Closing the gap in Australian Aboriginal infant immunisation rates -- the development and review of a pre-call strategy

Abstract

BackgroundImproving timely immunisation is key to closing the inequitable gap in immunisation rates between Aboriginal children and non-Indigenous children. Aboriginal Immunisation Officers were employed in Hunter New England Local Health District (HNELHD), New South Wales (NSW), Australia, to telephone the families of all Aboriginal infants prior to the due date for their first scheduled vaccination.MethodsAboriginal Immunisation Officers contacted the families of Aboriginal children born in the Hunter New England Local Health District (HNELHD) by telephone before their due immunisation date (pre-call) to provide the rationale for timely immunisation, and to facilitate contact with culturally safe local immunisation services if this was required. The impact of this strategy on immunisation coverage rates is reviewed.ResultsFor the period March 2010 to September 2014 there was a significant increase in immunisation coverage rate for Aboriginal children at 12 months of age in HNELHD (p < 0.0001). The coverage in the rest of NSW Aboriginal children also increased but not significantly (p = 0.218). Over the full study period there was a significant decrease in the immunisation coverage gap between Aboriginal children and non-Indigenous children in HNELHD (p < 0.0001) and the rest of NSW (p = 0.004). The immunisation coverage gap between Aboriginal and non-Indigenous infants decreased at a significantly faster rate in HNELHD than the rest of NSW (p = 0.0001). By the end of the study period in 2014, immunisation coverage in HNELHD Aboriginal infants had surpassed that of non-Indigenous infants by 0.8 %.ConclusionsThe employment of Aboriginal immunisation officers may be associated with closing of the gap between Aboriginal and non-Indigenous infants’ immunisation coverage in HNELHD and NSW. The pre-call telephone strategy provided accelerated benefit in closing this gap in HNELHD.

Closing the vaccination coverage gap in New South Wales: the Aboriginal Immunisation Healthcare Worker Program

“…Improving Indigenous identification is a key activity of AIHCWs, as is contacting and directing Indigenous families with young infants to culturally appropriate vaccination services. A pre‐call strategy (contacting parents of Indigenous children before their scheduled vaccination dates), as practised by many AIHCWs, has been found to be of particular benefit in increasing vaccination coverage of Indigenous children 20 …”

“…A pre-call strategy (contacting parents of Indigenous children before their scheduled vaccination dates), as practised by many AIHCWs, has been found to be of particular benefit in increasing vaccination coverage of Indigenous children. 20 The rise in full vaccination coverage during the pre-AIHCW period among Indigenous and non-Indigenous children in NSW and the rest of Australia, particularly at the 51-month milestone, is probably attributable to a focus on improved timeliness of vaccination…”

Immunisation rates among children in Nuuk

“…A reminder-system using local health care workers and SMS has proven useful among Australian Aboriginals [23]. Other electronic tools such as apps for the parents could be considered, or organising events where multiple children are immunised and information accessible for the parents or giving more immunisations at the same age, so that the risk of falling behind is lower.…”

Improving the accuracy of ACIR data and increasing vaccination rates

“…Successful interventions in Aboriginal populations include personalised calendars, 11 telephoning families before the due date for immunisa-tion 12 and the introduction of the Aboriginal Immunisation Healthcare Worker Program in New South Wales. 13 In a before-after study, Western Sydney Aboriginal children who received a personalised calendar showed improved timeliness of vaccination.…”

“…11 The Hunter New England (HNE) pre-call strategy was introduced around the time when Aboriginal immunisation workers were being introduced in all jurisdictions in NSW. 12 The families of HNE Aboriginal babies were telephoned two weeks before the first scheduled vaccine and encouraged to get their vaccinations on time. There was a significant increase in immunisation coverage for HNE Aboriginal children at 12 months while the coverage for Aboriginal children in the rest of NSW increased but not significantly.…”