Improve Immunization Coverage Research Articles

An Analysis of Consumer Awareness Regarding Jan Aushadhi Kendras

India has made significant advancements in various health aspects, including an increase in the life expectancy of both men and women, low infant and maternal mortality rates, improved immunization coverage, and the elimination of diseases like polio and smallpox. According to the World Health Organization, around 5.8 million Indians succumb to diseases like diabetes, cancer, stroke, and heart and lung diseases. Non-communicable diseases (NCDs) pose a substantial health challenge in India, with one out of every four Indians dying before the age of 70 due to an NCD. The Indian healthcare system is grappling with rising healthcare costs, which disproportionately burden the poor, as well as the emergence of new diseases and non-communicable diseases. Approximately 100 million Indians fall into poverty each year due to high healthcare expenses, with out-of-pocket spending constituting over 50 percent of this burden. To reduce healthcare costs, the government has established Jan Aushadhi Kendras, which offer generic medicines with the same composition as branded ones at affordable prices. A recent study focused on identifying the key factors influencing the purchase of generic drugs from Jan Aushadhi medical stores, public awareness of these stores, and consumer satisfaction. The study found that 40 percent of the public is unaware of Jan Aushadhi, and consumers opt for generic medicines due to their affordability, even though the quality is lower than that of branded drugs. Jan Aushadhi Kendra is known for selling significant quantities of sanitary pads. While most consumers are satisfied with Jan Aushadhi products, some express dissatisfaction due to differences in quality and composition. Government agencies and health departments must enhance the quality of generic medicines and educate healthcare professionals and the general public about them.

Management of the vaccination campaign in a population of frail older outpatients affected by cognitive or endocrinological conditions: a pilot study in Italy

Vaccination, particularly against pneumococcus and influenza, is a low-cost primary prevention, useful to avoid hard complications, particularly among frail older people. In this pilot study, we aimed to assess the effect of a strategy for influenza and pneumococcal vaccination for outpatients mainly affected by cognitive or endocrinological conditions, evaluating what could stimulate or demotivate vaccination among older people. This study was conducted during the 2023–2024 influenza season at the outpatient clinics in Palermo, Italy. A total 76 patients were included. More than half of the patients could be considered as pre-frail and about 20% frail, according to a comprehensive geriatric evaluation. Among patients, 46.05% received only vaccination against pneumococcus, 28.95% both vaccinations, and 25.0% only against influenza. Compared with the previous seasons, a 19.5% increase of influenza and 90.2% of pneumococcal vaccine uptake was observed. Side effects of vaccination were the main reason of the previous rejection, namely 76.9% for influenza and 53.8% for anti-pneumococcal vaccination. In conclusion, our study indicates how a new vaccination strategy in different settings could be feasible. Proposing influenza and pneumococcal vaccination for frail older outpatients could be an effective instrument to improve immunization coverage that is still low among older people.

Monitoring the VDPV2 outbreak in Egypt during 2020–2021 highlights the crucial role of environmental surveillance and boosting immunization in combating Poliovirus

BackgroundPoliovirus is a highly infectious enterovirus (EV) that primarily affects children and can lead to lifelong paralysis or even death. Vaccine-derived polioviruses (VDPVs) are a great threat since they are derived from the attenuated virus in the Oral Poliovirus Vaccine (OPV) and can mutate to a more virulent form. The purpose of this study was to identify VDPV serotype 2 through the year 2020–2021 via surveillance of sewage samples collected from different localities and governorates in Egypt and stool specimens from Acute Flaccid Paralysis (AFP) cases. Both were collected through the national poliovirus surveillance system and according to the guidelines recommended by the WHO.MethodsA total of 1266 sewage samples and 3241 stool samples from January 2020 to December 2021 were investigated in the lab according to World Health Organization (WHO) protocol for the presence of Polioviruses by cell culture, molecular identification of positive isolates on L20B cell line was carried out using real-time polymerase chain reactions (RT-PCR). Any positive isolates for Poliovirus type 2 and isolates suspected of Vaccine Derived Poliovirus Type 1 and type 3 screened by (VDPV1) or Vaccine Poliovirus Type 3 (VDPV3) assay in RT-PCR were referred for VP1 genetic sequencing.ResultsThe outbreak was caused by circulating VDPV2 (cVDPV2) strains started in January 2021. By the end of February 2021, a total of 11 cVDPV2s were detected in sewage samples from six governorates confirming the outbreak situation. One additional cVDPV2 was detected later in the sewage sample from Qena (June 2021). The first and only re-emergence of VDPV2 in stool samples during the outbreak was in contact with Luxor in June 2021. By November 2021, a total of 80 VDPVs were detected. The Egyptian Ministry of Health and Population (MOHP), in collaboration with the WHO, responded quickly by launching two massive vaccination campaigns targeting children under the age of five. Additionally, surveillance systems were strengthened to detect new cases and prevent further spread of the virus.ConclusionThe continued threat of poliovirus and VDPVs requires ongoing efforts to prevent their emergence and spread. Strategies such as improving immunization coverage, using genetically stable vaccines, and establishing surveillance systems are critical to achieving global eradication of poliovirus and efficient monitoring of VDPVs outbreaks.

Developing a roadmap to reach and sustain 90% full immunization coverage through a cross-sectoral system strengthening strategy in Bihar, India

IntroductionReducing childhood mortality by curtailing the incidence of vaccine preventable diseases is contingent upon a robust and high-performing routine immunization system. According to the available data, the full immunization coverage (FIC) in the state of Bihar (India) has reached ~ 71%. While the government aspires to reach 90% FIC, a systematic evidence-based investigation of the reasons behind underimmunization as well as the identification of drivers and enablers to reach and sustain 90% FIC is critical. This study aimed to review the factors leading to underimmunized children in the state of Bihar and develop a forward-looking roadmap to reach and sustain 90% FIC by adopting a system strengthening approach.MethodWe conducted a desk review, followed by extensive stakeholder interviews and field visits to document and analyze the data and evidence relevant to routine immunization system performance in the state of Bihar. The stakeholders included the State Immunization Officer, District Immunization Officers, Block-level health officials, representatives from development agencies, healthcare workers, and caregivers. A total of eighty-six structured interviews were conducted, which included qualitative and quantitative parameters.ResultWhile positive results were observed from the assessment of Bihar’s immunization system, the implementation of targeted strategies for supply, service delivery and demand can provide a means to achieve FIC of 90%. The roadmap developed by the Government of Bihar enlists 40 + interventions across key thematic areas and has been prioritized over a 5-year time horizon as short, medium, and long-term milestones to achieve 90% FIC. These interventions include strengthening the data availability and quality, improving the governance and review mechanism, augmenting the capacity of health workers involve with immunization programme, and initiatives to increase demand for immunization services.ConclusionThe Bihar’s Immunization Roadmap development project work follows a methodical approach to assess and identify intervention to improve immunization coverage and can provide information and reference to other states and countries that are aiming to formulate similar action plans.

Integrating Digital Health Solutions with Immunization Strategies: Improving Immunization Coverage and Monitoring in the Post-COVID-19 Era.

The COVID-19 pandemic underscored the critical importance of vaccination to global health security and highlighted the potential of digital health solutions to improve immunization strategies. This article explores integrating digital health technologies with immunization programs to improve coverage, monitoring, and public health outcomes. It examines the current landscape of digital tools used in immunization initiatives, such as mobile health apps, electronic health records, and data analytics platforms. Case studies from different regions demonstrate the effectiveness of these technologies in addressing challenges such as vaccine hesitancy, logistics, and real-time monitoring of vaccine distribution and adverse events. The paper also examines ethical considerations, data privacy issues, and the need for a robust digital infrastructure to support these innovations. By analyzing the successes and limitations of digital health interventions in immunization campaigns during and after the COVID-19 pandemic, we provide recommendations for future integration strategies to ensure resilient and responsive immunization systems. This research aims to guide policymakers, health professionals, and technologists in leveraging digital health to strengthen immunization efforts and prepare for future public health emergencies.

Measuring what matters: Context-specific indicators for assessing immunisation performance in Pacific Island Countries and Areas.

Increasing countries' access to data can improve immunisation coverage through evidence-based decision-making. However, data collection and reporting is resource-intensive, so needs to be pragmatic, especially in low-and-middle-income countries. We aimed to identify which indicators are most important for measuring, and improving, national immunisation performance in Pacific Island Countries (PICs). We conducted an expert elicitation study, asking 13 experts involved in delivering immunisation programs, decision-makers, health information specialists, and global development partners across PICs to rate 41 indicators based on their knowledge of the feasibility and relevance of each indicator. We also asked experts their preferences for indicators to be retained or removed from a list of indicators for PICs. Experts participated in two rating rounds, with a discussion on the reasons for ratings before the second round. We calculated mean scores for feasibility and relevance, and ranked indicators based on experts' preferences and mean scores. We used framework analysis to identify reasons for selecting indicators. Experts agreed that certain indicators were essential to measure (e.g. data use in program planning and measles vaccination coverage), but preferences varied for most indicators. Preferences to include indicators in a set of indicators for PICs moderately correlated with scores for relevance (r = 0.68) and feasibility (r = 0.56). In discussions, experts highlighted usefulness for decision-making and ease of data collection, reporting and interpretation as the main reasons driving indicator selection. Country-specific factors such as health system factors, roles and influence of various immunisation actors, and macro-level factors (namely population size, distribution and mobility) affected relevance and feasibility, leading us to conclude that a single set of indicators for all PICs is inappropriate. Rather than having a strict set of indicators that all countries must measure and report against, performance indicators should be flexible, country-specific, and selected in consultation with immunisation actors who collect and use the data.

Comprehensive Outreach: Reach Every Child Initiative Expanded Program on Immunization Khyber Pakhtunkhwa, Pakistan

Background: Vaccination is one of the most effective public health interventions for preventing infectious diseases. In regions like Khyber Pakhtunkhwa, Pakistan, where access to healthcare is limited, immunization coverage often remains below optimal levels. Targeted outreach activities can play a pivotal role in improving vaccine uptake, particularly in underserved populations. Objective: This study aimed to assess the effectiveness of immunization outreach activities in increasing vaccine coverage in Khyber Pakhtunkhwa over a defined period. Methods: A comprehensive methodological approach was utilized involving predefined Excel sheets for daily data collection by trained personnel. Data validation procedures were implemented to ensure accuracy, with regular feedback sessions to improve data collection processes. Monthly reports were compiled and analyzed using SPSS version 25 to summarize immunization activities and coverage rates. The outreach strategy included community announcements and door-to-door campaigns by Local Health Workers (LHWs), designed to identify and vaccinate zero-dose and defaulting children. Results: The outreach campaign significantly improved immunization coverage, with zero-dose vaccinations achieving 100% coverage. Penta I, II, and III vaccines saw coverage rates of 78.99%, 72.48%, and 78.02%, respectively. Measles vaccines MCV-I and MCV-II achieved coverage rates of 83.01% and 86.11%. The overall strategy effectively reduced gaps in vaccine coverage across various districts. Conclusion: The study confirms that structured and well-coordinated outreach activities can effectively increase immunization coverage in areas with limited healthcare access. Continuous effort and strategic planning are essential to sustain and build upon these gains to ensure comprehensive vaccine coverage.

IJCM_226A: Bridging the Gap: Model Immunization Centers in Urban Bihar - A Study on Factors Shaping Community Acceptance and Utilization for Improved Immunization Coverage

Background: Despite significant strides in immunization coverage, Full Immunization coverage in urban areas of India lags behind rural regions, with Urban India recording 75.5% compared to 76.8% in rural areas. Additionally, the prevalence of zero-dose children is higher in Urban India (7.5%) compared to rural counterparts (6.3%). Urbanization introduces a complex dynamic marked by poverty, migration, and growing disparities in health access, social services, and economic resources that necessitate innovative strategies to address immunization inequities in urban settings. In this direction, the Government of Bihar in 2017 introduced the concept of Model Immunization Centers (MICs) to provide high-quality immunization services to urban poor and marginalized to improve coverage and build trust, confidence and motivation for public immunization services. Objectives: The primary objective of the study was to assess and identify the factors that shape the community’s acceptance and utilization of immunization services at MICs in Patna and Siwan. Methodology: A mixed-methods approach was employed, combining quantitative data analysis of immunization records and demographic information with qualitative assessments of community perceptions through in-depth interviews and focus group discussions. The study site i.e., Patna and Siwan Districts of Bihar was purposively selected. Results: The study found that the effectiveness of MICs was significantly influenced by family, community, and social norms. Additionally, MICs played a pivotal role in enhancing people’s trust, confidence, and motivation through the provision of a favourable environment, hygiene maintenance, the availability of free vaccines, reduced waiting times, and courteous staff behaviour. These factors have collectively led to improved immunization coverage, increased footfall, and improved rates of full immunization. Conclusion: The success of MIC in gaining people’s trust and confidence has been a driving force behind the increase in footfall coverage at session sites and high Full Immunization Coverage in Patna and Siwan

Maintaining the Region of the Americas free of polio: best practices for incident management support teams.

The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to eradicate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Incident Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investigation; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022-2023) through a comprehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

Evaluation of Knowledge, Attitudes, and Practices towards Vaccination among Patients with Spina Bifida in Ukraine

Patients with spina bifida (SB) face an increased risk of infection due to frequent exposure to medical procedures and visits to healthcare centers, including rehabilitation centers. Infection can lead to complications in kidneys and urinary bladder, disrupt rehabilitation efforts, and reduce the quality of life. Purpose - to assess the knowledge, attitudes, and practices related to vaccination among patients with SB and identify the reasons for the low vaccination rates in this group of children. Materials and methods. An anonymous online survey was conducted among 56 parents of patients with SB. The questionnaire evaluates the knowledge (10 questions), attitudes and practices (4 questions) towards vaccination among parents of patients with SB in Ukraine. The results were analyzed using standard procedures with Statistica StatSoft 6.0 software package. Continuous variables were expressed as a mean and standard deviation (SD). The comparison of frequency parameters was performed using the Chi-square test. The differences between the parameters were statistically significant at p<0.05. Results. Overall, parents demonstrated good knowledge about the role of vaccines in preventing serious diseases (61.7% gave correct answers), and the percentage of correct answers did not significantly differ between vaccinated, partially vaccinated, or unvaccinated groups of children. However, only 12.5% of SB patients were fully vaccinated and 51.8% were completely unvaccinated. Among the unvaccinated, the majority (55.2%) indicated non-recommendation by specialist doctors (neurosurgeon, neurologist, etc.) as the main reason. Primary care physicians were less likely to not recommend vaccination. Delayed vaccination was primarily due to fear of adverse reactions (40%). Despite low vaccination rates, parents generally had a positive attitude towards vaccination (only 5.4% against). Doctors remained the most influential source of information (63.4%). Conclusions. A study suggests a need to enhance knowledge among healthcare professionals, increase public awareness, and provide education within patient groups to improve immunization coverage and protect SB children from preventable infectious diseases. No conflict of interests was declared by the authors.

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

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

Factors Influencing Utilisation of Immunisation Services among Children Under Five Years in Lira Municipality Lira District Northern Uganda

This study investigated the factors influencing the utilization of immunization services among children under 5 years in Lira Municipality, Lira district, Northern Uganda. Utilizing a community-based cross-sectional design with quantitative data collection methods, 380 mother-infant pairs were randomly selected from residents of Lira Municipality. Univariate, bivariate, and multivariate logistic regression analyses were conducted using STATA software version 14.0 to identify significant factors affecting immunization service utilization. The study found that 77.63% (295/380) of children under 5 years utilized immunization services, with the highest utilization observed among male children (82.71%). Factors significantly influencing utilization included mothers' education level (aOR 7.46, 95%CI 2.17 – 25.65, P=0.001), religion (Muslims vs. Christians: aOR 0.15, 95%CI 0.07 – 0.32, P<0.001), rudeness of health workers (aOR 3.50, 95%CI 1.73 – 7.06, P<0.001), awareness of subsequent immunization schedules (aOR 0.38, 95%CI 0.20 – 0.70, P=0.002), possession of a child immunization card (aOR 0.34, 95%CI 0.19 – 0.63, P=0.001), and understaffing at health facilities (aOR 2.87, 95%CI 1.43 – 5.78, P=0.003). The study highlights the importance of addressing these factors to improve immunization coverage, which currently falls below the global target recommended by WHO and UNICEF. Keywords: Immunization services, Children, Under-Vaccinated, Unvaccinated, Mothers, No versus Yes.

Assessment of Parents' Knowledge, Attitudes, and Satisfaction of Childhood Immunization: A Cross-Sectional Survey from a Rural District of Sindh, Pakistan

Background: Immunization is a cornerstone of public health, preventing millions of deaths annually, especially among children. Despite global efforts to increase vaccination coverage, significant gaps remain, influenced by parental knowledge, attitudes, and satisfaction with immunization services. These gaps are particularly pronounced in rural and socio-economically disadvantaged regions. Objective: This study aimed to assess parents' knowledge, attitudes, and satisfaction regarding childhood immunization and to identify barriers to vaccination in a rural district of Sindh, Pakistan. Methods: A cross-sectional survey was conducted in two cities, Mirpurkhas and Digri, within the Mirpur Khas district. Using the Raosoft® Sample Size Calculator, a sample size of 382 participants was determined with a 95% confidence level and a 5% margin of error. Participants were selected through convenience sampling. Data collection involved a semi-structured questionnaire developed from extensive literature review and validated through expert focus group discussions. The questionnaire covered demographics, perceptions of immunization, knowledge of the Expanded Programme on Immunization (EPI) schedule, and satisfaction with immunization services. Data analysis employed SPSS version 25, utilizing descriptive statistics and Mann-Whitney tests to analyze differences between variables. Results: Among 382 respondents, 55.76% were male, and 44.24% were female. A significant proportion (43.45%) were aged between 21–30 years. The majority acknowledged the importance of immunization (96.85% agreement), yet knowledge gaps were evident, with only 10.98% correctly identifying vaccines given at birth. Satisfaction with immunization services was high (73.56% satisfied with hospital services), despite 88.46% reporting incorrect knowledge about the vaccine given at birth. Barriers identified included affordability, vaccine unavailability, and long waiting times. Conclusion: While parental attitudes towards immunization were largely positive, significant knowledge gaps and barriers to immunization persist. Efforts to improve immunization coverage in rural Pakistan must address these knowledge deficits and structural barriers, emphasizing the development of targeted awareness campaigns and enhancing the accessibility and quality of immunization services.

A Holistic Strategy of Mother and Child Health Care to Improve the Coverage of Routine and Polio Immunization in Pakistan: Results from a Demonstration Project.

The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan's high-risk union councils of polio-endemic districts. We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (β = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (β = -0.38; p = 0.002), knowledge about polio vaccine (β = -0.25; p = 0.011), and knowledge about IPV (β = -0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (β = -0.4; p ≤ 0.0001) and lack of education (β = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (β = 0.26; p = 0.008) and attendance at health camp (β = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (β = -0.13; p = 0.008). This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

Vaccination Covid-19

Introduction: After the first vaccination campaign, a low vaccination coverage was observed in Brussels. This is linked to an accumulation of factors such as limited accessibility, confidence in the effectiveness and safety of the vaccine or in the public institutions combined with complicated transport solutions and a lack of vaccinators. These are significant barriers to improving immunization coverage, particularly in vulnerable neighborhoods.
 In order to increase coverage and also in the perspective of vaccinating everyone (vacci4all project), Common Community Commission (COCOM) has decentralized vaccination through temporary initiatives: local antennas, mobile teams, door-to-door visits, GP’s, awareness-raising by pharmacists, call-centers,...
 The results have reinforced the idea of decentralization to reach the most vulnerable. The idea of vaccination in pharmacies was explored, bringing new perspectives regarding long-term management.
 Method: 
 1. Pharma-on-tour
 Through an application system and the establishment of quality criteria, 5 pharmacies with
 experience in vaccination centers are integrated into the pilot project: doctors come to the
 pharmacy to vaccinate patients previously sensitized by the pharmacist. The pharmacists prepare the vaccines; the doctors administer them. The project is financed by the Brussels-Capital Region (BCR).
 2. Vaccipharma
 A few days after the publication of the March 11, 2022 law allowing pharmacists to vaccinate, the
 Vaccipharma project is launched: vaccination by pharmacists starts in 5 pharmacies that meet the quality requirements.
 3. Timesheet
 Without a remuneration framework, the acts of preparation and vaccination are still
 covered by the region on the basis of an hourly rate determined by Timesheets which are
 filled in by the pharmacists who keep track of the acts related to the vaccination which helped determine a remuneration in accordance with reality/practice.
 4. Implementation of the NIHDI remuneration framework and extension to the entire BRSince September 1, 2022, pharmacists can be remunerated for the acts of preparation of vaccine doses and vaccinations by the NIHDI. Any person, insured or not, can be vaccinated in a pharmacy.
 In addition to the vaccination in the pharmacy, the COCOM takes care of the delivery to the first line as well as the preparation and delivery to the nursing homes and communities.
 5. Extension of the project from 28 to 135pharmacies
 All Brussels municipalities have vaccinating pharmacies. Each pharmacy was inspected and given training to ensure the respect of the government's quality requirements.
 Results/Lessons learned: The need to focus on decentralized vaccination initiatives that combine proximity, quality and trust was reaffirmed. This is demonstrated by the fact that the preferred location for patients seeking a primary vaccination is the pharmacy. 
 This promising and sustainable project enables a local supplying and is a catalyst for first line vaccination in an infrastructure that provides a quality of reception and service in a place familiar to the public, with a very interesting cost-benefit-quality ratio. The individual approach and direct communication can increase vaccination coverage, particularly in vulnerable neighborhoods. A survey of patients reveals a high level of satisfaction both in terms of reception, booking, information received, privacy, proximity, ease, speed, accessibility and in the trust-based relationship.

Balancing Routine and Pandemic: The Synergy of India's Universal Immunization Program and COVID-19 Vaccination Program.

The COVID-19 pandemic posed substantial challenges to healthcare systems globally and severely disrupted essential health services, including routine immunization programs. In India, these disruptions were exacerbated due to the sudden emergence of the pandemic and lockdown measures, leading to mass migrations and a shortage of healthcare workers. Caregivers' concerns about routine immunization sessions further compounded the problem, resulting in a sharp increase in zero-dose children. This review paper examines India's strategies for conducting one of the world's largest COVID-19 vaccination programs while effectively restoring and perpetuating its Universal Immunization Program (UIP). The UIP played a pivotal role in sustaining immunization services during the pandemic, ultimately improving immunization coverage compared to pre-pandemic levels. India's accomplishments in this regard are highlighted through key performance indicators, the reach of immunization services, a reduction in zero-dose children, and antigen-wise coverage. The paper also discusses the successful integration of COVID-19 vaccination within the UIP framework, underscoring the significance of existing infrastructure, technology, and capacity building. India's dedication to concurrently managing routine immunization and COVID-19 vaccination showcases the adaptability and resilience of its healthcare system. India's journey serves as a global example of efficient mass immunization during challenging times, emphasizing the importance of political will, healthcare infrastructure investment, skilled healthcare workforces, and comprehensive vaccination programs. In a world grappling with the dual challenge of COVID-19 and routine immunization, India's experience provides a roadmap for strengthening healthcare systems and promoting public health as the critical agenda in challenging times.

ANALYSIS OF FACTORS RELATED TO THE COMPLETENESS OF TETANUS TOXOID IMMUNIZATION IN TRIMESTER III PREGNANT WOMEN

Tetanus toxoid immunization in third trimester pregnant women is very important to prevent the risk of tetanus infection in newborns. Most cases of neonatal death in developing countries are due to tetanus, and neonatal tetanus is the second leading cause of death worldwide in diseases that can be prevented through vaccination. The purpose of this study was to determine the factors associated with the completeness of Tetanus Toxoid immunization in third trimester pregnant women. This study employed an analytical cross-sectional observational design on pregnant women in the third trimester (n=47) at Puskesmas Karangan in 2023. A total sampling method was used, resulting in a sample of 47 infants. Data collection instruments included questionnaires (primary data) and the PWS KIA book (secondary data). The variables examined were immunization completeness (dependent variable) and knowledge, attitude, and spousal support (independent variables). Data were analyzed using the Chi Square test. The results of univariate analysis showed that the majority of respondents with incomplete TT immunization were 24 (51.1%). The results of the bivariate analysis found a relationship between knowledge and P Value (0.004), mother's attitude P Value (0.025) and husband's support P Value (0.029) with the completeness of Tetanus Toxoid immunization in third trimester pregnant women with a value of α = 0.05. The study highlights the strong influence of maternal knowledge on the completeness of Tetanus Toxoid immunization in pregnant women in the third trimester (P-value=0.004), which is more significant compared to maternal attitude and spousal support. Enhancing maternal knowledge regarding TT immunization is crucial in improving immunization coverage and reducing the risk of tetanus infection in newborns.

Level and Trend of Child Health and Nutrition Status in Nepal: Evidence from Demographic and Health Survey (1996-2016).

Child health and nutrition are key indicators of the country's socioeconomic development and quality of life. The purpose of the paper was to examine the level, trend, and socio-demographic differences of selected child health and nutrition indicators and to provide policy recommendations for improvement. Desk review was conducted to compile secondary information on child health and nutrition status published in the Nepal Demographic and Health Survey reports prepared by Ministry of Health and Population from 1996 to 2016. Trend lines, bar diagram, and GIS maps were prepared to study and present the findings. A substantial decrease in under-five mortality, from 118 to 39 (67% point decline) and neonatal mortality, from 50 to 21 (58% point decline) deaths per 1000 live births, was noted between 1996 and 2016. Full immunization coverage decreased from 87% in 2011 to 78% in 2016. 36% of children under the age of five were stunted, 25% were underweight, and 10% were wasted in 2016. Boys were more likely to receive treatment for diarrhoea (72%), compared to girls (56%). The majority of the children (74%) had their acute respiratory infections managed at private medical centers. Child health and nutritional status differed by geographic regions, being better in Gandaki and Bagmati and poor in Karnali and Madesh. Overall health and nutrition status of children were better among educated, and wealthier families. To further reduce childhood mortality and reach the targets for the Sustainable Development Goal, targeted interventions must be implemented to improve immunization coverage plus health and nutritional status among disadvantaged populations.

Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: a multilevel mixed-effects analysis

IntroductionThis study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh.MethodsBangladesh’s Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data for this study on vaccination coverage among children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed.ResultsThe overall prevalence (weighted) of full vaccination among children aged 12–35 months were 86.17% in 2011, 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of vaccination coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%).ConclusionTo improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.

Mothers’ knowledge, attitude, and behavior regarding child immunization, and the association with child immunization status in Medan City during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has caused disruption to healthcare access worldwide and has impacted basic childhood immunization services. A decline in immunization coverage can cause immunity gaps and lead to outbreaks of vaccine-preventable diseases. Our study evaluated the association between mothers’ knowledge, attitude, and behavior regarding immunization and child immunization status during the COVID-19 pandemic in Medan, Indonesia. MethodsAn analytical cross-sectional study was conducted from April to November 2021. Mothers with children aged 0–12 months were interviewed about their knowledge, attitude, and behavior regarding immunization, and their child's immunization status. ResultsOf 196 participants, 46.5% had low knowledge on immunization, 41.3% had a negative attitude, and 20.4% had negative behavior. Only 62.8% of participants had children with a complete vaccination status, and mothers with moderate knowledge (OR 2.65, 95% CI 1.08–6.61), negative attitude (OR 5.33, 95% CI 2.71–10.59), and negative behavior (OR 7.88, 95% CI 3.36–19.47) were more likely to not vaccinate their children. ConclusionMothers’ attitude, behavior, and educational background were associated with child immunization status. Recovery efforts to improve immunization coverage are urgently needed, and should include efforts to reduce mothers’ hesitancy regarding child vaccination during the pandemic.