Proportion of children aged 9–59 months reached by the 2017 measles supplementary immunization activity among the children with or without history of measles vaccination in Lilongwe district, Malawi

Abstract

Background The measles Supplementary Immunization Activity (SIA) was implemented in June, 2017 to close immunity gaps by providing an additional opportunity to vaccinate children aged between 9 months and up to 14 years in Lilongwe District, Malawi. This study was conducted to determine the proportion of eligible children that were reached by the 2017 measles SIA among those children with or without history of measles vaccination, and possible reasons for non-vaccination. Methods A cross-sectional survey using mixed methods was conducted. Caretakers of children who were eligible for the 2017 measles SIA were sampled from 19 households from each of the 25 clusters (villages) that were randomly selected in Lilongwe District. A child was taken to have been vaccinated if the caretaker was able to explain when and where the child was vaccinated. Eight Key Informant Interviews (KIIs) were conducted with planners and health care workers who were involved in the implementation of the 2017 measles SIA. Modified Poisson regression was used to examine the association between non-vaccination and child, caretaker and household related factors. A thematic analysis of transcripts from KIIs was also conducted to explore health system factors associated with non-vaccination of eligible children in this study. Results A total of 476 children and their caretakers were surveyed. The median age of the children was 52.0 months. Overall, 41.2% [95% CI 36.8–45.7] of the children included in the study were not vaccinated during the SIA. Only 59.6% of children with previous measles doses received SIA dose; while 77% of those without previous measles vaccination were reached by the SIA. Low birth order, vaccination history under routine services, low level of education among caretakers, unemployment of the household head, younger household head, provision of insufficient information by health authorities about the SIA were significantly associated with non-vaccination among eligible children during the 2017 measles SIA. Qualitative findings revealed strong beliefs against vaccinations, wrong perceptions about the SIA (from caretakers’ perspectives), poor delivery of health education, logistical and human resource challenges as possible reasons for non-vaccination. Conclusion Many children (41%) were left unvaccinated during the SIA and several factors were found to be associated with this finding. The Lilongwe District Health Team should endeavor to optimize routine immunization program; and community mobilization should be intensified as part of SIA activities.

Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi

“…20 22 Routine immunisation services are also supported by other periodic supplementary immunisation activities. [23][24][25] As of the 2015-2016 Malawi Demographic and Health Survey (DHS), an estimated 76% (95% CI 74% to 78%) of children aged 12-23 months had received basic immunisations (defined as one dose of BCG; three doses of oral polio vaccine (OPV); three doses of pentavalent vaccine (diphtheria, tetanus, pertussis, hepatitis B virus and Haemophilus influenzae type b (Hib)); and one dose of measles vaccine), a decline from 81% (95% CI 79% to 83%) in the 2010-2011 DHS. 26 Contrary to findings in other sub-Saharan settings and prior research within Malawi, childhood vaccination coverage was in fact higher among children living in rural areas (77%, 95% CI 74% to 79%) than children living in urban areas (70%, 95% CI 63% to 76%).…”

“…In the community, immunisation services are most frequently provided by health workers known as health surveillance assistants, who provide door-to-door visitations and staff village, outreach and mobile clinics 20 22. Routine immunisation services are also supported by other periodic supplementary immunisation activities 23–25…”

Insufficient measles antibody protection in 6‐month‐old Malawian infants: Reconsider vaccination schedule?

“…In Malawi, the measles vaccine was introduced in 1979, with the first dose recommended at 9 months of age; a second vaccine dose, at 15 months, was introduced in 2015 [3]. After the disruptive outbreak in 2010 [4], periodic mass campaigns have been implemented in addition to routine vaccination programmes [5]. Based on the Malawi Government's information, vaccine coverage was estimated at 90% in 2021 [6], but several studies reported a significant gap between official and field data [5,7,8].…”

“…After the disruptive outbreak in 2010 [4], periodic mass campaigns have been implemented in addition to routine vaccination programmes [5]. Based on the Malawi Government's information, vaccine coverage was estimated at 90% in 2021 [6], but several studies reported a significant gap between official and field data [5,7,8].…”