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      Vaccine receipt and vaccine card availability among children of the apostolic faith: analysis from the 2010-2011 Zimbabwe demographic and health survey

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          Abstract

          Introduction

          Vaccine hesitancy and refusal continue to be a global challenge to reaching immunization targets, especially among those in traditional or fundamentalist religions. The apostolic faith in Zimbabwe has been historically associated with objection to most medical interventions, including immunization.

          Methods

          We conducted a descriptive analysis of socio-demographic characteristics and vaccine coverage among apostolic and non-apostolic adults aged 15-49 years and children aged 12-23 months using the Demographic and Health Survey conducted in Zimbabwe during 2010-2011. We used logistic regression models to estimate associations between the apostolic religion and receipt of all four basic childhood vaccinations in the Expanded Program on Immunization, receipt of no vaccinations, and availability of child vaccination card.

          Results

          Among children aged 12-23 months, 64% had received all doses of the four basic vaccinations, and 12% had received none of the recommended vaccines. A vaccination card was available for 68% of children. There was no significant association between Apostolic faith and completion of all basic vaccinations (aOR = 0.90, 95% CI: 0.69-1.17), but apostolic children were almost twice as likely to have received no basic vaccinations (aOR = 1.83, 95% CI: 1.22-2.77) than non-Apostolic children, and they were 32% less likely to have a vaccination card that was available and seen by the interviewer (aOR = 0.68, 95% CI: 0.52-0.89).

          Conclusion

          Disparities in childhood vaccination coverage and availability of vaccination cards persist for apostolic in Zimbabwe. Continued collaboration with apostolic leaders and additional research to better understand vaccine hesitancy and refine interventions and messaging strategies are needed.

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          Most cited references33

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          Risk factors for incomplete vaccination and missed opportunity for immunization in rural Mozambique

          Background Inadequate levels of immunization against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunization services are poorly understood. This study aimed at finding out the reasons for non-vaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in southern Mozambique. Methods Mothers of children under two years of age (N = 668) were interviewed in a cross-sectional study. The Road-to-Health card was utilized to check for completeness and correctness of vaccination schedule as well as for identifying the appropriate use of all available opportunities for vaccination. The chi-square test and the logistic regression were used for statistical analysis. Results We found that 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. Conclusion Efforts to increase vaccination coverage should take into account factors that contribute to the incomplete vaccination status of children. Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility, specially in those countries where health services do not have 100% of coverage.
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            Assessing immunization data quality from routine reports in Mozambique

            Background Worldwide immunization coverage shows an increase in the past years but the validity of the official reports for measuring change over time has been questioned. Facing this problem, donor supported initiatives like the Global Alliance for Vaccine and Immunizations, have been putting a lot of effort into assessing the quality of data used, since accurate immunization information is essential for the Expanded Program on Immunization managers to track and improve program performance. The present article, discusses the practices on record keeping, reporting and the support mechanism to ensure data quality in Mozambique. Methods A process evaluation study was carried out in Mozambique in one district (Cuamba) in Niassa Province, between January and March 2003. The study was based on semi-structured interviews, participant observation and review of the data collection materials. Results Differences were found for all vaccine types when comparing facility reports with the tally sheets. The same applies when comparing facility reports with district reports. The study also showed that a routine practice during supervision visits was data quality assessment for the outpatient services but none related to data consistency between the tally sheets and the facility report. For the Expanded Program on Immunization, supervisors concentrated more on the consistency checks between data in the facility reports and the number of vaccines received during the same period. Meetings were based on criticism, for example, why health workers did not reach the target. Nothing in terms of data quality was addressed nor validation rules. Conclusion In this paper we have argued that the quality of data, and consequently of the information system, must be seen in a broader perspective not focusing only on technicalities (data collection tools and the reporting system) but also on support mechanisms. Implications of a poor data quality system will be reflected in the efficiency of health services facing increased demands, with stagnant or decreasing resources.
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              Assessment of factors associated with complete immunization coverage in children aged 12-23 months: a cross-sectional study in Nouna district, Burkina Faso

              Background The Expanded Program on Immunization (EPI) is still in need of improvement. In Burkina Faso in 2003, for example, the Nouna health district had an immunization coverage rate of 31.5%, compared to the national rate of 52%. This study identifies specific factors associated with immunization status in Nouna health district in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts. Methods A cross-sectional study was undertaken in 41 rural communities and one semi-urban area (urban in the text). Data on 476 children aged 12 to 23 months were analyzed from a representative sample of 489, drawn from the Nouna Health Research Centre's Demographic Surveillance System (DSS) database. The vaccination history of these children was examined. The relationships between their immunization status and social, economic and various contextual variables associated with their parents and households were assessed using Chi square test, Pearson correlation and logistic regression. Results The total immunization coverage was 50.2% (CI, 45.71; 54.69). Parental knowledge of the preventive value of immunization was positively related to complete immunization status (p = 0.03) in rural areas. Children of parents who reported a perception of communication problems surrounding immunization had a lower immunization coverage rate (p < 0.001). No distance related difference exists in terms of complete immunization coverage within villages and between villages outside the site of the health centres. Children of non-educated fathers in rural areas have higher rates of complete immunization coverage than those in the urban area (p = 0.028). Good communication about immunization and the importance of availability of immunization booklets, as well as economic and religious factors appear to positively affect children's immunization status. Conclusion Vaccination sites in remote areas are intended to provide a greater opportunity for children to access vaccination services. These efforts, however, are often hampered by the poor economic conditions of households and insufficient communication and knowledge regarding immunization issues. While comprehensive communication may improve understanding about immunization, it is necessary that local interventions also take into account religious specificities and critical economic periods. Particular approaches that take into consideration these distinctions need to be applied in both rural and urban settings. Abstract in French See the full article online for a translation of this abstract in French.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                11 May 2016
                2016
                : 24
                : 47
                Affiliations
                [1 ]Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
                [2 ]InterCountry Support Team East and Southern Africa, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
                [3 ]Immunization and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Brazzaville, Republic of the Congo
                Author notes
                [& ]Corresponding author: Jennifer Lara Kriss, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
                Article
                PAMJ-24-47
                10.11604/pamj.2016.24.47.8663
                5012723
                27642388
                06659235-cb7b-4302-963a-b919c7b8fb57
                © Jennifer Lara Kriss et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 December 2015
                : 09 February 2016
                Categories
                Research

                Medicine
                vaccines,immunization,apostolic faith,vaccine refusal,vaccine hesitancy
                Medicine
                vaccines, immunization, apostolic faith, vaccine refusal, vaccine hesitancy

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