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15 pages, 6332 KiB  
Article
Bridging the Vaccination Equity Gap: A Community-Driven Approach to Reduce Vaccine Inequities in Polio High-Risk Areas of Pakistan
by Imran A. Chauhadry, Sajid Bashir Soofi, Muhammad Sajid, Rafey Ali, Ahmad Khan, Syeda Kanza Naqvi, Imtiaz Hussain, Muhammad Umer and Zulfiqar A. Bhutta
Vaccines 2024, 12(12), 1340; https://doi.org/10.3390/vaccines12121340 - 28 Nov 2024
Cited by 1 | Viewed by 628
Abstract
Background: Immunization saves millions of lives, and globally, vaccines have significantly contributed to reducing mortality and morbidity due to more than 20 life-threatening illnesses. However, there are considerable disparities in vaccination coverage among countries and within populations. This study evaluates the reduction in [...] Read more.
Background: Immunization saves millions of lives, and globally, vaccines have significantly contributed to reducing mortality and morbidity due to more than 20 life-threatening illnesses. However, there are considerable disparities in vaccination coverage among countries and within populations. This study evaluates the reduction in disparities in vaccination coverage across various socio-economic groups by adopting an integrated community-engagement approach combined with maternal and child health services through mobile health camps. Methods: This secondary analysis is based on a community-based demonstration project conducted between 2014 and 2016 across 146 union councils in polio high-risk districts of Sindh, Khyber Pakhtunkhwa (KP) and Baluchistan in Pakistan. The intervention involved structured community engagement and mobile health camps providing routine immunization alongside maternal and child health services. Data were collected through cross-sectional independent surveys using the WHO two-stage cluster technique at the baseline and the endline, covering over 120,000 children under 5 years old. Four key outcome indicators were analyzed: fully vaccinated children, under-immunized children, unvaccinated children, and polio zero-dose children for equity in vaccine uptake. Results: The proportion of fully vaccinated children increased in the lowest wealth quintile from 28.5% (26.7%, 30.3%) at the baseline to 51.6% (49.5%, 53.8%) at the endline. In comparison, the increase in the richest quantities was 16.2% (14.0%, 18.4%) from the baseline 56.4% (54.6%, 58.2%) to the endline 72.7% (71.1%, 74.2%). Under-vaccination dropped by 10.2% (95% CI: −11.4%, −9.1%), with the poorest quintile showing an 11.8% reduction. The gap between the highest and lowest wealth quintiles in full immunization narrowed by 6.9%, from 27.9% to 21.0% at the baseline and the endline, respectively. The prevalence of zero-dose children significantly decreased across all quintiles, with the highest reduction observed in the lowest quintile of −11.3% (−13.6%, −9.1%). The difference between the highest and lowest wealth quintiles reduced from 6.2% to 3.8%. A significant reduction in polio zero-dose children was achieved, as 13.5% (95% CI: −14.8%, −12.2%), from 29.2% (95% CI: 28.0%, 30.3%) to 15.6% (14.8%, 16.5%). Conclusions: This study shows that integrating community engagement with maternal and child health services through health camps can significantly enhance immunization coverage and reduce wealth-based disparities in high-risk, hard-to-reach areas. The approach improved coverage for zero-dose and fully vaccinated children, suggesting a potential for scaling in regions with access issues, conflict, and vaccine hesitancy. Full article
(This article belongs to the Special Issue Acceptance and Hesitancy in Vaccine Uptake)
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15 pages, 2216 KiB  
Article
Monitoring the Risk of Type-2 Circulating Vaccine-Derived Poliovirus Emergence During Roll-Out of Type-2 Novel Oral Polio Vaccine
by Corey M. Peak, Hil Lyons, Arend Voorman, Elizabeth J. Gray, Laura V. Cooper, Isobel M. Blake, Kaija M. Hawes and Ananda S. Bandyopadhyay
Vaccines 2024, 12(12), 1308; https://doi.org/10.3390/vaccines12121308 - 22 Nov 2024
Viewed by 1326
Abstract
Background/Objectives: Although wild poliovirus type 2 has been eradicated, the prolonged transmission of the live- attenuated virus contained in the type-2 oral polio vaccine (OPV2) in under-immunized populations has led to the emergence of circulating vaccine-derived poliovirus type 2 (cVDPV2). The novel OPV2 [...] Read more.
Background/Objectives: Although wild poliovirus type 2 has been eradicated, the prolonged transmission of the live- attenuated virus contained in the type-2 oral polio vaccine (OPV2) in under-immunized populations has led to the emergence of circulating vaccine-derived poliovirus type 2 (cVDPV2). The novel OPV2 (nOPV2) was designed to be more genetically stable and reduce the chance of cVDPV2 emergence while retaining comparable immunogenicity to the Sabin monovalent OPV2 (mOPV2). This study aimed to estimate the relative reduction in the emergence risk due to the use of nOPV2 instead of mOPV2. Methods: Data on OPV2 vaccination campaigns from May 2016 to 1 August 2024 were analyzed to estimate type-2 OPV-induced immunity in children under 5 years of age. Poliovirus surveillance data were used to estimate seeding dates and classify cVDPV2 emergences as mOPV2- or nOPV2-derived. The expected number of emergences if mOPV2 was used instead of nOPV2 was estimated, accounting for the timing and volume of nOPV2 doses, the known risk factors for emergence from mOPV2, and censoring due to the incomplete observation period for more recent nOPV2 doses. Results: As of 1 August 2024, over 98% of the approximately 1.19 billion nOPV2 doses administered globally were in Africa. We estimate that approximately 76 (95% confidence interval 69–85) index isolates of cVDPV2 emergences would be expected to be detected by 1 August 2024 if mOPV2 had been used instead of nOPV2 in Africa. The 18 observed nOPV2-derived emergences represent a 76% (74–79%) lower risk of emergence by nOPV2 than mOPV2 in Africa. The crude global analysis produced similar results. Key limitations include the incomplete understanding of the drivers of heterogeneity in emergence risk across geographies and variance in the per-dose risk of emergence may be incompletely captured using known risk factors. Conclusions: These results are consistent with the accumulating clinical and field evidence showing the enhanced genetic stability of nOPV2 relative to mOPV2, and this approach has been implemented in near-real time to contextualize new findings during the roll-out of this new vaccine. While nOPV2 has resulted in new emergences of cVDPV2, the number of cVDPV2 emergences is estimated to be approximately four-fold lower than if mOPV2 had been used instead. Full article
(This article belongs to the Special Issue Recent Scientific Development of Poliovirus Vaccines)
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17 pages, 2168 KiB  
Project Report
Building Data Triangulation Capacity for Routine Immunization and Vaccine Preventable Disease Surveillance Programs to Identify Immunization Coverage Inequities
by Audrey Rachlin, Oluwasegun Joel Adegoke, Rajendra Bohara, Edson Rwagasore, Hassan Sibomana, Adeline Kabeja, Ines Itanga, Samuel Rwunganira, Blaise Mafende Mario, Nahimana Marie Rosette, Ramatu Usman Obansa, Angela Ukpojo Abah, Olorunsogo Bidemi Adeoye, Ester Sikare, Eugene Lam, Christopher S. Murrill and Angela Montesanti Porter
Vaccines 2024, 12(6), 646; https://doi.org/10.3390/vaccines12060646 - 11 Jun 2024
Viewed by 1967
Abstract
The Expanded Programme on Immunization (EPI) and Vaccine Preventable Disease (VPD) Surveillance (VPDS) programs generate multiple data sources (e.g., routine administrative data, VPD case data, and coverage surveys). However, there are challenges with the use of these siloed data for programmatic decision-making, including [...] Read more.
The Expanded Programme on Immunization (EPI) and Vaccine Preventable Disease (VPD) Surveillance (VPDS) programs generate multiple data sources (e.g., routine administrative data, VPD case data, and coverage surveys). However, there are challenges with the use of these siloed data for programmatic decision-making, including poor data accessibility and lack of timely analysis, contributing to missed vaccinations, immunity gaps, and, consequently, VPD outbreaks in populations with limited access to immunization and basic healthcare services. Data triangulation, or the integration of multiple data sources, can be used to improve the availability of key indicators for identifying immunization coverage gaps, under-immunized (UI) and un-immunized (zero-dose (ZD)) children, and for assessing program performance at all levels of the healthcare system. Here, we describe the data triangulation processes, prioritization of indicators, and capacity building efforts in Bangladesh, Nigeria, and Rwanda. We also describe the analyses used to generate meaningful data, key indicators used to identify immunization coverage inequities and performance gaps, and key lessons learned. Triangulation processes and lessons learned may be leveraged by other countries, potentially leading to programmatic changes that promote improved access and utilization of vaccination services through the identification of UI and ZD children. Full article
(This article belongs to the Special Issue Inequality in Immunization 2024)
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10 pages, 1975 KiB  
Article
Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021
by Kamal Fahmy, Quamrul Hasan, Md Sharifuzzaman and Yvan Hutin
Vaccines 2024, 12(3), 285; https://doi.org/10.3390/vaccines12030285 - 8 Mar 2024
Viewed by 1685
Abstract
Yearly national immunization coverage reporting does not measure performance at the subnational level throughout the year and conceals inequalities within countries. We analyzed subnational immunization coverage from seven high-priority countries in our region. We analyzed subnational, monthly immunization data from seven high-priority countries. [...] Read more.
Yearly national immunization coverage reporting does not measure performance at the subnational level throughout the year and conceals inequalities within countries. We analyzed subnational immunization coverage from seven high-priority countries in our region. We analyzed subnational, monthly immunization data from seven high-priority countries. Five were Gavi eligible (i.e., Afghanistan, Pakistan, Somalia, Syria, and Yemen); these are countries that according to their low income are eligible for support from the Global Alliance on Vaccine and Immunization, while Iraq and Jordan were included because of a recent decrease in immunization coverage and contribution to the regional number of under and unimmunized children. DTP3 coverage, which is considered as the main indicator for the routine immunization coverage as the essential component of the immunization program performance, varied monthly in 2019–2021 before reaching pre-pandemic coverage in the last two months of 2021. Somalia and Yemen had a net gain in DTP3 coverage at the end of 2021, as improvement in 2021 exceeded the regression in 2020. In Pakistan and Iraq, DTP3 improvement in 2021 equaled the 2020 regression. In Afghanistan, Syria and Jordan, the regression in DTP3 coverage continued in 2020 and 2021. The number of districts with at least 6000 zero-dose children improved moderately in Afghanistan and substantially in Somalia throughout the follow-up period. In Pakistan, the geographical distribution differed between 2020 and 2021.Of the three countries with the highest number of zero-dose children, DTP1 coverage reached 109% in Q4 of 2020 after a sharp drop to 69% in Q2 of 2020. However, in Pakistan, the number of zero-dose children decreased to 1/10 of its burden in Q4 of 2021. In Afghanistan, the number of zero-dose children more than a doubled. Among the even countries, adaptation of immunization service to the pandemic varied, depending on the agility of the health system and the performance of the components of the expanded program on immunization. We recommended monitoring administrative monthly immunization coverage data at the subnational level to detect low-performing districts, plan catchup, identify bottlenecks towards reaching unvaccinated children and customize strategies to improve the coverage in districts with zero-dose children throughout the year and monitor progress. Full article
(This article belongs to the Special Issue Inequality in Immunization 2024)
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10 pages, 2073 KiB  
Article
Poliovirus-Neutralizing Antibody Seroprevalence and Vaccine Habits in a Vaccine-Derived Poliovirus Outbreak Region in the Democratic Republic of Congo in 2018: The Impact on the Global Eradication Initiative
by Megan Halbrook, Adva Gadoth, Patrick Mukadi, Nicole A. Hoff, Kamy Musene, Camille Dzogang, Cyrus Shannon Sinai, D’Andre Spencer, Guillaume Ngoie-Mwamba, Sylvia Tangney, Frank Salet, Michel Nyembwe, Michel Kambamba Nzaji, Merly Tambu, Placide Mbala, Trevon Fuller, Sue K. Gerber, Didine Kaba, Jean Jacques Muyembe-Tamfum and Anne W. Rimoin
Vaccines 2024, 12(3), 246; https://doi.org/10.3390/vaccines12030246 - 27 Feb 2024
Viewed by 1507
Abstract
Despite the successes in wild-type polio eradication, poor vaccine coverage in the DRC has led to the occurrence of circulating vaccine-derived poliovirus outbreaks. This cross-sectional population-based survey provides an update to previous poliovirus-neutralizing antibody seroprevalence studies in the DRC and quantifies risk factors [...] Read more.
Despite the successes in wild-type polio eradication, poor vaccine coverage in the DRC has led to the occurrence of circulating vaccine-derived poliovirus outbreaks. This cross-sectional population-based survey provides an update to previous poliovirus-neutralizing antibody seroprevalence studies in the DRC and quantifies risk factors for under-immunization and parental knowledge that guide vaccine decision making. Among the 964 children between 6 and 35 months in our survey, 43.8% (95% CI: 40.6–47.0%), 41.1% (38.0–44.2%), and 38.0% (34.9–41.0%) had protective neutralizing titers to polio types 1, 2, and 3, respectively. We found that 60.7% of parents reported knowing about polio, yet 25.6% reported knowing how it spreads. Our data supported the conclusion that polio outreach efforts were successfully connecting with communities—79.4% of participants had someone come to their home with information about polio, and 88.5% had heard of a polio vaccination campaign. Additionally, the odds of seroreactivity to only serotype 2 were far greater in health zones that had a history of supplementary immunization activities (SIAs) compared to health zones that did not. While SIAs may be reaching under-vaccinated communities as a whole, these results are a continuation of the downward trend of seroprevalence rates in this region. Full article
(This article belongs to the Section Vaccines against Tropical and other Infectious Diseases)
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22 pages, 905 KiB  
Article
Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia
by Ahmed Said Bile, Mohamed A. Ali-Salad, Amina J. Mahmoud, Neha S. Singh, Nada Abdelmagid, Majdi M. Sabahelzain, Francesco Checchi, Sandra Mounier-Jack and Barni Nor
Vaccines 2024, 12(2), 154; https://doi.org/10.3390/vaccines12020154 - 1 Feb 2024
Cited by 3 | Viewed by 3989
Abstract
Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. [...] Read more.
Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff (n = 17), and with vaccinators and community members (n = 52). The data were analyzed using the GAVI Vaccine Alliance IRMMA framework. Nomadic populations, internally displaced persons, and populations living in remote and Al-shabaab-controlled areas are three vulnerable and neglected populations with a high proportion of zero-dose children. Despite the contextual heterogeneity of these population groups, the lack of targeted, population-specific strategies and meaningful engagement of local communities in the planning and implementation of immunization services is problematic in effectively reaching zero-dose children. This is, to our knowledge, the first study that examines vaccination strategies for zero-dose and under-vaccinated populations in the fragile context of Somalia. Evidence on populations at risk of vaccine-preventable diseases and barriers to vital vaccination services remain critical and urgent, especially in a country like Somalia with complex health system challenges. Full article
(This article belongs to the Section Human Vaccines and Public Health)
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12 pages, 1533 KiB  
Article
Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal
by Nicole Castle, Surakshya Kunwar, Leela Khanal, Lisa Oot, Katharine Elkes, Swechhya Shrestha, Anjali Joshi, Prasanna Rai, Sanju Bhattarai and Biraj Man Karmacharya
Vaccines 2023, 11(11), 1709; https://doi.org/10.3390/vaccines11111709 - 10 Nov 2023
Viewed by 4177
Abstract
Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral [...] Read more.
Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral science to immunization programs in Nepal is nascent. Through the Behavioral Science Immunization Network, JSI, UNICEF Nepal, and Dhulikhel Hospital–Kathmandu University School of Medical Sciences established a Behavioral Science Center to engage a diverse group of stakeholders in increasing the capacity of practitioners to use behavioral science in immunization programming. As a result of the engagement during formative research, government stakeholders requested and applied tools from behavioral science to solve different immunization challenges. Of particular value was the use of the Journey to Health and Immunization framework, which helped stakeholders identify behavioral and social drivers of zero-dose communities in Kathmandu. Our experience in Nepal demonstrates that there is strong demand for approaches and tools from behavioral science to use in relation to immunization and that this type of engagement model is effective for generating demand for and strengthening capacity to use behavioral science approaches. Full article
(This article belongs to the Section Human Vaccines and Public Health)
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9 pages, 890 KiB  
Perspective
Why Reaching Zero-Dose Children Holds the Key to Achieving the Sustainable Development Goals
by Dan Hogan and Anuradha Gupta
Vaccines 2023, 11(4), 781; https://doi.org/10.3390/vaccines11040781 - 31 Mar 2023
Cited by 24 | Viewed by 6882
Abstract
Immunization has one of the highest coverage levels of any health intervention, yet there remain zero-dose children, defined as those who do not receive any routine immunizations. There were 18.2 million zero-dose children in 2021, and as they accounted for over 70% of [...] Read more.
Immunization has one of the highest coverage levels of any health intervention, yet there remain zero-dose children, defined as those who do not receive any routine immunizations. There were 18.2 million zero-dose children in 2021, and as they accounted for over 70% of all underimmunized children, reaching zero-dose children will be essential to meeting ambitious immunization coverage targets by 2030. While certain geographic locations, such as urban slum, remote rural, and conflict-affected settings, may place a child at higher risk of being zero-dose, zero-dose children are found in many places, and understanding the social, political, and economic barriers they face will be key to designing sustainable programs to reach them. This includes gender-related barriers to immunization and, in some countries, barriers related to ethnicity and religion, as well as the unique challenges associated with reaching nomadic, displaced, or migrant populations. Zero-dose children and their families face multiple deprivations related to wealth, education, water and sanitation, nutrition, and access to other health services, and they account for one-third of all child deaths in low- and middle-income countries. Reaching zero-dose children and missed communities is therefore critical to achieving the Sustainable Development Goals commitment to “leave no one behind”. Full article
(This article belongs to the Special Issue Inequality in Immunization 2023)
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15 pages, 561 KiB  
Article
Uncovering the Drivers of Childhood Immunization Inequality with Caregivers, Community Members and Health System Stakeholders: Results from a Human-Centered Design Study in DRC, Mozambique and Nigeria
by Jessica C. Shearer, Olivia Nava, Wendy Prosser, Saira Nawaz, Salva Mulongo, Thérèse Mambu, Eric Mafuta, Khatia Munguambe, Betuel Sigauque, Yakubu Joel Cherima, Olawale Durosinmi-Etti, Obehi Okojie, Idris Suleman Hadejia, Femi Oyewole, Dessie Ayalew Mekonnen, Natasha Kanagat, Carol Hooks, Rebecca Fields, Vanessa Richart and Grace Chee
Vaccines 2023, 11(3), 689; https://doi.org/10.3390/vaccines11030689 - 17 Mar 2023
Cited by 14 | Viewed by 7863
Abstract
Background: The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions [...] Read more.
Background: The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions by engaging deeply with caregivers, community members, health workers, and other health system actors through participatory action research, intersectionality, and human-centered design lenses. Methods: This study was conducted in the Demographic Republic of Congo, Mozambique and Nigeria. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. We analyzed the data using the UNICEF Journey to Health and Immunization Framework. Results: Caregivers of zero-dose and under-immunized children faced multiple intersecting and interacting barriers related to gender, poverty, geographic access, and service experience. Immunization programs were not aligned with needs of the most vulnerable due to the sub-optimal implementation of pro-equity strategies, such as outreach vaccination. Caregivers and communities identified feasible solutions through co-creation workshops and this approach should be used whenever possible to inform local planning. Conclusions: Policymakers and managers can integrate HCD and intersectionality mindsets into existing planning and assessment processes, and focus on overcoming root causes of sub-optimal implementation. Full article
(This article belongs to the Special Issue Inequality in Immunization 2023)
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13 pages, 1728 KiB  
Article
Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles–Rubella Supplementary Immunization Activity during the COVID-19 Pandemic
by Yangyupei Yang, Natalya Kostandova, Francis Dien Mwansa, Chola Nakazwe, Harriet Namukoko, Constance Sakala, Patricia Bobo, Penelope Kalesha Masumbu, Bertha Nachinga, David Ngula, Andrea C. Carcelen, Christine Prosperi, Amy K. Winter, William J. Moss and Simon Mutembo
Vaccines 2023, 11(3), 608; https://doi.org/10.3390/vaccines11030608 - 7 Mar 2023
Cited by 3 | Viewed by 3309
Abstract
Background: Measles–rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey [...] Read more.
Background: Measles–rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey in Zambia to measure the proportion of measles zero-dose and under-immunized children who were reached by the 2020 MR-SIA and identified reasons associated with persistent inequalities following the MR-SIA. Methods: Children between 9 and 59 months were enrolled in a nationally representative, cross-sectional, multistage stratified cluster survey in October 2021 to estimate vaccination coverage during the November 2020 MR-SIA. Vaccination status was determined by immunization card or through caregivers’ recall. MR-SIA coverage and the proportion of measles zero-dose and under-immunized children reached by MR-SIA were estimated. Log-binomial models were used to assess risk factors for missing the MR-SIA dose. Results: Overall, 4640 children were enrolled in the nationwide coverage survey. Only 68.6% (95% CI: 66.7%, 70.6%) received MCV during the MR-SIA. The MR-SIA provided MCV1 to 4.2% (95% CI: 0.9%, 4.6%) and MCV2 to 6.3% (95% CI: 5.6%, 7.1%) of enrolled children, but 58.1% (95% CI: 59.8%, 62.8%) of children receiving the MR-SIA dose had received at least two prior MCV doses. Furthermore, 27.8% of measles zero-dose children were vaccinated through the MR-SIA. The MR-SIA reduced the proportion of measles zero-dose children from 15.1% (95% CI: 13.6%, 16.7%) to 10.9% (95% CI: 9.7%, 12.3%). Zero-dose and under-immunized children were more likely to miss MR-SIA doses (prevalence ratio (PR): 2.81; 95% CI: 1.80, 4.41 and 2.22; 95% CI: 1.21 and 4.07) compared to fully vaccinated children. Conclusions: The MR-SIA reached more under-immunized children with MCV2 than measles zero-dose children with MCV1. However, improvement is needed to reach the remaining measles zero-dose children after SIA. One possible solution to address the inequalities in vaccination is to transition from nationwide non-selective SIAs to more targeted and selective strategies. Full article
(This article belongs to the Special Issue Inequality in Immunization 2023)
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14 pages, 1410 KiB  
Article
Advancing Immunization Coverage and Equity: A Structured Synthesis of Pro-Equity Strategies in 61 Gavi-Supported Countries
by Vesela Ivanova, A. S. M. Shahabuddin, Alyssa Sharkey and Mira Johri
Vaccines 2023, 11(1), 191; https://doi.org/10.3390/vaccines11010191 - 16 Jan 2023
Cited by 4 | Viewed by 3607
Abstract
Background: Global immunization inequities persist, reflected in the 25 million underimmunized and 18 million zero-dose children in 2021. To identify country approaches to reach underimmunized and zero-dose children, we undertook a structured synthesis of pro-equity strategies across 61 countries receiving programmatic support from [...] Read more.
Background: Global immunization inequities persist, reflected in the 25 million underimmunized and 18 million zero-dose children in 2021. To identify country approaches to reach underimmunized and zero-dose children, we undertook a structured synthesis of pro-equity strategies across 61 countries receiving programmatic support from Gavi, the Vaccine Alliance. Methods: We extracted data from 174 Country Joint Appraisals and Multi-Stakeholder Dialogue reports (2016–2020). We identified strategies via a targeted keyword search, informed by a determinants of immunization coverage framework. Strategies were synthesized into themes consolidated from UNICEF’s Journey to Health and Immunization (JTHI) and the Global Routine Immunization Strategies and Practices (GRISP) frameworks. Results: We found 607 unique strategies across 61 countries and 24 themes. Strategies to improve care at the point of service (44%); to improve knowledge, awareness and beliefs (25%); and to address preparation, cost and effort barriers (13%) were common. Fewer strategies targeted experience of care (8%), intent, (7%) and after-service (3%). We also identified strategies addressing gender-related barriers to immunization and targeting specific types of communities. Conclusions: We summarize the range of pro-equity immunization strategies employed in Gavi-supported countries and interpret them thematically. Findings are incorporated into a searchable database which can be used to inform equity-driven immunization programs, policies and decision-making which target underimmunized and zero-dose communities. Full article
(This article belongs to the Special Issue Inequality in Immunization 2023)
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14 pages, 3037 KiB  
Communication
Zero-Dose, Under-Immunized, and Dropout Children in Nigeria: The Trend and Its Contributing Factors over Time
by Ryoko Sato
Vaccines 2023, 11(1), 181; https://doi.org/10.3390/vaccines11010181 - 14 Jan 2023
Cited by 3 | Viewed by 3141
Abstract
Introduction: This study analyzes the trend of prevalence of, and factors contributing to, children with incomplete vaccination status, namely zero-dose, under-immunized, and dropout children, over time from 2003 to 2018 in Nigeria, one of the countries with the highest number of children with [...] Read more.
Introduction: This study analyzes the trend of prevalence of, and factors contributing to, children with incomplete vaccination status, namely zero-dose, under-immunized, and dropout children, over time from 2003 to 2018 in Nigeria, one of the countries with the highest number of children with incomplete vaccination. Methods: Nigeria Demographic and Health Survey data from 2003 to 2018 were analyzed to calculate the prevalence of children with incomplete vaccination status by geographical zone over time and to investigate the factors contributing to the change in the prevalence of such children over time based on the Blinder–Oaxaca decomposition analysis. Results: The prevalence of children with incomplete vaccination status substantially decreased from 2003 to 2018 in most of zones in Nigeria. Rural areas and the northern zones had consistently higher prevalence of children with incomplete vaccination status than urban areas and the southern zones. It was identified that mothers’ education and the household wealth level explained the reduction in the prevalence of zero-dose and under-immunized children, but the degree of contribution of each factor varied by zone and place of residence, i.e., urban or rural. Both the mother’s education and household wealth level only weakly contributed to the reduction in the number of dropout children. Discussions and conclusion: Future studies should explore further how to improve the vaccination coverage in Nigeria over time. Examples of topics for future study include other contributing factors beyond education and wealth level, differential factors influencing the reduction in the number of children with incomplete vaccination status by area of residence (urban vs. rural), why the reduction in the number of dropout children is not explained by either education or wealth, and the significant contributors to the reduction in the number of such children. Full article
(This article belongs to the Special Issue Vaccination Hesitancy: Attitudes and Associated Factors)
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