Reducing missed opportunities for vaccination in Mozambique: findings from a cross-sectional assessment conducted in 2017

ObjectiveMissed opportunities for vaccination (MOV) are a significant contributor to low vaccination coverage. To better understand the magnitude and underlying causes of MOV among children aged 0–23 months in Mozambique, we conducted an assessment and developed a roadmap for strengthening the country’s childhood immunisation programme.SettingThree provinces in North, South and Central Mozambique.MethodsThe assessment applied a mixed-method approach. From a sample of 41 health facilities, we conducted exit interviews with caregivers of children aged 0–23 months (n=546), surveys with health workers (n=223), focus group discussions with caregivers (n=6) and health workers (n=5), and in-depth interviews with health facility managers (n=9). We analysed the data to assess the magnitude of MOV and to identify causes of MOV and ways of preventing them.ResultsVaccination records were available for 538 children. Sixty per cent (n=324) were eligible for vaccination on arriving for their health facility visit. Of these, 76% (n=245) were not fully vaccinated, constituting MOV. Our analysis shows that these MOV were most frequently attributable to practices of caregivers and health workers and also to health systems reasons. Inadequate information about vaccination among both caregivers and health workers, poor or poorly understood health facility practices, inadequate integration of curative and preventative services, inadequate tracking systems to identify children due for vaccination and, less often, limited supply of vaccines, syringes and other related supplies at service points resulted in MOV.ConclusionsThe results of the assessment informed the development of roadmaps for reducing MOV that may be applicable to other settings. The global immunisation community should continue to invest in efforts to reduce MOV and thereby make health service visits more effective and efficient for vaccination.

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Factors associated with Missed Opportunities for Vaccination among children in the first year of life at a tertiary health facility in Lagos

Annals of Health Research ◽

10.30442/ahr.0603-05-91 ◽

2020 ◽

Vol 6 (3) ◽

pp. 287-297

Author(s):

OA Kehinde ◽

YA Kuyinu ◽

OO Odusanya

Keyword(s):

Health Facility ◽

Health Workers ◽

Cross Sectional Study ◽

Vaccination Status ◽

First Year ◽

Cross Sectional ◽

Missed Opportunities ◽

Vaccination Rates ◽

Factors Associated ◽

First Year Of Life

Background: Low vaccination rates in children remain a major problem in resource-poor areas of the world. Missed opportunities for vaccination may be one of the important contributors to the menace. Objectives: To determine the prevalence of missed opportunities for vaccination and identify factors associated with this among Nigerian children in the first year of life. Methods: The study was a descriptive, cross-sectional study of children who were recruited consecutively and data were obtained using a questionnaire. Results: Two hundred and fifty-six children were recruited. The prevalence of missed opportunities for vaccination was 11.3%. Gender (p = 0.04) and parental socioeconomic status (p = 0.008) were significantly associated with missed opportunities for vaccination. Non- availability of required vaccines and reluctance to open a multi-dose vial of vaccine caused MOV in 55.5% and 51.8% of children respectively. The evaluation of vaccination status among subjects who were not fully vaccinated by health workers was low at 18.3%. Conclusion: The rate of missed opportunities for vaccination was low. Educating caregivers and encouraging health workers to evaluate the vaccination status of children at every contact with a health facility may reduce the prevalence of missed opportunities for vaccination.

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FACTORS AFFECTING THE PROVISION OF SOCIAL WORK SERVICES FOR CANCER PATIENTS AT THE VIETNAM NATIONAL CANCER HOSPITAL

10.18173/2354-1067.2020-0078 ◽

2020 ◽

Vol 65 (11) ◽

pp. 132-143

Author(s):

Nam Pham Tien

Keyword(s):

Social Work ◽

Cancer Patients ◽

Cross Sectional Study ◽

Group Discussions ◽

Cross Sectional ◽

Factors Affecting ◽

Policy Regimes ◽

Financial Factor ◽

Cancer Hospital ◽

Depth Interviews

The provision of social work service for cancer patients is facing many challenges. Therefore, this study aims to explore factors affecting the provision of social work services for cancer patients at the Vietnam National Cancer Hospital. This is a cross-sectional study that used 10 in-depth interviews, and three focus group discussions to collect data. Our findings showed that the factors such as specialized qualifications of social workers, available facilities, the network of social work collaborators, finance, and policy regimes hindered the provision of social work services for cancer patients at the hospital. Meanwhile, the financial factor contributed to promote social work services for cancer patients at the hospital. Besides, the demands for the provision of social work services for cancer patients were one of the factors that should be considered in the coming time. Our study suggested stakeholders pay more attention to these factors.

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Factors Affecting Uptake of Human Papilloma Virus (HPV) Vaccination among in- School Adolescent Girls in Wakiso District, Central Uganda.

10.51168/sjhrafrica.v1i12.11 ◽

2020 ◽

Author(s):

◽

Zaitune Nanyunja

Keyword(s):

Cervical Cancer ◽

Adolescent Girls ◽

Health Workers ◽

Hpv Vaccination ◽

Cluster Sampling ◽

Cross Sectional ◽

Factors Affecting ◽

Five Factors ◽

Vaginal Sex ◽

Depth Interviews

Background: Since 2008, the Human Papillomavirus (HPV) vaccination has been routinely recommended for pre-adolescents and adolescent girls in Uganda. The introduction of HPV vaccines represents a step forward in the primary prevention of cervical cancer and other HPV-related malignancies. This study examines the factors affecting the uptake of HPV vaccination among in-school adolescent girls in Wakiso district to generate information that can be used to improve the uptake of such critical services. Methodology: A cross-sectional analytical study was employed. Both quantitative and qualitative data were collected concurrently. Data were collected from secondary schools in Wakiso district, selected using cluster sampling. Semi-structured self-administered questionnaires were used to collect quantitative data while data from mothers in Wakiso were collected using In-depth interviews through group dialogue sessions. Data were analyzed using SPSS 16.0; characteristics of the sample were summarized by descriptive statistics Results: The findings indicate the HPV vaccination uptake rate as low as 9.2% among the In-school adolescent girls in the Wakiso district. 68.5% belonged to the age group 16-19 (older adolescents). 91.2% had already had vaginal sex and 90.4% had ever had any STI. In the bivariate analyses, five factors were presented to be statistically significant with a P<0.05, implying that these factors were associated with HPV vaccination. They included the occupation of the caretaker, education level of the caretaker, perceived susceptibility to HPV infections and cervical cancer, perceived benefits of HPV vaccination, and knowledge attributes regarding HPV and HPV infections. Conclusion: The Ministry of the health of Uganda and partners should offer ample orientation and training to all health workers and encourage them to disseminate information on HPV vaccination to all eligible adolescents and their caretakers in Wakiso district central Uganda.

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The Meaning of Having an Autistic Child in Malay Family Indonesia

Unnes Journal of Public Health ◽

10.15294/ujph.v0i0.29527 ◽

2019 ◽

Vol 8 (2) ◽

pp. 73-80

Author(s):

Cau Kim Jiu ◽

Somporn Rungreangkulkij

Keyword(s):

Autistic Child ◽

Health Workers ◽

Ethnographic Study ◽

Autistic Children ◽

Community Members ◽

Focus Group Discussions ◽

Group Discussions ◽

Study Results ◽

Second Category ◽

Depth Interviews

The condition of families with autistic children raises many views and judgments both from family and society. This ethnographic study aimed to describe the meaning of families and communities towards families with autistic children. Data were collected through focus group discussions and in-depth interviews. Key informants come from families who have autistic children and community members recruited by purposive sampling, while the data were analyzed using thematic analysis. This study results generate two categories of perception of the meaning of having autistic children. The first category was made by the families which comprises four themes such as 1) A test from God, 2) Destiny of God, 3) Autistic children different with other children, and 4) Children who need intensive helping. The second category was the perception made by the community members which consists of two themes, such as 1) Test for family, and 2) An autistic child as a holy child. This study further shows that culture is believed to determine how families and the members of the community perceive and interpret the existence of autistic children in the families so that it is very important for health workers to understand the culture that exists in the community.

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Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

10.21203/rs.3.rs-128061/v1 ◽

2020 ◽

Author(s):

Richard Mugambe ◽

Habib Yakubu ◽

Solomon Wafula ◽

Tonny Ssekamatte ◽

Simon Kasasa ◽

...

Keyword(s):

Health Facility ◽

Rural Areas ◽

Health Workers ◽

Public Health Facility ◽

Facility Delivery ◽

Health Facilities ◽

Public Facility ◽

Cross Sectional ◽

Western Uganda ◽

Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

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Are health workers reduced to being drug dispensers of antiretroviral treatment? A randomized cross-sectional assessment of the quality of health care for HIV patients in northern Uganda

Health Policy and Planning ◽

10.1093/heapol/czz074 ◽

2019 ◽

Vol 34 (8) ◽

pp. 559-565

Author(s):

Ulrike G Seeberger ◽

Joseph J Valadez

Keyword(s):

Physical Examination ◽

Health Facility ◽

Antiretroviral Treatment ◽

Treatment Guidelines ◽

Health Workers ◽

Northern Uganda ◽

High Quality ◽

Cross Sectional ◽

Sub Saharan

Abstract High quality of care (QoC) for antiretroviral treatment (ART) is essential to prevent treatment failure. Uganda, as many sub-Saharan African countries, increased access to ART by decentralizing provision to districts. However, little is known whether this rapid scale-up maintained high-quality clinical services. We assess the quality of ART in the Acholi and Lango sub-regions of northern Uganda to identify whether the technical quality of critical ART sub-system needs improvement. We conducted a randomized cross-sectional survey among health facilities (HF) in Acholi (n = 11) and Lango (n = 10). Applying lot quality assurance sampling principles with a rapid health facility assessment tool, we assessed ART services vis-à-vis national treatment guidelines using 37 indicators. We interviewed health workers (n = 21) using structured questionnaires, directly observed clinical consultations (n = 126) and assessed HF infrastructure, human resources, medical supplies and patient records in each health facility (n = 21). The district QoC performance standard was 80% of HF had to comply with each guideline. Neither sub-region complied with treatment guidelines. No HF displayed adequate: patient monitoring, physical examination, training, supervision and regular monitoring of patients’ immunology. The full range of first and second line antiretroviral (ARV) medication was not available in Acholi while Lango had sufficient stocks. Clinicians dispensed available ARVs without benefit of physical examination or immunological monitoring. Patients reported compliance with drug use (>80%). Patients’ knowledge of preventing HIV/AIDS transmission concentrated on condom use; otherwise it was poor. The poor ART QoC in northern Uganda raises major questions about ART quality although ARVs were dispensed. Poor clinical care renders patients’ reports of treatment compliance as insufficient evidence that it takes place. Further studies need to test patients’ immunological status and QoC in more regions of Uganda and elsewhere in sub-Saharan Africa to identify topical and geographical areas which are priorities for improving HIV care.

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Low Utilization of Insecticide-Treated Bed Net among Pregnant Women in the Middle Belt of Ghana

Malaria Research and Treatment ◽

10.1155/2017/7481210 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Grace Manu ◽

Ellen Abrafi Boamah-Kaali ◽

Lawrence Gyabaa Febir ◽

Emmanuel Ayipah ◽

Seth Owusu-Agyei ◽

...

Keyword(s):

Pregnant Women ◽

Premature Birth ◽

Preventive Strategies ◽

Insecticide Treated Nets ◽

Focus Group Discussions ◽

Group Discussions ◽

Missed Opportunities ◽

Malaria Burden ◽

Itn Use ◽

Depth Interviews

Background. Malaria in pregnancy leads to low birth weight, premature birth, anaemia, and maternal and neonatal mortality. Use of insecticide-treated nets (ITNs) during pregnancy is one of the proven interventions to reduce the malaria burden. However, Ghana has not achieved its target for ITN use among pregnant women. Methods. A qualitative study was conducted in seven communities purposively selected from the middle belt of Ghana. Participants who had delivered in the six months prior to this study were selected. In all, seven focus group discussions and twenty-four in-depth interviews were conducted between June and August 2010. Results. Respondents knew of the importance of ITNs and other malaria-preventive strategies. Factors such as financial access and missed opportunities of free distribution denied some pregnant women the opportunity to own or use an ITN. Reasons for not using ITNs during pregnancy included discomfort resulting from heat, smell of the net, and difficulty in hanging the net. Participants maintained their ITNs by preventing holes in the nets, retreatment, and infrequent washing. Conclusion. Pregnant women know about the causes and prevention of malaria. However, this knowledge is not transformed into practice due to lack of access to ITNs and sleeping discomforts among other logistical constraints.

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Young Married Women’s Perceptions On The Maeanings And Motivations For Their Husbands’ Opposition To Their Modern Contraceptive Use In Malawi

Population Horizons ◽

10.1515/pophzn-2017-0004 ◽

2017 ◽

Vol 14 (1) ◽

pp. 9-17 ◽

Cited By ~ 1

Author(s):

Benjamin Kaneka ◽

Akim J. Mturi

Keyword(s):

Contraceptive Use ◽

Health Workers ◽

Married Women ◽

Modern Contraceptive ◽

Group Discussions ◽

The Family ◽

Women’S Perceptions ◽

Modern Contraceptive Use ◽

Depth Interviews ◽

Programme Delivery

Abstract The aim of the study was to examine the perceptions of young married women on meanings and motivations of partner opposition to their contraceptive use. Qualitative data was collected from focus group discussions and individual in-depth interviews with young married women and key informant interviews with health workers and traditional leaders in the districts of Ntcheu, Mangochi and Zomba in Malawi. Thematic data analysis was done using ATLAS ti software version 7. The results show that partners’ opposition to young married women’s use of contraceptives was perceived to be principally motivated by their husbands’ quest to control the sexual and reproductive lives of their spouses. Related to this aspect are the fears and misconceptions that use of modern contraceptives would relieve young married women of the fear of engaging in extra marital affairs as they would no longer be afraid of being discovered through pregnancy. Hence, the opposition was perceived to safeguard their marriages from instability and dissolution. The paper asserts that there should be a shift in the family planning programme delivery in the country aimed at reducing or eliminating partner opposition to young married women’s contraceptive use through involvement and inclusion of partners in the designing and implementation of contraceptive information and service provision interventions.

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Missed opportunities for vaccination among children aged 0–23 months visiting health facilities in a southwest State of Nigeria, December 2019

PLoS ONE ◽

10.1371/journal.pone.0252798 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0252798

Author(s):

Akinola Ayoola Fatiregun ◽

Laura Nic Lochlainn ◽

Lassané Kaboré ◽

Modupeola Dosumu ◽

Elvis Isere ◽

...

Keyword(s):

Health Service ◽

Health Workers ◽

Immunization Coverage ◽

Cross Sectional Study ◽

Health Facilities ◽

Service Encounter ◽

Childhood Immunization ◽

Cross Sectional ◽

Missed Opportunities ◽

Attitudes And Practices

Background Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. Methods This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0–23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. Results 984 caregivers with children aged 0–23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. Conclusions One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers’ engagement and screening of vaccination documentation by health workers during every health service encounter.

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Enablers, Constraints and Extent of Implementation of the Elimination of Mother-to-child Transmission of HIV Policy Guidelines in Lira district; Application of a Policy Implementation Barometer

10.21203/rs.3.rs-57446/v1 ◽

2020 ◽

Author(s):

Noel Namuhani ◽

Hamiliton Kainga ◽

Olufemi Obafemi ◽

Adeyemi Adelabu ◽

Moses Mukuru ◽

...

Keyword(s):

Policy Implementation ◽

Health Facility ◽

Qualitative Data ◽

Health Workers ◽

Antenatal Clinic ◽

Health Coverage ◽

Mother To Child Transmission ◽

Child Transmission ◽

Cross Sectional ◽

Mother To Child

Abstract Background; Despite the adoption of Elimination of mother to child transmission (EMTCT) strategy in 2012, mother to child transmission of HIV remains one of the significant forms of new HIV infections among children in Uganda, accounting for 20% of new infections. However, the implementation of the EMTCT strategy in Uganda remains unclear and an under researched field. This study aimed at assessing the extent of implementation of EMTCT strategy, barriers and constraints in Lira district using the adapted Policy Implementation Barometer (PIB) approach. Methods; This was a cross sectional study that employed both quantitative and qualitative data collection methods. A Policy Implementation Barometer tool developed by a project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda was adopted to assess the extent of implementation of EMTCT strategy. A total of 32 interviews with health facility managers were purposively conducted from a random sample of 20 health facilities offering Antenatal clinic (ANC) services in Lira district. Quantitative data was analyzed using STATA 14. Qualitative data was analyzed using thematic content analysis approach. Results; Majority 17/32 (53.1%) of the respondents were health facility in charges, 14/32 (43.8%) were midwives and half 16/32 (50.0%) had been in service for more than five years. Half of the respondents perceived their facilities to have fully established programs for implementing EMTCT and only 2/32 (6.2%) perceived the EMTCT programs to be functioning optimally. The perceived level of EMTCT implementation was 80%. Almost all the respondents perceived the funding for EMTCT activities to be inadequate, untimely, and not sustainable. Only 4/32 (12.5%) of the respondents believed that the health workforce size was adequate to support EMTCT activities, 13/32 (40.6%) believed that health workers lacked the skills to provide EMTCT services.Conclusion/Recommendation; Overall, the perceived extent of EMTCT policy implementation was high, however slow progress was reported in some of the key policy objectives due to a number of hindrances including inadequate staff and funding. Therefore, there is a need for strategies to increase the number of health workers for EMTCT and solicit for more funding for the implementation of EMTCT strategy.

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