Social determinants of immunization services uptake in developing countries: a systematic review

Introduction: immunization is a strong pillar of community health. Attainment of the desired immunization coverage is always dependent on a range of determinants. These determinants are normally put into broad categories as immunization system based, clients based and service providers based. The objective of this study is to explore determinants of immunization services uptake in developing countries. This study reports magnitude of system, providers, and clients based determinants of immunization uptake in developing countries. Methods: systematic documentary review was a method for this study. Literature searches were made using Research4Life, HINARI and other online publication sources to identify relevant research articles. Twenty-six articles were reviewed. Results: seventeen Key Determinants were identified with frequencies in brackets: caregivers' social status (25); caregivers' knowledge on immunization (22); access to immunization services and information (20); health workers' knowledge attitude and practice (12); social influence and support (110); quality of immunization services (10); alternative strategies for hard-to-reach populations (9); caregivers' perceptions about immunization (7); gender (7); and care givers' beliefs and attitude towards immunization (6). Overall, 62.3% of the key determinants were clients based; 29.5% were immunization system based; 8.2% were providers based. Conclusion: majority of immunization services uptake determinants are based on clients. Therefore, immunization interventions in developing countries should majorly focus on social behaviour change communication.The Pan African Medical Journal 2016;2

Implementation of distance learning IMCI training in rural districts of Tanzania

Abstract Background The standard face-to-face training for the integrated management of childhood illness (IMCI) continues to be plagued by concerns of low coverage of trainees, the prolonged absence of trainees from the health facility to attend training and the high cost of training. Consequently, the distance learning IMCI training model is increasingly being promoted to address some of these challenges in resource-limited settings. This paper examines participants’ accounts of the paper-based IMCI distance learning training programme in three district councils in Mbeya region, Tanzania. Methods A cross-sectional qualitative descriptive design was employed as part of an endline evaluation study of the management of possible serious bacterial infection in Busokelo, Kyela and Mbarali district councils of Mbeya Region in Tanzania. Key informant interviews were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers, including beneficiaries and training facilitators. Results About 60 key informant interviews were conducted, of which 53% of participants were healthcare workers, including nurses, clinicians and pharmacists, and 22% were healthcare administrators, including district medical officers, reproductive and child health coordinators and programme officers. The findings indicate that the distance learning IMCI training model (DIMCI) was designed to address concerns about the standard IMCI model by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. The DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology (e.g., computers) and unfriendly learning materials. Personal challenges included work-study-family demands, and design and coordination challenges, including low financial incentives, which contributed to participants defaulting, and limited mentorship and follow-up due to limited funding and transport. Conclusion DIMCI was implemented successfully in rural Tanzania. It facilitated the training of many healthcare workers at low cost and resulted in improved knowledge, competence and confidence among healthcare workers in managing sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas; these will need to be addressed to maximize the success of DIMCI