Age-appropriate vaccination coverage and its determinants in children aged 12–36 months in Nepal: a national and subnational assessment

Abstract Background Vaccination is one of the effective ways to develop immunity against potential life-threatening diseases in children in early age. This study is focused on analysing the age-appropriate vaccination coverage at national and subnational levels and identify the factors associated with age-appropriate coverage in Nepal. Methods 460 children aged 12–36 months were included in the study. The data was obtained from Nepal Demographic and Health Survey (NDHS) 2016–17. Age-appropriate coverage of Bacillus Calmette-Guerin vaccine (BCG), oral polio vaccine (OPV) doses 1–3, pentavalent vaccine (PE) doses 1–3, and first dose of measles, mumps, and rubella vaccine (MMR) were estimated using Kaplan Meier method. Multilevel logistic regression with random intercept was used to identify the factors associated with age-appropriate vaccination. Results The crude coverage of the vaccines included in the study ranged from 91.5% (95% CI, 88.5–93.7) for PE3 to 97.8% (95.8–98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low, ranging from 41.5% (36.5–46.6) for PE3 to 73.9% (69.2–78.1) for PE1. Furthermore, high disparity in timely vaccination coverage was observed at regional level. Compared to the age-appropriate vaccination coverage in other provinces, Province 2 had the lowest coverage of all, followed by that in Province 6. The timeliness of vaccination was significantly associated with subnational regions i.e., provinces and the season of childbirth. Conclusion Although the immunization program in Nepal has achieved the target of 90% crude coverage of all the childhood vaccines, the age-appropriate coverage is significantly low which undermines the effectiveness of the vaccines administered. Thus, along with crude coverage, timeliness of the vaccines administered should be taken into consideration and thoroughly monitored at national and subnational levels. Provincial government should formulate tailored strategies to ensure the timely administration of the childhood vaccines.

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Age-appropriate vaccination coverage and its determinants in children aged 12-36 months in Nepal: a national and subnational assessment

10.21203/rs.3.rs-269052/v1 ◽

2021 ◽

Author(s):

Santosh Kumar Rauniyar ◽

Yoko Iwaki ◽

Daisuke Yoneoka ◽

Masahiro Hashizume ◽

Shuhei Nomura

Keyword(s):

Vaccination Coverage ◽

Oral Polio Vaccine ◽

Provincial Government ◽

Factors Associated ◽

Polio Vaccine ◽

Random Intercept ◽

Kaplan Meier ◽

Life Threatening ◽

Age Appropriate ◽

Childhood Vaccines

Abstract Background Vaccination is one of the effective ways to develop immunity against potential life-threatening diseases in children in early age. This study is focused on analysing the age-appropriate vaccination coverage at national and subnational levels and identify the factors associated with age-appropriate coverage in Nepal.Methods 460 children aged 12-36 months were included in the study. The data was obtained from Nepal Demographic and Health Survey (NDHS) 2016-17. Age-appropriate coverage of Bacillus Calmette-Guerin vaccine (BCG), oral polio vaccine (OPV) doses 1-3, pentavalent vaccine (PE) doses 1-3, and first dose of measles, mumps, and rubella vaccine (MMR) were estimated using Kaplan Meier method. Multilevel logistic regression with random intercept was used to identify the factors associated with age-appropriate vaccination. Results The crude coverage of the vaccines included in the study ranged from 91.5% (95% CI, 88.5-93.7) for PE3 to 97.8% (95.8-98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low, ranging from 41.5% (36.5-46.6) for PE3 to 73.9 % (69.2-78.1) for PE1. Furthermore, high disparity in timely vaccination coverage was observed at regional level. Compared to the age-appropriate vaccination coverage in other provinces, Province 2 had the lowest coverage of all, followed by that in Province 6. The timeliness of vaccination was significantly associated with subnational regions i.e., provinces and the season of childbirth.Conclusion Although the immunization program in Nepal has achieved the target of 90% crude coverage of all the childhood vaccines, the age-appropriate coverage is significantly low which undermines the effectiveness of the vaccines administered. Thus, along with crude coverage, timeliness of the vaccines administered should be taken into consideration and thoroughly monitored at national and subnational levels. Provincial government should formulate tailored strategies to ensure the timely administration of the childhood vaccines.

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Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon

Gates Open Research ◽

10.12688/gatesopenres.12898.1 ◽

2018 ◽

Vol 2 ◽

pp. 71 ◽

Cited By ~ 1

Author(s):

Ziad Mansour ◽

Racha Said ◽

Lina Brandt ◽

Joseph Khachan ◽

Alissar Rady ◽

...

Keyword(s):

Hepatitis B ◽

Vaccination Coverage ◽

Cross Sectional ◽

Factors Affecting ◽

Beliefs And Practices ◽

Polio Vaccine ◽

Kaplan Meier ◽

Birth Dose ◽

Age Appropriate ◽

Timely Administration

Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016. Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan–Meier curves and logistic regression to identify the predictors of age-appropriate immunization. Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination. Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon.

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Factors associated with the utilization of inactivated polio vaccine among children aged 12 to 23 months in Kalungu District, Uganda

Health Policy and Planning ◽

10.1093/heapol/czaa099 ◽

2020 ◽

Vol 35 (Supplement_1) ◽

pp. i30-i37

Author(s):

Mirembe Rachel Faith ◽

Babirye Juliet ◽

Nathan Tumuhamye ◽

Tumwebaze Mathias ◽

Emma Sacks

Keyword(s):

Health Care Providers ◽

Health Workers ◽

Oral Polio Vaccine ◽

Systematic Sampling ◽

Care Providers ◽

Cross Sectional ◽

Inactivated Polio Vaccine ◽

Factors Associated ◽

Polio Vaccine ◽

Eradication Strategy

Abstract Uganda officially introduced the inactivated polio vaccine (IPV) in May 2016 as part of the polio eradication strategy and integrated it into its routine immunization programme in addition to the oral polio vaccine. The current coverage stands at 60% as of July 2017. We therefore aimed to determine factors associated with the uptake of IPV among children in Kalungu District so as to inform the implementation of the vaccine policy. A community-based cross-sectional study was conducted among caregivers of 406 eligible children aged 12–23 months through multi-stage systematic sampling and a standardized semi-structured questionnaire. Nine key informant interviews were conducted through purposive selection of health care providers and members of Village Health Teams (VHTs) based on their expertize. Modified Poisson regression and thematic content analysis were used to determine factors significant to IPV uptake among children. 71% of sampled children aged 12–23 months had received IPV in Kalungu District. The survey found that being encouraged by health workers and VHTs was significant to children’s uptake of IPV (Adjusted PR 1.24, 95% CI; 1.22–3.47). Distance to the immunization point (Adjusted PR 0.32,95% CI; 0.16–0.62) and caregiver’s education level (Adjusted PR 1.16,95% CI; 1.05–2.22) were also associated with IPV uptake. Qualitative findings from health workers and VHT members further confirmed the perception that distance to the immunization post was important, and VHTs also stated that being encouraged by health workers was critical to IPV uptake. The current prevalence of IPV uptake among children aged 12–23 months in Kalungu is 71%, higher than the last reported national coverage (60%), though still below the recommended national coverage of 95%. Efforts should be focused on sensitization of caregivers through health workers and VHTs. Immunization outreach should be strengthened so as to bring services closer to patients.

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Characterization of Household and Community Shedding and Transmission of Oral Polio Vaccine in Mexican Communities With Varying Vaccination Coverage

Clinical Infectious Diseases ◽

10.1093/cid/ciy650 ◽

2018 ◽

Vol 67 (suppl_1) ◽

pp. S4-S17 ◽

Cited By ~ 1

Author(s):

Jonathan Altamirano ◽

Natasha Purington ◽

Rasika Behl ◽

Clea Sarnquist ◽

Marisa Holubar ◽

...

Keyword(s):

Vaccination Coverage ◽

Oral Polio Vaccine ◽

Polio Vaccine

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Pediatric Immunization: Current Recommendations and Controversies

Journal of Pharmacy Practice ◽

10.1177/089719009600900103 ◽

1996 ◽

Vol 9 (1) ◽

pp. 14-26 ◽

Cited By ~ 1

Author(s):

Heather J. Vosper

Keyword(s):

Varicella Vaccine ◽

Oral Polio Vaccine ◽

Haemophilus Influenzae Type ◽

Immunization Schedule ◽

Childhood Immunization ◽

Physician Visits ◽

Polio Vaccine ◽

Routine Childhood ◽

Life Threatening ◽

American Children

The prevention of life-threatening childhood infections through vaccination is a remarkable achievement in the history of medicine. Although 98% of all American children are fully immunized at age 5 to 6 years because state laws require it for school entry, in 1991 less than half of children younger than 2 years of age were up to date for their diphtheria, tetanus, and pertussis (DTP); polio; measles, mumps, and rubella (MMR), and Haemophilus influenzae type b (HIB) immunizations. These children are at greatest risk for life-threatening infection. The last decade has seen many changes in the recommendations for routine childhood immunization. The resurgence of measles led to the addition of a second measles immunization. The introduction of the HIB vaccine has had a significant impact on the incidence of dreaded childhood meningitis. The effort to reduce adverse events associated with the pertussis component of the DTP vaccine resulted in the development of a new pertussis vaccine. The oral polio vaccine (OPV) is still being used with much debate on the merits of the inactivated polio vaccine (IPV). The hepatitis B vaccine was recently incorporated into the childhood immunization schedule in an attempt to eliminate this costly and devastating disease. The childhood disease chickenpox may become a disease of the past with the recent introduction of the varicella vaccine. With the multiplicity of new vaccines on the horizon, childhood immunization schedules will become more complex. To ameliorate an increase in the number of injections and physician visits, major efforts are currently being devoted to the development of combination vaccines, and the latest routine childhood immunization schedule has made every attempt to provide flexibility. The Children's Vaccine Initiative (CVI) defines a goal of developing a single supervaccine that "could be given once at or near birth, provide immunity for life, require no boosters, permit storage without refrigeration, obviate the use of needles and syringes and protect against as many as 20 diseases at once." To achieve this goal, enormous investments in research and development will be necessary. In the meantime, pharmacists can do much to encourage good immunization practices in their daily interaction with patients, and in so doing further the goals of pharmaceutical care. Copyright © 1996 by W.B. Saunders Company

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Cumulative Vaccination Coverage of Measles-and Oral Polio Vaccine Obtained by the Nationwide Survey

Kansenshogaku zasshi ◽

10.11150/kansenshogakuzasshi1970.79.7 ◽

2005 ◽

Vol 79 (1) ◽

pp. 7-12 ◽

Cited By ~ 2

Author(s):

Naohide TAKAYAMA ◽

Hiroshi SAKIYAMA ◽

Tatsuo MIYAMURA ◽

Tatsuo KATO

Keyword(s):

Vaccination Coverage ◽

Oral Polio Vaccine ◽

Nationwide Survey ◽

Polio Vaccine

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Assessment of risk factors associated with oral polio vaccine refusal in Rahim Yar Khan District, Pakistan (2017)

Journal of Biosafety and Biosecurity ◽

10.1016/j.jobb.2020.02.003 ◽

2020 ◽

Vol 2 (1) ◽

pp. 27-30

Author(s):

Ambreen Chaudhry ◽

Najma Javed ◽

Muhammad Muhsan Wattoo

Keyword(s):

Risk Factors ◽

Oral Polio Vaccine ◽

Factors Associated ◽

Vaccine Refusal ◽

Polio Vaccine

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Polio and Measles Down the Drain: Environmental Enterovirus Surveillance in the Netherlands, 2005 to 2015

Applied and Environmental Microbiology ◽

10.1128/aem.00558-17 ◽

2017 ◽

Vol 83 (13) ◽

Cited By ~ 13

Author(s):

Kimberley S. M. Benschop ◽

Harrie G. van der Avoort ◽

Edin Jusic ◽

Harry Vennema ◽

Rob van Binnendijk ◽

...

Keyword(s):

The Netherlands ◽

Vaccination Coverage ◽

Measles Virus ◽

Virus Detection ◽

Oral Polio Vaccine ◽

Oral Poliovirus Vaccine ◽

Content Type ◽

Polio Vaccine ◽

Virus Rna ◽

Measles Outbreak

ABSTRACT Polioviruses (PVs) are members of the genus Enterovirus. In the Netherlands, the exclusion of PV circulation is based on clinical enterovirus (EV) surveillance (CEVS) of EV-positive cases and routine environmental EV surveillance (EEVS) conducted on sewage samples collected in the region of the Netherlands where vaccination coverage is low due to religious reasons. We compared the EEVS data to those of the CEVS to gain insight into the relevance of EEVS for poliovirus and nonpolio enterovirus surveillance. Following the polio outbreak in Syria, EEVS was performed at the primary refugee center in Ter Apel in the Netherlands, and data were compared to those of CEVS and EEVS. Furthermore, we assessed the feasibility of poliovirus detection by EEVS using measles virus detection in sewage during a measles outbreak as a proxy. Two Sabin-like PVs were found in routine EEVS, 11 Sabin-like PVs were detected in the CEVS, and one Sabin-like PV was found in the Ter Apel sewage. We observed significant differences between the three programs regarding which EVs were found. In 6 sewage samples collected during the measles outbreak in 2013, measles virus RNA was detected in regions where measles cases were identified. In conclusion, we detected PVs, nonpolio EVs, and measles virus in sewage and showed that environmental surveillance is useful for poliovirus detection in the Netherlands, where live oral poliovirus vaccine is not used and communities with lower vaccination coverage exist. EEVS led to the detection of EV types not seen in the CEVS, showing that EEVS is complementary to CEVS. IMPORTANCE We show that environmental enterovirus surveillance complements clinical enterovirus surveillance for poliovirus detection, or exclusion, and for nonpolio enterovirus surveillance. Even in the presence of adequate surveillance, only a very limited number of Sabin-like poliovirus strains were detected in a 10-year period, and no signs of transmission of oral polio vaccine (OPV) strains were found in a country using exclusively inactivated polio vaccine (IPV). Measles viruses can be detected during an outbreak in sewage samples collected and concentrated following procedures used for environmental enterovirus surveillance.

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Clinical Factors Associated with Progression to AIDS in the Italian Cohort of HIV-Positive Hemophiliacs

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648807 ◽

1994 ◽

Vol 72 (01) ◽

pp. 033-038 ◽

Cited By ~ 7

Author(s):

N Schinaia ◽

A M G Ghirardini ◽

M G Mazzucconi ◽

G Tagariello ◽

M Morfini ◽

...

Keyword(s):

Cumulative Incidence ◽

National Registry ◽

Factor Ix ◽

Clotting Factor ◽

Coagulation Disorders ◽

Factors Associated ◽

Kaplan Meier ◽

Significant Difference ◽

Congenital Coagulation Disorders ◽

Clotting Factor Concentrates

SummaryThis study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemophiliacs), and elucidates the role of age at seroconversion, type and amount of replacement therapy, and HBV co-infection in progression. Information was collected both retrospectively and prospectively on 767 HIV-1 positive patients enrolled in the on-going national registry of patients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient’s seroconversion interval, under a Weibull distribution applied to the overall interval. The independence of factors associated to faster progression was assessed by multivariate analysis. The cumulative incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 17.0% (95% Cl = 14.1-19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 years exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% Cl = 22.2-42.8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumulative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII recipients (i.e. severe A hemophiliacs), as did severe A hemophiliacs on less-than-20,000 IU/yearly of plasma-derived clotting factor concentrates, as opposed to A hemophiliacs using an average of more than 20,000 IU (18.8% vs 10.9%, p = 0.02). No statistically significant difference in progression was observed between HBsAg-positive vs HBsAg-negative hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investigated from the laboratory standpoint.

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