Déterminants du non-respect du calendrier vaccinal du programme élargi de vaccination au niveau district sanitaire : cas du district sanitaire de Boussé, Burkina Faso

Ouédraogo, Laurent; Ouédraogo, Seydou Mohamed; Ouédraogo, Z.T.; Traoré-Ouédraogo, Rasmata; Kam, Ludovic; Sawadogo, Amidou; Sondo, Blaise

doi:10.1016/j.medmal.2006.01.005

Cited by 11 publications

(4 citation statements)

References 7 publications

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“…This is not surprising, given the extent to which immunization activities are contingent upon the continuous availability of the vaccines. It confirms what has been largely demonstrated [15,16], including in Burkina Faso [8]. Third, immunization coverage did not change much in districts where geographic access improved during the period of observation.…”

Section: Discussionsupporting

confidence: 87%

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

Haddad

Bicaba

Feletto

et al. 2009

BMC Int Health Hum Rights

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BackgroundDespite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.MethodsA multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.ResultsThe districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).ConclusionThe discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.Abstract in FrenchSee the full article online for a translation of this abstract in French.

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Section: Discussionsupporting

confidence: 87%

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

Haddad

Bicaba

Feletto

et al. 2009

BMC Int Health Hum Rights

View full text Add to dashboard Cite

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“…In effect, combined analysis of these three dimensions at the district, regional, and national levels enables us to identify more clearly the extent to which children have received all the doses of vaccines, and the extent to which these doses respected the vaccination schedule, as well as the exact status of those who did not receive all the doses. At this time, there are studies [18-22] that have documented the various determinants of the elements of this performance, notably with respect to adherence to the vaccination schedule and full immunization coverage. More detailed studies should make it possible to better understand the reasons underlying the performance deficiencies encountered.…”

Section: Resultsmentioning

confidence: 99%

Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

Bicaba

Haddad²,

Kaboré³

et al. 2009

BMC Int Health Hum Rights

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BackgroundThe greatest challenge facing expanded programs on immunization in general, and in Burkina Faso in particular, lies in their capacity to achieve and sustain levels of immunization coverage that will ensure effective protection of children. This article aims to demonstrate that full immunization coverage of children, which is the primary indicator for monitoring national immunization programs, is sufficient neither to evaluate their performance adequately, nor to help identify the broad strategies that must be implemented to improve their performance. Other dimensions of performance, notably adherence to the vaccination schedule and the efficacy of the approaches used to reach all the children (targeting) must also be considered.MethodsThe study was carried out using data from surveys carried out in Burkina Faso: the 1993, 1998 and 2003 Demographic and Health Surveys and the 2003 national Survey of Immunization Coverage. Essentially, we described levels of immunization coverage and their trends according to the indicators considered. Performance differences are illustrated by amplitudes and maximum/minimum ratios.ResultsThe health regions' performances vary according to whether they are evaluated on the basis of full immunization coverage or vaccination status of children who have not completed their vaccinations. The health regions encompass a variety of realities, and efforts of substantially different intensity would be required to reach all the target populations.ConclusionDecision-making can be improved by integrating a tripartite view of performance that includes full immunization coverage, adherence to the vaccination schedule (timely coverage), and the status of children who are not fully vaccinated. With such an approach, interventions can be better targeted. It provides information on the quality and timeliness of vaccination and identifies the efforts required to meet the objectives of full immunization coverage.Abstract in FrenchSee the full article online for a translation of this abstract in French.

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“…- There were nevertheless reservations expressed regarding improving the quality of services, particularly the perceived quality [32]. Assurances about the quality of training provided to vaccination workers are nuanced at the regional level.…”

Section: Discussionmentioning

confidence: 99%

Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003)

et al. 2009

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BackgroundBurkina Faso's immunization program has benefited regularly from national and international support. However, national immunization coverage has been irregular, decreasing from 34.7% in 1993 to 29.3% in 1998, and then increasing to 43.9% in 2003. Undoubtedly, a variety of factors contributed to this pattern. This study aims to identify both individual and systemic factors associated with complete vaccination in 1998 and 2003 and relate them to variations in national and international policies and strategies on vaccination of rural Burkinabé children aged 12-23 months.MethodsData from the 1998 and 2003 Demographic and Health Surveys and the Ministry of Health's 1997 and 2002 Statistical Yearbooks, as well as individual interviews with central and regional decision-makers and with field workers in Burkina's healthcare system, were used to carry out a multilevel study that included 805 children in 1998 and 1,360 children in 2003, aged 12-23 months, spread over 44 and 48 rural health districts respectively.ResultsIn rural areas, complete vaccination coverage went from 25.9% in 1998 to 41.2% in 2003. District resources had no significant effect on coverage and the impact of education declined over time. The factors that continued to have the greatest impact on coverage rates were poverty, with its various dimensions, and the utilization of other healthcare services. However, these factors do not explain the persistent differences in complete vaccination between districts. In 2003, despite a trend toward district homogenization, differences between health districts still accounted for a 7.4% variance in complete vaccination.ConclusionComplete vaccination coverage of children is improving in a context of worsening poverty. Education no longer represents an advantage in relation to vaccination. Continuity from prenatal care to institutional delivery creates a loyalty to healthcare services and is the most significant and stable explanatory factor associated with complete vaccination of children. Healthcare service utilization is the result of a dynamic process of interaction between communities and the healthcare system; understanding this process is the key to understanding better the factors underlying the complete vaccination of children.

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Déterminants du non-respect du calendrier vaccinal du programme élargi de vaccination au niveau district sanitaire : cas du district sanitaire de Boussé, Burkina Faso

Cited by 11 publications

References 7 publications

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

Monitoring the performance of the Expanded Program on Immunization: the case of Burkina Faso

Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003)

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