Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach.

BACKGROUND: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. OBJECTIVE: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. METHODS: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke's thematic analysis was used to identify core themes. RESULTS: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). CONCLUSIONS: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population's perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups.

Development of motivational interviewing skills in immunization (MISI): a questionnaire to assess MI learning, knowledge and skills for vaccination promotion.

Objective: Vaccine hesitancy is a complex problem. We previously demonstrated that motivational interviewing (MI) could be helpful to enhance parents' motivation to vaccinate their child. The aim of this study is to develop a new, simple and robust evaluation tool that is suitable for evaluating MI learning of vaccination health professionals. Methods: We designed the Motivational Interviewing Skills in Immunization (MISI), a short written questionnaire to evaluate the MI knowledge and skills of participants in an immunization context. It covers three key areas: knowledge of MI, ability to apply MI-related skills, participant self-confidence in using MI. Questionnaire content and face validity were assessed by MI experts and internal consistency, reliability and effect size were analyzed using a multiple pretest-posttest design. Results: Psychometric measures showed good to excellent internal consistency of the questionnaire for all three areas (Cronbach's and KR coefficient: 0.70 to 0.88). Test-retest reliability showed good measurement stability (ICC: 0.53). Good sensitivity to change was also obtained (Cohen's d: 0.80 to 1.66). Conclusion: The MISI questionnaire is the first paper/pencil evaluation method to assess MI training specific to immunization. Psychometric measures showed high reliability. Practice implications: This questionnaire could provide a convenient and inexpensive method to evaluate knowledge and competencies following immunization-specific MI training.

Effect and cost-effectiveness of educating mothers about childhood DPT vaccination on immunisation uptake, knowledge, and perceptions in Uttar Pradesh, India: A randomised controlled trial.

BACKGROUND: To assess the effect of health information on immunisation uptake in rural India, we conducted an individually randomised controlled trial of health information messages targeting the mothers of unvaccinated or incompletely vaccinated children through home visits in rural Uttar Pradesh, India. METHODS AND FINDINGS: The study tested a brief intervention that provided mothers face-to-face with information on the benefits of the tetanus vaccine. Participants were 722 mothers of children aged 0-36 months who had not received 3 doses of diphtheria-pertussis-tetanus (DPT) vaccine (DPT3). Mothers were randomly assigned in a ratio of 1:1:1 to 1 of 3 study arms: mothers in the first treatment group received information framed as a gain (e.g., the child is less likely to get tetanus and more likely to be healthy if vaccinated), mothers in the second treatment group received information framed in terms of a loss (e.g., the child is more likely to get tetanus and suffer ill health if not vaccinated), and the third arm acted as a control group, with no information given to the mother. Surveys were conducted at baseline (September 2015) and after the intervention (April 2016). The primary outcome was the proportion of children who had received DPT3 measured after 7 months of follow-up. The analysis was by intention to treat. A total of 16 (2.2%) participants were lost to follow-up. The coverage of DPT3 was 28% in the control group and 43% in the pooled information groups, giving a risk difference of 15 percentage points (95% CI: 7% to 22%, p < 0.001) and a relative risk of 1.52 (95% CI: 1.2 to 1.9, p < 0.001). The information intervention increased the rate of measles vaccination by 22 percentage points (risk difference: 22%, 95% CI: 14% to 30%, p < 0.001; relative risk: 1.53, 95% CI: 1.29 to 1.80) and the rate of full immunisation by 14 percentage points (risk difference: 14%, 95% CI: 8% to 21%, p < 0.001; relative risk: 1.72, 95% CI: 1.29 to 2.29). It had a large positive effect on knowledge of the causes, symptoms, and prevention of tetanus but no effect on perceptions of vaccine efficacy. There was no difference in the proportion of children with DPT3 between the group that received information framed as a loss and the group that received information framed as a gain (risk difference: 4%, 95% CI: -5% to 13%; p = 0.352; relative risk: 1.11, 95% CI: 0.90 to 1.36). The cost per disability-adjusted life year averted of providing information was US$186, making the intervention highly cost-effective with respect to the WHO-recommended threshold of once the gross domestic product per capita (US$793 in the case of Uttar Pradesh). Key study limitations include the modest sample size for this trial, limiting power to detect small differences in the framing of information, and the potential for contamination among households. CONCLUSIONS: Providing mothers of unvaccinated/incompletely vaccinated children with information on tetanus and the benefits of DPT vaccination substantially increased immunisation coverage and was highly cost-effective. The framing of the health information message did not appear to matter. TRIAL REGISTRATION: The trial is registered with ISRCTN, number ISRCTN84560580.

What is 'confidence' and what could affect it?: A qualitative study of mothers who are hesitant about vaccines.

BACKGROUND: Public confidence in immunization is critical to maintaining high vaccine-coverage rates needed to protect individuals and communities from vaccine-preventable diseases. Recent attention has been placed on factors influencing confidence in vaccination in the US and globally, but comprehensive understanding of what drives or hinders confidence in childhood vaccination is yet to be reached. As such, assessing parents' confidence in childhood vaccination and the ways in which educational materials affect confidence is needed. OBJECTIVE: We sought to (1) learn how mothers who are hesitant about vaccination characterize confidence in health-related products for young children, including the recommended vaccines; (2) gain insights on what influences vaccine confidence beliefs; and (3) assess whether short, education materials affect parental confidence in childhood vaccinations. METHODS: Eight moderator-lead focus groups (n=61), stratified by socioeconomic status, were undertaken with mothers of children 5years of age of less who are hesitant about vaccines. Four of the groups were held in the Philadelphia, PA area and four were held in the San Francisco/Oakland, CA area. Three educational material pairs, each consisting of a 2-3min video and an infographic poster about an immunization-related topic, were reviewed and assessed for influence on confidence. RESULTS: Qualitative data analysis was used to identify overarching themes across the focus groups. Themes, insights, and illustrative quotes were identified and provided for each of the major discussion areas: primary health concerns for young children; confidence beliefs and perceptions, including for recommended vaccines; facilitators and barriers to confidence; and reactions to the educational materials. CONCLUSIONS: Results provide helpful insights into how mothers who are hesitant about vaccines perceive confidence in childhood vaccines and health-related products, suggestions for how to improve confidence, and support for the value and use of short videos as part of vaccination education efforts. Findings can aid those developing vaccination education materials and resources designed to foster vaccine confidence.

Knowledge, attitudes, and practices of private sector immunization service providers in Gujarat, India.

BACKGROUND: India is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. METHODS: We used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. RESULTS: The response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. CONCLUSIONS: Quality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services delivered and working through professional societies to adopt standards of practice.

Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study.

OBJECTIVES: The widespread availability and use of vaccines have tremendously reduced morbidity, mortality and health care costs associated with infectious diseases. However, parental beliefs about vaccination are one of the major factors in achieving high vaccination rates. Thus, this study aims to assess the perceptions and attitudes regarding routine childhood immunization among Saudi parents. METHODS: A cross sectional study with a pre-tested 18-item questionnaire was conducted using 467 randomly selected parents from the Hail region of Saudi Arabia in the period between February 1st, 2016, and February 1st, 2017. The validated questionnaire consisted of three sections that collected information on participants' demographics, parents' awareness of vaccine benefits, and parents' practices regarding the immunization of their children. RESULTS: Female and male parents comprised 54.5% (255) and 45.5% (212) of the sample, respectively, and the response and completion rates were 97%. The majority of the respondents had received a formal education (94.1%, 439), were gainfully employed (62.9%, 294) and had a regular monthly income (73.3%). The majority of the respondents were aware of childhood vaccinations (78.9%), completed vaccinations mandated for children up to 5 years (86.2%), encouraged other parents to do so (89.9%), and had easy access to vaccines (90.5%). Sixty to ninety percent of the respondents were knowledgeable regarding the health benefits of vaccinations in children, even though 18.4% of their children had experienced vaccination-related minor adverse effects during or after vaccination of which 23.2% required doctor's visits. Health care professionals were the most frequent source of parents' vaccine-related information (65.2%), and vaccination reminder services provided by the Ministry of Health (MOH) via mobile phones were cited by 57.5% of respondents. CONCLUSIONS: Confidence in and acceptance of childhood vaccinations, perceptions of vaccine-related health benefits and ease of access to immunizations appeared to be quite good among Saudi parents.

Promotion of Immunizations for Health Professionals in Europe: A Qualitative Study in Seven European Member States.

Health Care Workers (HCWs) are a high-risk group for contracting Vaccine-Preventable Diseases who, despite legislation and guidance, remain undervaccinated. In order to understand their barriers and needs, focus groups were formed with 278 physicians, nurses, infection-control personnel, and policy-makers in 7 EU MS. Several implications for the development of promotional initiatives were identified including the need to overcome organizational barriers, to sensitize HCWs about the importance of immunization and to provide specific up-to-date information about vaccinations covering prevalence of diseases, protection years, side effects, administration times, antibody examinations, costs and immunization settings.

Attitudes about adult vaccines and reminder/recall in a safety net population.

Little is known about adult patients' attitudes toward vaccination and preferences for reminder/recall. The objective of this study was to determine patient perspectives on adult vaccines generally; attitudes about Tdap, pneumococcal polysaccharide (PPSV-23), and seasonal influenza vaccines specifically; and preferences for adult reminder/recall delivery. Twelve focus groups were conducted with 68 patients in a safety net health system. The sample was stratified by preferred language (English or Spanish), age (18-64 or 65+), and health status (with or without chronic conditions). Participants expressed positive attitudes toward vaccines generally, but had little knowledge of specific vaccines other than influenza, about which they expressed concerns. Although none reported previous experience receiving reminder/recall notices for adult vaccines, all were in favor of receiving them. These results suggest potential patient interest in greater adoption of evidence-based methods to improve immunization rates, and highlight the need for improved communication between providers and patients about adult vaccines.

Adolescent values for immunisation programs in Australia: A discrete choice experiment.

OBJECTIVES: The importance of adolescent engagement in health decisions and public health programs such as immunisation is becoming increasingly recognised. Understanding adolescent preferences and further identifying barriers and facilitators for immunisation acceptance is critical to the success of adolescent immunisation programs. This study applied a discrete choice experiment (DCE) to assess vaccination preferences in adolescents. METHODS: This study was conducted as a cross-sectional, national online survey in Australian adolescents. The DCE survey evaluated adolescent vaccination preferences. Six attributes were assessed including disease severity, target for protection, price, location of vaccination provision, potential side effects and vaccine delivery method. A mixed logit model was used to analyse DCE data. RESULTS: This survey was conducted between December 2014 and January 2015. Of 800 adolescents aged 15 to 19 years, stronger preferences were observed overall for: vaccination in the case of a life threatening illness (p<0.001), lower price vaccinations (p<0.001), mild but common side effects (p = 0.004), delivery via a skin patch (p<0.001) and being administered by a family practitioner (p<0.001). Participants suggested that they and their families would be willing to pay AU$394.28 (95%CI: AU$348.40 to AU$446.92) more for a vaccine targeting a life threatening illness than a mild-moderate illness, AU$37.94 (95%CI: AU$19.22 to AU$57.39) more for being vaccinated at a family practitioner clinic than a council immunisation clinic, AU$23.01 (95%CI: AU$7.12 to AU$39.24) more for common but mild and resolving side effects compared to rare but serious side effects, and AU$51.80 (95%CI: AU$30.42 to AU$73.70) more for delivery via a skin patch than injection. CONCLUSIONS: Consideration of adolescent preferences may result in improved acceptance of, engagement in and uptake of immunisation programs targeted for this age group.

Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors.

BACKGROUND: Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live. METHODS: The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12-23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3). RESULTS: More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15-24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39-0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51-0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50-0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02-1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60-4.71) and states (aOR = 2.69; 955 CrI =1.37-4.73) were more likely to be incompletely immunized. CONCLUSIONS: This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.

Muslim Scholars' Knowledge, Attitudes and Perceived Barriers Towards Polio Immunization in Pakistan.

Pakistan is one of the two countries where polio remains endemic. Among multiple reasons of polio prevalence, false religious beliefs are accounted as major barriers towards polio immunization in Pakistan. Within this context, religious scholars are now engaged in polio immunization campaigns to dismantle the myths and battle the resurgence of polio in Pakistan. The objective of this study was to assess knowledge, attitudes and perceived barriers of Muslim scholars towards polio immunization in Pakistan. A descriptive, cross-sectional survey of Muslim scholars was conducted in Quetta and Peshawar divisions of Pakistan. From October to December 2015, a convenience sample of 770 Muslim scholars was recruited from the local mosques and religious institutions to participate in this study. Knowledge, attitudes, and perceived barriers were assessed by using self-administered, anonymous and pretested questionnaire. Descriptive and regression analyses were used to express the results with p < 0.05 taken as significant. Three hundred and forty-eight (45.2 %) participants exhibited good knowledge about polio with a mean score of 7.16 ± 2.12 (based on 14 questions). Knowledge gaps were identified about the transmission (32.6 %) and consequences of poliovirus (39.9 %). Overall, 527 (68.4 %) participants showed positive attitudes towards polio immunization with a mean attitude score of 27.35 ± 2.68 (based on nine statements). The majority of participants agreed on the need of depoliticizing polio immunization issues (87.1 %), while reservations were noted about their willingness to participate in future polio immunization programs (44.6 %). Security (75.8 %) and vaccine management issues (64 %) were reported by the participants as the major barriers towards polio immunization in Pakistan. The findings showed poor knowledge of Muslim scholars towards polio; however, their attitudes were positive towards polio immunization. More studies are required to assess the knowledge and attitudes of Muslim scholars at the national level to validate the findings of this study.

Parent Attitudes Toward Pain Management for Childhood Immunizations.

OBJECTIVES: Evidence-based pain-limiting strategies for pediatric immunizations remain underutilized, with barriers identified to date mostly pertaining to health care providers and systems of care. The present study sought to quantify and investigate parent attitudes toward pain management as another potential barrier to the routine use of pain-mitigating strategies during immunizations. MATERIALS AND METHODS: Questionnaires measuring parent attitudes, willingness to pay, and perceived barriers for using pain management for immunizations were completed by 259 parent/guardians of children ages 0 to 5 years attending appointments at an urban primary care clinic in the Midwestern United States. RESULTS: Parent attitudes toward pain management for immunization were relatively normally distributed and varied from strongly positive to negative, with 33% of parents disagreeing that they were concerned about the pain their child may experience and 50% agreeing that there are no lasting negative effects from immunization pain. Negative parent attitudes were associated with willingness to spend less in money or time for pain management and with greater perceived significance of cost, time, and other barriers for using pain-mitigating strategies. DISCUSSION: Some parents perceive limited value in trying to reduce pain during immunizations such that they may be hesitant to invest much time or effort in interventions. Greater success of translating evidence-based pain management into practice therefore may require accounting for differences in parent attitudes by tailoring educational efforts and pain management options accordingly.

Community pharmacists' knowledge, beliefs and attitudes towards immunization in Quebec.

OBJECTIVES: To describe the knowledge, beliefs and attitudes of Quebec's pharmacists towards immunization and determine their perceived barriers to pharmacist-led immunization. METHODS: The current study was a descriptive survey of pharmacists working in a community setting in Quebec. Pharmacists were randomly chosen from a list of Quebec's community pharmacies and were contacted by phone from January 17 to 25, 2013. Participating pharmacists were given a web link to the online questionnaire. An e-mail reminder was sent 5-7 days after the first contact. RESULTS: A total of 201 community pharmacists were contacted during the study period, and 115 answered the survey, generating a 57% response rate. The vast majority of respondents answered that vaccines have more benefits than adverse effects. Approximately 52% answered that pharmacists should be able to prescribe and administer vaccines, pending a legislative change. These pharmacists were more interested in administering travel (92%), flu (88%) and pandemic (85%) vaccines than regularly scheduled vaccines for adults (65%) or children (18%). Leading barriers to pharmacist-led immunization were lack of time (90%) and training (92%), and the most common factors that would help its implementation were increased immunization training (95%) and adequate remuneration (92%). CONCLUSION: These findings should push for a renewed discussion about the role of pharmacists as immunization agents in Canadian provinces where pharmacists do not have the right to administer vaccines.

UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): protocol for an exploratory, qualitative study.

INTRODUCTION: Gypsies, Travellers and Roma (referred to here as Travellers) experience significantly poorer health and have shorter life expectancy than the general population. They are also less likely to access health services including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. This study has two aims: (1) Investigate the barriers and facilitators to acceptability and uptake of immunisations among six Traveller communities in the UK; (2) Identify potential interventions to increase uptake in these Traveller communities. METHODS AND ANALYSIS: A three-phase qualitative study with six Traveller communities. PHASE 1: In each community, we will explore up to 45 Travellers' views about the influences on their immunisation behaviours and ideas for improving uptake in their community. PHASE 2: In each community, we will investigate 6-8 service providers' perspectives on barriers and facilitators to childhood and adult immunisations for Traveller communities with whom they work, and ideas to improve uptake. Interview data will be analysed using the Framework approach. PHASE 3: The findings will be discussed and interventions prioritised in six workshops, each with 10-12 phase 1 and 3-4 phase 2 participants. ETHICS AND DISSEMINATION: This research received approval from NRES Committee Yorkshire and The Humber-Leeds East (Ref. 13/YH/02). It will produce (1) findings on the barriers and facilitators to uptake of immunisations in six Traveller communities; (2) a prioritised list of potentially feasible and acceptable interventions for increasing uptake in these communities; and (3) methodological development in undertaking research with diverse Traveller communities. The study has the potential to inform new ways of delivering services to ensure high immunisation uptake. Findings will be disseminated to participants, relevant UK organisations with responsibility for the implementation of immunisation policy and Traveller health/welfare; and submitted for publication in academic journals. TRIAL REGISTRATION NUMBER: ISRCTN20019630.

Adverse events following immunization: is this time for the use of WHO causality assessment?

In recent years, public health authorities in industrialized countries have noted an increase in the numbers of parents choosing not to have their children vaccinated and in the activities of 'antivaccination' movements. Doubts about vaccine safety and lack of surveillance of adverse events following immunization (AEFI) are the most frequent themes proposed by antivaccination movements. This editorial aims to critically analyze the use of AEFI assessment procedures among national health authorities and public health researchers. In fact, the WHO recommended and published a systematic and standardized causality assessment process for serious AEFI, providing a method for individual causality assessment to be used by staff of national immunization programs, regulatory authorities and pharmacovigilance or surveillance departments. The last update was published in March 2013 but to date, an Internet search reveals no information or reports on AEFI surveillance that uses the WHO AEFI causality assessment.

Maternal satisfaction about childhood immunization in primary health care center, Egypt.

INTRODUCTION: Childhood immunization is considered to be among the most effective preventive services, and is therefore critical to monitor and evaluate. One prior study reported an association between parental satisfactions with pediatric care and up-to-date immunization at 24 months independent of maternal age, race, and education. In addition to promoting appropriate utilization, satisfaction may increase engagement in the health care process. Health system factors included inconvenient clinic hours, dates or locations, waiting lines, and conflicting information. The inconvenience of clinic hours dates of immunization clinics, and locations of clinics were reported by 75% of the parents. METHODS: A cross section study was conducted on three hundred and thirty five mothers chosen from PHCC participating in the study by providing information on satisfaction about the program and their knowledge about vaccination. RESULTS: Inappropriate knowledge was reported by most of mothers (84.8%). And 95.2% of mothers were satisfied with childhood immunization services in primary healthcare center, compared to 4.8% who were unsatisfied with them. CONCLUSION: This study shows that there was no statistically significant relation between maternal satisfaction with childhood immunization services and knowledge score, while in most satisfaction surveys information giving was an important need and this represent that client needs are changing, and priorities from client's perspectives are also changing, so on- going monitoring of client satisfaction is the safeguard to improve quality of care.

Assessment of attitudes towards adverse events following immunization with oral poliovirus vaccine: a pilot study among high school students of Kinshasa, the Democratic Republic of Congo.

OBJECTIVE: The aim of this study is to evaluate the reaction of students to adverse events following immunization in order to offer a baseline for developing a communication and risk management plan. METHOD: This is a cross-sectional study conducted in Kinshasa. A survey was conducted between the third and the fourth rounds of Supplementary Immunization Activity. Nine hundred and fifty questionnaires were used and addressed students who attended this university from 1 to 10 June 2011. RESULTS: Completed questionnaires were received from 848 students, with 485 females (57·2%), 343 males (40·4%), and 20 unknown (2·4%); 46·9% of students were from the faculty of medicine and 24·7% was from the third graduate degree. From those who completed the questionnaire, 136 (16·4%) reported experiencing an adverse events following immunization. Concerning the attitude of students towards adverse events following immunization, 79 students (58·5%) did nothing; 54 (40·0%) opted for self-medication; 2 (1·5%) went to the hospital. CONCLUSION: The main finding of our study is the low rate of people referring to health-care providers for vaccine-related problems, more specially for adverse events following immunization. A risk management plan should be focused in strategies to increase communication between population and health-care providers.

Involvement of males in antenatal care, birth preparedness, exclusive breast feeding and immunizations for children in Kathmandu, Nepal.

BACKGROUND: Men in patriarchal societies of developing countries are often identified as decision makers in all aspects of day-to-day life. The study explores the factors associated with male involvement in ANC, birth plans, exclusive breastfeeding and immunization of children. METHODS: A cross-sectional survey was conducted among 2178 married males between May and December 2010 in Kathmandu, Nepal. Twenty one clusters were selected for data collection using structured questionnaire. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CI) of associated factors were estimated by stepwise backward likelihood ratio method. RESULTS: This study determined the percentage of males who accompanied their partners for ANC (39.3%), arranged SBA (47.9%) and accompanied them for child immunization (10.9%). Factors found associated with respect to different activities were as follows: accompanied their partners on antenatal visits - uneducated or primary level education (AOR, 5.68, 95% CI, 4.44-7.27), income NPR 5001 (1USD = 85 NPR) or above (1.47, 1.20-1.80) and aged above 25 years (2.51, 1.89-3.33); arranged money for delivery - uneducated or primary level education (7.34, 5.84-9.23), income NPR 5001 or above (1.80, 1.48-2.20) and aged above 25 years (1.55, 1.18-2.03); arranged SBA - uneducated or primary level education (17.14, 12.65-23.22) and income NPR 5001 or above (2.89, 2.36-3.54); arranged transportation - uneducated or primary level education (17.65, 11.84-26.32), income NPR 5001 or above (1.69, 1.40-2.04) and aged above 25 years (1.69, 1.27-2.24); encouraged exclusive breast feeding - uneducated or primary level education (5.48, 4.39-6.83) and aged above 25 years (1.35, 1.03-1.77); accompanied their partners for immunization their children - uneducated or primary level education (3.88, 2.53-5.96) and aged above 25 years (1.72, 1.11-2.64). CONCLUSIONS: Men who were uneducated or had primary level education, aged above 25 years, had higher income, formal employment, came from Hindu religion and non-indigenous ethnicities demonstrated greater involvement and these factors should be emphatically considered during maternal health program development.