Family Health Days program contributions in vaccination of unreached and under-immunized children during routine vaccinations in Uganda

Mupere, Ezekiel; Babikako, Harriet; Okaba-Kayom, Violet; Mutyaba, Robert B.; Mwisaka, Milton Nasiero; Tenywa, Emmanuel; Lule, Albert; Aceng, Jane Ruth; Mpanga-Kaggwa, Flavia; Matseketse, David; Aga, Eresso

doi:10.1371/journal.pone.0218239

Cited by 4 publications

(7 citation statements)

References 11 publications

(10 reference statements)

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“…The north and south Buganda had the lowest rates of achievement for full vaccination. The central region (north and south Buganda), includes Kampala, the capital city of Uganda which grapples with unique challenges including having a large population of urban informal settlement dwellers (especially the urban-poor) as well as new populations with widely varying health seeking behaviour and limited access to public health services [ 7 ]. For example, it is sometimes argued that given the nature of their work, several caretakers fail to apportion time to take their children for immunization [ 7 ] leading to inequitable access to immunization services [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The central region (north and south Buganda), includes Kampala, the capital city of Uganda which grapples with unique challenges including having a large population of urban informal settlement dwellers (especially the urban-poor) as well as new populations with widely varying health seeking behaviour and limited access to public health services [ 7 ]. For example, it is sometimes argued that given the nature of their work, several caretakers fail to apportion time to take their children for immunization [ 7 ] leading to inequitable access to immunization services [ 31 ]. In addition to strengthening routine immunization, the government in partnership with UNICEF and other NGOs implemented supplementary immunization activities, such as Family Health Days, which significantly improved the coverage of DPT3 and MCV1 in the last decade [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, it is sometimes argued that given the nature of their work, several caretakers fail to apportion time to take their children for immunization [ 7 ] leading to inequitable access to immunization services [ 31 ]. In addition to strengthening routine immunization, the government in partnership with UNICEF and other NGOs implemented supplementary immunization activities, such as Family Health Days, which significantly improved the coverage of DPT3 and MCV1 in the last decade [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Facing a resurgence of vaccine-preventable human ( e.g., yellow fever) and animal diseases ( e.g., Peste des petits ruminants) due to increased sedentarism, efforts were recently made to deliver both human and animal vaccines to Karamoja [ 32 , 33 ]. According to Mupere et al [ 7 ], strengthened routine immunization in Karamoja allowed the region to achieve good coverage before Family Health Days were implemented in 2011 – a notable difference from other Ugandan regions.…”

Section: Discussionmentioning

confidence: 99%

“…However despite this overall relatively high coverage, inequities in access to vaccination has been noted and remains one of the biggest challenges in several districts of Uganda [ 7 ]. Such inequities should not be ignored, because persisting inequities in vaccine coverage can contribute to the frequent occurrence of outbreaks of vaccine preventable diseases [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity

Ssebagereka,

de Broucker,

Ekirapa-Kiracho

et al. 2024

BMC Public Health

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Background This study analyses vaccine coverage and equity among children under five years of age in Uganda based on the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Understanding equity in vaccine access and the determinants is crucial for the redress of emerging as well as persistent inequities. Methods Applied to the UDHS for 2000, 2006, 2011, and 2016, the Vaccine Economics Research for Sustainability and Equity (VERSE) Equity Toolkit provides a multivariate assessment of immunization coverage and equity by (1) ranking the sample population with a composite direct unfairness index, (2) generating quantitative measure of efficiency (coverage) and equity, and (3) decomposing inequity into its contributing factors. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon fair and unfair sources of variation in vaccination coverage. Our fair source of variation is defined as the child’s age – children too young to receive routine immunization are not expected to be vaccinated. Unfair sources of variation are the child’s region of residence, and whether they live in an urban or rural area, the mother’s education level, the household’s socioeconomic status, the child’s sex, and their insurance coverage status. For each unfair source of variation, we identify a “more privileged” situation. Results The coverage and equity of the Diphtheria-Pertussis-Tetanus vaccine, 3rd dose (DPT3) and the Measles-Containing Vaccine, 1st dose (MCV1) – two vaccines indicative of the health system’s performance – improved significantly since 2000, from 49.7% to 76.8% and 67.8% to 82.7%, respectively, and there are fewer zero-dose children: from 8.4% to 2.2%. Improvements in retaining children in the program so that they complete the immunization schedule are more modest (from 38.1% to 40.8%). Progress in coverage was pro-poor, with concentration indices (wealth only) moving from 0.127 (DPT3) and 0.123 (MCV1) in 2000 to -0.042 and -0.029 in 2016. Gains in overall equity (composite) were more modest, albeit significant for most vaccines except for MCV1: concentration indices of 0.150 (DPT3) and 0.087 (MCV1) in 2000 and 0.054 and 0.055 in 2016. The influence of the region and settings (urban/rural) of residence significantly decreased since 2000. Conclusion The past two decades have seen significant improvements in vaccine coverage and equity, thanks to the efforts to strengthen routine immunization and ongoing supplemental immunization activities such as the Family Health Days. While maintaining the regular provision of vaccines to all regions, efforts should be made to alleviate the impact of low maternal education and literacy on vaccination uptake.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity

Ssebagereka,

de Broucker,

Ekirapa-Kiracho

et al. 2024

BMC Public Health

View full text Add to dashboard Cite

show abstract

Accelerating access for all through research and innovation in immunization: Recommendations from Strategic Priority 7 of the Immunization Agenda 2030

Sarley

Hwang²,

Hall

et al. 2024

Vaccine

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Equity in vaccine coverage in Uganda from 2000 to 2016: Revealing the multifaceted nature of inequity.

Ssebagereka

Broucker

Ekirapa-Kiracho

et al. 2022

Preprint

View full text Add to dashboard Cite

Background This study analyses vaccine coverage and equity among children under five years of age in Uganda based on the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Understanding equity in vaccine access and the determinants is crucial for the redress of emerging as well as persistent inequities. Methods Applied to the UDHS for 2000, 2006, 2011, and 2016, the Vaccine Economics Research for Sustainability and Equity (VERSE) Equity Toolkit provides a multivariate assessment of immunization coverage and equity by (1) ranking the sample population with a composite direct unfairness index, (2) generating quantitative measure of efficiency (coverage) and equity, and (3) decomposing inequity into its contributing factors. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon fair and unfair sources of variation in vaccination coverage. Our fair source of variation is defined as the child’s age – children too young to receive routine immunization are not expected to be vaccinated. Unfair sources of variation are the child’s region of residence, and whether they live in an urban or rural area, the mother’s education level, the household’s socioeconomic status, the child’s sex, and their insurance coverage status. For each unfair source of variation, we identify a “more privileged” situation. Results DPT3 and MCV1 coverage and equity – two vaccines indicative of performance – improved significantly since 2000, from 49.7–76.8% and 67.8–82.7%, respectively, and there are fewer zero-dose children: from 8.4–2.2%. Improvements in retaining children in the program so that they complete the immunization schedule are more modest (from 38.1–40.8%). Except for MCV1, the main drivers for the lack of vaccination shifted from supply-side factors (e.g., availability of vaccines at clinics, disparities between regions) to more demand-side factors – primarily maternal education. Conclusion The past two decades have seen significant improvements in vaccine coverage and equity, thanks to the efforts to strengthen routine immunization and ongoing SIA such as the Family Health Days. While maintaining the regular provision of vaccines to all regions, efforts should be made to alleviate the impact of low maternal education and literacy on vaccination uptake.

show abstract

Family Health Days program contributions in vaccination of unreached and under-immunized children during routine vaccinations in Uganda

Cited by 4 publications

References 11 publications

Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity

Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity

Accelerating access for all through research and innovation in immunization: Recommendations from Strategic Priority 7 of the Immunization Agenda 2030

Equity in vaccine coverage in Uganda from 2000 to 2016: Revealing the multifaceted nature of inequity.

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