Dataset Information

A multilevel analysis of the determinants of missed opportunities for vaccination among children attending primary healthcare facilities in Kano, Nigeria: Findings from the pre-implementation phase of a collaborative quality improvement programme.

ABSTRACT:

Background

We aimed to determine the factors that are responsible for missed opportunities for vaccination (MOV) among children aged 0-23 months attending primary health care (PHC) facilities in Nassarawa, Kano State, Nigeria.

Methods

This cross-sectional study was conducted in the pre-implementation phase of a quality improvement programme. One-stage cluster sampling technique was employed. Data were collected from caregivers of children aged 0-23 months in ten randomly selected PHC facilities in Nassarawa Local Government Area of Kano State. Semi-structured, interviewer administered questionnaires were used. Frequencies and percentages were used to summarize the data. Multilevel logistic regression model with fixed effect and random effect component was fitted to obtain measures of association and variation respectively.

Results

Caregivers of 675 children responded. Among these children, the prevalence of MOV (for at least one antigen) was 36.15%. MOV (for individual antigens) was highest for inactivated polio vaccine followed by measles vaccine. The random effect model yielded an intraclass correlation coefficient of 9.60% for the empty model. The fixed effect model revealed that MOV was more likely among children that were accompanying a caregiver to the health facility (OR = 2.86, 95%CrI: 1.28 to 5.80) compared to those that were visiting the health facility for medical consultation. Failure to receive vaccination on the day of health facility visit (OR = 2.32, 95%CrI: 1.12 to 4.12) and visiting a clinic with three or more vaccinators (OR = 12.91, 95%CrI: 4.82 to 27.14) increased the likelihood of MOV.

Conclusion

The study identified important local factors that are responsible for MOV which can be addressed in the QI programme.

SUBMITTER: Adamu AA

PROVIDER: S-EPMC6619653 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

A multilevel analysis of the determinants of missed opportunities for vaccination among children attending primary healthcare facilities in Kano, Nigeria: Findings from the pre-implementation phase of a collaborative quality improvement programme.

Adamu Abdu A AA Uthman Olalekan A OA Gadanya Muktar A MA Adetokunboh Olatunji O OO Wiysonge Charles S CS

PloS one 20190710 7

<h4>Background</h4>We aimed to determine the factors that are responsible for missed opportunities for vaccination (MOV) among children aged 0-23 months attending primary health care (PHC) facilities in Nassarawa, Kano State, Nigeria.<h4>Methods</h4>This cross-sectional study was conducted in the pre-implementation phase of a quality improvement programme. One-stage cluster sampling technique was employed. Data were collected from caregivers of children aged 0-23 months in ten randomly selected ...[more]

PMID: 31291267

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Project description:Background: Although understanding implementation context is essential, there is a dearth of research on how to systematically explore it in quality improvement (QI) programs. Therefore, in this study, we used the consolidated framework for implementation research (CFIR) to guide a systematic evaluation of the implementation context of an ongoing QI program in order to generate rapid site-specific feedback that can be used to improve subsequent plan-do-study-act (PDSA) cycles.Methods: Formative cross-case evaluation was conducted using convergent mixed methods design. The study was conducted in five primary health care (PHC) facilities (PHC 1, PHC 3, PHC 5, PHC 9 and PHC 10) implementing the QI program. Health workers in those facilities formed the study population. Quantitative data were collected using a self-administered, Likert-based rating tool, while qualitative data collection was guided by an interview guide. The interviews were transcribed verbatim, and thematic analysis was performed. Raw median score and factor scores were computed. Methodological integration occurred at the design, analysis and reporting stage.Results: A total of 165 health workers were included in this study with a mean age of 33.43 years (standard deviation of 7.15). Majority were females and they all had post-secondary education. Health workers in two facilities; PHC 1 and PHC 5, reported higher score for the QI program across all five domains of CFIR. Implementation facilitators included intervention flexibility, relative advantage, self-efficacy among health workers, health workers confidence in the intervention, services integration. While implementation barriers included vaccine stock out, faulty cold chain infrastructure, lack of incentives, and socio-cultural beliefs.Conclusion: This study demonstrated that theory-driven formative evaluation can be integrated in QI programs in a low resource setting. It buttressed the value in conducting such assessment as they can be used to generate rapid feedback on factors that influence implementation success which can then be addressed in subsequent cycles.

Project description:BackgroundDespite 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.MethodsThis 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.Results984 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.ConclusionsOne 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.

Project description:BackgroundIn November 2016, the Kenya National Vaccines and Immunization Programme conducted an assessment of missed opportunities for vaccination (MOV) using the World Health Organization (WHO) MOV methodology. A MOV includes any contact with health services during which an eligible individual does not receive all the vaccine doses for which he or she is eligible.MethodsThe MOV assessment in Kenya was conducted in 10 geographically diverse counties, comprising exit interviews with caregivers and knowledge, attitudes, and practices (KAP) surveys with health workers. On the survey dates, which covered a 4-day period in November 2016, all health workers and caregivers visiting the selected health facilities with children <24 months of age were eligible to participate. Health facilities (n = 4 per county) were purposively selected by size, location, ownership, and performance. We calculated the proportion of MOV among children eligible for vaccination and with documented vaccination histories (i.e., from a home-based record or health facility register), and stratified MOV by age and reason for visit. Timeliness of vaccine doses was also calculated.ResultsWe conducted 677 age-eligible children exit interviews and 376 health worker KAP surveys. Of the 558 children with documented vaccination histories, 33% were visiting the health facility for a vaccination visit and 67% were for other reasons. A MOV was seen in 75% (244/324) of children eligible for vaccination with documented vaccination histories, with 57% (186/324) receiving no vaccinations. This included 55% of children visiting for a vaccination visit and 93% visiting for non-vaccination visits. Timeliness for multi-dose vaccine series doses decreased with subsequent doses. Among health workers, 25% (74/291) were unable to correctly identify the national vaccination schedule for vaccines administered during the first year of life. Among health workers who reported administering vaccines as part of their daily work, 39% (55/142) reported that they did not always have the materials they needed for patients seeking immunization services, such as vaccines, syringes, and vaccination recording documents.ConclusionsThe MOV assessment in Kenya highlighted areas of improvement that could reduce MOV. The results suggest several interventions including standardizing health worker practices, implementing an orientation package for all health workers, and developing a stock management module to reduce stock-outs of vaccines and vaccination-related supplies. To improve vaccination coverage and equity in all counties in Kenya, interventions to reduce MOV should be considered as part of an overall immunization service improvement plan.

Project description:BackgroundIn 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)-when eligible children have contact with the health system but are not fully vaccinated-to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment.MethodsUsing the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children <24 months of age visiting the selected health facilities on the day of the assessment were requested to participate in focus group discussions. Health workers were purposively sampled to capture a broad range of perspectives. Key informants were selected based on their perceived insight on immunization services at the county, sub-county, or health facility level.ResultsSix focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies.ConclusionsIdentified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.

Project description:BACKGROUND:Malaria surveillance system strengthening is essential in the progress towards malaria elimination. In Nigeria, more attention is being given to this recently as the country is striving towards achieving elimination. However, the surveillance system performance is fraught with challenges including poor data quality with varying magnitude by state. This study evaluated the operation of the Kano State malaria surveillance system and assessed its key attributes. METHODS:An observational study design comprising a survey, record review and secondary data analysis, and mixed methods data collection approach were used. Four key stakeholders' and 35 Roll Back Malaria Focal Persons (RBMs) semi-structured interviews on operation of the system and attributes of the surveillance system, were conducted. We analyzed the abstracted 2013-2016 National Health Management Information System web-based malaria datasets. The surveillance system was evaluated using the "2001 United States Centers for Disease Control's updated guidelines for Evaluating Public Health Surveillance Systems". Data were described using means, standard deviation, frequencies and proportions. Chi-squared for linear trends was used. RESULTS:Overall, 24 RBMs (68.6%) had ≤ 15-year experience on malaria surveillance, 29 (82.9%) had formal training on malaria surveillance; 32 RBMs (91.4%) reported case definitions were easy-to-use, reporting forms were easy-to-fill and data flow channels were clearly defined. Twenty-seven respondents (69.2%) reported data tools could accommodate changes and all RBMs understood malaria case definitions. All respondents (4 stakeholders and 34 RBMs [97.1%]) expressed willingness to continue using the system and 33 (84.6%) reported analyzed data were used for decision-making. Public health facilities constituted the main data source. Overall, 65.0% of funding were from partner agencies. Trend of malaria cases showed significant decline (χ2trend = 7.49; P = 0.0006). Timeliness of reporting was below the target (≥ 80%), except being 82% in 2012. CONCLUSIONS:Malaria surveillance system in Kano State was simple, flexible, acceptable, useful and donor-driven but the data were not representative of all health facilities. Timeliness of reporting was suboptimal. We recommended reporting from private health facilities, strengthening human resource capacity for supportive supervision and ensuring adequate government funding to enhance the system's representativeness and improve data quality.

Project description:ObjectivesChildren accessing healthcare systems represent a vulnerable population with risk factors for poor health outcomes, including vaccine-preventable diseases. We aimed to quantify missed vaccination opportunities among hospitalised children in India, and identify vaccination barriers perceived by caregivers and healthcare providers.DesignCross-sectional study.SettingTwo public-sector tertiary-care hospitals in northern India, during November 2018 and March 2019.ParticipantsWe tracked 263 hospitalised children aged 1-59 months through hospital discharge, to assess vaccination status, and document catch-up vaccinations given during the hospital stay. We interviewed caregivers and healthcare providers to assess their perceptions on vaccination.OutcomesProportion of hospitalised children considered under-vaccinated for their age; proportion of missed opportunities for vaccination among under-vaccinated children who were eligible for vaccination; and vaccine coverage by antigen.ResultsWe found that 65.4% (172/263) of hospitalised children were under-vaccinated for their age when they presented to the hospital. Among under-vaccinated children, 61.0% were less than 4 months old, and 55.6% reported prior contact with a health facility for a sick visit. The proportion of under-vaccinated children in hospitals were higher compared with the general population as indicated by regional vaccination coverage data. Among under-vaccinated children who were tracked till discharge, 98.1% (158/161) remained incompletely vaccinated at discharge and were considered 'missed opportunities for vaccination'. Perceived vaccination contraindications that are not part of established contraindications included in national and international guidelines was the most common reason for healthcare providers not to vaccinate children during hospital stay. Among caregivers of under-vaccinated children, 90.1% reported being comfortable having their children vaccinated while they were sick, if recommended by the healthcare provider.ConclusionThis pilot study confirmed that hospitalised sick children had substantial missed vaccination opportunities. Addressing these opportunities through concerted actions involving caregivers, healthcare providers and healthcare systems can improve overall vaccination coverage.

Project description:BackgroundStillbirths are a poignant representation of global inequality. Nigeria is documented to have the second highest rate; yet, the reporting system is inadequate in most Nigerian healthcare facilities. The aim was to identify the determinants of stillbirth among deliveries in the Murtala Muhammad Specialist Hospital (MMSH), Kano, Nigeria.MethodsTwo study designs were used: a case-control study (S1) and a prospective cohort study (S2). Both studies were carried out at the MMSH. For S1, stillbirths were retrospectively matched to a livebirth by time (target of 24 hours' time variation) to establish a case-control study with a 1:1 ratio. Eligibility into S2 included all mothers who were presented at the MMSH in labour regardless of birth outcome. Both were based on recruitment durations, not sample sizes (3 months and 2 months, respectively, 2017-2018). The demographic and clinical data were collected through paper-based questionnaires. Univariable logistic regression was used. Multivariable logistic regression was used to explore relationships between area type and other specific factors.FindingsStillbirth incidence in S2 was 180/1,000 births. Stillbirth was associated with the following factors; no maternal education, previous stillbirth(s), prematurity, living in both semi-rural and rural settings, and having extended time periods between rupture of membranes and delivery. Findings of the multivariable analysis (S1 and S2) indicated that the odds of stillbirth, for those living in a rural area, were further exacerbated in those mothers who had no education, lived in a shack, or had any maternal disease.InterpretationThis research identifies the gravity of this situation in this area and highlights the need for action. Further understanding of some of the findings and exploration into associations are required to inform intervention development.FundingThis collaboration was partially supported by funding from Health and Care Research Wales.

Dataset Information

A multilevel analysis of the determinants of missed opportunities for vaccination among children attending primary healthcare facilities in Kano, Nigeria: Findings from the pre-implementation phase of a collaborative quality improvement programme.

Background

Methods

Results

Conclusion

Publications

A multilevel analysis of the determinants of missed opportunities for vaccination among children attending primary healthcare facilities in Kano, Nigeria: Findings from the pre-implementation phase of a collaborative quality improvement programme.

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