr Infect Dis J 2019; 38:248-252. [PMID: 29957731 DOI: 10.1097/inf.0000000000002132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Use of Haemophilus influenzae type b conjugate vaccine is effective in reducing the disease burden, but its coverage in China is unclear. The aim of this meta-analysis is to assess the coverage of Hib conjugate vaccines in children in Mainland China. METHODS We systematically searched Pubmed, Web of Science, Medline, CNKI and Wanfang to identify studies assessing the coverage of Hib vaccine in Chinese children. Random-effects models were used to obtain pooled estimates for Hib vaccine coverage and analyzed heterogeneity with meta-regression and subgroup analyses. RESULTS Thirty-three studies that included 7,227,480 subjects in 12 provinces met our inclusion criteria. The pooled overall coverage of Hib conjugate vaccine was 54.9% [95% confidence interval (CI): 52.9-57.0]. The pooled coverage for the nonlocal population (54.3%; 95% CI: 52.4-56.3) was lower than that for the local residents (62.0%; 95% CI: 58.4-65.6). The region-pooled coverage was higher in the east of China (59.7%; 95% CI: 57.3-62.1) than in the central and west parts of the country (48.5%; 95% CI: 40.6-56.4). Overall, 26.7% (95% CI: 20.1-33.2) had 1 dose only, 14.8% (95% CI: 10.0-19.6%) had 2 doses, 13.5% (95% CI: 9.1-17.8) had 3 doses and 14.3% (95% CI: 9.7-18.9) had 4 doses. CONCLUSIONS We found a low coverage of Hib conjugate vaccine, particularly for the nonlocal children and those living in the central and west parts of China. Including Hib vaccine into the national immunization program is recommended to reduce disparities in vaccination coverage.
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Hu Y, Chen Y, Wang Y, Liang H. Hepatitis B Vaccination among 1999⁻2017 Birth Cohorts in Zhejiang Province: The Determinants Associated with Infant Coverage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122915. [PMID: 30572681 PMCID: PMC6313558 DOI: 10.3390/ijerph15122915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 01/29/2023]
Abstract
This study aimed to investigate the coverage of hepatitis B vaccine (Hep B) and its completeness and timeliness for birth cohorts from 1999 to 2017 in Zhejiang province, East China. Demographic characteristics and vaccination records of Hep B of children born from 1 January 1999 to 31 June 2017 were extracted from the Zhejiang provincial immunization information system. The timeliness of the first dose of Hep B (Hep B1) was defined as the proportion of children who received the Hep B1 within 24 h after birth among the target population. The completeness of Hep B was defined as the proportion of children who completed the three-dose series of Hep B before 7 years of age. The demographic characteristics of the target population were described. The coverage of each dose of Hep B, the timeliness of Hep B1, and the completeness of Hep B for each birth cohort were described. A logistic regression model was applied to detect the determinants of the timeliness of Hep B1 and the completeness of Hep B vaccination. The coverage of Hep B1 increased from 90.3% to 98.3%, the coverage of Hep B2 increased from 88.8% to 96.1%, and the coverage of Hep B3 increased from 86.4% to 94.2%. The timeliness of Hep B1 increased from 80.3% to 91.3%. The completeness of Hep B increased from 81.3% to 91.5%. The determinants of timeliness of Hep B1 included children’s delivery place, immigration status, maternal education level, and economic development level of resident area. The determinants of completeness of Hep B included children’s delivery place, immigration status, maternal education level, economic development level of resident area, maternal occupation, and frequency of vaccination service. Zhejiang province had achieved significant improvements in the timely administration of Hep B1 and the completeness of Hep B. To accelerate progress toward additional reductions in the transmission of hepatitis B virus, further efforts need to be focused on improving the timeliness of Hep B1 vaccination and reducing the drop-outs among disadvantaged children with the risk factors identified in this study.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310000, China.
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Mansour Z, Said R, Brandt L, Khachan J, Rady A, Fahmy K, Danovaro-Holliday MC. Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon. Gates Open Res 2018; 2:71. [PMID: 30734029 PMCID: PMC6362301 DOI: 10.12688/gatesopenres.12898.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/06/2023] Open
Abstract
Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016. Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan-Meier curves and logistic regression to identify the predictors of age-appropriate immunization. Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination. Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon.
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Affiliation(s)
- Ziad Mansour
- Connecting Research to Development, Beirut, Lebanon
| | - Racha Said
- Connecting Research to Development, Beirut, Lebanon
| | - Lina Brandt
- Connecting Research to Development, Beirut, Lebanon
| | | | - Alissar Rady
- World Health Organization Lebanon Country Office, Beirut, Lebanon
| | - Kamal Fahmy
- World Health Organization Eastern Mediterranean Region Office, Cairo, Egypt
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Jafree SR, Zakar R, Mustafa M, Fischer F. Mothers employed in paid work and their predictors for home delivery in Pakistan. BMC Pregnancy Childbirth 2018; 18:316. [PMID: 30075757 PMCID: PMC6091079 DOI: 10.1186/s12884-018-1945-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Pakistan has one of the highest rates of maternal and neonatal mortality in the world. It is assumed that employed mothers in paid work will be more empowered to opt for safer institutional deliveries. There is a need to understand the predictors of home deliveries in order to plan policies to encourage institutional deliveries in the region. Methods The study aimed to ascertain the predictors for home deliveries among mothers employed in paid work in Pakistan. Data analysis is based on secondary data taken from the Pakistan Demographic Health Survey 2012–13. Bivariate and multivariate logistic regression models were conducted. Results The findings show that the majority (53.6%) of employed mothers in Pakistan give birth at home. Employed mothers in paid work with the following characteristics had higher chances for delivering at home: (i) women from rural areas (AOR 1.26; 95% CI: 0.94–1.71), or specific regions within Pakistan, (ii) those occupied in unskilled work (AOR 2.61; 95% CI: 1.76–3.88), (iii) women married to uneducated (AOR 1.70; 95% CI: 1.08–2.66), unemployed (AOR 1.69; 95% CI: 1.21–2.35), or unskilled men (AOR 2.02; 95% CI: 1.49–2.72), (iv) women with more than 7 children (AOR 1.57; 95% CI: 1.05–2.35), (v) women who are unable in the prenatal period to have an institutional check-up (AOR 4.84; 95% CI: 3.53–6.65), take assistance from a physician (AOR 3.98; 95% CI: 3.03–5.20), have a blood analysis (AOR 2.63; 95% CI: 1.95–3.57), urine analysis (AOR 2.48; 95% CI: 1.84–3.33) or taken iron tablets (AOR 2.64; 95% CI: 2.06–3.38), and (vi) are unable to make autonomous decisions with regard to spending their earnings (AOR 1.82; 95% CI: 1.27–2.59) and healthcare (AOR 1.12; 95% CI: 0.75–1.65). Conclusions Greater efforts by the central and provincial state bodies are needed to encourage institutional deliveries and institutional access, quality and cost. Maternal and paternal benefits are needed for workers in both the formal and informal sectors of the economy. Finally, cultural change, through education, media and religious authorities, is necessary to support institutional deliveries and formal sector paid employment and out of home work opportunities for mothers of Pakistan.
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Affiliation(s)
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Mudasir Mustafa
- Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
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Hu Y, Chen Y, Liang H, Wang Y. Analysis of the effects of individual- and community- level predictors on migrant children's primary immunization in Yiwu city, east China. Hum Vaccin Immunother 2018; 14:2239-2247. [PMID: 29792549 DOI: 10.1080/21645515.2018.1467684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND To evaluate the effects of a wide range of individual- and community-level factors on migrant children's primary immunization. METHODS Migrant children aged 13-24 months (born from 1 June 2013 to 31 May 2014) were surveyed in Yiwu city, in June 2015. Social-demographic factors and vaccination records were collected. Five factors at community-level including community wealth, distance to the nearest immunization clinic, maternal education, antenatal clinic (ANC) visits, and hospital delivery were constructed. The relationship between individual- and community-level factors and a child's vaccination status for Chinese primary immunization were evaluated by logistic regression model and the adjusted odds ratio (AOR) with the p-values and 95% confidence interval (CI) were calculated. RESULTS The community wealth (aOR:1.4; 95% CI:1.1-2.7), the community maternal education (aOR:1.8; 95% CI:1.4-4.5), the community ANC visits (aOR:1.8; 95% CI:1.3-2.8), and the community hospital delivery (aOR:2.2; 95% CI:1.6-4.8) were positively associated with the completeness of primary immunization, while community distance to the nearest immunization clinic was negatively associated with the completeness of primary immunization (aOR:0.7; 95% CI:0.5-0.9). The coverage of completeness of primary immunization was higher among children living in rural areas than those living in urban areas (aOR:1.7; 95% CI: 1.3-3.1). CONCLUSIONS In order to achieve better vaccination coverage among migrant children in Yiwu, as well as to close the gaps and disparities of acceptability and accessibility in childhood vaccination in urban areas, policy makers should design interventions based on the factors addressed in this study.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Hui Liang
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention , Hangzhou , China
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Abstract
The objective of this project was to document and increase vaccine coverage in migrant school children on the Thailand-Myanmar border. Migrant school children (n = 12,277) were enrolled in a school-based immunization program in four Thai border districts. The children were evaluated for vaccination completion and timing, for six different vaccines: Bacille Calmette-Guerin (BCG); Oral Polio vaccine (OPV); Hepatitis B vaccine (HepB); Diphtheria, Pertussis and Tetanus vaccine (DTP); Measles Containing Vaccine or Measles, Mumps and Rubella vaccine (MMR); Tetanus and Diphtheria containing vaccine (Td). Vaccine coverage proportions for BCG, OPV3, DTP3, HepB3 and measles containing vaccine were 92.3, 85.3, 63.8, 72.2, and 90.9 % respectively. Most children were able to receive vaccines in a time appropriate manner. School-based immunization programs offer a suitable vaccine delivery mechanism for hard-to-reach populations. However, these data suggest overall low vaccine coverage in migrant populations. Further efforts toward improving appropriate vaccine coverage and methods of retaining documentation of vaccination in mobile migrant populations are necessary for improved health.
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Sheerin D, Openshaw PJM, Pollard AJ. Issues in vaccinology: Present challenges and future directions. Eur J Immunol 2017; 47:2017-2025. [PMID: 28861908 PMCID: PMC7163762 DOI: 10.1002/eji.201746942] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/07/2017] [Accepted: 08/24/2017] [Indexed: 12/21/2022]
Abstract
Vaccination is a principal and highly cost-effective means of controlling infectious diseases, providing direct protection against pathogens by conferring long-lasting immunological memory and inducing population-level herd immunity. Despite rapid ongoing progress in vaccinology, there remain many obstacles to the development and deployment of novel or improved vaccines; these include the underlying science of how to induce and sustain appropriate protective immune responses as well as bureaucratic, logistic and socio-political hurdles. The failure to distribute and administer existing vaccines to at-risk communities continues to account for a large proportion of infant mortality worldwide: almost 20 million children do not have access to basic vaccines and several million still die each year as a result. While emerging epidemic or pandemic diseases pose a significant threat to global health and prosperity, there are many infectious diseases which provide a continuous or cyclical burden on healthcare systems which also need to be addressed. Gaps in knowledge of the human immune system stand in the way of developing technologies to overcome individual and pathogenic variation. The challenges in tackling infectious disease and directions that the field of preventive medicine may take to improve the current picture of global health are the focus of this review.
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Affiliation(s)
- Dylan Sheerin
- Oxford Vaccine GroupDepartment of PaediatricsUniversity of OxfordOxfordUK
- the NIHR Oxford Biomedical Research Centre
| | - Peter JM Openshaw
- Respiratory MedicineNational Heart and Lung InstituteImperial College LondonUK
| | - Andrew J Pollard
- Oxford Vaccine GroupDepartment of PaediatricsUniversity of OxfordOxfordUK
- the NIHR Oxford Biomedical Research Centre
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Hu Y, Chen Y, Wang Y, Liang H. Knowledge, Attitude and Practice of Pregnant Women towards Varicella and Their Children's Varicella Vaccination: Evidence from Three Distrcits in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101110. [PMID: 28946647 PMCID: PMC5664611 DOI: 10.3390/ijerph14101110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Background: The objectives of this study were to examine the knowledge, attitudes and practice (KAP) towards varicella and varicella vaccine (VarV) vaccination among pregnant women in three distrcits in Zhejiang Province, China. Methods: From 1 January to 31 March 2014, pregnant women with ≥12 gestational weeks were recruited and received a self-administrated questionnaire. The first dose of VarV (VarV1) vaccination status of children from present pregnancy was extracted at 24 months of age from Zhejiang provincial immunization information system (ZJIIS). Three variables was defined as the main outcomes, which included: (1) knowing about both the availability of VarV and the number of doses required; (2) positive attitude towards the utility of varicella vaccination; (3) the vaccination coverage of VarV1, which meant the proportion of children having received the VarV1. Counts and proportions were used to describe the socio-demographic characteristics of study participants, and their relationship with study outcomes were tested using chi-square tests in univariate analysis and logistic regression in multivariable analysis. Results: A total of 629 pregnant women participated in this study. The majority of the participants (68.0%) answered correctly about the transmission route of varicella. The proportion of participants who heard about varicella vaccination was 76.5% and 66.8% knew that VarV was currently available. Only 13.5% of the participants answered correctly that the complete VarV series needed two doses. Age, immigration status, education level, household income, and number of children of the pregnant women were significant predictors of the KAP regarding the VarV vaccination. Conclusions: The current survey indicated that optimal KAP levels and coverage on VarV vaccination were observed in three districts of Zhejiang Province. Health education programs on varicella and VarV vaccination directed towards both pre-natal and post-natal women are needed, which will result in a better attitude on vaccination of VarV and in a high coverage of VarV.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou 310051, China.
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Examining the structure and behavior of Afghanistan’s routine childhood immunization system using system dynamics modeling. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-04-2017-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to demonstrate how public health and systems science methods can be combined to examine the structure and behavior of Afghanistan’s routine childhood immunization system to identify the pathways through which health system readiness to deliver vaccination services may extend beyond immunization outcomes.
Design/methodology/approach
Using findings from an ecological study of Afghanistan’s immunization system and a literature review on immunization program delivery, the routine immunization system was mapped using causal loop diagrams. Next, a stock-and-flow diagram was developed and translated to a system dynamics (SD) model for a system-confirmatory exercise. Data are from annual health facility assessments and two cross-sectional household surveys. SD model results were compared with measured readiness and service outcomes to confirm system structure.
Findings
Readiness and demand-side components were associated with improved immunization coverage. The routine immunization system was mapped using four interlinking readiness subsystems. In the SD model, health worker capacity and demand-side factors significantly affected maternal health service coverage. System readiness components affected their future measures mostly negatively, which may indicate that the reinforcing feedback drives current system-structured behavior.
Originality/value
The models developed herein are useful to explore the potential impact of candidate interventions on service outcomes. This paper documents the process through which public health and systems investigators can collaboratively develop models that represent the feedback-driven behavior of health systems. Such models allow for more realistically addressing health policy and systems-level research questions.
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Fang H, Yang L, Zhang H, Li C, Wen L, Sun L, Hanson K, Meng Q. Strengthening health system to improve immunization for migrants in China. Int J Equity Health 2017; 16:19. [PMID: 28666442 PMCID: PMC5493864 DOI: 10.1186/s12939-016-0504-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Immunization is the most cost-effective method to prevent and control vaccine-preventable diseases. Migrant population in China has been rising rapidly, and their immunization status is poor. China has tried various strategies to strengthen its health system, which has significantly improved immunization for migrants. Methods This study applied a qualitative retrospective review method aiming to collect, analyze and synthesize health system strengthening experiences and practices about improving immunizations for migrants in China. A conceptual framework of Theory of Change was used to extract the searched literatures. 11 searched literatures and 4 national laws and policies related to immunizations for migrant children were carefully studied. Results China mainly employed 3 health system strengthening strategies to significantly improve immunization for migrant population: stop charging immunization fees or immunization insurance, manage immunization certificates well, and pay extra attentions on immunization for special children including migrant children. These health system strengthening strategies were very effective, and searched literatures show that up-to-date and age-appropriate immunization rates were significantly improved for migrant children. Conclusions Economic development led to higher migrant population in China, but immunization for migrants, particularly migrant children, were poor. Fortunately various health system strengthening strategies were employed to improve immunization for migrants in China and they were rather successful. The experiences and lessons of immunization for migrant population in China might be helpful for other developing countries with a large number of migrant population.
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Affiliation(s)
- Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Li Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Huyang Zhang
- China Center for Health Development Studies, Peking University, Beijing, China.,Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Chenyang Li
- China Center for Health Development Studies, Peking University, Beijing, China.,Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Liankui Wen
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Li Sun
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China.
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29
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Hu Y, Wang Y, Chen Y, Li Q. Determinants of inequality in the up-to-date fully immunization coverage among children aged 24-35 months: Evidence from Zhejiang province, East China. Hum Vaccin Immunother 2017; 13:1902-1907. [PMID: 28604178 DOI: 10.1080/21645515.2017.1327108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aimed to determine the degree and determinants of inequality in up-to-date fully immunization (UTDFI) coverage among children of Zhejiang province, east China. METHOD We used data from the Zhejiang provincial vaccination coverage survey of 2014 and the health outcome was the UTDFI status among children aged 24-35 months. The household income per month was used as an index of socio-economic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in UTDFI coverage. RESULTS The UTDFI coverage was 80.63% and the CI for UTDFI coverage was 0.12028 (95% CI: 0.10852-0.13175), indicating that immunization practice significantly favored children with relatively higher socio-economic status. The results of decomposition analysis suggested that 68.2% of the socio-economic inequality in UTDFI coverage should be explained by the mother's education level. Furthermore, factors such as birth order, ethnic group, maternal employment status, residence, immigration status, GDP per-capital and percentage of public health spending of the total health spending also could explain the disparity in UTDFI coverage. CONCLUSION There exists inequality in UTDFI coverage among the socio-economic disadvantage children. Health interventions of narrowing the socio-economic inequality in UTDFI coverage will benefit from being supplemented with strategies aimed at poverty and illiteracy reduction.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Qian Li
- a Institute of Immunization and Prevention , Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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Oleribe O, Kumar V, Awosika-Olumo A, Taylor-Robinson SD. Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria. Pan Afr Med J 2017; 26:220. [PMID: 28690734 PMCID: PMC5491752 DOI: 10.11604/pamj.2017.26.220.11453] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/30/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Immunization is the world's most successful and cost-effective public health intervention as it prevents over 2 million deaths annually. However, over 2 million deaths still occur yearly from Vaccine preventable diseases, the majority of which occur in sub-Saharan Africa. Nigeria is a major contributor of global childhood deaths from VPDs. Till date, Nigeria still has wild polio virus in circulation. The objective of this study was to identify the individual and socioeconomic factors associated with immunization coverage in Nigeria through a secondary dataset analysis of Nigeria Demographic and Health Survey (NDHS), 2013. METHODS A quantitative analysis of the 2013 NDHS dataset was performed. Ethical approvals were obtained from Walden University IRB and the National Health Research Ethics Committee of Nigeria. The dataset was downloaded, validated for completeness and analyzed using univariate, bivariate and multivariate statistics. RESULTS Of 27,571 children aged 0 to 59 months, 22.1% had full vaccination, and 29% never received any vaccination. Immunization coverage was significantly associated with childbirth order, delivery place, child number, and presence or absence of a child health card. Maternal age, geographical location, education, religion, literacy, wealth index, marital status, and occupation were significantly associated with immunization coverage. Paternal education, occupation, and age were also significantly associated with coverage. Respondent's age, educational attainment and wealth index remained significantly related to immunization coverage at 95% confidence interval in multivariate analysis. CONCLUSION The study highlights child, parental and socioeconomic barriers to successful immunization programs in Nigeria. These findings need urgent attention, given the re-emergence of wild poliovirus in Nigeria. An effective, efficient, sustainable, accessible, and acceptable immunization program for children should be designed, developed and undertaken in Nigeria with adequate strategies put in place to implement them.
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Affiliation(s)
- Obinna Oleribe
- Excellence and Friends Management Care Centre (EFMC), Dutse Abuja FCT, Nigeria.,Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London
| | - Vibha Kumar
- Walden University, 100 Washington Ave S #900, Minneapolis, Minnesota, USA
| | - Adebowale Awosika-Olumo
- Walden University, 100 Washington Ave S #900, Minneapolis, Minnesota, USA.,GHMIGROUP INC, 3845 Cypress Creek Parkway #305, Houston, Tx 77068
| | - Simon David Taylor-Robinson
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London.,Faculty of Medicine, Imperial College London, St Mary's Hospital Campus, Norfolk Place, London W2 1PG, United Kingdom
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Adedokun ST, Adekanmbi VT, Uthman OA, Lilford RJ. Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria. PLoS One 2017; 12:e0173578. [PMID: 28296905 PMCID: PMC5351867 DOI: 10.1371/journal.pone.0173578] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/30/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria. MATERIALS AND METHODS The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3). RESULTS About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03), from rich households (aOR = 1.76; 95% CrI = 1.35-2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08-1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99) were less likely to have used health service for their children. CONCLUSIONS Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care centres.
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Affiliation(s)
- Sulaimon T. Adedokun
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Victor T. Adekanmbi
- NIHR Collaboration for Leadership in Applied Health Research and Care, West Midlands (CLAHRC WM), University of Warwick Medical School, Coventry, United Kingdom
| | - Olalekan A. Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| | - Richard J. Lilford
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
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Shrestha S, Shrestha M, Wagle RR, Bhandari G. Predictors of incompletion of immunization among children residing in the slums of Kathmandu valley, Nepal: a case-control study. BMC Public Health 2016; 16:970. [PMID: 27619349 PMCID: PMC5020516 DOI: 10.1186/s12889-016-3651-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Immunization is one of the most effective health interventions averting an estimated 2–3 million deaths every year. In Nepal, as in most low-income countries, infants are immunized with standard WHO recommended vaccines. However, 16.4 % of children did not receive complete immunization by 12 months of age in Nepal in 2011. Studies from different parts of the world showed that incomplete immunization is even higher in slums. The objective of this study was to identify the predictors of incompletion of immunization among children aged 12–23 months living in the slums of Kathmandu Valley, Nepal. Methods The unmatched case-control study was conducted in 22 randomly selected slums of Kathmandu Valley. The sampling frame was first identified by complete enumeration of entire households of the study area from which 59 incompletely immunized children as cases and 177 completely immunized children as controls were chosen randomly in 1:3 ratio. Data were collected from the primary caretakers of the children. Backward logistic regression with 95 % confidence interval and adjusted odds ratio (AOR) were applied to assess the factors independently associated with incomplete immunization. Result Twenty-six percent of the children were incompletely vaccinated. The coverage of BCG vaccine was 95.0 % while it was 80.5 % for measles vaccine. The significant predictors of incomplete immunization were the home delivery of a child, the family residing on rent, a primary caretaker with poor knowledge about the schedule of vaccination and negative perception towards vaccinating a sick child, conflicting priorities, and development of abscess following immunization. Conclusion Reduction of abscess formation rate can be a potential way to improve immunization rates. Community health volunteers should increase their follow-up on children born at home and those living in rent. Health institutions and volunteers should be influential in creating awareness about immunization, its schedule, and post-vaccination side effects.
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Affiliation(s)
- Sumina Shrestha
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Monika Shrestha
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rajendra Raj Wagle
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Gita Bhandari
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Hu Y, Chen Y, Zhang B, Li Q. An Evaluation of Voluntary Varicella Vaccination Coverage in Zhejiang Province, East China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060560. [PMID: 27271649 PMCID: PMC4924017 DOI: 10.3390/ijerph13060560] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022]
Abstract
Background: In 2014 a 2-doses varicella vaccine (VarV) schedule was recommended by the Zhejiang Provincial Center for Disease Control and Prevention. We aimed to assess the coverage of the 1st dose of VarV (VarV1) and the 2nd dose of VarV (VarV2) among children aged 2–6 years through the Zhejiang Provincial Immunization Information System (ZJIIS) and to explore the determinants associated with the VarV coverage. Methods: Children aged 2–6 years (born from 1 January 2009 to 31 December 2013) registered in ZJIIS were enrolled. Anonymized individual records of target children were extracted from the ZJIIS database on 1 January 2016, including their VarV and (measles-containing vaccine) MCV vaccination information. The VarV1 and VarV2 coverage rates were evaluated for each birth cohorts. The coverage of VarV also was estimated among strata defined by cities, gender and immigration status. We also evaluated the difference in coverage between VarV and MCV. Results: A total of 3,028,222 children aged 2–6 years were enrolled. The coverage of VarV1 ranged from 84.8% to 87.9% in the 2009–2013 birth cohorts, while the coverage of VarV2 increased from 31.8% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Higher coverage rates for both VarV1 and VarV2 were observed among resident children in relevant birth cohorts. The coverage rates of VarV1 and VarV2 were lower than those for the 1st and 2nd dose of MCV, which were above 95%. The proportion of children who were vaccinated with VarV1 at the recommended age increased from 34.6% for the 2009 birth cohort to 75.2% for the 2013 birth cohort, while the proportion of children who were vaccinated with VarV2 at the recommended age increased from 19.7% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Conclusions: Our study showed a rapid increasing VarV2 coverage of children, indicating a growing acceptance of the 2-doses VarV schedule among children’s caregivers and physicians after the new recommendation released. We highlighted the necessity for a 2-doses VarV vaccination school-entry requirement to achieve the high coverage of >90% and to eliminate disparities in coverage among sub-populations. We also recommended continuous monitoring of the VarV coverage via ZJIIS over time.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Bing Zhang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Qian Li
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
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Awoh AB, Plugge E. Immunisation coverage in rural-urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis. J Epidemiol Community Health 2016; 70:305-11. [PMID: 26347277 PMCID: PMC4789817 DOI: 10.1136/jech-2015-205652] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/06/2015] [Accepted: 08/04/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural-urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural-urban migrant (RUM) children being less likely to be immunised. OBJECTIVES To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children. METHODS A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis. RESULTS Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates. CONCLUSIONS This review indicates that there is an association between rural-urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.
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Affiliation(s)
- Abiyemi Benita Awoh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Emma Plugge
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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Minh An DT, Lee JK, Van Minh H, Trang NTH, Thu Huong NT, Nam YS, Van Dung D. Timely immunization completion among children in Vietnam from 2000 to 2011: a multilevel analysis of individual and contextual factors. Glob Health Action 2016; 9:29189. [PMID: 26950555 PMCID: PMC4780107 DOI: 10.3402/gha.v9.29189] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background Since the beginning of 2014, there have been nearly 6,000 confirmed measles cases in northern Vietnam. Of these, more than 86% had neither been immunized nor was their vaccination status confirmed. Objective To establish the likelihood that children under five in Vietnam had ‘timely immunization completion’ (2000–2011) and identify factors that account for variations in timely immunization completion. Design Secondary data from the Multiple Indicator Cluster Survey (MICS), which sampled women aged 15–49 from the 1999 Vietnamese Population and Housing Census frame, were analyzed. Multilevel analysis using Poisson regression was undertaken. Results Proportions of children under five who had timely immunization completion were low, especially for HBV dose 2 and HBV dose 3, which decreased between 2000 and 2011. Among seven vaccines used in the National Expanded Program of Immunization (EPI) in 2000, 2006, and 2011, measles dose 1 had the highest timely immunization completion at 65.3%, 66.7%, and 73.6%, respectively, and hepatitis B dose 1 had the lowest at 17.5%, 19.3%, and 45.5%, respectively. Timely immunization completion was less common among children whose mothers had relatively less household wealth, were from ethnic minorities, lived in rural areas, and had less education. At the community level, the child's region of residence was the main predictor of timely immunization completion, and the availability of hospital delivery and community prenatal care in the local community were also determinants. Conclusion The EPI should include ‘timely immunization completion’ as a quality indicator. There should also be greater focus and targeting in rural areas, and among women who have relatively low education, belong to minority groups, and have less household wealth. Further research on this topic using multilevel analysis is needed to better understand how these factors interact.
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Affiliation(s)
- Dao Thi Minh An
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam;
| | - Jong-Koo Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea;
| | - Hoang Van Minh
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thi Huyen Trang
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thi Thu Huong
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - You-Seon Nam
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Van Dung
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Popova O, Ibarra de Palacios P. Reaching more children with vaccines in developing countries: key challenges of innovation and delivery. Curr Med Res Opin 2016; 32:177-81. [PMID: 26471345 DOI: 10.1185/03007995.2015.1108910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As we reach the deadline for the United Nations fourth Millennium Development Goal to reduce child mortality, many inequalities in vaccine access still exist, particularly for children in developing countries. Here we discuss some of the barriers to vaccine access in these countries, as well as some of the innovative approaches that could address these. Finally, we discuss the need to create a global environment conducive to innovation directed at low-resource settings, aimed to ultimately increase vaccine coverage.
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Affiliation(s)
- Olga Popova
- a Janssen Infectious Diseases and Vaccines , Crucell Holland BV , Leiden , the Netherlands
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Hu Y, Luo S, Tang X, Lou L, Chen Y, Guo J. Comparative assessment of immunization coverage of migrant children between national immunization program vaccines and non-national immunization program vaccines in East China. Hum Vaccin Immunother 2015; 11:761-8. [PMID: 25760670 DOI: 10.1080/21645515.2015.1012015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%- vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention ; Hangzhou , China
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Nath L, Kaur P, Tripathi S. Evaluation of the Universal Immunization Program and Challenges in Coverage of Migrant Children in Haridwar, Uttarakhand, India. Indian J Community Med 2015; 40:239-45. [PMID: 26435596 PMCID: PMC4581143 DOI: 10.4103/0970-0218.164389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Studies show that immunization among migrant children is poor. India has a dropout rate of 17.7% between Bacillus Calmette-Guιrin (BCG) and measles (District Level Household Survey (DLHS)-3). Haridwar district had the highest dropout rate of 27.4% from BCG to diphtheria, pertussis, and tetanus (DPT) 3 (DLHS-3) in Uttarakhand. We evaluated the Universal Immunization Programme (UIP) among migrants in Haridwar in two blocks. MATERIALS AND METHODS We developed input, process, and output indicators on infrastructure, human resources, and service delivery. A facility, session site and cross-sectional survey of 180 children were done and proportions for various indicators were estimated. We determined factors associated with not taking vaccination using multivariate analysis. RESULTS We surveyed 11 cold chain centers, 25 subcenters, 14 sessions, and interviewed 180 mothers. Dropouts were supposed to be tracked using vaccination card counterfoils and tracking registers. The dropout rate from BCG to DPT3 was 30%. Lack of knowledge (adjusted odds ratio (AOR) 6.6,95% confidence interval (CI) 2.6-16.7), mother not being decision maker (AOR 4.0,95%CI 1.7-9.2), lack of contact by Accredited Social Health Activist (ASHA; AOR 3.0,95%CI 1.1-7.7), not being given four post-vaccination messages (AOR 7.7, 95% CI 2.9-20.2), and longer duration of stay in Haridwar (AOR 3.0 95% 1.9-7.6) were risk factors for nonimmunization. The reasons stated by mothers included lack of awareness of session site location (67%) and belief that child should only be vaccinated in their resident district (43%). CONCLUSIONS There was low immunization coverage among migrants within adequate supervision, poor cold chain maintenance, and improper tracking of dropouts. Mobile immunization teams, prelisting of migrant children, and change in incentives of ASHAs for child tracking were needed. A monitoring plan for sessions and cold chain needed enforcement.
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Affiliation(s)
- Latika Nath
- Master of Public Health scholar, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Prabhdeep Kaur
- Scientist C, Department of Health Systems Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Saurabh Tripathi
- Surveillance Medical Officer, National Polio Surveillance Project, Haridwar, Uttarakhand, India
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Hu Y, Luo S, Tang X, Lou L, Chen Y, Guo J, Zhang B. Does introducing an immunization package of services for migrant children improve the coverage, service quality and understanding? An evidence from an intervention study among 1548 migrant children in eastern China. BMC Public Health 2015; 15:664. [PMID: 26173803 PMCID: PMC4501193 DOI: 10.1186/s12889-015-1998-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An EPI (Expanded Program on Immunization) intervention package was implemented from October 2011 to May 2014 among migrant children in Yiwu, east China. This study aimed to evaluate its impacts on vaccination coverage, maternal understanding of EPI and the local immunization service performance. METHODS A pre- and post-test design was used. The EPI intervention package included: (1) extending the EPI service time and increasing the frequency of vaccination service; (2) training program for vaccinators; (3) developing a screening tool to identify vaccination demands among migrant clinic attendants; (4) Social mobilization for immunization. Data were obtained from random sampling investigations, vaccination service statistics and qualitative interviews with vaccinators and mothers of migrant children. The analysis of quantitative data was based on a "before and after" evaluation and qualitative data were analyzed using content analysis. RESULTS The immunization registration (records kept by immunization clinics) rate increased from 87.4 to 91.9% (P = 0.016) after implementation of the EPI intervention package and the EPI card holding (EPI card kept by caregivers) rate increased from 90.9 to 95.6% (P = 0.003). The coverage of fully immunized increased from 71.5 to 88.6% for migrant children aged 1-4 years (P < 0.001) and increased from 42.2 to 80.5% for migrant children aged 2-4 years (P < 0.001). The correct response rates on valid doses and management of adverse events among vaccinators were over 90% after training. The correct response rates on immunization among mothers of migrant children were 86.8-99.3% after interventions. CONCLUSION Our study showed a substantial improvement in vaccination coverage among migrant children in Yiwu after implementation of the EPI intervention package. Further studies are needed to evaluate the cost-effectiveness of the interventions, to identify individual interventions that make the biggest contribution to coverage, and to examine the sustainability of the interventions within the existing vaccination service delivery system in a larger scale settings or in a longer term.
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Affiliation(s)
- Yu Hu
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Shuying Luo
- Yiwu Center for Disease Control and Prevention, Institute of Immunization and Prevention, Yiwu, China.
| | - Xuewen Tang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Linqiao Lou
- Yiwu Center for Disease Control and Prevention, Institute of Immunization and Prevention, Yiwu, China.
| | - Yaping Chen
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Jing Guo
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
| | - Bing Zhang
- Zhejiang Center for Disease Control and Prevention, Institute of Immunization and Prevention, No. 3399 Binsheng Road, Binjiang District, Hangzhou, P. R. China.
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Does an education seminar intervention improve the parents' knowledge on vaccination? Evidence from Yiwu, East China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3469-79. [PMID: 25811770 PMCID: PMC4410197 DOI: 10.3390/ijerph120403469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND caregivers' knowledge on vaccination is an important impact factor for their children's vaccination status. The aims of this study were to evaluate the caregivers' knowledge of vaccination, and to assess effectiveness of a health education seminar for improving caregivers' knowledge on immunization. METHODS pre- and post-assessment design was adopted for a single group to evaluate the effectiveness of the health education seminar on vaccination. The seminar consisted of a lecture using simple understandable language. Improvements in total knowledge score before and after the seminar were assessed using a validated questionnaire that included ten questions. Description analysis and non-parametric tests were applied to evaluate and compare the vaccination knowledge level before and after the seminar. RESULTS 378 caregivers participated in this study. The majority were mothers. Of the ten questions, the correct response rates had significantly increased for nine questions after the education seminar. The mean total score of the assessment before the seminar was 5.2 ± 1.2 while that was 8.4 ± 0.9 for the assessment after the seminar, with a significant increase of 3.18 points. CONCLUSION a short education seminar designed for caregivers had a remarkable effect on their vaccination knowledge. Health education on vaccination targeting migrant caregivers, caregivers with lower education level or household income, and employed caregivers are needed in future.
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Emmanuel OW, Samuel AA, Helen KL. Determinants of childhood vaccination completion at a peri-urban hospital in Kenya, December 2013 -January 2014: a case control study. Pan Afr Med J 2015; 20:277. [PMID: 26161200 PMCID: PMC4484325 DOI: 10.11604/pamj.2015.20.277.5664] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 03/18/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Vaccine preventable diseases account for about 17% of deaths among children below five years in Kenya. Immunization is one the most cost-effective ways of reducing child mortality and morbidity worldwide. In Kenya, national full vaccination coverage today stands at above 80%. However there continue to be pockets of low full vaccination coverage like the catchment area of Alupe Sub-District Hospital which pose a threat to the rest of the country. METHODS This was a case-control study at Alupe Sub-District Hospital, Western Kenya. Sixty one (61) cases and 122 controls were sampled from the facility maternal and child health register by systematic random sampling and traced to their households. Cases were defined as children 12-23 months resident in Kenya who received at least one infant vaccine at the facility but were not fully vaccinated at the time of the study, while controls were children 12-23 months who were fully vaccinated by the time of the study. Pretested structured questionnaires were used for data collection. Data entry and analysis was done using Epi-Info 3.5.4 statistical software. RESULTS Independent determinants of infant vaccination completion were the child's age < 18 months (AOR 4.2(1.8-9.6), p < 0.01), maternal age < 25 years (AOR 2.5(1.1-5.0), p = 0.03), maternal tetanus toxoid vaccination status < 2 TT doses (AOR 2.5(1.2-5.4), p < 0.02) and late receipt of BCG [AOR 3.2(1.4-7.3), p = 0.005). CONCLUSION Strategies to increase full vaccination should target young mothers especially during antenatal period.
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Affiliation(s)
| | - Amwayi Anyangu Samuel
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
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Maltezou HC, Lionis C. The financial crisis and the expected effects on vaccinations in Europe: a literature review. Infect Dis (Lond) 2015; 47:437-46. [PMID: 25739315 DOI: 10.3109/23744235.2015.1018315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Starting in 2008 several European countries experienced a financial crisis. Historically, diseases whose prevention and treatment depend highly on the continuity of healthcare re-emerge during political and financial crises. Evidence suggests that the current financial crisis has had an impact on the health and welfare of Europeans and that population health status and morbidity as well as mortality patterns may change in the coming years. At the same time decisions about expenditure for health services may impact the ability of public health providers to respond. It is expected that the current crisis will further exacerbate socioeconomic and health inequalities and novel vulnerable groups will emerge in addition to existing ones. We review the available evidence and discuss how the current crisis may have an impact on vaccine-preventable diseases and influence vaccination coverage rates in Europe.
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Affiliation(s)
- Helena C Maltezou
- From the 1 Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention , Athens
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Branco FLCC, Pereira TM, Delfino BM, Braña AM, Oliart-Guzmán H, Mantovani SAS, Martins AC, Oliveira CSDM, Ramalho AA, Codeço CT, da Silva-Nunes M. Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil. Int J Equity Health 2014; 13:118. [PMID: 25428334 PMCID: PMC4256802 DOI: 10.1186/s12939-014-0118-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Vaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination. Methods A census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes. Results Only 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95). Conclusions This study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.
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Affiliation(s)
| | | | - Breno Matos Delfino
- Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil.
| | - Athos Muniz Braña
- Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil.
| | | | | | | | | | | | - Claudia Torres Codeço
- Scientific Computing Program, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, Brazil.
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Abstract
Since its foundation 30 years ago, the mission of the Asia-Pacific Academic Consortium for Public Health has been promoting “health for all” through public health. “Health for all” became the theme of Walter Patrick’s public health career and inspired his contribution to APACPH. However, the universality of health care is now under threat, more from economists and politicians than public health workers. Health for all remains a continuing challenge for all public health workers in our region. Progress is being made toward this goal as life expectancy in the Western Pacific has increased from 64 to 78 in the past 3 decades. Prof Walter Patrick was strong public health advocate, and this review was written as a tribute to good friend and inspiring colleague who believed in, and worked for “health for all.”
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Public health workers and vaccination coverage in Eastern China: a health economic analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5555-66. [PMID: 24859680 PMCID: PMC4053906 DOI: 10.3390/ijerph110505555] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/16/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022]
Abstract
Background: Vaccine-preventable diseases cause more than one million deaths among children under 5 years of age every year. Public Health Workers (PHWs) are needed to provide immunization services, but the role of human resources for public health as a determinant of vaccination coverage at the population level has not been assessed in China. The objective of this study was to test whether PHW density was positively associated with childhood vaccination coverage in Zhejiang Province, East China. Methods: The vaccination coverage rates of Measles Containing Vaccine (MCV), Diphtheria, Tetanus and Pertussis combined vaccine (DTP), and Poliomyelitis Vaccine (PV) were chosen as the dependent variables. Vaccination coverage data of children aged 13–24 months for each county in Zhejiang Province were taken from the Zhejiang Immunization Information System (ZJIIS). Aggregate PHW density was an independent variable in one set of regressions, and Vaccine Personnel (VP) and other PHW densities were used separately in another set. Data on densities of PHW and VP were taken from a national investigation on EPI launched by Ministry of Health of China in 2013. We controlled other determinants that may influence the vaccination coverage like Gross Domestic Product (GDP) per person, proportion of migrant children aged <7 years, and land area. These data were taken from Zhejiang Provincial Bureau of Statistics and ZJIIS. Results: PHW density was significantly influence the coverage rates of MCV [Adjusted Odds Ratio(AOR) = 4.29], DTP3(AOR = 2.16), and PV3 (AOR = 3.30). However, when the effects of VPs and other PHWs were assessed separately, we found that VP density was significantly associated with coverage of all three vaccinations (MCV AOR = 7.05; DTP3 AOR = 1.82; PV3 AOR = 4.83), while other PHW density was not. Proportion of migrant children < 7 years and Land area were found as negative and significant determinants for vaccination coverage, while GDP per person had no effect on vaccination coverage. Conclusions: A higher density of PHWs (VP) would improve the availability of immunization services over time and space, which may increase the possibility of achieving a higher childhood vaccination coverage rate. It was indicated that the level of GDP per person had no association with the improved vaccination coverage after controlling for other potential factors. Our findings implicated that PHW density was a major constraint on immunization coverage in Zhejiang Province.
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Hu Y, Chen Y, Guo J, Tang X, Shen L. Completeness and timeliness of vaccination and determinants for low and late uptake among young children in eastern China. Hum Vaccin Immunother 2014; 10:1408-15. [PMID: 24584000 DOI: 10.4161/hv.28054] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We studied completeness and timeliness of vaccination and determinants for low and delayed uptake in children born between 2008 and 2009 in Zhejiang province in eastern China. METHODS We used data from a cross-sectional cluster survey conducted in 2011, which included 1146 children born from 1 Jan 2008 to 31 Dec 2009. Various vaccination history, social-demographic factors, attitude and satisfaction toward immunization from caregivers were collected by a standard questionnaire. We restricted to the third dose of HepB, PV, and DPT (HepB3, PV3, and DPT3) as outcome variables for completeness of vaccination and restricted to the first dose of HepB, PV, DPT, and MCV(HepB1, PV1, DPT1, and MCV1) as outcome variables for timeliness of vaccination. The χ(2) test and logistic regression analysis were applied to identify the determinants of completeness and timeliness of vaccination. Survival analysis by the Kaplan-Meier method was performed to present the timeliness vaccination. RESULTS Coverage for HepB1, HepB3, PV1, PV3, DPT1, DPT3, and MCV1 was 93.22%, 90.15%, 96.42%, 91.63%, 95.80%, 90.16%, and 92.70%, respectively. Timely vaccination occurred in 501/1146(43.72%) children for HepB1, 520/1146(45.38%) for PV1, 511/1146(44.59%) for DPT1, and 679/1146(59.25%) for MCV1. Completeness of specific vaccines was associated with mother' age, immigration status, birth place of child, maternal education level, maternal occupation status, socio-economic development level of surveyed areas, satisfaction toward immunization service and distance of the house to immunization clinic. Timeliness of vaccination for specific vaccines was associated with mother' age, maternal education level, immigration status, siblings, birth place, and distance of the house to immunization clinic. CONCLUSION Despite reasonably high vaccination coverage, we observed substantial vaccination delays. We found specific factors associated with low and/or delayed vaccine uptake. These findings can help to improve strategies such as Reaching Every District (RED), out-reach vaccination services and health education to reach children who remain inadequately protected.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Yaping Chen
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Jing Guo
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Xuewen Tang
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
| | - Lingzhi Shen
- Institute of Immunization and Prevention; Zhejiang Center for Disease Control and Prevention; Hangzhou, PR China
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Ma C, Hao L, Zhang Y, Su Q, Rodewald L, An Z, Yu W, Ma J, Wen N, Wang H, Liang X, Wang H, Yang W, Li L, Luo H. Monitoring progress towards the elimination of measles in China: an analysis of measles surveillance data. Bull World Health Organ 2014; 92:340-7. [PMID: 24839323 DOI: 10.2471/blt.13.130195] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/28/2013] [Accepted: 12/31/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyse the epidemiology of measles in China and determine the progress made towards the national elimination of the disease. METHODS We analysed measles surveillance data - on the age, sex, residence and vaccination status of each case and the corresponding outcome, dates of onset and report and laboratory results - collected between January 2005 and October 2013. FINDINGS Between 2005 and October 2013, 596 391 measles cases and 368 measles-related deaths were reported in China. Annual incidence, in cases per 100 000 population, decreased from 9.95 in 2008 to 0.46 in 2012 but then rose to more than 1.96 in 2013. The number of provinces that reported an annual incidence of less than one case per million population increased from one in 2009 to 15 in 2012 but fell back to one in 2013. Median case age decreased from 83 months in 2005 to 14 months in 2012 and 11 months in January to October 2013. Between 2008 and 2012, the incidence of measles in all age groups, including those not targeted for vaccination, decreased by at least 93.6%. However, resurgence started in late 2012 and continued into 2013. Of the cases reported in January to October 2013, 40% were aged 8 months to 6 years. CONCLUSION Although there is evidence of progress towards the elimination of measles from China, resurgence in 2013 indicated that many children were still not being vaccinated on time. Routine immunization must be strengthened and the remaining immunity gaps need to be identified and filled.
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Affiliation(s)
- Chao Ma
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Lixin Hao
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Yan Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiru Su
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | | | - Zhijie An
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Wenzhou Yu
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Jing Ma
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Ning Wen
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Huiling Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huaqing Wang
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Weizhong Yang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Li
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Huiming Luo
- National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
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