Magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 2023: institution-based cross-sectional study design.

Background: Self-harm is a preventable, but a leading, cause of maternal morbidity and mortality all over the world, with a significant impact on healthcare systems. Objective: To assess the magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics. Methods: An institution-based cross-sectional study was employed among postnatal mothers attending infant immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 1 October to 30 October 2023. A pretested, face-to-face interviewer-administered structured questionnaire prepared by Kobo Toolbox was used to collect the data. Both bivariable and multivariable logistic regression analyses were done. The level of significance was declared at p-value <0.05 with a 95% CI. Results: Among the 423 mothers enrolled in the study, 415 of them finally participated, at a response rate of 98.10%. The magnitude of self-harm was 12.53% (95% CI: 9.33, 15.73). Involvement of husband in maternity and child healthcare (AOR = 1.90; 95% CI: 1.12, 2.10), depression (AOR = 2.79; 95% CI: 2.14, 6.94), loneliness (AOR = 2.49; 95% CI: 1.15, 5.40), postpartum intimate partner violence (AOR = 2.15; 95% CI: 1.01, 4.54), average monthly income (AOR = 3.70; 95% CI: 2.17, 10.50), and postnatal care (AOR = 2.72; 95% CI: 1.28, 5.80) were significantly associated factors. Conclusion and recommendations: The study sought a magnitude of self-harm that was slightly higher than the previous study conducted in the northern part of Ethiopia. Therefore, healthcare providers should focus on identified factors during postnatal care to overcome them. Similarly, the concerned body should develop an effective strategy based on the identified factors to pay attention to postnatal mothers.

Determinants of default from completion of child immunization among children aged 15-23 months in Kacha Bira district, Kembata Tembaro zone, South Ethiopia: a case-control study.

Background: Child immunization is crucial to protect children from vaccine-preventable diseases. However, if a child defaults from completing immunization, they are at a greater risk of contracting such diseases. Previous studies have evaluated various factors that contribute to defaulting from immunization, but they did not consider the fear of COVID-19 as a variable. Additionally, there is inconsistency in the factors identified across different areas. This study aimed to examine the determinants of defaulting from child immunization among children aged 15-23 months in Kacha Bira district, Kembata Tembaro zone, South Ethiopia. Methods: A study was conducted using a community-based unmatched case-control design to identify the determinants of child immunization completion. The study included 255 children aged 15-23 months in the Kacha Bira district from 3 May 2022 to 1 June 2022, using a multi-stage sampling technique. Face-to-face interviews of mothers or immediate caretakers of the child were conducted using a mobile device, and the questionnaire was developed using the Kobo Toolbox. The data collected were analyzed using SPSS version 25. Multivariable logistic regression was used to identify the determinants, and the adjusted odds ratio with 95% CI and a p < 0.05 were considered statistical significant. Results: The multivariable logistic regression analysis identified four independent predictors of immunization defaulting. Antenatal care (ANC) follow-up [AOR = 5.40, 95% CI (2.24-13.52)], postponing vaccination schedule [AOR = 2.28, 95% CI: (1.05-4.93)], parity of the mother [AOR = 3.25, 95% CI: (1.45-7.27)], and knowledge of the mother about vaccination [AOR = 6.77, 95% CI: (2.33-19.64)] were determinants of immunization defaulting. Conclusion: In this study, lack of ANC follow-up, postponement of the vaccination schedule, mothers with parity of greater than four, and poor knowledge of the mothers about immunization were identified as determinants of immunization defaulting.

Coverage, spatial distribution and determinants of childhood inactivated poliovirus vaccine immunization in Ethiopia.

INTRODUCTION: Polio eradication is a current and common strategy throughout the globe. The study of the newly introduced inactivated poliovirus vaccine provides a grasp on the current status of immunization and identifies any disparities in the implementation of the vaccine throughout Ethiopia. Thus, this study aimed to demonstrate the spatial distribution, coverage, and determinants of inactivated poliovirus vaccine immunization in Ethiopia. METHOD: Spatial distribution and determinants of inactivated poliovirus vaccine immunization in Ethiopia were conducted using Ethiopian mini-demographic and health survey 2019 data. A total of 2,056 weighted children aged 12 to 35 months were included in the analysis. The association between the outcome and explanatory variables was determined by commuting the adjusted odds ratio at a 95% confidence interval. The p-value of less than 0.05 was used to declare factors as significantly associated with the inactivated poliovirus vaccine immunization. RESULT: The weighted national coverage of inactivated poliovirus vaccine immunization in Ethiopia was 51.58% at a 95% confidence interval (49.42, 53.74). While the rates of inactivated poliovirus vaccine immunization were observed to be greater in Addis Ababa, Tigiray, Amahara, and Benishangul Gumuz provinces and lower in the Somali, Afar, and SNNPR provinces of Ethiopia, Antenatal care follow-up, place of delivery, place of residence, and region were significantly associated with inactivated poliovirus immunization in Ethiopia. CONCLUSION: The distribution of inactivated poliovirus immunization was spatially variable across Ethiopia. Only about half of the children aged twelve to thirty-five months received the inactivated poliovirus vaccine in the country. The factors, both at the individual and community level, were significantly associated with inactivated poliovirus immunization. Therefore, policies and strategies could benefit from considering antenatal care follow-up, place of delivery, place of residence, and region while implementing inactivated poliovirus vaccine immunization.

Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study.

INTRODUCTION: Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). METHODS: This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. RESULTS: Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR = 1.17; 95% CI, 1.04-1.31; p = .004) and the four-dose pneumococcal conjugate vaccine series (OR = 1.36; 95% CI, 1.18-1.57; p < .001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. CONCLUSIONS: Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.

A Systematic Review of Immunization Administration Training for African Pharmacists and Student Pharmacists.

OBJECTIVES: Recent calls to action have encouraged African pharmacists to become trained to administer immunizations with the goals of developing a strong pharmacy vaccination workforce, addressing a shortage of vaccinators, and improving vaccination access. However limited availability of training programs for pharmacists and student pharmacists to learn to administer immunizations may restrict the ability of African pharmacists and student pharmacists to meet these goals. This work sought to systematically identify literature published regarding immunization administration training for pharmacists and student pharmacists in Africa. FINDINGS: In total, 940 articles were identified from 6 databases and gray literature. After eligibility criteria were applied, a total of 8 studies from 7 African countries were included, representing Democratic Republic of Congo, Ethiopia, Nigeria, Senegal, South Africa, Uganda, and Zimbabwe. Three studies described immunization administration training programs for pharmacists and 1 described training for student pharmacists. SUMMARY: This literature review identified that there are limited publications describing immunization training for pharmacists and student pharmacists in Africa. Training pharmacists to immunize could make a meaningful impact in increasing immunization access and reducing the spread of vaccine-preventable diseases in Africa. Expansion of available immunization administration training is needed for African pharmacists and student pharmacists if calls to action are to be met.

Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach.

The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12-35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers' occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

Avaliação da cobertura vacinal da poliomielite nos estados da região sul, com foco no município de Pato Branco, entre os anos de 2009-2019 / Assessment of polio vaccination coverage in the southern states, focusing on the municipality of Pato Branco, from 2009-2019 / Evaluación de la cobertura de vacunación contra la poliomielitis en los estados de la región sur, con enfoque en el municipio de Pato Branco, entre los años 2009-2019

Objetivo: Analisar a taxa de cobertura vacinal da poliomielite em relação às metas de vacinação de 95% da população-alvo, estabelecidas pelo Ministério da Saúde, com base nos registros de imunização do DATASUS nos estados do Paraná, Santa Catarina e Rio Grande do Sul, que compõem a região sul do Brasil, e na cidade de Pato Branco, PR. Métodos: Estudo descritivo de abordagem quantitativa referente à cobertura vacinal da Poliomielite nos estados da região sul e no município de Pato Branco, PR com resultados da cobertura avaliados quanto ao alcance das metas estabelecidas pelo Ministério da Saúde e comparado o desempenho entre os estados e o município no período de 2009 a 2019. Os dados foram recolhidos da seção de Imunizações do DATASUS, o departamento de informática do Sistema Único de Saúde do Brasil. Resultados: No período analisado, o município de Pato Branco se manteve com uma taxa satisfatória em relação à meta estabelecida pelo Ministério da Saúde, exceto nos anos de 2017 e 2018, onde ficou abaixo da meta em cerca de 3% e 11%, respectivamente. Em relação aos estados do sul, o estado do Paraná mostrou-se abaixo da meta de cobertura vacinal recomendada na maioria dos anos estudados, com a menor cobertura ocorrendo em 2017, ficando 15% abaixo do esperado; o estado de Santa Catarina, apesar de apresentar queda desde o ano de 2014, apresentou os melhores índices de cobertura vacinal, com a maior taxa de queda de cobertura no ano de 2018 com cerca de 7%; e o estado do Rio Grande do Sul se apresentou como o estado com o pior desempenho na região, demonstrando quedas significativas da cobertura desde 2010, com menor taxa de vacinação em 2017, ficando 18% abaixo do esperado. Conclusões: Pode-se observar uma queda nos valores da cobertura vacinal entre os anos de 2009 a 2019, tanto no município de Pato Branco, PR, quanto nos estados do Paraná, Santa Catarina e Rio Grande do Sul, algo que é motivo de crescente preocupação pelos serviços de saúde do país devido à possibilidade de reintrodução da doença no território nacional. Ressalta-se, então, a necessidade de criação de estratégias eficazes para o combate das quedas das taxas de cobertura vacinal no país.

Objective: To analyze the rate of polio vaccination coverage in relation to the vaccination goals of 95% of the target population, set by the Ministry of Health, based on DATASUS immunization records in the states of Paraná, Santa Catarina, and Rio Grande do Sul, which make up the southern region of Brazil, and in the city of Pato Branco, PR. Methods: A descriptive study of quantitative approach regarding the vaccination coverage of Poliomyelitis in the states of the southern region and in the municipality of Pato Branco, PR with coverage results evaluated as to the achievement of the goals set by the Ministry of Health and compared performance between the states and the municipality in the period from 2009 to 2019. The data were collected from the Immunizations section of DATASUS, the computer department of the Brazilian Unified Health System. Results: In the period analyzed, the municipality of Pato Branco remained with a satisfactory rate in relation to the target set by the Ministry of Health, except in the years 2017 and 2018, where it was below the target by about 3% and 11%, respectively. Regarding the southern states, the state of Paraná showed below the recommended vaccine coverage target in most of the years studied, with the lowest coverage occurring in 2017, being 15% below expected; the state of Santa Catarina, despite showing a drop since the year 2014, showed the best rates of vaccine coverage, with the highest rate of drop in coverage in the year 2018 with about 7%; and the state of Rio Grande do Sul presented itself as the state with the worst performance in the region, showing significant drops in coverage since 2010, with the lowest rate of vaccination in 2017, being 18% below expectations. Conclusions: A drop in vaccination coverage values can be observed between the years 2009 and 2019, both in the municipality of Pato Branco, PR, and in the states of Paraná, Santa Catarina, and Rio Grande do Sul, something that is a cause of growing concern for the country's health services due to the possibility of reintroduction of the disease in the national territory. Therefore, the need to create effective strategies to combat the declines in vaccination coverage rates in the country is highlighted.

Objetivo: Analizar la tasa de cobertura de vacunación antipoliomielítica en relación con las metas de vacunación del 95% de la población objetivo, establecidas por el Ministerio de Salud, a partir de los registros de inmunización DATASUS en los estados de Paraná, Santa Catarina y Rio Grande do Sul, que conforman la región sur de Brasil, y en la ciudad de Pato Branco, PR. Métodos: Estudio descriptivo de abordaje cuantitativo referente a la cobertura vacunal de la Poliomielitis en los estados de la región sur y en el municipio de Pato Branco, PR con resultados de la cobertura evaluados en cuanto al alcance de las metas establecidas por el Ministerio de Salud y comparado el rendimiento entre los estados y el municipio en el período de 2009 a 2019. Los datos se recogieron de la sección de Inmunizaciones de DATASUS, el departamento de informática del Sistema Único de Salud de Brasil. Resultados: En el período analizado, el municipio de Pato Branco se mantuvo con una tasa satisfactoria en relación a la meta establecida por el Ministerio de Salud, excepto en los años 2017 y 2018, donde estuvo por debajo de la meta en cerca de 3% y 11%, respectivamente. En lo que respecta a los estados del sur, el estado de Paraná se mostró por debajo de la meta de cobertura vacunal recomendada en la mayoría de los años estudiados, siendo la cobertura más baja la que se produjo en el año 2017, estando un 15% por debajo de lo esperado; el estado de Santa Catarina, a pesar de mostrar una caída desde el año 2014, mostró los mejores índices de cobertura vacunal, siendo la mayor tasa de caída de la cobertura en el año 2018 con cerca de un 7%; y el estado de Río Grande do Sul se presentó como el estado con peor desempeño en la región, demostrando caídas significativas en la cobertura desde 2010, con la tasa de vacunación más baja en 2017, siendo un 18% por debajo de lo esperado. Conclusiones: Se observa una caída en los valores de las coberturas de vacunación entre los años 2009 y 2019, tanto en el municipio de Pato Branco, PR, como en los estados de Paraná, Santa Catarina y Rio Grande do Sul, algo que es motivo de creciente preocupación para los servicios de salud del país debido a la posibilidad de reintroducción de la enfermedad en el territorio nacional. Por lo tanto, se destaca la necesidad de crear estrategias eficaces para combatir el descenso de las tasas de cobertura de vacunación en el país.

Using Quality Measures to Drive Improvements in Immunization Rates: Findings from a Real-World Evaluation from 3 US Health Care Organizations.

Adult immunization rates are low and continue to fail to meet national targets. The coronavirus disease 2019 pandemic halted routine health care services for many, including vaccinations. This study explored whether the National Committee for Quality Assurance's Adult Immunization Status (AIS) measure, which had previously only been evaluated for reporting by health plans, could be leveraged by health care organizations (HCOs) as a tactic to improve immunization rates. Methods included a quantitative analysis of deidentified patient electronic health record data from 3 HCOs, supplemented by qualitative interviews to further understand opportunities and barriers. The analysis indicated that the data necessary for calculation of the AIS measure are available within HCOs and that measure performance could be enhanced with supplemental data from external sources, such as state immunization registries. Although HCOs rates were consistent with national estimates, this research further validated that adult immunization rates in the United States are low and highlighted the profound disparities that exist. For instance, the likelihood of completing all age-appropriate vaccinations was lower if patients were Black or African American, enrolled in Medicaid, or without health insurance. As a result of this study, the authors concluded that the AIS measure is feasible for use in medical groups and could potentially help drive quality improvements in immunization rates; however, there are considerations for implementation particularly if providers are being held accountable for measure performance.

Profile of Diphtheria Cases Hospitalized at Tertiary Referral Hospital in Indonesia: 10 Years' Experience.

This is a report about children diphtheria cases' profile in Cipto Mangunkusumo Hospital, Jakarta from 2006 to 2017. Occurrence was the highest in ≥5-years-old age group (67.7%) with male predominance (58.8%). Thirty five point three percent cases had no immunization history and 38.2% cases had incomplete booster history. Pseudomembrane occurred in all cases, mostly found in pharynx (67.6%) and tonsil (61.8%).

Cobertura vacinal em crianças até 1 ano de idade no estado do Rio de Janeiro entre 2008 a 2020 / Vaccination coverage in children up to 1 year in the state of Rio de Janeiro from 2008 to 2020

O Programa Nacional de Imunizações (PNI) observa um declínio na cobertura vacinal (CV), que pode representar um risco para o retorno de doenças consideradas controladas. Objetivou-se avaliar a tendência temporal e a variação espacial das CV em crianças nos municípios do estado do Rio de Janeiro (ERJ) entre 2008 a 2020. Tratou-se de um estudo ecológico misto em que são analisadas as taxas de CV em cada município do ERJ. Utilizou-se dados secundários de doses aplicadas dos imunobiológicos das vacinas tríplice bacteriana (DTP) e tríplice viral (SCR) contidos no Sistema de Informação do Programa Nacional de Imunizações (SI-PNI) e dados de nascidos vivos do Sistema de Informação de Nascidos Vivos (SINASC). A CV foi calculada por antígeno para os 92 municípios e para as 9 regiões de saúde do ERJ. O município do RJ foi analisado separadamente. A análise da tendência temporal das CV foi realizada utilizando o programa Join Point Regression e a mudança percentual anual (APC). Para a análise descritiva foram construídos mapas temáticos com o software QGIS adotando cinco estratos de CV: <70%; 70-80%; 80-90%; 90-95% e 95% ou mais. As CV foram suavizadas através do estimador Bayes empírico global. Para avaliar as correlações espaciais, calculou-se o Índice Local de Associação Espacial (LISA). Foram elaborados 39 mapas de CV suavizados e 39 mapas com o indicador LISA, um para cada ano e para cada vacina de interesse. Os cálculos foram realizados por intermédio do software TerraView. O nível de significância foi de 5%. Os resultados demonstraram que para a primeira dose (D1) da DTP, entre os anos 2008 e 2014, as regiões do Médio Paraíba, Metropolitana I, II e o município do RJ não alcançam a meta de CV de 95%, em 2010; entre 2008 a 2010, o município do RJ não alcança a meta de CV. Entre os anos de 2015 e 2020, observamos redução da CV da D1 da DTP nas regiões da Baía de Ilha grande e Norte, iniciadas desde 2017. Para a terceira dose (D3) da DTP houve maior número de CV abaixo de 95% entre 2008 e 2014 em relação à D1. Entre os anos de 2015 a 2020, destaca-se a região Metropolitana I que, não alcança a meta de CV de 95% e a partir de 2016 têm redução progressiva das CV até 2020, chegando a apresentar CV de 30,45% nesse ano. Para a D1 da SCR entre os anos 2008 e 2014, Centro-Sul e Serrana alcançam as metas de CV em todos os anos. Em 2019, Baixada litorânea, Noroeste e Norte não alcançam a meta, as demais regiões mantêm altas CV nesse ano. Em 2020, nenhuma região alcança a meta de CV e Metropolitana I e II têm as menores CV. A análise da tendência mostrou que para D1 da DTP o ERJ apresentou tendência de queda da CV a partir de 2017 (APC: -14,25); para SCR, apresentou crescimento até 2018 (APC: 1,8) e redução da CV a partir de 2018 (APC: -16,56). Os mapas do LISA mostram a presença de clusters de alta CV para a D1 da DTP em 2008, 2013 e 2018 e baixa CV em 2014; de alta CV para a D3 da DTP em 2008 e 2016 e alta CV para SCR em 2016 e 2018. A distribuição da CV demonstra padrões distintos entre as regiões de saúde e interiormente nos municípios ao longo dos anos. A análise temporal e espacial é uma ferramenta útil para a localização de áreas geográficas com bolsões de baixa ou alta CV, visando identificar áreas de maior vulnerabilidade.

The National Immunization Program (PNI) observes a decline in vaccination coverage (CV), which may represent a risk for the return of diseases considered controlled. The objective was to evaluate the temporal trend and the spatial variation of CV in children in the municipalities of the state of Rio de Janeiro (ERJ) between 2008 and 2020. It was a mixed ecological study in which CV rates in each municipality are analyzed of the ERJ. Secondary data of applied doses of immunobiologicals of the triple bacterial (DTP) and triple viral (SCR) vaccines contained in the National Immunization Program Information System (SI-PNI) and live birth data from the Live Birth Information System were used. (SINASC). The CV was calculated by antigen for the 92 municipalities and for the 9 health regions of the ERJ. The municipality of RJ was analyzed separately. The analysis of the temporal trend of the CV was performed using the Join Point Regression program and the annual percentage change (APC). For the descriptive analysis, thematic maps were built with the QGIS software, adopting five CV strata: <70%; 70-80%; 80-90%; 90-95% and 95% or more. The CVs were smoothed using the global empirical Bayes estimator. To assess spatial correlations, the Local Spatial Association Index (LISA) was calculated. 39 smoothed CV maps and 39 maps with the LISA indicator were prepared, one for each year and for each vaccine of interest. The calculations were performed using the TerraView software. The significance level was 5%. The results showed that for the first dose (D1) of DTP, between 2008 and 2014, the regions of Médio Paraíba, Metropolitan I, II and the municipality of RJ did not reach the CV goal of 95% in 2010; between 2008 and 2010, the municipality of RJ did not reach the CV goal. Between 2015 and 2020, we observed a reduction in the CV of D1 of DTP in the regions of Ilha Grande and Norte Bay, which started since 2017. For the third dose (D3) of DTP, there was a greater number of CV below 95% between 2008 and 2014 in relation to D1. Between 2015 and 2020, the Metropolitan Region I stands out, which does not reach the CV goal of 95% and from 2016 onwards has a progressive reduction in CV until 2020, reaching a CV of 30.45% that year. For SCR's D1 between 2008 and 2014, Centro-Sul and Serrana achieve their CV goals every year. In 2019, Baixada Litorânea, Northwest and North did not reach the goal, the other regions maintain high CV this year. In 2020, no region achieves the CV target and Metropolitan I and II have the lowest CV. The trend analysis showed that for D1 of the DTP, the ERJ showed a downward trend in VC from 2017 onwards (APC: -14.25); for SCR, it showed growth until 2018 (APC: 1.8) and a reduction in CV from 2018 (APC: -16.56). The LISA maps show the presence of clusters of high CV for DTP D1 in 2008, 2013 and 2018 and low CV in 2014; of high VC for D3 of DTP in 2008 and 2016 and high VC for SCR in 2016 and 2018. The distribution of CV shows distinct patterns between health regions and within municipalities over the years. Temporal and spatial analysis is a useful tool for locating geographic areas with pockets of low or high CV, in order to identify areas of greater vulnerability.

A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020.

BACKGROUND In the Republic of Kosovo, full vaccination status in children under age 2 years includes: 1 dose of Bacillus Calmette-Guerin (BCG) hepatitis B virus (HBV) vaccine; 3 doses of diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-HB-IPV-Hib) vaccine; 3 doses of inactivated polio vaccine (IPV); and 1 dose of measles, mumps, and rubella (MMR) vaccine. Lot quality assurance sampling (LQAS) is a method used to assess the performance of health quality indicators. MATERIAL AND METHODS A national cross-sectional study with children aged between 12 and 24 months from Kosovo was performed between 2018 and 2020. The vaccination status of children was assessed with lot quality assurance sampling (LQAS) using randomized samples. RESULTS Among 430 children, more than 90% had completed the full immunization schedule. Delays in children's immunizations were observed. Most vaccinations showed short delays of less than 1 month, followed by delays of up to 3 months. The main reason for vaccination delay was the COVID-19 pandemic, following by child's illness at the scheduled time of vaccination or the parents were too busy to take the child to the vaccination site. Meanwhile, child age was the only parameter that showed difference among non-vaccinated and fully vaccinated (P<0.001). CONCLUSIONS LQAS analysis showed that between 2018 and 2020 lack of full immunization was due to delay caused by the parent not taking the child to the vaccination site, which may be prevented by improving information given to parents and the use of vaccination reminders.

Fertility intentions and child health in India: Women's use of health services, breastfeeding, and official birth documentation following an unwanted birth.

This study examines the relationship between women's prospective fertility intentions and child health, measured via access to healthcare facilities for children and postpartum maternal behaviors that are indicative of future child health. We analyze two waves of nationally representative data (2005 and 2012) from the India Human Development Survey (IHDS). The analytic sample includes 3,442 non-pregnant, currently married women aged 18-40 in 2005 who participated in both rounds of the IHDS, and had at least one birth between 2005 and 2012. We investigate the influence of women's prospective fertility intentions on access to benefits from the Integrated Child Development Services (ICDS), indicators of breastfeeding as recommended by the World Health Organization, and official documentation of births via birth certificates or registration. We find that 58 percent of births among women in the sample were labeled as unwanted. We use an adaptation of propensity score matching-the inverse-probability-weighted regression adjustment (IPWRA) estimator-and show that, after accounting for maternal and household characteristics that are known to be associated with maternal and child health, children who resulted from unwanted births were less likely to obtain any benefits or immunizations from the ICDS, to be breastfed within one hour of birth, and to have an official birth certificate. Results from this study have direct policy significance given the evidence that women's fertility intentions can have negative implications for child health and wellbeing in the short and longer term.

Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000-17: a financial modelling study.

BACKGROUND: Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. METHODS: For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO-UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. FINDINGS: Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5-118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7-61·9) and 79·3% (73·8-81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3-2·8] and $6·4 billion [6·0-7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38-42) in low-income countries and $42 (39-46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6-72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. INTERPRETATION: These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. FUNDING: Bill & Melinda Gates Foundation.

Overview of the United States' Immunization Program.

This manuscript describes the history, background, and current structure of the United States Immunization Program, founded upon public- and private-sector partnerships that include federal agencies, state and local health departments, tribal nations and organizations, healthcare providers, vaccine manufacturers, pharmacies, and a multitude of additional stakeholders. The Centers for Disease Control and Prevention sets the U.S. adult and childhood immunization schedules based on recommendations from the Advisory Committee on Immunization Practices. We review the current immunization schedules; describe the set of surveillance and other systems used to monitor the health impact, coverage levels, and safety of recommended vaccines; and note significant challenges. Vaccines have reduced the incidence of many diseases to historic lows in the US, and have potential to further reduce the burden of respiratory and other infectious diseases in the United States. Though the United States vaccination program has had notable successes in reducing morbidity and mortality from infectious disease, challenges-including disparities in access and vaccine hesitancy-remain. Supporting access to and confidence in vaccines as an essential public health intervention will not only protect individuals from vaccine-preventable diseases; it will also ensure the country is prepared for the next pandemic.

Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria.

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.

Incidence and Types of Human Papillomavirus Infections in Adolescent Girls and Young Women Immunized With the Human Papillomavirus Vaccine.

Importance: Rates of human papillomavirus (HPV) infection have decreased since the introduction of HPV vaccines in populations with high vaccine uptake. Data are limited for adolescent and young adult populations in US metropolitan centers. Objective: To determine HPV infection rates in adolescent girls and young women aged 13 to 21 years in New York City following HPV vaccination. Design, Setting, and Participants: This cohort study of type-specific cervical HPV detection was conducted at a large adolescent-specific integrated health center in New York City between October 2007 and September 2019. Participants included an open cohort of adolescent girls and young adult women who received the HPV vaccine (Gardasil; Merck & Co) over a 12-year period following HPV vaccination introduction. Data analysis was concluded September 2019. Exposures: Calendar date and time since receipt of first vaccine dose. Main Outcomes and Measures: Temporal associations in age-adjusted postvaccine HPV rates. Results: A total of 1453 participants, with a mean (SD) age at baseline of 18.2 (1.4) years, were included in the cohort (African American with no Hispanic ethnicity, 515 [35.4%] participants; African American with Hispanic ethnicity, 218 [15.0%] participants; Hispanic with no reported race, 637 [43.8%] participants). Approximately half (694 [47.8%] participants) were vaccinated prior to coitarche. Age-adjusted detection rates for quadrivalent vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18) and related types (HPV-31, and HPV-45) decreased year over year, with the largest effect sizes observed among individuals who had been vaccinated before coitarche (adjusted odds ratio [aOR], 0.81; 95% CI, 0.67-0.98). By contrast, detection was higher year over year for nonvaccine high-risk cervical HPV types (aOR, 1.08; 95% CI, 1.04-1.13) and anal HPV types (aOR, 1.11; 95% CI, 1.05-1.17). The largest effect sizes were observed with nonvaccine types HPV-56 and HPV-68. Conclusions and Relevance: Whereas lower detection rates of vaccine-related HPV types were observed since introduction of vaccines in female youth in New York City, rates of some nonvaccine high-risk HPV types were higher. Continued monitoring of high-risk HPV prevalence is warranted.

Geographical variations and associated factors of defaulting from immunization among children aged 12 to 23 months in Ethiopia: using spatial and multilevel analysis of 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization. METHODS: An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran's I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization. RESULTS: A spatial heterogeneity of defaulting from immunization was observed (Global Moran's I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level. CONCLUSIONS: A clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.