Can vaccination coverage be improved by reducing missed opportunities for vaccination? Findings from assessments in Chad and Malawi using the new WHO methodology.

BACKGROUND: In 2015, the World Health Organization (WHO) updated the global methodology for assessing and reducing missed opportunities for vaccination (MOV), when eligible children have contact with the health system but are not vaccinated. This paper presents the results of two pilot assessments conducted in Chad and Malawi. METHODS: Using the ten-step global WHO MOV strategy, we purposively selected districts and health facilities, with non-probabilistic sampling of <24 month old children for exit interviews of caregivers and self-administered knowledge, attitudes, and practices (KAP) surveys of health workers. MOV were calculated based on a child's documented vaccination history (i.e., from a home-based record (HBR) or a health facility vaccination register), including selected vaccines in the national schedule. RESULTS: Respondents included caregivers of 353 children in Chad and of 580 children in Malawi. Among those with documented vaccination history, 82% (195/238) were eligible for vaccination in Chad and 47% (225/483) in Malawi. Among eligible children, 51% (99/195) in Chad, and 66% (149/225) in Malawi had one or more MOV on the survey date. During non-vaccination visits, 77% (24/31) of children eligible for vaccination in Chad and 92% (119/129) in Malawi had a MOV compared to 46% (75/164) and 31% (30/96) during vaccination visits, respectively. Among health workers, 92% in Chad and 88% in Malawi were unable to correctly identify valid contraindications for vaccination. CONCLUSION: The new MOV tool was able to characterize the type and potential causes of MOV. In both countries, the findings of the assessments point to two major barriers to full vaccination of eligible children-a lack of coordination between vaccination and curative health services and incomplete vaccination during vaccination visits. National immunization programs should explore tailored efforts to improve health worker practices and to increase vaccine delivery by making better use of existing health service contacts

Crimean-Congo Hemorrhagic Fever, Mauritania

A hospital outbreak of CCHF in Mauritania alerted authorities to sporadic cases occurring in the community; in all, 38 persons were infected

Reasons for non-vaccination for the proposed vaccines among children aged six weeks to 59 months in Bassikounou district reported in VCS2, Mauritania 2018.

Each children’s caregiver gave one reason for non-vaccination per dose of vaccine not received. In total 43 children gave 11 reasons for non-vaccination and 99 gave between 1 and 10 reasons for non- vaccination.</p

Children aged 12 to 59 months eligible for vaccination during 2RMASVC.

Children aged 12 to 59 months eligible for vaccination during 2RMASVC.</p

Reasons for non-vaccination questionnaire.

Standardized questionnaire to collect the reasons for non-vaccination by vaccine and doses. (XLSX)</p

Inclusivity in global research.

Although Mauritania carried out its Expanded Programme on Immunization (EPI), in 2015 the goal of vaccination coverage (VC) remained unmet in Bassikounou district and Mbera camp, contexts with large migrant populations. In response, during 2018, the national authorities, together with Médecins Sans Frontières organised two rounds of multi-antigenic mass vaccination campaigns (2RMASVC). The campaigns included oral polio (OPV), pneumococcal (PCV13), pentavalent and rotavirus vaccines for all eligible children six weeks to 59 months old. This study describes the results of the 2RMASVC. Cross-sectional household VC surveys (VCS1 and VCS2) were conducted before and after the 2RMASVC. Data were collected on vaccination status according to self-reporting and vaccination cards, and on reasons for non-vaccination (RNV). In total, 4,569 children received at least one dose of vaccine in the first round and 5,602 children in the second. Baseline VC, as fully vaccinated, according to VCS1, was 59.9% of children 12 to 59 months in Bassikounou district and 65.8% in Mbera camp. After the 2RMASVC, the coverages increased to 84.7% and 75.9% respectively. Absence from home, lack of motivation, late initiation of vaccinations and lack of awareness about vaccination were the main RNV during the 2RMASVC. Although the 2RMASVC did not reach its goal of 90%-95% VC, the strategy significantly increased VC in the two settings for children aged 12 to 59 months. Therefore, this catch-up approach could be considered to improve VC of children who miss out of the EPI strategy in resource-limited settings.</div

Reasons for non-vaccination for the proposed vaccines among children aged six weeks to 59 months in Bassikounou district reported in VCS1, Mauritania 2018.

Each children’s caregiver gave one reason for non-vaccination per dose of vaccine not received. In total 115 children gave 11 reasons for non-vaccination and 267 gave between 1 and 10 reasons for non-vaccination. (TIFF)</p

Vaccination status questionnaire.

Standardized questionnaire to obtain vaccination status by vaccine and doses among children aged six weeks to 59 months in Bassikounou district and Mbera camp, Mauritania 2018. (XLSX)</p