Childhood Immunization Uptake Research Articles

Exploring how the uptake of childhood immunisations can be improved in England: A systematic review

Background: Childhood immunisations protect communities against preventable and infectious diseases. Coverage for childhood immunisations in the UK is declining and coverage for the MMR vaccine stands at 85.5%, significantly below the target set by the Department of Health and Social Care to achieve herd immunity and prevent sustained disease transmission. Methods: Three medical databases were searched using PICO, supported by the application of inclusion and exclusion criteria and critical appraisal. Results: Reminder and recall activities are identified as a cost-effective method for improving childhood immunisation uptake but targeted, individualised and family-centred interventions should be utilised to promote access to childhood immunisations for underserved populations. Vaccination data should remain up to date and a child's vaccination status should be reviewed and meaningfully discussed at every healthcare contact and staff involved in immunisation should have access to appropriate education, training and support. Recommendations: Understanding how to provide services and improve vaccine coverage for patients who frequently are not brought is identified as an opportunity for further research, as well as analysing the role of public health teams in identifying local inequalities and supporting GP practices to design and deliver bespoke interventions for their community. It is recommended that communication emphasises the safety and effectiveness of vaccines, while highlighting a child's susceptibility or risk to developing complications. Further research is needed to evaluate how best to communicate this to ensure that the information provided is clear and factual and comprehensible to all parents and carers.

Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks

BackgroundDespite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at birth—tuberculosis (Bacille Calmette–Guérin [BCG]) and polio (OPV0)—remains inconsistent. As countries such as Democratic Republic of the Congo (DRC) prepare to add yet another birth-dose vaccine to their immunization schedule, this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe.MethodsThe study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B (HepB3) immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels. The assessment leveraged survey data collected during a continuous quality improvement study (NCT03048669) conducted in 105 maternity centers throughout Kinshasa Province, DRC. The final sample included 2398 (BCG analysis) and 2268 (HepB3 analysis) women-infant dyads living with HIV.ResultsBetween 2016 and 2020, 1981 infants (82.6%) received the BCG vaccine, and 1551 (68.4%) received the first dose of HepB3 vaccine. Of those who received the BCG vaccine, 26.3%, 43.5%, and 12.8% received BCG within 24 h, between one and seven days, and between one and 14 weeks, respectively. Of infants who received the HepB3 vaccine, 22.4% received it within six weeks, and 46% between six and 14 weeks of life. Many factors were positively associated with BCG uptake, including higher maternal education, household wealth, higher facility general readiness score, and religious-affiliated facility ownership. The factors influencing HepB3 uptake included older maternal age, higher education level, household wealth, transport by taxi to a facility, higher facility general and immunization readiness scores, and religious-affiliated facility ownership.ConclusionsThis study demonstrated that the study participants’ uptake of vaccines was consistent with the country average, but not in a timely manner. Various factors were associated with timely uptake of BCG and HepB3 vaccines. These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.

Global Vaccine Access Demands Combating Both Inequity And Hesitancy.

The world's population suffered from lack of access to COVID-19 vaccines. Although inequities in vaccine availability for low- and middle-income countries are widely cited as a component of this lack of access, there is a related but less discussed component: vaccine refusal or hesitancy. Regarding the first component (global vaccine inequities), there are multiple dimensions to this topic and its causes, but for low- and middle-income countries, the most glaring one resulted from upstream science policies that prioritized speed and innovation at the expense of technologies that could be produced by low- and middle-income country vaccine producers. Regarding the second component (vaccine refusal or hesitancy), as COVID-19 waves swept across the United States in 2021, thousands of unvaccinated Americans perished from refusing COVID-19 immunizations. These deaths occurred because of an expanding antiscience ecosystem that now extends into low- and middle-income countries and could block the uptake of new vaccines or routine childhood immunizations. Future vaccine policies must address both elements of global access and their political identities. This recommendation reflects the author's experiences as a vaccine scientist who both develops affordable COVID-19 and neglected disease vaccines and lives on the front lines combating vaccine refusal.

Improved vaccine coverage for First Nations children receiving first dose on-reserve: a retrospective cohort study in western Canada

IntroductionFragmentation in immunisation reporting systems pose challenges in measuring vaccine coverage for First Nations children in Canada. Some Nations have entered into data-sharing agreements with the province of Alberta’s health...

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review.

Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.

A national survey of parents' views on childhood vaccinations in Ireland.

Vaccine hesitancy is complex and multifactorial and a threat to global health. Uptake of some recommended childhood immunisations in Ireland remains below World Health Organisation targets. The aim of this study was to determine factors associated with vaccine uptake in Ireland. A cross-sectional, national survey of parental attitudes towards childhood vaccination for children aged 0 to 48 months was conducted between June and August 2021 (N = 855). A descriptive analysis of questionnaire responses was conducted. Univariate and multivariable logistic regression models were constructed to identify the association of demographic parental characteristics and parental vaccine attitude scores with a delay in or lack of parental vaccine acceptance. There was a strongly positive sentiment towards childhood vaccinations. Self-reported uptake of recommended vaccines was 96.1 % with a strong belief in the importance (94.4 %) and safety (89.2 %) of vaccines. Trust in official vaccine information sources was high; 91.5 % and 89.2 % reported trust in the vaccine information provided by healthcare professionals and the Health Service Executive (HSE) respectively. The most commonly identified reasons for missed vaccines were concerns about safety and vaccine side effects. In multivariable regression analysis, parental trust in official vaccine information sources was a significant predictor of vaccine acceptance. For every one unit increase in the median parental trust in official vaccine information score, the odds of a parent having reduced vaccine acceptance decreased significantly (aOR 0.27 95 % CI 0.16, 0.46, p < 0.001). Understanding parental attitudes towards vaccination will inform the development of evidence-informed, targeted interventions to increase childhood immunisation uptake. Vaccine information for parents should focus on vaccine safety and public health action should be taken to build trust and engage communities in order to increase and sustain the uptake of childhood vaccines delivered as part of the national childhood primary immunisation programme in Ireland.

Reasons for reductions in routine childhood immunisation uptake during the COVID-19 pandemic in low- and middle-income countries: A systematic review.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a substantial decline in routine immunisation coverage in children globally, especially in low- and middle-income countries (LMICs). This study summarises the reasons for disruptions to routine child immunisations in LMICs. A systematic review (PROSPERO CRD42021286386) was conducted following PRISMA 2020 guidelines. Six databases were searched: MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on 11/02/2022. Observational and qualitative studies published from January 2020 onwards were included if exploring reasons for missed immunisations during the COVID-19 pandemic in LMICs. Study appraisal used National Heart, Lung, and Blood Institute and Critical Appraisal Skills Programme tools. Reasons for disruption were defined with descriptive codes; cross-sectional (quantitative) data were summarised as mean percentages of responses weighted by study population, and qualitative data were summarised narratively. A total of thirteen studies were included describing reasons behind disruptions; 7 cross-sectional (quantitative), 5 qualitative and 1 mixed methods. Seventeen reasons for disruptions were identified. In quantitative studies (total respondents = 2,853), the most common reasons identified were fear of COVID-19 and consequential avoidance of health centres (41.2%, SD ±13.3%), followed by transport challenges preventing both families and healthcare professionals from reaching vaccination services (11.1% SD ±16.6%). Most reasons stemmed from reduced healthcare-seeking (83.4%), as opposed to healthcare-delivery issues (15.2%). Qualitative studies showed a more even balance of healthcare-seeking (49.5%) and healthcare-delivery issues (50.5%), with fear of COVID-19 remaining a major identified issue (total respondents = 92). The most common reasons for disruption were parental fear of COVID-19 and avoidance of health services. Health systems must therefore prioritise public health messaging to encourage vaccine uptake and recovery of missed immunisations.

The Impact of the COVID-19 Pandemic on Uptake of Routine Childhood Immunization: How a Behavioral Science Led Analysis Can Strengthen Vaccination Policy

In addition to the direct health and economic impacts of the COVID-19 pandemic, routine immunization of children for vaccine-preventable diseases has also suffered. Quantitative studies have shown evidence of backsliding in routine immunization, i.e., children failing to receive their vaccinations on schedule. Pandemic restrictions were the cause for some of this behavior, and there are signs that subsequent campaigns and supply-side initiatives have influenced trends toward routine immunization catch-up. However, limited qualitative research indicates that the pandemic may have disrupted parents/caregivers’ decision-making processes around routine immunization, and their attitudes toward vaccination, in ways that could have long-term effects on rates of immunization. Further behavioral research can help elucidate this and provide guidance to policymakers to boost immunization uptake. This policy article explores the decision dynamics leading to missed routine immunization doses during the pandemic, through an analysis of secondary literature, a summary of primary-research studies on COVID-19 vaccine hesitancy conducted during the pandemic across Côte d’Ivoire, Burkina Faso, Kenya and Pakistan, and a summary of a study on the impact of COVID-19 on routine immunization uptake in South Africa. We found that the COVID-19 pandemic severely disrupted prior patterns of engagement with the health system, turning routine immunization from a default decision for parents/caregivers into an “active decision-making” moment. Restrictions on movement, limited routine immunization supplies and other practical impediments combined with fear of contracting COVID-19 at health facilities, misinformation, and fear of vaccine side-effects, creating an emergent behavior of missed immunization doses during the pandemic period. We also found that hesitancy about COVID-19 vaccines may be transferred onto previously accepted vaccines, impacting routine immunization. We identified three decision-making pathways for routine immunization uptake among South African parents/caregivers once the lockdowns were lifted: the “path of procrastination,” the “path of doubt,” and the “path of persistence.” We highlight the policy implications of these, and suggest potential interventions to increase routine immunization uptake for parents/caregivers on each path, as well as for general communications, service delivery, and pandemic readiness.

Predictors of Uptake of Childhood Immunisation by Mothers in an Urban Community in Osun State

Predictors of Uptake of Childhood Immunisation by Mothers in an Urban Community in Osun State

THE FACTORS OF PRIMARY CHILDHOOD IMMUNIZATION UPTAKE AMONG THE URBAN POOR CHILDREN IN MALAYSIA

Reducing childhood immunization coverage has led to re-emerging of vaccine-preventable diseases among young children. This study aimed to identify the prevalence and predictors of complete childhood immunization among the low socioeconomic urban households’ children in Malaysia. A nationwide survey data from the National Health and Morbidity Survey (NHMS) 2016 was utilized to extract 2668 completed data of respondents who had a household income of less than RM 4,000 and living in urban areas were included in the analysis. The children’s home-based cards were used to verify the data on the primary childhood immunization status. Related data from the household and child health modules were extracted three levels of analysis were conducted using SPSS Version 25 that were descriptive analysis, bivariate analysis and multivariable analysis. The prevalence of complete primary childhood immunization uptake was 89.5%. Mothers of 20 to 29 years old, 30 to 39 years old, and 40 years old and above had 2.704 (aOR=2.704, 95% CI:1.255-5.827), 3.305 (aOR=3.305, 95% CI:1.526-7.160), 3.058 (aOR=3.058, 95% CI:1.165-8.029) higher odds of having children with complete childhood immunization status compared to those younger. Meanwhile, mothers who were self-employed, students and utilized private healthcare facilities had 0.2773 (aOR=0.273, 95% CI:0.138-0.540), 0.063 (aOR=0.063, 95% CI:0.014-0.288) and 0.200 (aOR=0.200, 95% CI:0.118-0.338) lower odds towards complete primary childhood immunization uptake among their children. Below global recommended coverage of complete primary immunization uptake was observed among the urban poor children. Mothers who were young, self-employed, students and utilizing private healthcare facilities should be targeted to improve immunization coverage among children or urban localities.

Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM framework

BackgroundShort Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention’s internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs.MethodsIn June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews.ResultsThe perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants’ participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state’s priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention’s impact on improving coverage was critical for scalability.ConclusionsOur study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake.

Forecasting sub-national trends in COVID-19 vaccine uptake in the UK before vaccine rollout

Vaccines have reduced the burden of COVID-19 disease in the UK since their introduction in December 2020. At the time of their introduction, it was unclear the extent to which COVID-19 vaccines would be accepted and how spatial variations in uptake would emerge, driven by socio-demographic characteristics. In this study, data from a large-scale cross-sectional study of over 17,000 adults, surveyed in September and October 2020, was used to provide sub-national forecasts of COVID-19 vaccine uptake across the UK. Bayesian multilevel regression and poststratification was deployed to forecast COVID-19 vaccine acceptance before vaccine rollout across 174 regions of the UK. Although it was found that a majority of the UK adult population would likely take the vaccine, there were substantial heterogeneities in uptake intent across the UK. Large urban areas, including London and North West England, females, Black or Black British ethnicities, and Polish speakers were among the least likely to state an intent to vaccinate. These predicted spatial trends were validated by comparison to observed observed COVID-19 vaccine uptake in late 2021. The methodological approaches deployed in this validated forecasting study may be replicable for the prediction of routine childhood immunisation uptake. Given recent pandemic-induced disruptions to routine immunisation systems, reliable sub-national forecasts of vaccine uptake may provide policymakers and stakeholders early warning signals of potential vaccine confidence issues.

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.

How to improve uptake of childhood immunisations

Primary care has a key role to play in providing the childhood vaccination programme in the UK. There are several challenges facing primary care when delivering the childhood immunisation programme including vaccine concerns from parents, competing priorities and staffing. This article provides some key practical tips to help address these challenges and improve immunisation uptake.

The Determinants of Parental Uptake of Childhood Immunization in Peri-Urban Areas of Karachi - A Cross-Sectional Study

Background: Immunization is one of the simplest and cost-effective ways to protect a child from infectious diseases and mortality worldwide, and while global immunization coverage has increased dramatically the impact is low in developing countries like Pakistan, where many children remain unvaccinated or partially vaccinated. Aim: To determine the potential factors related to parents that impact the uptake of immunization in children living in the peri-urban area of Karachi, Pakistan. Methodology: An analytical cross-sectional study was conducted between Oct 2020 to May 2021. Purposive sampling technique based on the inclusion and exclusion criteria was used and a total of 100 parents of children were interviewed using the self-developed structured questionnaire focusing on factors like socio-demographic, parental health-seeking behavior, parental knowledge and perception of immunization and the reasons why a child is partially immunized. The data was collected from two EPI centers from the peri-urban area of Karachi to determine the parental factors associated with child immunization. Results: The results of the study show association between Child immunization and father occupation (p=0.000), parental education (p=0.000) and household income (p-value=0.000). history of sibling’s complete vaccination 35(70%), frequency of maternal antenatal visits 41(82%) accompanied by the husband 37 (74%) and have delivered the child in hospital 50(100%) by an obstetrician 50 (100) and for medical treatment child is always taken to a hospital 47(94%). Parents who consider vaccination important 48 (86%) with the significance of (p=0.001) and they have awareness regarding the total number of immunizations 38(76%) have fully immunized children. Conclusion: According to the study, parental education, occupation, income, health-seeking behavior, father’s involvement, child birth-related factors, parental awareness on immunization, perception of immunization Keywords: Immunization coverage, EPI, Parental factors, Peri-Urban, Sindh, Fully Immunized, Partially Immunized

IMPACT OF COVID-19 PANDEMIC RESPONSE ON THE UPTAKE OF ROUTINE CHILDHOOD IMMUNISATION AT A TERTIARY CARE CENTRE IN MUMBAI.

Background The COVID-19 pandemic response has impacted the delivery of healthcare, including routine childhood immunisation. This manuscript studies the extent of this impact. To assess the decline in daily average routine childhood immunisation uptake compared toObjectives the baseline level and to assess the problems faced by the beneciaries in accessing the immunisation services during the pandemic period at a tertiary care centre in Mumbai. Data of daily routine childhood immunisations in the year 2019 and 2020 was collected from theMethods immunisation records register of Child Welfare Centre (CWC) of the tertiary care centre. The baseline (2019) and the COVID-19 lockdown period data were compared to analyse the impact on daily routine childhood immunisation uptake. Guardians of beneciaries visiting the CWC from 24 December 2020 to 23 January 2021 were interviewed using a questionnaire to study the causes of delayed/missed immunisations. ThereResults was 24.62% decline (p&lt;0.05) in the number of immunisations administered in 2020 compared to 2019. Fear of COVID-19 infection (45.9%), migration to hometown due to lockdown (13.11%), travelling restrictions during lockdown (9.84%) and miscellaneous reasons (31.15%) were the reasons given by the 93 guardians interviewed for delayed/missed immunisations (63.16%). COVID-19 pandemic response has led toConclusion a disruption in immunisation services, leading to a drop in uptake. Childhood immunisation and implementation of strategies to achieve signicant immunisation coverage should be prioritised during pandemics.

Effective Approaches to Combat Vaccine Hesitancy.

Effective Approaches to Combat Vaccine Hesitancy.

Uptake of infant and preschool immunisations in Scotland and England during the COVID-19 pandemic: An observational study of routinely collected data.

In 2020, the SARS-CoV-2 (COVID-19) pandemic and lockdown control measures threatened to disrupt routine childhood immunisation programmes with early reports suggesting uptake would fall. In response, public health bodies in Scotland and England collected national data for childhood immunisations on a weekly or monthly basis to allow for rapid analysis of trends. The aim of this study was to use these data to assess the impact of different phases of the pandemic on infant and preschool immunisation uptake rates. We conducted an observational study using routinely collected data for the year prior to the pandemic (2019) and immediately before (22 January to March 2020), during (23 March to 26 July), and after (27 July to 4 October) the first UK "lockdown". Data were obtained for Scotland from the Public Health Scotland "COVID19 wider impacts on the health care system" dashboard and for England from ImmForm. Five vaccinations delivered at different ages were evaluated; 3 doses of "6-in-1" diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP/IPV/Hib/HepB) and 2 doses of measles, mumps, and rubella (MMR) vaccine. This represented 439,754 invitations to be vaccinated in Scotland and 4.1 million for England. Uptake during the 2020 periods was compared to the previous year (2019) using binary logistic regression analysis. For Scotland, uptake within 4 weeks of a child becoming eligible by age was analysed along with geographical region and indices of deprivation. For Scotland and England, we assessed whether immunisations were up-to-date at approximately 6 months (all doses 6-in-1) and 16 to 18 months (first MMR) of age. We found that uptake within 4 weeks of eligibility in Scotland for all the 5 vaccines was higher during lockdown than in 2019. Differences ranged from 1.3% for first dose 6-in-1 vaccine (95.3 versus 94%, odds ratio [OR] compared to 2019 1.28, 95% confidence intervals [CIs] 1.18 to 1.39) to 14.3% for second MMR dose (66.1 versus 51.8%, OR compared to 2019 1.8, 95% CI 1.74 to 1.87). Significant increases in uptake were seen across all deprivation levels. In England, fewer children due to receive their immunisations during the lockdown period were up to date at 6 months (6-in-1) or 18 months (first dose MMR). The fall in percentage uptake ranged from 0.5% for first 6-in-1 (95.8 versus 96.3%, OR compared to 2019 0.89, 95% CI 0.86- to 0.91) to 2.1% for third 6-in-1 (86.6 versus 88.7%, OR compared to 2019 0.82, 95% CI 0.81 to 0.83). The use of routinely collected data used in this study was a limiting factor as detailed information on potential confounding factors were not available and we were unable to eliminate the possibility of seasonal trends in immunisation uptake. In this study, we observed that the national lockdown in Scotland was associated with an increase in timely childhood immunisation uptake; however, in England, uptake fell slightly. Reasons for the improved uptake in Scotland may include active measures taken to promote immunisation at local and national levels during this period and should be explored further. Promoting immunisation uptake and addressing potential vaccine hesitancy is particularly important given the ongoing pandemic and COVID-19 vaccination campaigns.

Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: perspectives from caregivers, community leaders, and healthcare workers.

vaccination is one of the most successful and cost-effective public health interventions, significantly reducing childhood morbidity and mortality. In 2019, Nigeria had almost 2.5 million unvaccinated children. This study highlights barriers, facilitators, and recommendations for childhood immunisation uptake from various stakeholder perspectives. the study team conducted ten focus groups with mothers/caregivers and community leaders and nine semi-structured interviews with healthcare workers who provide routine immunisation services in Lagos State primary healthcare facilities. We performed a descriptive thematic analysis of the focus groups and semi-structured interviews. study participants included 44 mothers/caregivers and 24 community leaders, and 19 primary healthcare workers in the State. Study participants reported barriers, facilitators, and recommendations for childhood immunisation uptake. Barriers include poor geographical and financial constraints to access healthcare services, inconducive health facility attributes, negative attitudes of health facility staff, vaccination misperceptions, and adverse events following immunisation. Facilitators include free immunisation service policy, optimal vaccine and device supply chain system, adequate knowledge of immunisation benefits and efficacy, vaccination outreaches, and provision of incentives to caregivers. Participants also made recommendations for implementation, including more awareness creation, use of community resources, employing more healthcare workers, frequent and optimal immunisation services and planning, and instituting a reminder system and defaulter tracking. Conclusion: our results can inform the development of interventions to improve childhood immunisation uptake. In addition, study findings can be employed to improve adult immunisation acceptance and uptake and other services provided within the primary healthcare setting.

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

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