Household experience and costs of seeking measles vaccination in rural Guinea‐Bissau

Abstract

Abstractobjectives Children younger than 12 months of age are eligible for childhood vaccines through the public health system in Guinea-Bissau. To limit open vial wastage, a restrictive vial opening policy has been implemented; 10-dose measles vaccine vials are only opened if six or more children aged 9-11 months are present at the vaccination post. Consequently, mothers who bring their child for measles vaccination can be told to return another day. We aimed to describe the household experience and estimate household costs of seeking measles vaccination in rural Guinea-Bissau.methods Within a national sample of village clusters under demographic surveillance, we interviewed mothers of children aged 9-21 months about their experience with seeking measles vaccination. From information about time and money spent, we calculated household costs of seeking measles vaccination.results We interviewed mothers of 1308 children of whom 1043 (80%) had sought measles vaccination at least once. Measles vaccination coverage was 70% (910/1308). Coverage decreased with increasing distance to the health centre. On average, mothers who had taken their child for vaccination took their child 1.4 times. Mean costs of achieving 70% coverage were 2.04 USD (SD 3.86) per child taken for vaccination. Half of the mothers spent more than 2 h seeking vaccination and 11% spent money on transportation.conclusions We found several indications of missed opportunities for measles vaccination resulting in suboptimal coverage. The household costs comprised 3.3% of the average monthly income and should be taken into account when assessing the costs of delivering vaccinations.

Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities

“…MOV may be preventing countries from reaching their immunization targets. By ensuring that children who are already receiving health services are screened and vaccinated during regular health service encounters, addressing the underlying causes of MOV can significantly increase coverage and timeliness with minimal and sustainable cost [11][12][13][14].…”

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

“…Vaccines are often given later than scheduled partly because of the ‘restrictive vial-opening policy’. In Guinea-Bissau, focus on not wasting vaccines has led to a policy of not opening Bacillus Calmette–Guérin (BCG) and measles vaccine (MV) vials unless several children are present to be vaccinated [19,20], and similar policies are implemented in Burkina Faso. This policy creates missed vaccination opportunities for many children and leads to delayed vaccination with BCG and MV.…”

Health workers’ perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso

“…It is possible that health workers were worried about accountability for their allotted vaccines based on population estimates for children in their catchment geographic areas. The practice of not opening vials unless a certain minimum number of children were present has been observed in other resource-limited settings [26][27][28][29]. In an analysis of 46 countries, including Burkina Faso, one study revealed that missed opportunities to vaccinate children with MCV were more frequent than for diphtheria-pertussis-tetanus (DPT) vaccine or oral polio vaccine; this may in part be due to the fact that MCV is a lyophilized vaccine and must be discarded within a 6-to 8-h window once reconstituted or at the end of the immunization session, whichever comes first, whereas DPT and polio vaccines can be used as long as the Vaccine Vial Monitor is valid or the vaccine is not expired [30].…”