Mapping vaccination coverage to explore the effects of delivery mechanisms and inform vaccination strategies

Utazi, C. Edson; Thorley, Julia; Alegana, Victor A.; Ferrari, Matthew J.; Takahashi, Saki; Metcalf, C. Jessica E.; Lessler, Justin; Cutts, Felicity; Tatem, Andrew J.

doi:10.1038/s41467-019-09611-1

Cited by 94 publications

(111 citation statements)

References 41 publications

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“…There was a significant effect on both fully immunised status and DPT3 coverage up to more than two-hours. Observed lower odds of longer travel time on DPT3 compared to fully immunised status highlight a differential access problem since infants require three contacts with the health facility to receive DPT3 vaccine, which is typically delivered through stationary health posts unlike fully immunised status that is influenced by supplemental immunisation activities for measles and polio vaccines [ 63 ]. Across SSA, the effect of spatial access on immunisation uptake has been varied.…”

Section: Discussionmentioning

confidence: 99%

Spatial access inequities and childhood immunisation uptake in Kenya

et al. 2020

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Background Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. Methods Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. Results Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33–0.94) and receive DPT3 [AOR:0.51(0.21–0.92) after controlling for household wealth, mother’s highest education level, parity and urban/rural residence. Conclusion Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.

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Section: Discussionmentioning

confidence: 99%

Spatial access inequities and childhood immunisation uptake in Kenya

et al. 2020

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“…The 2018 PMCCS confirmed that SIAs reach much higher coverage than routine in much of Nigeria and importantly, SIA coverage among previously MCV zero-dose children was high (27), suggesting that lack of acceptance of vaccination is not a major barrier. A mixedmethods study in two Nigerian states found that receipt of MCV was related to awareness of vaccination, parental education, maternal participation in decision-making, presence of a government vaccination facility, and lack of barriers such as having to pay for vaccination (48).…”

Section: Discussionmentioning

confidence: 80%

“…To compound the problem of low average coverage, Nigeria was recently ranked highest among 45 GAVIsupported countries for inequity in coverage (46,47) Crude coverage of MCV was higher than that of Penta3, and four states achieved over 80% coverage for measles. This probably reflects the inclusion of campaign doses in the measure of measles vaccination coverage (27), as about half the age cohort included in MICS-NICS would have been eligible for the 2015-16 measles SIA. This conclusion is supported by the finding that MCV coverage was slightly lower than Penta3 coverage among children with cards (where documented doses reflect RI) whereas it was about twice as high as Penta3 by recall (Table 1) and the low availability of HBR meant that most information was obtained by verbal recall, though some missed-opportunities to give Penta when a child present late for vaccination cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

“…If no HBR was seen, caretakers were asked whether the child had received each vaccine-dose in the schedule and their answer was recorded as verbal recall. The availability of HBR in Nigeria has been below 50% in all recent surveys and even though recent guidance recommends that interview teams might visit health facilities to seek documentation for children lacking HBRs (4,9,27), health facility visits were not included in this survey due to logistical and resource constraints.…”

Section: Introductionmentioning

confidence: 99%

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Implementing WHO Guidance on Conducting and Analysing Vaccination Coverage Cluster Surveys: Two Examples from Nigeria

Wagai¹,

Rhoda²,

Prier³

et al. 2020

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In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software to calculate them. In addition to tabular presentations of coverage by vaccine and age group, the guidance document and software (named the Vaccination Coverage Quality Indicators - VCQI) – provide insight into crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. The current WHO survey guidance was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria – one to assess routine immunization and one to measure post campaign coverage. The primary analysis for both surveys was conducted using VCQI. This paper describes those surveys and highlights some of the analyses that are facilitated by the new resources.

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“…Nonetheless, there has been a limited number of research in DRC concerning vaccination dropout (36). To our knowledge, the present study is the rst conducted at both ne spatial scale and individual level to understand the main health concern of vaccine services and identify factors related to low vaccination completeness among children aged 12-23 months.…”

Section: Discussionmentioning

confidence: 98%

Vaccination Dropout Rates Among Children Aged 12-23 Months in the Urban-Rural Health District of Mont Ngafula II, Democratic Republic of the Congo: A Cross-sectional Study

Ntumba¹,

Vangola²,

Ansobi³

et al. 2020

Preprint

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Background: Globally, 1.8 million children failed to receive the 3-dose diphtheria, tetanus and pertussis (DTP) series every year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces, including the capital of Kinshasa, is launched to reinforce routine immunization. The Mont Ngafula II health district (HD) was the only one to report high vaccination dropout rates over almost five consecutive years. This study aimed to assess issues within the local dynamic system of vaccination services and identify associated risk factors among children aged 12-23 months. Methods: A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from local authority of HD and mapped. Chi-square test and multivariate logistic regression were used to identify predictors of high vaccination dropout. Statistical significance was defined as p < 0.05. Results: Of 14 health areas included in the Mont Ngafula II HD, four reported high vaccine coverage, only one recorded low vaccine coverage and three registered both low vaccine coverage and high dropout rate. Multivariate logistic regression showed the predictors of immunization dropout as follows: no possession of immunization card (aOR = 2.49; 95% CI = 1.25-4.93; p = 0.010), living in rural areas (aOR = 1.53; 95% CI = 1.02-2.32; p = 0.042), unavailability of seating places (aOR = 7.10; 95% CI = 1.39-36.27; p = 0.019), no respect of the order of arrival (aOR = 3.88; 95% CI = 1.48-10.16; p = 0.006) during vaccination in health facilities, and the lack of a reminder system on days before the scheduled vaccination (aOR = 2.17; 95% CI = 1.43-3.32; p < 0.001). Conclusion: The poor utilization of immunization services seemed as the main health concern followed by the poor access. Residing in rural areas, no immunization card possession, absence of seating places, no respect of the order of arrival, and the lack of a reminder system were the predictors of vaccination dropout rates. These results advocate for prioritizing targeted interventions and programs that will strengthen interpersonal communication between vaccination service providers and users during vaccination in health facilities as well as implement and extend a reminder system using SMS reminders on days before the scheduled vaccination.

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Mapping vaccination coverage to explore the effects of delivery mechanisms and inform vaccination strategies

Cited by 94 publications

References 41 publications

Spatial access inequities and childhood immunisation uptake in Kenya

Spatial access inequities and childhood immunisation uptake in Kenya

Implementing WHO Guidance on Conducting and Analysing Vaccination Coverage Cluster Surveys: Two Examples from Nigeria

Vaccination Dropout Rates Among Children Aged 12-23 Months in the Urban-Rural Health District of Mont Ngafula II, Democratic Republic of the Congo: A Cross-sectional Study

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