The effect of introduction of routine immunization for rotavirus vaccine on paediatric admissions with diarrhoea and dehydration to Kenyan Hospitals: an interrupted time series study

Background: Dehydration secondary to diarrhoea is a major cause of hospitalization and mortality in children aged less than five years. Most diarrhoea cases in childhood are caused by rotavirus, and routine introduction of rotavirus vaccine is expected to reduce the incidence and severity of dehydration secondary to diarrhoea in vaccinated infants. Previously, studies have examined changes in admissions with stools positive for rotavirus but this study reports on all admissions with dehydration secondary to diarrhoea regardless of stool rotavirus results. We aimed to assess the changes in all-cause severe diarrhoea and dehydration (DAD) admissions following the vaccine’s introduction. Methods: We examined changes in admissions of all clinical cases of DAD before and after introduction of routine vaccination with rotavirus vaccine in July 2014 in Kenya. We use data from 13 public hospitals currently involved in a clinical network, the Clinical Information Network (CIN). Routinely collected data for children aged 2-36 months were examined. We used a segmented mixed effects model to assess changes in the burden of diarrhoea and dehydration after introduction of rotavirus vaccine. For sensitivity analysis, we examined trends for non-febrile admissions (surgical or burns). Results: There were 17,708 patients classified as having both diarrhoea and dehydration. Average monthly admissions due to DAD for each hospital before vaccine introduction (July 2014) was 35 (standard deviation: ±22) and 17 (standard deviation: ±12) after vaccine introduction. Segmented mixed effects regression model showed there was a 33% (95% CI, 30% to 38%) decrease in DAD admissions immediately after the vaccine was introduced to the Kenya immunization program in July 2014. There was no change in admissions due to non-febrile admissions pre-and post-vaccine introduction. Conclusion: The rotavirus vaccine, after introduction into the Kenya routine immunization program resulted in reduction of all-cause admissions of diarrhoea and dehydration in children to public hospitals.

Covid-19 and Routine Vaccination Programme: Did it Affect Badly?

Background: The impact of COVID-19 on general health care delivery systems has been huge including the immunization services. Several measures were taken by most of the government all over the world to prevent the spread of infection such as lockdown, wearing masks, social distancing, etc. People have suffered a lot during the pandemic, not only due to the burden of the disease but have also faced difficulties in other domains of life. One of the important concerns is the interruption of routine immunization services. The consequences of interrupted immunization services may be life-threatening, as chances of outbreaks of vaccine-preventable diseases (VPD) in susceptible children could be high. Aim: To find out delay in routine immunization services during covid-19 and also to determine the factors associated with delay in immunization. Materials and Methods: This study was a cross-sectional hospital-based observational study at Career Institute Of Medical Sciences And Hospital, Lucknow, India. We collected the vaccination record after lockdown from Well-Baby Clinic and telephonically from the parents, starting from 1st June 2020 till 31st December 2020. We checked the records of vaccination of infants to find out delay in the vaccinations, as per the National Immunization Schedule. The records of a total of 265 infants were enrolled. Out of which, 33 did not fit the inclusion criteria and therefore were excluded from this study. Results: Findings of our study pointed that there was significant delay in routine immunization among infants. The factors responsible for delay in different vaccination observed in this study were, Phobia of COVID-19- 20%, lockdown- 22%, interruption of routine health services-15%, social myths-8%, poor transport facility- 10%, illness of child- 8%, did not notice- 3% and multiple factors- 13%. Conclusion: COVID -19 pandemic has affected the routine immunization services that results in delay of different vaccines at different ages which may lead to outbreak of vaccine preventable diseases, so it is need of the hour to intervene at the earliest to prevent such outbreaks among children.

Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria

Background Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria. Methods The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada. Results At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents’ mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful). Conclusion The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.

Acceptability of mobile-phone reminders for routine childhood vaccination appointments in Nigeria – a systematic review and meta-analysis

Background Mobile-phone reminders have gained traction among policymakers as a way to improve childhood vaccination coverage and timeliness. However, there is limited evidence on the acceptability of mobile-phone reminders among patients and caregivers. This systematic review and meta-analysis aimed to evaluate the ownership of mobile-phone device and the willingness to receive mobile-phone reminders among mothers/caregivers utilizing routine childhood immunization services in Nigeria. Method MEDLINE, Scopus, CINAHL, CNKI, AJOL (African Journal Online), and Web of Science were systematically searched for studies on the acceptability of mobile-phone reminders for routine immunization appointments among mothers/caregivers in Nigeria. Studies were assessed for methodological quality using the Newcastle Ottawa Scale and JBI critical appraisal checklists. Meta-analysis was conducted using random-effects model to generate pooled estimates (proportion) of mothers who owned at least one mobile phone and proportion of mothers willing to receive mobile-phone reminders. Results Sixteen studies (13 cross-sectional and three interventional) involving a total of 9923 mothers across 15 states and the Federal Capital Territory Abuja met inclusion criteria. Pooled estimates showed that the proportion of mothers who owned at least one mobile phone was 96.4% (95% CI = 94.1–98.2%; I2 = 96.3%) while the proportion of mothers willing to receive mobile-phone reminders was 86.0% (95% CI = 79.8–91.3%, I2 = 98.4%). Most mothers preferred to receive text message reminders at least 24 h before the routine immunization appointment day, and in the morning hours. Approximately 52.8% of the mothers preferred to receive reminders in English, the country’s official language. Conclusion Current evidence suggests a high acceptability for mobile-phone reminder interventions to improve routine childhood immunization coverage and timeliness. Further studies, however, are needed to better understand unique regional preferences and assess the operational costs, long-term effects, and risks of this intervention. Systematic review protocol registration PROSPERO CRD42021234183.

Introduction of Two-Dose Mumps-Containing Vaccine into Routine Immunization Schedule in Quzhou, China, Using Cox-Proportional Hazard Model

Mumps is a vaccine-preventable disease caused by the mumps virus, but the incidence of mumps has increased among the children who were vaccinated with one-dose measles-mumps-rubella (MMR) in recent years. In this study, we analyzed the influence of different doses of mumps-containing vaccine (MuCV) against mumps using Cox-proportional hazard model. We collected 909 mumps cases of children who were born from 2006 to 2010 and vaccinated with different doses of MuCV in Quzhou during 2006-2018, which were all clinically diagnosed. Kaplan-Meier survival methods and Cox-proportional hazard model were used to estimate the hazard probabilities. Kaplan–Meier curves showed that the cumulative hazard of male and female has no difference; lower hazards were detected among those who were vaccinated with two-dose MuCV, born in 2006, and infected after supplementary immunization activities (SIA). Cox-proportional hazard regression suggested that onset after SIA, born in 2006, and vaccinated with two-dose MuCV were protective factors against infection even after adjusting for potential confounding effects. Our study showed that it was necessary to revise the diagnostic criteria of mumps and identify RT-PCR as the standard for mumps diagnosis in China. We suggested that routine immunization schedule should introduce two doses of MMR and prevaccination screening should be performed before booster immunization in vaccinated populations.

Association of infant and young child feeding practices and acute lower respiratory infections

Background: Suboptimal maternal–child nutrition leading to malnutrition is the major cause increasing morbidity and mortality from severe acute lower respiratory infection (ALRI) among under two children. This research compares the infant and young child feeding (IYCF) practices in children with ALRI and children coming for routine immunization to find out the independent risk factors.Methods: The study was a hospital-based case control study. Infant and young children from 6 months to two years with ALRI admitted to the pediatric ward were studied as cases. Infant and young children of same age coming for routine immunization to the pediatric immunization clinic were studied as controls. Feeding patterns, socio-demographic, environmental and parenting factors were obtained from them in between May 2019 to April 2020.Results: Mixed feeding till 6 months (adjusted OR=34.191; 95% CI, 2.158–541.801; p=0.012), early initiation of complimentary feeding (AOR=30.389; 95% CI, 1.426–647.603; p=0.029), late initiation of complimentary feeding (AOR=28.696; 95% CI, 1.217–676.566; p=0.037) and inadequate amount of complimentary feeding (AOR=14.406; 95% CI, 1.898–109.371; p=0.010) were significant in multivariate analysis.Conclusions: Interventions to increase awareness of breastfeeding and complimentary feeding practices seldom reach lower sections of the society. Feeding visits, mother support groups and community projects to provide home based counselling on IYCF are needed to improve the situation.

Vaccination coverage and the factors influencing routine childhood vaccination uptake among communities experiencing disadvantage in Vellore, southern India: a mixed-methods study

Background In 2015, the Vellore district in southern India was selected for intensified routine immunization, targeting children from communities experiencing disadvantage such as migrant, tribal, and other hard-to-reach groups. This mixed-methods study was conducted to assess routine immunization coverage and the factors influencing childhood vaccination uptake among these communities in Vellore. Methods We conducted a cross-sectional household survey (n = 100) and six focus group discussions (n = 43) among parents of children aged 12–23 months from the known communities experiencing disadvantage in Vellore during 2017 and 2018. Multivariate logistic regression was conducted to examine associations between the parental characteristics and children’s vaccination status in the household survey data; the qualitative discussions were analyzed by using the (previously published) “5As” taxonomy for the determinants of vaccine uptake. Results In the household survey, the proportions of fully vaccinated children were 65% (95% CI: 53–76%) and 77% (95% CI: 58–88%) based on information from vaccination cards or parental recall and vaccination cards alone, respectively. Children whose mothers were wage earners [Adjusted prevalence odds ratio (aPOR): 0.21, 95% CI = 0.07–0.64], or salaried/small business owners [aPOR: 0.18, 95% CI = 0.04–0.73] were less likely to be fully vaccinated than children who had homemakers mothers. In the focus group discussions, parents identified difficulties in accessing routine immunization when travelling for work and showed knowledge gaps regarding the benefits and risks of vaccination, and fears surrounding certain vaccines due to negative news reports and common side-effects following childhood vaccination. Conclusions Vaccination coverage among children from the surveyed communities in Vellore was suboptimal. Our findings suggest the need to target children from Narikuravar families and conduct periodic community-based health education campaigns to improve parental awareness about and trust in childhood vaccines among the communities experiencing disadvantage in Vellore.