The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

Ndwandwe, Duduzile; Nnaji, Chukwudi A; Wiysonge, Charles Shey

doi:10.3390/vaccines8040705

Cited by 15 publications

(16 citation statements)

References 24 publications

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“…Changes to the anti-HBc IgM testing practices, particularly in Mpumalanga and Eastern Cape provinces, may have contributed to the change in rates over time. Given these findings and provincial disparities within South Africa, further investigations to better understand risk behaviour, testing practices and vaccination coverage, are warranted in Limpopo, Mpumalanga, Eastern Cape and Kwazulu-Natal provinces [58]. Where applicable, targeted provincial interventions would subsequently decrease countrywide incidence of HBV infection.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and incidence rates of laboratory-confirmed hepatitis B infection in South Africa, 2015 to 2019

et al. 2022

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Background Hepatitis B virus (HBV), a global public health threat, is targeted for elimination by 2030. As national HBV prevalence and incidence is lacking for South Africa, our study aimed to provide such data in the public health sector. Methods We analysed laboratory-confirmed HBV data from 2015 to 2019 to determine annual prevalence and incidence rates of HBV infection per 100,000 population, HBsAg and anti-HBc IgM test positivity rates, and HBsAg and anti-HBc IgM testing rates per 100,000 population. Time trend and statistical analyses were performed on HBsAg and anti-HBc IgM test positivity rates. Results The national prevalence rate of HBV infection per 100,000 population increased from 56.14 in 2015 to 67.76 in 2019. Over the five years, the prevalence rate was higher in males than females, highest amongst individuals 25 to 49 years old and highest in Gauteng province. The HBsAg test positivity rate dropped from 9.77% in 2015 to 8.09% in 2019. Over the five years, the HBsAg test positivity rate was higher in males than females, amongst individuals 25 to 49 years old and amongst individuals of Limpopo province. Amongst HBsAg positive children under 5 years old, the majority (65.7%) were less than a year old. HBsAg testing rates per 100,000 population were higher in females under 45 years of age and in males 45 years and above. The national incidence rate of acute HBV infection per 100,000 population dropped from 3.17 in 2015 to 1.69 in 2019. Over the five-year period, incidence rates were similar between males and females, highest amongst individuals 20 to 39 years old and highest in Mpumalanga province. Amongst individuals 20 to 24 years old, there was a substantial decline in the incidence and anti-HBc IgM test positivity rates over time. Anti-HBc IgM testing rates per 100,000 population were higher in females under 40 years of age and in males 40 years and above. Conclusion Critical to hepatitis B elimination is strengthened infant vaccination coverage and interruption of vertical transmission. Transmission of HBV infection in adults may be reduced through heightened awareness of transmission routes and prevention measures.

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Section: Discussionmentioning

confidence: 99%

Prevalence and incidence rates of laboratory-confirmed hepatitis B infection in South Africa, 2015 to 2019

et al. 2022

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“…Others have analyzed proportion of children who experience MOVs across a cross-section of archived DHS datasets [ 58 , 59 ], but we believe this is the first longitudinal analysis showing both visit-based and child-based indicators. VCQI, and its underlying algorithm, addresses the need that other researchers have recently noted in this journal for vaccine-specific and dose-specific indicators [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Using Household Surveys to Assess Missed Opportunities for Simultaneous Vaccination: Longitudinal Examples from Colombia and Nigeria

Rhoda¹,

Prier²,

Clary³

et al. 2021

Vaccines

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One important strategy to increase vaccination coverage is to minimize missed opportunities for vaccination. Missed opportunities for simultaneous vaccination (MOSV) occur when a child receives one or more vaccines but not all those for which they are eligible at a given visit. Household surveys that record children’s vaccination dates can be used to quantify occurrence of MOSVs and their impact on achievable vaccination coverage. We recently automated some MOSV analyses in the World Health Organization’s freely available software: Vaccination Coverage Quality Indicators (VCQI) making it straightforward to study MOSVs for any Demographic & Health Survey (DHS), Multi-Indicator Cluster Survey (MICS), or Expanded Programme on Immunization (EPI) survey. This paper uses VCQI to analyze MOSVs for basic vaccine doses among children aged 12–23 months in four rounds of DHS in Colombia (1995, 2000, 2005, and 2010) and five rounds of DHS in Nigeria (1999, 2003, 2008, 2013, and 2018). Outcomes include percent of vaccination visits MOSVs occurred, percent of children who experienced MOSVs, percent of MOSVs that remained uncorrected (that is, the missed vaccine had still not been received at the time of the survey), and the distribution of time-to-correction for children who received the MOSV dose at a later visit.

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“…The findings from our preliminary analysis of the 2016 South African Demographic and Health Survey data suggest that MOV constitutes a major burden, with a national prevalence of 42% and a Western Cape provincial prevalence of 36% [ 28 ]. The study identified individual-level factors, such as maternal attendance of antenatal care during pregnancy, and geographical factors, such as province of residence, as significant determinants of MOV.…”

Section: Missed Opportunities For Vaccination As a Driver Of Suboptimal Immunisation Coveragementioning

confidence: 99%

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

et al. 2021

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Despite South Africa’s substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.

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The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

Cited by 15 publications

References 24 publications

Prevalence and incidence rates of laboratory-confirmed hepatitis B infection in South Africa, 2015 to 2019

Prevalence and incidence rates of laboratory-confirmed hepatitis B infection in South Africa, 2015 to 2019

Using Household Surveys to Assess Missed Opportunities for Simultaneous Vaccination: Longitudinal Examples from Colombia and Nigeria

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

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