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Sakaue T, Sugawara T, Mukasa K, Nohara M. Varicella outbreak at nursery school under routine immunization in Japan in 2017 and 2018 and vaccine effectiveness. Vaccine 2024; 42:2637-2645. [PMID: 38480103 DOI: 10.1016/j.vaccine.2024.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND In Japan, routine administration to one-year-old children of two-dose immunization for varicella was introduced in October 2014. Object The object of this study was to report outbreaks of varicella under routine immunization at a nursery school and in its surrounding area using data of surrounding areas from the (Nursery) School Absenteeism Surveillance System. Then, we measured the effectiveness of routine two-dose immunization for varicella to onset. We tentatively assessed its severity in a nursery school. METHOD The study period extended from April 2017 through March 2018. The study area comprised Nursery school B and other nursery schools, and elementary and junior high schools in City A. Subjects in Nursery school B were 120 children. We analyzed vaccine effectiveness (VE) as an observational study and assessed severity using Fisher's exact test. We also assessed VE for severity using linear regression. Severity was defined as the length of nursery school absence attributable to varicella infection. RESULTS During the one month preceding a period of two weeks before the initial case at Nursery school B, there were 16 cases of varicella infection in nursery schools, 45 cases in elementary schools, and one case in junior high schools in City A. For children who had received one vaccine dose or more, VE was 48.1% for all ages and 49.2% among children three years old and older. No significant VE against infection was found. Vaccination using one dose or more can reduce severity significantly. DISCUSSION AND CONCLUSION Because many nursery school children who had received two doses of vaccine were infected, VE was estimated as low in the nursery school and not significant. Although VE for severity with more than one dose was confirmed, a second dose might not reduce severity compared to one dose.
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Affiliation(s)
| | - Tamie Sugawara
- National Institute of Infectious Diseases, Tokyo, Japan.
| | - Kyoko Mukasa
- Department of Social Welfare, Faculty of Humanities and Social Science, Showa Women's University, Tokyo, Japan
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Jabbar F, Kadhim KA, Alhilfi RA, Chitheer A, Rahi A, Hipgrave DB. Intensification of integrated immunization services to recover routine vaccination coverage and bring COVID-19 vaccine to the population of Iraq in 2022. Vaccine 2024; 42:2036-2043. [PMID: 38418341 DOI: 10.1016/j.vaccine.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION COVID-19 seriously impacted routine immunization (RI) in Iraq. Coverage declined to a 6-year low in 2021, and COVID-19 vaccination uptake was slow. In response, government implemented intensification of integrated immunization services (3IS), a nationwide approach comprising regular outreach sessions of COVID-19 vaccination and RI for children who had either missed doses or never commenced scheduled vaccination (zero-dose children). We describe the 3IS and its impact on vaccination coverage in Iraq. METHODS 3IS comprised new outreach sessions for urban and rural communities where administrative data suggested there were gaps in coverage. Groups of six personnel from each of 1,321 primary healthcare centres implemented six outreach sessions per month during February-November 2022. Community engagement was an integral component. We compared RI administrative data (2019-2022) and data reported during 3IS activities to assess its impact. RESULTS In total 4,189,859 vaccine doses were administered during 72,495 3IS outreach sessions, over one-fifth of 19,106,849 vaccine doses administered in Iraq over these 10 months. Among them, 957,874 (22.9 %) were COVID-19 vaccines, adding slightly to national coverage, and 3,231,985 (77.1 %) were RI vaccines, dramatically reducing zero-dose children, adding 18 %, 25 %, 21 %, and 31 % to 2022 penta1, penta3, measles first-dose and MMR1 vaccine coverage, and contributing to national coverage of 102.2 %, 94.5 %, 91.8 % and 96.3 % for these vaccines during February-November, respectively. Moreover, 3IS sessions delivered 133,528 doses of tetanus toxoid, 16,353 doses of adult HepB vaccine, and 315,032 vitamin A doses to eligible individuals. CONCLUSION In the context of global encouragement to integrate vaccination services, Iraq's 3IS approach enabled dramatic improvements in RI coverage, virtual elimination of zero-dose status among children born during the pandemic, and small improvements in COVID-19 and adult vaccination. Our findings provide lessons for future integrated primary care towards universal health coverage in Iraq, and for other countries yet to undertake integration.
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Affiliation(s)
- Firas Jabbar
- Expanded Programme on Immunization, Ministry of Health, Baghdad, Iraq
| | - Kamal A Kadhim
- Expanded Programme on Immunization, Ministry of Health, Baghdad, Iraq
| | | | - Abdulaal Chitheer
- Expanded Programme on Immunization, Ministry of Health, Baghdad, Iraq
| | - Alaa Rahi
- Health and Nutrition Section, UNICEF, Baghdad, Iraq.
| | - David B Hipgrave
- Health and Nutrition Section, UNICEF, Baghdad, Iraq; Saw Swee Hock School of Public Health, National University of Singapore; SingHealth Duke-NUS Global Health Institute, Singapore.
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Cao Z, Yu R, Yuan Q, Ji W, Li X, Gao P, Miao L, Wen X, Suo L. Impact of the COVID-19 pandemic on routine vaccination coverage under varying prevalence Conditions: A cohort study in Beijing, China. Vaccine 2024; 42:213-219. [PMID: 38097454 DOI: 10.1016/j.vaccine.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND The COVID-19 pandemic has experienced various phases including outbreaks, a global health crisis, and eventual de-escalation from a public health emergency of international concern, significantly affecting the delivery and utilization of healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on the coverage rate of routine immunization in children under varying prevalence conditions. METHODS We conducted a retrospective, population-based cohort study in Beijing, China, utilizing stratified random sampling by birthdate to obtain a sample of 29,811 participants. Subjects were categorized into four cohorts based on when they became eligible for vaccination: the Pre-COVID Period cohort, the COVID-19 Low Epidemic Period cohort, the COVID-19 Surging Period cohort, and the COVID-19 Slowing Down Period cohort. A one-month follow-up was conducted. Cox proportional hazards model was employed to examine associations between the COVID-19 epidemic status and timely vaccination. RESULTS Participants age-eligible for vaccination during the COVID-19 Low Epidemic Period demonstrated higher rates of timely vaccination (HR 1.18, 95% CI 1.15-1.22) compared to those eligible during the Pre-COVID Period. Conversely, those eligible during the COVID-19 Surging Period displayed lower rates (HR 0.73, 95% CI 0.66-0.82). No significant difference in vaccination timeliness was observed for those eligible during the COVID-19 Slowing Down Period in comparison to the Pre-COVID Period (HR 0.99, 95% CI 0.91-1.09). By the end of May 2023, DTP3 rate among eligible children during the COVID-19 Surging Period had surpassed 90%. CONCLUSIONS Significantly declining rates of timely vaccination were observed during the COVID-19 Surging Period, which lasted two months, but not during the nearly three-year-long COVID-19 Low Epidemic Period. An upward trend in vaccination timeliness followed, culminating in a return to baseline levels over the subsequent 3-4 months. Our findings suggested that the pandemic exerted a decreasing and recoverable impact on the coverage rate of routine immunizations in China.
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Affiliation(s)
- Zhiqiang Cao
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Rui Yu
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Qianli Yuan
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Wenyan Ji
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Xiaomei Li
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Pei Gao
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Liang Miao
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Xiaojing Wen
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China
| | - Luodan Suo
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 10013, China.
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Fadl N, Abdelmoneim SA, Gebreal A, Youssef N, Ghazy RM. Routine childhood immunization in Sub-Saharan Africa: addressing parental vaccine hesitancy. Public Health 2024; 226:66-73. [PMID: 38007843 DOI: 10.1016/j.puhe.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries. STUDY DESIGN A cross-sectional study was conducted from November 1 to December 15, 2022. METHODS Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed. RESULTS Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10-1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19-1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69-2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19-0.32), and had a healthcare facility-based delivery (AOR = 0.55, 95% CI: 0.44-0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68-16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10-0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95-0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44-0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166-0.00168). CONCLUSIONS Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage.
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Affiliation(s)
- N Fadl
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | - S A Abdelmoneim
- Clinical Research Administration, Directorate of Health Affairs, Egyptian Ministry of Health, Alexandria, Egypt.
| | - A Gebreal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - N Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Saudi Arabia.
| | - R M Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
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Banza Mpiongo P, Kibanza J, Kambol Yav F, Nyombo D, Mwepu L, Basame D, Mpoyi R, Madika C, Hatton T, Mafuta E, Gascon O, Tschirhart K, Nkosi F, Lusamba P, Merritt S, Mwenda J, Tangney S, Hoff NA, Nkamba Mukadi D, Rimoin AW, Kaba D, El Mourid A, Senouci K, Ngoie Mwamba G, Mukamba Musenga E, Cikomola A. Strengthening immunization programs through innovative sub-national public-private partnerships in selected provinces in the Democratic Republic of the Congo. Vaccine 2023; 41:7598-7607. [PMID: 37989612 DOI: 10.1016/j.vaccine.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/27/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Low immunization coverage rates in the Democratic Republic of Congo (DRC) have been reflective of challenges with vaccine access, support and delivery in the country. Motivated by measles and vaccine-derived polio virus (VDPV) outbreaks in 2016-17 and low vaccination rates, the provinces of Haut Lomami and Tanganyika were identified as pilot locations for an innovative approach focused on establishing a consortium of partners supporting local government. This approach was formalized through Memorandums of Understanding (MoUs) between the Bill and Melinda Gates Foundation and Provincial governments in 2018. A third province, Lualaba, established an MoU in 2021. MOU IMPLEMENTATION These MoUs were 5-year partnerships designed to aid provinces in meeting four key objectives: 80 % immunization coverage, management/elimination of polio/cVDPV outbreaks, improvement of vaccine accessibility, and transfer of immunization service management to provincial leadership. OUTCOMES During the MoU period, Haut-Lomami saw an increase in full immunization coverage, from 35.7 % (MICS 2018) to 88.9 % (VCS 2021-22), the highest in country. A sharp drop in percentage of zero-dose children was observed in the 3 provinces, confirming improved access to immunization services. Tanganyika saw initial improvement in full immunization coverage, followed by a drop in the VCS 2021-22 due to COVID-19 and healthcare worker strikes. Coverage improved in Tanganyika in the 2023 VCS. The 3 provinces increased their financial contributions to routine immunization and are now the top contributing provinces. While no cVDPV cases were recorded in 2020 and 2021, cVDPV1 and cVDPV2 outbreaks are afflicting the 3 provinces since 2022. CONCLUSIONS Ultimately, the provincial MoUs were successful in bolstering provincial autonomy and capacity building with the biggest success being a drop in zero-dose children. While not all objectives have been met, the MoU approach served as an innovative program for key aspects of strengthening routine immunization in the DRC.
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Affiliation(s)
- Patrick Banza Mpiongo
- Provincial Division of Health, Ministry of Health, Haut Lomami, Democratic Republic of the Congo
| | - Jerry Kibanza
- Provincial Division of Health, Ministry of Health, Tanganyika, Democratic Republic of the Congo
| | - Francis Kambol Yav
- Provincial Division of Health, Ministry of Health, Lualaba, Democratic Republic of the Congo
| | - Didier Nyombo
- McKing Consulting, Kinshasa, Democratic Republic of the Congo
| | - Lucie Mwepu
- McKing Consulting, Kinshasa, Democratic Republic of the Congo
| | - Djogo Basame
- McKing Consulting, Kinshasa, Democratic Republic of the Congo
| | - Raoul Mpoyi
- McKing Consulting, Kinshasa, Democratic Republic of the Congo.
| | - Collard Madika
- McKing Consulting, Kinshasa, Democratic Republic of the Congo
| | - Trad Hatton
- PATH, Kinshasa, Democratic Republic of the Congo.
| | - Eric Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Freddy Nkosi
- VillageReach RDC, Kinshasa, Democratic Republic of the Congo.
| | - Paul Lusamba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Sydney Merritt
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Julio Mwenda
- PATH, Kinshasa, Democratic Republic of the Congo.
| | - Sylvia Tangney
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Dalau Nkamba Mukadi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Didine Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
| | | | | | | | | | - Aimé Cikomola
- Expanded Programme for Immunization, Minister of Health, Kinshasa, Democratic Republic of the Congo
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Sigdel B, Jin Y, Dhakal P, Luitel T, Ghimire PK, Wasti SP. Factors affecting on compliance of childhood immunization in Ilam District of Nepal; A case-control study. Dialogues Health 2023; 2:100140. [PMID: 38515491 PMCID: PMC10953870 DOI: 10.1016/j.dialog.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 03/23/2024]
Abstract
Childhood immunization is one of the most important public health interventions to reduce child morbidity and mortality. Reaching all children with full immunization services is critical to meet Nepal's commitment to Sustainable Development Goals (SDGs). This study aimed to identify factors affecting compliance with childhood immunization in children aged 16 to 36 months in Nepal. A community-based unmatched case-control study was conducted with 250 (83 cases and 167 controls) respondents in the Ilam district of Nepal. Respondents were randomly selected using a multi-stage cluster sampling technique. Data were collected using a structured questionnaire and analysed using SPSS version 16 statistical software. Bivariate and multivariate logistic regression analyses were done to identify the factors influencing compliance with childhood immunization of the sampled respondents. More than two-thirds (66.8%) of the sampled children were fully immunized, and 19.3% of the children defaulted to the Measles-Rubella vaccines. Only 19.2% of the respondents had good knowledge about the type of vaccine, and more than half (59.2%) of the respondents had a positive attitude towards immunization. Multivariate logistic regression analysis revealed that lack of knowledge about vaccines (AOR = 49.4, 95% CI = 12.94 to 188.59), father's level of education (AOR = 2.1, 95% CI = 1.05 to 4.30), not getting immunization on the day of the appointment (AOR = 4.8, 95% CI = 2.30 to 9.89), lack of knowledge about immunization schedule (AOR = 2.4, 95% CI = 1.14 to 4.84), and negative attitude towards immunization (AOR = 2.1, 95% CI = 1.03 to 4.19) were independently impeded on compliance on the childhood immunization. Targeted intervention in health promotion activities at the household level should be promoted and integrated immunization services into the existing primary health care services.
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Affiliation(s)
| | - Yan Jin
- Xiang Ya Nursing School, Central South University, Changsha, China
| | - Pushpa Dhakal
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Luitel
- Emergency Department, Ilam Hospital, Ilam, Nepal
| | | | - Sharada P. Wasti
- School of Human Sciences, University of Greenwich, London, United Kingdom
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Grills LA, Wagner AL. The impact of the COVID-19 pandemic on parental vaccine hesitancy: A cross-sectional survey. Vaccine 2023; 41:6127-6133. [PMID: 37659897 PMCID: PMC10954085 DOI: 10.1016/j.vaccine.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND It is unclear how hesitancy towards pediatric vaccines has changed quantitatively since the onset of the COVID-19 pandemic, and if changes are more readily apparent in clusters of low COVID-19 vaccination. In this study, we assess how clusters of low COVID-19 vaccination correlate with changing parental beliefs about childhood vaccines. METHODS A cross-sectional, opt-in, internet-based survey of parents resident in the U.S. was conducted during August-September 2022. Our survey measured changes in beliefs about childhood vaccine safety, importance, and effectiveness since the start of COVID-19. We also measured parents' perceived vaccination rates in the community, assessing its relationship with changing vaccination perceptions using Rao-Scott chi-square tests, and multinomial logistic regression models. RESULTS Among 310 parents of children 0-17 years old, 11 % (95 % CI: 7 %, 15 %) believed that childhood vaccines are less safe, 12 % (95 % CI: 8 %, 17 %) less important, and 13 % (95 % CI: 9 %, 18 %) less effective since the start of the COVID-19 pandemic. About 9 % (95 % CI: 5 %, 12 %) stated COVID-19 vaccination coverage was low in their community. Among those who stated COVID-19 vaccination coverage was low, 38 % reported believing childhood vaccines were less effective (vs 12 % of those who stated vaccination coverage was high). This corresponds to 4.34 times greater odds of believing childhood vaccines were less effective since the start of the pandemic (95 % CI: 1.38, 13.73) in those who believe COVID-19 vaccination coverage to be low in their community vs high. CONCLUSION Our study demonstrates that parental perceptions about childhood vaccines have been affected by the COVID-19 pandemic through geographic and social clustering of non-vaccination. Beliefs about the COVID-19 vaccine have spillover with beliefs about childhood vaccines, and more negative beliefs may be clustering in areas with low vaccination coverage, which could predispose the area to outbreaks of vaccine-preventable disease.
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Affiliation(s)
- Lily A Grills
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
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Escoffery C, Ogutu EA, Sakas Z, Hester KA, Ellis A, Rodriguez K, Jaishwal C, Yang C, Dixit S, Bose A, Sarr M, Kilembe W, Bednarczyk RA, Freeman MC. Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: a multiple case study analysis using the Consolidated Framework for Implementation Research. Implement Sci Commun 2023; 4:109. [PMID: 37667374 PMCID: PMC10478385 DOI: 10.1186/s43058-023-00489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies - including the facilitators and barriers - contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success. METHODS We conducted 278 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) constructs of inner and outer settings to identify immunization program key facilitators and barriers. RESULTS We found that the common facilitators to program implementation across the countries were the CFIR inner setting constructs of (1) networks and communications, (2) goals and feedback, (3) relative priority, and (4) readiness for implementation and outer setting constructs of (5) cosmopolitanism and (6) external policies and mandates. The common barriers were incentives and rewards, available resources, access to knowledge and information, and patients' needs and resources. Critical to the success of these national immunization programs were prioritization and codification of health as a human right, clear chain of command and shared ownership of immunization, communication of program goals and feedback, offering of incentives at multiple levels, training of staff central to vaccination education, the provision of resources to support the program, key partnerships and guidance on implementation and adoption of vaccination policies. CONCLUSION Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Zoe Sakas
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kyra A Hester
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Ellis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katie Rodriguez
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chandni Jaishwal
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chenmua Yang
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sameer Dixit
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - Anindya Bose
- WHO Nepal Immunization Preventable Disease Division, Kathmandu, Nepal
| | - Moussa Sarr
- Institut de Recherche en Santé de Surveillance Epidemiologique Et de Formation (IRESSEF), Dakar, Senegal
| | - William Kilembe
- Center for Family, Health Research in Zambia, Lusaka, Zambia
| | | | - Matthew C Freeman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Lucinde RK, Karia B, Ouma N, Amadi D, Nyundo C, Mataza C, Nyaguara A, Scott JAG, Gallagher KE, Kagucia E. The impact of the COVID-19 pandemic on vaccine coverage in Kilifi, Kenya: A retrospective cohort study. Vaccine 2023; 41:666-75. [PMID: 36543684 DOI: 10.1016/j.vaccine.2022.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic caused unprecedented disruption in health service delivery, globally. This study sought to provide evidence on the impact of the pandemic on vaccine coverage in Kilifi County, Kenya. We conducted a vaccine coverage survey between April and June 2021 within the Kilifi Health and Demographic Surveillance System (KHDSS). Simple random sampling was used to identify 1500 children aged 6 weeks-59 months. Participants were grouped into three retrospective cohorts based on when they became age-eligible for vaccination: before the pandemic, during the first year, or during the second year of the pandemic. Survival analysis with Cox regression was used to evaluate the association between the time-period at which participants became age-eligible for vaccination and the rate of vaccination within a month of age-eligibility for the third dose of pentavalent vaccine (Pentavalent-3) and within three months of age-eligibility for the first dose of Measles vaccine (MCV-1). A total of 1,341 participants were included in the survey. Compared to the pre-COVID-19 baseline period, the rate of vaccination within a month of age-eligibility for Pentavalent-3 was not significantly different in the first year of the pandemic (adjusted hazard ratio [aHR] 1.03, 95 % confidence interval [CI] 0.90-1.18) and was significantly higher during the second year of the pandemic (aHR 1.33, 95 % CI 1.07-1.65). The rate of vaccination with MCV-1 within three months of age-eligibility was not significantly different among those age-eligible for vaccination during the first year of the pandemic (aHR 1.04, 95 % CI 0.88-1.21) and was 35 % higher during the second year of the pandemic (95 % CI 1.11-1.64), compared to those age-eligible pre-COVID-19. After adjusting for known determinants of vaccination, the COVID-19 pandemic did not adversely affect the rate of vaccination within the KHDSS.
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Prosperi C, Thangaraj J, Hasan A, Kumar M, Truelove S, Kumar V, Winter A, Bansal A, Chauhan S, Grover G, Jain A, Kulkarni R, Sharma S, Soman B, Chaaithanya I, Kharwal S, Mishra S, Salvi N, Sharma N, Sharma S, Varghese A, Sabarinathan R, Duraiswamy A, Rani D, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Chonker S, Cutts F, Sangal L, Mehendale S, Sapkal G, Gupta N, Hayford K, Moss W, Murhekar M. Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20. Vaccine 2023; 41:486-495. [PMID: 36481106 PMCID: PMC9831119 DOI: 10.1016/j.vaccine.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.
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Affiliation(s)
- C. Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J.W.V. Thangaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A.Z. Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M.S. Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - S. Truelove
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V.S. Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A.K. Winter
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A.K. Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - S.L. Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - G.S. Grover
- Directorate of Health Services, Government of Punjab, Chandigarh, India
| | - A.K. Jain
- ICMR-National Institute of Pathology, New Delhi, India
| | - R.N. Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - S.K. Sharma
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
| | - B. Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - I.K. Chaaithanya
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - S. Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - S.K. Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - N.R. Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - N.P. Sharma
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - S. Sharma
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - A. Varghese
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - R. Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A. Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D.S. Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - K. Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A. Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - P. Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - M. Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - S.K. Chonker
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - F.T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - L. Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | - S.M. Mehendale
- PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - G.N. Sapkal
- ICMR-National Institute of Virology, Pune, India
| | - N. Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - K. Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W.J. Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author at: International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - M.V. Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
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Claire Endegue M, Sein C, Lopez Cavestany R, Jeyaseelan V, Palmer T, Norbert Soke G, Diaha A, Jafri B, Mainou BA, Verma H, Mach O. Community-based survey to assess seroprevalence of poliovirus antibodies in far-north Cameroon in 2020. Vaccine X 2022; 12:100244. [PMID: 36560978 PMCID: PMC9763508 DOI: 10.1016/j.jvacx.2022.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background This study assessed seroprevalence of poliovirus antibodies in children from selected poliovirus high-risk areas of the Far North region of Cameroon which serves to monitor polio immunization program. Methods This was a community-based cross-sectional seroprevalence survey involving collection of dried blood specimens (DBS) among children aged 12-59 months (n = 401). Multi-stage cluster sampling using GIS was applied to select the study sample. Collected DBS were analysed with microneutralization assays for poliovirus neutralizing antibody levels. Results The overall seroprevalence of types 1, 2 and 3 neutralizing antibodies were 86.8 % (95 % confidence interval [CI]: 83.1-89.8), 74.6 % (95 % CI: 70.1-78.6) and 79.3 % (95 % CI: 75.1-83.0), respectively. Median titers (log2 scale) for type 1, 2 and 3 were 7.17 (6.5-7.5), 5.17 (4.83-5.5), and 6.17 (5.5-6.5), respectively. There was an increasing trend in median titers and seroprevalence with age, statistically significant between the youngest and oldest age groups (p < 0.001). Conclusion Though there were several opportunities for vaccination through supplementary immunization activities (SIA) and routine immunization (RI), seroprevalence levels were low for all three serotypes, particularly for type 2. This highlights the need to strengthen RI and SIA quality coverage. Low population immunity makes Cameroon vulnerable to new importations and spread of polioviruses.
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Affiliation(s)
| | - Carolyn Sein
- Polio Eradication, World Health Organization HQ, 1211 Geneva, Switzerland
| | | | - Visalakshi Jeyaseelan
- Polio Eradication, World Health Organization HQ, 1211 Geneva, Switzerland,Corresponding author at: Polio Department, World Health Organization, Avenue Appia 20, CH-1211 Genève 27, Switzerland.
| | - Tess Palmer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Gnakub Norbert Soke
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Aissata Diaha
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Basit Jafri
- Population Immunity Laboratory, Polio and Picornavirus Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Bernardo A. Mainou
- Population Immunity Laboratory, Polio and Picornavirus Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Harish Verma
- Polio Eradication, World Health Organization HQ, 1211 Geneva, Switzerland
| | - Ondrej Mach
- Polio Eradication, World Health Organization HQ, 1211 Geneva, Switzerland
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12
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Chiem A, Olaoye F, Quinn R, Saini V. Reasons and suggestions for improving low immunization uptake among children living in low socioeconomic status communities in Northern Alberta, Canada - A qualitative study. Vaccine 2022; 40:4464-4472. [PMID: 35701329 DOI: 10.1016/j.vaccine.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Under-immunization increases the risk of acquiring vaccine-preventable diseases in children and the community. The targeted coverage rate for routine childhood immunization in Alberta, especially in disadvantaged communities in rural and remote geographic areas, has not been achieved for many years. This study was conducted to identify reasons for under-immunization in children in low socioeconomic status (SES) communities and propose suggestions to address issues/concerns identified by low SES parents for improving immunization coverage in their communities. METHODS Fourteen semi-structured phone interviews of low SES parents with under-immunized children living in rural and remote geographic areas in Northern Alberta were conducted. Transcripts were analyzed to identify relevant themes. RESULTS Busy lifestyles of many parents prevented them from taking their children to clinics for immunization, which were exacerbated by long distances to clinics, transportation issues, operating hours of clinics, and lack of reminders. Many disadvantaged parents also exhibited varying levels of vaccine hesitancy due to safety concerns, especially about newer vaccines, thereby causing some parents to delay immunizing their child intentionally. CONCLUSION Implementing procedures to alleviate access issues, such as offering extended operating hours, opening drop-in clinics/satellite clinics in distant areas, nurse visits to their homes, updating contact information of parents, frequent reminder options and addressing safety and effectiveness concerns about vaccines in plain language using evidence-based communication strategies can promote timely immunization among children of low SES parents.
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Affiliation(s)
- Alexander Chiem
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Funmilayo Olaoye
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada
| | - Renee Quinn
- Population and Public Health, North Zone, Alberta Health Services, 4720 55 Street, Cold Lake, Alberta T9M 1V8, Canada
| | - Vineet Saini
- Research & Innovation, Provincial Population and Public Health, Alberta Health Services, 10101, Southport Road SW, Calgary, Alberta T2W 3N2, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada.
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13
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Ogbonnaya LU, Okedo-Alex IN, Akamike IC, Azuogu B, Urochukwu H, Ogbu O, Uneke CJ. Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria. Health Res Policy Syst 2021; 19:154. [PMID: 34969398 PMCID: PMC8717671 DOI: 10.1186/s12961-021-00804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria. Methods The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada. Results At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents’ mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful). Conclusion The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.
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Affiliation(s)
- Lawrence Ulu Ogbonnaya
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria. .,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Benedict Azuogu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Henry Urochukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria
| | - Ogbonnaya Ogbu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Applied Microbiology, Faculty of Science, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Medical Microbiology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
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14
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Eze P, Agu SA, Agu UJ, Acharya Y. Acceptability of mobile-phone reminders for routine childhood vaccination appointments in Nigeria - a systematic review and meta-analysis. BMC Health Serv Res 2021; 21:1276. [PMID: 34836531 PMCID: PMC8627092 DOI: 10.1186/s12913-021-07296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile-phone reminders have gained traction among policymakers as a way to improve childhood vaccination coverage and timeliness. However, there is limited evidence on the acceptability of mobile-phone reminders among patients and caregivers. This systematic review and meta-analysis aimed to evaluate the ownership of mobile-phone device and the willingness to receive mobile-phone reminders among mothers/caregivers utilizing routine childhood immunization services in Nigeria. METHOD MEDLINE, Scopus, CINAHL, CNKI, AJOL (African Journal Online), and Web of Science were systematically searched for studies on the acceptability of mobile-phone reminders for routine immunization appointments among mothers/caregivers in Nigeria. Studies were assessed for methodological quality using the Newcastle Ottawa Scale and JBI critical appraisal checklists. Meta-analysis was conducted using random-effects model to generate pooled estimates (proportion) of mothers who owned at least one mobile phone and proportion of mothers willing to receive mobile-phone reminders. RESULTS Sixteen studies (13 cross-sectional and three interventional) involving a total of 9923 mothers across 15 states and the Federal Capital Territory Abuja met inclusion criteria. Pooled estimates showed that the proportion of mothers who owned at least one mobile phone was 96.4% (95% CI = 94.1-98.2%; I2 = 96.3%) while the proportion of mothers willing to receive mobile-phone reminders was 86.0% (95% CI = 79.8-91.3%, I2 = 98.4%). Most mothers preferred to receive text message reminders at least 24 h before the routine immunization appointment day, and in the morning hours. Approximately 52.8% of the mothers preferred to receive reminders in English, the country's official language. CONCLUSION Current evidence suggests a high acceptability for mobile-phone reminder interventions to improve routine childhood immunization coverage and timeliness. Further studies, however, are needed to better understand unique regional preferences and assess the operational costs, long-term effects, and risks of this intervention. SYSTEMATIC REVIEW PROTOCOL REGISTRATION PROSPERO CRD42021234183.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802 USA
| | - Sergius Alex Agu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ujunwa Justina Agu
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802 USA
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Uba BV, Waziri NE, Akerele A, Biya O, Adegoke OJ, Gidado S, Ugbenyo G, Simple E, Usifoh N, Sule A, Kibret B, Franka R, Wiesen E, Elmousaad H, Ohuabunwo C, Esapa L, Mahoney F, Bolu O, Vertefeuille J, Nguku P. Strengthening facility-based immunization service delivery in local government areas at high risk for polio in Northern Nigeria, 2014-2015. Pan Afr Med J 2021; 40:6. [PMID: 36157565 PMCID: PMC9474952 DOI: 10.11604/pamj.supp.2021.40.1.25865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The National Stop Transmission of Polio (NSTOP) program was created in 2012 to support the Polio Eradication Initiative (PEI) in Local Government Areas (LGAs) at high risk for polio in Northern Nigeria. We assessed immunization service delivery prior to the commencement of NSTOP support in 2014 and after one year of implementation in 2015 to measure changes in the implementation of key facility-based Routine Immunization (RI) components. METHODS The pre- and post-assessment was conducted in selected health facilities (HFs) in 61 LGAs supported by NSTOP in 5 states. A standardized questionnaire was administered to the LGA and HF immunization staff by trained interviewers on key RI service delivery components. RESULTS At the LGA level, an increase was observed in key components including availability of updated Reach Every Ward (REW) micro-plans with identification of hard to reach settlements (65.6% baseline, 96.8% follow-up, PR = 1.5 (95% CI 3.4 - 69.8), vaccine forecasting (77.1% baseline, 93.5% follow-up, PR =1.2 (95% CI 1.8 - 13.8), and timely delivery of monthly immunization reports (73.8% baseline, 90.2% follow-up; PR =1.2 (95% CI 1.2 - 9.0). At the HF level, there was an increase in percentage of HFs with written supervisory feedback (44.5% baseline, 82.5% follow-up, PR = 1.8 (95% CI 4.7 - 7.3), written stock records (66.5% baseline, 87.9% follow-up, PR = 1.3 (95% CI 2.9 - 4.7) and updated immunization monitoring charts (76.3% baseline, 95.6% follow-up, PR = 1.3 (95% CI 4.6 - 9.9). CONCLUSION We observed an improvement in key RI service delivery components following implementation of NSTOP program activities in supported LGAs.
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Affiliation(s)
- Belinda Vernyuy Uba
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria,,Corresponding author: Belinda Vernyuy Uba, National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria.
| | | | - Adekunle Akerele
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Oladayo Biya
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Saheed Gidado
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Gideon Ugbenyo
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Edwin Simple
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Nnamdi Usifoh
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Adamu Sule
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Beza Kibret
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Richard Franka
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Wiesen
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hashim Elmousaad
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chima Ohuabunwo
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
| | - Lisa Esapa
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Frank Mahoney
- International Federation of Red Cross, Geneva, Switzerland
| | - Omotayo Bolu
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Vertefeuille
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick Nguku
- National Stop Transmission of Polio, African Field Epidemiology Network, Abuja, Nigeria
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Tchoualeu DD, Elmousaad HE, Osadebe LU, Adegoke OJ, Nnadi C, Haladu SA, Jacenko SM, Davis LB, Bloland PB, Sandhu HS. Use of a district health information system 2 routine immunization dashboard for immunization program monitoring and decision making, Kano State, Nigeria. Pan Afr Med J 2021; 40:2. [PMID: 36157564 PMCID: PMC9474830 DOI: 10.11604/pamj.supp.2021.40.1.17313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction a district health information system 2 tool with a customized routine immunization (RI) module and indicator dashboard was introduced in Kano State, Nigeria, in November 2014 to improve data management and analysis of RI services. We assessed the use of the module for program monitoring and decision-making, as well as the enabling factors and barriers to data collection and use. Methods a mixed-methods approach was used to assess user experience with the RI data module and dashboard, including 1) a semi-structured survey questionnaire administered at 60 health facilities administering vaccinations and 2) focus group discussions and 16 in-depth interviews conducted with immunization program staff members at the local government area (LGA) and state levels. Results in health facilities, a RI monitoring chart was used to review progress toward meeting vaccination coverage targets. At the LGA, staff members used RI dashboard data to prioritize health facilities for additional support. At the State level, immunization program staff members use RI data to make policy decisions. They viewed the provision of real-time data through the RI dashboard as a "game changer". Use of immunization data is facilitated through review meetings and supportive supervision visits. Barriers to data use among LGA staff members included inadequate understanding of the data collection tools and computer illiteracy. Conclusion the routine immunization data dashboard facilitated access to and use of data for decision-making at the LGA, State and national levels, however, use at the health facility level remains limited. Ongoing data review meetings and training on computer skills and data collection tools are recommended.
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Affiliation(s)
- Dieula Delissaint Tchoualeu
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America,,Corresponding author: Dieula Delissaint Tchoualeu, Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America.
| | | | - Lynda Uju Osadebe
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Chimeremma Nnadi
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Sara Michele Jacenko
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Lora Baker Davis
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Peter Brian Bloland
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Hardeep Singh Sandhu
- Global Immunization Division, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, United States of America
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Uba BV, Waziri NE, Adegoke OJ, Akerele A, Gidado S, Usifoh N, Adeoye OB, Akataobi CM, Ahmed SH, Obansa RU, Simple E, Kibret B, Ohuabunwo C, Biya O, Wiesen E, Nnadi C, Nguku P. Pilot implementation of a routine immunization module of the district health information system version 2 in Kano State, Nigeria, 2014 - 2015. Pan Afr Med J 2021; 40:5. [PMID: 36157556 PMCID: PMC9474934 DOI: 10.11604/pamj.supp.2021.40.1.24879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Timely and accurate data are necessary for informing sound decision-making and developing effective routine immunization (RI) programs. We launched a pilot project in Kano State to strengthen routine immunization (RI) data reporting through the immunization module of the District Health Information System version 2 (DHIS2). We examined the completeness and timeliness of reporting monthly RI data one year before and one year after DHIS2 module pilot in the State. Methods The first phase of the DHIS2 RI module pilot in Kano included training on RI data tools in November 2014 and in January 2015 for 36 state and zonal personnels, 276 local government area (LGA) personnel, and 2,423 health facility (HF) staff. A RI-focused dashboard to display core RI accountability framework indicators, such as completeness and timeliness of reporting, planned immunization sessions conducted, coverage and dropout was implemented. Report completeness was ratio of submitted reports to number of health facilities while report timeliness was ratio of reports on the DHIS2 by 14th of the month to number of expected. Results Completeness of data reporting increase from 70% in 2014 to 87% in 2015, while timeliness of reporting increase from 64% to 87% over the same period. Challenges encountered during the implementation process included limited access to internet, power outages, health workers strike, staff attrition and competing state activities. Conclusion The pilot implementation of the DHIS2 immunization module in Kano State led to modest improvement in the reporting of RI services. Several lessons learned were used to guide scale-up to other states in the country.
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Affiliation(s)
- Belinda Vernyuy Uba
- African Field Epidemiology Network, Abuja, Nigeria,,Corresponding author: Belinda Vernyuy Uba, African Field Epidemiology Network.
| | | | | | | | | | | | | | | | | | | | - Edwin Simple
- African Field Epidemiology Network, Abuja, Nigeria
| | - Beza Kibret
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Oladayo Biya
- United States Centre for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Wiesen
- United States Centre for Disease Control and Prevention, Atlanta, Georgia
| | - Chime Nnadi
- African Field Epidemiology Network, Abuja, Nigeria
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18
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Akwataghibe NN, Ogunsola EA, Popoola OA, Agbo AI, Dieleman MA. Using participatory action research to improve immunization utilization in areas with pockets of unimmunized children in Nigeria. Health Res Policy Syst 2021; 19:88. [PMID: 34380510 PMCID: PMC8356382 DOI: 10.1186/s12961-021-00719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2005, Nigeria adopted the Reaching Every Ward strategy to improve vaccination coverage for children 0-23 months of age. By 2015, Ogun state had full coverage (100%) in 12 of its 20 local government areas, but eight had pockets of unimmunized children, with the highest burden (37%) in Remo North. A participatory action research (PAR) approach was used to facilitate implementation of local solutions to contextual barriers to immunization in Remo North. This article assesses and seeks to explain the outcomes of the PAR implemented in Remo North to understand whether and possibly how it improved immunization utilization. METHODS The PAR intervention took place from 2016 to 2017. It involved two (4-month) cycles of dialogue and action between community members, frontline health workers and local government officials in two wards of Remo North, facilitated by the research team. The PAR was assessed using a pre/post-intervention-only design with mixed methods. These included household surveys of caregivers of 215 and 213 children, respectively, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community members. Data were analysed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy framework. RESULTS Collaboration among the three stakeholder groups enabled the development and implementation of solutions to identified problems related to access to and use of immunization services. At endline, assessment by card for children older than 9 months revealed a significant increase in those fully immunized, from 60.7% at baseline to 90.9% (p < .05). A significantly greater number of caregivers visited fixed government health facilities for routine immunization at endline (83.2%) than at baseline (54.2%) (p < .05). The reasons reported by caregivers for improved utilization of routine immunization services were increased community mobilization activities and improved responsiveness of the health workers. Spillover effects into maternal health services enhanced the use of immunization services by caregivers. Spontaneous scale-up of actions occurred across Remo North due to the involvement of local government officials. CONCLUSION The PAR approach achieved contextual solutions to problems identified by communities. Collection and integration of evidence into discussions/dialogues with stakeholders can lead to change. Leveraging existing structures and resources enhanced effectiveness.
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Affiliation(s)
- Ngozi N Akwataghibe
- Royal Tropical Institute, Amsterdam, The Netherlands. .,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | - Marjolein A Dieleman
- Royal Tropical Institute, Amsterdam, The Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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19
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Mafigiri DK, Iradukunda C, Atumanya C, Odie M, Mancuso A, Tran N, McGrath J, Luzze H. A qualitative study of the development and utilization of health facility-based immunization microplans in Uganda. Health Res Policy Syst 2021; 19:52. [PMID: 34380523 PMCID: PMC8356367 DOI: 10.1186/s12961-021-00708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background In 2006, Uganda adopted the Reaching Every District strategy with the goal of attaining at least 80% coverage for routine immunizations in every district. The development and utilization of health facility/district immunization microplans is the key to the strategy. A number of reports have shown suboptimal development and use of microplans in Uganda. This study explores factors associated with suboptimal development and use of microplans in two districts in Uganda to pinpoint challenges encountered during the microplanning process. Methods A qualitative study was conducted comparing two districts: Kapchorwa, with low immunization coverage, and Luwero with high immunization coverage. Data were collected through multilevel observation of health facilities, planning sessions and planning meetings; records review of microplans, micromaps and meeting minutes; 57 interviews with health workers at the ministry level and lower-level health facility workers. Data were analysed using NVivo 8 qualitative text analysis software. Transcripts were coded, and memos and display matrices were developed to examine the process of developing and utilizing microplans, including experiences of health workers (implementers). Results Three key findings emerged from this study. First, there are significant knowledge gaps with regard to the microplanning process among health workers at all levels (community and district health facility and nationally). Limited knowledge about communities and programme catchment areas greatly hinders the planning process by limiting the ability to identify hard-to-reach areas and to prioritize areas according to need. Secondly, the microplanning tool is bulky and complex. Finally, microplanning is being implemented in the context of already overtasked health personnel who have to conduct several other activities as part of their daily routines. Conclusions In order to achieve quality improvement as outlined in the Reaching Every District campaign, the microplanning process should be revised. Health workers’ misunderstanding and limited knowledge about the microplanning process, especially at peripheral health facilities, coupled with the complex, bulky nature of the microplanning tool, reduces the effectiveness of microplanning in improving routine immunization in Uganda. This study reveals the need to reduce the complexity of the tool and to identify ways to train and support workers in the use of the revised tool, including support in incorporating the microplanning process into their busy schedules.
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Affiliation(s)
- David Kaawa Mafigiri
- Center for Social Sciences Research on AIDS, School of Social Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Constance Iradukunda
- Center for Social Sciences Research on AIDS, School of Social Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Catherine Atumanya
- Center for Social Sciences Research on AIDS, School of Social Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Michael Odie
- Center for Social Sciences Research on AIDS, School of Social Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Arielle Mancuso
- Alliance for Health Policy and Systems Research, WHO Headquarters, Geneva, Switzerland
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, WHO Headquarters, Geneva, Switzerland
| | - Janet McGrath
- Department of Anthropology, Center for Social Sciences Research on AIDS, Case Western Reserve University, Cleveland, OH, USA
| | - Henry Luzze
- Uganda Ministry of Health/UNEPI, P.O. Box 7272, Kampala, Uganda
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20
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Aizawa Y, Katsuta T, Sakiyama H, Tanaka-Taya K, Moriuchi H, Saitoh A. Changes in childhood vaccination during the coronavirus disease 2019 pandemic in Japan. Vaccine 2021; 39:4006-4012. [PMID: 34059371 PMCID: PMC8139263 DOI: 10.1016/j.vaccine.2021.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has greatly affected daily life. COVID-19 often causes asymptomatic or mild disease in children; however, delayed routine childhood immunization is a concern, as it could increase the risk of vaccine-preventable disease. No study has evaluated the status of childhood vaccinations in Japan during the COVID-19 pandemic. Methods This retrospective observational study evaluated the number of vaccine doses administered to children in 4 Japanese cities (2 cities in the Tokyo metropolitan area and 2 cities far from Tokyo) during the period from 2016 to 2020. Vaccine doses administered between January and September 2020 during the COVID-19 pandemic were compared, by month, with those given during 2016–2019. Age-stratified demographic data were collected to determine whether factors other than change in the child population over time affected vaccination trends. Results In all cities the decrease in vaccine doses administered was most apparent in March and April 2020, i.e., just before or coincident with the declaration of a nationwide COVID-19 emergency on April 7, 2020. The decrease started as early as February in the Tokyo metropolitan area. As child age increased, the decrease became more apparent. Before the lift of national emergency on May 25, catch-up of the vaccination was observed in all age groups in all cities. Vaccine doses persistently increased in older age groups but not in infants. The overall vaccination trends did not differ significantly among the 4 cities. Conclusions The COVID-19 pandemic significantly affected routine childhood immunization in Japan. Thus, a nationwide electronic surveillance system and announcements for guardians to encourage timely routine immunization are warranted.
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Affiliation(s)
- Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan
| | - Tomohiro Katsuta
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Hiroshi Sakiyama
- Department of Pediatrics, Sakiyama Children's Clinic, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan.
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21
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Raguindin PF, Morales-Dizon M, Aldaba J, Mangulabnan LP, Reyes RP, Batmunkh N, Ducusin MJ, Lopez AL. Timeliness of childhood vaccinations in the Philippines. J Public Health Policy 2021; 42:53-70. [PMID: 33398056 PMCID: PMC7979588 DOI: 10.1057/s41271-020-00255-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 12/02/2022]
Abstract
Timeliness of vaccinations is rarely part of monitoring in a routine immunization program. We reviewed infant immunization and conducted caregiver interviews in three regions in the Philippines from January to October 2016. We randomly selected thirty public health centers, one for each region. We defined timeliness of the receipt of antigen as within 4 weeks after the recommended age at vaccination. We assessed a total of 986 infants for timeliness of vaccination. The median age of receipt of vaccine was at 2.7 weeks (BCG), 10.1 weeks (Penta 1), and 21.7 weeks (Penta 3) compared to the recommended 0, 6, and 14 weeks of age, respectively. We found timely receipt only in 74.4% for BCG, 70.3% for Penta 1, and 39.1% for Penta 3 recipients. Thus, alongside declining immunization coverage, the infants in the Philippines had substantial delays in vaccine receipt.
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Affiliation(s)
- Peter Francis Raguindin
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
- Present Address: Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Merrylle Morales-Dizon
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
| | - Josephine Aldaba
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
| | - Lailani P. Mangulabnan
- Department of Health, Center for Health Development Region 3, San Fernando City, Pampanga Philippines
| | - Renelyn P. Reyes
- Department of Health, Center for Health Development Region 6, Iloilo City, Iloilo Philippines
| | - Nyambat Batmunkh
- Vaccine Preventable Diseases and Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Maria Joyce Ducusin
- Department of Health, Disease Prevention and Control Bureau, Manila, Philippines
| | - Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health – University of the Philippines Manila, Manila, Philippines
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22
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Cutts FT, Ferrari MJ, Krause LK, Tatem AJ, Mosser JF. Vaccination strategies for measles control and elimination: time to strengthen local initiatives. BMC Med 2021; 19:2. [PMID: 33397366 PMCID: PMC7781821 DOI: 10.1186/s12916-020-01843-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.
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Affiliation(s)
- F T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - M J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - L K Krause
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - A J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - J F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98121, USA
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23
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MacDonald NE, Comeau JL, Dubé È, Bucci LM. COVID-19 and missed routine immunizations: designing for effective catch-up in Canada. Can J Public Health 2020; 111:469-472. [PMID: 32761546 PMCID: PMC7408971 DOI: 10.17269/s41997-020-00385-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
COVID-19 has led to disruption in routine immunization programs around the globe and here in Canada. The National Advisory Committee on Immunization (NACI) in Canada has indicated that this sets the stage for serious outbreaks of vaccine-preventable diseases. The World Health Organization has evidence-based guidance on how to address missed opportunities for vaccination, albeit predominately applicable for low- and middle-income countries. In Canada, immunization applies beyond infant and childhood immunization, with immunization across the life course being recommended by NACI. Three components stand out and must be integrated and used concurrently for best effect on catch-up in Canada: (1) Identify who has been missed across the life course; (2) detect delivery gaps, adapt and adjust, and develop multipronged tailored strategies for catch-up; and (3) communicate, document, evaluate and readjust the immunization programs. All must be adapted to the reality of the evolving COVID-19 pandemic. We cannot go back to a pre-COVID-19 world. However, ensuring that routine immunization and catch-up programs are done well during this pandemic strengthens the immunization foundation in Canada for when COVID-19 vaccines become available.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. .,IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Jeannette L Comeau
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada.,Université Laval, Québec City, Québec, Canada
| | - Lucie M Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
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24
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Sreevatsava M, Burman AL, Wahdan A, Safdar RM, O'Leary A, Amjad R, Salam A, Quershi M, Ishaq R, Khan J, Khan J, Parker EPK, Sheikh Mahamud A, Ahmed J. Routine immunization coverage in Pakistan: a survey of children under 1 year of age in community-based vaccination areas. Vaccine 2020; 38:4399-4404. [PMID: 32402754 DOI: 10.1016/j.vaccine.2020.04.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022]
Abstract
Pakistan is one of two countries in which poliovirus remains endemic. Considering the high number of children born every year, reaching and vaccinating new birth cohorts by improving routine immunization coverage in children <1 year of age is crucial to halting virus transmission. In 2015, a community-based vaccination (CBV) strategy, using local community members to enhance vaccine acceptance and improve routine immunization service delivery, was introduced in areas of Pakistan that have never interrupted poliovirus transmission. In order to assess progress towards improving routine immunization, we performed house-to-house immunization surveys across ten CBV areas in 2017 and 2018. In each household, we determined age-appropriate routine antigen coverage for children <1 year of age based on vaccination card and caregiver recall. We surveyed 5,499 and 5,264 children in 2017 and 2018, respectively. Overall, coverage of inactivated poliovirus vaccine (IPV) at 14 weeks of age was 32% in 2017 and 39% in 2018 based on vaccination card and recall. Across the surveyed areas, coverage ranged from 7% in Killa Abdullah to 61% in Peshawar in 2018. Oral poliovirus vaccination coverage decreased with successive vaccination visits, ranging from 66% for the birth dose to 42% for the 14-week dose in 2018. No area reached the target of 80% coverage for any routine antigen. Our findings highlight the need for concerted efforts to improve routine immunization coverage in these critical areas of wild poliovirus transmission.
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Affiliation(s)
| | | | | | - Rana M Safdar
- Ministry of National Health Services, Islamabad, Pakistan
| | | | - Raabya Amjad
- United Nations Children's Fund, Islamabad, Pakistan
| | - Abdul Salam
- World Health Organization, Islamabad, Pakistan
| | | | | | - Jawed Khan
- World Health Organization, Islamabad, Pakistan
| | | | - Edward P K Parker
- The Vaccine Centre, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jamal Ahmed
- World Health Organization, Islamabad, Pakistan
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25
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Das MK, Sood M, Tambe MP, Sharma TD, Parande MAG, Surwade JB, Salunkhe NM, Patil SS, Pawar B, Guleri R, Kaushal C, Sindhu M. Documentation of vaccine wastage in two different geographic contexts under the universal immunization program in India. BMC Public Health 2020; 20:556. [PMID: 32334554 PMCID: PMC7183620 DOI: 10.1186/s12889-020-08637-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background Government of India is introducing new and relatively costly vaccines under immunization program. Monitoring of vaccine wastage is needed to guide the program implementation and forecasting. Under pilot introduction of rotavirus vaccine in two districts both 5- and 10-doses vials were used, which was considered as an opportunity for documenting the wastage. The wastage rates for other routine vaccines were also documented. Methods A survey conducted in two districts (Kangra, Himachal Pradesh and Pune, Maharashtra) covered 49 vaccine stores, 34 sub-centres and 34 outreach sessions collected vaccine receipt, distribution and usage data for two complete years 2016 and 2017. Results The overall wastage rates for almost all vaccines were higher in Kangra district (BCG 37.1%, DPT 32.1%, Measles 32.2%, OPV 50.8%, TT 34.1% and pentavalent 18.4%) than Pune district (BCG 35.1%, DPT 25.4%, Measles 21.7%, OPV 14.3%, TT 23.1% and pentavalent 13.2%). Wastage for pneumococcal conjugate and measles-rubella vaccines in Kangra district were 27 and 40.5%, respectively. With transition from 5- to 10-doses vials for rotavirus vaccine, wastage at stores levels increased in both Kangra (29 to 33.2%) and Pune (17.8 to 25.7%) districts. With transition from intramuscular to intradermal fractional inactivated polio vaccine, the wastage increased from 36.1 to 54.8% in Kangra and 18.4 to 26.9% in Pune district. Conclusions The observed vaccine wastage rates for several vaccines were relatively higher than program assumption for forecasting. The observed variations in the vaccine wastage indicates need for state or region based documentation and monitoring in India for appropriate programmatic action.
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Affiliation(s)
- Manoja Kumar Das
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India.
| | - Mangla Sood
- Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.,Department of Health and Family Welfare, Government of Himachal Pradesh, Shimla, Himachal Pradesh, India
| | | | - Thakur Dutt Sharma
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India
| | | | | | | | | | - Bhagwan Pawar
- Department of Health and Family Welfare, Government of Maharashtra, Pune, Maharashtra, India
| | - Rajesh Guleri
- Department of Health and Family Welfare, Government of Himachal Pradesh, Kangra, Himachal Pradesh, India
| | - Chitra Kaushal
- Department of Health and Family Welfare, Government of Himachal Pradesh, Kangra, Himachal Pradesh, India
| | - Monica Sindhu
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India
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26
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Utazi CE, Wagai J, Pannell O, Cutts FT, Rhoda DA, Ferrari MJ, Dieng B, Oteri J, Danovaro-Holliday MC, Adeniran A, Tatem AJ. Geospatial variation in measles vaccine coverage through routine and campaign strategies in Nigeria: Analysis of recent household surveys. Vaccine 2020; 38:3062-3071. [PMID: 32122718 PMCID: PMC7079337 DOI: 10.1016/j.vaccine.2020.02.070] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/21/2022]
Abstract
Measles vaccination campaigns are conducted regularly in many low- and middle-income countries to boost measles control efforts and accelerate progress towards elimination. National and sometimes first-level administrative division campaign coverage may be estimated through post-campaign coverage surveys (PCCS). However, these large-area estimates mask significant geographic inequities in coverage at more granular levels. Here, we undertake a geospatial analysis of the Nigeria 2017-18 PCCS data to produce coverage estimates at 1 × 1 km resolution and the district level using binomial spatial regression models built on a suite of geospatial covariates and implemented in a Bayesian framework via the INLA-SPDE approach. We investigate the individual and combined performance of the campaign and routine immunization (RI) by mapping various indicators of coverage for children aged 9-59 months. Additionally, we compare estimated coverage before the campaign at 1 × 1 km and the district level with predicted coverage maps produced using other surveys conducted in 2013 and 2016-17. Coverage during the campaign was generally higher and more homogeneous than RI coverage but geospatial differences in the campaign's reach of previously unvaccinated children are shown. Persistent areas of low coverage highlight the need for improved RI performance. The results can help to guide the conduct of future campaigns, improve vaccination monitoring and measles elimination efforts. Moreover, the approaches used here can be readily extended to other countries.
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Affiliation(s)
- C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton SO17 1BJ, UK.
| | - John Wagai
- World Health Organization Consultant, Abuja, Nigeria
| | - Oliver Pannell
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Matthew J Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, PA, 16802, USA
| | | | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
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Okenwa UJ, Dairo MD, Bamgboye E, Ajumobi O. Maternal knowledge and infant uptake of valid hepatitis B vaccine birth dose at routine immunization clinics in Enugu State - Nigeria. Vaccine 2020; 38:2734-2740. [PMID: 32007294 DOI: 10.1016/j.vaccine.2020.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/14/2019] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND World Health Organization recommends hepatitis B vaccine birth dose for all infants within 24 hours of birth as the most cost-effective measure to prevent perinatal hepatitis B virus infection (HBV). We assessed and identified the predictors of maternal knowledge and infants' uptake of valid hepatitis B vaccine birth dose (HepB-BD). METHODS We conducted a hospital-based cross-sectional survey among 366 mother-infant attendees of routine immunization clinics selected by multi-stage sampling technique in Enugu State, Nigeria. We collected data on socio-demographic characteristics, delivery history, maternal knowledge and infant's receipt of valid HepB-BD with interviewer-administered questionnaire. Maternal knowledge was assessed using nine domain questions. Overall, good knowledge was defined as a score of ≥50%. Only infants who received first hepatitis B dose within 24 hours were considered to have received valid BD. We calculated frequencies, performed Chi square test and logistic regression. RESULTS One hundred and two (29.7%) mothers knew HBV can be transmitted from mother to child; 119 (34.6%) and 156 (45.3%) knew their infant should receive valid HepB-BD and four doses for full immunization of HepB respectively. Overall, 114 (31.1%) mothers had good knowledge of HBV and 88 (26.9%) of 327 who delivered at the health facilities had valid HepB-BD. Predictors of maternal knowledge were attainment of tertiary education (adjusted Odds Ratio (aOR): 2.1, 95%CI: 1.3-3.5) and living in rural areas (aOR: 0.5, 95%CI: 0.3-0.9). Predictors of valid HepB-BD uptake were maternal knowledge (aOR: 2.4, 95%CI: 1.4-4.0) and delivery at facilities offering routine immunization services (aOR: 5.4, 95%CI: 2.5-11.9). CONCLUSION Knowledge and uptake of valid HepB-BD were low. Health education on benefits of valid HepB-BD was given to mothers after administration of questionnaires. We disseminated findings to the State Ministry of Health and recommended integration of child delivery and immunization services for birth dose vaccines especially valid HepB-BD.
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Affiliation(s)
- Uchechukwu Joel Okenwa
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; Enugu State Ministry of Health, Enugu, Nigeria.
| | - Magbagbeola David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Eniola Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; School of Community Health Sciences, University of Nevada, Reno, United States; Federal Ministry of Health, Abuja, Nigeria
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Abstract
The direct benefits of childhood vaccination in reducing the burden of disease morbidity and mortality in a cost-effective manner are well-established. By preventing episodes of vaccine-preventable diseases, vaccination can also help avert associated out-of-pocket medical expenses, healthcare provider costs, and losses in wages of patients and caregivers. Studies have associated vaccines positively with cognition and school attainment, suggesting benefits of long-term improved economic productivity. New evidence suggests that the measles vaccine may improve immunological memory and prevent co-infections, thereby forming a protective shield against other infections, and consequently improving health, cognition, schooling and productivity outcomes well into the adolescence and adulthood in low-income settings. Systematically documenting these broader health, economic, and child development benefits of vaccines is important from a policy perspective, not only in low and middle-income countries where the burden of vaccine-preventable diseases is high and public resources are constrained, but also in high-income settings where the emergence of vaccine hesitancy poses a threat to benefits gained from reducing vaccine-preventable diseases. In this paper, we provide a brief summary of the recent evidence on the benefits of vaccines, and discuss the policy implications of these findings.
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Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics & Policy , Washington, DC, USA
| | - Anita Shet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
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Morgan CJ, Saweri OPM, Larme N, Peach E, Melepia P, Au L, Scoullar MJL, Reza MS, Vallely LM, McPake BI, Beeson JG. Strengthening routine immunization in Papua New Guinea: a cross-sectional provincial assessment of front-line services. BMC Public Health 2020; 20:100. [PMID: 31973691 PMCID: PMC6979348 DOI: 10.1186/s12889-020-8172-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 01/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background Routine immunization programs face many challenges in settings such as Papua New Guinea with dispersed rural populations, rugged geography and limited resources for transport and health. Low routine coverage contributes to disease outbreaks such as measles and the polio that re-appeared in 2018. We report on an in-depth local assessment that aimed to document immunization service provision so as to review a new national strategy, and consider how routine immunization could be better strengthened. Methods In East New Britain Province, over 2016 and 17, we carried out a cross-sectional assessment of 12 rural health facilities, staff and clients. The study was timed to follow implementation of a new national strategy for strengthening routine immunization. We used interview, structured observation, and records review, informed by theory-based evaluation, a World Health Organization quality checklist, and other health services research tools. Results We documented strengths and weaknesses across six categories of program performance relevant to national immunization strategy and global standards. We found an immunization service with an operational level of staff, equipment and procedures in place; but one that could reach only half to two thirds of its target population. Stronger routine services require improvement in: understanding of population catchments, tracking the unvaccinated, reach and efficiency of outreach visits, staff knowledge of vaccination at birth and beyond the first year of life, handling of multi-dose vials, and engagement of community members. Many local suggestions to enhance national plans, included more reliable on-demand services, integration of other family health services and increased involvement of men. Conclusions The national strategy addresses most local gaps, but implementation and resourcing requires greater commitment. Long-term strengthening requires a major increase in centrally-allocated resources, however there are immediate locally feasible steps within current resources that could boost coverage and quality of routine immunization especially through better population-based local planning, and stronger community engagement. Our results also suggest areas where vaccination campaigns in PNG can contribute to routine immunization services.
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Affiliation(s)
- Christopher J Morgan
- Burnet Institute, Melbourne, Australia. .,Melbourne School of Population and Global Health and Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Olga P M Saweri
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Nicholas Larme
- East New Britain Provincial Government, Kokopo, Papua New Guinea
| | | | | | - Lucy Au
- Burnet Institute, Kokopo, Papua New Guinea
| | - Michelle J L Scoullar
- Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mohammad Salim Reza
- World Health Organization, Country Office Port Moresby, Port Moresby, Papua New Guinea
| | - Lisa M Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Barbara I McPake
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Australia
| | - James G Beeson
- Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health and Department of Medicine, University of Melbourne, Melbourne, Australia.,Central Clinical School and Department of Microbiology, Monash University, Melbourne, Australia
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Zaidi S, Riaz A, Hussain SS, Omer SB, Ali A. Applying a governance barometer to vaccine delivery systems: Lessons from a rural district of Pakistan. Vaccine 2019; 38:627-634. [PMID: 31699503 DOI: 10.1016/j.vaccine.2019.10.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Weak vaccine delivery systems in countries off-track for routine immunization targets, need in-depth evidence on system level barriers to be critically resourced and monitored. We applied a Balanced Score Card (BSC) approach in a rural underserved district of Pakistan to (i) identify critical areas needing support in the government vaccine delivery system; and (ii) for benchmarking improvements in the vaccine delivery system. METHODOLOGY BSC was developed drawing on desk review, government consultations and field testing. 45 immunization indicators were finalized across 8 domains: human resource; vaccine supply; safe vaccination practice; cold chain maintenance; outreach preparedness; records & supervision; verifiable vaccination volume; and client communication. Data were collected through health facility assessments, client exit interviews and household vaccination assessment. A composite score was calculated for each domain and banded into unsatisfactory, borderline and satisfactory categories. 5 lowest ranking domains were targeted for 2 years of health systems strengthening (HSS) interventions. Post-intervention assessment tracked progress. RESULTS The district obtained a cumulative score of 51% (unsatisfactory) at pre-intervention and improved to 82% (satisfactory) at post-intervention. At pre-intervention, 4 domains scored satisfactory and 4 scored unsatisfactory. Unsatisfactory scores were received for: outreach preparedness; records & supervision; verifiable vaccination volume; and client communication. Post intervention 6 of 8 domains scored satisfactory and 2 moved from unsatisfactory to borderline. Highest percentage point (pp) improvements were seen in outreach preparedness (53 pp, p = 0.01), EPI supervision (52 pp, p = 0.01) and verified vaccination volume (46 pp, p = 0.02). 3 domains that were not intervened through HSS interventions had minimal change in scoring - cold chain maintenance (6 pp), safe vaccination practice (12 pp) and vaccine supply (11 pp). CONCLUSION BSC served to prioritize interventions towards critical unmet needs for vaccine delivery in the district health system and particularly helped to improve outreach preparedness, EPI supervision and verified vaccination volume.
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Affiliation(s)
- Shehla Zaidi
- Women & Child Health Division, Aga Khan University, Karachi, Pakistan; Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Atif Riaz
- Women & Child Health Division, Aga Khan University, Karachi, Pakistan; Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Saad B Omer
- Departments of Global Health, Epidemiology, Paediatrics, and Emory Vaccine Center, Emory University, Atlanta, Georgia
| | - Asad Ali
- Women & Child Health Division, Aga Khan University, Karachi, Pakistan
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31
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Zimmermann M, Frey K, Hagedorn B, Oteri AJ, Yahya A, Hamisu M, Mogekwu F, Shuaib F, McCarthy KA, Chabot-Couture G. Optimization of frequency and targeting of measles supplemental immunization activities in Nigeria: A cost-effectiveness analysis. Vaccine 2019; 37:6039-47. [PMID: 31471147 DOI: 10.1016/j.vaccine.2019.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Measles causes significant childhood morbidity in Nigeria. Routine immunization (RI) coverage is around 40% country-wide, with very high levels of spatial heterogeneity (3-86%), with supplemental immunization activities (SIAs) at 2-year or 3-year intervals. We investigated cost savings and burden reduction that could be achieved by adjusting the inter-campaign interval by region. METHODS We modeled 81 scenarios; permuting SIA calendars of every one, two, or three years in each of four regions of Nigeria (North-west, North-central, North-east, and South). We used an agent-based disease transmission model to estimate the number of measles cases and ingredients-based cost models to estimate RI and SIA costs for each scenario over a 10 year period. RESULTS Decreasing SIAs to every three years in the North-central and South (regions of above national-average RI coverage) while increasing to every year in either the North-east or North-west (regions of below national-average RI coverage) would avert measles cases (0.4 or 1.4 million, respectively), and save vaccination costs (save $19.4 or $5.4 million, respectively), compared to a base-case of national SIAs every two years. Decreasing SIA frequency to every three years in the South while increasing to every year in the just the North-west, or in all Northern regions would prevent more cases (2.1 or 5.0 million, respectively), but would increase vaccination costs (add $3.5 million or $34.6 million, respectively), for $1.65 or $6.99 per case averted, respectively. CONCLUSIONS Our modeling shows how increasing SIA frequency in Northern regions, where RI is low and birth rates are high, while decreasing frequency in the South of Nigeria would reduce the number of measles cases with relatively little or no increase in vaccination costs. A national vaccination strategy that incorporates regional SIA targeting in contexts with a high level of sub-national variation would lead to improved health outcomes and/or lower costs.
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Oladepo O, Dipeolu IO, Oladunni O. Nigerian rural mothers' knowledge of routine childhood immunizations and attitudes about use of reminder text messages for promoting timely completion. J Public Health Policy 2019; 40:459-77. [PMID: 31427672 DOI: 10.1057/s41271-019-00180-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mothers' poor knowledge and attitudes about routine immunization impede childhood immunization completion. This study assessed mothers' knowledge in rural communities about routine immunization and acceptability of mobile phone reminder text messages as an intervention for improving uptake and timely completion of routine immunization. The study adopted a descriptive cross-sectional design among 3440 consenting mothers of infants in six randomly selected Nigerian states and in the Federal Capital Territory (FCT). We used a Focus Group Discussion guide and validated questionnaire to collect data; we analysed data using a thematic approach and descriptive statistics. Respondents' ages were 26.7 ± 5.5 years. Knowledge of routine immunization was poor; attitudinal disposition was positive. Most (90.5%) indicated willingness to accept reminder text messages for routine immunization and 91.5% opined that mobile phones can be effective in providing such information. Mothers' willingness to accept the use of SMS reminder text messages for promoting routine immunization completion requires well-designed and culture-sensitive persuasive messages.
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Feldhaus I, Schütte C, Mwansa FD, Undi M, Banda S, Suharlim C, Menzies NA, Brenzel L, Resch SC, Kinghorn A. Incorporating costing study results into district and service planning to enhance immunization programme performance: a Zambian case study. Health Policy Plan 2019; 34:327-336. [PMID: 31157376 PMCID: PMC6736183 DOI: 10.1093/heapol/czz039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 11/13/2022] Open
Abstract
Donors, researchers and international agencies have made significant investments in collection of high-quality data on immunization costs, aiming to improve the efficiency and sustainability of services. However, improved quality and routine dissemination of costing information to local managers may not lead to enhanced programme performance. This study explored how district- and service-level managers can use costing information to enhance planning and management to increase immunization outputs and coverage. Data on the use of costing information in the planning and management of Zambia's immunization programme was obtained through individual and group semi-structured interviews with planners and managers at national, provincial and district levels. Document review revealed the organizational context within which managers operated. Qualitative results described managers' ability to use costing information to generate cost and efficiency indicators not provided by existing systems. These, in turn, would allow them to understand the relative cost of vaccines and other resources, increase awareness of resource use and management, benchmark against other facilities and districts, and modify strategies to improve performance. Managers indicated that costing information highlighted priorities for more efficient use of human resources, vaccines and outreach for immunization programming. Despite decentralization, there were limitations on managers' decision-making to improve programme efficiency in practice: major resource allocation decisions were made centrally and planning tools did not focus on vaccine costs. Unreliable budgets and disbursements also undermined managers' ability to use systems and information. Routine generation and use of immunization cost information may have limited impact on managing efficiency in many Zambian districts, but opportunities were evident for using existing capacity and systems to improve efficiency. Simpler approaches, such as improving reliability and use of routine immunization and staffing indicators, drawing on general insights from periodic costing studies, and focusing on maximizing coverage with available resources, may be more feasible in the short-term.
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Affiliation(s)
- Isabelle Feldhaus
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carl Schütte
- Strategic Development Consultants, Pietermaritzburg, South Africa
| | - Francis D Mwansa
- Department of Public Health, Ministry of Health, Plot 12193, Woodlands Chalala, Lusaka, Zambia
| | - Masauso Undi
- Independent consultant, 35 Nalikwanda Road, Woodlands, Lusaka, Zambia
| | - Stanley Banda
- Independent consultant, Plot 34270, Shantumbu Road, Hillview Park, Lusaka, Zambia
| | - Chris Suharlim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, USA
| | - Logan Brenzel
- Bill & Melinda Gates Foundation, 500 Fifth Avenue N, Seattle, WA, USA
| | - Stephen C Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, USA
| | - Anthony Kinghorn
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Chris Hani Road, Diepkloof, Soweto, South Africa
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34
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Satoh H, Tanaka-Taya K, Shimizu H, Goto A, Tanaka S, Nakano T, Hotta C, Okazaki T, Itamochi M, Ito M, Okamoto-Nakagawa R, Yamashita Y, Arai S, Okuno H, Morino S, Oishi K. Polio vaccination coverage and seroprevalence of poliovirus antibodies after the introduction of inactivated poliovirus vaccines for routine immunization in Japan. Vaccine 2019; 37:1964-1971. [PMID: 30827736 DOI: 10.1016/j.vaccine.2019.02.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/07/2019] [Accepted: 02/15/2019] [Indexed: 01/28/2023]
Abstract
In Japan, the oral poliovirus vaccine (OPV) was changed to 2 types of inactivated poliovirus vaccine (IPV), the standalone conventional IPV (cIPV) and the Sabin-derived IPV combined with diphtheria-tetanus-acellular pertussis vaccine (DTaP-sIPV), for routine immunization in 2012. We evaluated polio vaccination coverage and the seroprevalence of poliovirus antibodies using data from the National Epidemiological Surveillance of Vaccine-Preventable Diseases (NESVPD) from 2011 to 2015. Several years before the introduction of IPV in 2012, OPV administration for children was refused by some parents because of concerns about the risk of vaccine-associated paralytic poliomyelitis. Consequently, in children aged <1 years who were surveyed in 2011-2012, polio vaccination coverage (45.0-48.8%) and seropositivity rates for poliovirus (type 1: 51.7-65.9%, type 2: 48.3-53.7%, and type 3: 15.0-29.3%) were decreased compared to those surveyed in 2009. However, after IPV introduction, the vaccination coverage (95.5-100%) and seropositivity rates (type 1: 93.2-96.6%, type 2: 93.1-100%, and type 3: 88.6-93.9%) increased among children aged <1 years in 2013-2015. In particular, seropositivity rates and geometric mean titers (GMTs) for poliovirus type 3 in <5-year-old children who received 4 doses of IPV (98.5% and 247.4, respectively) were significantly higher than in those who received 2 doses of OPV (72.5% and 22.9, respectively). Furthermore, in <5-year-old children who received 4 doses of either DTaP-sIPV or cIPV, the seropositivity rates and the GMTs for all 3 types of poliovirus were similarly high (96.5-100% and 170.3-368.8, respectively). Our findings from the NESVPD demonstrate that both the vaccination coverage and seropositivity rates for polio remained high in children after IPV introduction.
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Affiliation(s)
- Hiroshi Satoh
- Department of Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Keiko Tanaka-Taya
- Department of Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo 208-0011, Japan
| | - Akiko Goto
- Hokkaido Institute of Public Health, North-19, West-12, Kita-ku, Sapporo, Hokkaido 060-0819, Japan
| | - Shizuka Tanaka
- Yamagata Prefectural Institute of Public Health, 1-6-6 Tokamachi, Yamagata, Yamagata 990-0031, Japan
| | - Tsuyoshi Nakano
- Gunma Prefectural Institute of Public Health and Environmental Sciences, 378 Kamiokimachi, Maebashi, Gunma 371-0052, Japan
| | - Chiemi Hotta
- Chiba Prefectural Institute of Public Health, 666-2 Nitonacho, Chuo-ku, Chiba, Chiba 260-8715, Japan
| | - Terue Okazaki
- Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunincho, Shinjuku, Tokyo 169-0073, Japan
| | - Masae Itamochi
- Toyama Institute of Health, 17-1 Nakataikoyama, Imizu, Toyama 939-0363, Japan
| | - Miyabi Ito
- Aichi Prefectural Institute of Public Health, 7-6 Nagare, Tsujicho, Kita-ku, Nagoya, Aichi 462-8576, Japan
| | - Reiko Okamoto-Nakagawa
- Yamaguchi Prefectural Institute of Public Health and Environment, 2-5-67 Aoi, Yamaguchi, Yamaguchi 753-0821, Japan
| | - Yasutaka Yamashita
- Ehime Prefectural Institute of Public Health and Environmental Science, 8-234 Sanbancho, Matsuyama, Ehime 790-0003, Japan
| | - Satoru Arai
- Department of Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Hideo Okuno
- Department of Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Saeko Morino
- Department of Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Kazunori Oishi
- Department of Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
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Sibeudu FT, Uzochukwu BS, Onwujekwe OE. Rural-urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria. SAGE Open Med 2019; 7:2050312118823893. [PMID: 30719291 PMCID: PMC6348577 DOI: 10.1177/2050312118823893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives: The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas. Method: The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses. Result: Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05). Conclusion: Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.
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Affiliation(s)
- Florence Tochukwu Sibeudu
- Department of Nursing Science, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Benjamin Sc Uzochukwu
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna E Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.,Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu, Nigeria
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Nomhwange TI, Shuaib F, Braka F, Godwin S, Kariko U, Gregory U, Tegegne SG, Okposen B, Onoka C. Routine immunization community surveys as a tool for guiding program implementation in Kaduna state, Nigeria 2015-2016. BMC Public Health 2018; 18:1313. [PMID: 30541515 PMCID: PMC6291913 DOI: 10.1186/s12889-018-6197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Routine childhood immunization remains an important strategy for achieving polio eradication and maintaining a polio-free world. To address gaps in reported administrative coverage data, community surveys were conducted to verify coverage, and guide strategic interventions for improved coverage. Methods We reviewed the conduct of community surveys by World Health Organization (WHO) field volunteers deployed as part of the surge capacity to Kaduna state and the use of survey results between July 2015 and June 2016. Monthly and quarterly collation and use of these data to guide the deployment of various interventions aimed at strengthening routine immunization in the state. Results Over 97,000 children aged 0–11 months were surveyed by 138 field volunteers across 237 of the 255 wards in Kaduna state. Fully or appropriately immunized children increased from 67% in the fourth quarter of 2015 to 76% by the end of the second quarter of 2016. Within the period reviewed, the number of local government areas with < 80% coverage reduced from eight to zero. Conclusions The routine conduct of community surveys by volunteers to inform interventions has shown an improvement in the vaccination status of children 0–11 months in Kaduna state and remains a useful tool in addressing administrative data quality issues.
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Affiliation(s)
| | | | - Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
| | - Sambo Godwin
- World Health Organization, Kaduna Field Office, Kaduna, Nigeria
| | - Usman Kariko
- Kaduna State Primary Healthcare Development Agency, Kaduna, Nigeria
| | - Umeh Gregory
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | - Chima Onoka
- National Primary Health Care Agency, Abuja, Nigeria
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Umeh GC, Madubu DM, Korir C, Loveday N, Ishaku S, Iyal H, Omoleke SA, I Nomhwange T, Aliyu A, Musa A, Dankoli R, Mi Ningi A, Braka F, Dogo PM, Soba H, Iliyasu N. Micro-planning for immunization in Kaduna State, Nigeria: Lessons learnt, 2017. Vaccine 2018; 36:7361-7368. [PMID: 30366806 PMCID: PMC6238078 DOI: 10.1016/j.vaccine.2018.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/24/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The OPV 3 coverage for Kaduna State, 12-23 months old children was 34.4%. The low OPV 3 coverage, due mainly to weak demand for routine antigens and the need to rapidly boost population immunity against the disabling Wild Polio Virus (WPV), led the Global Polio Eradication Initiatives (GPEI) to increase supplemental OPV campaigns in Kaduna State, despite the huge cost and great burden on personnel. The OPV campaigns, especially in high risk (low vaccine uptake, <80% OPV 3 coverage and high vaccines refusal rate) states of northern Nigeria with poliovirus transmission has resulted in overestimated denominators or target population, as the highest ever vaccinated is used to set OPV campaign targets. METHODS We utilized a cross-sectional study that assessed the impacts and possible solutions to the challenges of overestimated denominators in immunization services planning, delivery and performance evaluation in Kaduna State, Nigeria. We used both descriptive and quantitative approaches. We enumerated households and obtained the target populations for routine immunization (<1 year), polio campaign (<5 years) and acute flaccid paralysis surveillance (<15 years). RESULTS We found a significant difference in mean scores between the micro-planning and supplemental vaccination data on a number of <5 years (M = 102967, SD = 62405, micro-planning compared to M = 157716, SD = 72212, supplemental vaccination, p < 0.05). We also found a significant difference in mean scores between the micro-planning and projected census data on a number of <1 year (M = 26128, SD = 16828, micro-planning compared to M = 14154, SD = 4894, census, p < 0.05). CONCLUSION Periodic household-based micro-planning, aided with the use of technology for validation remains a useful tool in addressing gaps in immunization planning, delivery and performance evaluation in developing countries, such as Nigeria with overestimated denominators.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul M Dogo
- Kaduna State Ministry of Health, Kaduna, Nigeria
| | - Haliru Soba
- Emergency Operations Centre (sEOC), Kaduna, Nigeria
| | - Neyu Iliyasu
- Kaduna State Primary Health Care Agency, Kaduna, Nigeria
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Aye HNN, Saw YM, Thar AMC, Oo N, Aung ZZ, Tin H, Than TM, Kariya T, Yamamoto E, Hamajima N. Assessing the operational costs of routine immunization activities at the sub-center level in Myanmar: What matters for increasing national immunization coverage? Vaccine 2018; 36:7542-7548. [PMID: 30377065 DOI: 10.1016/j.vaccine.2018.10.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myanmar's national immunization program was launched in 1978. Routine immunization is mainly provided at sub-center level with midwives assigned as main vaccinators. The vaccinators at the sub-centers have to obtain vaccines from their designated township health department's cold room for immunization services. This study aimed to calculate the operational costs of routine immunization at sub-centers in Myanmar. METHODS A cross-sectional study was conducted among 160 sub-centers throughout the country. Face-to-face interviews were conducted with the main vaccinator at each sub-center using a pre-tested questionnaire. The study analyzed the operational costs per facility and the associations between sub-center characteristics and operational costs. RESULTS In Myanmar, the average operational costs of routine immunization per sub-center ranged from 434,700-990,125 MMK for rural areas and 235,875-674,250 MMK for urban areas. The operational costs increased by 8,749.50 MMK (95% CI: 6,805.79-10,693.21; p < 0.001) per mile and 5,752.50 MMK (95% CI: 914.22-10,590.79; p < 0.05) per working day. CONCLUSION This study indicated that the operational costs at sub-centers were high and varied significantly among the different geographical areas. The operational costs could be reduced by additional support for the resources, for example, installing cold chain facilities at sub-centers and opening new sub-centers throughout the country.
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Affiliation(s)
- Hnin Nwe Ni Aye
- Expanded Programme on Immunization/Communicable Diseases Unit, Mandalay Regional Public Health Department, Ministry of Health and Sports, Mandalay, Myanmar; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan; Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Aye Mya Chan Thar
- Central Expanded Programme on Immunization, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Nwe Oo
- Department of Food and Drug Administration, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Zaw Zaw Aung
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Htun Tin
- Central Epidemiological Unit, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thet Mon Than
- Department of Medical Services, Ministry of Health and Sports, Myanmar
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Chatterjee S, Ghosh A, Das P, Menzies NA, Laxminarayan R. Determinants of cost of routine immunization programme in India. Vaccine 2018; 36:3836-3841. [PMID: 29776749 PMCID: PMC5999352 DOI: 10.1016/j.vaccine.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 11/24/2022]
Abstract
The costs of delivering routine immunization services in India vary widely across facilities, districts and states. Understanding the factors influencing this cost variation could help predict future immunization costs and suggest approaches for improving the efficiency of service provision. We examined determinants of facility cost for immunization services based on a nationally representative sample of sub-centres and primary health centres (99 and 89 facilities, respectively) by regressing logged total facility costs, both including and excluding vaccine cost, against several explanatory variables. We used a multi-level regression model to account for the multi-stage sampling design, including state- and district-level random effects. We found that facility costs were significantly associated with total doses administered, type of facility, salary of the main vaccinator, number of immunization sessions, and the distance of the facility from the nearest cold chain point. Use of pentavalent vaccine by the state was an important determinant of total facility cost including vaccine cost. India is introducing several new vaccines including some supported by Gavi. Therefore, the government will have to ensure that additional resources will be made available after the support from Gavi ceases.
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Affiliation(s)
| | - Arpita Ghosh
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Palash Das
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Nicolas A Menzies
- Department of Global Health and Population and Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramanan Laxminarayan
- Centre for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
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Biellik RJ, Orenstein WA. Strengthening routine immunization through measles-rubella elimination. Vaccine 2018; 36:5645-5650. [PMID: 30041881 PMCID: PMC6143483 DOI: 10.1016/j.vaccine.2018.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/12/2018] [Accepted: 07/15/2018] [Indexed: 11/27/2022]
Abstract
The 2016 mid-term review of the Global Measles-Rubella Strategic Plan 2012-20 for achieving measles-rubella elimination concluded that the full potential of strategies and activities to strengthen routine immunization (RI) service delivery had not been met. In December 2017, we contacted WHO and partner agency immunization staff in all six WHO Regions who identified 23 countries working on measles or rubella elimination that have implemented examples of recommended activities to improve RI, adapted to their needs. Among those examples, opportunities to strengthen RI through implementing supplementary immunization activities (SIAs) were reported most frequently, including advocacy for immunization and educational activities targeted at the public and skills training targeted at health professionals. The expansion of cold chain capacity to accommodate supplies required for SIAs facilitated widening RI service delivery to reach more communities, introduce new vaccines, and reduce the risk of vaccine stock-outs. Substantial numbers of under-vaccinated children, according to the national immunization schedule, have been identified during SIAs, but it is not possible to confirm whether these children actually received missing RI doses. Micro-planning exercises for SIAs have generated data that permitted the revision of catchment populations for fixed site and outreach RI services. Some countries reported using the opportunity afforded by measles/rubella elimination to strengthen overall vaccine-preventable disease surveillance and outbreak preparedness and to introduce mandatory school-entry vaccination requirements covering other vaccines in addition to measles and rubella. Unfortunately, we were unable to obtain information regarding the cost, impact or sustainability of these activities. The evaluation of the many other strategies that have been deployed in recent years to strengthen RI systems and raise vaccination coverage was beyond the scope of this survey. We conclude by providing recommendations to encourage more countries to adapt and implement a comprehensive set of RI-strengthening activities in association with the MR elimination goal.
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Morino S, Tanaka-Taya K, Satoh H, Arai S, Takahashi T, Sunagawa T, Oishi K. Descriptive epidemiology of varicella based on national surveillance data before and after the introduction of routine varicella vaccination with two doses in Japan, 2000-2017. Vaccine 2018; 36:5977-5982. [PMID: 30166199 DOI: 10.1016/j.vaccine.2018.08.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
Abstract
Routine childhood immunization using two doses of the varicella vaccine was introduced in Japan in October 2014. In this study, we analyzed the data extracted from national varicella surveillance, including pediatric sentinel surveillance from 2000 to 2017 and hospitalized varicella surveillance from the 38th week of 2014 to the 37th week of 2017. Compared with the 2000-2011 baseline data, the number of varicella cases per sentinel decreased substantially by 76.6% overall and by 88.2% among children aged 1-4 years in 2017. Of 997 hospitalized patients, we found a decreasing trend in the number of cases among children aged <5 years. We also found a decreasing trend in the number of cases with complications among children aged 1-4 years. Data on the self-reported transmission sites in 35.5% (354/997) of the hospitalized varicella patients showed that transmission of varicella zoster virus (VZV) occurred frequently in household, at school for young children, in the workplace for adults, and at hospital for all age groups. Data from 29.0% (289/997) of the hospitalized patients with a self-reported source of infection showed that transmission of VZV occurred from a patient with herpes zoster (HZ) in 30.4% (88/289) of cases. Our data demonstrate a substantial decrease in the number of varicella cases in young children following introduction of routine childhood vaccination program with two-dose varicella vaccination in Japan. These data highlight the unique aspects of transmission sites across age groups and the important role of HZ cases in disease circulation.
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Affiliation(s)
- Saeko Morino
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Hiroshi Satoh
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Satoru Arai
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Takuri Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
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Abstract
Vaccines are very effective in providing individual and community (herd) immunity against a range of diseases. In addition to protection against a range of diseases, vaccines also have social and economic benefits. However, for vaccines to be effective, routine immunization programmes must be undertaken regularly to ensure individual and community protection. Nonetheless, in many countries in Africa, vaccination coverage is low because governments struggle to deliver vaccines to the most remote areas, thus contributing to constant outbreaks of various vaccine-preventable diseases. African governments fail to deliver vaccines to a significant percentage of the target population due to many issues in key areas such as policy setting, programme management and financing, supply chain, global vaccine market, research and development of vaccines. This review gives an overview of the causes of these issues and what is currently being done to address them. This review will discuss the role of philanthropic organisations such as the Bill and Melinda Gates Foundation and global partnerships such as the global alliance for vaccines and immunizations in the development, purchase and delivery of vaccines.
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Affiliation(s)
- Mario Songane
- McGill Life Sciences Complex, McGill University, 3649 Promenade Sir-William-Osler, Montreal, H3G 0B1, Canada.
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Yu W, Lu M, Wang H, Rodewald L, Ji S, Ma C, Li Y, Zheng J, Song Y, Wang M, Wang Y, Wu D, Cao L, Fan C, Zhang X, Liu Y. Routine immunization services costs and financing in China, 2015. Vaccine 2018; 36:3041-3047. [PMID: 29685593 DOI: 10.1016/j.vaccine.2018.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/21/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To estimate the costs of routine immunization (RI) services in China in 2015, to provide objective data relevant to investment in the Expanded Program on Immunization, and to contribute to global data on costing and financing of RI. METHODS The study was conducted between January and March 2016. We selected 276 villages, 138 townships, 46 counties, and 40 prefectures from 15 provinces as investigation sites at random, stratified by eastern, middle, and western regions. Direct cost items included vaccines, personnel, cold chain, surveillance, communication, training, and supervision at the national, provincial, prefecture, county, township, and village levels. We obtained financial data from governmental and external sources. Indirect costs of RI included parents' transportation costs and productivity lost due to taking their children for vaccination. RESULTS Total direct costs were $92.42 for each child fully immunized ($4.20/dose), which equates to $1529.55 million per birth cohort. RI costs were higher in the eastern region than in the western region, and higher than that of the central region. Vaccination coverage was positively associated with direct routine immunization costs. The cost of the recommended vaccines was $19.08/child and vaccine only accounted for 20.64% of total costs. Operational cost, including surveillance, communication, training and supervision, was $217.31/child, accounting for 14.21% of total cost. The indirect cost per child was $72.86; the total indirect cost was $1205.83 million for the birth cohort. Government investment in RI accounted for about 70% of total costs. Revenue from sales of private-sector vaccine supported the remaining 30% of RI costs. CONCLUSIONS While government financing has increased, some operating costs continue to be provided from revenue generated by sales of Category 2 (private-sector) vaccines to families. China could benefit from bringing new and underutilized vaccines into the EPI system based on evidence that includes routine immunization vaccine and operations costs.
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Affiliation(s)
- Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Ming Lu
- National Health and Family Planning Commission of the People's Republic of China, No. 1, Xizhimenwai Street, Xicheng District, Beijing, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Lance Rodewald
- World Health Organization Office in China, 401, Dongwai Diplomatic Office Building, No. 23, Dong zhi men wai Street, Beijing, China
| | - Saisai Ji
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yixing Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Jingshan Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yifan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Miao Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Chunxiang Fan
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Xuan Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China
| | - Yanmin Liu
- National Immunization Program, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xicheng District, Beijing, China.
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Phoummalaysith B, Yamamoto E, Xeuatvongsa A, Louangpradith V, Keohavong B, Saw YM, Hamajima N. Factors associated with routine immunization coverage of children under one year old in Lao People's Democratic Republic. Vaccine 2018; 36:2666-2672. [PMID: 29606518 DOI: 10.1016/j.vaccine.2018.03.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/16/2018] [Accepted: 03/19/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage. METHODS Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group). RESULTS Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages. CONCLUSIONS Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage.
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Affiliation(s)
- Bounfeng Phoummalaysith
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan; National Health Insurance Bureau, Ministry of Health, Vientiane, Lao Democratic People's Republic
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Anonh Xeuatvongsa
- National Immunization Program, Maternal and Child Health Center, Ministry of Health, Vientiane, Lao Democratic People's Republic
| | - Viengsakhone Louangpradith
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan; Administration and Planning Department, Mittaphab Hospital, Vientiane, Lao Democratic People's Republic
| | - Bounxou Keohavong
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan; Food and Drug Department, Ministry of Health, Vientiane, Lao Democratic People's Republic
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ashbaugh HR, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Cherry JD, Rimoin AW. Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo. Vaccine 2018; 36:587-593. [PMID: 29248265 PMCID: PMC5780300 DOI: 10.1016/j.vaccine.2017.11.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS). METHODS We examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence. RESULTS Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas. CONCLUSIONS Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control.
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Affiliation(s)
- Hayley R Ashbaugh
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
| | - Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Vivian H Alfonso
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Adva Gadoth
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, WA 98109, United States
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
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Poy A, van den Ent MMVX, Sosler S, Hinman AR, Brown S, Sodha S, Ehlman DC, Wallace AS, Mihigo R. Monitoring Results in Routine Immunization: Development of Routine Immunization Dashboard in Selected African Countries in the Context of the Polio Eradication Endgame Strategic Plan. J Infect Dis 2017; 216:S226-S236. [PMID: 28838180 PMCID: PMC5853840 DOI: 10.1093/infdis/jiw635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background To monitor immunization-system strengthening in the Polio Eradication Endgame Strategic Plan 2013–2018 (PEESP), the Global Polio Eradication Initiative identified 1 indicator: 10% annual improvement in third dose of diphtheria-tetanus-pertussis–containing vaccine (DTP3) coverage in polio high-risk districts of 10 polio focus countries. Methods A multiagency team, including staff from the African Region, developed a comprehensive list of outcome and process indicators measuring various aspects of the performance of an immunization system. Results The development and implementation of the dashboard to assess immunization system performance allowed national program managers to monitor the key immunization indicators and stratify by high-risk and non–high-risk districts. Discussion Although only a single outcome indicator goal (at least 10% annual increase in DTP3 coverage achieved in 80% of high-risk districts) initially existed in the endgame strategy, we successfully added additional outcome indicators (eg, decreasing the number of DTP3-unvaccinated children) as well as program process indicators focusing on cold chain, stock availability, and vaccination sessions to better describe progress on the pathway to raising immunization coverage. Conclusion When measuring progress toward improving immunization systems, it is helpful to use a comprehensive approach that allows for measuring multiple dimensions of the system.
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Affiliation(s)
- Alain Poy
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | - Sidney Brown
- Bill and Melinda Gates Foundation, Seattle, Washington
| | - Samir Sodha
- United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Ehlman
- United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron S Wallace
- United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Francis MR, Nohynek H, Larson H, Balraj V, Mohan VR, Kang G, Nuorti JP. Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998-2008. Vaccine 2017; 36:6559-6566. [PMID: 28844636 DOI: 10.1016/j.vaccine.2017.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/04/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite almost three decades of the Universal Immunization Program in India, a little more than half the children aged 12-23months receive the full schedule of routine vaccinations. We examined socio-demographic factors associated with partial-vaccination and non-vaccination and the reasons for non-vaccination among Indian children during 1998 and 2008. METHODS Data from three consecutive, nationally-representative, District Level Household and Facility Surveys (1998-99, 2002-04 and 2007-08) were pooled. Multinomial logistic regression was used to identify individual and household level socio-demographic variables associated with the child's vaccination status. The mother's reported reasons for non-vaccination were analyzed qualitatively, adapting from a previously published framework. RESULTS The pooled dataset contained information on 178,473 children 12-23months of age; 53%, 32% and 15% were fully vaccinated, partially vaccinated and unvaccinated respectively. Compared with the 1998-1999 survey, children in the 2007-2008 survey were less likely to be unvaccinated (Adjusted Prevalence Odds Ratio (aPOR): 0.92, 95%CI=0.86-0.98) but more likely to be partially vaccinated (aPOR: 1.58, 95%CI=1.52-1.65). Vaccination status was inversely associated with female gender, Muslim religion, lower caste, urban residence and maternal characteristics such as lower educational attainment, non-institutional delivery, fewer antenatal care visits and non-receipt of maternal tetanus vaccination. The mother's reported reasons for non-vaccination indicated gaps in awareness, acceptance and affordability (financial and non-financial costs) related to routine vaccinations. CONCLUSIONS Persisting socio-demographic disparities related to partial-vaccination and non-vaccination were associated with important childhood, maternal and household characteristics. Further research investigating the causal pathways through which maternal and social characteristics influence decision-making for childhood vaccinations is needed to improve uptake of routine vaccination in India. Also, efforts to increase uptake should address parental fears related to vaccination to improve trust in government health services as part of ongoing social mobilization and communication strategies.
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Affiliation(s)
- Mark Rohit Francis
- Department of Epidemiology, Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Hanna Nohynek
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Pekka Nuorti
- Department of Epidemiology, Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland; Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland.
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Taiwo L, Idris S, Abubakar A, Nguku P, Nsubuga P, Gidado S, Okeke L, Emiasegen S, Waziri E. Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015. Pan Afr Med J 2017; 27:186. [PMID: 29187919 PMCID: PMC5687880 DOI: 10.11604/pamj.2017.27.186.11191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/06/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. METHODS We enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. RESULTS Mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2nd-5th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. CONCLUSION There is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community. Efforts should be made by the Governments to scale up sensitization of mothers/caregivers to improve their knowledge on routine immunization through radio jingles.
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Affiliation(s)
- Lydia Taiwo
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
- Federal Ministry of Health, Abuja, FCT, Nigeria
| | - Suleiman Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Aisha Abubakar
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
| | | | - Saheed Gidado
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
| | - Lilian Okeke
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
| | - Samuel Emiasegen
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
| | - Endie Waziri
- Nigeria Field Epidemiology & Laboratory Training Program (NFELTP), Abuja, Nigeria
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Adeloye D, Jacobs W, Amuta AO, Ogundipe O, Mosaku O, Gadanya MA, Oni G. Coverage and determinants of childhood immunization in Nigeria: A systematic review and meta-analysis. Vaccine 2017; 35:2871-2881. [PMID: 28438406 DOI: 10.1016/j.vaccine.2017.04.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The proportion of fully immunized children in Nigeria is reportedly low. There are concerns over national immunization data quality, with this possibly limiting country-wide response. We reviewed publicly available evidence on routine immunization across Nigeria to estimate national and zonal coverage of childhood immunization and associated determinants. METHODS A systematic search of Medline, EMBASE, Global Health and African Journals Online (AJOL) was conducted. We included population-based studies on childhood immunization in Nigeria. A random effects meta-analysis was conducted on extracted crude rates to arrive at national and zonal pooled estimates for the country. RESULTS Our search returned 646 hits. 21 studies covering 25 sites and 26,960 children were selected. The estimated proportion of fully immunized children in Nigeria was 34.4% (95% confidence interval [CI]: 27.0-41.9), with South-south zone having the highest at 51.5% (95% CI: 20.5-82.6), and North-west the lowest at 9.5% (95% CI: 4.6-14.4). Mother's social engagements (OR=4.0, 95% CI: 1.9-8.1) and vaccines unavailability (OR=3.9, 95% CI: 1.2-12.3) were mostly reported for low coverage. Other leading determinants were vaccine safety concerns (OR=3.0, 95% CI: 0.9-9.4), mother's low education (OR=2.5, 95% CI: 1.8-3.6) and poor information (OR=2.0, 95% CI: 0.8-4.7). CONCLUSION Our study suggests a low coverage of childhood immunization in Nigeria. Due to the paucity of data in the Northern states, we are still uncertain of the quality of evidence presented. It is hoped that this study will prompt the needed research, public health and policy changes toward increased evenly-spread coverage of childhood immunization in the country.
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Affiliation(s)
- Davies Adeloye
- Demography and Social Statistics, Covenant University, PMB 1023, Ota, Ogun State, Nigeria; Centre for Global Health Research, Usher Institute, University of Edinburgh, UK.
| | - Wura Jacobs
- Department of Health Science, California State University, Fullerton, CA, USA
| | - Ann O Amuta
- Department of Health Studies, Texas Woman's University, Denton, TX, USA
| | - Oluwatomisin Ogundipe
- Economics and Development Studies, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
| | - Oluwaseun Mosaku
- Computer and Information Sciences, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
| | - Muktar A Gadanya
- Department of Community Medicine, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | - Gbolahan Oni
- Demography and Social Statistics, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
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Sibeudu FT, Uzochukwu BSC, Onwujekwe OE. Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state. BMC Res Notes 2017; 10:78. [PMID: 28143605 PMCID: PMC5286773 DOI: 10.1186/s13104-017-2407-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis. RESULT Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X2 = 9.97, p < 0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility. CONCLUSION Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.
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Affiliation(s)
- Florence T. Sibeudu
- Department of Nursing Science, NnamdiAzikiwe University, Nnewi Campus, Nnewi, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Benjamin S. C. Uzochukwu
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna E. Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
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