Are providers’ recommendation and knowledge associated with uptake of optional vaccinations among children? A multilevel analysis in three provinces of China

Abstract

BackgroundImmunization services providers play a crucial role in the successful implementation of immunization, particularly for new vaccines. Several childhood vaccinations that are important for public health are not included in the National Immunization Programme in China, although they are available as optional and self-paid vaccines. Their coverage remains low. ObjectiveTo examine the association between providers’ knowledge and recommendations of optional vaccines, as well as other supply- and demand-side factors, and their uptake among children. MethodsA cross-sectional study, that included an in-person questionnaire survey for parents of children under-3 years and a self-administrative questionnaire survey for their vaccination services providers, was conducted in 36 townships or sub-districts in three provinces of China in 2013. Using a sample of 1791 household from 30 townships or sub-districts, we applied multilevel logistic analyses to examine the factors associated with the uptake of optional vaccines based on a hierarchal framework that combined demand-side and supply-side factors. ResultsCoverage of optional childhood vaccinations varied across small areas. Supply- and demand-side factors were both associated with the uptake of these vaccines. Immunization services providers’ recommendations and their knowledge about optional vaccination were positively and significantly associated with uptake. Children were more likely to receive the vaccines if they lived in communities with higher immunization worker density or larger immunization clinics. Several demand-side psychological factors about childhood vaccination were also associated with optional vaccinations. ConclusionsPromoting immunization services providers to conduct evidence-based recommendations about some important childhood optional vaccinations and enhancing their knowledge regarding optional vaccinations and communication skills are useful strategies to increase the coverage of these vaccinations.