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      Vaccination coverage and reasons for non-vaccination in a district of Istanbul

      , 1 , 2

      BMC Public Health

      BioMed Central

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          Abstract

          Background

          In order to control and eliminate the vaccine preventable diseases it is important to know the vaccination coverage and reasons for non-vaccination. The primary objective of this study was to determine the complete vaccination rate; the reasons for non-vaccination and the predictors that influence vaccination of children. The other objective was to determine coverage of measles vaccination of the Measles Immunization Days (MID) 2005 for children aged 9 month to 6 years in a region of Umraniye, Istanbul, Turkey.

          Methods

          A '30 × 7' cluster sampling design was used as the sampling method. Thirty streets were selected at random from study area. Survey data were collected by a questionnaire which was applied face to face to parents of 221 children. A Chi-square test and logistic regression was used for the statistical analyses. Content analysis method was used to evaluate the open-ended questions.

          Results

          The complete vaccination rate for study population was 84.5% and 3.2% of all children were totally non-vaccinated. The siblings of non-vaccinated children were also non-vaccinated. Reasons for non-vaccination were as follows: being in the village and couldn't reach to health care services; having no knowledge about vaccination; the father of child didn't allow vaccination; intercurrent illness of child during vaccination time; missed opportunities like not to shave off a vial for only one child. In logistic regression analysis, paternal and maternal levels of education and immigration time of both parents to Istanbul were found to influence whether children were completely vaccinated or non-vaccinated. Measles vaccination coverage during MID was 79.3%.

          Conclusion

          Efforts to increase vaccination coverage should take reasons for non-vaccination into account.

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          Most cited references 27

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          Migration, community context, and child immunization in Ethiopia.

          This paper examines the relationship between parental migration status and child immunization in Southern Ethiopia, a region characterized by high mortality and morbidity. Using the 1997 Community and Family Survey and a multilevel modeling approach, we find that children born to rural-rural migrant mothers have significantly less chance of receiving full immunization coverage than children born to non-migrant mothers. The social mechanism that explains this huge disparity is that rural-rural migrant women have limited social networks in the host community. In addition, significant variation in receiving complete immunization is found by age of child (a likely period effect), mother's education, and distance to nearest health center. Marked child immunization differentials are also observed by ethnicity. The results from the multilevel analysis confirm the persistence of substantial community effects, even after controlling for a standard array of personal and household characteristics. Given the low levels of vaccination among children born to migrant women, health policy interventions and information campaigns might be effectively augmented to reach such migrant women and their children. Community and ethnic group effects suggest that further targeting of health activities could be efficient and effective.
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            Maternal recall error of child vaccination status in a developing nation.

            In the absence of vaccination card data, Expanded Program on Immunization (EPI) managers sometimes ask mothers for their children's vaccination histories. The magnitude of maternal recall error and its potential impact on public health policy has not been investigated. In this study of 1171 Costa Rican mothers, we compare mothers' recall with vaccination card data for their children younger than 3 years. Analyses of vaccination coverage distributions constructed with recall and vaccination-card data show that recall can be used to estimate population coverage. Although the two data sources are correlated (r = .71), the magnitude of their difference can affect the identification of the vaccination status of an individual child. Maternal recall error was greater than two doses 14% of the time. This error is negatively correlated with the number of doses recorded on the vaccination card (r = -.61) and is weakly correlated with the child's age (r = -.35). Mothers tended to remember accurately the vaccination status of children younger than 6 months, but with older children, the larger the number of doses actually received, the more the mother underestimated the number of doses. No other variables explained recall error. Therefore, reliance on maternal recall could lead to revaccinating children who are already protected, leaving a risk those most vulnerable to vaccine-preventable diseases.
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              Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey.

              The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                2006
                5 May 2006
                : 6
                : 125
                Affiliations
                [1 ]Marmara University Medical Faculty Department of Public Health, Istanbul, Turkey
                [2 ]Assistant Professor of Public Health, Marmara University Medical Faculty Department of Public Health, Istanbul, Turkey
                Article
                1471-2458-6-125
                10.1186/1471-2458-6-125
                1464125
                16677375
                Copyright © 2006 Torun and Bakırcı; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Public health

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