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Missed opportunities for immunization during visits for curative care: a randomized cross-over trial in Sudan
B P Loevinsohn1, E Gareaballah
1Management Sciences for Health/Child Survival Program, Department of Health, Manila, Philippines.
Insights
Simple interventions like relocating vaccination sites or doctor recommendations increased infant immunization rates to 55% in Sudan. However, reaching sick or unvaccinated infants requires further community engagement and education.
Area of Science:
- Pediatrics
- Public Health
- Vaccination Strategies
Background:
- Infants in developing countries often miss vaccinations during curative care visits.
- Integrating vaccination services with routine healthcare is a challenge.
Purpose of the Study:
- To evaluate the effectiveness of two simple interventions to increase infant immunization rates.
- To assess if proximity of vaccination services or physician recommendation improves vaccination uptake.
Main Methods:
- A randomized cross-over study was conducted in twelve urban health centers in Sudan.
- Two interventions were tested: moving vaccination services closer to consultation rooms and physician-prescribed vaccination recommendations.
- Vaccination coverage was compared between the two approaches.
Main Results:
- An average of 55% of eligible infants received immunization under either intervention.
- No significant difference was observed between the two interventions (mean difference, 2%; 95% CI, -4% to +7%).
- Maternal perception of infant sickness, infant age, and prior vaccination status influenced refusal rates.
Conclusions:
- Simple, low-cost interventions can reduce missed vaccination opportunities.
- Addressing barriers for sick, unvaccinated, or underserved infants requires enhanced social mobilization, health education, and outreach programs.
Abstract:
Infants who come to health facilities for curative care in developing countries are usually not vaccinated at the same time. To assess what could be done a randomized cross-over study was carried out in twelve urban health centres in Sudan where two approaches were investigated: (1) the place for vaccination was moved very close to the consulting room, and (2) the doctor seeing the infant wrote a prescription recommending vaccination for the child. On average, 55% of the infants needing immunization were vaccinated when either of these approaches was followed. No difference was found between the two interventions in terms of the proportion of eligible children who were immunized (mean difference, 2%; 95% Cl, -4% to +7%). The more sick an infant appeared to be to the mother, the more likely she was to refuse vaccination. Older infants and infants not previously vaccinated were also less likely to be immunized. The number of missed opportunities can thus be reduced using these simple approaches. However, to immunize infants who are sick, unvaccinated, or have limited access to health facilities will require more social mobilization, health education, and outreach activities.
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