Reasons why children miss vaccinations in Western Kenya; A step in a five-point plan to improve routine immunization

Agócs, Mary; Ismail, Amina; Kamande, Kenneth; Tabu, Collins; Momanyi, Christine; Sale, Graham; Rhoda, Dale A.; Khamati, Sylvia; Mutonga, Kelvin; Mitto, Bernard; Hennessey, Karen

doi:10.1016/j.vaccine.2021.02.071

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…This heterogeneity has important implications for disease control, as areas with a high proportion of undervaccinated children may be at risk of outbreaks despite high coverage overall (over 95% of children 9-60 months in the study had received MCV1 before the mass vaccination campaign). The observed increase in zero-dose prevalence as travel time to the nearest health facility increased suggests that travelling long distances may be an impediment to vaccination, as has been previously observed [14,18,19]. This is also supported by the decrease in proportion of measles zero-dose children vaccinated during the mass vaccination campaign as distance to the nearest vaccination increased.…”

Section: Discussionsupporting

confidence: 71%

“…The copyright holder for this this version posted September 22, 2021. ; https://doi.org/10.1101/2021.09.16.21263705 doi: medRxiv preprint Several studies have investigated risk factors for low vaccine coverage or incomplete vaccination, often identifying accessibility to healthcare, maternal education, parental attitude, and socioeconomic status as important factors [15][16][17][18][19][20]. However, remote or marginalized communities may be underrepresented in studies that recruit participants from those already engaged with the formal healthcare system, for example, studies requiring child health cards for eligibility [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign

Arambepola

Yang

Hutchinson³

et al. 2021

Preprint

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Introduction: Despite gains in global coverage of childhood vaccines, many children remain undervaccinated. Vaccination campaigns also known as Supplemental Immunization Activity (SIA) are commonly conducted to reach those who are undervaccinated. However, reaching these children even during an SIA is challenging. We evaluated the effectiveness of an SIA in reaching zero dose children. Methods: We conducted a prospective study in 10 health center catchment areas in Southern province, Zambia in November 2020. About 2 months before the measles and rubella SIA we developed aerial satellite maps which were then used to enumerate and survey households. Zero dose children were identified during this exercise. After the SIA, households with zero dose children identified before the SIA were targeted for mop up vaccination and to assess if they were vaccinated during the SIA. A Bayesian geospatial model was used to identify factors associated with zero-dose status before the campaign and produce fine-scale prevalence maps. Models were used to identify factors associated with measles zero-dose children reached in the campaign and identify optimal locations for additional vaccination sites. Results: Before the vaccination campaign, 4% of children under 9 months were DTP zero-dose and 17% of children 9-60 months were measles zero-dose. Of the 461 measles zero-dose children identified before the vaccination campaign, 338 (73.3%) were vaccinated during the campaign, 118 (25.6%) were reached by a targeted mop-up activity. The presence of other children in the household, younger age, greater travel time to health facilities, and living between health facility catchment areas were associated with zero-dose status. Mapping zero-dose prevalence revealed substantial heterogeneity, both within and between catchment areas. Several potential locations were identified for additional vaccination sites. Conclusion: Fine-scale variation in zero-dose prevalence and the impact of accessibility to healthcare facilities on vaccination coverage were identified. Geospatial modeling can aid targeted vaccination activities.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign

Arambepola

Yang

Hutchinson³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Several studies have investigated risk factors for low vaccine coverage or incomplete vaccination, often identifying accessibility to healthcare, maternal education, parental attitude and socioeconomic status as important factors. [15][16][17][18][19][20] While there has been limited work in this area in Zambia in particular, Setse et al 21 found that lower levels of maternal education and larger family sizes were associated with incomplete DTP and polio vaccination in Lusaka, Zambia. However, remote or marginalised communities may be under-represented in studies that recruit participants from those already engaged with the formal healthcare system, for example, studies requiring child health cards for eligibility.…”

Section: Introductionmentioning

confidence: 99%

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign in Southern province, Zambia

et al. 2021

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IntroductionDespite gains in global coverage of childhood vaccines, many children remain undervaccinated. Although mass vaccination campaigns are commonly conducted to reach these children their effectiveness is unclear. We evaluated the effectiveness of a mass vaccination campaign in reaching zero-dose children.MethodsWe conducted a prospective study in 10 health centre catchment areas in Southern province, Zambia in November 2020. About 2 months before a national mass measles and rubella vaccination campaign conducted by the Ministry of Health, we used aerial satellite maps to identify built structures. These structures were visited and diphtheria-tetanus-pertussis (DTP) and measles zero-dose children were identified (children who had not received any DTP or measles-containing vaccines, respectively). After the campaign, households where measles zero-dose children were previously identified were targeted for mop-up vaccination and to assess if these children were vaccinated during the campaign. A Bayesian geospatial model was used to identify factors associated with zero-dose status and measles zero-dose children being reached during the campaign. We also produced fine-scale zero-dose prevalence maps and identified optimal locations for additional vaccination sites.ResultsBefore the vaccination campaign, 17.3% of children under 9 months were DTP zero-dose and 4.3% of children 9–60 months were measles zero-dose. Of the 461 measles zero-dose children identified before the vaccination campaign, 338 (73.3%) were vaccinated during the campaign and 118 (25.6%) were reached by a targeted mop-up activity. The presence of other children in the household, younger age, greater travel time to health facilities and living between health facility catchment areas were associated with zero-dose status. Mapping zero-dose prevalence revealed substantial heterogeneity within and between catchment areas. Several potential locations were identified for additional vaccination sites.ConclusionFine-scale variation in zero-dose prevalence and the impact of accessibility to healthcare facilities on vaccination coverage were identified. Geospatial modelling can aid targeted vaccination activities.

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“…The 5-Point Plan (5PP) is a methodology developed by AmCross to identify pockets of zero-dose and under-vaccinated children and understand the reasons they are under-served [ 6 ]. In November 2019, AmCross, the Kenya Red Cross Society (KRCS), the Kenyan Expanded Program on Immunization (EPI) team, and the Ministry of Health (MoH) piloted the 5PP in Bobasi, a rural sub-county in Western Kenya with the intention of scaling up the 5PP program in Kenya and elsewhere.…”

Section: Illustrative Examples Of Vaccination Coverage Pilot Testsmentioning

confidence: 99%

A Practical Guide to Pilot Testing Community-Based Vaccination Coverage Surveys

Rhoda,

Cutts,

Agócs

et al. 2023

Vaccines

Self Cite

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Pilot testing is crucial when preparing any community-based vaccination coverage survey. In this paper, we use the term pilot test to mean informative work conducted before a survey protocol has been finalized for the purpose of guiding decisions about how the work will be conducted. We summarize findings from seven pilot tests and provide practical guidance for piloting similar studies. We selected these particular pilots because they are excellent models of preliminary efforts that informed the refinement of data collection protocols and instruments. We recommend survey coordinators devote time and budget to identify aspects of the protocol where testing could mitigate project risk and ensure timely assessment yields, credible estimates of vaccination coverage and related indicators. We list specific items that may benefit from pilot work and provide guidance on how to prioritize what to pilot test when resources are limited.

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Reasons why children miss vaccinations in Western Kenya; A step in a five-point plan to improve routine immunization

Cited by 5 publications

References 20 publications

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign in Southern province, Zambia

A Practical Guide to Pilot Testing Community-Based Vaccination Coverage Surveys

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