Missed Opportunities For Vaccination Research Articles

Factors Influencing Missed Opportunities in Infant Vaccination Among Children Aged 0-23 Months Within the Hohoe Municipality in The Volta Region, Ghana: A Facility-Based Study

Background Immunization is a vital public health strategy to enhance child survival by addressing significant diseases that cause child mortality. Annually, over 31 million children under five in sub-Saharan Africa are affected by vaccine-preventable conditions, with more than half a million dying due to lack of access to necessary vaccines. This study explored the factors contributing to Missed Opportunities for Vaccination (MOV) among caregivers of children aged 0-23 months in the Hohoe municipality. Methods The study employed a cross-sectional design. Structured questionnaires were administered to caregivers of children aged 0-23 months in selected health facilities in the Hohoe municipality. Three hundred seventy-eight caregivers aged 18 years and above participated in the study. Results The prevalence of MOV was found to be 22.2%. Factors predicting MOV included respondent’s age, marital status, parity status, knowledge and attitude. Younger mothers were more likely to have missed opportunities in infant vaccination [aOR=0.20(0.09,0.43) p<0.001]. Being unmarried and having a large family size also contributed to missed opportunities in infant vaccination [aOR=2.0(1.12,3.44) p= 0.019] and [aOR=5.80(2.67,12.6) p=<0.001] respectively. Conclusion MOV is prevalent in many settings and hinders immunization coverage. Age, number of children and family size were found predictors inhibiting infant vaccination. Furthermore, caregivers’ knowledge and attitudes were associated with missed opportunities for vaccination, indicating a need for strategies to enhance their understanding and combat missed opportunities in the Hohoe municipality

Trends of non-vaccination, under-vaccination and missed opportunities for vaccination (2003-2014) amongst children 0-23 months in Kenya.

Vaccines are effective and cost-effective. Non-vaccination, under-vaccination, and missed opportunities for vaccination (MOV), have contributed to incomplete vaccination coverage in Kenya. Analyzing their trends is essential for targeting interventions and improvement strategies. This study aimed to assess trends of non-vaccination, under-vaccination, and MOV among children aged 0-23 months in Kenya using data obtained from the Kenya Demographic and Health Surveys (KDHS) conducted in 2003, 2008/09, and 2014. A two-stage, multi-stage, and stratified sampling technique was used. Weighted analysis was conducted to ensure generalizability to the full population. Using the KDHS sample size estimation process, the sample size was estimated for each indicator, with varying standard error estimates, level of coverage and estimated response rates. Final sample size was 2380 (2003), 2237 (2008/09) and 7380 (2014). To determine the level of non-vaccination, under-vaccination and MOV among children aged 0-23 months, a weighted descriptive analysis was used to estimate their prevalence, with 95% confidence intervals (CI) for each year. MOV was defined using an algorithm as a binary variable. Data coding and recoding were done using Stata (version 14; College Station, TX: StataCorp LP). Trends in proportions of non-vaccination, under-vaccination and MOV were compared between 2003, 2008/09, and 2014 using the Cochrane-Armitage trend test. All results with P≤0.05 were considered statistically significant. Trends in proportion of non-vaccination among children aged 0-23 months in Kenya was 13.2%, 6.1% and 3.2% in 2003, 2008/09 and 2014, respectively (P = 0.0001). Trends in proportion of under-vaccination among children aged 0-23 months in Kenya was 54.3%, 50% and 51.3% in 2003, 2008/09 and 2014, respectively (P = 0.0109). The trends in proportion of children who experienced MOV was 22.7% in 2003, 31.9% in 2008/09 and 37.6% in 2014 (P = 0.0001). In the study duration, non-vaccination decreased by 10%, under-vaccination remained relatively stable, and MOV increased by ~15%. There is need for the Government and partners to implement initiatives that improve vaccine access and coverage, particularly in regions with low coverage rates, and to address missed opportunities for vaccination.

Suboptimal MMR Vaccination Coverages-A Constant Challenge for Measles Elimination in Romania.

Measles is targeted for elimination since 2001, with a significant reduction in cases recorded worldwide, but outbreaks occur periodically due to immunization gaps. This study analyzes the evolution of vaccination coverage rates (VCRs) in Romania, a EU country with large measles epidemics during the last two decades, including an ongoing outbreak in 2023. Vaccination against measles has been part of the National Immunization Program since 1979, initially as a single dose, and from 1994 onwards it has had two doses. The initially high national VCRs of >97% gradually declined from 2010 onward and remained constantly under 90%, with further decreases during the COVID-19 pandemic. The lowest VCRs for both vaccine doses in the last decade were recorded in 2022 and were 83.4% for the first dose and 71.4% for the second dose, with significant differences among Romania's 42 counties. Several factors contributed to this decline, including failure to attend the general practitioners' offices, increased number of children lost to follow-up due to population movements, missed vaccination opportunities due to temporary medical contraindications, a surge in vaccine hesitancy/refusal, a decreasing number of general practitioners and discontinuities in vaccine supply. The persisting suboptimal VCRs in Romania threaten the progress toward measles elimination.

Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa.

We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.

Factors associated with missed opportunities for vaccination in children aged <5 years in Oaxaca, Mexico, 2018

Introduction. We estimated the frequency of missed opportunities for vaccination and the factors associated with them in children under five as they exited the health facilities in two health districts of Oaxaca, Mexico in 2018. Population and Methods. We conducted a cross-sectional study out of an exit survey of public health facilities with low immunization coverage. The study population was comprised of 837 children and their caregivers who had visited those health facilities. Crude and adjusted odds ratios were calculated to analyze factors associated with missed opportunities for vaccination. Results. A total of 502 children were eligible to receive 1338 doses of missing vaccines; 986 missed opportunities for vaccination were observed. The factors related to missing opportunities were related to health facilities (810, 82.2%); mainly due to total or partial vaccine shortages (789, 97.4%), followed by health personnel (108, 10.9%) and child caregivers (68, 6.9%). Discussion. The main variable associated with missed vaccination opportunities was partial or complete vaccine shortages.

Missed opportunity for routine vaccination and associated factors among children aged 0-23 months in public health facilities of Jimma Town.

The current recommendation obligates children to receive all vaccines within two years of birth. The Expanded Program on Immunization (EPI) was established in Ethiopia to increase the immunization rate by 10% annually and to reach 100% in 10 years but not been achieved in twenty years. Missed opportunity for vaccination (MOV) is one of the major factors in vaccination coverage. Hence, this study aimed to assess the prevalence of MOV and associated factors in Jimma Town public health facilities. A facility-based cross-sectional study design was employed with a quantitative data collection method. The sample size was calculated using a single population proportion formula. The data were collected through face-to-face interviews, and data extraction methods and analyzed using SPSS version 26. The statistical association was decided at p-value <0.05 with 95% CI, and AOR. A total of 422 children were involved in this study making a 100% response rate. The magnitude of MOV was 39.8% (95%CI: 35-45). Parents/caretakers have not attended formal education (AOR = 4.65, CI:1.64-13.24), residing in rural (AOR = 2.60, CI: 1.35-5.03), poor knowledge about immunization (AOR = 2.61, CI: 1.58-4.30), the child not assessed for vaccination status (AOR = 3.01, CI: 1.65-5.49), and parents/caretakers not seen/heard vaccination message in the last month (AOR = 2.42, CI: 1.40-4.18) were statistically positively associated with the MOV. In conclusion, this study indicated that MOV among the children was high in the study facilities. The researchers recommended stakeholders work on strengthening community awareness creation. Additionally, further study incorporating physician-related factors is also suggested.

Timeliness and missed opportunities for vaccination among children aged 0 to 23 months in Dschang health district, West region, Cameroon: A cross-sectional survey.

Missed opportunities for vaccination (MOV) reflect quality of immunization service. The objective of this study was to assess vaccination timeliness, prevalence, and characteristics of MOVs among children aged 0-23 months, as well as knowledge, attitude and practice of health workers towards immunization. An exit interview method was used to select caregivers and health personnel. Selection took place in 26 health facilities within 14 health areas in the Dshcang Health district. Data were collected using two face-to-face questionnaires adapted from the World Health Organization (WHO) tools. We conducted an evaluation of all free vaccines in the Expanded Programme on Immunisation (EPI). We studied timeliness, assessed MOV, and knowledge, behaviour and attitude of health workers on immunization. Basic statistical tests were used to study the association between MOV and socio demographic characteristics. A total of 363 children aged 0 to 23 months were surveyed. A total of 88 (91.66%) of health personnel agreed to participate in our study. A total of 298 (82.1%) children had vaccination cards with dates, leading to 18% not completely vaccinated. Vaccination timeliness ranged from 20% to 77%. Overall MOV estimated was 23.83%, range from 0% to 16.4% among all vaccines. Among health workers, 70.45% (62/88) had insufficient knowledge on vaccination, 73.86% assessed the vaccination status of children during any routine visit and 74% ask parents to bring the child's vaccination record to any health facility visit. The study highlighted presence of MOV among children. Strategies for remedying this includes strengthening parents' knowledge, organizing refresher courses for health workers on vaccination, and systematically assessing children's vaccination status.

Incomplete Childhood Vaccination and Associated Factors Among Children Aged 12–23 Months; Assessment of Time-To-Corrected Missed Opportunity for Vaccination for Routine Immunization: Evidence from The Cameroon Demographic and Health Survey 2018

Background: Complete childhood vaccination remains poor in Sub-Saharan African countries. Although missed opportunity for vaccination (MOV) was found responsible for low coverage, median time-to-corrected is useful to assess delay in vaccination. We explored incomplete vaccination coverage, describe characteristics of children who experienced corrected MOV for all antigens, and estimate median survival time. Method: Secondary analyses of a sample of 1285 (total weights=1315.91) children aged 12 to 23 months with at least one vaccination date, was performed. A weighted survival Kaplan-meier curve was use to estimate median time-to-corrected MOV for for each vaccine. Multiple correspondance analysis (MCA) was called to describe characteristics of children with corrected MOV and incomplete vaccination. We used the YFV corrected MOV status in the MCA analysis as it had the highest probability of outcome. A binary logistic regression analysis was used to identify factors associated to both outcomes. Results: Median survival time ranged from 5 (OPV0) to 96 days (Penta3). For the YFV, it was 22 days, and 65 days for MCV1. MCA analysis revealed two main dimensions characterized mainly by: first, by children who experienced MOV for simultaneous vaccines, born to uneducated mothers with no occupation, who were in contact with health facility within 2 months after birth; second, by first of third bird order children, born to caregivers less than 24 years or more than 31 years, who either had an occupation skill, or were not working. Probability of corrected MOV decreases among caregivers less than 24 years, those who delivered at home and had no antenatal care. Factors associated to incomplete vaccination revealed a decrease in the odds: in children whose mothers attended health facility within 2 months after birth, mother’s age more than 31 years than less than 24 years and, an increase in the odds with children who had less than 5 contacts with the health facility. Conclusion: Enhance effort on strategies targetting mothers during their stay in the maternity, heads of households, and younger mothers, is needed to increase vaccination coverage among children. Caregivers should pay attention to child’s vaccination schedule, and complete each vaccine ontime.

Perceived Barriers and Use of Evidence-Based Practices for Adolescent HPV Vaccination among East Texas Providers.

Adolescents living in rural areas are less likely to be up to date on the human papillomavirus (HPV) vaccine, which can prevent cervical cancer. We administered a telephone survey to 27 clinics in rural East Texas to assess perceived barriers to HPV vaccination and current use of evidence-based interventions to promote HPV vaccination. Perceived barriers were assessed using a 5-point Likert scale and clinical implementation of evidence-based practices was determined. Findings are reported using descriptive statistics. The most commonly reported barriers were missed vaccination opportunities due to the pandemic (66.7%), followed by vaccine hesitancy due to the pandemic (44.4%) and due to the HPV vaccine specifically (33.3%). Fewer than a third of clinics reported using the evidence-based strategies of use of a "refusal to vaccinate" form (29.6%), having an identified HPV vaccine champion (29.6%), and recommending the HPV vaccine at age 9 (22.2%). While many clinics surveyed currently implement evidence-based practices to promote HPV vaccination, there is a need and desire for additional HPV vaccination interventions in East Texas clinics.

Assessment of missing opportunity of vaccination at primary health care center: A retrospective study

Objectives: The study aim is to assess the vaccination status of children under two years old in Al-Asatetha primary health care center / Hilla-Iraq.&#x0D; Method: Retrospective study design (Retrospective chart review) was used to assess the missed opportunities of vaccination for children under the age of two years by reviewing their immunization status from medical reports at the primary health care center. The purposive sampling was used to collect the data of 1000 children born from 1-1-2020 to 31-12-2020 through the period from 1 December 2021 to 1 February 2022.&#x0D; Results: the finding of the current study showed that the age of children in the selected period (2020-2021) was between11-23 months, the number of children (1-8) in the same family, and almost all of these families reside in urban areas. Regarding the parents’ educational level the high percentage of both fathers and mothers were attained a primary level of education, and most of the fathers were working, while most of the mothers were not work. Concerning the vaccination status the finding showed that the percentage of missed vaccination opportunities reached 61%, and there was a significant positive correlation between vaccination status and (family residence, parental education level, and fathers' occupation) with a P value of 0.01. On the other hand, the number and the order of children in families had an inversely significant relationship with vaccination status at a P value of 0.01.&#x0D; Conclusion: the study concludes that numerous factors affect the vaccination rate such as parents' education attainment and awareness, family size, address, and economic status of the family.

Comprehensive assessment of the implementation of maternal immunization programs in Italy: A national survey across maternity care units.

The authors aimed to assess the characteristics and integration of immunization services into the prenatal care provided by maternity care units (MCUs) in Italy. A cross-sectional nationwide study using a web-based survey was conducted from June to August 2021. The study population consisted of 342 obstetricians/gynecologists (OB/GYNs), members of the Italian Society of Gynecology and Obstetrics, and heads of MCUs. The main outcome was to assess the performance of several vaccine-related services among the surveyed MCUs. Overall, 112 of 342 MCUs completed the survey, for an overall response rate of 32.7%. Almost all MCUs (96.4%) provided vaccine information, but only 22% had an onsite vaccination clinic. Less than half (43.8%) offered vaccines during prenatal visits and 75% of those sites required women to set up an extra appointment for vaccination. Although 68% MCUs recorded vaccines administered, only 20% of them managed to record vaccines in their own medical records. The institutional-logistic issues were the most voted vaccination barrier (40.2%). Institutional barriers and lack of certain vaccine-related services offered during prenatal care in Italian MCUs might be responsible for many missed vaccination opportunities. Embedding maternal immunization programs within the current prenatal care services might optimize vaccine coverage.

Contextualising missed opportunities for children’s vaccination: A theory-informed qualitative study in primary care settings in Cape Town, South Africa

ABSTRACT This study aimed to explore the contextual factors that may be associated with missed opportunities for vaccination (MOV) from the perspectives of healthcare providers and caregivers attending primary healthcare facilities in the Cape Town Metro Health District, South Africa. The ultimate goal of the assessment was to help inform the design and implementation of a contextually appropriate quality improvement programme targeted at reducing MOV in primary healthcare settings. We used a theory-informed exploratory qualitative research design involving focus group discussions with caregivers of children aged 0–23 months; and in-depth interviews of facility staff. A thematic template analysis approach, integrating the theoretical domains framework (TDF) and the capability, opportunity and motivation model of behavior (COM-B) was used to code and analyze the data. Three focus group sessions were conducted, each consisting of 5–8 caregivers and five in-depth interviews involving facility staff. Capability factors comprised caregivers’ knowledge, attitude and behavior toward children’s immunization. Opportunity factors included the organization of immunization services, long waiting time, vaccine stock out, staff shortage and health workers’ attitude, knowledge and capability to assess children’s immunization status and needs. Motivation factors included optimism and beliefs about immunization, fear of vaccine-preventable diseases and immunization safety concerns. This study identified important caregiver-, provider- and health system-related factors, which influence immunization outcomes; offering useful contextual insights for informing quality improvement strategies for reducing MOV at primary healthcare level.

Assessment of the Burden and Factors Associated with Missed Opportunities for Vaccination in a South-Western State of Nigeria: Toward Immunization Agenda 2030

ABSTRACT Background: Immunization Agenda 2030 prioritized the tackling of certain factors stalling immunization progress globally, among which are missed opportunities for vaccination (MOV), when eligible children have contact with health facilities without being vaccinated. Aim: This paper presents the baseline of an implementation research aimed at assessing the burden and identifying the factors leading to MOV in a South-Western Nigerian state. Materials and Methods: The 10-step World Health Organization MOV strategy was used to select local government areas and health facilities in Lagos State purposively. Children 0–23 months and healthcare workers were sampled through exit interviews with caregivers and knowledge, attitude, and practice surveys with health workers. MOV was estimated using documented (child health card or health facility register) vaccination histories included in the National Immunization Programme (NIP). Result: Among the caregivers, 475 (79.2%) had complete documentation of vaccination histories among which 292 (61.5%) children were eligible for vaccination. About 15% of the eligible children had one or more MOVs at the survey dates. Among curative service visits, 80% of the children had MOVs compared to 6.7% for vaccination visits. Among the healthcare workers, about two-thirds have poor knowledge of NIP and are not aware that the immunization status of children should be screened at each visit. Conclusion: The findings showed that MOV occurs especially in non-vaccination visits, where healthcare workers care less about immunization statuschecks. Active immunization status checks and providing linkages for immunization services may help in reducing MOV and improving immunization coverage rates in Lagos State towards fulfiling immunization Agenda 2030.

False Contraindications for Vaccinations Result in Sub-Optimal Vaccination Coverage in Quito, Ecuador: A Cross-Sectional Study

Vaccination coverage in Ecuador has decreased since 2013, falling short of the World Health Organization's vaccination goal. There are several causes for this deficiency in coverage, one of these are lost vaccination opportunities, which are caused when a patient without contraindications postpones, or for other reasons fails to receive a recommended immunization. The objective of this study was to determine the state of knowledge regarding vaccination contraindications among the Metropolitan District of Quito health personnel to assess missed vaccination opportunities. Through this cross-sectional descriptive study, health personnel were surveyed online and asked 18 clinical scenarios which were created to evaluate their knowledge of the true contraindications of vaccination, and measure missed opportunities. A total of 273 surveys were collected; 74% belonged to the public health system, and the rest represented by private practitioners. Of those surveyed, 98.2% of health personnel had improperly denied vaccination at least once. We specifically found vaccinations were incorrectly denied more frequently in cases where the hypothetical patient presented mild or moderate fever cases. The use of corticosteroids, autoimmune diseases, and egg allergy were also incorrectly denied (89%, 71.4%, 72.9%, and 58.6%, respectively). Among the health personnel surveyed, there is an apparent lack of knowledge of the true contraindications of vaccination and differences in knowledge about contraindications according to personnel in charge of administering immunization to children. Our preliminary results suggest that lack of education related to side effects could be biasing medical professionals' decisions, causing them to unnecessarily delay or deny vaccinations, which likely contributes to explaining low overall vaccination coverage in Quito, the capital city of Ecuador.

Dropout of Vaccination Among Iraqi Children

Immunization has been a successful method of preventing and controlling life-threatening  infectious diseases since the 20th century. About 2-3 million child deaths are avoided annually  through vaccination. Despite increasing vaccination rates worldwide, many children in  developing nations still miss their vaccinations. Therefore, many children are still vulnerable  to the Expanded Program on Immunization (EPI) targeted diseases. Missed opportunities for  vaccination (MOVs) occur when people who are eligible for vaccination visit a medical facility  but do not receive the necessary vaccinations. Therefore, vaccination has the opportunity to  achieve more if missed vaccination opportunities (MOVs) are removed and global  immunization coverage increases. A narrative review was conducted to summarize vaccination  missing among Iraqi children, and factors affecting the vaccine coverage rate.

Pneumococcal vaccination uptake and missed opportunities for vaccination among Canadian adults: A cross-sectional analysis of the Canadian Longitudinal Study on Aging (CLSA).

IntroductionIn Canada, pneumococcal vaccination is recommended to all adults aged ≥65 and those <65 who have one or more chronic medical conditions (CMCs). Understanding vaccine uptake and its determinants among eligible groups has important implications for reducing the burden of pneumococcal disease.MethodsUsing data from a large national cohort of Canadian residents aged ≥47 years between 2015–2018, we calculated self-reported pneumococcal vaccine uptake among eligible groups, estimated associations between key factors and non-vaccination, assessed missed opportunities for vaccination (MOV) and examined risk factors for MOV. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for relevant associations were estimated through logistic regression.Results45.8% (95% CI: 45.2–46.5) of 22,246 participants aged ≥65 and 81.3% (95% CI: 80.5–82.0) of 10,815 individuals aged 47–64 with ≥1 CMC reported never having received a pneumococcal vaccine. Receipt of influenza vaccination in the previous year was associated with the lowest odds of pneumococcal non-vaccination (aOR = 0.14 [95% CI: 0.13–0.15] for older adults and aOR = 0.23 [95% CI: 0.20–0.26] for those aged 47–64 with ≥1 CMC). Pneumococcal vaccine uptake was also more likely in case of contact with a family doctor in the previous year (versus no contact), increased with age and varied widely across provinces. Among individuals recently vaccinated against influenza, 32.6% (95% CI: 31.9–33.4) of those aged ≥65 and 71.1% (95% CI: 69.9–72.3) of those aged 47–64 with ≥1 CMC missed an opportunity to get a pneumococcal vaccine. Among individuals who had contact with a family doctor, 44.8% (95% CI: 44.1–45.5) of those aged ≥65 and 80.4% (95% CI: 79.6–81.2) of those aged 47–64 with ≥1 CMC experienced a MOV.ConclusionsPneumococcal vaccine uptake remains suboptimal among at-risk Canadian adults who are eligible for vaccination. Further research is needed to clarify the reasons behind missed opportunities for vaccination and adequately address the main barriers to pneumococcal vaccination.

Missed opportunities for vaccination in Peru 2010–2020: A study of socioeconomic inequalities

Missed Opportunities for Vaccination (MOV) represent a major risk in the re-emergence of immunopreventable diseases. However, in the region, there are few published studies on MOVs using national databases such as demographic and health surveys (DHS). This study aims to describe the frequency and trends of MOVs for the first dose of vaccines against the leading causes of infant morbidity and mortality, their complete vaccination coverage, and trends in socioeconomic inequalities at the national and departmental levels for an 11-years period. Using DHS data from an 11-year period (2010-2020), we calculated frequencies and trends in MOVs of vaccines for the leading causes of child morbidity and mortality, estimated inequalities in MOVs using the Slope Inequality Index (SII) and conducted a spatial autocorrelation test to identify clusters of higher or lower inequality in MOVs at the national level. We found that, at the national level, greater inequality was concentrated in the wealthiest categories of each socioeconomic variable. We identified that departments with higher poverty rates concentrated higher levels of inequality in the MOVs in the lowest strata of the socioeconomic variables. In addition, we found that some departments with similar geographic and socioeconomic characteristics had spatially correlated levels of inequality on MOVs. These findings can help to identify the heterogeneity that exists in the distribution of MOVs among departments and socioeconomic strata, which would help to prioritize specific areas and subpopulations for national immunization strategies. No additional funding source was required for this study.

Motivators and Barriers to HPV Vaccination: A Qualitative Study of Underserved Women Attending Planned Parenthood.

Human papilloma virus (HPV) is the most common sexually transmitted infection in the United States. Disease-associated strains of HPV can cause genital warts and six cancer types. HPV-associated cervical cancer disproportionately impacts medically underserved women including Black and Latina women with respect to incidence, prevalence, and mortality rates. Although safe and effective vaccines are available, HPV vaccination rates remain low among low-income individuals and women of color. The current study examined individual and structural motivators and barriers to HPV vaccination among medically underserved women utilizing a Planned Parenthood health center in Southeast Pennsylvania. Guided by narrative engagement theory (NET), qualitative interviews (N = 24) were used to elicit HPV vaccine decision stories from both vaccinated and unvaccinated women. Using a phronetic iterative data analysis approach, we identified three motivators to vaccinate against HPV: (1) receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) feeling empowered to take control of one’s health (an individual determinant), and (3) knowing someone infected with HPV (an individual determinant). Among unvaccinated participants, barriers to HPV vaccination included: (1) not receiving an explicit vaccine recommendation from a healthcare provider (a structural determinant), (2) low perceived risk for acquiring HPV or that HPV is not severe (an individual determinant), and (3) lack of maternal support to vaccinate (a structural determinant). Healthcare providers are optimally positioned to fill the gap in prior missed vaccine opportunities and empower women by recommending HPV vaccination.

Missed opportunities for vaccination (MOV) in children up to 5 years old in 19 Médecins Sans Frontières-supported health facilities: a cross-sectional survey in six low-resource countries

ObjectiveTo describe missed opportunities for vaccination (MOV) among children visiting Médecins Sans Frontières (MSF)-supported facilities, their related factors, and to identify reasons for non-vaccination.DesignCross-sectional surveys conducted between 2011 and 2015.Setting...

Systematic review on reducing missed opportunities for vaccinations in Latin America.

ABSTRACTObjectives.To estimate the prevalence of missed opportunities for vaccination (MOV) in Latin America and the effect of interventions targeting health systems, health workers, patients, and communities on MOV.Methods.Searches were conducted in MEDLINE, EMBASE, CINAHL, and LILACS electronic databases and relevant organizations were contacted, including the Pan American Health Organization (PAHO), to identify studies meeting eligibility criteria. A pair of reviewers identified 27 randomized and non-randomized studies quantifying the effectiveness of any intervention for reducing MOV and 5 studies assessing the rate of MOV in Latin America. Results are reported narratively when criteria to pool results were not met, and the certainty of this evidence was assessed using the GRADE approach.Results.Evidence suggests the rate of MOV in Latin America ranged from 5% to 37% with a pooled estimate of 17% (95% CI [9, 32]) (low certainty) and that monetary incentives to healthcare teams, training for healthcare teams on how to communicate with patients, and educational interventions for caregivers probably reduce MOV (moderate to very low certainty).Conclusions.There is insufficient evidence supporting the implementation of any intervention as policy based only on the potential reduction of MOV without considering several factors, including costs, feasibility, acceptability, and equity.