Child Immunization Services Research Articles

The impact of COVID-19 on routine child immunisation in South Africa

BackgroundThe COVID-19 pandemic disrupted immunisation programs worldwide, reversing gains that had brought vaccine-preventable diseases largely under control. This study explored the impact of COVID-19 on the uptake of routine child immunisation services in South Africa.MethodsWe conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020–2022 and with 12 healthcare providers who provided public immunisation services during the pandemic.ResultsDuring the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities, healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a “bad vaccine” mental model among some caregivers regarding COVID vaccinations, which could lead to doubts about the safety of routine childhood vaccinations.DiscussionThe shift from default to active decision-making highlights a risk that routine immunisation will backslide in future pandemics. Governments should build resilient health systems at all levels and communicate clearly about the benefits and availability of RIs and the safety of vaccinations in general, alongside supply-side interventions.ConclusionRoutine immunisation is widely accepted in South Africa, driven by generational norms and provider recommendations. During the COVID-19 pandemic, many caregivers faced the dilemma of balancing COVID-19 exposure risk with the risk of their child developing a deadly VPD, leading to missed RI visits. This shift to active decision-making highlights a future pandemic risk. Governments should build resilient health systems and focus on understanding and engaging procrastinating and doubtful caregivers. Clear communication about RI benefits and vaccine safety is crucial, as misinformation can lead to distrust in new vaccines.

Women's Responsiveness and Utilization of Family Planning and Childhood Immunization Services at Primary Health Care Clinics

Women's Responsiveness and Utilization of Family Planning and Childhood Immunization Services at Primary Health Care Clinics

Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia.

Objectives: This study aimed to describe the impact of COVID-19 on maternal and child health service utilization in the Eastern part of Ethiopia. Methods: Comparative analysis was used to examine 2years of maternal and child health service utilization. Data were extracted from client registers. A traditional Expert Modeler and one-way Analysis of Variance were used to compare service utilization before and during the COVID-19 pandemic. Results: A total of 34,576 client records were reviewed, of which 17,100 (49.5%) and 17,476 (50.5%) had visited the MCH service before and during the COVID-19 pandemic, respectively. The total client visit has shown a 2% percentage point increase. However, postnatal care and child immunization services showed a decrease. Moreover, there was a significant difference between service visits before and during COVID-19 (f = 4.6, p < 0.04). Conclusion: Mothers and children have missed or unattended facility appointments due to protective impositions or fear of getting infected with COVID-19, which might suggest a higher proportion of MCH issues were not addressed during the pandemic. The health system should therefore improve its resilience and strengthen its access at the lowest health care inlets.

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.

Effect of HIV-Integrated Care on Uptake of Maternal Health and Routine Childhood Immunization Services at Primary Health Care Facility in Northern Nigeria: An Interrupted Time Series Analysis

Background: This study assessed the effect of HIV-integrated care delivered within routine primary health care (PHC) in Kano, Nigeria, on the uptake of maternal health and routine childhood immunization services. Methods: A retrospective cohort design was used to review and collect anonymized data from medical records of women and children who accessed health care from the PHC facility between January 2009 and December 2016. Data were analyzed using SPSS version 22. Interrupted time series analysis (ITS) was performed to estimate changes in maternal and childhood immunization service usage over time following the delivery of the integrated care. Results: Uptake of maternal health services increased over time: antenatal care attendance (effect/month [95% confidence interval (CI)]: 6.6 [44.55–8.65], P = 0.0001), family planning (effect/month [95% CI]: 1.3 [0.26–2.26], P = 0.014), and delivery (effect/month [95% CI]: 0.9 [0.39–1.45], P = 0.0009). Uptake of routine immunization also increased over time with the integrated care: Bacille Calmette Guerin (BCG) (Effect/month [95% CI]: 1.8 [0.64–2.88], P = 0.002), and diphtheria, tetanus, and pertussis 1 (DPT1)/Penta 1 vaccinations (Effect/month [95% CI]: 1.0 [0.20–1.73], P = 0.013) also showed a moderate increase over time, but DPT3/Penta 3 vaccination dropped gradually over time (Effect/month [95% CI]: −0.1 [−0.74–0.46], P = 0.649). Conclusion: The integrated care resulted in increased uptake of both maternal health and childhood routine immunization services. This suggests that the reorganization and restructuring of the HIV-integrated care in the Kumbotso Comprehensive Health Centre has had a positive impact on non-HIV services provided at the center. There are still opportunities for further research to refine and elaborate on the novel findings of this study.

Trends in household out-of-pocket health expenditures and their underlying determinants: explaining variations within African regional economic communities from countries panel data

BackgroundThe persistently high out-of-pocket health spending (OOPHE) in Africa raise significant concern about the prospect of reaching SDG health targets and UHC. The study examines the convergence hypothesis of OOPHE in 40 African countries from 2000 to 2019.MethodsWe exploit the logt\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\ ext{log }}t$$\\end{document}, club clustering, and merging methods on a panel of dataset obtained from the World Development Indicators, the World Governance Indicators, and the World Health Organization. Then, we employ the multilevel linear mixed effect model to examine whether countries' macro-level characteristics affect the disparities in OOPHE in the African regional economic communities (RECs).ResultsThe results show evidence of full panel divergence, indicating persistent disparities in OOPHE over time. However, we found three convergence clubs and a divergent group for the OOPHE per capita and as a share of the total health expenditure. The results also show that convergence does not only occur among countries affiliated with the same regional economic grouping, suggesting disparities within the regional groupings. The findings reveal that countries' improved access to sanitation and quality of governance, increased childhood DPT immunization coverage, increased share of the elderly population, life expectancy at birth, external health expenditure per capita, and ICT (information and communication technology) significantly affect within-regional groupings’ disparities in OOPHE per capita. The results also show that an increasing countries’ share of elderly and younger populations, access to basic sanitation, ICT, trade GDP per capita, life expectancy at birth, childhood DPT immunization coverage, and antiretroviral therapy coverage have significant impacts on the share of OOPHE to total health expenditure within the regional groupings.ConclusionTherefore, there is a need to develop policies that vary across the convergence clubs. These countries should increase their health services coverage, adopt planned urbanization, and coordinate trade and ICT access policies. Policymakers should consider hidden costs associated with access to childhood immunization services that may lead to catastrophic health spending.

Immunization coverage and its associated factors among children aged 12-23 months in Ethiopia: An umbrella review of systematic review and meta-analysis studies.

Immunization estimated to prevent 2 to 3 million children deaths every year from vaccine preventable disease. In Ethiopia, limited and inconclusive studies have been conducted on immunization coverage so far. Therefore, this umbrella review was intended to estimate the pooled national immunization coverage and its associated factors among children age 12-23 months in Ethiopia. This umbrella review included five systematic reviews and meta-analyses through literature search from PubMed, Science direct, and web of science, CINHALE, and data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and Prospero, the International Prospective Register of Systematic Reviews from May 1 to 30/ 2023. Only systematic reviews and meta-analyses published in English from inception to May 1, 2023, were included. The quality of each study was assessed using Assessment of Multiple Systematic Reviews. Data were extracted using Microsoft excel 2016 and analyzed using STATA 17.0 statistical software. Heterogeneity among studies was assessed using the Cochran Q statistics and I2 test. The pooled effect sizes were determined using pooled proportion for the full vaccination coverage and odds ratios for the associated factors with the corresponding 95% confidence interval were used to declare statically significance. Five studies with 77,161 children aged 12-23 months were included. The overall pooled full vaccination coverage was 57.72% (95% CI 50.17, 65.28). Institutional delivery (OR: 2.12, 95% CI: 1.78-2.52), travel to vaccination site for <2 hours (OR: 2.43, 95%CI: 1.97-3.00), received at least one antenatal (ANC) visit (OR: 3.2, 95%CI: 2.46-4.1), good maternal knowledge of immunization (OR: 3.63, 95%CI: 2.82-4.67), being informed on immunization schedule (OR: 2.54, 95%CI: 2.02-3.2), living in urban areas (OR: 2, 95% CI: 1.54-2.6), and a household visit by health-care providers (HCP) during the postnatal period (OR: 2.23, 95%CI: 1.22-4.09) were the independent predictors of immunization coverage. This study showed the full immunization coverage in Ethiopia was lower compared to the WHO-recommended level. Besides, the current umbrella review identifies several factors that contribute to higher immunization coverage. These includes; institutional delivery, near to vaccination site, having ANC visit, being urban residence, household visited by HCP, having good knowledge and informed on immunization schedule. Thus, the government should intensify the growth of immunization services by emphasizing outreach initiatives to reach remote areas and professionals must combine child immunization service with other medical services offered by health institutions.

A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage.

Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.

Estimated effect of age of marriage on utilisation of India’s Integrated Child Development Service programme

BackgroundAge of marriage among women is considered an important indicator of their readiness for familial integration and parenting. This study estimated the effect of age of marriage of young mothers...

Resilience of routine childhood immunization services in two counties in Kenya in the face of the COVID-19 pandemic

The recently emerged coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide and disrupted health services. We describe the effect of the COVID-19 pandemic on utilization of childhood vaccination services during the pandemic. Using a mixed methods approach combining retrospective data review, a cross-sectional survey, focus group discussions among care givers and key informant interviews among nurses, we collected data between May and September 2021 in Mombasa and Nakuru counties. Overall, there was a <2 % decline in the number of vaccine doses administered during the pandemic period compared to the pre-pandemic period but this was statistically insignificant, both for the pentavalent-1 vaccine (ß = −0.013, p = 0.505) and the pentavalent-3 vaccine (ß = −0.012, p = 0.440). In government health facilities, there was 7.7 % reduction in the number of pentavalent-1 (ß = −0.08, p = 0.010) and 10.4 % reduction in the number of pentavalent-3 (ß = −0.11, p < 0.001) vaccine doses that were administered during the pandemic period. In non-government facilities, there was a 25.8 % increase in the number of pentavalent-1 (ß=0.23, p < 0.001) and 31.0 % increase in the number of pentavalent-3 (ß = −0.27, p < 0.001) vaccine doses that were administered facilities during the pandemic period. The strategies implemented to maintain immunization services during the pandemic period included providing messaging on the availability and importance of staying current with routine vaccination and conducting catch-up vaccinations and vaccination outreaches. Our findings suggest that the COVID-19 pandemic did not impact childhood vaccination services in Mombasa and Nakuru counties in Kenya. The private health facilities cushioned vaccination services against the effects of the pandemic and the strategies that were put in place by the ministry of health ensured continuation of vaccination services and encouraged uptake of the services during the pandemic period in the two counties in Kenya. These findings provide useful information to safeguard vaccination services during future pandemics.

Assessment of Primary Health care Facilities on readiness for Antenatal Care and Childhood Immunization Services in Zamfara State, Nigeria

Effective maternal and child healthcare delivery centers on availability of essential medical equipment, drugs and trained medical personnel in health facilities. Poor funding, inadequate supply of physicians, essential equipment and drugs as well as mismanagement characterized healthcare delivery system in Nigeria. This study assessed public primary health care facilities on readiness of Antenatal Care (ANC) and childhood immunization services in Zamfara State, Nigeria. Based on theoretical orientation of Political Economy of Health Care, quantitative and qualitative data were used for the study. Descriptive statistic was used for quantitative data analysis using Statistical Package for Social Sciences (SPSS), while ATLASti8 software was used for qualitative data. The study found most of the visited health facilities offered various components of ANC and childhood immunisation services but did not comply with the current eight (8) ANC visits as recommended by WHO. Other essential services including hepatitis B tests, breast examination, Fansida for malaria prevention, free folic acid and iron supplements, insecticide treated nets, weight scale, ROTA vaccine and midwives were grossly inadequate in most health facilities. The study also found urban bias in terms of distribution of healthcare staff in Zamfara State. This study recommends that Zamfara State government, non-governmental organisations and donor agencies should urgently channel their efforts to PHC centers and address the challenges confronting primary health care centers in Zamfara State.

Maternal Perception, Hesitancy, and Satisfaction Toward Childhood Immunization in Primary Health Centers, Hafr Al-Batin: A Multicenter Cross-Sectional Study from Eastern Saudi Arabia.

Consumer perception of and satisfaction with vaccination services is a critical and commonly used indicator for evaluating the quality of services provided by concerned authorities. The present survey assessed maternal perceptions, hesitancy, satisfaction, and factors associated with childhood immunization services provided at the primary health centers (PHCs) of eastern Saudi Arabia. The current analytical cross-sectional study included mothers of childhood vaccine beneficiaries attending PHCs in Hafr Al-Batin. We collected data related to mothers' perceptions, hesitancy, and satisfaction using a validated Arabic version of the data collection tool. Factors associated with low and high satisfaction with the immunization services were evaluated using logistic regression analysis. We performed Spearman correlation test to identify the correlation between the perception and satisfaction scores. Of the 675 participants, 87.4% were satisfied with the immunization services provided at the PHCs. The participants' satisfaction was significantly associated with the immunized child's age group (adjusted odds ratio [AOR] = 1.89, 95% CI = 1.39-2.89, p = 0.037) and occupation status (AOR = 1.42, 95% CI = 1.17-1.74, p = 0.024). Vaccine hesitancy was significantly associated with the mother's age group (AOR = 1.89, 95% CI of AR = 1.35-3.39, P = 0.003) and number of children (AOR = 1.42, 95% CI of AR = 1.17-1.74, P = 0.024), Additionally, we found a significant positive correlation (Spearman's rho = 0.207, p < 0.001) between perception and satisfaction scores. We recommend targeted health education programs for mothers to improve their perceptions and the importance of all recommended childhood vaccines. Additionally, we suggest continuing maternal satisfaction assessments to enhance and maintain the quality of vaccination services.

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.

Evidence on community-based intervention for tackling childhood pneumonia Project in Bangladesh

Abstract In Bangladesh, pneumonia is a major cause of child mortality, killed 26,766 under 5 children, accounting for 24% of all under 5 child deaths in 2022. To address this issue, we implemented a community-based project in Barishal from June 2021 to December 2022. Project activities aimed to strengthen the health system for improved access and utilization of quality child health care and child immunization services, encouraged community practice and behavior for care-seeking and exclusive breastfeeding. During the project period, 22 medical doctors, 30 paramedics and 168 MoHFW employed service providers including community clinics, community-based health facility for six thousand population, received case management training, 38 health centers were equipped with necessary logistics and supplies for improved case management of sick children. We also conducted special vaccination campaigns in 13 hard-to-reach areas, deployed 11 vaccination aids for improving child vaccination coverage in remote areas and raised awareness of recommended health practices at the community level. A comparison of baseline and endline survey data showed significant improvements in children among 12-23 months of age who received all recommended basic vaccines by 12 months [77% in baseline (n = 239) vs. 92% in endline (n = 235); p &amp;lt; 0.01]; care-seeking from health facilities or trained health service providers for sick children with pneumonia [40% in baseline (n = 127) vs. 52% in endline (n = 225); p &amp;lt; 0.005]; and exclusive breastfeeding for children below 6 months [52% in baseline (n = 122) vs. 62% in endline (n = 120); p &amp;lt; 0.01]. These results revealed the project's success with simple but contextualized efforts to enhance the health system by developing the capacity and skills of service providers to provide high-quality child health care for sick children, improving access to equitable child immunization, and raising social awareness through partnerships with the MoHFW and community engagement initiatives. Key messages • Community-based intervention with minimum resources have potential to scale up with improving accessibility and utilization of health services, specially in hard to reach areas in Bangladesh. • Contextualized and simple intervention through collaboration with local government and community engagement is critical for success of community based health system strengthening project.

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.

Young Child Undernutrition: Crucial to Prioritize Nutrition Interventions in the First 1000 Days of Life.

The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the 'at risk' households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services.

A scoping review of maternal and neonatal health services impacted during COVID-19 in Nepal

Background Coronavirus Disease 2019 (COVID-19), a global pandemic, has resulted in millions of deaths worldwide and severely impacted health service delivery systems. Developing countries, including Nepal, faced the risk of health system failure due to limited infrastructures. During the pandemic, Nepal experienced a decline in medical service utilization by pregnant women and a decrease in national child immunization rates. Maternity services and child immunization services had significant consequences, serving as a warning for future pandemics. This article examines the effects of pandemic-induced stay-at-home policies on maternal and child immunization in Nepal. Methods A comprehensive literature search was conducted to identify relevant articles on PubMed, Scopus, and Google Scholar. The search terms employed were “maternal mortality in Nepal during COVID-19”, “maternity service utilisation in Nepal during COVID-19”, and “child immunisation in Nepal during COVID-19”. The search was limited to articles published between 2019 and 2022, research conducted in Nepal, and that included maternal mortality, utilisation of maternity services, and child immunisation in the title of the full text. Results Factors such as the closure of public transportation and service centres and fear of contamination contributed to a decline in antenatal care visits. The disruption of programs aimed at reducing the Maternal Mortality Rate (MMR) and decreased activities of Female Community Health workers in most parts of the country led to an increase in the maternal mortality rate during the stay-at-home policies. Institutional delivery decreased by 52.4% during the stay-at-home policies compared to the period before. The neonatal mortality rate increased from 13 to 40 per 1000 live births during the pandemic stay-at-home policies. Immunization centres were also closed in Nepal during the early stages of stay-at-home policies, with 50% of centres ceasing services. Measles outbreaks were reported in some parts of the country during the pandemic. Conclusions To mitigate future damage, specific guidelines should be established based on regional factors and infrastructure development. Measures such as providing protective equipment and maintaining communication with pregnant women via telephone can help reduce the impact of future pandemics.

Assessment of childhood immunization services at private healthcare facilities in Indonesia: a case study in a highly-populated city.

The need to enhance the utilization of the private sector for immunization programs in Indonesia while maintaining the high quality of services provided is evident. This study aimed to rapidly assess immunization services at private healthcare facilities in Indonesia by using Bandung, the most densely populated city, as the reference case. Initially, a situation analysis was conducted by collecting data from selected healthcare facilities (n = 9). Furthermore, a qualitative study was taken into account by developing framework approaches and conducting interviews with different layers, such as mid-level managers at healthcare facilities (n = 9), professional organizations (n = 4), and public stakeholders (n = 7). The situation analysis showed that private healthcare facilities had provided sufficient time for essential childhood immunization services with adequate staff. Nevertheless, the number of limited staff the Ministry of Health (MoH) has trained remains a programmatic problem. Furthermore, private healthcare facilities have used the MoH guidelines and additional internal guidelines for immunization services as the primary reference, including in the efforts to provide complete and reliable equipment. Vaccine availability at private healthcare facilities is manageable with an acceptable out-of-stock level. The results of our interviews highlighted three key findings: the lack of coordination across public and private sectors, the need for immunization service delivery improvement at private healthcare facilities, and the urgency to strengthen institutional capacity for advocacy and immunization systems support. Even though private healthcare facilities have been shown to make a modest contribution to childhood immunization services in Indonesia, efforts should be made to expand the role of private healthcare facilities in improving the performance of routine immunization programs.

Quality assessment of childhood immunisation services in primary health centres in Oron, Akwa Ibom State, Nigeria

Introduction. With 20% of the African population, low routine immunization coverage, and a wild poliovirus reservoir, Nigeria contributes significantly to the overall regional burden of vaccine-preventable diseases. Since the introduction of the EPI in 1974 (which later became the National Programme on Immunization), Nigeria’s immunization program has suffered declining coverage. Poor quality affects service utilization, even where the services are provided free, just as immunization services are. Quality assessment will give an indication of the degree of satisfaction of clients with services as well as provide a framework for review of program priorities, strategies, and componentsPurpose of the study. The purpose of the study is to evaluate the quality of immunisation services provided to children in primary health centres in Oron, Akwa Ibom State, Nigeria. The study aims to identify the strengths and weaknesses of the immunisation services, assess the level of compliance with national and international standards for immunisation, and make recommendations for improvement where necessary. Additionally, the study seeks to contribute to the body of knowledge on the quality of childhood immunisation services in Nigeria, particularly in the context of primary health centres. Ultimately, the findings of this study may help to improve the delivery of immunisation services in the region and ensure that more children are vaccinated and protected against vaccine-preventable diseases. Materials and methods. This was a cross-sectional descriptive study of the quality of immunization services in Primary Health Centers in Akwa Ibom State, Nigeria. This study utilized some variables as indicators which included physical environment, resource availability, client satisfaction etc. formed into a questionnaire. The study involved 402 caregivers and 156 healthcare providers in 12 Primary Health Centers. The study utilized six instruments namely the Client questionnaire, Facility staff questionnaire, Facility Checklist, Personal Observation, Focus Group Discussion Guide, and Client Flow Chart.Outcomes. The results showed that the quality of immunization services was poor. The caregivers were dissatisfied with the reception by the providers. They were also not satisfied with the waiting time which they complained of as being too long. The attitude of the health care providers was also a cause of dissatisfaction.Discussion. This study found that the Community Health Extension Workers constituted the majority (39,4%) of the immunization service providers. Of the 152 healthcare providers that participated in the study, 92 (60,9%) had attended in-service training on immunization within the previous two years while 59 (39,1%) had not. A comparison of staff categories with attendance at in-service training showed a statistically significant difference (p=0.0072),suggesting that whether one attended in-service training or not depended on the category of staff he/she belongs to. One hundred and twelve (73,3%) of staff knew the correct vaccine storage temperature while 40 (26,7%) did not know. Healthcare providers who do not know the correct vaccine storage temperature may administer vaccines whose potency has been compromised. One-hundred and forty-nine (98,0%) healthcare providers were aware that clients have certain rights collectively referred to as clients’ rights. It is only by knowing the rights of clients that providers would be expected to respect these rights. The clients’ right to which most providers indicated strong agreement that clients are entitled to, was the right to information as indicated by 105 (70,2%) providers while the right to which most providers indicated disagreement was the right to choice of where and when to access services. Fifty-two (34,0%) health care providers felt clients were not entitled to this right.Conclusion. In conclusion, the study conducted a thorough quality assessment of childhood immunisation services in primary health centres in Oron, Akwa Ibom State, Nigeria. The findings reveal both strengths and weaknesses in the delivery of immunisation services to children in the region. While there were areas of average performance, such as experienced and trained healthcare workers, there were also areas of concern, such as inadequate cold chain storage and insufficient record-keeping practices.The study recommends that steps be taken to improve the quality of immunisation services in the region, including strengthening the cold chain system, ensuring adequate record-keeping practices, and implementing regular training and supervision of healthcare workers. These measures are crucial to ensuring that more children are vaccinated and protected against vaccine-preventable diseases.Overall, the findings of this study contribute to the body of knowledge on the quality of childhood immunisation services in Nigeria and underscore the importance of continued efforts to improve the delivery of immunisation services to children. It is hoped that the recommendations put forth in this study will inform policy decisions and ultimately lead to better health outcomes for children in Oron, Akwa Ibom State, and beyond

Experiences of migrant mothers attending vaccination services at primary healthcare facilities.

Migration to South Africa is currently dominated by women and children, for socio-economic and refugee reasons or to utilise the healthcare system for various services. Migrants and refugees are at risk of vaccine-preventable diseases, and many of their children have an incomplete or unknown immunisation status. This study aimed to explore the experiences of migrant mothers in utilising child immunisation services in primary healthcare facilities. Ten primary healthcare facilities that were providing immunisation services, located in the Buffalo City Metropolitan Municipality, Eastern Cape province, South Africa. A qualitative research design, making use of in-depth interviews (IDIs) from 18 purposefully selected migrant women, was used for data collection. Thematic content analysis was used to analyse the recorded data of the experiences of study participants in their access to immunisation services. From the IDIs, four themes were identified: difficulty in communicating with the healthcare workers because of language barriers, access challenges, interpersonal barriers and interpersonal relationships were identified in this study, which influenced the utilisation of immunisation services by migrant mothers. The findings of this study support and reinforce the duty of the South African government and healthcare facilities to work together to improve migrant women's access to immunisation services. A positive relationship between healthcare workers and migrant mothers while accessing immunisation services should contribute to reducing child mortality in South Africa and achieving Sustainable Development Goal 3 by the year 2030.