Diphtheria resurgence in Sada'a-Yemen, 2017–2020

Background Diphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. As a consequence of war and collapse of the health system, a fatal epidemic occurred at the end of 2017. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children. Methods A study was conducted in Sada'a governorate by using accumulative line list of diphtheria from November 2017 to September 2020 at electronic Integrated Disease Early Warning System (eIDEWS). The case definition of WHO was adopted. Data was analyzed by Microsoft Excel and Epi info- version 7.2 and multivariable logistic analysis used for identifying significant associated factors. Results 747 cases were met of WHO case definition. The annual peak of cases started during week 31 and weak 49. Males were slightly more than females (51% vs 49%) and about 35% of cases involved children aged 10 to < 15 years. The overall incidence of diphtheria and case fatality rate (CFR) were 69/ 100,000 and 6.4%, respectively. The highest CFR was among age groups under 5 years 11% (P < 0.001) and among females was 8%. Dysphagia and swollen lymph nodes were the predominant symptoms 98%, 92%, respectively. Based on the Vaccination status, the percentage of unvaccinated and unknown were 53% and 41% respectively, with CFR 11% among cases who received one dose. Furthermore, the most case were from Sahar 40% with case fatality rate 8% and the highest CFR was significantly higher among cases in border and ongoing conflict district (P < 0.05). Conclusions The findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada'a that is rising with the low diphtheria immunization coverage. Therefore, concomitant efforts should now focus on improving and monitoring routine immunization across all age groups and healthcare services, especially in borders and continuing conflict districts.

THE ROLE HEALTH OFFICERS AS A DETERMINING FACTOR FOR THE SUCCESSFUL MEASLES RUBELLA IMMUNIZATION IN THE WORK AREA OF THE RAWANG HEALTH CENTER, PADANG CITY

Background: The measles rubella (MR) immunization coverage rate in Padang City is only 30.82%, still far below Indonesia's national target of 95%. The coverage of measles rubella immunization at the Rawang Health Center is around 62.1%. This study aims to determine the role of health workers in the success of measles rubella immunization in the Rawang Public Health Center, Padang City. Methods: This study used a cross sectional design. The study was conducted in October 2018-July 2019. The research population is mothers who have children aged 12-59 months (toddlers) as many as 1807 respondents. The sampling method is proportional random sampling with a sample of 87 respondent. Data was collected by interview using a questionnaire. Results: The results showed that 37.9% of children under five had not been immunized against measles rubella and 44.8% of health workers had an unfavorable role. The results of the chi-square test showed a significant relationship between the role of officers in the success of measles rubella immunization (p-value=0.020). Recommendation: It is hoped that health workers can increase health promotion activities regarding the risks due to children not being immunized against measles rubella and intensify door-to-door programs in the implementation of measles rubella immunization

Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: A multilevel mixed-effects analysis

There is a dearth of information on childhood vaccination coverage in Bangladesh. Thus, this study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data on vaccination coverage for children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. The overall prevalence (weighted) of full vaccination among children aged 12-35 months was 86.17% in 2011 and 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of immunization coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.

HUBUNGAN TINGKAT PENGETAHUAN IBU TENTANG IMUNISASI DPT PADA BAYI DENGAN PERILAKU PENCEGAHAN PENYAKIT DIFTERI PERTUSIS DAN TETANUS DI PUSKESMAS KORPRI BANDAR LAMPUNG TAHUN 2020

DPT immunization is the basic immunization used to prevent diphtheria pertussis and tetanus. According to data from the Bandar Lampung City Health Office from 30 health centers in Bandar Lampung, the Korpri Puskesmas in Sukarame District is the health center with the lowest complete basic immunization coverage, which is 60.8% in 2015. The low immunization coverage rate is inseparable from health behavior and parental knowledge about DPT immunization. Purpose of this study to determine the relationship between the level of mother's knowledge about DPT immunization in infants with the prevention behavior of diphtheria pertussis and tetanus at the Korpri Puskesmas Bandar Lampung in 2020. This study used an observational and analytic type of study with a cross sectional approach and a questionnaire interview method. The sample used in this study were mothers who had babies in the work area of the Korpri Bandar Lampung Community Health Center in 2020. Data analysis used Chi-Square. The result It is known that 7 mothers (77.8%) have bad knowledge about DPT immunization and bad behavior towards DPT disease prevention, as many as 2 mothers (22.2%) have bad knowledge about DPT immunization and good behavior towards DPT disease prevention. A total of 28 mothers (33.3%) had good knowledge about DPT immunization and bad behavior towards DPT disease prevention, as many as 56 mothers (66.7%) had good knowledge about DPT immunization and good behavior towards DPT disease prevention. Chi-square test results obtained p-value = 0.024 (p ≤ 0.05), which means that there is a relationship between the level of maternal knowledge and the prevention behavior of diphtheria, pertussis and tetanus. There is a significant relationship between the level of maternal knowledge about DPT immunization in infants with the prevention behavior of diphtheria pertussis and tetanus at the Korpri Puskesmas Bandar Lampung in 2020 with a p-value = 0.024 (p ≤ 0.05).

Role of Female Labor Force Participation in Child Health

The objective of the study is to investigate the impact of female labor force participation on child (under 5-years of age) health in Pakistan. Child health was gauged through child immunization coverage status measured by recording receipt of 22 doses of eight basic vaccines. A micro data set (i.e., 5872 children) from Pakistan Demographic Health Survey (PDHS) 2017-2018 was utilized for the study. As per recommendations of the World Health Organization, if a child had received all the 22 doses of those eight important vaccinations, he/she was assumed as highly immunized, and vice versa. The impact of mothers’ employment and other explanatory variables, on child health, was investigated using Ordered logistic regression. The child with higher birth order (OR = 0.927; p-value = 0.000), the child of not-working mother (OR = 0.829; p-value = 0.012), the child of illiterate mothers (OR = 0.606; p-value = 0.000), the child of the mother having no own mobile phone (OR = 0.793; p-value = 0.000), and the child belonged to the poorest family (OR = 0.535; p-value = 0.000) had less likelihood of immunization coverage. Mother’s age (OR = 1.055; p-value = 0.005), number of ANC visits made by the mother (OR = 0.925; p-value = 0.000), and male gender of the child (OR = 1.086; p-value = 0.082) had more probabilities for child immunization coverage. Hence, there is a need to alleviate poverty and gender discrimination as well as to create opportunities to increase female education, awareness, and labor force participation for better outcomes relating to child health.

Influence of Community-Based Interventions on Routine Immunization Uptake among Children Under Five Years in Ntungamo District-Uganda

Evidence of the effectiveness of community-based interventions in improving immunization coverage in populations of low coverage is limited. Vaccine-preventable diseases is a major public health challenge in low-income countries where Uganda lies, and immunization is the only reliable strategy for child survival. The study's objective was to assess the influence of a community-based intervention on the uptake of immunization services to recommend strategies to health stakeholders to improve immunization coverage. A quasi-experimental study was conducted in three phases. Structured and key informant interviews were used as data collection tools. Phase one provided baseline data before the intervention, the second phase was a community-based intervention, and the third phase was post-intervention evaluation. There was no significant difference on the uptake of BCG, POLIO-0, POLIO-1, POLIO-2, DPTHeP-Hib1, DPTHeP-Hib2, PCV1 and PCV2 immunizations between the intervention and control group post-intervention (P= 1.00, α =0.5). The level of knowledge on immunization was 68.8% and 29.6% in the intervention and control groups, respectively. The difference between the two was statistically significant (P=0.00 = α= 0.5). There was a significant association between the level of knowledge of the caregivers on immunization and the uptake of immunization services (P=0.00, α=0.5). There was also a statistically significant difference in immunization coverage between the intervention and control groups (97.5%) and (75.1%) for the intervention and control groups, respectively. The difference was statistically associated with the community-based intervention (P =0.00, α=0.5). Community-based interventions influenced the uptake of routine immunization services.

Factors Associated with Uptake of Immunizations for Vaccine-Preventable Childhood Diseases in a Peri-Urban Settlement; A Case Study of Nansana Municipality, Uganda

Immunization uptake for childhood vaccine-preventable diseases remains low in urban areas of Uganda, leading to repeated outbreaks of diseases like measles, despite easy communication and accessibility to services. The objectives of this study were to establish immunization coverage and to identify the factors that affect the uptake of immunization among the children aged 10 – 23 months in Nansana Municipality, Wakiso District, Uganda. This was a cross-sectional mixed methods study, utilizing both qualitative and quantitative approaches. Assessment of immunization uptake was carried out on 344 parents/guardians of children aged 10–23 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 and key informant interviews with immunization focal persons were also conducted. Immunization coverage was found to be 90.4% for BCG, 89.3% for Penta1, 80.7% for Penta2, 72.5% for Penta3 and 73.9% for measles1. Availability of vaccines (AOR= 33, 95% CI, 1.44 – 792, p=0.03), accessibility to immunization services (AOR = 32, 95% CI, 2.0 – 513, p=0.01) and communication between the parents and health workers about the return dates (AOR = 0.03, 95% CI, 0.01 – 0.83, p=0.03), were the factors that were independently associated with immunization uptake. The coverage rates were higher than the national average, with the health care service-related factors identified as being critical for improving immunization uptake. There is a need for improved vaccine supply and communication about immunization services, which should be designed considering the local context in collaboration with slum-dwelling communities.

Factors Influencing Knowledge and Attitude of Mothers Towards Immunization of Children Under-Five Years in Farato, Gambia

Globally, immunization coverage dropped from 86% in 2019 to 83% in 2020. An estimated 23 million children under one year did not receive basic vaccines, which is the highest number since 2009. Thus, this study aimed at identifying factors influencing the knowledge and attitude of mothers of under-five children towards immunization in Farato, The Gambia. A descriptive cross-sectional study was conducted in the peri-urban community of Farato. A sample of 132 mothers were conveniently sampled and interviewed using a structured questionnaire. Descriptive statistics such as percentages, frequencies, and proportions were used to present the results of this study. The study revealed a low level of knowledge of mothers towards immunization. About 25% of mothers cannot clearly explain immunization; 23% knew that the first vaccine dose should be administered to a child at birth or soon after, and 60% were found to be unaware if their children were immunized. This indicates that the concept of immunization is not even clear to mothers and also showcased inadequate knowledge. However, 70% highlighted that immunization prevents infections and enhances child survival. Inadequate knowledge about immunization, literacy and education level, occupation of mothers, inadequate information from health workers, and limited information among mothers were major influencing factors to drop-out of immunization uptake. The study suggests that mothers need to be taught what immunization is about and its importance to children. At health facilities and clinic sites, health workers need to continue communicating to mothers on the importance of immunization to enlighten them about immunization.