Prévision de la séroprévalence de l'hépatite A dans la Wilaya de Setif en 2024 / Forecast of hepatitis a seroprevalence in the Wilaya of Setif in 2024

La séroprévalence des anticorps anti hépatite A (correspondant au taux d'immunisation) était de 100% à Sétif (Algérie), chez les personnes âgées entre 10 et 14 ans en 1986. Elle est passée à 70,4% en 2011. Partant de ce fait, les auteurs se proposent de prévoir cette séroprévalence, dans la même wilaya en 2024, à travers le modèle 'Logit binaire multiple', sur la base des données d'une enquête réalisée en 2011. La séroprévalence globale chez les sujets âgés entre 5 et 19 ans serait, selon les résultats de ce modèle, de 67% en 2024; les principaux facteurs associés à cette séroprévalence seraient l'âge, l'habitat, la taille des ménageset l'antécédent d'ictère. En conséquence, un programme de vaccination pourrait s'imposer comme une nouvelle stratégie de lutte contre la maladie dans la wilaya de Sétif.

The seroprevalence of anti-hepatitis A antibodies (corresponding to the immunization rate) was 100% in Sétif, in people aged between 10 and 14 years in 1986. It has declined to 70.4% in 2011. Starting from this fact, the authors propose to predict this seroprevalence, in the same wilaya (district) in 2024, through the 'multiple binary logit' model, based on data from a survey carried out in 2011. The overall seroprevalence in subjects aged between 5 and 19 years would be, according to the results of this model, 67% in 2024; the main factors associated with this seroprevalence would be age, habitat, household size and a history of jaundice. As a result, a vaccination program could establish itself as a new disease control strategy in Sétif.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

Knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities in Ibadan North-West Local Government Area, Ibadan, Oyo State, Nigeria

Supplementary immunization activities campaigns provide children with an additional dose of vaccine and deliver other interventions. However, there is dearth of information on knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities. A descriptive cross-sectional study which employed multistage sampling technique was designed to fill this gap. Four wards were randomly selected from eleven wards in Ibadan North-West Local Government Area and houses were enumerated from the selected wards, systematic random sampling was used to select houses and then respondents. A semi-structured interviewer administered questionnaire was used to elicit information on three hundred and five respondents. Knowledge scores of ≤4, 5-8, and ≥ 9 were rated poor, fair and good, respectively. Attitude scores of ≤5 and >5 was rated negative and positive attitude, respectively while perception scores ≤4 and >4 were rated negative and positive perception, respectively. Data was analyzed with SPSS version 25 using descriptive statistics and Chi-square test at 5% level of significance. The mean age of respondents was 30.6±6.1years, the highest level of education for most (68.5%) was secondary school. Their mean parity and number of under-five were 2.5±1.4 and 1.2±0.4, respectively. Knowledge was generally poor, more than half (53.1%) had poor knowledge, majority (88.2%) have positive attitude while 84.6% have a positive perception. One-fourth (24.6%) and one-fifth are of the opinion that frequent vaccination will make the vaccine ineffective and overload immune system, respectively. There was generally poor knowledge of supplementary immunizations and mothers need to be educated on the importance.

Impact of COVID-19 on the antenatal care services utilization in the region of Guelmim Oued Noun, Morocco

Background: Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. Objective: This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco. Methods: The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The interrupted time series was mobilized to conduct statistical analysis. Results: The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2 = -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). Conclusion: The effect of the covid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Modelling COVID-19 vaccination status and adherence to public health and social measures, Eastern Mediterranean Region and Algeria

Objective: To study the link between coronavirus disease 2019 (COVID-19) vaccination status and adherence to public health and social measures in Members of the Eastern Mediterranean Region and Algeria. Methods: We analysed two rounds of a large, cross-country, repeated cross-sectional mobile phone survey in June­July 2021 and October­November 2021. The rounds included 14 287 and 14 131 respondents, respectively, from 23 countries and territories. Questions covered knowledge, attitudes and practices around COVID-19, and demographic, employment, health and vaccination status. We used logit modelling to analyse the link between self-reported vaccination status and individuals' practice of mask wearing, physical distancing and handwashing. We used propensity score matching as a robustness check. Findings: Overall, vaccinated respondents (8766 respondents in round 2) were significantly more likely to adhere to preventive measures than those who were unvaccinated (5297 respondents in round 2). Odds ratios were 1.5 (95% confidence interval, CI: 1.3­1.8) for mask wearing; 1.5 (95% CI: 1.3­1.7) for physical distancing; and 1.2 (95% CI: 1.0­1.4) for handwashing. Similar results were found on analysing subsamples of low- and middle-income countries. However, in high-income countries, where vaccination coverage is high, there was no significant link between vaccination and preventive practices. The association between vaccination status and adherence to public health advice was sustained over time, even though self-reported vaccination coverage tripled over 5 months (19.4% to 62.3%; weighted percentages). Conclusion Individuals vaccinated against COVID-19 maintained their adherence to preventive health measures. Nevertheless, reinforcement of public health messages is important for the public's continued compliance with preventive measures.

Maternal vaccination: A narrative review

Background: Vaccinations in general are considered to be one of the greatest achievements in medicine, saving millions of lives globally. Aim: This narrative review highlights issues related to vaccination in pregnancy and provides information on those vaccines registered for use in pregnancy. Method: Published articles on vaccinations in pregnancy are included in this review. The search engines used included PubMed, Medline, Google Scholar, and ScienceDirect. Results: Vaccinations during pregnancy are more likely to be administered in high income countries (HICs) compared to low-income countries (LICs) due to easier access to healthcare services and better communicable disease awareness. Maternal and perinatal morbidity and mortality rates associated with infectious diseases are higher in LICs with access to maternal care services, infrastructure and hospital equipment lacking in these settings. Conclusion: Suitable vaccinations are recommended for use in pregnancy to prevent harm to women, their foetuses and newborns from some communicable diseases, and they have resulted in declines in maternal and infant morbidity and mortality. Furthermore, this review has shown that vaccination during pregnancy is not only safe for both the woman and her foetus but also effective. Therefore, health professionals and national governments should strongly consider approved vaccinations prior to or during pregnancy.

Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi

Objective: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. Methods: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. Findings: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. Conclusion: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.

Prioritization of operational research questions on COVID vaccination in the African Region

Introduction: a year after the start of COVID-19 vaccination, coverage remains very low in the African Region. Different challenges and operational barriers have been documented, but countries will need to supplement the available information with operational research in order to adequately respond to practical questions regarding how best to scale up COVID-19 vaccination. We conducted a survey among immunisation program staff working in the African Region, in order to identify the high priority operational research questions relevant to COVID-19 vaccination. Methods: proposed operational research questions categorized into six topic areas were sent to resource persons, asking them to rate according to the relevance, urgency, feasibility, and potential impact of the research questions on the progress of COVID vaccination. Results: a total of 25 research questions have been given an average weighted rating of 75% or more by the respondents. Nine of these top priority research questions were in the area of demand generation, risk communication and community engagement while 8 questions covered the area of service delivery. Conclusion: countries should plan for and coordinate stakeholders to ensure that relevant operational research is done to respond to the top priority research questions, with a view to influence policies and implementation of strategies.

Coverage of vitamin A supplementation, deworming and immunisations: Associations with nutritional status among urban children younger than 5 years in Nelson Mandela Bay, Eastern Cape Province, South Africa

Background. Even though immunisation coverage is tracked through the district health system in South Africa (SA), limited information is available regarding interventions linked to the Expanded Programme on Immunisation (EPI) and the impact on the nutritional status of children <5 years of age.Objectives. To describe coverage of immunisations, vitamin A supplementation and deworming among children <5 years old in an urban area of Nelson Mandela Bay, Eastern Cape Province, SA. A secondary objective was to investigate whether a history of missed immunisations, vitamin A supplementation or deworming was associated with wasting or stunting in children.Methods. A descriptive study was conducted between September 2015 and February 2016, where cross-sectional anthropometrical data were collected from 1 513 children in 32 pre-schools, together with a retrospective analysis of the participants' Road-to-Health/clinic cards to collect data on immunisation, vitamin A and deworming. Participants were categorised into 3-month age intervals to facilitate data analysis. Ethical approval was obtained from the Nelson Mandela University Research Ethics Committee (Human). Results. Data of 1 496 children were included in the analysis. The prevalence of underweight was 2.5% (n=37), while 11.2% (n=167) were stunted and 1.1% (n=16) were wasted. There were associations between age category and delayed vitamin A supplementation (χ2=32.105; df=19; n=836; p=0.03) and deworming (χ2=45.257; df=17; n=558; p<0.001), but there was no association between delayed vaccinations and age category. There were no significant differences in anthropometrical indicators for children with delayed vitamin A supplementation, deworming and vaccinations compared with children in this sample who were up to date regarding the relevant indicators. However, weight-for-age, height-for-age and weight-for-height z-scores and stunting risk were associated with low birthweight (LBW) (odds ratio (OR) 4.658; p<0.001). Conclusion. Coverage of vitamin A supplementation and deworming but not immunisations was poorer among children in older age categories. A history of delayed vitamin A, deworming and vaccinations was not associated with the anthropometrical status of children. Children with LBW should be considered for more rigorous follow-up, as they are at higher risk of stunting.

Uptake of antenatal care services among women of reproductive age in Mandera County, Kenya

Background: Antenatal care is an opportunity for prevention and management of existing and potential causes of maternal and newborn mortality and morbidity. The new WHO antenatal care model, stipulates that, the first antenatal care visit takes place within the first trimester (gestational age of <12 weeks) and then, additional seven visits. Only 37% of women in Mandera County had utilized the recommended minimum four ANC visits. Objectives: There was need to assess the critical factors influencing the uptake of ANC in Mandera County Kenya, in order to enlighten stakeholders on the development of appropriate ANC Service Provision Program. This study took the intiative of bridging the gap. Methodology: The study adopted cross-sectional design using both quantitative and qualitative methods. Stratified and Sample random sampling were used to get a quantity of 348 respondents. Data was collected using questionnaire, FGDs and KIIs guides and Pearson's Chi-square test. Multivariate analysis using logistic regression was summarized to establish the strengths of the association. Odds Ratio (OR) and 95% Confidence Interval (CI) were used and threshold for statistical significance was set at p<0.05. Qualitative data was transcribed and analyzed thematically. Results: The proportion of women who utilized ANC was 83.0% and only 60.3% had attended recommended visits. Individual factors that influenced ANC uptake were; age, level of education, monthly income, gravida, parity and complications during pregnancy. Contextual factors that influenced ANC were; time taken to reach health facilities, source of maternal information and local discouragements. There was no significant relationship between Religion, marital status, age at first pregnancy with ANC uptake. Conclusion: The negative perception can change by; improving culturally sensitive ANC services accessibility by; increasing the number of female skilled health workers and reducing traveling time to the health facilities by conducting regular outreach services targeting villages with no close facility to pastoral communities. It will be important to strengthen CHVs' capacity to emphasize primary health care and accelerate progress towards UHC in the County. Provide health education and promotion targeting older mothers with high parity, women inclined to harmful cultural practices and their partners. In spite of a wide range of literature on ANC topics in most parts of Kenya, it was limited pertaining Mandera County. Recomandations: Meticulous understanding of local barriers and facilitating factors of ANC utilization is prerequisite for designing and implementing interventions that aim to improve ANC uptake. Well developed infrastructure is a basic need that falls in the category of basic wants for Mandera County

Vaccine hesitancy among medical practitioners

Background: Vaccine hesitancy defined as "delay in acceptance or refusal of vaccination despite availability of vaccination services is a global phenomenon. There have been anecdotal evidence or rather poor documentation of hesitancy or noncompliance among medical practitioners in Northern Nigeria. Objective: We explored the perceptions and perspectives of doctors in Kebbi State, Nigeria, on immunization programs. Materials and Methods: We conducted this cross­sectional study involving 63 medical doctors, whose self­administered questionnaires were analyzed using descriptive statistics. Results: Only 43.55% of the doctors reported having under­five children with complete vaccination, whereas 84% of the doctors surveyed had a child or a relative with a child who had missed routine immunization (RI) previously. Approximately 66.67% and 67.74% of the doctors believed in the quality of the vaccine and capacity of the health workers to effectively deliver polio supplementary immunization activities (PSIAs), respectively. Adequate training of workers (26.23%) and public enlightenment campaigns (23.68%) were suggested as PSIAs enhancers. Collaboration with community and religious leaders (29.2%), education and public sensitization (28.09%), and improved government funding (13.48%) to improve RI were suggested. Others include incentives and fines (8.99%), adequate training of staff (10.11%), house­to­house vaccination (4.49%), and media publicity (5.62%). Conclusion: Vaccine hesitancy among medical doctors could be a threat to sustained polio interruption and efforts toward improving RI in Kebbi State. The state government and development partners should modify the current approaches to attaining polio­free certification standards and strengthen RI in the state. In addition, there is a need to improve sensitization of doctors in the state on vaccines and their safety profiles with a view to reducing vaccine hesitancy among them

Impact of COVID-19 pandemic on immunization services in Nigeria; A preliminary report by Paediatric Association of Nigeria (PAN)

Background: Since the onset of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic also known as Coronavirus disease 2019 (COVID-19) beginning in Wuhan, China in December 2019 and spreading to Nigeria in February 2020 (as well as the rest of the world), there have been enormous resultant impact on health, social, emotional and economic aspects lives and services. The disease as well as its mitigation measures have negatively affected other aspects of lives and health services. This paper aims to assess the preliminary effects on immunization services, blow the whistle and suggest measures to limit these effects. Methods: Data was obtained by interviews and use of a structured proforma from Immunization Field Experts/Consultants working with national and international agencies in four states, heads of immunization units, officers in charge of immunization centres and facility immunization records from seven sites across Nigeria. Results: There were disrupted immunization services with total absence of outreach services and campaigns, limited fixed sessions, disease outbreaks, general drop in number of immunized children. These were thought to be due to the lockdown effects, fears, rumours and panic among others. Outright routine vaccines amongst rejections were also reported. Conclusion: Reports suggest that the pandemic and its mitigation measures are affecting immunization services in terms of demand/ access (physical and economic), services and logistics with overall drop in coverage and rise in dropout rates. The effects are still unfolding. It does not appear that health facilities are monitoring and interrogating their data with a view to making specific response action plans. All stakeholders in immunization (Government, non- governmental and professional organizations, the media, traditional / religious institutions) should work to flood the mainstream / social media with positive messages on immunization; monitor immunization progress by ongoing data collection, collation, analysis, interpretation and action; actively counter rumours and anti- vaccine messages and plan for post COVID 19 intensification/ catch- up

Immunization service availability and readiness in primary health care in pastoral and semi-pastoral CGPP Ethiopia implementation districts

Background: The availability of immunization services and the readiness of skilled health workers in health institutions to deliver potent vaccines to end users when required to do so are important inputs that contribute to the reduction of child morbidity and mortality from vaccine-preventable diseases(VPDs). Objective: Assess immunization service availability and readiness in primary health care units (PHCUs) in pastoral and semi-pastoral regions of CGPP Ethiopia implementation districts. Methods: A facility-based cross-sectional survey was employed on 14­23 August 2016 in all health centers (HCs) and three randomly selected health posts (HPs) in each HC catchment area in 85 CGPP implementation districts. An observation checklist was filled in by trained data collectors for all study PHCUs. Results: Immunization service availability and service delivery, based on 19 tracer items ,were assessed in 860 PHCUs in both pastoral and semi-pastoral areas. In total, 92%of the PHCUs reported providing an immunization service. However, only 18.1% of the PHCUs were observed and 32.4% reported providing immunization on the day data were collected. Overall,immunization service readiness was 56.6%: 85% of the HCs and 46.6% of the HPs were ready for immunization service over the study period. The proportion of PHCUs found to have functional refrigerators was 65%. Conclusions and recommendations: Great variability observed in terms of service readiness among HCs and HPs in this study. All PHCUs should be equipped with functional refrigerators that are regularly maintained; all immunization antigens and schedule immunization services should be available at the PHCUs daily to avoid missed opportunities; cold chain managers/immunization service providers should be given supervisory support to ensure that they record refrigerator temperatures

Contribution of plastic bags to the retention of child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region, Ethiopia

Background: Many vaccines are given more than once, at different ages, and in combinations. Parents are expected to retain immunization cardsfor their children, however in Ethiopia,the retention of child immunization cardsis minimal. For example,the 2005 and 2011 Ethiopian Demographic and Health Surveysshowed that 37% and 29% of immunization cards, respectively, were retained. The CORE Group Polio Project developed an innovative approach to keeping home vaccination records for a long time and safely,in the form of a plastic bag designed to hold the immunization card. The pilot project for this innovation was held in Gambella Region and Assosa Zone, Benishangul-Gumuz Region since 2015. Objective: Evaluate the contribution of plastic bags for holding and retaining child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region. Methods: The study was a household-based cross-sectional survey and the target population was households with at least one child aged under 2years who had received at least one vaccination dose. A sample of 239 households (120 from Gambella Region and 119 from Assosa Z one in Benishangul-Gumuz Region) were selected randomly from immunization registration records. Up to 12 kebeles were included from each region, with at least 10 children per kebele. Data were collected using an Amharic language questionnaire and analyzed with STATA version 13.0. Results: Of all 239 respondents, 139 (58.2%) received the plastic bag for retaining immunization cards, while 100 (41.8%) did not receive the bag. Of the 139 respondents who received immunization cards, 125 (89.9%) utilized the plastic bag. Of those that utilized the bags to hold immunization cards, 50.4% were from Gambella Region and 49.6% were from Benishangul-Gumuz Region. A total of 125 (58.7%) respondents were presented with the immunization card inside the plastic bag, and 88 (41.3%) respondents received the immunization card with no accompanying plastic bag. However, of all respondents who received the plastic bag, 14 (10%) did not put the card inside it. The reasons given by respondents were that it was difficult to put the card inside the plastic bag(seven cases, (58.3%))and that it was lost/damaged or used for some other purpose (five cases, (41.7%)).A total of 145(70%)respondents reported that they placed the plastic bag that contains the immunization card in a secure place, such as in a box, and 53 (25.6%) hung it on a wall.Conclusion:In general, there was89.5% card retention;90% of respondents utilized the plastic bag,and 88% of mothers said they would advise others to use the plastic bag

Healthcare workers readiness to provide immunization services at primary health care units in pastoral and semi pastoral regions in Ethiopia Core Group Polio Project implementation areas

Background: Ethiopia has been implementing immunization programs for the past four decades. However, coverage remains low, especially in pastoral and semi-pastoral regions. Among the obstacles to achieving immunization targets is the level of health workers' readiness to provide immunization services, measured in terms of levels of motivation, capacity and involvement. Objective: To assess the extent of health care providers' readiness to provide immunization services at primary healthcare units in pastoral and semi-pastoral areas of Ethiopia. Methods:A cross-sectional survey was conducted on a sample of 1,283 healthcare providers involved in immunization services in 233 health centers, and 699 health posts in the health center catchment areas. From five CORE Group Polio Project intervention regions in Ethiopia, interviews were held with personnel in each health center ­an Extended Program on Immunization focal person, a midwife, and the medical director or head. From each health post, interviews were held with one health extension worker. Data were collected using a self-administered questionnaire facilitated by woreda and zonal health and CORE Group staff. The outcome variable of interest, readiness, was measured using three indicator variables­high to very high levels of self-reported motivation and involvement in immunization service provision, and having received at least one immunization-related training in the last two years. In addition to health care workers' background characteristics, where workers were based ­in pastoral or semi-pastoral areas ­ were included as factors for readiness. Data were entered into EpiData and exported to STATA version 12 for analysis. Binary logistic regression was used to identify independent factors associated with readiness, and p<0.05 was used to declare statistical significance. Results: Among health center respondents, those with a diploma were 2.3 times more likely to be ready compared to those with a first degree. Similarly, nurses and those who claimed higher satisfaction with supportive supervision were 2.1 and 6.2 times more likely to be ready to provide immunization services compared to midwives and those with a medium level of satisfaction, respectively. Among health post staff, being female (AOR=2.2), having more than five years of work experience (AOR=2.2) and having a high level of satisfaction with supportive supervision (AOR=4.5) showed higher readiness levels compared to males, those with less than or equal to two years of service, and those with a medium level of satisfaction, respectively. Conclusions: To ensure health care workers' readiness to provide immunization services, providing ongoing in-service training and improving supportive supervision, particularly for men in health posts, should be prioritized

Child vaccination timing, intervals and missed opportunities in pastoral and semi-pastoral areas in Ethiopia

Background: Immunization is one of the most powerful and cost-effective public health interventions. Most vaccines in the immunization schedule require two or more doses to trigger adequate immune response; appropriate timing, proper interval between vaccine doses, and completion of all vaccine doses are important to attain optimal protection. Objective: To evaluate and identify factors associated with the timeliness of vaccine doses; assess the interval between vaccine doses; and identify missed opportunities amon children aged 12 to 23 months. Methods: A cross-sectional descripive study was conducted that employed the 30 by 10 modified WHO immunization coverage cluster sampling technique. Considering pastoral and semi-pastoral areas, a total of 60 clusters with a sample of 600 children aged 12 to 23 months and mothers/care givers were included. Data were collected using smart phones loaded with the Open Data Kit (ODK) system and exported to STATA 12.0 for data description and analysis. Results: The response rate was 97%, with 54.8% of the sample from pastoral areas. About 51% of the respondents were Muslim, 68% had no education, and 67% were aged 30 or above. More than one fifth (21.9%) of children received at least one vaccine dose earlier than the recommended minimum age. Nearly half (47.7%) of children received at least one subsequent dose earlier than an interval of four weeks. The overall rate of missed opportunities was 42.7%, which was higher in pastoral (61.4%) compared to semi-pastoral areas (30.9%) (P <0.001). Children from pastoral areas had a higher rate of missed opportunities compared to children from semi-pastoral areas (OR=4.05; 95% CI: 2.28-7.22); and children from mothers/caregivers aged 30 or above had a higher rate of missed opportunities than mothers aged <30 (OR=1.89; 95% CI: 1.32-3.13). Conclusions: The study identified high proportions of children who started vaccination earlier than the recommended age (later for the first dose of Oral Polio Vaccine (OPV0)). In addition, multiple vaccine doses were administered before the minimum interval of four weeks. Children in pastoral areas have higher rate of missed opportunities compare to children in semi pastoralist and pastoralist areas for vaccines with same schedule. Recommendations: Strong interpersonal communication between mothers and vaccination providers is vital for the timely administration of vaccines. Emphasis should be placed on regular supervision and periodic in service training of health workers to practice timely vaccine commencement, and maintain proper intervals between doses. Immunization service providers should give all the recommended vaccines with same schedule to reduce rate of missed opportunities

Immunization service providers' knowledge, attitude and practice in primary health care units in pastoral and semi-pastoral areas of Ethiopia: CORE Group Polio Project

Background: Adequate knowledge is key for immunization service provision and related practices, such as providing the right vaccine at the right time, keeping vaccines potent, and to prevent vaccine failures. This study was conducted to assess the knowledge, attitude and practices of immunization service providers in primary health care units in pastoral and semi-pastoral areas of Ethiopia. Methods:A facility-based cross-sectional study was conducted of 1,280 health workers drawn from health centers (233) and health posts(632)in five regions of Ethiopia: Somali, Gambella, Benishangul-Gumuz, Oromiya and SNNPR. Data were collected using a self-administered questionnaire prepared in English and translated into three local languages, and analyzed using STATA version 13.0. Descriptive statistics and binary logistic regression analysis were carried out to determine the magnitude of, and identify associated factors for,knowledge, attitude and practice.A p-value of less than 0.05 was used to declare statistical significance. Results: Of all health center respondents,389 (61.3%) had a good knowledge of the vaccination schedule; 403 (63.5%) had poor practices relating to vaccine placement in refrigerators;and 321(54%) had poor attitudes in relation to vaccines and vaccination. With respect to the vaccination schedule, midwives and Health officers/Medical Doctors were 0.28(95% CI:0.08-0.95) times less knowledgeable than nurses; and health workers with more than five years'work experience were 2.78 (95% CI: 1.54-5.01) times more knowledgeable than health workers who had three years'work experience.Conclusions and recommendations: In this study, gaps were observed in health service providers' knowledge, attitudes and practices in relation to immunization. Support to address these gaps ­through training, supervision, monitoring and other mechanisms should focus on HEWs whose education is less than or equal to grade 12 at health post level, and on midwives and Health Officers (HOs)/MDs at the health center level. Similarly, attention should be given to enhance the vaccine and vaccination knowledge of semi-pastoral health facility service providers. The government, immunization working partners and other responsible bodies should give attention and take corrective measuresto use maximum vaccine preventive potency

Child vaccination coverage and dropout rates in pastoral and semi-pastoral regions in Ethiopia: CORE Group Polio Project implementation areas

Background: Vaccination programs are one of the priority health interventions, and all children in every country should be vaccinated. The World Health Organization (WHO) aims for 90% coverage of the Expanded Program on Immunization (EPI) by the age of 12 months. The CORE Group Polio Project (CGPP) Ethiopia implemented interventions in pastoral and semi-pastoral regions to increase routine immunization coverage and support supplemental immunization campaigns. Objective: Assess vaccination coverage, estimate dropout rates and identify associated factors. Methods: A cross-sectional study using the modified WHO EPI cluster survey method was conducted as part of the mid-term evaluation in 2015 in six pastoral and semi-pastoral zones in Ethiopia. A sample of 600 children age 12 to 23 months was selected, and mothers/caregivers were interviewed at home using face-to-face interviews, supported by mobile data collection using the Open Data Kit (ODK)system. Data were exported from the server, cleaned, and analysed using STATA 12.0.Both descriptive analytical methods were used and p-values less than 0.05 were used to declare statistical significance. Results: Of the estimated sample, 577 (96.6%) children were included in the analysis. The overall rate of full vaccination was estimated to be 44.0% (21.2%in pastoral areas and 71.6% in semi-pastoral areas). With vaccine specific coverage of 53.7% for Bacillus Calmette-Guérin(BCG);58.8% for oral polio vaccine 3 (OPV 3);58.8% for pentavalent 3;56.3% for OCV 3 and 53.6% for measles.Mothers'/caregivers' residence, age and education were found to be significant predictors for children not being fully vaccinated, i.e.children of mothers living in pastoralist communities, young age, and with no education were at a significantly higher risk of being not fully vaccinated. Among those children who had at least one vaccine, 20.5% failed to take at least one of the next higher doses. Specifically, among those who took BCG and pentavalent 1, 10.1% and 14.1%, respectively,failed to take the measles vaccination. Conclusions and recommendations: The proportion of children who were fully vaccinated in pastoral and semi-pastoral zones was low. Dropout rates for measles, BCG and pentavalent 1 immunization were above the acceptable rate of less than 10%.Therefore, efforts should focus on mobilizing the community to complete all child vaccinations, and community-based approaches with the integration of community volunteers, health extension workers and health center staff should be strengthened so that dropout children can be traced so that they can complete their vaccinations. More information is also required on why mothers/caregivers fail to ensure that their children take all available vaccinations

Providing mothers with mobile phone message reminders increases childhood immunisation and vitamin A supplementation coverage in Côte d'Ivoire: a randomised controlled trial

We conducted a randomized controlled trial to assess the effect of providing mothers with mobile voice or text (SMS) reminder messages on health facility attendance at five infant immunization and vitamin A supplementation (VAS) visits. The study was conducted at 29 health facilities in Korhogo district. Mothers were randomized to receive a voice or text reminder message two days prior to each scheduled visit and two additional reminders for missed doses (n=798; intervention group), or no phone reminder messages (n=798; control group). Infants in the intervention group were 2.85 (95% CI: 1.85-4.37), 2.80 (95% CI: 1.88-4.17), 2.68 (95% CI: 1.84-3.91), and 4.52 (95% CI: 2.84-7.20) times more likely to receive pentavalent 1-3 and MMR/yellow fever doses, respectively, and 5.67 (95% CI: 3.48-9.23) times more likely to receive VAS, as compared to the control group. In the reminder group, 58.3% of infants completed all five visits, compared to 35.7% in the control group (P<0.001). Providing mothers mobile phone message reminders is a potentially effective strategy for improving immunization and VAS coverage in Cote d'Ivoire

Knowledge and home treatment of measles infection by caregivers of children under five in a low-income urban community, Nigeria

Background: Despite the availability of a safe and effective vaccine for over 50 years, measles remains a leading cause of death among young children in developing countries.Aim: This study assessed the knowledge and home treatment of measles by caregivers of children under 5 years.Setting: Abebi community, Ibadan, Oyo State, Nigeria.Methods: A descriptive cross-sectional study of 509 caregivers of children aged 6 months to 5 years in a semi-urban community in Ibadan was conducted using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect information on socio-demographic characteristics, knowledge of aetiology, main symptoms and signs, and home treatment of measles. Chi-square test and logistic regression were used to explore associations at 5% level of significance.Results: Most of the caregivers were females (96.3%), married (86.1%) and were the biological parents of the children (90.9%). More than half had good knowledge of the cause (59.7%) and main symptoms and signs (52.8%) of measles. However, the composite knowledge was good in 57.6% of caregivers. Over half (54.4%) of the caregivers reported that their children ever had measles. Majority (91.3%) of caregivers whose children had measles gave home treatment, while 24 (8.7%) sought treatment from health facilities alone. There was a significant association between caregivers' educational status, age, tribe and marital status and their knowledge of measles; however, tribe was the only significant predictor of knowledge after regression analysis. Caregivers from other tribes were 3.3 times more likely to have good knowledge of measles than Yoruba caregivers. Caregivers who were 35 years and older compared to those younger than 35 years (OR: 0.625; 95% CI: 0.425­0.921) and those who were not currently married compared to those married (OR: 0.455; 95% CI: 0.273­0.758) had lower odds of having good knowledge of measles, respectively. Conclusion: Home treatment by caregivers of children with measles is high. Health education on the cause, prevention and treatment of measles should be provided for caregivers