Vaccination Status Of Children Research Articles

Improving Vaccination for Young Children (IVY): A Stepped-Wedge Cluster Randomized Trial.

High childhood vaccination rates are critical for public health. We hypothesized that implementation of a vaccine education and quality improvement (QI) program, Improving Vaccinations for Young Children (IVY), would improve childhood vaccine rates. Eight pediatric practices (3 academic-based, 5 community-based) were randomized to implement IVY within a stepped-wedge cluster randomized trial (SWCRT) in middle Tennessee. Two educational modules on vaccines were developed using best practices in instructional design. Modules were provided electronically and were tailored to providers or office staff. Practices completed in-person QI coaching sessions and selected at least 2 vaccination-related QI changes. Data were collected monthly. The primary analysis examined intervention effect on the primary outcome of Combination 10 vaccination status for children who turned 2 in the previous month. Combination 10 status without influenza vaccine was a secondary outcome, and exploratory analyses assessed intervention effects after adjusting for time and practice type. Data from 4041 patients (1788 control; 2253 intervention) were collected. The intervention effect was not significant on the primary outcome (OR=1.01; 95% CI [0.76, 1.34]; P > .9), however there were positive intervention effects in secondary and exploratory models analyzing Combination10 rates without flu, including models adjusting for variation over time (0.20; 95% CI [0.04,0.35]; P=.01) and practice type (higher vaccination rate in academic practices, 0.23; 95% CI [0.03,0.42]; P=.03). Combination 10 rates were not significantly improved with IVY, yet evidence of beneficial effect on rates without flu vaccine was found. Future studies could evaluate effects over a longer time period and within a larger practice sample.

Rotavirus A infection in pre- and post-vaccine period: Risk factors, genotypes distribution by vaccination status and age of children in Nampula Province, Northern Mozambique (2015-2019)

Mozambique introduced the monovalent rotavirus vaccine (Rotarix®, GSK Biologicals, Rixensart, Belgium) in September 2015. Previous analysis, showed that Nampula province continues reporting a high frequency of Rotavirus A (RVA) infection and the emergence of G9P[6], G9P[4] and G3P[4] genotypes. This analysis aimed to determine the RVA frequency; risk factors; genotype distribution by vaccination status and age between pre- and post-vaccine periods in children under-five years old with diarrhea in Nampula. A cross-sectional, hospital-based surveillance study was conducted in the Hospital Central de Nampula in Mozambique. Socio-demographic and clinical data were collected to assess factors related to RVA infection in both periods. Stool specimens were screened to detect RVA by ELISA, and positive samples were genotyped. Between 2015 (pre-vaccine period) and 2016–2019 (post-vaccine period), 614 stool specimens were collected and tested for RVA in which 34.9% (67/192) were positive in pre-vaccine period and 21.8% (92/422) in post-vaccine (p = 0.001). In the post-vaccine period, age, year, and contact with different animal species (chicken, duck, or multiple animals) were associated with RVA infection. RVA infection was higher in children partially vaccinated (40.7%, 11/27) followed by the fully vaccinated (29.3%, 56/191) and the unvaccinated (15.3%, 21/137) (p = 0.002). G1P[8] and G9P[4] were common in vaccinated children less than 12 months. The present analysis showed that RVA infection reduced slightly in the post-vaccine period, with a high proportion of infection and genotype diversity in children, under 12 months of age, vaccinated. Further research on factors associated with RVA infection on vaccinated compared to unvaccinated children and vaccination optimization should be done.

Clinical Profiles and Outcome of Children Admitted with Measles in District Level Hospital, Nilphamari, Bangladesh

Introduction: Measles is a highly contagious acute viral infection. It is a common cause of morbidity and mortality constituting half of vaccine preventable diseases. Aim of the study: The study was designed to describe the demographic, vaccination status, clinical profiles, and outcome of children admitted with measles during study time. Method: This was a retrospective observational study conducted in the department of Pediatrics at Adhunik Sadar Hospital, Nilphamari, Bangladesh. The diagnosis of measles based on clinical features. Demographic characteristics of patients and occurrence of measles from the time of vaccination was recorded. Patients below the age of 2 years who were clinically diagnosed as cases of measles were treated and followed. Data were analyzed by using SPSS version 22. Results: The most frequent age group of children admitted with measles during the study time 10-14 months was which constitute 35(54.69%) of cases. The youngest age group was 4-9 months constitute 24(37.50%) and the oldest was 15-18 months constitute 5(7.81%).This study showed that 36(56.25%) patients were males and 28(43.75%) were females with a male/female ratio of 1.14:1.21(32.81%) cases where from urban areas and 43(67.19%) were from rural area.39 (60.94%) cases were malnourished in 10-14 months age group, in 4-9months age group 20(30.25%) and in 15-18months age group was 5(7.81%).39(60.94%) children had history of contact with a case of measles in the preceding 3 weeks.20(31.25%) children had no history of contact and 5(7.81%) children had unknown history of contact. The total death ratio of the participants was 4(6.25%) where vaccinated patients was 1(1.56%), not vaccinated was 2(3.13%) which was significant and unknown cases was 1(1.56%). Conclusion: One third of measles infections occurred before the age of 9 months. Half of measles cases were not vaccinated. The majority of the complicated cases had occurred in the unvaccinated children. Pneumonia was found to .....

Discovery of Foci of Type-2 Poliovirus Derived from Oral Polio Vaccine in Central African Republic in 2019

RésuméObjectifEn 2019, la République centrafricaine a découvert des foyers de poliovirus de type 2 dérivé vaccinal circulant (PVDV2c). L'objectif de ce travail est de décrire l'état vaccinal des enfants paralysés par le PVDV2c et leurs contacts et d'évaluer la circulation de cette souche chez ces contacts.Patients et MéthodeIl s'agit d'une étude rétrospective et descriptive. La population d'étude est constituée des enfants atteints de paralysie flasque aiguë (PFA) et de leurs contacts. Nous avons inclus les enfants paralysés dont les résultats de séquençage ont montré la présence du PVDV2c.RésultatsAu total, 21 enfants paralysés par le PVDVc et 64 contacts ont été enrôlés dans cette étude. Quatorze enfants paralysés sur 21 (66%) avaient reçu au moins une dose de vaccin antipoliomyélitique oral (VPO) bivalent contre 36 sur 64 (57%) chez les contacts (différence non significative). Parmi les malades vaccinés, 7 avaient reçu moins de trois doses. Pour le vaccin polio injectable (VPI), la couverture vaccinale chez les malades comme pour les contacts était de 33%.La proportion des enfants ayant reçu à la fois des doses de VPO et de VPI était de 33% chez les malades et 25% chez les contacts. Les contacts porteurs de VDPV2 ont été vaccinés par le VPO et VPI, respectivement 55% et 27%. Le VDPV2 et le Sabin 2 ont également été trouvés dans les selles des contacts, respectivement 34% et 9%.ConclusionL'insuffisance de vaccination en VPO et VPI pendant plusieurs années a des conséquences graves par la survenue de virus dérivé du vaccin et responsable de paralysie à vie. Pour arrêter l'épidémie de VDPVc, il faut renforcer la couverture vaccinale par une campagne de masse couvrant tous les districts en même temps.

Relation of Parents Economical, Educational and Awareness on Immunization Status of Children

Aim: To determine the immunization status of children 0 to 2 years and factors leading to low vaccination status in children visiting tertiary care center. Study design: Cross-sectional study Place and duration of study: Department of Paediatrics Shaikh Zayed Hospital Lahore from 1st November 2019 to 31st April 2020. Methodology: Five hundred children age between 0-2 years were enrolled after fulfilling inclusion and exclusion criteria. Results: The mean age was 9.9±6.1 months, with mean weight of 7.4±3.4 kg and 200 (40%) were male and 300 (60%) were female patients. Sixty (12%) were not vaccinated, 145 (29%) partially vaccinated and 295 (59%) fully vaccinated. In the distribution by income level 255 (51%),180 (36%) and 65 (13%) parents were having low, middle and high income respectively; By education level,155 (31%) with no education, 140 (28%) some education and 205 (41%) with high education, regarding knowledge of immunization, 50 (10%) had no knowledge, 215 (43% )had wrong perception of immunization and 235 (47%) were fully aware.295 (59%) had up-to-date immunization Conclusion: More than half of the study populations were upto date about immunization status. It is also concluded that majority of parents of low-income level and uneducated were unknown about immunization status and majority of middle and high-income level and educated people were partial known or up-to-date about immunization status Keywords: Economical level, Educational level, Awareness level, Immunization status

Stopping a polio outbreak in the midst of war: Lessons from Syria

BackgroundOutbreaks of circulating vaccine-derived polioviruses (cVDPVs) pose a threat to the eventual eradication of all polioviruses. In 2017, an outbreak of cVDPV type 2 (cVDPV2) occurred in the midst of a war in Syria. We describe vaccination-based risk factors for and the successful response to the outbreak. MethodsWe performed a descriptive analysis of cVDPV2 cases and key indicators of poliovirus surveillance and vaccination activities during 2016–2018. In the absence of reliable subnational coverage data, we used the caregiver-reported vaccination status of children with non-polio acute flaccid paralysis (AFP) as a proxy for vaccination coverage. We then estimated the relative odds of being unvaccinated against polio, comparing children in areas affected by the outbreak to children in other parts of Syria in order to establish the presence of poliovirus immunity gaps in outbreak affected areas. FindingsA total of 74 cVDPV2 cases were reported, with paralysis onset ranging from 3 March to 21 September 2017. All but three cases were reported from Deir-ez-Zor governorate and 84% had received < 3 doses of oral poliovirus vaccine (OPV). After adjusting for age and sex, non-polio AFP case-patients aged 6–59 months in outbreak-affected areas had 2.5 (95% CI: 1.1–5.7) increased odds of being unvaccinated with OPV compared with non-polio AFP case-patients in the same age group in other parts of Syria. Three outbreak response rounds of monovalent OPV type 2 (mOPV2) vaccination were conducted, with governorate-level coverage mostly exceeding 80%. InterpretationSignificant declines in both national and subnational polio vaccination coverage, precipitated by war and a humanitarian crisis, led to a cVDPV2 outbreak in Syria that was successfully contained following three rounds of mOPV2 vaccination.

Evaluation of measles vaccination coverage in Lincang City, Yunnan Province, China

ABSTRACT Background: Lincang City in Yunnan Province on the China-Myanmar border, has reached the World Health Organization recommended coverage (95%) for measles-containing vaccine (MCV), but measles outbreaks still occur. We conducted a survey in Lincang City to determine the measles vaccination status of children on the China–Myanmar border. Methods: We used multistage sampling among children aged 8–83 months. Information on measles vaccination status was obtained from the child’s vaccination certificate, and serum samples were tested using commercially available ELISA kits. Results: A total of 938 children were surveyed. The vaccination coverage rate was 98.9% (95% CI: 98.2–99.6%) for measles–containing vaccine dose 1 (MCV1), and 95.8% (95% CI:94.9–96.7%) for measles–containing vaccine dose 2 (MCV2). The timely vaccination coverage rate was 52.0% (95% CI:48.8–55.2%) for MCV1, and 74.1% (95% CI: 82.9–89.0%) for MCV2. The timely-and–complete vaccination coverage rate was 41.0% (95% CI: 36.7–45.3%). The median delay period was 33 (95% CI: 27–39) days for MCV1, and 196 (95% CI: 146–246) days for MCV2. The seropositivity rate in children aged less than 7 years was 94.0% (95% CI: 92.5–95.5%) with a geometric mean titer of 1210.1 mIU/mL. Conclusions: The MCV coverage was high, but timely and timely-and-complete vaccination coverage were low and insufficient to prevent measles outbreaks. It is necessary to add the timely and timely-and-complete vaccination coverage as indicators of vaccination to provide a more complete picture of measles immunization status.

Institutional mistrust and child vaccination coverage in Africa

IntroductionDespite considerable improvements in vaccination coverage over the last decade, half of the world’s unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination...

Factors associated with measles vaccination status in children under the age of three years in a post-soviet context: a cross-sectional study using the DHS VII in Armenia

BackgroundThe resurgence of measles globally and the increasing number of unvaccinated clusters call for studies exploring factors that influence measles vaccination uptake. Armenia is a middle-income post-Soviet country with an officially high vaccination coverage. However, concerns about vaccine safety are common. The purpose of this study was to measure the prevalence of measles vaccination coverage in children under three years of age and to identify factors that are associated with measles vaccination in Armenia by using nationally representative data.MethodsCross-sectional analysis using self-report data from the most recent Armenian Demographic Health Survey (ADHS VII 2015/16) was conducted. Among 588 eligible women with a last-born child aged 12–35 months, 63 women were excluded due to unknown status of measles vaccination, resulting in 525 women included in the final analyses. We used logistic regression models in order to identify factors associated with vaccination status in the final sample. Complex sample analyses were used to account for the study design.ResultsIn the studied population 79.6% of the children were vaccinated against measles. After adjusting for potential confounders, regression models showed that the increasing age of the child (AOR 1.07, 95% CI: 1.03–1.12), secondary education of the mothers (AOR 3.38, 95% CI: 1.17–9.76) and attendance at postnatal check-up within two months after birth (AOR 2.71, 95% CI: 1.17–6.30) were significantly associated with the vaccination status of the child.ConclusionsThe measles vaccination coverage among the children was lower than the recommended percentage. The study confirmed the importance of maternal education and attending postnatal care visits. However, the study also showed that there might be potential risks for future measles outbreaks because of delayed vaccinations and a large group of children with an unknown vaccination status.

Impact of COVID-19 pandemic on vaccination coverage among children aged 15 to 23 months at Dessie town, Northeast Ethiopia, 2020

ABSTRACT Background: Disturbances are occurring in healthcare, trade, and travel, with countries closing off their borders due to the pandemic of coronavirus disease 2019(COVID-19) in the world. The pandemic has its impact on the delivery of important health services, including vaccinations. This study aimed to assess the impact of COVID-19 on vaccination coverage among children aged 15–23 months. Methods: A community-based cross-sectional study was conducted from July 22 to August 7, 2020, in Dessie town, Ethiopia. 633 children with their mother/caregiver were interviewed. Interviewer administered pre-tested structured questioner was used. Data was entered into EPI data and analyzed by using SPSS (Statistical Package for Social Sciences). Both binary and multivariate logistic regression analyses were tested. In multivariate analysis, a significant association was declared at a p-value of < 0.05. Result: Response rate was 96.4%. Based on the vaccination card plus recall, 350 (57.4%) of children finished all recommended vaccines. Age-eligible vaccination coverage during the COVID-19 outbreak was 12.5% lower than before the outbreak. Being a father main caregiver, mother/caregiver who can write and read, and mother/caregiver who educated from grade 1 to 8 mother/caregiver who is divorced, mother/caregiver who spend more than 30 minutes to reach health institution, and mother/caregiver who aware about the benefit of vaccination, about the campaign, and knowledge of COVID-19 each shows statistically significant association with full vaccination status of children. Conclusion: Full vaccination coverage among children aged 15–23 months remains low in Dessie town, which further decreases after the COVID-19 pandemic. Hence, measures should be taken to increase consciousness about vaccination and the COVID-19 pandemic.

Association of Bacteremia with Vaccination Status in Children Aged 2-36 Months

Association of Bacteremia with Vaccination Status in Children Aged 2-36 Months

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial.

BackgroundIn Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation.ObjectiveThis trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage.MethodsCommunities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness.ResultsFunded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing.ConclusionsThis trial is expecting to test an innovative approach to improving children’s immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources.Trial RegistrationPan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnseInternational Registered Report Identifier (IRRID)DERR1-10.2196/21734

Sero-survey of measles virus antibodies among symptomatic children attending Abuja Teaching Hospital, Nigeria.

Background: Nigeria is one of the countries with a high prevalence of measles outbreak in children under 5 years old, despite a history of vaccination. This study aims to determine the prevalence of anti-measles virus IgM and IgG among children under 5 years attending the University of Abuja Teaching Hospital (UATH), Gwagwalada, FCT Abuja, Nigeria.Materials and methods: Whole blood was collected, centrifuged, and serum anti-IgM and anti-IgG against measles virus was analysed using ELISA. Sociodemographic variables and vaccination history of subjects were obtained by interview-based questionnaires.Results: The overall anti-Measles virus IgG and IgM seroprevalences were 29.2% and 14.6%, respectively. The prevalence of measles IgG was significantly associated with the parent’s employment status (X2=11.67, p=0.008). However, the prevalence of measles virus IgM was significantly associated with children’s age (X2=16.62, p=0.002), parents’ employment status and children’s vaccination status (X2 =7.72, p=0.02).Conclusion: A majority of study participants were not immunised against measles, and a significant number of participants had serological evidence of acute measles virus infection. There is a need for more concerted and massive measles vaccination of children.

Real-time monitoring of the rollout of pneumococcal conjugate vaccines in rural India using a digital tracking platform

Background: In 2017, the pneumococcal conjugate vaccine (PCV) was introduced into the Indian immunization program as a priority. However, monitoring the implementation of this program has been a major challenge in rural India. Novel digital health platforms, used to track vaccine delivery, can address this issue. Methods: We analyzed data collected in a rural part of the Udaipur District of India, which recently introduced PCV13 into the routine immunization program. The data were collected by Khushi Baby, a novel technology platform which facilitates tracking the vaccination status of individual children. We assessed the percent of children receiving 1, 2, or 3 doses of the vaccine at different ages and time points, as well as geographic variations in uptake. Only doses received before 12 months of age were considered for this analysis. Results: More than 96% of children captured by the database received the first dose of PCV13. Uptake of the second dose ranged from 69% to 90% across the five regions, and 44% to 76% of children received the third (booster) dose within 3 months of the recommended date. Conclusions: These data provide early evidence that the primary doses of PCV13 are being administered at a high level in rural India; however, there is considerable variability between regions. Additionally, the receipt of the booster dose may be lower than desired. Given the importance of the booster dose in reducing pneumococcal transmission, its delivery is essential to ensure maximal benefit of the vaccine program.

Paradoxical health care utilization patterns among children in Korea who did not receive mandatory pneumococcal vaccination

BackgroundUnvaccinated children in the National Immunization Program (NIP) are a public health concern. We used Korean national population data to analyze health care utilization patterns of NIP-eligible children and identify the unvaccinated group. MethodsPneumococcal vaccination (PCV) records were reviewed to determine the vaccination status of children born between 2013 and 2015. Children who received three doses or more from a 3 + 1 schedule were defined as vaccinated, while those who had not received any pneumococcal vaccinations were defined as unvaccinated. Corresponding health care utilization records were retrieved from the National Health Insurance Review and Assessment Service. The incidence of combined pneumococcal infections and health care utilization rates were estimated and the proportion of complementary and alternative medicine (CAM) utilization among the total health care utilization records was measured. ResultsIn total, 26,893 (2.1%) of 1,272,685 children remained unvaccinated. The incidence of pneumococcal infection was lower in unvaccinated children, at 10.1 cases (9.8–10.3) per 1000 person-months. However, their health care utilization was significantly lower than that noted for vaccinated children (hospital visit rate: 26.6 (95% confidence interval [CI] 26.5–26.7) vs. 3.2 (3.2–3.3) visits annually), indicating underdetection. CAM treatment was sought at least three times often more in unvaccinated children than in vaccinated children (3.5% vs. 1.1%). ConclusionUnvaccinated children showed significantly lower utilization of overall health care than the vaccinated children; however, a higher preference for CAM was noted among unvaccinated children than among vaccinated children. These differences in care-seeking patterns should be considered when identifying unvaccinated children and providing protection through vaccination programs.

Association of Bacteremia with Vaccination Status in Children Aged 2 to 36 Months

To determine the association between bacteremia and vaccination status in children aged 2-36months presenting to a pediatric emergency department. Retrospective cohort study of children aged 2-36months with blood cultures obtained in the pediatric emergency department between January 2013 and December 2017. The exposure of interest was immunization status, defined as number of Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae vaccinations, and the main outcome positive blood culture. Subjects with high-risk medical conditions were excluded. Of 5534 encounters, 4742 met inclusion criteria. The incidence of bacteremia was 1.5%. The incidence of contaminated blood culture was 5.0%. The relative risk of bacteremia was 0.79 (95% CI 0.39-1.59) for unvaccinated and 1.20 (95% CI 0.52-2.75) for undervaccinated children relative to those who had received age-appropriate vaccines. Five children were found to have S pneumoniae bacteremia and 1 child had Hib bacteremia; all of these subjects had at least 3 sets of vaccinations. No vaccine preventable pathogens were isolated from blood cultures of unvaccinated children. We found no S pneumoniae or Hib in children 2-6months of age who were not fully vaccinated due to age (95% CI 0-0.13%) and the contamination rate in this group was high compared with children 7-36months (6.6% vs 3.7%). Bacteremia in young children is an uncommon event. Contaminated blood cultures were more common than pathogens. Bacteremia from S pneumoniae or Hib is uncommon and, in this cohort, was independent of vaccine status.

Assessment of Vaccination Status and Associated Factors Among 9 to 12 Months Children in Central Ethiopia

Background: Immunization coverage is one of the indicators used to monitor progress towards the reduction of child morbidity and mortality, as it is one of the most cost-effective public health interventions(1). However many children around the world especially in developing countries like our country Ethiopia still remain incomplete or unvaccinated. For instance; as Ethiopian Demographic Health Survey 2011 shows fully vaccination coverage in urban and rural settings was 48.2% and 20.4%, respectively(2). Likewise the programmatic report on immunization of Adama town 2014/15 shows out of total targets 10,927 under one year age children 7867(72%) fully vaccinated; relatively lower achievement. Therefore this research designed for validation of the programmatic report by using scientific study and identifying factors associated with vaccination status of children at the target age, in each sampled kebeles, census of study population done to develop sampling frame. Objectives: This study was designed to assess the vaccination status and associated factors among 9 to 12 months children in Adama town, Oromia, Ethiopia. Methods: Community-based cross-sectional study design was employed from March to July. Mixed probability sampling technique (stratified random sampling, probability proportion to size and simple random sampling) were used at various stages of sampling to include 456 care takers of children 9-12 months. Data were collected within structured and pre tested questionnaire, entered into Epi.info version7 and analyzed using the statistical products and service solution (SPSS) version 21 computer software. Both descriptive and analytical methods were used to report the result. Bivariate and multivariate analyses were executed using binary logistic regression. To determine significance of association 95% confidence level was used. Results: from the planned sample, 437(96% response rate) of primary care takers of children age 9-12 months were included in the study of which 417(95%) were confirmed to complete routine vaccination. Using multivariate logistic regression models, factors significantly associated with complete immunization were age the child should complete vaccination (adjusted odd ratio [AOR], 16.2; 95% CI: 4.2-62.0) and health education given by health workers about vaccination (AOR, 3.2; 95% CI: 1.2-8.7), whereas parents/caretakers socio-demographic characteristics and the rest were not significantly associated with full immunization among children 9-12months. Conclusion and recommendation: fully vaccination status is higher than what is being reported by Adama town health office and factors significantly associated with the vaccination status in study setting are; at which age the child should complete vaccination and health education given by the health workers about vaccination. The town health office and health workers should be strengthened to raising awareness of the community on the benefit and about vaccine preventable diseases, which is also used to ensure quality of vaccination services. Funding Statement: There is no source of fund for this study. Declaration of Interests: The authors declare that there is no conflict of interest regarding the publication of this paper. Ethics Approval Statement: The study protocol was reviewed and approved by Ethical review committee of Oromia regional health bureau. Also permission to undertake the study was obtained from every relevant authority in the town including Adama town health office. Verbal informed consent was obtained from the participants prior to participation in the study.

NEUROLOGICAL COMPLICATIONS AND BACILLE CALMETTE-GUERIN VACCINATION STATUS OF CHILDREN WITH TUBERCULOUS MENINGITIS: A TERTIARY CARE HOSPITAL EXPERIENCE

OBJECTIVE: To assess for the neurological complications and Bacille Calmette-Guerin (BCG) vaccination status of children with tuberculosis meningitis (TBM). METHODS: This retrospective study was conducted in Ayub Teaching Hospital, Abbottabad, Pakistan. Data of diagnosed case of TBM who received anti-tuberculous therapy from 2017 to 2020 was retrieved from records. Records of children, aged 6 months to 10 years of either gender were included and vaccination status was documented along with CT scan findings. Neurological complications in hospital and outcome were recorded as discharge, expiry and transfer to other hospital. RESULTS: Out of 40 patients, 17 (42.5%) were males and 23 (57.5%) females. Age ranged from 6 months to 8 years with mean age of 2.81±2.29 years. Weight ranged from 5 to 24 kg and mean weight was 10.36±4.96 kg. About 72.5% patients were <5 years of age. About 47.5% (n=19/40) patients were not vaccinated for BCG. Primary source of tuberculosis in close contacts was identified in 35% (n=14/40) patients. Common findings on CT scan were hydrocephalus (35.0%; n=14/40) & cerebral infarct (15.0%; n=6/40). The common complication observed were hydrocephalus (35%; n=14/40), acute stroke (20%; n=8/40), cranial nerve palsies (12.5%; n=5/40), seizure disorder (12.5%; n=5/40). Mortality rate was 2.5% (n=1/40). Only 35.7% (5/14) of patients with hydrocephalus and no patient with stroke or seizures were fully vaccinated. CONCLUSION: Hydrocephalus & stroke are the most common complication in children with TBM. Neurological complications were observed more commonly in children who were either not vaccinated or partially vaccinated for BCG.

Feeding practices and knowledge regarding vaccination in mothers of under 5 children: a questionnaire based study in a metropolitan city hospital of India

Background: India has a high burden of under five mortality. Faulty feeding practices and mortality due to vaccine preventable diseases is a major hurdle. Objective was to assess breast feeding practices and vaccination status of children of less than 5 years by age and its correlation with socio-demographic profile.Methods: This was a cross- sectional descriptive study involving children of nine months to five years.Results: Health seeking behavior in terms of adequate antenatal checkup and institutional deliveries was quite high; but only one third of children had early initiation of breast feeding and the main reason was delay in rooming-in. Early breast feeding had significant correlation with the greater duration of breast feeding and the duration of exclusive breast feeding was significantly associated with the literacy status of mother. Only 34% of children were vaccinated on time and frequent migration was the cause of delay in 25%. Ground level workers were the main source of information regarding vaccination in this study population.Conclusions: Feeding practices were not satisfactory. Institutional fallacies also came into focus such as delayed rooming-in. Awareness regarding vaccination was inadequate and was incomplete in majority of children. General awareness and health seeking behavior of our community still need enhancement to a great extent.

Women's Empowerment and Child Vaccination in Kenya: The Modifying Role of Wealth

Although vaccination coverage is high in Kenya relative to other African nations, undervaccinated children remain, making it important to identify characteristics of these children and their caregivers. Potentially relevant but understudied factors are women's empowerment and early marriage. Women who marry older and have more autonomous decision-making authority may be better able to ensure their children receive health services, including immunizations. This analysis examines the relationship between early marriage and multiple dimensions of women's empowerment and child vaccination status in Kenya and explores whether these relationships are modified by wealth. Data were from the 2014 Kenya Demographic and Health Survey. The analysis was completed in 2020 using updated data made available to researchers in 2019. Logistic regressions assessed relationships among early marriage, 3 dimensions of women's empowerment (enabling conditions, intrinsic agency, and instrumental agency), and child vaccination. Analyses were stratified by wealth to explore potential effect modification. For women in the middle wealth tertile, the odds of having a fully vaccinated child were 3.45 (95% CI=1.51, 7.91) times higher for those with higher versus lower empowerment. Further, among the wealthiest women, those with middle empowerment were 5.99 (95% CI=2.06, 17.40) times more likely to have a fully vaccinated child than women with lower empowerment. Results suggest a threshold effect of wealth's role in the relationship between empowerment and vaccination. Enabling conditions may not influence immunization among the poorest women but exert a stronger positive influence on childhood vaccination among wealthier women. This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.