Child Immunization Services Research Articles

Implications of Young Child Malnutrition on Health and Development: Prioritize Nutrition Interventions in the First 1000 Days of Life

Implications of child undernutrition is not limited to adverse impact on physical growth but on optimum brain growth, mental health and cognitive development. The adverse effects of micronutrient deficiencies in mothers and children are serious with impact on morbidity, mortality, anemia, school performance, overall productivity and national development. Only in the last two decades, studies on the month-wise trend in the prevalence rate of child undernutrition in under five years has drawn attention to the fact that the stunting and underweight rate increases steadily up to 24 months, peaks at about two years of age and then stabilises. Efforts are therefore being directed to the significance of concentrating on implementation of child undernutrition preventive measure in the first 1000 days of life. As per the globally accepted conceptual framework of child malnutrition and the evidence available of effective interventions, emphasis is to ensure universal coverage of selected package of essential nutrition interventions (ENIs) and coupling these with nutrition sensitive interventions. Priority interventions in the first 1000 days comprise nutrition care package linked to antenatal care services, intensive efforts for universal adoption of appropriate infant and young child feeding practices and context specific nutrition sensitive measures .For effective implementation, special attention to mapping of the ’at risk’ households having a member falling in the 1000 days window needs special attention. The contacts of health workers with antenatal care and routine child immunization services need to be effectively used for promoting appropriate maternal nutrition care and breastfeeding and complementary feeding practices in the first 1000 days of life. Along with universal coverage of ‘at risk’ households with ENIs, it is imperative to ensure that the context specific nutrition sensitive interventions are simultaneously addressed, as reflected in the design of India’s National Nutrition Mission/Poshan2.0.

Perceptions of Healthcare Workers (HCWs) towards childhood immunization and immunization services in Fiji: a qualitative study

IntroductionChildhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision–making process. This research aimed to explore the factors that influence healthcare workers’ experience and perceptions about delivering childhood immunization in Fiji.Materials and methodsA qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi–structured open–ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews.ResultsThere were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule.ConclusionSome of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.

Influence of family planning and immunization services integration on contraceptive use and family planning information and knowledge among clients: A cross-sectional analysis in urban Nigeria.

Reproductive autonomy necessitates that women have access to high quality family planning information and services. Additionally, closely spaced pregnancies increase maternal and infant morbidity and mortality. Although integrating family planning into child immunization services may increase access to information and services and postpartum contraceptive use, evidence on how integration affects service delivery and health outcomes is scarce. One limitation of previous studies is the use of binary integration measures. To address this limitation, this study applied Provider and Facility Integration Index scores to estimate associations between integration and contraceptive use, receipt of family planning information, and knowledge of family planning services availability. This study leveraged pooled cross-sectional health facility client exit interview data collected from 2,535 women in Nigeria. Provider and Facility Integration Index scores were calculated (0–10, 0 = low, 10 = high) for each facility (N = 94). The Provider Integration Index score measures provider skills and practices that support integrated service delivery; the Facility Integration Index score measures facility norms that support integrated service delivery. Logistic regression models identified associations between Provider and Facility Integration Index scores and (a) contraceptive use among postpartum women, (b) receipt of family planning information during immunization visits, and (c) correct identification of family planning service availability. Overall, 46% of women were using any method of contraception, 51% received family planning information during the immunization appointment, and 83% correctly identified family planning service availability at the facility. Mean Provider and Facility Integration Index scores were 6.46 (SD = 0.21) and 7.27 (SD = 0.18), respectively. Provider and Facility Integration Index scores were not significantly associated with postpartum contraceptive use. Facility Integration Index scores were negatively associated with receipt of family planning information. Provider Integration Index scores were positively associated with correct identification of family planning service availability. Our results challenge the position that integration provides a clear path to improved outcomes. The presence of facility and provider attributes that support integration may not result in the delivery of integrated care.

Integrated delivery of family planning and childhood immunisation services: A causal loop analysis of service responsiveness in Malawi

Evidence suggests that integrating family planning (FP) services with childhood immunisations can increase postpartum contraceptive use by providing timely contact with FP services during the year following childbirth. However, little is known about clients' experiences of FP services within this context. Systems thinking was applied to examine the responsiveness of FP services that were integrated with childhood immunisations in routine outreach clinics across two districts of Malawi. A causal loop analysis of qualitative data captured through 1) structured exit interviews with clients (n=146) and 2) semi-structured interviews with clients (n=23) and their FP providers (n=10) was carried out to explain the system dynamics influencing the responsiveness of integrated FP services. Through this analysis, six feedback loops were identified as having a balancing effect on service responsiveness. Importantly, the clinic's client load was found to drive the responsiveness experienced by clients in the studied context. Overall, the results suggest that efforts to enhance the responsiveness of integrated FP services in outreach clinics should focus on 1) enhancing the providers' ability to alter the client flow in response to fluctuations in the clinic's client load, and 2) ensuring that an appropriate buffer of FP supplies is available in clinics to enable clients to consistently receive their preferred contraceptive irrespective of surges in demand. This study represents the first attempt at modelling the responsiveness of integrated FP services and its findings can be used to inform the design and delivery of FP services that are integrated with childhood immunisations in different settings.

How COVID‐19 has impacted immunisation service delivery in Australia: a national study

Objective:The objective of this study was to determine the impact the COVID‐19 pandemic had on the delivery of adult, maternal and childhood immunisation services in Australia in 2020 prior to the rollout of COVID‐19 vaccines, and to understand the adaptations made at a service delivery level that may have contributed to the successful delivery of immunisation services during the first year of the pandemic. Methods:An electronic survey was sent to immunisation providers and pharmacists in all states and territories in Australia between November 2020 and December 2020. It explored interruption to the delivery of immunisation services, strategies implemented to maintain services, prioritisation of populations, and self‐reported challenges and solutions initiated by providers. Results:A total of 850 people responded to the survey. Of these, the most common professional groups identified were pharmacists followed by nurse immunisers, nurses/midwives and general practitioners. Several changes were implemented including relocation of vaccination clinics, change to bookings rather than walk‐in appointments, infection prevention measures, clients waiting in cars pre‐ and post‐vaccination and reduced observation period post‐vaccination. Conclusion:The pandemic has provided opportunities for services to trial new and innovative strategies such as electronic pre‐assessment, electronic consent and drive‐through vaccination services. Implications for public health:Immunisation providers mostly viewed these changes positively and intend to continue many post‐pandemic. The experience gained from the trialling of these strategies may be adapted for vaccine delivery and National Immunisation Program vaccines beyond the pandemic.

Integrated delivery of family planning and childhood immunization services: a qualitative study of factors influencing service responsiveness in Malawi.

Evidence from several countries in sub-Saharan Africa suggests that the integration of family planning (FP) with childhood immunization services can help reduce the unmet need for FP among postpartum women without undermining the uptake of immunizations. However, the quality and responsiveness of FP services that are integrated with childhood immunizations remain understudied. A qualitative study was conducted in two districts of Malawi, which examined the factors influencing the responsiveness of FP services that were integrated with childhood immunizations in monthly public outreach clinics. Semi-structured interviews with clients (n = 23) and FP providers (n = 10) and a clinic audit were carried out in six clinics. Hardware (material) and software (relational) factors influencing service responsiveness were identified through thematic and framework analyses of interview transcripts, and clinic characteristics were summarized from the audit data to contextualize the qualitative findings. Overall, 13 factors were found to influence service responsiveness in terms of the ease of access, choice of provider, environment, service continuity, confidentiality, communication, dignity and FP counselling afforded to clients. Among these factors, hardware deficiencies, including the absence of a dedicated building for the provision of FP services and the lack of FP commodities in clinics, were perceived to negatively affect service responsiveness. Crucially, the providers’ use of their agency to alter the delivery of services was found to mitigate the negative effects of some hardware deficits on the ease of access, choice of provider, environment and confidentiality experienced by clients. This study contributes to an emerging recognition that providers can offset the effect of hardware deficiencies when services are integrated if they are afforded sufficient flexibility to make independent decisions. Consideration of software elements in the design and delivery of FP services that are integrated with childhood immunizations is therefore critical to optimize the responsiveness of these services.

Perceptions of quality and the integrated delivery of family planning with childhood immunisation services in Kenya and Uganda.

The integration of family planning (FP) with childhood immunisations is considered a promising approach to addressing postpartum women’s unmet need for FP in resource limited settings. This study set out to examine client and health provider perceptions of the quality of FP services that were integrated with childhood immunisations in Kenya and Uganda. Semi-structured interviews with clients (n = 30) and health providers (n = 27) were conducted in 16 rural health facilities. Interviews centred on the respondents’ experiences receiving/delivering FP services, their interactions with providers/clients, and their views on the quality of FP services. Client and provider perceptions of quality were compared through a thematic analysis of interview transcripts, and findings were synthesised using Jain and Hardee’s revised FP Quality of Care Framework. Using audit data, health facility characteristics and resources were also summarised through descriptive statistics to contextualise the qualitative findings. The dignity and respect experienced by clients was central to the respondents’ perceptions of quality. These two dimensions were not conceptualised as distinct facets of quality, but were instead perceived to be a product of the 1) access to needed services, 2) choice of contraceptives, 3) interpersonal communication, 4) information, and 5) confidentiality afforded to clients. Additionally, clients and providers alike believed that the integration of FP services with childhood immunisations had a positive effect on clients’ access to needed services and on the confidentiality they experienced in a context where modern contraceptive use was stigmatised and where a lack of support from some husbands impeded access to FP services. Understanding clients’ and providers’ conceptualisation of quality is critical to the design of high quality and client-centred integrated FP services.

DAMPAK PANDEMI COVID-19 TERHADAP KEPUTUSAN ORANG TUA MELAKUKAN IMUNISASI RUTIN ANAK: LITERATURE REVIEW

The COVID-19 pandemic has affected to health care system including routine childhood immunization services globally. According to official data published by WHO and UNICEF, 23 million children missed out on basic routine immunization services and up to 17 million children did not receive a single vaccine in 2020. The objective of this study is to provide an overview of the impact of the COVID-19 pandemic on parental decisions to carry out routine immunization. The design used is a literature review with an electronic search using Elsevier, Google Scholar, and PubMed published between 2020-2022. Inclusion criteria for this study were primary studies, parents with children under 24 months of age, open-access journals written in English and Indonesia. Four journals that met the inclusion criteria found that the fear of COVID-19 infection was a major factor for parents who had delayed their children's routine immunization. Socioeconomic factors and the availability of accurate information about immunization affect parental decisions to immunize their children during the COVID-19 pandemic.

\u201cIt was my own decision\u201d: the transformational shift that influences a woman's decision to use contraceptives covertly

BackgroundFamily planning (FP) is an important element of sexual and reproductive health and rights, but socio-cultural barriers and unbalanced gender relations often limit women’s decision-making about contraceptive use. Covert contraceptive use (CCU) exemplifies the limits on women’s decision-making and represents a way in which some women overcome constraints to achieve their reproductive goals. This study explores the decision-making process through which women choose to use contraceptives covertly.MethodsA qualitative synthesis was conducted using data from women, health providers, community members, health administrators, and intervention implementers (n = 400) to explore the decision-making process through which women choose to use contraceptives covertly. Interviews and focus group discussions were conducted at two time points as part of an evaluation of interventions integrating FP and childhood immunisation services at sites in Benin, Kenya, Malawi and Uganda. The sexual and reproductive health empowerment framework by Karp et al. (2020) was adapted and used to guide the analysis.ResultsWomen recognised that although they suffered the negative consequences of frequent pregnancies and of raising large families, they lacked overt decision-making power over their fertility. Women were confident to engage in CCU because they believed their husbands did not understand these consequences nor acknowledged their suffering, which justified not informing them. CCU was a difficult choice however, women felt comfortable voicing their reproductive preferences in settings where health providers were supportive.ConclusionsWomen chose to use contraceptives covertly when they questioned the unfairness of their situation and recognised their own power to act in accordance with their reproductive preferences. This represented an important shift in a woman’s perception of who is entitled to make decisions about contraceptive use. Importantly, health providers can play a key role in supporting women’s autonomous decision making about contraceptive use and should be careful not to undermine women’s confidence.

Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness

BackgroundPostpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients’ experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation.MethodsThe responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson’s chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics.ResultsResponsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients’ exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers’ individual behaviours were found to be critical to service responsiveness.ConclusionsThis study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.

Changes in Childhood Immunizations and Intermittent Preventive Malaria Treatment in a Peripheral, Referral Immunization Center During the First 12 Months of COVID-19 Pandemic in Sierra Leone, Western Africa.

BackgroundThere is increasing evidence that the COVID-19 pandemic disrupted childhood immunization services. However, detailed reports on immunizations and preventive antimalarial prophylactic treatments delivered and how the trends changed in referral centers in low-income countries are still missing.MethodsWe performed a retrospective cross-sectional study. Data for vaccinations administered to children <5 years of age, according to the local vaccination schedule, were extracted from the official records of the Kent Community Health Post, Sierra Leone, in the period between April 2019 and March 2021. We compared the vaccinations performed in the first year, considered as a pre-Covid period, with the second year, post-Covid period. Both the period was then divided in four trimester each and the same analysis was operated for each trimester. A Chi-square goodness of fit test was performed to compare the number of vaccinations performed both in the 2 years and in the 8 trimesters.FindingsSeven thousand two hundred and eighty-three vaccinations were administered: 4,641 in the period between April 2019 and March 2020 and 2,642 between April 2020 and March 2021. The drop in immunizations performed began as soon as the first cases were described in China. The drops were statistically significant when the first three trimesters of the two study periods were compared, while no statistically significant differences were observed for all the vaccines performed in the 4th trimesters. Vaccines administered at birth (BCG) were less affected compared to booster vaccinations.ConclusionsImmunizations administered in a referral health center in Sierra Leone significantly declined during the pandemic. Although the decline was less pronounced in the last months of the pandemic, we don't think that the small increase would indicate the recovery of previously missed vaccinations. These findings open new public health challenges for the coming years.

Contribution of health information system to child immunization services in Ethiopia: baseline study of 33 woredas

BackgroundMonitoring progress using appropriate data, with a functional health information system (HIS), believed to be very crucial for success of immunization program. Baseline study was conducted to assess, immunization service coverage, HIS performance status, and their relationships.MethodsA linked facility and population-based survey was conducted concurrently from September 21 to October 15, 2020. A total of 3016 households were reached to interview mothers having children aged 12–23 months in the 33 woredas. Overall 81 health posts, 71 health centers, and 15 hospitals were selected for the facility survey. The study used modified Performance of Routine Information System Management (PRISM) tools for the facility survey and a structured questionnaire for the household survey. Using STATA 14.0 software, mixed effect modeling was employed to control the effect of clustering and potential confounders.ResultsThe proportion of fully immunized children was 58%. Coverages of measles (at least one dose) and penta3 immunization (received all 3 doses of DPT-HepB-Hib vaccine) were 86%, and 85% respectively. About 27% of mothers had missed their child immunization card mainly due to misplacing or lost. Except ‘source document completeness’ (85%) and ‘use of data for planning and target setting’ (84%), other data quality and use indicators like ‘data accuracy’ (63%), ‘data use for performance review and evidence-based decision making’ (50%), and ‘data use to produce analytical reports’ (31%) show low performance. The odds of fully immunized children is 37% lower in Muslims compared with Orthodox Christians (AOR, 0.63; 95%CI: 0.46, 0.88), higher by 42% with father’s secondary education compared with no education (AOR, 1.42; 95%CI: 1.05, 1.92), and highest wealth quintile compared with lowest quintile (AOR, 2.49; 95%CI: 1.54, 4.03). For each additional score of HIS infrastructure availability, the odds of fully immunized children increased by 22% (AOR:1.22; 95% CI: 1.03, 1.44).ConclusionsChild immunization coverages are promising However, the current HIS performance is suboptimal. Both service user and HIS related factors are important for immunization service uptake. Documenting required information and advising mothers to keep immunization cards by health workers, and working to have functional HIS are recommended.

Maternal satisfaction on child immunization services of rural health extension workers in Dawie Harewa district, Northeast Ethiopia: A community based cross-sectional study

The Ethiopian health extension program was established to enhance rural poor access and equity to health interventions, such as immunization programs. Client satisfaction with child immunization services is a clear measure of service quality and plays a vital role in improving immunization coverage and quality. Thus, the goal of this study was to analyze client satisfaction with rural health extension workers' child vaccination services and associated characteristics in Dawie Harewa District, North East Ethiopia. A cross-sectional survey was conducted among mothers and caregivers of children who received immunization services from March 5–20, 2016. The data was collected from 722 mothers through a structured interviewer-administered questionnaire. Epi.info version 7 was used to enter the data, and SPSS version 20.0 was used to analyze it. To identify factors that influence mothers' satisfaction with immunization services, logistic regression analyses were employed. The degree of relationship between the independent and dependent variables was determined using an odds ratio with a 95 percent confidence interval, with a P-value of 0.05 considered statistically significant. The majority of mothers (84.68%) were happy with the child immunization services provided by health extension workers (HEWs). Mothers with good knowledge (AOR=3.31; 95% CI: 1.67–6.56), a positive attitude (AOR=7.56; 95% CI: 3.12–16.90), and whose homes were visited by HEWs (AOR=2.98; 95%CI: 1.83–4.85) were more likely than their counterparts to be satisfied with child immunization services. Majority of the respondents were satisfied with the services provided by HEWs. The level of knowledge and attitude of mothers, as well as the health extension workers' habit of visiting clients at home, were found to be the most important factors in determining client satisfaction with the vaccination program. Improved client knowledge, ongoing follow-up, and increased HEW home visits are all essential elements in boosting customer satisfaction.

Tailoring childhood immunisation services in a socioeconomically disadvantaged community in New South Wales, Australia: a cost analysis.

Using the World Health Organization's 'Guide to Tailoring Immunization Programmes' (TIP), a three-step program was developed by health services in partnership with a marginalised community in New South Wales, Australia. The aim was to improve immunisation rates of 1-year-old children. For Step 1, nurses identified and monitored local children overdue for immunisation from a national register, and sent parents or family doctors reminders by mail or telephone. For Step 2, parents were offered appointments at a local health centre; and for Step 3, they were offered home visits. An economic costing study was undertaken to examine the program's resource use. Costs were collected between 1 June 2020 and 31 May 2021. Case records were obtained for 139 children. A total of 56 children became up to date after receiving TIP services; most after receiving Step 1 services (n =37). Total annual costs (A$) for the program were $34250 or $246 per case; or $612 per case becoming up to date. At $44 per case and $98 per case becoming up to date, Step 1B: personalised reminders, was the lowest costing step. Sensitivity analysis showed a possible 8% program savings through employment of nurses with a lower salary and use of video conference meetings. This study provides information to the local health provider on the cost of TIP alongside their community-based programs. It also identified ways in which TIP could be made more cost-effective. Decision-makers can use this information to consider whether the investment in TIP is recommended.

Acceptance of Post-Partum Family Planning among Mothers Attending for Child Immunisation Services at Tertiary Care Hospital, Kolkata

Introduction:Postpartum family planning (PPFP) is avoidance of closely spaced and unplanned pregnancies by use of family planning services within first year following delivery.World Health Organisation (WHO) reports postpartum women to have greatest unmet need of contraception. There is further recommendation to link immunisation clinics to PPFP services.Objectives:1. To assess the acceptance rate ofPPFPamong mothers attending immunisation clinic 2. To explore the determinants of usage, intention to use and PPFP methods used. 3. To find the reasons for non-acceptance ofPPFP among the study participants. Method:Study participants werewomen attendingimmunisation clinicof a tertiary level teaching hospital of Kolkatafor child’s immunisation service. Studydesign was cross sectional.Systematic random sampling technique was used to recruit participants. Data was collected by interviewer administered semi-structured questionnaire.Frequencies and percentages for categorical variables while mean and standard deviation for continuous variables were calculated. Crude Odds ratio with 95% confidence interval was calculated to explore strength of association between PPFP acceptance and independent variables.Results:About 1 in every 3 women (37.36%) was PPFP acceptor; intra uterine device was the most commonly used method. Odds of acceptance was lower for respondents’ age &lt;25 years and primipara whileit was higher for exposure to counselling, having male child, resumption of sex and past use of contraception. Fear of adverse effects was the most common reason for non-acceptance of PPFP.Conclusions: PPFP acceptance was low, however among acceptors long acting reversible contraceptives were more commonly accepted methods. There is scope to improve PPFP acceptance with intensified contraceptive counselling during delivery and immediate hospital stay as women were afraid of adverse effects of contraceptives.

Community Health Workers' Experiences in Strengthening the Uptake of Childhood Immunization and Malaria Prevention Services in Urban Sierra Leone.

Introduction: Community health workers (CHWs) play an integral role in Sierra Leone's health systems strengthening efforts. Our goal was to understand CHWs' experiences of providing immunization and malaria prevention services in urban settings and explore opportunities to optimize their contributions to these services.Methods: In 2018, we conducted an exploratory qualitative assessment in the Western Area Urban district, which covers most of the capital city of Freetown. We purposively selected diverse health facilities (i.e., type, ownership, setting) and recruited CHWs through their supervisors. We conducted eight focus group discussions (FGD) with CHWs, which were audio-recorded. The topics explored included participants' background, responsibilities and priorities of urban CHWs, sources of motivation at work, barriers to CHWs' immunization and malaria prevention activities, and strategies used to address these barriers. The local research team transcribed and translated FGDs into English; then we used qualitative content analysis to identify themes.Results: Four themes emerged from the qualitative content analysis: (1) pride, compassion, recognition, and personal benefits are important motivating factors to keep working as CHWs; (2) diverse health responsibilities and competing priorities result in overburdening of CHWs; (3) health system- and community-level barriers negatively affect CHWs' activities and motivation; (4) CHWs use context-specific strategies to address challenges in their work but require further support.Conclusion: Focused support for CHWs is needed to optimize their contributions to immunization and malaria prevention activities. Such interventions should be coupled with systems-level efforts to address the structural barriers that negatively affect CHWs' overall work and motivation, such as the shortage of work supplies and the lack of promised financial support.

Experiences of seeking healthcare across the border: lessons to inform upstream policies and system developments on cross-border health in East Africa

ObjectivesThis study explored the experiences of accessing care across the border in East Africa.ParticipantsFrom February to June 2018, a cross-sectional study using qualitative and quantitative methods was conducted among 279...

Acceptability of mobile-phone reminders for routine childhood vaccination appointments in Nigeria \u2013 a systematic review and meta-analysis

BackgroundMobile-phone reminders have gained traction among policymakers as a way to improve childhood vaccination coverage and timeliness. However, there is limited evidence on the acceptability of mobile-phone reminders among patients and caregivers. This systematic review and meta-analysis aimed to evaluate the ownership of mobile-phone device and the willingness to receive mobile-phone reminders among mothers/caregivers utilizing routine childhood immunization services in Nigeria.MethodMEDLINE, Scopus, CINAHL, CNKI, AJOL (African Journal Online), and Web of Science were systematically searched for studies on the acceptability of mobile-phone reminders for routine immunization appointments among mothers/caregivers in Nigeria. Studies were assessed for methodological quality using the Newcastle Ottawa Scale and JBI critical appraisal checklists. Meta-analysis was conducted using random-effects model to generate pooled estimates (proportion) of mothers who owned at least one mobile phone and proportion of mothers willing to receive mobile-phone reminders.ResultsSixteen studies (13 cross-sectional and three interventional) involving a total of 9923 mothers across 15 states and the Federal Capital Territory Abuja met inclusion criteria. Pooled estimates showed that the proportion of mothers who owned at least one mobile phone was 96.4% (95% CI = 94.1–98.2%; I2 = 96.3%) while the proportion of mothers willing to receive mobile-phone reminders was 86.0% (95% CI = 79.8–91.3%, I2 = 98.4%). Most mothers preferred to receive text message reminders at least 24 h before the routine immunization appointment day, and in the morning hours. Approximately 52.8% of the mothers preferred to receive reminders in English, the country’s official language.ConclusionCurrent evidence suggests a high acceptability for mobile-phone reminder interventions to improve routine childhood immunization coverage and timeliness. Further studies, however, are needed to better understand unique regional preferences and assess the operational costs, long-term effects, and risks of this intervention.Systematic review protocol registrationPROSPERO CRD42021234183.

A rapid qualitative assessment of barriers associated with demand and uptake of health facility-based childhood immunizations and recommendations to improve immunization service delivery in Sokoto State, Northwest Nigeria, 2017.

IntroductionThis rapid qualitative assessment aimed to understand factors associated with persistent low vaccination demand and uptake, and recommendations to improve health facility-based childhood immunization services in Sokoto State, Nigeria.MethodsIn 2017, 20 focus group discussions and 16 in-depth interviews were conducted with administrative personnel, healthcare workers, caregivers, and community influencers across three local government areas in Sokoto state, Northwest Nigeria. Participants were purposefully selected to capture a range of perspectives regarding access to health services, campaign- and facility-based immunizations, confidence in immunizations, and recommendations to improve childhood immunization uptake.ResultsOne hundred and ninety-three individuals participated in the assessment. Commonly reported barriers to receiving childhood immunizations include: inadequacy of health services to meet community needs, preference for campaign vs. facility-based immunizations, the negative influence of rumors and misinformation, and opposition to vaccines among male heads of households. Recommendations to improve uptake of childhood immunizations include: improving immunization service delivery in health facilities, involving community leaders in building demand for immunization, and providing access to free health services and non-cash incentives.ConclusionRapid assessment results highlight community, facility, and administrative barriers associated with low demand for and uptake of health facility-based childhood immunizations and offer recommendations to improve immunization services in Sokoto state, Nigeria. Findings demonstrate the persistence of service and supply side barriers such as infrastructure and personnel issues, but also highlight the influence of behavioral factors such as low prioritization of receiving childhood immunizations, misinformation, and gender dynamics on whether communities accept or seek out immunization services.

Impact of the first phase of COVID-19 pandemic on childhood routine immunisation services in Nepal: a qualitative study on the perspectives of service providers and users

BackgroundThe COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services in Nepal during the COVID-19 pandemic.MethodsSemi-structured qualitative interviews were conducted with childhood immunisation service providers and users (i.e., parents of children) from Kathmandu valley, Nepal. All interviews were conducted through phone or internet-based tools, such as Zoom, WhatsApp, and messenger. All interviews were audio-recorded, transcribed verbatim, and analysed using theme-based content analysis in an Excel spreadsheet.ResultsA total of 15 participants (n = 7 service providers and n = 8 service users) participated. Six themes were identified, namely: (1) impact of COVID-19 and lockdown on childhood immunisation services; (2) motivation and resilience for childhood immunisation; (3) Biosafety practices and Personal Protective Equipment (PPE) availability during the COVID-19 pandemic; (4) service adjustments and guidelines during pandemic; (5) availability of vaccines; and (6) immunisation program resilience in view of COVID-19. Service providers mentioned facing disruptions in services and some parents had decided to delay scheduled immunisation. However, most service providers showed determinations to deliver the services with high morale, while most service users reported taking their children for immunisation. Families migrating from urban to rural areas during the pandemic led to service providers having no means to confirm complete immunisation of migrating children. Service providers also experienced lack of adequate guidance to deal with the pandemic and personal protective equipment to protect themselves and service users.ConclusionDespite experiencing disruptions in childhood immunisation service due to the COVID-19 pandemic, service users and providers were determined to vaccinate the children. There is an urgent need for effective preparedness plans to be in place to address the observed barriers and to ensure resilient immunisation services during ongoing and future pandemics.