Immunization Uptake Research Articles

Perception of Childhood Routine Immunisation among Adults in Selected Communities of Ido Local Government Area, Ibadan, Oyo State, Nigeria

Aims: Immunisation is one of the medical achievements of the twentieth century; however, some vaccines are receiving less and less support. Increasing people's understanding of vaccination's direct advantages, beyond avoiding infectious diseases, may aid in regaining vaccine acceptance for children two years and below. The study determines the perception of childhood routine immunization among adults in selected communities of Ido Local Government Area, Ibadan, Oyo State. Study Design: Mixed method study design. Methodology: A mixed-method study design that adopted a multi-stage sampling technique to select 417 respondents for the study was used. Two instruments were used for data collection: a questionnaire and an in-depth interview guide. The questionnaire assessed perceived severity and benefits with 36 items each, and scores below < 19 and score ≥ 19 were categorized as low and high for each variable, respectively. Quantitative data was analyzed using descriptive and inferential (Chi-square) statistics at a significance level 0.05. The qualitative data was analyzed using a thematic approach Results: There were 41(9.8%) men and 376(90.2%) women, totaling 417 adults. The respondents 208 (49.9%) have a Secondary School Certificate, the highest educational qualification among the respondents. Results also revealed that 172(41.3%) of respondents had good knowledge about children's routine vaccinations. About 396(95.0%) had a high severity level of vaccine-preventable diseases. Also, 409(98.1%) had high perceived benefits of immunization uptake. Conclusion: This study showed a high level of perceived benefits of immunization uptake among the respondents. Since respondents perceptions of childhood routine immunization and education level were substantially correlated, the government should encourage and improve maternal education.

Determinants of uptake of routine immunization among mothers of under five children in rural areas of North-Eastern Nigeria

Background: Immunization against the vaccine preventable diseases is one of components of Primary Health Care and the most cost-effective public health intervention in the history of mankind: but it has failed to meet the health needs of the majority of the people particularly in underdeveloped countries. Method: this was a cross-sectional descriptive study that utilized interviewer administered questionnaire to 313 participants through multistage sampling. Data was analyzed using SPSS and a p-value of <0.05 was considered statistically significant. Results: about half (50.5%) of the study participants had good level of aggregate knowledge scores, nearly one-third (34.2%) had positive attitude, and about one quarter (25.9%) had good uptake/practice of routine immunization. After adjusting for the confounding effects using logistic regression analysis; educational status of secondary school (AOR=1.99, 95% CI=1.43 – 33.65) and tertiary (AOR=4.04,95%CI=3.25 – 15.75), number of ANC visit of > 4 times (AOR=3.02, 95%CI= 1.76 – 41.45) monthly income of >N70,000.00 (AOR=5.01, 95%CI=3.25 – 35.77), good aggregate knowledge scores of routine immunization (AOR=4.06 95%CI=2.99-13.89), and positive aggregate scores on attitudes of routine immunization (AOR=5.03, 95%CI= 5.13-27.33) remained significant predictors of uptake/practices of routine immunization among the study participants. Conclusions: most of the study participants had negative attitude on routine immunization that led to low uptake. It was recommended that more strategies that will ensure increase in uptake like health education and provision of adequate vaccine should be employed by the state government.

Effective integration of COVID-19 vaccination with routine immunization: A case study from Kinshasa, DRC

BackgroundIn response to the challenge of maintaining COVID-19 vaccination coverage amidst the pandemic, VillageReach, in collaboration with the Ministry of Public Health Prevention and Hygiene in Kinshasa, DRC, integrated COVID-19 vaccination with routine immunization services at two primary healthcare facilities. This initiative, launched in July 2022, represented the first of its kind in the DRC, aiming to assess the effectiveness and scalability of a multimodal vaccination approach. MethodsThrough a rapid appraisal involving key informant interviews and analysis of pre- and post-integration service delivery data, this case study explores the operational dynamics and outcomes of integrating COVID-19 and routine immunizations. ResultsResults demonstrated that the integrated approach not only maintained COVID-19 vaccine coverage but also significantly enhanced routine immunization uptake, particularly among under-immunized and zero-dose children. Overall, the vaccination sites, outreach, and integrated health facilities administered 229,983 (33 %) of COVID-19 vaccines in Kinshasa, of which 53 % were referred by community health workers. Additionally, 998 under-immunized children received routine immunizations, of whom 126 were zero-dose children. Key success factors included sustained community health worker engagement, neighborhood-specific strategies, accessible vaccination points, and robust data management. The findings suggest that such integrative strategies can effectively bolster immunization coverage in urban poor communities, offering valuable insights for similar initiatives in the DRC and beyond. ConclusionThis study advocates for sustained investment in innovative immunization models to strengthen primary healthcare systems post-pandemic.

Effect of oncology provider conversations on patients’ vaccination decision-making: Patient perspectives at a safety-net system.

266 Background: Low immunization rates among adults are associated with worse outcomes, particularly among immunocompromised individuals, such as those diagnosed with a cancer. To better understand vaccination communication and decision-making experiences among adult cancer patients treated at a safety-net system, we conducted structured interviews to: (1) explore patients’ perceptions of their oncology providers’ role in adult immunization, and (2) understand the potential factors that underlie patients’ hesitancy to receive vaccines. Methods: Parkland Health is the safety-net system for Dallas County, providing care for a primarily minority and un-/under-insured population. Cancer patients who had previously deferred or declined immunization participated in either in-person or telephone interviews in their preferred language (English/Spanish), using a structured 8-question interview guide. Questions centered on oncology providers’ role, vaccine hesitancy, and vaccine decision-making. Interviews averaged 12 minutes and were recorded for transcription. Aggregated interview responses were coded by question and interpreted through content analysis which noted frequency (i.e., times concept stated) and extensiveness (i.e., repetition across questions). Results: Thirteen patients were interviewed – 7 in English, 6 in Spanish. Patient’s perceived their oncology providers as highly important to their vaccination decision-making as they were: (1) more likely to get a vaccine if it is recommended by their provider (P2: Well, if the doctor hadn’t told me I wouldn’t have gotten vaccinated ; P3: If they didn’t recommend it, I would not get it ; P12: If they recommend it, it's worth looking into or thinking about ), and (2) identified their oncology provider as a preferred means for learning about vaccines (P8: Asking the doctor or the doctor communicating with us patients about a vaccine... in my personal opinion, I would say, go ahead and vaccinate me ). Patient-identified reasons for hesitancy included concerns about side effects (P2: “several people told me that is why we got cancer” ), fear of needles, previous negative experiences, and preference for alternative medicine approaches. Conclusions: Results from this preliminary study suggest that while patients may not initiate vaccination conversations with their oncology providers, they do identify their providers as influential in their decision-making. Oncology providers may not consider immunization as their primary responsibility but can be a primary source for effective vaccine communication in conjunction with the oncology care team. Findings from our patient interviews informed interventions in a quality improvement project to increase immunization uptake among cancer patients at our safety-net system.

Barriers to Childhood Immunisation and Local Strategies in Four Districts in South Africa: A Qualitative Study.

Introduction: In South Africa over the past 20 years, immunisation has saved countless lives as well as prevented illnesses and disabilities. Despite this, vaccine-preventable illnesses remain a danger. The demand for and uptake of immunisation services are shaped by a variety of factors that can either act as barriers or facilitators to immunisation uptake. The aim of this project was to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero-dose districts in South Africa. Materials and Methods: This study used a mixed-method approach. In each of these four districts, 15 in-depth key informant interviews with health workers and local health managers and four focus group discussions (10 participants per focus group discussion) with community members and caregivers were held over a three-month period. Transcribed interviews were thematically analysed using qualitative analysis software (Nvivo®) into 10 factors as identified as important in influencing immunisation demand and uptake in previous studies. A further four were identified during the data analysis process. Results: Despite the varying role of factors affecting demand and uptake of immunisation services, three consistent findings stand out as major barriers across all districts. The first is interaction with healthcare staff. This clearly highlights the crucial role that the interactions between patients and staff play in shaping perceptions and behaviours related to immunisation services. The second is the overall experience of care at healthcare facilities. This emphasises the role that patient experience of services plays in perceptions and behaviours related to immunisation services. The third is family dynamics. This highlights the important role family dynamics play in shaping individuals' decisions regarding immunisation uptake as well as the impact it has on the ability of people to access health services. Discussion: The role played by the different factors in the demand and uptake of immunisation services varied across the four districts examined in this study. Each of the districts presents a unique landscape where different factors have varying degrees of importance in affecting the utilisation of immunisation services. In some districts, certain factors are major barriers, clearly hindering the demand and uptake of immunisation services, while in others, these same factors might be a relatively minor barrier. This discrepancy highlights the unique nature of healthcare challenges across the districts and the need for tailored strategy recommendations to address them effectively.

Impact of the Welsh Government Flying Start programme on children’s BMI and immunisation uptake

Flying Start (FS) is the Welsh Government’s targeted Early Years programme for families with children under 4 years of age who live in some of the most disadvantaged areas of Wales. The programme aims to mitigate the impact of poverty which is linked to poor life outcomes in early childhood. In particular, this study aims to investigate the impact of FS programme on FS children’s health outcomes in the form of Body Mass Index (BMI) and immunisation uptake, using linking analysis. The datasets linked to the FS cohort are respectively the Child Measurement Programme (CMP) and the National Community Child Health (NCCH). CMP consists of routinely taking height and weight measures of children in reception year to monitor BMI, whereas the NCCH is used to monitor health surveillance programmes, including immunisation. This project will use linked data to investigate the prevalence of fully immunised children across different levels of engagement with FS programme (normal and under-engagement). It will also look at prevalence of different BMI thresholds (underweight, overweight, and normal weight) and differences in mean BMI scores by FS programme engagement levels. In particular, chi-square will be used to explore differences in the proportion of fully immunised children and BMI thresholds, and t-test will be used to identify between-group differences in mean BMI scores. Results from this programme will inform of long-term health outcomes in relation to Early Years programmes. It will also help policy target resources and inform relevant interventions to support the healthy growth of children.

Esoteric beliefs and CAM impact SARS-CoV-2 immunization drivers, uptake and pediatric immunization views in Germany

Recent studies demonstrate that sociopolitical attitudes partially explain variance in (SARS-CoV-2) vaccine hesitancy and uptake. Other attitudes, such as those towards esoteric beliefs, complementary and alternative medicine (CAM), and religion, have also been proposed. However, pertinent studies provide limited direction for public health efforts, as the impact of such attitudes has been tested in isolation or on different outcomes. Moreover, related associations between SARS-CoV-2 immunization drivers as well as views towards other modes of immunization (e.g., routine pediatric immunization), remain unclear. Based on a sample of ~7400 survey participants (Germany), where esoteric belief systems and CAM (Waldorf, homeopathy) are rather prevalent, and controlling for other sociological factors, we found that (i) individuals with positive attitudes towards Waldorf education and homeopathy are significantly less likely to have received a (further) dose of SARS-CoV-2 vaccine compared to those with positive views of mainstream medicine; (ii) for the former, immunization decisions are primarily driven by external pressures, and for the latter overwhelmingly by voluntary considerations; (iii) attitudes influencing adult SARS-CoV-2 vaccine uptake similarly influence views towards routine pediatric immunization. Our findings provide significant evidence informing a more nuanced design of public health and communication campaigns, and pertinent policies.

A New Validated Approach for Identifying Childhood Immunizations in Electronic Health Records in the United Kingdom.

Routinely collected electronic health records (EHR) offer a valuable opportunity to carry out research on immunization uptake, effectiveness, and safety, using large and representative samples of the population. In contrast to other drugs, vaccines do not require electronic prescription in many settings, which may lead to ambiguous coding of vaccination status and timing. We propose a comprehensive algorithm to identifying childhood immunizations in routinely collected EHR. In order to deal with ambiguous coding, over-recording, and backdating in EHR, we suggest an approach combining a wide range of medical codes in combination to identify vaccination events and using appropriate wash-out periods and quality checks. We illustrate this approach on a cohort of children born between 2006 and 2014 followed up to the age of five in the Clinical Practice Research Datalink (CPRD) Aurum, a UK primary care dataset of EHR, and validate the results against national estimates of vaccine coverage by NHS Digital and Public Health England. Our algorithm reproduced estimates of vaccination coverage, which are comparable to official national estimates and allows to approximate the age at vaccination. Electronic prescription data only do not cover vaccination events sufficiently. Our new proposed method could be used to provide a more accurate estimation of vaccination coverage and timing of vaccination for researchers and policymakers using EHR. As with all observational research using real-world data, it is important that researchers understand the context of the used dataset used and the clinical practice of recording.

The use of community-oriented primary care (COPC) model to generate vaccine demand: The case of a remote fishing community in Cameroon

BackgroundCameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model. MethodologyThis cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis. ResultsOver 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention. ConclusionThe use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.

Evaluating the impact of COVID-19 on routine childhood immunizations coverage in Zambia.

There are growing concerns about the comeback of vaccine-preventable diseases. Epidemics exert shocks which affect other health performance indicators such as routine immunizations. Early model forecasts indicate decreased use of immunization services, which puts children at greater risk. Concerns about an increase in morbidity and mortality for illnesses other than COVID-19, particularly in children missing routine vaccinations, are of public health interest. In this study, we evaluate COVID-19 effects on the uptake of routine immunization in Zambia.This was an interrupted time series study. National data on routine immunization coverage between January 2017 and December 2022 were analyzed. Interrupted time series analysis was performed to quantify changes in immunization utilization. To determine if changes in the underlying patterns of utilization of immunization service were correlated with the commencement of COVID-19, seasonally adjusted segmented Poisson regression model was utilised.Utilization of health services was similar with historical levels prior to the first case of COVID-19. There was a significant drop in immunization coverage for measles dose two (RR, 0.59; 95% CI: 0.43-0.80). A decreased slope was observed in immunization coverage of Rotavirus dose one (RR, 0.97; 95% CI: 0.96-0.98) and Rotavirus dose two (RR, 0.97; 95% CI: 0.96-0.98). A growing slope was observed for Oral Poliovirus two (RR, 1.007; 95% CI: 1.004-1.011) and Oral Poliovirus three (RR, 1.007; 95% CI: 1.002-1011). We also observed a growing slope in BCG Bacille Calmette-Guerin (BCG) (RR, 1.001; 95% CI: 1.000-1011) and Pentavalent one (RR, 1.00; 95% CI: 1.001-1008) and three (RR, 1.004; 95% CI: 1.001-1008).The COVID-19 pandemic has had a number of unintended consequences that have affected the use of immunization services. Ensuring continuity in the provision of health services, especially childhood immunization, during pandemics or epidemics is crucial. Therefore, Investing in robust healthcare infrastructure to withstand surges, training and retaining a skilled workforce capable of handling emergencies and routine services simultaneously is very cardinal to avoid vaccine-preventable diseases, causing long-term health effects especially child mortality.

Pharmacist's role in influenza immunisation: a scoping review

AbstractBackgroundCommunity pharmacists have become flu vaccine immunisers in several countries to increase vaccine uptake.AimThis study aimed to perform a scoping review to evaluate the pharmacist's role and contribution to flu immunisation coverage, satisfaction and promotion as vaccine providers.DesignThe framework proposed by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews (PRISMA‐ScR) were considered for this analysis. Two electronic databases (PubMed and Cochrane Library) were used to search for relevant peer‐reviewed quantitative, qualitative and mixed‐method studies published between 1990 and 2022.ResultsA total of 37 studies were included. These studies suggested that, over time, there was an increase in the rate of vaccine administration within community pharmacies across the various countries examined. Moreover, patients have consistently expressed their satisfaction with the convenience and accessibility of pharmacy‐based vaccine services, with some expressing a preference for pharmacies over traditional visits to their general practitioner′s office.ConclusionSeveral initiatives aimed at promoting flu vaccination have been rolled out in pharmacy settings, and a number of these initiatives have demonstrated positive outcomes. The flu vaccination service provided by pharmacists has proven to be an asset in public health by improving accessibility to immunisation services. Pharmacists should continue to take part in yearly flu vaccination programs as flu vaccine providers as they contribute to an increased uptake of immunisations by the population. Extending these services to other vaccines should be further considered.

Recent increase in infant pertussis cases in Europe and the critical importance of antenatal immunizations: We must do better…now

Recent months have seen an increase in pertussis cases in several countries across the Northern and Southern hemispheres. The lack of immune stimulation during the COVID-19 pandemic due to the reduced circulation of Bordetella pertussis, the pathogen responsible for pertussis, is likely to have led to increased population susceptibility which has been magnified the typical three to five yearly cyclical peaks in activity. Maternal immunization for pertussis proves highly effective in protecting infants under three months of age. It's also critical for immunizers and parents to maintain high and timely immunization uptake to ensure infants receive maximum early protection when they are most at risk of severe disease.

Factors Associated with the Outcome of 2023 Diphtheria Outbreak in Jigawa State, Nigeria: A Retrospective Review of the Surveillance Data.

The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria. A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak. The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5-8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases <5 years of age (7.7%), female cases (5.9%), rural residence (7.7%) and cases from the northeast senatorial zone (8.2%) of the state. Significantly higher mortalities (8.8%, P = 0.003) were recorded amongst cases with nasopharyngitis. The odds of diphtheria-related mortality were higher amongst cases who presented clinically with nasopharyngitis and were 4 times more likely to die (adjusted odds ratio = 3.9; 95% confidence interval = 1.1-14.3) compared with those with no nasopharyngitis. Significantly higher mortalities were recorded amongst diphtheria cases whose samples were not taken, and those with nasopharyngitis. These findings underscored the importance of improved immunisation uptake, early and prompt case detection, investigation and proper management.

COVID-19 vaccine mistrust, health literacy, conspiracy theories, and racial discrimination among a representative ethnically diverse sample in Canada: The vulnerability of Arab, Asian, Black, and Indigenous peoples.

Despite increased risk of severe acute respiratory syndrome coronavirus 2infections and higher rates of COVID-19-related complications, racialized and Indigenous communities in Canada have lower immunization uptake compared to White individuals. However, there is woeful lack of data on predictors of COVID-19 vaccine mistrust (VM) that accounts for diverse social and cultural contexts within specific racialized and Indigenous communities. Therefore, we sought to characterize COVID-19 VM among Arab, Asian, Black, and Indigenous communities in Canada. An online survey was administered to a nationally representative, ethnically diverse panel of participants in October 2023. Arabic, Asian, Indigenous, and Black respondents were enriched in the sampling panel. Data were collected on demographics, COVID-19 VM, experience of racial discrimination, health literacy, and conspiracy beliefs. We used descriptive and regression analyses to determine the extent and predictors of COVID-19 VM among racialized and Indigenous individuals. All racialized respondents had higher VM score compared to White participants. Among 4220 respondents, we observed highest VM among Black individuals (12.18; ±4.24), followed by Arabic (12.12; ±4.60), Indigenous (11.84; ±5.18), Asian (10.61; ±4.28), and White (9.58; ±5.00) participants. In the hierarchical linear regression analyses, Black participants, women, everyday racial discrimination, and major experience of discrimination were positively associated with COVID-19 VM. Effects of racial discrimination were mediated by addition of conspiracy beliefs to the model. Racialized and Indigenous communities experience varying levels of COVID-19 VM and carry specific predictors and mediators to development of VM. This underscores the intricate interaction between race, gender, discrimination, and VM that need to be considered in future vaccination campaigns.

An Appraisal of Routine Immunization Coverage Among Children 0-2 Years in Akure South Local Government Area of Ondo State

Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases such as Tuberculosis, Poliomyelitis, Haemophilus Influenza type b (HIB), Diphtheria, Pertusis, Tetanus and Hepatitis B, neonatal tetanus yellow fever, measles, cerebrospinal meningitis and is estimated to avert between 2 and 3 million deaths each year. The objective of this study is to appraise routine immunization coverage among children 0-2 years in Akure South Local Government Area of Ondo State. This is a descriptive cross-sectional study, designed to appraise routine immunization coverage among children 0-2 years in Akure South Local Government Area of Ondo State. The study focused on children 0-2 years. Majority 102 (25.2%) of the respondents were within the age range of 25-29 years, 82 (20.5%) were &amp;gt;39 years. 314 (78.5%) were Yorubas. 385 (96.2%) had good knowledge while 15 (3.8%) had poor knowledge. 374 (93.5%) of the women have positive attitude while 26 (6.5%) of them have negative attitude. Most of the respondents, 391 (97.8%) of the respondents reported that they have taken their child to the health facility for immunization and 232 (58%) have taken their child to 4-5 immunization sessions. Based on the findings of the present study, it could be concluded that very few of the women had poor knowledge of childhood immunization, majority of the women had positive attitude score and practice of childhood immunization, practice of childhood immunization is quite high, and the uptake of childhood immunization is quite high.

Persistence and heterogeneity of the effects of educating mothers to improve child immunisation uptake: Experimental evidence from Uttar Pradesh in India

Childhood vaccinations are among the most cost-effective health interventions. Yet, in India, where immunisation services are widely available free of charge, a substantial proportion of children remain unvaccinated. We revisit households 30 months after a randomised experiment of a health information intervention designed to educate mothers on the benefits of child vaccination in Uttar Pradesh, India. We find that the large short-term effects on the uptake of diphtheria–pertussis–tetanus and measles vaccination were sustained at 30 months, suggesting the intervention did not simply bring forward vaccinations. We apply causal forests and find that the intervention increased vaccination uptake, but that there was substantial variation in the magnitude of the estimated effects. We conclude that characterising those who benefited most and conversely those who benefited least provides policy-makers with insights on how the intervention worked, and how the targeting of households could be improved.

Incomplete immunization uptake and associated factors among children aged 12–23 months in sub-Saharan African countries; multilevel analysis evidenced from latest demography and health survey data, 2023

BackgroundIn 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to control vaccine-preventable diseases, saving millions of lives annually. However, the coverage of basic vaccines recommended by the WHO in Africa was only 75%, which fell short of the goal of 90% by 2015. To formulate effective policies and implementation programs to reduce incomplete vaccination rates, it is important to conduct a study to determine the factors contributing to incomplete immunization among children aged 12–23 months.MethodsThe study was conducted in 16 sub-Saharan African countries, using data extracted from the latest DHS data. It was a community-based cross-sectional survey that used two-stage stratified probability sampling sample designs. The vaccination coverage was assessed using vaccination cards and mother recalls. Multilevel multivariable logistic regression was used to determine the extent of incomplete immunization and the individual and community-level factors associated with partial immunization among children aged 12–23 months. Variables with a p-value less than 0.05 were considered statistically significant predictors of incomplete immunization.ResultA total of 35, 193 weighted samples were used to determine the pooled prevalence of partial immunization. The pooled prevalence of incomplete immunization was 36.06%. In the final model factors significantly associated were: being uneducated mother(AOR:1.75;95%CI:1.48,2.05), being an unemployed mother (AOR:1.16;95%CI:1.09,1.23), no history of family planning utilization (AOR: 1.71; 95% CI: 1.61, 1.84), non-antenatal care (AOR: 1.79; 95% CI: 1.58, 2.04), non-postnatal care (AOR: 1.25; 95%CI: 1.17, 1.35), rural residence(AOR:1.50;95%CI:1.37,1.63), home delivery (AOR: 2.04; 95%CI:1.89, 2.21), having children more than five (AOR: 1.56; 95%CI: 1.13, 2.17), and non-utilization of health insurance (AOR: 1.74; 95%CI: 1.48, 2.05).ConclusionThe pooled prevalence of incomplete immunization was found to be high in this investigation. Based on the findings of the study we recommended that policymakers and stakeholders prioritize enhancing prenatal and postnatal care, contraception, and reducing home birth rates to minimize the rate of incomplete immunization.

Conspiracy Theories, Vaccine Hesitancy and Determinants of Vaccination Acceptance in Nigeria: A Conceptual Review

Purpose: This conceptual review aims to dissect the intricate web of conspiracy theories, vaccine hesitancy and determinants of vaccination acceptance within Nigeria's socio-cultural context, shedding light on their genesis, propagation and impact on public health outcomes. Methodology: Employing a multidisciplinary approach, this study synthesizes existing literature and theoretical frameworks from various disciplines, including sociology, anthropology, public health, and communication studies. Methodological rigor is ensured through comprehensive literature review and critical appraisal of relevant studies, enabling a holistic exploration of the subject matter. Findings: Through a systematic analysis, the review identifies and examines socio-cultural, economic and political influences that shape vaccination behavior in Nigeria. It illuminates the multifaceted determinants contributing to vaccine hesitancy, ranging from religious beliefs to historical legacies to socio-economic factors and healthcare accessibility challenges. The review also highlights the genesis and propagation of conspiracy narratives, their impact on public trust in vaccination and consequent implications for immunization uptake. Unique Contribution to Theory, Policy and Practice: This review makes several contributions to theory, policy, and practice in the field of vaccination and public health. Firstly, it advances theoretical understanding by synthesizing existing knowledge and proposing conceptual frameworks that elucidate the socio-cultural, economic, and political determinants of vaccination behavior in Nigeria. Secondly, it informs policy development by identifying key areas for intervention, such as addressing vaccine hesitancy, countering misinformation, and strengthening healthcare infrastructure to enhance vaccine delivery. Finally, it offers practical insights for public health practitioners and policymakers, providing evidence-based recommendations for designing effective vaccination campaigns, communication strategies, and community engagement initiatives tailored to the Nigerian context.

Effect of HIV-Integrated Care on Uptake of Maternal Health and Routine Childhood Immunization Services at Primary Health Care Facility in Northern Nigeria: An Interrupted Time Series Analysis

Background: This study assessed the effect of HIV-integrated care delivered within routine primary health care (PHC) in Kano, Nigeria, on the uptake of maternal health and routine childhood immunization services. Methods: A retrospective cohort design was used to review and collect anonymized data from medical records of women and children who accessed health care from the PHC facility between January 2009 and December 2016. Data were analyzed using SPSS version 22. Interrupted time series analysis (ITS) was performed to estimate changes in maternal and childhood immunization service usage over time following the delivery of the integrated care. Results: Uptake of maternal health services increased over time: antenatal care attendance (effect/month [95% confidence interval (CI)]: 6.6 [44.55–8.65], P = 0.0001), family planning (effect/month [95% CI]: 1.3 [0.26–2.26], P = 0.014), and delivery (effect/month [95% CI]: 0.9 [0.39–1.45], P = 0.0009). Uptake of routine immunization also increased over time with the integrated care: Bacille Calmette Guerin (BCG) (Effect/month [95% CI]: 1.8 [0.64–2.88], P = 0.002), and diphtheria, tetanus, and pertussis 1 (DPT1)/Penta 1 vaccinations (Effect/month [95% CI]: 1.0 [0.20–1.73], P = 0.013) also showed a moderate increase over time, but DPT3/Penta 3 vaccination dropped gradually over time (Effect/month [95% CI]: −0.1 [−0.74–0.46], P = 0.649). Conclusion: The integrated care resulted in increased uptake of both maternal health and childhood routine immunization services. This suggests that the reorganization and restructuring of the HIV-integrated care in the Kumbotso Comprehensive Health Centre has had a positive impact on non-HIV services provided at the center. There are still opportunities for further research to refine and elaborate on the novel findings of this study.

Effectiveness of behavioural change interventions to influence maternal and child healthcare-seeking behaviour in low and lower-middle-income countries: A systematic review of literature.

While behavioural change interventions are utilized in low- and lower-middle-income countries and may be essential in reducing maternal and child mortality, evidence on the effectiveness of such interventions is lacking. This review provides evidence on the effectiveness of behavioural change interventions designed to improve maternal and child healthcare-seeking behaviour in low- and lower-middle-income countries. We searched three electronic databases (PUBMED, EMBASE, and PsycINFO) for articles published in English and French between January 2013 and December 2022. Studies that evaluated interventions to increase maternal and child healthcare utilization, including antenatal care, skilled birth care, postnatal care, immunization uptake, and medication or referral compliance, were included. We identified and included 17 articles in the review. Overall, 11 studies found significant effects of the behavioural change interventions on the desired healthcare outcomes, 3 found partially significant effects, and 3 did not observe any significant impact. A major gap identified in the literature was the lack of studies reporting the effect of behavioural change interventions on women's non-cognitive and personality characteristics, as recent evidence suggests the importance of these factors in maternal and child healthcare-seeking behaviour in low-resource settings. This review highlights some intervention areas that show encouraging trends in maternal and child healthcare-seeking behaviours, including social influence, health education, and nudging through text message reminders.