Opportunities to improve vaccination coverage in a country with a fledgling health system: Findings from an assessment of missed opportunities for vaccination among health center attendees—Timor Leste, 2016

Abstract

Introduction: Since its independence in 2002, Timor Leste has made significant strides in improving childhood vaccination coverage. However, coverage is still below national targets, and children continue to have missed opportunities for vaccination (MOV), when eligible children have contact with the health system but are not vaccinated. Timor Leste implemented the updated World Health Organization methodology for assessing MOV in 2016. Methods: The MOV data collection included quantitative (caregiver exit interviews and health worker knowledge, attitudes, practices surveys (KAP)) and qualitative arms (focus group discussions (FGDs) with caregivers and health workers and in-depth interviews (IDIs) with health administrators). During a four-day period, health workers and caregivers with children <24 months of age attending the selected eight facilities in Dili Municipality were invited to participate. The researchers calculated the proportion of MOV and timeliness of vaccine doses among children with documented vaccination histories (i.e., from a home-based record or facility register) and thematically analyzed the qualitative data. Results: Researchers conducted 365 caregiver exit interviews, 169 health worker KAP surveys, 4 FGDs with caregivers, 2 FGDs with health workers, and 2 IDIs with health administrators. Among eligible children with documented vaccination histories (n = 199), 41% missed an opportunity for vaccination. One-third of health workers (33%) believed their knowledge of immunization practices to be insufficient. Qualitative results showed vaccines were not available at all selected health facilities, and some facilities reported problems with their cold chain equipment. Conclusion: This study demonstrates that many children in Timor Leste miss opportunities for vaccination during health service encounters. Potential interventions to reduce MOV include training of health workers, improving availability of vaccines at more health facilities, and replacing unusable cold chain equipment. Timor Leste should continue to scale up successful MOV interventions beyond Dili Municipality to improve vaccination coverage nationally and strengthen the health system overall.

Assessment of missed opportunities for vaccination in Kenyan health facilities, 2016

“…Overall, all health workers must be trained on the vaccination schedule and further work may be useful to identify exact gaps in knowledge within the immunization schedule for targeted education. Additionally, although the questionnaire did not test their understanding of catch-up schedules, previous studies show this to be a confusing concept for many health workers and it is necessary to also ensure health workers understand the national policy on catch-up vaccination for children with a delayed schedule [5,29]. As Kenya has continued to add more antigens to their national immunization schedule, with varying target age groups (MCV second dose in 2015, IPV and YF in 2016 and human papillomavirus vaccine in 2019), the potential for MOV has increased and will accelerate further.…”

“…As of April 2019, a total of 12 countries across four WHO regions have implemented this methodology [7-9, 27, 28]. Recent studies in Chad, Malawi and Timor Leste using the updated WHO methodology showed that between 41-66% of eligible children had made contact with the health system and were not vaccinated with all the vaccines for which they were eligible [8,29]. In November 2016, to better understand the reasons for under-vaccination and to prioritize needed interventions, the Kenya NVIP conducted a MOV assessment using the updated WHO methodology [28].…”

COVID-19 and the Gaping Wounds of South Africa’s Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination

“…In 2016, the Strategic Advisory Group of Experts (SAGE) on immunisation recommended the prioritisation of MOV assessments, based on evidence indicating a global MOV prevalence of 32% [ 31 , 32 ]. While there is currently limited evidence on the magnitude of MOV and the multi-dimensional nature of the factors associated with it, research efforts in this area have increased over the last decade, including in African and other low- and middle-income countries [ 29 , 30 , 33 , 34 , 35 , 36 ].…”

Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis (Preprint)

“…While there is currently limited evidence on the structural and contextual factors responsible for missed opportunities for vaccination in different contexts, research efforts in this area have increased in recent years. As a result, there has been an increasing body of evidence on the prevalence of missed opportunities for vaccination and associated factors over the last decade, including in African and other low-and middle-income countries contexts [46][47][48][49][50][51]. To date, however, there remain enormous gaps in what is known.…”