Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

Introduction: While the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them. Methods: In this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630). Results: According to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers. Conclusion: Our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components

Maternal Knowledge and Attitudes Toward Routine Immunization Among Mothers Patronizing Ugbiyokho Primary Healthcare Centre, Edo State

The study investigated maternal knowledge and attitudes toward routine immunization among mothers patronizing Ugbihoko Primary Healthcare Centre. It also assessed the influence of age, educational level and religion on the respondents. In view of these, eight research questions were raised and six hypotheses were formulated and tested at 0.05 level of significance. The theoretical framework of the study was hinged on the health belief model.The study utilized the descriptive survey research design. The population of the study was four and fifty-five (455) mothers of Ugbihoko quarters and its environs whose children are less than fifteen (15) months and have had their infants immunized at the Ugbihioko Primary Healthcare Centre. The sample size was two hundred and two (202) mothers selected from Ugbihioko Primary Healthcare Centre. The systematic sampling technique was used in selecting the respondents in the study. The instrument for the study was a self-structured questionnaire titled maternal knowledge and attitude towards routine immunization. The instrument was content and face validated by the researcher’s supervisor and two other experts from the Department of Health, Safety and Environmental Education, Faculty of Education, University of Benin, Benin City. To establish the reliability of the instrument on knowledge, the split half reliability was used and Kuda-Richardson 20 was used to analyze the collected data, while the internal consistency on the items on attitude was measured using Cronbach alpha statistics. The instrument was administered to 20 respondents who do not form part of the sample. Items measuring knowledge reported alpha values of 0.75 and 0.78 for attitude.    Data were analyzed using frequency counts, percentages and stated hypotheses were tested using chi square at 0.05 level of significance.It was discovered in the study that majority of the respondents have moderate knowledge on routine immunization, majority of the respondents in the study have positive attitudes toward routine immunization, knowledge on routine immunization among mothers patronizing Ugbiyokho Primary Health Care Center is significantly influenced by age, attitude toward routine immunization among mothers patronizing Ugbiyokho Primary Health Care Center are significantly influenced by age, knowledge of routine immunization among mothers patronizing Ugbiyokho Primary Health Care Center is significantly influenced by education, attitude of routine immunization among mothers patronizing Ugbiyokho Primary Health Care Center is not significantly influenced by education, knowledge of routine immunization among mothers patronizing Ugbiyokho Primary Health Care Center is significantly influenced by religion, attitudes of routine immunization among mothers patronizing Ugbiyokho Primary Health Care Center is significantly influenced by religion. It is recommended that mothers should be motivated to have their children immunized by doubling efforts at enlightening them and by reiterating the benefits of child immunization to pregnant women during ante-natal clinics. DOI: 10.7176/JEP/14-16-07 Publication date:June 30th 2023

Understanding internal accountability in Nigeria’s routine immunization system: perspectives from government officials at the national, state, and local levels

BACKGROUND: Routine immunization coverage in Nigeria has remained low, and studies have identified a lack of accountability as a barrier to high performance in the immunization system. Accountability lies at the heart of various health systems strengthening efforts recently launched in Nigeria, including those related to immunization. Our aim was to understand the views of health officials on the accountability challenges hindering immunization service delivery at various levels of government. METHODS: A semi-structured questionnaire was used to interview immunization and primary healthcare (PHC) officials from national, state, local, and health facility levels in Niger State in north central Nigeria. Individuals were selected to represent a range of roles and responsibilities in the immunization system. The questionnaire explored concepts related to internal accountability using a framework that organizes accountability into three axes based upon how they drive change in the health system. RESULTS: Respondents highlighted accountability challenges across multiple components of the immunization system, including vaccine availability, financing, logistics, human resources, and data management. A major focus was the lack of clear roles and responsibilities both within institutions and between levels of government. Delays in funding, especially at lower levels of government, disrupted service delivery. Supervision occurred less frequently than necessary, and the limited decision space of managers prevented problems from being resolved. Motivation was affected by the inability of officials to fulfill their responsibilities. Officials posited numerous suggestions to improve accountability, including clarifying roles and responsibilities, ensuring timely release of funding, and formalizing processes for supervision, problem solving, and data reporting. CONCLUSION: Weak accountability presents a significant barrier to performance of the routine immunization system and high immunization coverage in Nigeria. As one stakeholder in ensuring the performance of health systems, routine immunization officials reveal critical areas that need to be prioritized if emerging interventions to improve accountability in routine immunization are to have an effect

Missed immunization opportunities among children under 5 years of age dwelling In Karachi city

Background: Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi.Methods: A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data was analysed by using Statistical Package of Social Sciences.Results: There were around 59.09% (n=156) and 64.43% (n=165) parents who have correctly responded regarding the number of essential immunization visit during the first and second year of their child life respectively. About 28.12% (n=108) parents responded that they do not know about the name and number of missed doses of vaccines. 31.78% (n=122) parents responded that their children have missed either one or more than one doses of routine immunization vaccines. Of which 34.42% (n=42) children have missed more than one vaccine. Lack of knowledge regarding immunization schedule 28.68% (n=34), concern about vaccine side effects 21.31%, (n=26), child sickness 17.21% (n=21), and lack of trust about government 10.65%, (n=13) were the major barriers identified by parents for missed immunization opportunities.Conclusion: Parents have inadequate knowledge regarding routine immunization visits, immunization schedule and vaccine doses. The practices of parents for routine childhood immunization are also poor. Parents refuse to immunize their child because of lack of immunization visit knowledge and also because of their doubts regarding vaccine potency and side effects. A proper system of immunization promotion, advocacy and reminder systems with proper follow-up mechanism need to be developed by all healthcare centres

Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis

AbstractVaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication

HUBUNGAN IMUNISASI RUTIN LENGKAP TERHADAP PERTUMBUHAN DAN PERKEMBANGAN ANAK USIA 36-59 BULAN DI INDONESIA (ANALISIS DATA RISKESDAS TAHUN 2018)

WHO reports that 28.7% of children under five experience impaired growth and development in Southeast Asia. In Indonesia, the complete basic immunization coverage has not reached the target. It is 57.9%. This study aims to analyze the relationship of complete routine immunization with the growth and development of children in Indonesia. The method of data analysis uses a complex sample survey from Riskesdas 2018 with a cross sectional research design. Sampling used multistage random sampling with a sample of 10462 respondents. The results showed that the prevalence of children with abnormal growth was 27.1% and doubtful development was 39.9%. The results of multivariate analysis showed that there was no significant relationship between complete routine immunization and child growth (p value = 0.266; PR = 1.088; 95%CI = 0.9381.261) after controlling by variable sex and there was no significant relationship between complete routine immunization with child development (p value = 0.131; PR = 1.110; 95%CI = 0.969 -1.271) after controlling by variable access to health care facilities. Parents should provide complete routine immunizations, give an adequate food intake, maintain a clean environment and routinely bring children to the posyandu to monitor children's growth and development

Experiences from polio supplementary immunization activities in Anambra State, Nigeria

Background: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio‑free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization.Materials and Methods: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions.Results: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State’s cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero‑dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV3) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV3 target.Conclusion: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.Key words: Community involvement/participation, polio eradication, supplemental immunization activities, vaccination coverag

Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo.

BackgroundMeasles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS).MethodsWe examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence.ResultsUrban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas.ConclusionsResults indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control

Global Routine Immunization Policies For Refugees

BackgroundIn 2020, approximately 26 million refugees resettled in a new country—fleeing their homes due to conflict, persecution, violence, and human rights violations. Refugees often migrate from developing countries with limited access to adequate health care, routine immunizations, and public health resources. Because of low immunization coverage and potentially underlying health conditions, including stress, trauma, overcrowding during transit, poor hygiene and sanitation services, and malnutrition, refugees face a greater risk of contracting vaccine-preventable diseases (VPDs). This presents a key public health challenge and ethical imperative to serve the health needs of refugees resettling each year. ObjectiveThe purpose of our study was to collect, analyze, and compare policies and guidelines related to routine immunizations for refugees across 20 low- and middle-income countries (LMICs) and 20 high-income countries (HICs), with the highest number of refugees per 1000 residents. MethodsPrimary and secondary data sources were used to collect policy evidence from LMICs. Primary data were obtained from WHO-country officers, who were emailed between November and December 2020 to confirm data collected, provide additional information, and/or recommend different contact person(s). Secondary data for both LMICs and HICs were collected systematically through searches of information from government health ministries, public health agencies, non-governmental organizations, and the medical and public health literature. ResultsAmong the 20 LMICs, the number of refugees per 1000 residents ranged from 8 to 209 refugees, while for the 20 HICs it ranged from 2 to 15 refugees. Across the policy data collected for 20 LMICs, 13 countries specified standing routine immunization policies and guidelines applicable nationwide for refugees, five countries reported refugee vaccination guidelines only in response to specific infectious disease outbreaks, and six countries published guidelines on time-limited vaccination campaigns for refugees. Among the 20 HICs, 14 countries included refugees in their national routine immunization programs, 10 countries required a basic clinical screening prior to arrival, and 18 countries required a basic clinical screening upon arrival. Additionally, 15 HICs implemented local, community refugee clinics to provide routine immunizations, seven HICs required refugees to pay out of pocket for their vaccinations, and 11 HICs required refugees to receive specific vaccinations upon arrival. DiscussionRefugees are at increased risk of contracting infectious diseases. Our review of routine immunization policies and guidelines for refugees in 20 LMICs and 20 HICs, with the highest number of refugees per 1000 residents, found significant variations in how countries provide and deliver immunizations to their refugee communities. LMICs and HICs must strongly consider including refugees in their national routine immunization programs, providing easily accessible and affordable vaccinations, and collecting routine immunization data for refugees to reduce vaccine-preventable diseases and protect the health of refugee populations—especially during the COVID-19 pandemic