Childhood Immunization Coverage Research Articles

Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study

BackgroundReproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking.ObjectiveTo investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage.MethodsA cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest.ResultsThe percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16–1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17–1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04–1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04–1.24) had a higher risk of not using modern contraceptives.ConclusionOur study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.

Migration and child health: Understanding the coverage of child immunization among migrants across different socio-economic groups in India

Factors such as education, caste, religion, and wealth index have been known to influence child immunization coverage in India. We are interested in understanding whether migration has any influence on these factors. Not many studies have analyzed migration as a factor for child immunization uptake in India. This paper is therefore attempts to understand the inequality in accessing different child vaccination coverage across migrants and non-migrants in India. The objective of this study to look at the immunization uptake among migrants children in different socio-economic groups in comparison to non-migrants children in India. Study used data from the National Family Health Survey, the fourth in the NFHS series which was conducted in 2015–2016. Logistic regression was done to compare migrants and non– migrants by the selected background characteristics. Further, decomposition analysis was employed to decompose the difference between migrant and non-migrant. Overall, migrants’ children have better vaccination coverage compared to non-migrant. Education and wealth index is found to be an important variables to explain the vaccination status between migrants and non-migrants. The age of the mother is also an important variable explaining the difference between migrant and non-migrant. Regression analysis suggests that migration among poor, SC/ST and non-literate groups might not improve vaccination compared to non-migrants in those groups. On the contrary, migration help in improving vaccination of children in literate, other caste groups, and non-poor groups. The finding adds to the notion that migrants in literate, wealthy, non-SC/ST groups will be better positioned to improve their health. A focused approach to improving immunization for the low socio-economic vulnerable groups can be useful in improving immunization among children in India.

Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization’s revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage

BackgroundDespite the remarkable achievements of the Expanded Programme on Immunization (EPI) in Burkina Faso, numerous challenges remain, including missed opportunities for vaccination (MOV) which occur when people visit a health facility with at least one vaccine due according to the national immunization schedule, are free of contraindications, and leave without receiving all due vaccine doses. In 2016, we used the revised World Health Organization’s (WHO) MOV strategy to assess the extent of and reasons for MOV in Burkina Faso. MethodsWe purposively selected 27 primary health facilities (PHFs) from the eight health districts with the highest absolute numbers of children who missed the first dose of measles-rubella (MR1) in 2015. We conducted exit interviews with caregivers of children aged 0–23 months, and requested health workers to complete a self-administered knowledge, attitudes and practices (KAP) questionnaire. ResultsA total of 489 caregivers were interviewed, of which 411 were eligible for inclusion in our analysis. Medical consultation (35%) and vaccination (24.5%) were the most frequent reasons for visiting PHFs. Among the 73% of children eligible for vaccination, 76% of vaccination opportunities were missed. Among eligible children, the percentage with MOV was significantly higher in those aged ≥12 months and also in those attending for a reason other than vaccination. A total of 248 health workers completed the KAP questionnaire. Of these, 70% (n = 168/239) considered their knowledge on immunization to be insufficient or outdated; 83% failed to correctly identify valid contraindications to vaccination. ConclusionAddressing MOV offers the potential for substantial increases in vaccine coverage and equity, and ultimately reducing the burden of vaccine-preventable diseases (VPDs). This will require the implementation of a series of interventions aimed at improving community knowledge and practices, raising health workers’ awareness, and fostering the integration of immunization with other health services.

Pediatric Immunization Practice During Coronavirus Disease-2019 Pandemic

At the end of 2019, coronavirus disease-2019 (COVID-19) started to spread worldwide and caused a pandemic in March 2020. Epidemiologic data of COVID-19 in the pediatric population are not certain. The pandemic also decreases routine immunization coverage in children which lead to increased risk of vaccine-preventable disease outbreak. Routine immunization practice should be continued with due regard to health protocol. Children in contact with COVID-19 patients or children who previously have COVID-19 may be immunized after 14 days of symptom-free or confirmed negative by two polymerase chain reaction tests at a minimum interval of 24 h. Bacillus Calmette–Guerin, influenza, and pneumococcal immunization give a positive effect on COVID-19. Until present, there is no available vaccine for COVID-19.

Factors Associated with Low Immunization Coverage in Children Under Five Years in Asuogyaman District in Eastern Region of Ghana

Expanded Programme on Immunization is one of the most successful and cost effective programmes adopted by World Health Organization and other partners to prevent vaccine preventable diseases which are the major cause of infant morbidity and mortality worldwide. Since 2012, Africa has demonstrated unprecedented commitments in the Global Vaccine Action Plan and this has resulted in the protection of millions of children. Despite this, some infants still remained unvaccinated and at risk of vaccine preventable diseases. Even though, Ghana was among countries which achieved 95% DPT3 coverage, this was not evenly distributed across all districts and Asuogyaman District was not an exception. The study assessed the factors associated with low immunization coverage among children under five years in Asuogyaman District. A descriptive cross-sectional study was conducted among mothers/caregivers in the Asuogyaman district. A total of 401 mothers/caregivers were enrolled into the study and structured questionnaire was used to collected data from mothers/caregivers on factors associated with low immunization coverage in children under 5 years. The caregivers were mostly females, 396(98.7%) with mean age of 28.6(±6.7) years and the majority of them, 216(53.9%) were in the age group 20-29 years. Only 250(62.3%) of the participants had good knowledge on immunization. The level of knowledge of the caregivers was significantly associated with ethnicity (χ 2 =9.83, p=0.043, 16?=0.05"> ), occupation (χ 2 =10.92, p=0.012, 16?=0.05"> ), and place of delivery (χ 2 =4.37, p=0.037, 16?=0.05"> ). Participants who were self-employed were 38% more likely to have good knowledge compared to those who were unemployed (AOR=0.62; 95% CI=0.40-0.95; p=0.030) and those who delivered at home were also twice more likely to have good knowledge on immunization compared to those who delivered at the health facility (AOR=2.12; 95% CI=1.19-3.77; p=0.010). Most of the caregivers, 304(75.8%) had positive attitude and good practices, 346(86.3%) on immunization. Majority of the mothers/caregivers, 353(88.0%) perceive health workers had positive attitude towards them. Conclusion : Immunization services were largely accessible to the caregivers. Knowledge of mothers/caregivers on immunization was low, but they had positive attitude and good practices on immunization. Keywords: Immunization, coverage, Asuogyaman district, Eastern region, Ghana DOI: 10.7176/JHMN/81-09 Publication date: October 31 st 2020

Evaluating small conditional cash transfers to improve vaccine coverage and timeliness in Pakistan

Abstract Background Low immunization coverage rates have prompted the need to design effective demand-side interventions to improve uptake. Simple SMS reminders and large (≥USD 100) incentives have been demonstrated to effectively increase immunization coverage. However, research on small incentives (≤USD 15) for immunization is sparse and there is uncertainty regarding the optimal structure of incentives in terms of size, schedule, and design. Methods A 12-arm randomized controlled trial is being conducted in Karachi, Pakistan with 10 incentive arms of varying size (amount), schedules (progressivity) and design (certainty of payment), an exclusive SMS arm and control arm. The incentives are provided through two mechanisms: mobile air time and mobile-money through a mobile-money provider. Children were enrolled when they presented to the study sites for either BCG, Penta-1, or Penta-2 vaccine. Results A total of 11,197 children were enrolled between Nov 2017 and Oct 2018 with approximately 800 children in each incentive arm and 1600 and 1599 in SMS and Control arm, respectively. As of Jan 09, 2020, Penta-3 and Measles-1 coverage are lowest in the control arm (71% and 60% respectively) and highest in the high-flat-lottery arm (78% and 69% respectively) with uniformly progressing incentive amounts along the immunization schedule. Discussion Interim results suggest that small mobile-based incentives coupled with SMS reminders can significantly improve immunization coverage in children. The final analysis will provide robust evidence of this impact and provide policy implications for the most optimal incentive structure that can build caregiver demand for effectively increasing child immunization in an LMIC setting. Key messages Small incentives (USD<15) coupled with simple SMS reminders can improve immunization coverage and timeliness in low resource settings in an inexpensive, logistically simple way. The study will provide experimental evidence on optimal incentive design, structure, and size of small incentives for a cost-effective approach to increase immunization coverage and timeliness.

Assessing Effectiveness of Multipurpose Voucher Scheme to Enhance Contraceptive Choices, Equity, and Child Immunization Coverage: Results of an Interventional Study from Pakistan.

BackgroundPakistan has a high total fertility and unmet contraceptive need and is the fifth most populous country. This research aims to assess the effectiveness of a subsidized, multi-purpose voucher intervention to enhance the client–provider interaction for improved contraceptive counseling resulting in a potential increase in the modern methods uptake, continued use, and its impact on equity through better targeting, while increasing uptake of postnatal care and child immunization among women from the lowest two wealth quintiles in rural and urban communities of Punjab province, Pakistan.MethodsWe used a quasi-experimental design with pre- and post-phases in intervention and control sites in Punjab province (August 2012–March 2015). To detect a 20% increase in modern contraceptive prevalence rate compared to baseline, 1276 women were enrolled in each arm. Difference-in-differences (DID) estimates are reported for key variables. Absolute and relative index of inequality including concentration curves and concentration index are used to describe the magnitude and extent of equity.ResultsWith no net increase in modern contraception use, the intervention area, however, reported a low modern method discontinuation rate. Vaccination rates for BCG increased significantly by 14%, and 5% each for DPT, HBV, and measles. Concentration index and slope index of inequalities for first-time use of modern contraceptives, knowledge of contraceptives, receiving ANC, and delivery at health facilities were negative, indicating that the use of these services was more concentrated among the disadvantaged in intervention areas than the wealthy counterparts.ConclusionThis Greenstar-led multiple voucher model did not significantly increase modern contraceptive use in the intervention study area but positively impacted equity. The integrated approach combining contraception with child immunization led to an increase in immunization coverage. It will be important for public policy decision-makers to assess the usefulness of this approach, as a long-term provision of free contraceptive services may lead to dependency in targeted communities.

Evaluating mobile conditional cash transfers for improving immunization coverage in Pakistan

Abstract Background Despite progress in increasing immunization coverage, poor uptake of vaccines remains a challenge, particularly in LMICs. In part, this is due to the poor socio-economic status of caregivers, lack of motivation, and parental procrastination. While there is evidence that large (≥100 USD) incentives can overcome these problems, research on small incentives that are more appropriate for an LMIC setting is sparse. Our study addresses this gap by evaluating the impact of small (≤12 USD) CCTs in increasing immunization coverage for children under the age of two. Methods A 2-year program utilizing two small incentive schemes of different amounts (high: USD9; low: USD5) was implemented in Shikarpur District, Pakistan. Caregivers (with children 0-24 months) visiting any of the 33 study immunization centers were given the opportunity to enroll. All consenting parent-child pairs were randomized in one of the two incentive schemes and incentives were disbursed following each immunization visit, using mobile money. A baseline and end-line survey was conducted to evaluate changes in pre-post coverage. Results A total of 63,336 participants were enrolled between March 2016 - April 2018, of which 41,483 were randomized in the high or low incentive schemes (remaining caregivers were enrolled in the no-incentive group). Results show a 13% and 28% increase in age-appropriate coverage for Measles-1 (M1) and fully immunized children (FIC) compared to the baseline (FIC:16%, M1: 38%). There was no difference in M1 coverage between the high and low incentive schemes. Discussion Small CCTs have induced positive behavioral change and are a powerful tool for improving immunization coverage and compliance within LMICs. Key messages Small mobile conditional cash transfers (USD<12) can serve as nudges to parents and lead to behavioral shifts resulting in improved immunization outcomes for children. There was no significant difference in outcomes between high and low incentives, indicating that small mobile conditional cash transfers were equally effective in improving immunization coverage.

Eliminating measles: contributions by the Oporto international vaccination centre from 2017 to 2018

Abstract Background Measles is one of world's most contagious diseases and a growing population mobility has promoted its spreading. Outbreaks have been recorded around the world, despite public health efforts. Measles spreads faster among clusters of unvaccinated people. In 2018, World Health Organization reported 328629 cases worldwide, of which 82596 in Europe and 171 in Portugal- 93% of the latter were imported. Portugal had one of the highest proportions of childhood immunization coverage for Measles-Mumps-Rubella (MMR): 98% for first dose, and 96-98% for second. The main goal of this study was to describe the contribution of the Oporto International Vaccination Centre (OIVC), one of the largest in Portugal, to measles elimination. Methods Cross-sectional study, with analysis of vaccination records from travelers vaccinated for MMR at OIVC between January 2017 and December 2018. Results OIVC held 5426 pre-travel consultations in 2017, and 6192 in 2018. 535 travelers got the MMR vaccine (57.2% males). Mean age was 44.3±10.9 [1;76] years. Among travelers aged 12 months-18 years (n = 10), 50% were inoculated with the first dose and 50% with the second. Regarding adult travelers (n = 525), 71.6% received the first dose; 24.2% the second; 2.9% the third dose; and 1.3% received both first and second (within > 4 weeks). Conclusions The substantial number of inoculated vaccines in OIVC resulted from checking traveler's vaccination immunity status in all pre-travel consultations; this routine practice aimed at reducing the risk of importing/exporting measles. The second dose of MMR was justified by the diversity of travelers who came to OIVC, and to whom such inoculation was indicated: health professionals, humanitarian travelers, and workers in airlines and cruises. The third dose was given due to loss of measles serologic immunity. These measures are important to implement the recommendations of the Measles National Elimination Program, while contributing to global public health. Key messages This is an original study on the contribution of international vaccination centers to reduce the number of imported/exported cases and to eliminate measles - which is a global public health issue. At a global level, measles has a large disease burden. Therefore, it is essential to take every opportunity, including pre-travel consultations, to vaccinate people.

Assessment of immunization service delivery in Pakistan: A cross-sectional survey of health facilities

Abstract Background Routine childhood immunization coverage in Pakistan remains sub-par, in part, due to the poor quality of service delivery. This study aims to summarize the quality of immunization centers throughout the Sindh province, Pakistan, by assessing all Government vaccination facilities and their associated health workers. Methods A health facility and worker assessment survey adapted from tools developed by BASICS and EPI-Sindh was used to record facility infrastructure, processes, and human resources. Using expert panel ranking, we developed critical criteria to indicate items immunization centers need to be operational (vaccinator, a cold box or refrigerator, and vaccine supplies) as well as high, low, and moderate function requirements and their respective scores. Results Out of 1396 centers assessed, 1236 (88.5%) were operational, while 1209 (86.6%) offered immunization services. Only 793 (66.0%) of the functional immunization facilities met the critical criteria. The average scores for high, moderate, and low function requirements were significantly lower for centers that did not meet the critical criteria. Of 2,153 healthcare workers interviewed, 1874 (87.1%) were vaccinators. 1805 (96.3%), 1655 (88.3%), and 1387 (74.0%) were trained in vaccination, cold chain, and inventory, respectively. Discussion One out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. Health workers have adequate training and experience, suggesting that sub-optimal vaccination center quality is due to inadequate infrastructure and inefficient processes. Our study presents innovative and critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within an LMIC setting. Key messages Every 2 out of 5 facilities in Sindh Province lacked essential equipment for immunizations such as vaccines, vaccinator and cold box for vaccination. In all health facilities, the health workers appear sufficiently trained, indicating that poor quality may be due to missing infrastructure and inefficient processes in resource-constrained settings.

Investigating spatial variation and change (2006-2017) in childhood immunisation coverage in New Zealand.

Immunisation is a safe and effective way of protecting children and adults against harmful diseases. However, immunisation coverage of children is declining in some parts of New Zealand. Use a nationwide sample to first, examine the socioeconomic and demographic determinants of immunisation coverage and spatial variation in these determinants. Second, it investigates change in immunisation coverage in New Zealand over time. Individual immunisation records were obtained from the National Immunisation Register (NIR) (2005-2017; 4,482,499 events). We calculated the average immunisation coverage by year and milestone age for census area units (CAU) and then examined the immunisation coverage by selected socioeconomic and demographic determinants. Finally, local variations in the association between immunisation coverage and selected determinants were investigated using geographically weighted regression. Findings showed a decrease of immunisation rates in recent years in CAUs with high immunisation coverage in the least deprived areas and increasing immunisation rates in more deprived areas. Nearly all explanatory variables exhibited a spatial variation in their association with immunisation coverage. For instance, the strongest negative effect of area-level deprivation is observed in the northern part of the South Island, the central-southern part of the North Island, around Auckland, and in Northland. Our findings show that childhood immunisation coverage varies by socioeconomic and demographic factors across CAUs. We also identify important spatial variation and changes over time in recent years. This evidence can be used to improve immunisation related policy in New Zealand.

Maternal Satisfaction towards Childhood Immunization Service and Its Associated Factors in Wadla District, North Wollo, Ethiopia, 2019

Background. Maternal satisfaction is considered one of the most frequently used indicators to measure the quality and efficiency of childhood immunization service. Evaluating maternal satisfaction towards childhood immunization service is very relevant as it likely affects the clinical and revisit adherence, service quality, and its coverage. In countries like Ethiopia, where childhood immunization coverage is below average (39%) with low maternal satisfaction on the service, identifying factors associated with maternal satisfaction is very critical. Despite the acknowledgement made on the importance of maternal satisfaction for the successful provision of child immunization services, there is limited knowledge in Ethiopia on its contributing factors. Objective. The aim of this study was to assess maternal satisfaction towards childhood immunization service and its associated factors among mothers’ having children aged less than 1 year in Wadla district, North Wollo, Ethiopia, 2019. Methods. A community-based cross-sectional study was conducted among 682 mothers from March to April 2019 in Wadla district, North Wollo, Ethiopia. A two-stage cluster sampling technique was used to select households of the study participants. A pretested interviewer-administered structured questionnaire was used. During the period of data collection, every questionnaire was cross-checked and the collected data were checked for completeness and consistency on a daily basis. Then, the cleaned data was coded and entered in to Epi Info software version 7.2.2.2 and exported to SPSS software version 23.0 for analysis. Bivariable and multivariable logistic regression analysies were done to identify variables having a significant association with maternal satisfaction. Variables with a p value of ≤ 0.05 and adjusted odds ratio with 95% CI were considered having a statistically significant association during multivariable logistic regression analysis. Then, the findings were presented using tables, graphs, and charts. Result. The overall proportion of maternal satisfaction towards childhood immunization service was found to be 68.2% [95%CI=64.7%−71.7%]. The finding revealed that attending secondary education [adjusted odds ratio AOR=0.26; 95%CI=0.13−0.53], being divorced [AOR=0.46; 95%CI=0.23−0.91], and having favorable attitude towards child immunization [AOR=1.58; 95%CI=1.05–2.33] were found to be significantly associated with maternal satisfaction. Furthermore, the multivariable logistic regression analysis showed that short waiting time before receiving service [AOR=1.83; 95%CI=1.21−2.79], greeting from care providers, [AOR=5.69; 95%CI=3.36−9.65], having information about the current vaccine [AOR=2.03; 95%CI=1.25−3.32], dose of vaccine [AOR=2.24; 95%CI=1.40−3.58], and next immunization schedule [AOR=3.21; 95%CI=1.70−6.04] were also significantly associated with maternal satisfaction towards childhood immunization services. Conclusion and Recommendation. Generally, the study showed that more than two-thirds of the mothers were satisfied by the immunization service rendered. The level of satisfaction was higher with respect to the health workers’ relationship, communication, and immunization system aspects. However, more efforts need to be put towards improving the service waiting time for immunization, and provision of health information and communication is also recommended to enhance the level of favorable attitude among mothers towards childhood immunization services.

Barriers to childhood immunization in sub-Saharan Africa: A systematic review

BackgroundImmunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa.MethodThis systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control.ResultsOf the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker’ barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, lifestyle, migration, occupation and parent’s forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines.ConclusionIn this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.

Effect of vaccine reminder and tracker bracelets on routine childhood immunization coverage and timeliness in urban Pakistan (2017-18): a randomized controlled trial

BackgroundInability to track children’s vaccination history coupled with parents’ lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines.MethodsChildren < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan–Meier method.ResultsA total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination.ConclusionAlthough we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools.Trial registrationClinicalTrials.gov NCT03310762. Retrospectively Registered on October 16, 2017.

Provision of Pediatric Immunization Services During the COVID-19 Pandemic: an Assessment of Capacity Among Pediatric Immunization Providers Participating in the Vaccines for Children Program - United States, May 2020.

Recent reports suggest that routine childhood immunization coverage might have decreased during the coronavirus disease 2019 (COVID-19) pandemic (1,2). To assess the capacity of pediatric health care practices to provide immunization services to children during the pandemic, a survey of practices participating in the Vaccines for Children (VFC) program was conducted during May 12-20, 2020. Data were weighted to account for the sampling design; thus, all percentages reported are weighted. Among 1,933 responding practices, 1,727 (89.8%) were currently open; 1,397 (81.1%) of these reported offering immunization services to all of their patients. When asked whether the practice would likely be able to accommodate new patients to assist with provision of immunization services through August, 1,135 (59.1%) respondents answered affirmatively. These results suggest that health care providers appear to have the capacity to deliver routinely recommended childhood vaccines, allowing children to catch up on vaccines that might have been delayed as a result of COVID-19-related effects on the provision of or demand for routine well child care. Health care providers and immunization programs should educate parents on the need to return for well-child and immunization visits or refer patients to other practices, if they are unable to provide services (3).

What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis.

In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care.

A Cross-Sectional Study of Immunization Coverage in Children in Urban Slums of Western Maharashtra

Background: Children in urban slums suffer accentuated vulnerability to illnesses, as outbreaks of vaccine-preventable diseases are more common in urban slums. Though the immunization coverage has been steadily increasing, the average level remains far less, which is 62% (NFHS4) than the desired coverage (90%).Objectives: 1) To estimate Immunization coverage in children aged between 12–23 months living in Urban Slum area 2) To study sociodemographic factors influencing immunization coverage & reasons behind missed vaccination.Material and Methods: A community-based cross-sectional study was conducted from September to December 2018. A sample of 210 children aged 12–23 months was selected using WHO 30 cluster sampling technique from urban slum areas. Data were collected by parent interviews using the pretested questionnaire and checking immunization card.Results: Out of a total of 210 children studied, 106 were boys, and 104 were girls. BCG, OPV1/Penta1, OPV3/Penta3 and Measles1 immunization was received by 207 (98.6%), 203 (96.7%), 181 (86.2%) and 154 (73.3%) children respectively. Socio-demographic factors like Religion, Birthplace, socio-economic status, mother’s education, Mother’s Occupation were found significantly associated with full immunization coverage. Common reasons for missed immunization were sick child (35%) and unawareness of missed doses (23%).Conclusion: In urban slum area coverage of full immunization was found only 66.2%, which is though above the national coverage (62%) but still far lower than the expected coverage under Mission Indradhanush (90%). This demands vigorous efforts to improve immunization through IEC, Community Participation and Inter-sectoral coordination.

Evaluating the population measles susceptibility in Tianjin, China

BackgroundMeasles is a highly infectious illness requiring herd immunity of 95% to interrupt transmission. China has not reached elimination goals despite high vaccination coverage. We estimated the population susceptibility against measles in Tianjin, China and to tailor awareness raising activities in the measles elimination plan. MethodsAge-specific measles seroprevalence was evaluated by Enzyme-Linked Immunosorbent Assay (ELISA) on 12,164 individual aged 0–44 years in 2009–2018. Measles IgG avidity testing was performed to confirm the relationship of the waning immunity after vaccination and secondary vaccination failures (SVF) on 324 confirmed measles cases in 2013–2018. Results11,108 samples (91.32%) tested positive for measles IgG, 239 (1.96%) tested as equivocal and 817 (6.72%) were negative. The age distribution of measles cases in Tianjin followed a U-shaped curve and was highest for those at <8 months and again at 20–39 years which correlated closely with the age distribution of measles susceptibility based on measles IgG antibody status (r = 0.72, P < 0.001). The seropositivity rate and antibody geometric mean concentration (GMC) for the 2018 study population were significantly lower (χ2 = 7.45, P = 0.006 and t = 12.01, P < 0.001) compared to 2009. The multivariate stepwise logistic regression analysis showed that age and region were the risk factors for both measles seropositivity rate and GMC after vaccination. The proportion of high avidity cases increased with age, being significantly higher in 75.31% of cases in patients aged 30–34 years (χ2 = 18.04, P = 0.003). ConclusionsHigh immunization coverage in children alone will not be adequate to realizing sufficient levels of population herd immunity, particularly given that the potential susceptibility window in adult. Implementation of supplemental immunization activity (SIA) targeted to appropriate group aged 30–34 years is recommended.

Assessment of the status of malnutrition and immunization coverage in under-five children attending Anganwadis

Background: Malnutrition affects people worldwide. Immunization is the most cost-effective and accessible health investment which if taken efficiently can prevent a vast spectrum of diseases in children. Aim: The focus of this study is to assess the nutrition status and immunization coverage of children attending various Anganwadis. Materials and Methods: A study of immunization and nutrition status was held among 252 children under the age of 5, attending 30 Anganwadis in Western India. Results: This study showed that 27.12% of female and 38.94% of male children fell under malnutrition status, including both moderate and severe category. About 72% of children completed their vaccination schedule, as compared to 14% of children with incomplete immunization. The remaining 14% lacked complete records. Conclusion: Our study showed a smaller proportion of children under severe and moderate acute malnutrition compared to other settings. A few dietary modifications and counseling can give us a better future scenario.

Low vaccination in rural Sindh, Pakistan: A case of refusal, ignorance or access?

IntroductionPakistan is suffering from low routine childhood immunization (RI) coverage, meriting a systematic examination of community acceptance and barriers towards vaccination with a view to inform responsive strategies. We examine community perspectives on RI for children 0–23 months of age, unveiling community beliefs, health systems barriers and willingness to actively seek immunization services. MethodsA qualitative study was conducted in the rural under-resourced district of Tando Muhammad Khan of Pakistan’s Sindh province. 12 focus group discussions were conducted to probe immunization perceptions and experience: 6 with female caregivers of children <2 years and 6 with Lady Health workers (LHWs). An adapted Health Access Livelihood Framework guided data collection, qualitative data were thematically coded using inductive analysis and findings were triangulated across caregivers and LHWs. ResultsCaregivers were either indifferent to vaccination or had an unmet need to know more, with few reporting outright refusals to vaccinate. Caregiver beliefs were characterized by a lack of awareness and a confusion of RI with Polio and a fear of side effects. Religious beliefs were not major considerations. Second, health systems issues of hurried and infrequent vaccination encounters, driven by LHWs’ poor capability to handle the vaccine counter-narrative, interrupted vaccine delivery to villages. These challenges were exacerbated by interruptions due to the Polio campaigns. Third, time and public transport constrained access to the Extended Program on Immunization centers. However, female caregivers usually took decisions on vaccination without recourse to male household members, with child’s health viewed to be the main concern. ConclusionsAn ineffective vaccination narrative, low LHW capability and prioritization of RI, intermittent outreach vaccination encounters, and overshadowing of RI activities by Polio campaigns limit the uptake of childhood RI services. We contend that critical attention is required for post-immunization messaging, client-centric services, positive immunization experiences and the availability of vaccination encounters.