Determining the burden of missed opportunities for vaccination among children admitted in healthcare facilities in India: a cross-sectional study

Abstract

ObjectivesChildren accessing healthcare systems represent a vulnerable population with risk factors for poor health outcomes, including vaccine-preventable diseases. We aimed to quantify missed vaccination opportunities among hospitalised children in India, and identify vaccination barriers perceived by caregivers and healthcare providers.DesignCross-sectional study.SettingTwo public-sector tertiary-care hospitals in northern India, during November 2018 and March 2019.ParticipantsWe tracked 263 hospitalised children aged 1–59 months through hospital discharge, to assess vaccination status, and document catch-up vaccinations given during the hospital stay. We interviewed caregivers and healthcare providers to assess their perceptions on vaccination.OutcomesProportion of hospitalised children considered under-vaccinated for their age; proportion of missed opportunities for vaccination among under-vaccinated children who were eligible for vaccination; and vaccine coverage by antigen.ResultsWe found that 65.4% (172/263) of hospitalised children were under-vaccinated for their age when they presented to the hospital. Among under-vaccinated children, 61.0% were less than 4 months old, and 55.6% reported prior contact with a health facility for a sick visit. The proportion of under-vaccinated children in hospitals were higher compared with the general population as indicated by regional vaccination coverage data. Among under-vaccinated children who were tracked till discharge, 98.1% (158/161) remained incompletely vaccinated at discharge and were considered ‘missed opportunities for vaccination’. Perceived vaccination contraindications that are not part of established contraindications included in national and international guidelines was the most common reason for healthcare providers not to vaccinate children during hospital stay. Among caregivers of under-vaccinated children, 90.1% reported being comfortable having their children vaccinated while they were sick, if recommended by the healthcare provider.ConclusionThis pilot study confirmed that hospitalised sick children had substantial missed vaccination opportunities. Addressing these opportunities through concerted actions involving caregivers, healthcare providers and healthcare systems can improve overall vaccination coverage.

Missed opportunities for vaccination (MOV) in children up to 5 years old in 19 Médecins Sans Frontières-supported health facilities: a cross-sectional survey in six low-resource countries

“…Our data draw attention to the high proportion of children missing an opportunity to get vaccinated at hospital level. A similar proportion has been found in a recent study performed in northern Indian hospitals 24. This could be explained by vaccine shortage at hospital level but also by the belief in the false contraindication for vaccination in a sick child among caregivers and healthcare workers.…”

“…A similar proportion has been found in a recent study performed in northern Indian hospitals. 24 This Open access could be explained by vaccine shortage at hospital level but also by the belief in the false contraindication for vaccination in a sick child among caregivers and healthcare workers. For example, a study in Haiti reported that up to 13% of reasons for undervaccination were child illness, despite the fact that mild infections should not prevent vaccination.…”

Prevalence of missed opportunities of immunization among children below two years attending primary healthcare centers In Baghdad/Al-Karkh

“…Compared to other regional countries UNICEF statistics report in 2015 shows the following results: Saudi Arabia (96%), Turkey (97.6%), Jordan and Iran (98%) and Syria (58%) [16] . Several reports from other countries revealed higher rates of MOI in comparison to our results; as that reported in Africa (47%) [22] , Ethiopia (49.1%) [23] , India (65.4%) [24] , and in Kenya (75%) [25] ; conversely, it was higher than that reported in China (12.6%) [26] , and South Africa (14.1%) [27] , and relatively similar to that reported in Sudan (35%) [28] and Pakistan (31.78%) [29] . These disparities in the MOI prevalence among the studies could be due to differences in MOI assessment methodologies regarding the study design, the study settings, the study population, study period differences, sample size, sampling techniques and low accessibility for healthcare facility infrastructure.…”

Influenza vaccine administration in a paediatric intensive care unit

“…Out of 43 children offered vaccination, there was 65% uptake. In another study, 65.4% (172/263) of hospitalised children were under‐vaccinated on presentation to hospital to two tertiary paediatric hospitals in India 11 . A study of 2329 children aged between 0 and 2 years found immunisations were delayed greater than or equal to 2 months in 18% (355) of children 12 .…”

“…In another study, 65.4% (172/263) of hospitalised children were under-vaccinated on presentation to hospital to two tertiary paediatric hospitals in India. 11 A study of 2329 children aged between 0 and 2 years found immunisations were delayed greater than or equal to 2 months in 18% (355) of children. 12 Successful administration of rotavirus vaccine has also been shown in neonatal intensive care units.…”