Childhood Immunization Uptake Research Articles

Migration and immunization: determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India

To determine the coverage of childhood immunization appropriate for age among socioeconomically disadvantaged rural-urban migrants living in Delhi and to identify the determinants of full immunization uptake among these migrant children. This is a cross-sectional survey of 746 rural-urban migrant mothers with a child aged up to 2 years, who were interviewed with a pretested questionnaire. Data pertaining to the reception of various vaccines, migration history and some other social, demographic and income details were collected. Multiple logistic regression analyses were performed to identify the determinants of full immunization status. Immunization coverage rates were lower among migrants than the general population of Delhi and even lower among recent migrants. The likelihood of a child receiving full immunization rose with age of the mother, her educational attainment and the frequency of her use of health care. The head of household having a secured salaried job also significantly increased the likelihood of full immunization, as did post-natal visits by a health worker. Migrant status favours low immunization uptake particularly in the vulnerability context of alienation and livelihood insecurity. Services must be delivered with a focus on recent migrants; investments are needed in education, socio-economic development and secure livelihoods to improve and sustain equitable health care services.

Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants.

BackgroundImmunization coverage in many parts of Nigeria is far from optimal, and far from equitable.Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world, and the country is among the ten countries in the world with vaccine coverage below 50 percent. Studies focusing on community-level determinants therefore have serious policy implicationsMethodsMultilevel multivariable regression analysis was used on a nationally-representative sample of women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey. Multilevel regression analysis was performed with children (level 1) nested within mothers (level 2), who were in turn nested within communities (level 3).ResultsResults show that the pattern of full immunization clusters within families and communities, and that socio-economic characteristics are important in explaining the differentials in full immunization among the children in the study. At the individual level, ethnicity, mothers' occupation, and mothers' household wealth were characteristics of the mothers associated with full immunization of the children. At the community level, the proportion of mothers that had hospital delivery was a determinant of full immunization status.ConclusionSignificant community-level variation remaining after having controlled for child- and mother-level characteristics is indicative of a need for further research on community-levels factors, which would enable extensive tailoring of community-level interventions aimed at improving full immunization and other child health outcomes.

Uptake Of Childhood Immunization Among Mothers Of Under-Five In Southwestern Nigeria

Background Immunization preventable childhood diseases are a major cause of the under five mortality in Nigeria. Objective The study was aimed at determining the awareness, attitude of mothers of under-five towards immunization and proportion of children fully immunized in the 12-28 month age. Methods The study was a descriptive cross sectional household survey of perception of mothers with children under 5 years of age to immunization in Igbo-Ora, Oyo state. A cluster sampling of the mothers were carried out. Results A total of 503 mothers were interviewed with a mean age of 27.3 years and SD of 5.7 years. The mean age of the children was 19.7 months with a SD of 14.4 months. Almost all the women interviewed (99%) were aware of the immunization with 65.7% obtaining information at antenatal clinics. A good proportion of children aged 12 to 33 months were fully immunized (76.9%), 30% were partially immunized and 0.7% were not fully immunized. Majority had good attitudes to immunization with 84.3% having attitude scores of 75% and above. Immunization of the children was not significantly associated with the socio-demographic characteristics at 5% level of significance. The reasons reported for not completing immunization include long waiting on queues (46.1%), payment at private clinics (20.2%) and distance (17.7%). Conclusion The role of antenatal clinic as a source of awareness should further be strengthened by training more health workers to work since majority of the respondents got informed about immunization in the antenatal clinics.

Residential mobility and uptake of childhood immunisations: Findings from the UK Millennium Cohort Study

It has been hypothesised that lower vaccine uptake in childhood among some groups, such as children of lone parents or from larger families, may be due to their higher levels of residential mobility. This paper aimed to explore this association in a large cohort of children born in the UK at the turn of the century. Using multi-variable Poisson regression we found that children who lived in families which had moved during pregnancy or more frequently were more likely to be partially immunised with the primary immunisations and unimmunised against measles, mumps and rubella. Mobility was not associated with being unimmunised with the primary vaccines, or with single measles, mumps and rubella antigen vaccine use. These findings suggest that policies are needed to encourage the building and maintenance of relationships between health care professionals and parents, before and after they move, and better use of IT systems to aid follow-up of mobile families.

Exploring childhood immunization uptake with First Nations mothers in north-western Ontario, Canada.

Childhood immunization is an important component of preventive health care for young children. Successful control of vaccine-preventable diseases depends on high levels of immunization coverage. Immunization statistics show that on-reserve First Nations (Native Indian) children have lower vaccination coverage than children in the general Canadian population. There has been little research, however, conducted with First Nations populations on this topic. This study explored First Nations parents' beliefs about childhood immunizations and examined factors influencing immunization uptake. This study used a qualitative descriptive design to explore the issue of childhood immunization uptake. Twenty-eight mothers from two First Nations communities in north-western Ontario, Canada, were interviewed about their perceptions of childhood immunizations and vaccine-preventable diseases. The interviews were transcribed and content analysis was used to examine the data. Data analysis revealed the following six themes: (1) the fear of disease; (2) the efficacy of immunizations; (3) the immunization experience; (4) the consequences of immunization; (5) interactions with health professionals; and (6) barriers to immunizations. Participants were motivated to seek immunizations for their children by a fear of vaccine preventable diseases. A small proportion of mothers, however, questioned the effectiveness of vaccines in preventing disease. Traumatic immunization experiences, vaccine side-effects and sequelae, negative interactions with health professionals, and barriers such as time constraints and childhood illnesses all served as deterrents to immunization. The research outcomes highlight the varied beliefs of First Nations parents about childhood immunizations and the numerous factors that both positively and negatively influence immunization uptake. Further research is needed to explore the issue of childhood immunizations in First Nations communities and to determine strategies to improve uptake.

Factors affecting uptake of childhood immunisation: a Bayesian synthesis of qualitative and quantitative evidence

Falls in levels of measles, mumps, and rubella (MMR) immunisation in the UK and the continuing debate on how to respond to this situation emphasise the importance of identifying and understanding the factors that affect the uptake of recommended childhood immunisations. Both qualitative and quantitative evidence could be useful in this process. We aimed to explore the feasibility and value of an approach to formal synthesis of qualitative and quantitative evidence in the context of factors affecting the uptake of childhood immunisation in developed countries. We used a Bayesian approach to meta-analysis. Evidence from 11 qualitative and 32 quantitative studies of factors affecting uptake of childhood immunisation was combined and assessed. We conclude that use of either qualitative or quantitative research alone might not identify all relevant factors, or might result in inappropriate judgments about their importance, and could thus lead to inappropriate formulation of evidence-based policy. Further development of our methods might enable rigorous synthesis of qualitative and quantitative evidence in this and other contexts.

Lay workers for improving the uptake of childhood immunization.

The aim of this review was to identify whether non-professional volunteer support might be effective in improving the uptake of child immunization. The Cochrane Library, Medline, Cumulative Index to Nursing and Allied Health Literature and Embase databases were searched for randomized controlled trials comparing groups of parents supported by lay volunteers with those supported by conventional child health services. Two such trials met the review criteria. These studies suggested that using non-professional volunteers to support parents can be an effective strategy for improving the uptake of immunization in children younger than 2 years, but there is limited evidence to suggest that this effect is sustained for older children, Equally, intervention effects could, because of differing cultural and sociodemographical factors, be less marked when applied to British populations, in which the parents of pre-school-aged children have access to immunization support from a generic health visiting service.

An audit into homeless families in temporary accommodation.

This article describes a clinical audit project undertaken in a number of hostels providing temporary housing for homeless families and individuals in Hinckley, Leicestershire. The audit, carried out over a 6-week period, aimed to collect information about the health and social needs of the residents in the hostels to determine whether an on-site dedicated health visiting service would be of any benefit to them. Family members housed in three council-run hostels were interviewed and a detailed questionnaire was completed. This was used to gather information about the facilities in the hostels, the nutritional and mental status and health and social needs of the residents, the uptake of childhood immunizations and child health surveillance. It also provided information about the resident families' contact with their family health visitor. Families were living in cramped conditions with shared facilities and no safe play areas for their children. The audit clearly demonstrated that the residents living in the hostels had a range of health problems similar to those described in the literature about the homeless. As a result of the audit, a number of recommendations were made which are discussed in this article.

Mothers’ Perceptions of Childhood Immunizations in First Nations Communities of the Sioux Lookout Zone

Low uptake of childhood immunizations is a problem in many First Nations communities. This article describes the results of a study that examined mothers' perceptions of childhood immunizations and the factors that influence uptake. Person-centred interviews focussing on childhood immunizations and child health were conducted with 28 mothers of young children in two First Nations communities in the Sioux Lookout Zone. Content analysis was applied to the interview data and patterns and themes were developed. Data analysis identified four key factors as negatively influencing immunization uptake: knowledge barriers, the influence of others, vaccine barriers, and missed opportunities. Further research with Elders and community members along with culturally sensitive education initiatives are required to address low immunization uptake. Changes in health professionals' behaviours may serve to reduce missed opportunities.

Demographic characteristics and primary health care utilization patterns of strictly orthodox Jewish and non-Jewish patients

The importance of providing health care services that are acceptable to different cultural groups is widely acknowledged. Strictly orthodox Jewish communities have particular health care needs that reflect their religious teaching and beliefs. To describe the demographic characteristics and health care usage patterns of the strictly orthodox Jewish population of Gateshead. Registration and claims data were used in combination with encounter data from computerized and manual practice records. Jewish patients were identified and comparisons made between Jewish and non-Jewish populations registered at the same practices. The orthodox Jewish population was predominantly young (69% aged under 20). The birth rate in orthodox Jewish women aged 20-44 was much higher (294 per 1000) than non-Jewish women. Rates of uptake of cervical screening and childhood immunizations were significantly lower in the orthodox Jewish population. Uptake of breast screening and attendance at diabetic clinics did not differ significantly. The average number of consultations and home visits per annum was higher in Jewish than in non-Jewish patients. The demographic and health care utilization patterns of orthodox Jewish and non-Jewish patients in Gateshead are different. There are implications for the provision of primary care services, particularly with regard to preventative health care.

The effect of home visiting programmes on uptake of childhood immunization: a systematic review and meta-analysis.

The aim of the study was to evaluate the effectiveness of home visiting programmes on the uptake of childhood immunization. A systematic review was carried out of the literature of controlled studies evaluating home visiting programmes involving at least one post-natal visit, which included tasks within the remit of British health visiting and reporting outcomes relevant to British health visiting. Eleven studies were considered, nine of which used socio-economically disadvantaged families. The outcome measure was uptake of a range of childhood immunizations. Eleven studies reported uptake of immunization. Effect sizes from nine studies were included in the meta-analysis. Fixed effects models demonstrated a significant effect of home visiting for all studies and also for several subgroups of studies, but with significant heterogeneity of effect sizes. A random effects model failed to demonstrate an effect of home visiting. Home visiting programmes have not been shown to be effective in increasing the uptake of immunization. Other methods of increasing uptake and reducing inequalities in uptake will need to be explored.

Health care incentives in immunisation

BackgroundAustralia has Introduced a nationwide immunisation incentive scheme. This yet to be evaluated two-year program offers financial rewards to providers and parents to encourage childhood immunisations. ObjectivesTo review the use of incentives in immunisation uptake, identify issues in developing an incentive program for childhood immunisation and examine the findings within the context of the Australian scheme. MethodsMedline was searched under ‘immunization and financial incentive’ and ‘immunization and incentive’ in English 1966 to 1998. ResultsThe search identified six and 93 articles respectively, of which six examined the role of material incentives influencing coverage of immunisation. References and reviews identified a further three studies. Among these nine studies (two British, six American, one Nicaraguan), two reported the same intervention. Of the eight incentives examined, four referred to non-financial incentives such as food vouchers and four to monetary incentives for parents (1) or providers (3). Groups receiving the incentives were up to three times more likely to be immunised and had overall immunisation rates up to 17% higher than comparison groups. ConclusionsEffective incentives require collaboration of key players, using a program appropriate to the characteristics of the population. Although varying in cost-effectiveness, both monetary and nonmonetary incentives can improve childhood immunisation uptake. Evaluation of current programs including the Australian ones will assist future allocation of resources.

Initiatives to improve childhood immunisation uptake: a randomised controlled trial

Levels of childhood immunisation are high in the United Kingdom but are proving difficult to maintain. Several initiatives to improve uptake have been described, including sending written information to parents,1...

Immunization uptake and doctors' perceptions of uptake in a minority group: Implications for interventions

Abstract Abstract Uptake of childhood immunizations was studied among orthodox Jews and others in North London, before and after the introduction of revised immunization schedules. Orthodox-Jewish uptake was lower than that of others, especially for immunizations that were administered later, were optional and seen as risky. Uptakes were compared with doctors' impressions of uptakes. Doctors' impressions of uptake were not always accurate: there was an over-optimistic impression of raised orthodox-Jewish uptake under the revised schedules. Some possible reasons for low orthodox-Jewish uptake were examined, including logistic difficulties of bringing babies for immunization when family size is large and the religious calendar is demanding, and mothers' perceptions of the riskiness of immunization. It was suggested that it may be important to examine health-related behaviour and beliefs in minority groups, as these may differ both from behaviour and beliefs in the majority, and from doctors' impressions of behaviour and beliefs. This in turn has implications for the design of interventions affecting behaviour and beliefs.

Comparison of uptake of breast screening, cervical screening, and childhood immunisation

The national breast screening programme invites women aged 50–64 to have mammography every three years, by using the lists of the family health services authorities and health boards to provide a call and recall system. Breast screening centres ask general practitioners to check previous notification lists, encourage attendance, provide practical advice, allay fears, and, with non-attenders, discuss breast screening. Despite the additional workload that promoting a high uptake entails no financial incentive is paid to general practitioners. Cervical screening and childhood immunisation are largely managed and delivered by general practitioners and primary care teams, although some practices also use a central call and recall system. General practitioners receive target payments (payments for reaching certain levels of uptake) for cervical screening and childhood immunisation.1 Different methods of management and remuneration may influence …

The uptake of childhood immunization and financial incentives to general practitioners.

Among the target-linked services introduced by the 1990 general practitioners' contract, childhood immunization in Scotland is the best suited for GPs to achieve the high target, given a centralized call and recall system and public confidence in the service. Yet over 25% of the practices in the area of the Greater Glasgow Health Board did not qualify for the high target payments in the last quarter of the 1991/92 financial year. Examining indicators of the socioeconomic characteristics of the patient population, practice profiles and the effect of financial incentives, we discuss the reasons for cross-practice variation in the uptake of this service and estimate the probability of practices which missed the high target achieving it in the future.

Ecological and individual effects in childhood immunisation uptake: A multi-level approach

Analyses of childhood immunisation uptake have traditionally been conducted at either the ecological or the individual scale. In this paper the problems stemming from these distinct strategies are explored and the potential of a multi-level modelling approach taking simultaneous account of processes at both levels is discussed. This discussion is set in the context of a case-study of pertussis immunisation uptake using data gathered from routine child health surveillance and immunisation uptake monitoring. The role of multi-level modelling in medical geographic research is briefly evaluated.