Immunization Service Delivery Research Articles

Assessment of Accredited Social Health Activists (ASHAs) Regarding Their Roles and Responsibilities in Selected Villages of a District in India: A Qualitative Study

Background: Vaccination in children against vaccine preventable diseases is an important public healthintervention. ASHAs are receiving performance-based incentives for promoting universal immunisation. A recent local outbreak of Measles in two health Blocks of Rajouri district prompted us to conduct this study. The objectives of this study were to study the awareness and perception of ASHAs regarding their roles and responsibility in delivering routine immunization services to children and to study the factors affecting their performance in delivery of routine immunization services to children.Methods: It was a qualitative study; non-probability sampling method was used for selection of subjects. Data was collected through interview and analysed using thematic framework approach.Conclusion: The study revealed that ASHAs were aware of their roles and responsibilities except few in delivery of routine immunization services to children. Delayed and Poor incentives, Lack of proper transport and hilly area were the demotivating factors. Support from community members and Health Staff, and Supportive supervision were the motivating factors for ASHAs in delivery of routine immunization service to children. Periodic training, better and timely incentives and proper transportation for ASHAs are required to augment the immunization service delivery to the children.

Completion of multidose vaccine series in early childhood: current challenges and opportunities.

Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.

Exploring the impact of the COVID-19 pandemic on perceptions of national scheduled childhood vaccines among Māori and Pacific caregivers, whānau, and healthcare professionals in Aotearoa New Zealand

ABSTRACT In Aotearoa New Zealand, there has been a marked decrease in the uptake of routine childhood vaccinations since the onset of the COVID-19 pandemic, particularly among Māori and Pacific children. This Māori and Pacific-centered research used an interpretive description methodology. We undertook culturally informed interviews and discussions with Māori and Pacific caregivers (n = 24) and healthcare professionals (n = 13) to understand their perceptions of routine childhood vaccines. Data were analyzed using reflexive thematic analysis and privileged respective Māori and Pacific worldviews. Four themes were constructed. “We go with the norm” reflected how social norms, health personnel and institutions promoted (and sometimes coerced) participants’ acceptance of routine vaccines before the pandemic. “Everything became difficult” explains how the pandemic added challenges to the daily struggles of whānau (extended family networks) and healthcare professionals. Participants noted how information sources influenced disease and vaccine perceptions and health behaviors. “It needed to have an ethnic-specific approach” highlighted the inappropriateness of Western-centric strategies that dominated during the initial pandemic response that did not meet the needs of Māori and Pacific communities. Participants advocated for whānau-centric vaccination efforts. “People are now finding their voice” expressed renewed agency among whānau about vaccination following the immense pressure to receive COVID-19 vaccines. The pandemic created an opportune time to support informed parental vaccine decision-making in a manner that enhances the mana (authority, control) of whānau. Māori and Pacific-led vaccination strategies should be embedded in immunization service delivery to improve uptake and immunization experiences for whānau.

Leveraging the CORE Group Partners Project Polio Infrastructure to Integrate COVID-19 Vaccination and Routine Immunization in South Sudan.

Countries with fragile health systems like South Sudan experienced significant impacts on routine immunization during the COVID-19 pandemic. Routine immunization in children aged younger than 1 year declined due to pandemic-related constraints and was compounded by the introduction of the COVID-19 vaccine, which was met with hesitancy and reluctance. When South Sudan reported the first COVID-19 case in March 2020, the CORE Group Partners Project (CGPP) rapidly integrated the COVID-19 outbreak response into its ongoing polio eradication activities, leveraging the existing polio infrastructure and human resources. We describe the integration process, results, and challenges and detail the impact of the integration on coverage for both routine immunization and COVID-19 vaccinations. Efforts to integrate COVID-19 vaccination and routine immunization service delivery were implemented in 5 phases: assessing the need, developing multisector collaborations, developing a service delivery plan, assessing implementation readiness, and implementing and evaluating the service delivery plan. Integration efforts prioritized coordination, training vaccinators and volunteers, development of microplans, data management, and last-mile vaccine delivery. Integrated service delivery was implemented through "one-stop shop" sessions where communities accessed routine immunizations for children, COVID-19 vaccinations for adults, and other primary health services. Integrating health service delivery contributed to improved routine immunization coverage among children, improved COVID-19 vaccination coverage among adults, reduced cost for service delivery, and increased access to more comprehensive health services in hard-to-reach communities. COVID-19 vaccinations were delivered at US$4.70 per dose, a cost substantially lower than other reported delivery mechanisms. Integration can yield positive results and improve access to vaccination and other health services for communities. However, it requires clear policy guidelines, commitment, and strong collaboration. Challenges included resistance from stakeholders, overstretched human resources, and diversion of funding and attention from program areas, which were overcome through deliberate high-level advocacy, partnership, and intensified community engagement.

Lessons From the COVID-19 Pandemic Response Implementation: A Case Study of South Sudan and Sierra Leone.

The COVID-19 pandemic caused havoc to health systems worldwide and in countries that already had weak health systems. There are lessons to be learned that could contribute to improved response preparedness to future public health emergencies, but there is little documentation on best practices in fragile countries. We describe lessons from South Sudan and Sierra Leone during the COVID-19 response implementation. We conducted a retrospective descriptive analysis of COVID-19 vaccination implementation at national and subnational levels between 2020 and 2022 in South Sudan and Sierra Leone to identify those practices that had a positive impact on public health. Several interventions were identified that not only improved the COVID-19 situation but also had a positive effect on routine immunizations. The development of a near-real-time vaccination dashboard gave stakeholders a quick look at vaccine implementation, allowing them to make decisions based on current data. The experience acquired from deploying the COVID-19 dashboard has since been applied to the development of a routine immunization dashboard in South Sudan. Surge vaccination was an effective approach to improving COVID-19 vaccination uptake. A measles reactive campaign was conducted during the initial stages of the pandemic when movement was restricted; experience gained from that effort was subsequently applied to COVID-19 mass vaccination initiatives and outbreak reactive campaigns. Additional vaccinators recruited for COVID-19 response also received comprehensive Immunization in Practice training, allowing them to provide routine childhood vaccinations alongside COVID-19 vaccination, contributing to the maintenance of routine vaccination services in both countries. Lessons were learned during the COVID-19 response implementation that have had a positive impact on routine health services. However, it is essential that these effects are maintained and further refined to strengthen the country's preparedness for future public health emergencies and better support the broader immunization service delivery.

Designing an online educational program to improve immunisation service delivery for migrants and refugees in Australia and New Zealand

Migrants and refugees are likely to be under-immunised according to the host country's national immunisation schedule and may remain under-immunised post-resettlement for various reasons. In Australia and Aotearoa New Zealand, primary health care professionals including general practitioners and nurses provide the majority of routine and catch-up immunisations for migrants and refugees. However, immunisation service delivery for migrants and refugees is complex, with evidence that unmet training needs for immunisation providers, particularly in the development of catch-up plans, is a significant barrier to immunisation service delivery for this group. Targeted professional development opportunities for immunisation providers are essential to improve their awareness, confidence, and capability to improve immunisation service delivery for migrants and refugees. We developed an educational program to support learning for immunisation providers and equip them with the requisite knowledge and confidence to improve immunisation service delivery for refugees and migrants. The development of the multi-module online educational program drew on evidence-based web design principles, adult learning theories, and its content aimed to complement general immunisation training and align with the continuing professional development standards of Australian and New Zealand general practice and nursing colleges. Input from experts and feedback from a few selected providers in Australia and New Zealand added to the robustness of the program. This program has the potential to improve the understanding and capacity of immunisation providers, to improve vaccination experiences and increase overall vaccine uptake among migrants and refugees.

The evaluation of quality of immunization services of children in Primary Medical Sanitary Centers in Oron, Akwa Ibom state, Nigeria

Nigeria, with its low routine immunization coverage and wild poliovirus reservoir, significantly contributes to overall regional burden of vaccine-preventable diseases. Since introduction of the EPI in 1974 (which later became the National Program of Immunization), Nigeria's immunization program suffered from declining coverage. The poor quality of immunization affects service utilization, even where they are provided for free, just as immunization services are. The quality assessment will provide both notion of degree of satisfaction of clients with services and framework for revision of program priorities, strategies and components Purpose of the study is to evaluate quality of immunization services provided to children in primary health centers in Oron, Akwa Ibom State, Nigeria. The study targets to identify strengths and weaknesses of immunization services, to evaluate level of compliance with national and international standards of immunization and to develop corresponding recommendations. The study seeks to contribute to body of knowledge about quality of children immunization services in Nigeria, particularly in context of primary health centers. The study may help to improve delivery of immunization services in the region and to ensure that more children will be vaccinated and protected against vaccine-preventable diseases. The cross-sectional descriptive study of quality of immunization services in primary health centers was carried on in Akwa Ibom State, Nigeria. The variables as indicators such as physical environment, resource availability, client satisfaction etc. were utilized and included into questionnaire. The study covered 402 caregivers and 152 medical workers in 12 primary health centers. The client questionnaire, facility staff questionnaire, facility checklist, personal observation,focus group discussion guide and client flow chart were applied. The results demonstrated that quality of immunization services was poor. The caregivers were dissatisfied both with reception by providers and too long waiting time. The attitude of health care providers was also mentioned as cause of dissatisfaction. This study demonstrated that community health extension workers constituted majority (39.4%) of immunization service providers. Out of 152 health care providers that participated in the study, 92 (60.9%) had attended in-service training on immunization within previous two years. The comparison of staff categories with attendance at in-service training established statistically significant difference (p=0.0072), suggesting that whether one attended in-service training or not depended on category of staff one belongs to. Of all staff, 112 workers (73.3%) knew proper vaccine storage temperature while 40 (26.7%) did not. The health care providers who do not know proper vaccine storage temperature may administer vaccines with compromised potency. Most of health care providers (149 or 98.0%) were aware that clients have particular rights that in overall is referred as client rights. Only by knowing rights of clients providers would be expected to respect these rights. The client right with which most of providers were agreed was right to information (105 or 70.2%). While right with which most providers were disagree (52 or 34.0%)) was right to choice of where and when access immunization services. The study conducted thorough quality assessment of children imunization services in primary health centers in Oron, Akwa Ibom State, Nigeria. The results revealed both strengths and weaknesses in delivery of immunization services to children in the region. While there were areas of average performance due to experienced and trained health care workers, there were also areas of concern with inadequate cold chain storage and insufficient record-keeping practices. The study recommends to improve quality of immunization services in the region, including strengthening cold chain system, ensuring adequate record-keeping practices and implementing regular training and supervision of medical workers. These measures are crucial to ensure that more children are vaccinated and protected against vaccine-preventable diseases. The results of the study contribute to body of knowledge on quality of children immunization services in Nigeria and emphasize importance to continue efforts improving delivery of immunization services to children. There is hope that proposed recommendations will become a basis for policy decisions making and ultimately will result in better health outcomes for children in Oron, Akwa Ibom State and beyond.

COVID-19 Vaccination: Opportunity to Strengthen Immunization System in Belize

Objective: To describe the process of leveraging COVID-19 vaccination roll out to strengthen immunization system in Belize. Methodology: The Case study was conducted using desk review of relevant documents for the roll out of COVID 19 vaccination in response to the pandemic and analysis of the COVID-19 vaccination and routine immunization data extracted from the Belize Health Information System. The approach was a retrospective review of the strategies adopted by the government of Belize with support of UNICEF and other health partners using the roll out of COVID-19 vaccination to strengthen the country’s immunization system. Descriptive data is presented in graph and table and a test of association was done using a paired t-test to compare the mean change in annual routine immunization coverage before (2020) and after (2022) roll out of COVID-19 vaccination and p-value was set at a significant level of 5% Results: The National Vaccine Implementation Plan for the introduction of COVID-19 vaccination in 2021 was used as a transformative opportunity for building resilient immunization programs. Key areas focused on in the study were the enhancement of cold chain equipment and storage capacity, utilization of digital tools, improved data management, and innovative immunization service delivery. The result shows that the annual coverage of the first dose and third dose of pentavalent vaccine (Penta 3) increased from 79% and 78.5% in 2020 to 91% and 84.3% in 2022 respectively though not statistically significant (p value> 0.05). So far, 258,443 (65% of the total population) have received at least one dose of COVID-19 vaccine and 221,402 individuals (51.3% of the total population) have been fully vaccinated. Conclusion: The study contributes to the existing literature on the use of COVID-19 investments as an opportunity to strengthen the health system with a focus on immunization services which is essential in building a resilient health system.

Simultaneous administration of mRNA COVID-19 bivalent booster and influenza vaccines

The U.S. Food and Drug Administration authorized use of mRNA COVID-19 bivalent booster vaccines on August 31, 2022. Currently, CDC’s clinical guidance states that COVID-19 and other vaccines may be administered simultaneously. At time of authorization and recommendations, limited data existed describing simultaneous administration of COVID-19 bivalent booster and other vaccines. We describe simultaneous influenza and mRNA COVID-19 bivalent booster vaccine administration between August 31–December 31, 2022, among persons aged ≥6 months in the Vaccine Safety Datalink (VSD) by COVID-19 bivalent booster vaccine type, influenza vaccine type, age group, sex, and race and ethnicity. Of 2,301,876 persons who received a COVID-19 bivalent booster vaccine, 737,992 (32.1%) received simultaneous influenza vaccine, majority were female (53.1%), aged ≥18 years (91.4%), and non-Hispanic White (55.7%). These findings can inform future VSD studies on simultaneous influenza and COVID-19 bivalent booster vaccine safety and coverage, which may have implications for immunization service delivery.

Childhood vaccination uptake among children born in Aotearoa New Zealand based on parental nationality

ABSTRACT Migrants and refugees generally experience immunization inequities compared to their host populations. Childhood vaccination coverage rates are influenced by a complex set of interrelated factors, including child and parental nativity. Coverage rates for MMR, pertussis, and HPV vaccines were compared among children born in Aotearoa New Zealand (NZ) of overseas-born parents or NZ-born parents. A nationwide retrospective cohort study was conducted using linked, de-identified data. Logistic regression models examined the most influential factors contributing to differences in timely vaccine uptake. Of the total study population who had received all scheduled vaccines (N = 760,269), 32.9% were children of migrant parents. Children of migrant parents had higher rates of complete and timely uptake for MMR, pertussis, and HPV vaccinations compared to non-migrant children. NZ-born children of migrant parents were significantly more likely to receive MMR and pertussis-containing vaccines on-time compared to those of non-migrants. All included factors, except for the child’s gender and parents’ English ability, significantly influenced vaccine uptake. Among NZ-born children of migrant parents, additional logistic modeling found significant differences based on parental duration of residence, visa group, and region of nationality. Findings point to the importance of differentiating between parent versus child nativity when examining immunization coverage. While vaccination rates were higher for NZ-born children of migrant parents, compared to non-migrant parents, timely coverage rates across both groups were below national targets. Continued efforts are needed to improve timely immunization service delivery to address suboptimal and inequitable coverage.

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.

Determinants of defaulter to full vaccination among children aged 12–23 months in Siraro district, West Arsi zone, Oromia, Ethiopia: a case-control study

BackgroundVaccination is one of the most cost-effective global public health interventions to reduce childhood morbidity and mortality. Defaulters to full vaccination can put children at greater risk of acquiring vaccine-preventable disease outbreaks. The reason for not receiving full vaccination is not well explored, and hence, there is limited evidence about defaulters of vaccination in Ethiopia.ObjectivesTo identify determinants of defaulter to full vaccination among children aged 12–23 months in Siraro District, West Arsi Zone, Oromia Region, Ethiopia.MethodsA community-based unmatched case-control study was conducted among children aged 12–23 months from March 20 to April 30, 2022, with a total sample size of 444 (148 cases and 296 controls). Cases were children aged 12–23 months who had missed at least one routine vaccination dose, while controls were children who had received all of the recommended routine vaccinations. Consecutive sampling and simple random sampling techniques were used to select representative cases and controls respectively. Data were collected using a structured questionnaire, entered into Epi-data version 4.6, and exported to Statistical Package for Social Sciences version 26 for analysis. Logistic regression was used to identify determinants of the defaulter to full vaccination and the variables with p-value < 0.25 were recruited for multivariable analysis, and an adjusted odds ratio with a 95% confidence interval and a p-value of ≤ 0.05 was used to declare the statistical significance of the association.ResultOf the assessed determinants of the defaulter to full vaccination; inadequate knowledge of mothers/caretakers (AOR = 4.32, 95% CI:2.78–6.70), educational status of a father unable to read and write (AOR = 3.66, 95% CI:1.29–10.39), time to reach health facility ≥ 30 minutes (AOR = 2.45, 95% CI:1.51–3.97), not told about the type of vaccine received (AOR = 2.37, 95% CI;1.27–4.45), no parents discussion on vaccination (AOR = 2.16, 95% CI:1.24–3.79), home delivery (AOR = 2.43, 95% CI:1.39–4.25) and not participated in pregnant mother conference (AOR = 2.47, 95% CI = 1.35–4.49) were the identified determinants of the defaulter to full vaccination.ConclusionMother’s’ knowledge, father’s education, place of delivery, time to reach a health facility, health workers who told the type of vaccine received, participation in pregnant mother conference, and parents’ discussion on vaccination were the determinants of the defaulter to full vaccination status. Thus, the district health office should work on defaulters of vaccination by strengthening immunization service delivery and improving maternal knowledge on vaccination through pregnant mother conference participation.

Vaccine Preventable Disease Seroprevalence in a Nationwide Assessment of Timor-Leste (VASINA-TL): study protocol for a population-representative cross-sectional serosurvey

IntroductionHistoric disruption in health infrastructure combined with data from a recent vaccine coverage survey suggests there are likely significant immunity gaps to vaccine preventable diseases and high risk of outbreaks...

MMR vaccine coverage and associated factors among overseas-born refugee children resettled in Aotearoa New Zealand: a national retrospective cohort study

Refugee children may be under-immunised against common vaccine-preventable diseases due to a myriad of factors related to their migration journey. This retrospective cohort study explored the rates and determinants of enrolment on the National Immunisation Register (NIR) and measles, mumps and rubella (MMR) coverage among refugee children up to 18 years old who resettled in Aotearoa New Zealand (NZ) from 2006 to 2013. Univariate and multivariable logistic regression were conducted to determine associations. Of the cohort (N=2796), two thirds of the children (69%) were enrolled on the NIR. Among this sub-cohort (n=1926), less than one third (30%) were age-appropriately vaccinated with MMR. MMR coverage was highest among younger children and improved over time. Logistic modelling revealed that visa category, year of arrival, and age group were significant factors that influenced NIR enrolment and MMR vaccine uptake. Those arriving via asylum seeking, family reunification and humanitarian pathways were less likely to be enrolled and vaccinated compared to refugees who entered under the national quota programme. More recent arrivals and younger children were more likely to be enrolled and vaccinated compared to children who arrived in NZ longer ago and were older. Resettled refugee children have suboptimal NIR enrolment and MMR coverage rates which varied significantly by visa category, highlighting the need for immunisation services to better engage with all refugee families. These findings suggest that broad structural factors related to policy and immunisation service delivery may influence the differentials seen. Health Research Council of New Zealand (18/586).

COVID-19 Vaccine Service Delivery Challenges: A Rapid Assessment of Private Health Facilities Providing COVID-19 Vaccination in Maharashtra, India, 2021

International Journal of Medicine and Public Health,2022,12,4,169-174.DOI:10.5530/ijmedph.2022.4.31Published:January 2023Type:Original ArticleCOVID-19 Vaccine Service Delivery Challenges: A Rapid Assessment of Private Health Facilities Providing COVID-19 Vaccination in Maharashtra, India, 2021Aikant Bhatti, Purva Raj, Rishabh Chopra, Ravdeep Gandhi, Jessica Mooney, Farzana Muhib, and Manoj Mehta Aikant Bhatti1, Purva Raj2,*, Rishabh Chopra3, Ravdeep Gandhi4, Jessica Mooney5, Farzana Muhib6, Manoj Mehta7 1Senior Monitoring, Evaluation and Learning Officer, PATH, India Country Program, 15th floor, Gopal Das Bhawan, Barakhamba Road, New Delhi, INDIA. 2Monitoring, Evaluation and Learning associate, PATH, India Country Program, 15th floor, Gopal Das Bhawan, Barakhamba Road, New Delhi, INDIA. 3Lead, Strategy and Communications, South Asia Region, PATH, India Country Program, 15th floor, Gopal Das Bhawan, Barakhamba Road, New Delhi, INDIA. 4Deputy Director, Marketing and Operations, PATH, India Country Program, 15th floor, Gopal Das Bhawan, Barakhamba Road, New Delhi, INDIA. 5Program Officer, CVIA Policy, Access, and Introduction Functional Area, PATH, Seattle Headquaters, 2201 Westlake Ave Suite 200, Seattle, WA 98121, UNITED STATES OF AMERICA. 6Senior Program Officer, CVIA Policy, Access, and Introduction Functional Area, Washington DC Headquarters, UNITED STATES OF AMERICA 7Data Manager, PATH, India Country Program, 15th floor, Gopal Das Bhawan, Barakhamba Road, New Delhi, INDIA. Abstract:Background: The private health sector has a significant role in the delivery of health services in India. However, given fast changing COVID-19 pandemic, it is critical to understand the role of the private health sector in delivery of services going forward. The supply of COVID-19 vaccines is firmly regulated by the Government of India and the private sector received unrestricted access to vaccine supply directly from manufacturers from June 2021 onwards. Materials and Methods: PATH carried out a rapid assessment of private health facilities in the state of Maharashtra to understand the challenges faced by private facilities in providing COVID-19 vaccination. Results: During the assessment it was found that 100% of the private health facilities have a robust cold chain system which is essential for safe storage of COVID-19 vaccines and delivery of immunization services. The in-charges of the health facilities reported difficulty in estimating requirement of COVID-19 vaccines doses, as 67% of the beneficiaries in Mumbai and Nashik were direct walk-ins. During the assessment 93.3% of the facilities were observed to have adequate availability of COVID-19 vaccines doses, based on the beneficiary registration data for the day. Ministry of Health, Government of India, recommends a trained 5-member vaccination team for providing services at each vaccination site. Conclusion: The key challenges faced by private health facilities during delivery of COVID-19 immunization were associated with differential vaccine pricing, time taken to receive supply of vaccines, difficulties in accurately estimating vaccine demand, multiple record keeping at the facility level and declining vaccine demand. Keywords:COVID–19 pandemic, Private health sector., Service delivery, VaccinationView:PDF (142.3 KB)

Thinking Out-of-Box in Addressing Communication and Service Delivery Challenges: Use of a Traditional Communication Method for Improving Immunization Coverage in Remote Rural Hard-to-Reach Areas of India

Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers; more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.

Perspectives of Immunization Data users on Quality and use of Immunization Data in the Federal Capital Territory, Nigeria: A Qualitative Study

ABSTRACT Background: Despite the benefits of immunization in saving the life of children, about one in every five children in the African region did not receive an initial dose of Diphtheria, Pertussis, and Tetanus. This has been attributed to the inefficient use of data in planning immunization service delivery in many African countries, including Nigeria. Aim: To explore barriers to efficient use of good quality data in planning immunization service delivery in Nigeria. Methods: A total of 31 in-depth interviews were conducted among key stakeholders in immunization data in the immunization program of the Federal Capital Territory (FCT), Nigeria. Questions were asked on their perceived use of immunization data; archiving of immunization data; major challenges in keeping and using immunization data among others. Thematic content analysis was performed on the data using the Atlas.ti software. Results: There was a consensus on the importance of data for efficient delivery of immunization services. However, oftentimes the immunization data were not used because of the poor quality and late submission attributed to the poor tools, poor facilities, and data capture materials. Some of the staff were not well trained and when trained, the staff rotation did not allow them to stay on the job for a long time. There was also the predominance of private for-profit health facilities that rarely submit reports and data. Conclusion: Several capacity-related factors affect the efficient use of immunization data in the FCT immunization program. Some of these include the unavailability of the right tools and facilities for data generation, storage, and use. Inadequate training of the staff was also mentioned.

Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study.

Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child's 18-month immunization appointment. The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. Following the intervention, the health center in Edmonton had a reduction of 6.4% (95% CI 3%-9.8%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8%, 95% CI -1.4% to 3%). The acceptability surveys were completed by 222 parents (response rate: 23.9%) and 22 staff members. Almost all (>95%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57%), Punjabi (52/207, 25.1%), Arabic (13/207, 6.3%), Spanish (12/207, 5.8%), Italian (4/207, 1.9%), Chinese (4/207, 1.9%), French (2/207, 0.9%), Tagalog (1/207, 0.5%), and Vietnamese (1/207, 0.5%). The study's findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings.

Lessons Learned From Integrating Infant and Young Child Feeding Counseling and Iron-Folic Acid Distribution Into Routine Immunization Services in Ethiopia.

Immunization programs reach more children and communities than any other health intervention, thus making immunization a promising platform for integrating other essential health services. There is a dearth of literature on integrating nutrition interventions, such as infant and young child feeding (IYCF) counseling and iron-folic acid (IFA) supplementation, into routine immunization services.To address this evidence gap, a 15-month pilot study (August 2019 to November 2020) tested the feasibility of integrating IYCF counseling and IFA supplement distribution into immunization service delivery in Ethiopia. The interventions focused on joint microplanning for integrated services (including estimating target populations for all services), revising client flows for service delivery, and providing on-the-job support to HWs for implementing and monitoring integrated service delivery.Findings suggest that planning for and delivering IYCF counseling and IFA supplementation with immunization services is feasible. Integrating these services provided opportunities for collaborative planning and enabled health workers (HWs) to offer multiple services to clients through 1 interaction. However, HWs felt that additional human resources were needed to manage integrated services, especially during integrated outreach and mobile service delivery. HWs also reported that communities appreciated accessing 2 services in 1 visit but expressed reservations about the longer wait times.Countries may consider expanding fixed and outreach immunization services to provide integrated service delivery provided that it is feasible, sustainable, of high quality, and incorporates the careful planning, follow-up, and increased human and financial resources needed to reinforce new practices and expand access to a broader array of health services.

Catch-up immunisation for migrant children in Melbourne: A qualitative study with providers to determine key challenges

BackgroundCurrent models of immunisation service delivery in Australia are not meeting the needs of migrant children, who experience a higher burden of vaccine preventable disease and lower immunisation rates compared to non-migrant children. Understanding the experiences of immunisation providers is critical for designing effective and tailored interventions to improve this service. This study aimed to identify the facilitators and barriers to providers delivering a comprehensive catch-up immunisation service to migrant children in Melbourne, Australia. MethodsSemi-structured interviews with council and general practice immunisation providers were conducted. Recorded interviews were transcribed and coded inductively using thematic analysis. Identified themes were then deductively categorised according to the Capability, Opportunity and Motivation of Behaviour (COM-B) model. ResultsTwenty-four providers (five practice nurses, six general practitioners, six council nurses and seven council administration officers) were interviewed between March and June 2021. Fourteen themes were identified that contributed to the delivery of an effective catch-up immunisation service. Capability themes included training, experience and skills to perform the service and communicate with families. Opportunity themes incorporated time, workplace norms, traits of migrant families, costs, systems and resources. Themes related to motivation were provider responsibility, beliefs about migrant health, and immunisation prioritisation. ConclusionsKey barriers for providers to deliver a comprehensive catch-up immunisation service were related to opportunity. Developing an online tool to support catch-up schedule development and reporting, and funding provider time to calculate the schedule are primary actions that could overcome opportunity barriers. Capability and motivation barriers for general practitioners included limited time, skills, and motivation compared to nurses. These barriers may be overcome with improvements to training that focus on upskilling nurses to deliver the catch-up service. Service delivery challenges are multifactorial, requiring a range of strategies to optimise this service and increase immunisation coverage in migrant children.