Childhood Immunization Coverage Research Articles

The synergistic impact of Universal Health Coverage and Global Health Security on health service delivery during the Coronavirus Disease-19 pandemic: A difference-in-difference study of childhood immunization coverage from 192 countries.

Universal Health Coverage (UHC) and Global Health Security (GHS) are two high-priority global health agendas that seek to foster health system resilience against health emergencies. Many countries have had to prioritize one agenda over the other due to scarce resources and political pressures. To aid policymakers' decision-making, this study investigated the individual and synergistic effects of countries' UHC and GHS capacities in safeguarding essential health service delivery during the COVID-19 pandemic. We used a quasi-experimental difference-in-difference methodology to quantify the relationship between 192 countries' progress towards UHC and GHS and those countries' abilities to provide 12 essential childhood immunization services between 2015 and 2021. We used the 2019 UHC Service Coverage Index (SCI) to divide countries into a "high UHC group" (UHC SCI≥75) and the rest (UHC SCI 75), and similarly used the 2019 GHS Index (GHSI) to divide countries into a "high GHS group" (GHSI≥65) and the rest (GHSI<65). All analyses were adjusted for potential confounders. Countries with high UHC scores prevented a 1.14% (95% CI: 0.39%, 1.90%) reduction in immunization coverage across 2020 and 2021 whereas countries with high GHSI scores prevented a 1.10% (95% CI: 0.57%, 1.63%) reduction in immunization coverage over the same time period. The stratified DiD models showed that across both years, high UHC capacity needed to be augmented with high GHS capacity to prevent a decline in immunization coverage while high GHS alone was able to safeguard immunization coverage. This study found that greater progress towards both UHC and GHS capacities safeguarded essential health service delivery during the pandemic but only progress towards GHS capacity was both a necessary and likely sufficient element for yielding this protective effect. Our results call for strategic investments into both health agendas and future research into possible synergistic effects of the two health agendas.

Decentralization and immunization program in a single-party state: the case of the Lao People’s Democratic Republic

BackgroundThe Lao People’s Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied.MethodsA case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents.ResultsThe Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change.ConclusionUnprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program.

Demographic determinants of poor childhood immunization coverage among women in Bayelsa state

The study examined at the extent demographic factors influence childhood immunization coverage in Bayelsa State. The design was cross-sectional. The total female population of Bayelsa State is estimated to be 1,116, 200.9. National Population Commission and National Bureau of Statistics (2016); National Bureau of Statistics (2018) According to the World Health Organizatio, women of reproductive age account for 22% of the total population of 501, 502 people. The study population consists solely of women in Bayelsa State who have child(ren) between the ages of 0 and 5 years. A multi-stage procedure was used to select 20 women with at least one child under the age of five from each selected community, yielding a sample size of 1100. The instrument's internal consistency was assessed using Cronbach's Alpha statistics, yielding a reliability of 0.77. At the 0.05 level of significance, simple regression statistics was used to analyze the hypotheses. The findings revealed that mothers’ age and education influence childhood immunization coverage, as the educated and older mothers have higher probability of getting their children immunized completely. Maternal education was recommended in the State, also that the National Orientation Agency should ensure mass media exposure and community education awareness and campaigns on immunization.

IJCM_225A: Assessment of factors influencing measles vaccine uptake in a metropolitan city: A cross-sectional study

Background: Globally, measles deaths were estimated to be over 1,28,000 in the year 2021, despite the easy availability of safe and effective vaccines to prevent the infection. Routine childhood immunization coverage rates dropped during the COVID-19 pandemic and India has been one of the worst affected countries. The most recent measles outbreak was reported last year in Mumbai, Maharashtra. Objectives: 1. To estimate the level of uptake of measles vaccine in children aged 12 months to 5 years 2. To determine the factors associated with the uptake of measles vaccine. Methodology: This cross-sectional study was conducted over 2 months in a municipal ward of Mumbai during Oct-Nov 2023 in mothers with children aged 12 to 60 months, living in the area for at least past 6 months. Five out of fifteen clusters of Municipal Health Post areas were selected randomly &amp; from each, 82 eligible households were chosen randomly for door-to-door interviews with the participants. Results: Among the sample of 428 children, measles vaccine coverage was 96.7%, but only 263 (61.45%) children were vaccinated in timely manner. The facilitator for mothers in vaccine uptake was receiving information from healthcare workers during and after pregnancy (77.57%). The barriers were lack of information about vaccination schedule (18.69%), and child being unwell during vaccination (10.74%). Conclusion: Huge efforts have been taken by the Public Health Department for achieving this level of vaccine coverage, however, measles elimination is still a challenge due to delayed vaccination.

Acute malnutrition relapse and associated factors among 6-59 months old children treated in the community-based management of acute malnutrition in Dessie, Kombolcha, and Haik towns, Northeast Ethiopia.

Undernutrition is a major health concern in many developing countries, and is one of the main health problems affecting children in Ethiopia. Although many children experience multiple relapses following the management of severe acute malnutrition, it is scarcely studied in Ethiopia. A community-based cross-sectional study was conducted in Dessie, Kombolcha, and Haik towns among 6-59-month-old children enrolled and discharged from community-based acute malnutrition management (CMAM). The total sample size was 318 children, and data were collected from April 15, 2021, to May 14, 2021. The data were entered into EPI data version 4.4.1 before being exported and analyzed with SPSS version 25 software. A multivariate logistic regression analysis was performed, and a 95% confidence interval and p-value <0.05 were used to identify significantly associated variables. Additionally, the weight-for-height z-score (WHZ) was generated using the WHO Anthro 3.2.2 software. The overall acute malnutrition relapse after discharge from CMAM was 35.2% (6.6% relapsed to severe acute malnutrition and 28.6% relapsed to moderate acute malnutrition). The following variables were significantly associated with the relapse of acute malnutrition: child age (AOR: 3.08, 95% CI; 1.76, 5.39), diarrhea after discharge (AOR: 2.93, 95%CI; 1.51, 5.69), have not immunized (AOR: 3.05, 95% CI; 1.14, 8.23), MUAC at discharge (AOR: 3.16, 95% CI; 1.56, 6.40), and poorest and poor wealth index (AOR: 3.65, 95% CI; 1.45, 9.18) and (AOR: 2.73, 95% CI; 1.13, 6.59), respectively. Over one-third of children treated with the CMAM program reverted to SAM or MAM. The age of the child, diarrhea after discharge, lack of immunization, MUAC at discharge (<13 cm), and poor and poorest wealth index were significantly associated with acute malnutrition relapse. Therefore, adequate health education and counseling services are essential for mothers to improve child immunization coverage and maintain adequate hygiene to prevent diarrhea. In addition, further experimental research is needed to investigate the effect of MUAC at discharge on the risk of acute malnutrition relapse.

Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

IntroductionThe COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in...

Influence of women empowerment on childhood (12–23 months) immunization coverage: Recent evidence from 17 sub-Saharan African countries

BackgroundThere is a global consensus that child immunization plays an important role in promoting the health and well-being of children. Despite the quintessential role of immunization, not all children receive full immunization coverage. We examined the association between women empowerment and childhood immunization coverage in sub-Saharan Africa (SSA).MethodsThe most recent Demographic and Health Survey data of 17 SSA countries were used for the analysis, with a sample of 19,223. The outcome and exposure variables were full immunization coverage and women empowerment, respectively. Full immunization was computed from percentage of children between the ages of 12 and 23 months who had received the following vaccines at any point in time: one dose of Bacille Calmette–Guérin, three doses of the vaccine protecting against diphtheria, pertussis, and tetanus or the tetravalent/pentavalent vaccine, three doses of the polio vaccine, and one dose of the measles vaccine (either as a standalone measles vaccine or as part of a combination with other immunogens). Women’s empowerment was an index of labour participation, acceptance towards spousal violence, decision-making capacity and general knowledge level. Descriptive analysis and multilevel logistic regression were performed. Results were reported in adjusted odds ratio with a corresponding 95% confidence interval.ResultsThe study found that 56.6% of children were fully immunized. Children of employed mothers were 1.16 times more likely to be fully immunized. Children of mothers with higher acceptance toward violence were less likely to be fully immunized [aOR = 0.90, CI 0.81, 0.99]. The odds of full immunization were higher among children born to mothers with high [aOR = 1.11, CI 1.01, 1.22] decision-making capacity. Higher odds of full immunization were found among children born to mothers with medium [aOR = 1.24, CI 1.13, 1.36] to high [aOR = 1.44, CI 1.27, 1.63] general knowledge level.ConclusionsWe conclude that empowering women through livelihood empowerment interventions can increase their decision-making capacity and foster their resolve to ensure the full immunization of their children. This can be achieved by consciously investing in initiatives such as vocational training programs, job placement services, or support for entrepreneurship initiatives to encourage and support women's workforce participation.

Cost-efficient child vaccination project results from hard-to-reach rural communities in Kenya

Abstract Child immunization is a cost-effective public health measure for reducing child morbidity and mortality. Child immunization coverage in Kenya has improved in recent years, with coverage rates for most vaccines exceeding 80%. However, there are still pockets of low coverage, particularly in remote or hard-to-reach areas. We implemented a community-based project to improve access and equity in child immunization services in three Kenyan counties (Nairobi, Wajir and Mandera). We trained health workers, promoted community acceptance, and provided logistical support to Ministry of Health (MoH) for child immunization services through community outreach centers. During the project period (January 2020 to February 2023), our project facilitated full immunization coverage for 93,879 children and we reached 200,554 community members whom we communicated relevant messages for recommended practice about health, nutrition and child vaccination. Our project achieved a 26 percentage-point increase (increased from 62% at baseline in 2020 to 88% at endline in 2022) in age-appropriate child vaccinations by end of the project. We also conducted a cost-efficiency analysis by taking the actual costs incurred and project achievements into account. The key results from the cost-efficiency analysis revealed approximate cost for a fully immunized child as 21 US dollar, while per capita cost for communicating health messages to community members and health care worker training was 10 US dollar. UNICEF estimated approximately 32 US$ as vaccine delivery cost (=total cost - cost of vaccine and supply) per fully vaccinated child with standard schedule for children &amp;lt; 24 months which is higher than the cost for ensuring a fully immunized child in our project. These data clearly indicate the efficiency and success of community-based approach for strengthening MoH child immunization services in Kenyan rural and hard-to-reach communities. Key messages • Strong collaboration with Ministry of Health and community participation are critical key aspects for implementing child vaccination program successfully and cost-efficiently in rural communities. • Facilitating Ministry of Health for health system strengthening focus yields sustainable impact as footprint after end of a short-term of a community based project in developing country settings.

High vaccine confidence and strong approval of the mandatory immunization schedule among Bulgarian general practitioners in 2022

ABSTRACT In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 vaccines in Bulgaria, this study measures vaccine hesitancy among general practitioners (GPs) in the country, as they are central to forming patients’ attitudes. In 2022, a face-to-face survey was conducted through a simple random sample from an exhaustive national database of Bulgarian GPs. This study measured attitudes on vaccine importance, safety, and effectiveness, and attitudes toward the Bulgarian immunization schedule. Information was collected on demographic and GP practice characteristics and possible predictors of vaccine confidence in order to test for associations with attitudes toward immunization. GP attitudes toward vaccines and the immunization schedule in Bulgaria were generally positive. Among 358 respondents, 351 (98%,95%CI96–99%) strongly agreed/agreed that vaccines are important, 352 (98%,95%CI96–99%) that vaccines are effective, and 341 (95%,95%CI93–97%) that vaccines are safe. 347 respondents (97%,95%CI95–98%) affirmed that “it’s good that vaccines from the children’s immunization schedule are mandatory”, and 331 (92%,95%CI89–95%) agreed with the statement “Bulgaria’s childhood immunization has my approval”. Trust in information from official institutions was among the strongest predictors of vaccine confidence. Respondents’ vaccine confidence levels are within the ranges reported by GPs in other European countries and above those reported within the general Bulgarian population. GPs’ vaccine confidence is highly associated with trust in official institutions. It is important to maintain trust in official institutions and to support GPs in communicating vaccine knowledge with patients so that vaccine hesitancy in the general population is countered.

Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces

BackgroundMigrant and left-behind families are vulnerable in health services utilization, but little is known about their disparities in immunization of non-National Immunization Program (NIP) vaccines. This study aims to evaluate the immunization coverage, knowledge, satisfaction, and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.MethodsA cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China. A total of 1648 caregivers of children aged 1–6 years were interviewed face-to-face by a pre-designed online questionnaire, and their families were grouped into four types: local urban, migrant, non-left-behind, and left-behind. Non-NIP vaccines included Hemophilus influenza b (Hib) vaccine, varicella vaccine, rotavirus vaccine, enterovirus 71 vaccine (EV71) and 13-valent pneumonia vaccine (PCV13). Log-binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the difference on immunization coverage of children, and knowledge and satisfaction of caregivers among families. The network models were conducted to explore the interplay of immunization coverage, knowledge, and satisfaction. Logistic regression models with odds ratios (ORs) and 95% CIs were used to estimate the associated factors of non-NIP vaccination.ResultsThe immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest, followed by migrant, non-left-behind and left-behind families. Compared with local urban children, the PRs (95% CIs) for getting all vaccinated were 0.65 (0.52–0.81), 0.29 (0.22–0.37) and 0.14 (0.09–0.21) among migrant children, non-left-behind children and left-behind children, respectively. The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule. Non-NIP vaccination was associated with characteristics of both children and caregivers, including age of children (> 2 years-OR: 1.69, 95% CI: 1.07–2.68 for local urban children; 2.67, 1.39–5.13 for migrant children; 3.09, 1.23–7.76 for non-left-behind children); and below caregivers’ characteristics: family role (parents: 0.37, 0.14–0.99 for non-left-behind children), age (≤ 35 years: 7.27, 1.39–37.94 for non-left-behind children), sex (female: 0.49, 0.30–0.81 for local urban children; 0.31, 0.15–0.62 for non-left-behind children), physical health (more than average: 1.58, 1.07–2.35 for local urban children) and non-NIP vaccines knowledge (good: 0.45, 0.30–0.68 for local urban children; 7.54, 2.64–21.50 for left-behind children).ConclusionsThere were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts. Non-NIP vaccination promotion strategies, including education on caregivers, and optimization of the immunization information system, should be delivered particularly among left-behind and migrant families.Graphical

Increase in institutional delivery and child immunisation coverage through an appreciative inquiry-based community dialogue intervention in Afghanistan

ObjectiveA community dialogue intervention with an appreciative inquiry approach was undertaken to improve institutional delivery and child immunisation coverage in a hard-to-reach province, namely, Kandahar, in Afghanistan. This study aimed to evaluate the intervention's effectiveness in promoting institutional delivery and child immunisation. Study designA pre-post intervention evaluation study. MethodsAn intervention and a non-intervention district were selected in Kandahar. Children aged under 5 years participated in surveys at baseline (October 2018) and follow-up (Post-intervention: November 2019). We analysed age, sex, place of birth, and confirmed immunisation coverage data concerning 1046 and 927 children pre- and post-interventions, respectively. Changes in institutional delivery and confirmed immunisation status were evaluated using net intervention effect and difference-in-difference (DID) analysis. ResultsInstitutional delivery rates increased from 66.3% to 83.6% (p = 0.016) in the intervention district and decreased from 71.3% to 46.7% (p < 0.001) in the non-intervention district, with a net intervention effect of 41.9%. Full immunisation coverage among children aged 12–23 months and 24–35 months significantly increased from 26.4% to 76.9% (p < 0.001) and from 40.0% to 78.6% (p < 0.001), respectively, in the intervention district, whereas coverage significantly decreased in the non-intervention district. The net intervention effects were 59.1% and 44.8% for children aged 12–23 months and 24–35 months, respectively. The DID analysis also revealed significant differences in outcomes after intervention at follow-up. The results concerning antigen-specific immunisation coverage indicated a significant increase in immunisation coverage in the intervention district. ConclusionsThe appreciative inquiry-based community dialogue intervention considerably increased institutional delivery and child immunisation coverage, even in a hard-to-reach province in Afghanistan.

Relapse of severe acute malnutrition among children discharged from outpatient therapeutic program in western Ethiopia

BackgroundChildren with severe acute malnutrition (SAM) without complication are treated in the outpatient therapeutic program (OTP) and the program has been reported to be effective. However, relapse post-discharge from the program is poorly defined, and scarcely evaluated across programs and research. The objective of this study is to assess the prevalence of SAM among children post-discharge from the OTP and to identify factors associated with SAM relapse in Gambella Region, Western Ethiopia.MethodsWe conducted a facility-based cross-sectional study among 208 children aged 6–59 months who have been discharged from the OTP as cured. Baseline data were collected from caregivers using structured questionnaire. Child anthropometry and oedema was measured. The association between SAM relapse and the risk factors were assessed using bivariate and multivariable logistic regression models.ResultsThe prevalence of SAM relapse was 10.1% (95% CI: 5.8–14.0%). The odds of SAM relapse was significantly higher in children with mothers who had no exposure to education and promotion about infant and young child feeding (IYCF) practices (OR = 5.7; 95% CI: 1.3–12.6), children who were not fully immunized for their age (OR = 8.0; 95% CI: 3.8–23.4), and children with mid-upper arm circumference (MUAC) at discharge of < 12.5 cm (OR = 4.4; 95% CI: 2.1–12.8) than their counterparts.ConclusionsTo reduce SAM relapse, the OTP programs should avoid premature discharge and consider provision of supplementary food for children with low MUAC at discharge. Further, the OTP discharge criteria should consider both the anthropometric indicators – weight-for-height/length z-score (WHZ) and MUAC – and the absence of bilateral pitting oedema irrespective of the anthropometric indicator that is used during admission. Promotion of nutrition education and improving child immunization services and coverage would help reduce SAM relapse.

Innovative approach in assessing the children's immunization status when it cannot be documented.

During surveys, it is recommended that children immunization status should be based on immunization documents. It has been noted that in some communities, a number of children are claimed to be vaccinated but have no evidence of vaccination. This work is proposed to estimate routine immunization coverage in children based on both documented vaccination and the tracking of undocumented immunization. It was a community-based survey targeting children aged 0-59 months in which the immunization status of children was assessed based on vaccination documents and based on a questionnaire tracking immunization sites and period for children with undocumented vaccination. The vaccination coverage and completeness were estimated from data collected in immunization cards and re-estimated after tracking the immunization status of children with no immunization cards. Of 1435 children reached in households, 1430 (99.7%) were included. Of 1072 children aged 12-59 months, 194 (18.1%) received DPT-Hi+Hb 3 with evidence and 399 (37.2%) with evidence and tracking. In the same age group, the dropout rate from DPT-Hi+Hb 1 (157 doses administered) to DPT-Hi+Hb 3 (127 doses administered) with evidence was 19.1% and 42.4% with evidence and tracking. The tracking of immunization status in children with no evidence of vaccination allows to determine their immunization status and to improve the reliability of the estimated vaccination coverage. This strategy could be adopted to be part of the planning and implementation of vaccination coverage surveys of EPI vaccines.

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review.

Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.

BACKSLIDING ON CHILDHOOD IMMUNIZATIONS DUE TO ONGOING COVID-19 PANDEMIC: A RETROSPECTIVE STUDY IN BANADIR REGION, SOMALIA.

SARS-CoV-2 has resulted in a global public health crisis. During the pandemic, considerable delay was observed making it impossible for some children to receive their due vaccines on time. Like most resource-poor countries, COVID-19 pandemic is thought to have a negative impact on Somalia's immunization coverage. This study aimed to assess the impact of the COVID-19 pandemic on routine childhood immunization coverage in Somalia. A retrospective comparative cross-sectional approach was employed to investigate the number of under-5-year children who got their immunization from the two major mother and child hospital, (Banadir and SOS hospitals) in Mogadishu, Somalia from October 2019 to December 2020. To do this, a total of 112, 060 data relating to the routine childhood immunization (measles, polio, whooping cough, hepatitis B, pneumonia, and tuberculosis) were collected from the monthly immunization report-data from the two hospitals. The results showed that all the vaccines except birth vaccines have remarkably dropped with Penta-3 (27%), Penta-2 (11%), measles (10%) and Penta-1 (8%) respectively. However, the birth vaccines (BCG and Polio 0) were not affected as observed in this study. The reduction in children immunization rate in Somalia may be a combination of many other factors, we however recognize that the COVID-19 pandemic may have contributed significantly to this outcome . The government needed to take proactive measures to encourage parents to present their children for immunizations, including increasing community awareness concerning the importance of these routine childhood immunizations despite the ongoing COVID-19 pandemics.

Childhood Immunization and Competing Mortality Risks in Kenya: A Longitudinal Analysis for Multiparous Mothers

To assess the relationship between childhood immunization and mortality risks for nonvaccine-preventable diseases (competing mortality risks, or CMR) in Kenya. A combination of the Global Burden of Disease and Demographic Health Survey data was used to measure basic vaccination status, CMR, and control variables for each child in the Demographic Health Survey data. A longitudinal analysis was performed. This uses within-mother variation between children to compare the vaccine decisions for different children, who are exposed to different mortality risks. The analysis also distinguishes between overall and disease-specific risks. The study included 15 881 children born between 2009 and 2013, who were at least 12months old at the time of interview and not part of a twin birth. Mean basic vaccination rates ranged from 27.1% to 90.2% and mean CMR from 13.00 to 738.32 deaths per 100 000 across different counties. A one-unit increase in mortality risk from diarrhea, the most prevalent disease among children in Kenya, is associated with a 1.1 percentage point decline in basic vaccination status. In contrast, mortality risks for other diseases and HIV increase the likelihood of vaccination. The effect of CMR was found to be stronger for children with higher birth orders. A significant negative correlation between severe CMR and vaccination status was found, which has important implications for immunization policies, particularly in Kenya. Interventions aimed at reducing the most severe CMR, such as diarrhea, and targeted toward multiparous mothers may improve childhood immunization coverage.

Study protocol for a cluster-randomised controlled trial of hybrid parents and health workers adaptive intervention for optimal routine childhood immunisation coverage in the communities of Ebonyi state, Nigeria: the AGINTOPIC trial protocol

IntroductionVaccine-preventable infectious diseases (VPDs) are major causes of morbidity/mortality among children under 5 years of age worldwide and in Nigeria/Ebonyi state. Routine childhood immunisation is an invaluable prevention strategy for...

The Impact of the No Jab No Play and No Jab No Pay Legislation in Australia: A Scoping Review

Australia has a long history of population-based immunisation programs including legislations. This paper reports on a review of evaluations of the impact of the federal No Jab No Pay (NJNPay) and state implemented No Jab No Play (NJNPlay) legislations on childhood immunisation coverage and related parental attitudes. Five databases were searched for peer-review papers (Medline (Ovid); Scopus; PsycInfo; ProQuest; and CINAHL). Additional searches were conducted in Google Scholar and Informit (Australian databases) for grey literature. Studies were included if they evaluated the impact of the Australian NJNPay and/or NJNPlay legislations. Ten evaluations were included: nine peer-review studies and one government report. Two studies specifically evaluated NJNPlay, five evaluated NJNPay, and three evaluated both legislations. Findings show small but gradual and significant increases in full coverage and increases in catch-up vaccination after the implementation of the legislations. Full coverage was lowest for lower and higher socio-economic groups. Mandates are influential in encouraging vaccination; however, inequities may exist for lower income families who are reliant on financial incentives and the need to enrol their children in early childhood centres. Vaccine refusal and hesitancy was more evident among higher income parents while practical barriers were more likely to impact lower income families. Interventions to address access and vaccine hesitancy will support these legislations.

Mobile Applications in Childhood Immunization: A Systematic Review

The central objective of this paper is to distinguish the impact of different cell phone applications on child vaccination completion. A systematic literature review was conducted to determine how mobile applications have improved the acceptance, education, and fulfillment of vaccines. To this end, an analysis of the aspects, objectives, and differentiated technologies that have fostered the growth of mobile applications and new technologies in childhood immunization is presented. In addition, the obstacles to achieving positive results reported in the scientific literature are identified. Lastly, suggestions are made for future work to improve childhood immunization coverage.

Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough

Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough