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

Of Money and Men: A Scoping Review to Map Gender Barriers to Immunization Coverage in Low- and Middle-Income Countries

Among the multiple factors impeding equitable childhood immunization coverage in low- and middle-income countries (LMICs), gender barriers stand out as perhaps the most universal. Despite increasing recognition of the importance of gender considerations in immunization programming, there has not yet been a systematic assessment of the evidence on gender barriers to immunization. We conducted a scoping review to fill that gap, identifying 92 articles that described gender barriers to immunization. Studies documented a range of gender influencers across 43 countries in Africa and South Asia. The barrier to immunization coverage most frequently cited in the literature is women's lack of autonomous decision-making. Access to immunization is significantly impacted by women's time poverty; direct costs are also a barrier, particularly when female caregivers rely on family members to cover costs. Challenges with clinic readiness compound female caregiver's time constraints. Some of the most important gender barriers lie outside of the usual purview of immunization programming but other barriers can be addressed with adaptations to vaccination programming. We can only know how important these barriers are with more research that measures the impact of programming on gender barriers to immunization coverage.

Contextualising missed opportunities for children's vaccination: A theory-informed qualitative study in primary care settings in Cape Town, South Africa

This study aimed to explore the contextual factors that may be associated with missed opportunities for vaccination (MOV) from the perspectives of healthcare providers and caregivers attending primary healthcare facilities in the Cape Town Metro Health District, South Africa. The ultimate goal of the assessment was to help inform the design and implementation of a contextually appropriate quality improvement programme targeted at reducing MOV in primary healthcare settings. We used a theory-informed exploratory qualitative research design involving focus group discussions with caregivers of children aged 0-23 months; and in-depth interviews of facility staff. A thematic template analysis approach, integrating the theoretical domains framework (TDF) and the capability, opportunity and motivation model of behavior (COM-B) was used to code and analyze the data. Three focus group sessions were conducted, each consisting of 5-8 caregivers and five in-depth interviews involving facility staff. Capability factors comprised caregivers' knowledge, attitude and behavior toward children's immunization. Opportunity factors included the organization of immunization services, long waiting time, vaccine stock out, staff shortage and health workers' attitude, knowledge and capability to assess children's immunization status and needs. Motivation factors included optimism and beliefs about immunization, fear of vaccine-preventable diseases and immunization safety concerns. This study identified important caregiver-, provider- and health system-related factors, which influence immunization outcomes; offering useful contextual insights for informing quality improvement strategies for reducing MOV at primary healthcare level.

Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa

BACKGROUND

We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services.

METHODS

Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey.

RESULTS AND DISCUSSION

The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence.

CONCLUSIONS

The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.

Missed opportunity for routine vaccination and associated factors among children aged 0-23 months in public health facilities of Jimma Town

The current recommendation obligates children to receive all vaccines within two years of birth. The Expanded Program on Immunization (EPI) was established in Ethiopia to increase the immunization rate by 10% annually and to reach 100% in 10 years but not been achieved in twenty years. Missed opportunity for vaccination (MOV) is one of the major factors in vaccination coverage. Hence, this study aimed to assess the prevalence of MOV and associated factors in Jimma Town public health facilities. A facility-based cross-sectional study design was employed with a quantitative data collection method. The sample size was calculated using a single population proportion formula. The data were collected through face-to-face interviews, and data extraction methods and analyzed using SPSS version 26. The statistical association was decided at p-value <0.05 with 95% CI, and AOR. A total of 422 children were involved in this study making a 100% response rate. The magnitude of MOV was 39.8% (95%CI: 35-45). Parents/caretakers have not attended formal education (AOR = 4.65, CI:1.64-13.24), residing in rural (AOR = 2.60, CI: 1.35-5.03), poor knowledge about immunization (AOR = 2.61, CI: 1.58-4.30), the child not assessed for vaccination status (AOR = 3.01, CI: 1.65-5.49), and parents/caretakers not seen/heard vaccination message in the last month (AOR = 2.42, CI: 1.40-4.18) were statistically positively associated with the MOV. In conclusion, this study indicated that MOV among the children was high in the study facilities. The researchers recommended stakeholders work on strengthening community awareness creation. Additionally, further study incorporating physician-related factors is also suggested.