Factors affecting compliance with measles vaccination in Lao PDR.

In line with WHO objectives, the Lao Government is committed to eliminate measles by 2012. Yet from 1992 to 2007, the annual incidence of measles remained high while the vaccination coverage showed a wide diversity across provinces. A descriptive study was performed to determine factors affecting compliance with vaccination against measles, which included qualitative and quantitative components. The qualitative study used a convenience sample of 13 persons in charge of the vaccination program, consisting of officials from different levels of the health care structure and members of vaccination teams. The quantitative study performed on the target population consisted of a matched, case-control survey conducted on a stratified random sample of parents of children aged 9-23 months. Overall, 584 individuals (292 cases and 292 controls) were interviewed in the three provinces selected because of low vaccination coverage. On the provision of services side (supply), the main problems identified were a lack of vaccine supply and diluent, a difficulty in maintaining the cold chain, a lack of availability and competence among health workers, a lack of coordination and a limited capacity to assess needs and make coherent decisions. In the side of the consumer (demand), major obstacles identified were poor knowledge about measles immunization and difficulties in accessing vaccination centers because of distance and cost. In multivariate analysis, a low education level of the father was a factor of non-immunization while the factors of good compliance were high incomes, spacing of pregnancies, a feeling that children must be vaccinated, knowledge about immunization age, presenting oneself to the hospital rather than expecting the mobile vaccination teams and last, immunization of other family members or friends' children. The main factors affecting the compliance with vaccination against measles in Laos involve both the supply side and the demand side. Obtaining an effective coverage requires upgrading and training the Expanded Programme on Immunization (EPI) staff and a reinforcement of health education for target populations in all provinces.

Scaling up interventions to eliminate neonatal tetanus: factors associated with the coverage of tetanus toxoid and clean deliveries among women in Vientiane, Lao PDR.

The Lao People's Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries.

Factors affecting routine immunization coverage among children aged 12-59 months in Lao PDR after regional polio eradication in western Pacific region.

The global poliomyelitis eradication programme had a great impact on routine immunization coverage in Lao PDR: DPT3 increased 23% in 1992 to 56% in 1999; OPV3 27% to 64%. However, after the achievement of regional eradication, coverage became stagnant in accordance with the withdrawal of various sources of financial supports. In place of the former funds, a public-private global partnership began to support EPI. We aim to explore factors affecting routine immunization coverage. From February to March of 2005, a cross-sectional questionnaire survey was conducted, targeting 341 mothers living in two districts where immunization coverage was the lowest and the middle in Oudomxay province. DPT3 coverage was 72%, higher than the national target of 65%; however, the drop-out rate was 21%. Influential factors on fully immunized child was distance, literacy, possession of livestock; mothers knowledge of immunization target diseases, measles immunization schedule; and mother's willingness to pay for immunization. In total, 98% of all mothers lived within a 30-minute walk of the immunization site. Household visits increased the immunization status among mothers who were illiterate, utilizing an outreach site for immunization, not willing to pay for immunization, receiving home delivery, and without health education attendance. The much higher routine immunization coverage especially in a district of poor EPI activities suggests a well-designed primary health care approach under the district strategy, the zone-zero social mobilization strategy and good lines of communications; it also points to the benefits of the polio eradication initiative. Household visits were found to be effective for people living with difficulties in such as education, living location, and finance. An equally shared funding system for the basic health as well as international policy for respecting the existing system in poor country is important.