Clients' Satisfaction with Immunization Services at Primary Health Care Centers in Baghdad, Al-Karkh

Background: Client satisfaction with the immunization service is used to evaluate the quality of the admitted service and at the same time it affects the goodness of the health care outcome. Objectives: This study assessed the satisfaction with immunization services offered to children and factors affecting this satisfaction. Methods: Exit interviews for clients were conducted in Baghdad, Al-Karkh in a representative sample of primary health care centers to assess clients’ satisfaction with immunization services. Clients are companions of children encountered at study settings. Results: Among the 253 respondent clients, 183 (72.3%) reflected satisfaction with the immunization services administered to their children at primary health care centers and 70 (27.7%) were dissatisfied. This satisfaction was significantly associated with younger age of clients (P < 0.05), clients who are mothers of the accompanied children (P < 0.05), and waiting no more than 30 minutes at the health facility to obtain immunization (P < 0.05). The major cause of dissatisfaction was the long waiting time before receiving the service. Conclusion: Although the majority of clients are satisfied with immunization services; it is important to shorten the time consumed for vaccinating children at PHCCs in a way that gains more satisfied clients.

Pertussis outbreak investigation in Likimsa-Bokore kebele, Meda Walebu district, Bale zone, Oromia region, Ethiopia, 2019

Background Pertussis is a major cause of childhood morbidity and mortality. Globally, an estimated 45 million cases and 400,000 deaths occur every year. Meda-Walebu district health office reported the outbreak of pertussis in one of the remote villages/kebele. This study aims to describe an outbreak of pertussis in Likimsa-Bokore village of Meda-Walebu district, Bale Zone, Southeast Ethiopia. Methods A descriptive cross-sectional study was conducted in April 2019. We identified the pertussis cases recorded on the line-list from the District Public Health Emergency Management (PHEM) database. A suspected case of pertussis was defined as any person with cough illness and with at least one of the following symptoms: paroxysms of coughing, inspiratory whooping, post-tussive vomiting, or apnea. The data were cleaned and then analyzed by Microsoft Excel and SPSS version 23 software. Data were reported stratified by age groups, sex, and geographical locations and described in terms of time, place, and person. Results From September 2018 to December 2018, a total of 439 suspected cases of pertussis were reported from Likimsa-Bokore village of Meda-Walebu district. The age of the cases ranged from 2 months to 30 years. The overall attack rate was 55/1000 population with a case fatality rate of 0.7% (3 deaths/439). Children below five years of age and females were the most affected group with an attack rate of 198/1000 and 57/1000 population respectively. Delay to seek medical care by patients or caretakers ranged from 2-9 days with a mean delay of 3 days. Immunization service is not provided regularly, available refrigerators in the health posts were not functional and the cold chain management system was poor. Conclusion The suspected pertussis outbreak has occurred in the remote villages of Meda-Walebu district. The absence of regular immunization service, unfunctional cold chain management system and weak surveillance system in early detection and notification might have contributed to the outbreak. Provision of regular immunization service, strengthening cold chain management, and intensified surveillance system is required for early detection, investigation, and response to the outbreak

Organization of immunization services for public health

Immunization is a key public health intervention that can help nations attain Goal #3 of the UN Sustainable Development Goals as vaccines already prevent about 2–3 million deaths each year. To be effective, immunization services must be designed and delivered in a way to reach populations who need them, irrespective of who they are and where they live. Effective national immunization systems must have clear plans based on a vision of the future and a step-by-step process on how the vision will be translated into reality. Such plans are structured around eight topics that go beyond vaccine licensure and recommendations, including management, financing, logistics, human resources, service delivery, vaccine supply and quality, disease surveillance, advocacy and communication. The cold chain system is the backbone of any immunization program and consists of a network of equipment, material, people, processes, and financial resources that enable safe transportation of vaccines from the factory to the point of administration to the patient. Immunization service delivery includes any strategies and activities for delivering immunization service to a target population. Introduction of a new vaccine in a country program requires coordinated decision-making, considering the burden of disease, the characteristics of the respective vaccine and the capacity of the immunization system to deliver it. Adverse Events Following Immunization is another key component as documentation of vaccine safety is crucial for trust in a vaccination program. Scientifically valid and timely burden-of-disease surveillance as well as vaccine uptake data are core functions of any vaccination program and needed for information of the public and for timely actions.

Immunization Visit Delay in Children Aged 0-24 Months During The Covid-19 Pandemic in Greater Jakarta

The COVID-19 pandemic since the beginning of 2020 has had a significant impact on other essential health services. One of them is the immunization service. Jakarta, Depok, Tangerang, and Bekasi, or Greater Jakarta is the epicenter of the spread of COVID-19 in Indonesia. This study aimed to find the distribution of immunization delay in women with children aged 0-24 months and its reasons in Greater Jakarta. This study used an observational method with a cross-sectional study design. The research process was carried out for six months, from June to November 2020, and 274 samples were collected through online google forms. The study found the proportion of mothers who delayed their children's immunization was 48,9%. The most common reasons are fear of being infected with COVID-19, health facilities not providing immunizations for children, limited vaccine availability, and declining family income during the pandemic. The government should increase the promotion of primary immunization to the community and ensure the availability, safety, and implementation of health protocols in health care facilities.

Determinants of Hesitancy to Childhood Immunizations in a Peri -Urban Settlement; A Case Study of Nansana Municipality, Uganda

Vaccine hesitancy to immunization against the childhood vaccine-preventable diseases is increasingly becoming a concern worldwide, which negatively impacts the parents’ willingness to vaccinate their children. The objective of this study was to establish the current prevalence of vaccine hesitancy and the factors that determine parent’s hesitancy to childhood immunizations in Nansana Municipality, Wakiso District, Uganda. This was a cross-sectional mixed methods study, utilizing both qualitative and quantitative approaches. Evaluation of the determinants of vaccine hesitancy was carried out on 344 parents of children under 24 months, using simple random sampling on pre-tested structured questionnaires. Data was analyzed using SPSS 20.0 software. Additionally, 2 focus group discussions with parents were also conducted. Vaccine hesitancy was found to be 27.6%. Education level (AOR=4.9, 95% CI, 2.6 -29.5, p=0.01), belief in vaccine effectiveness (AOR= 0.47, 95% CI, 0.17 – 0.97, p=0.01), health workers attitude (AOR=0.22, 95% CI, 0.06 - 0.86, p=0.03), timing of immunization service clinic (AOR = 3.4, 95% CI, 1.8 – 6.4, p=0.01) and adequate information provision (AOR = 0.64, 95% CI, 0.16 – 0.99, p=0.04), were the factors that were independently determining vaccine hesitancy. The vaccine hesitancy prevalence rate is comparatively similar to previous urban area studies. Despite parents overwhelmingly believing in vaccines protecting their children from vaccine-preventable disease, these same parents, express concerns regarding timing of the clinic and the side effects of vaccines. There is a need to improve on communication and information flow to address the many vaccine safety concerns, such as side effects. Keywords: Childhood, Determinants, Hesitancy, Immunization, Urban.

Impact Assessment of COVID-19 on Immunization Service for Children

Background: Coronavirus Disease 2019 (COVID-19) or the coronavirus disease caused by the SARS-CoV-2 virus has become a concern around the world, especially in Indonesia. As of January 31, 2021, the total cases of COVID-19 infection in the world reached 103 million with 2.22 million cases. The COVID-19 pandemic threatened to have an impact on health progress and particularly on children's development due to the obstruction of immunization services as a national program. Objective: This study aims to assess the impact of the COVID-19 pandemic on child immunization services. Methods: The method used was a narrative literature review conducted by synthesizing and analyzing 4 search engines including ProQuest, ScienceDirect, Pubmed, and SpringerLink. The search for this manuscript found 22 texts that matched the specified topic, namely the impact of the presence of COVID-19 on immunization services in children, searched for the keywords immunization, COVID-19, immunization service, and child. Results: The COVID-19 pandemic has an impact on changes in immunization services for children who have become obstructed, reduced service coverage, perceptions of parents reflecting the high demand for immunization, and an impact on health status, namely by carrying out routine immunizations resulting in trained immunity and generating immunity. Conclusion: COVID-19 has a special impact on child immunization services. Immunization services must continue to run and carry out according to applicable standards following local government policies by taking into account the principles and guidelines given. Collaboration between the government, the community, non-governmental organizations, and health professionals are needed to prevent a double burden during the COVID-19 pandemic.

Barriers to Implementing a Pharmacist-Run Immunization Service, as Perceived by community Pharmacists in a Middle Eastern Country: A cross sectional web-based survey

Background: Several barriers to instigating a pharmacist-run immunization program existed. This survey aims to identify the barriers perceived by Lebanese community pharmacists (CPs) to implementing such a program and the association of these barriers with their willingness to provide immunization services.Methods:A cross-sectional study using an online survey was conducted over the period of time extending between the 1st of November and the end of December 2020 among Lebanese community pharmacists. The questionnaire included information on their socio-demographic characteristics, willingness to vaccinate and the perceived barriers to the run of immunization service. Statistical analyses were performed using SPSS version 24.0. Two logistic regression were conducted, one to identify factors associated with pharmacists high perception of barriers and another one to determine the predictors of the pharmacist’s willingness to vaccinate.Results:Out of the 412 surveyed community pharmacists, 67.48% of them were willing to expand their practice scope to include immunization. The main perceived barriers were the conflict with other professionals, liability, and reimbursements concerns, time for professional development and lack of knowledge of adverse events after immunization. Our results showed that females were more likely to perceive barriers than males (aOR=2.460, 95% CI (1.876:6.909)). However, pharmacists reporting previous experience in immunization (aOR=0.250, 95% CI (0.170:0.586)), working in urban area (aOR=0.451, 95% CI (0.199:0.926)) and having extensive working hours (aOR=0.244, 95% CI (0.05:1.2)) were less likely to perceive barriers. Female pharmacists were less willing to vaccinate (aOR=0.211, 95% CI (0.116:0.383)). However, having less than 40 years old (aOR=2.518, 95% CI (1.236:5.130)), having large experience ((aOR=1.78, 95% CI (1.087 to 2.993)) or previous experience in immunization (aOR=1.702, 95% CI (1.092 to 3.141)), being pharmacy owner (aOR=1.504, 95% CI (1.098:2.103)) and working more than 24 hours per week (aOR=2.622, 95% CI (1.447:4.752) were positively associated to the willingness to vaccinate. Pharmacists who perceived reimbursement (aOR=0.449 with 95% CI (0.264-0.765)), lack of pharmacy space (aOR=0.410 with 95% CI (0.158-1.060)), sharp safety (aOR=0.298 with 95% CI (0.146-0.609)) and insufficient staff (aOR=0.388 with 95% CI (0.190-0.794)) as barriers were less likely to implement pharmacy-run immunization.Conclusion:Addressing the identified barriers driving pharmacist’s lower willingness to vaccinate would be required to fully harness the potential of pharmacists as vaccinators.

Measuring coverage of maternal and child health services using routine health facility data: a Sierra Leone case study

Background There are limited existing approaches to generate estimates from Routine Health Information Systems (RHIS) data, despite the growing interest to these data. We calculated and assessed the consistency of maternal and child health service coverage estimates from RHIS data, using census-based and health service-based denominators in Sierra Leone. Methods We used Sierra Leone 2016 RHIS data to calculate coverage of first antenatal care contact (ANC1), institutional delivery and diphtheria-pertussis-tetanus 3 (DPT3) immunization service provision. For each indicator, national and district level coverages were calculated using denominators derived from two census-based and three health service-based methods. We compared the coverage estimates from RHIS data to estimates from MICS 2017. We considered the agreement adequate when estimates from RHIS fell within the 95% confidence interval of the survey estimate. Results We found an overall poor consistency of the coverage estimates calculated from the census-based methods. ANC1 and institutional delivery coverage estimates from these methods were greater than 100% in about half of the fourteen districts, and only 3 of the 14 districts had estimates consistent with the survey data. Health service-based methods generated better estimates. For institutional delivery coverage, five districts met the agreement criteria using BCG service-based method. We found better agreement for DPT3 coverage estimates using DPT1 service-based method as national coverage was close to survey data, and estimates were consistent for 8 out of 14 districts. DPT3 estimates were consistent in almost half of the districts (6/14) using ANC1 service-based method. Conclusion The study highlighted the challenge in determining an appropriate denominator for RHIS-based coverage estimates. Systematic and transparent data quality check and correction, as well as rigorous approaches to determining denominators are key considerations to generate accurate coverage statistics using RHIS data.

Perceived quality of essential newborn care implementation among health facility deliveries in North Gondar Zone, Northwest Ethiopia: a cross-sectional study

Background Quality of essential newborn care is defined as the extent of health care services to improve the health of newborns. However, studies are scarce regarding the quality of newborn care implementation. Therefore, this study aimed to measure the magnitude and factors associated with essential newborn care implementation perceived quality among health facility deliveries in Northwest Ethiopia. Methods A facility-based cross-sectional study design was employed to collect data from 370 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. Essential newborn care implementation perceived quality was assessed in two domains (delivery and process) from clients’ perspectives. A pre-tested interviewer-administered structured questionnaire was adopted from different kinds of literature and guidelines. The research data were collected by trained midwives and nurses. A binary logistic regression model was used to identify associated factors with newborn care implementation perceived quality. Odds ratio with 95% CI was computed to assess the strength and significant level of the association at p-value < 0.05. Results About 338 mothers completed the interview with a response rate of 97.1%. The mean age of the study participants was 26.4 (SD = 5.7) with a range of 12 and 45 years. Most mothers, 84.3%, have attended antenatal care. The overall implementation perceived quality of essential newborn care was found to be 66.3%. The implementation perceived quality of cord care, breast-feeding and thermal care was 75.4, 72.2 and 66.3% respectively. Newborn immunization and vitamin K administration had the lowest implementation perceived quality i.e. 22.4 and 24.3% respectively. Friendly care during delivery (AOR = 5.1, 95% CI: 2.4, 11.0), partograph use (AOR = 3.0, 95% CI: 1.1, 8.6), child immunization service readiness (AOR = 2.9, 95% CI: 1.5, 5.7), BEmEONC service readiness (AOR = 2.1, 95% CI: 1.2, 3.9) and facing no neonatal illness at all (AOR = 4.2, 95% CI: 1.6, 10.9) were significantly associated with good essential newborn care implementation qualities. Conclusions The perceived quality of essential newborn care implementation was low in the study area. This is associated with poor readiness on BEmEONC and child immunization services, unfriendly care and not using partograph during delivery. Hence, availing the BEmEONC and the child immunization service inputs, continuous training and motivation of healthcare workers for friendly care are vital for improving essential newborn care implementation perceived quality.

Breastfeeding Obstacles at Primary Healthcare Centers in Northern Mexico

Objectives Mexico is a country with one of the lowest breastfeeding (BF) rates in America. In order to plan effective strategies that promote and support breastfeeding in different settings, we must identify factors that have an influence on infant-feeding behaviors. Therefore, the objective of this study is to identify breastfeeding obstacles and their association with exclusive breastfeeding (EBF) practices. Methods This was a cross-sectional study conducted in Tijuana, Mexico. Participants included were mothers of infants less than 6 months of age attending immunization service at two primary health care centers. Breastfeeding obstacles were assessed with a questionnaire developed from previous formative research conducted in a comparable population. To determine the association between obstacles and EBF, logistic regression models were used. Covariates included were maternal age, occupation, educational level, parity, delivery methods and previous BF assistance. A p-value of less than 0.05 was considered statistically significant. The analysis was performed with IBM SPSS statistics version 25. Results A total of 106 mothers were included with a mean age of 26.25 ± 5.66. A total of 53.8% (57) had vaginal delivery, 37.7% (40) had no previous pregnancies, and 67% (72) received previous BF information. The main obstacles reported were infant dissatisfaction (54%), pain (53%), perception of insufficient milk (PIM) (46%), and breastfeeding in public (43%). The percentage of mothers with at least one obstacle was 92%. After adjustment, we found a statistically significant association between PIM (OR 0.247, 0.097–0.627, p = 0,003) and EBF, and between infant dissatisfaction (OR = 0.109, 0.037–0.320, p &lt; 0.001) and EBF. Conclusions Findings suggest that mothers who experience PIM and infant dissatisfaction may be at risk of decreasing exclusive breastfeeding practices. Since breastfeeding practices depend on then socio-ecological environment in which the mother lives, identification of obstacles in particular settings are necessary to develop breastfeeding programs in low- and middle-income countries. Funding Sources Programa para el Desarrollo Profesional Docente (Prodep) para fortalecimiento de cuerpos académicos. Convocatoria 2019.