Okeibunor Joseph C, Ogbuanu Ikechukwu, Blanche Anya, Chiwaya Kwame, Chirwa Geoffrey, Machekanyanga Zorodzai, Mihigo Richard, Zawaira Felicitas
WHO/AFRO, Brazzaville, Congo.
WHO/HQ, Geneva, Switzerland.
J Immunol Sci. 2018 Jul 2;Suppl(7):46-54.
Missed opportunities for vaccination (MOVs), estimated to be about 32-47% of child healthcare clinic visits in various settings globally, contribute to unfulfilled childhood vaccination coverage targets in the African region.
We assessed the extent of MOVs, identify local drivers and test interventions to reduce MOVs in Malawi.
We conducted in-depth and key informant interviews with administrators of district hospitals and officers in charge of community health facilities. Focus group discussions were held with health workers and caregivers of children under 24 months of age who received services from study health facilities in Malawi. Coverage rates were collected from the health facility records.
Vaccination is appreciated in the communities, but coverage is generally below targets. In some facilities, reported coverage was less than 50%. Opportunities to provide up-to-date vaccination for children were missed due to lack of awareness and knowledge of health workers and caregivers, attitude and priority of health workers, long waiting time, poor coordination and referral of eligible children by clinicians and nurses and overall lack of a team approach to vaccination perceived as a responsibility of health surveillance assistants. Other notable issues included limited time of caregivers labouring on estate farms, unavailability of vaccines resulting from poorly functioning of cold chain equipment and limited transport and failure to appreciate the impact of MOV on poor immunization coverage.
Simple, low-cost, pragmatic and community-driven interventions that may reduce MOVs and improve vaccine coverage.
据估计，全球各地儿童保健门诊就诊中约32%-47%存在疫苗接种错失机会（MOVs），这导致非洲区域儿童疫苗接种覆盖率目标未能实现。
我们评估了马拉维MOVs的程度，确定了当地的驱动因素，并测试了减少MOVs的干预措施。
我们对地区医院管理人员和社区卫生设施负责人进行了深入访谈和关键信息提供者访谈。与在马拉维研究卫生设施接受服务的24个月以下儿童的卫生工作者和照顾者进行了焦点小组讨论。从卫生设施记录中收集覆盖率数据。
社区重视疫苗接种，但覆盖率普遍低于目标。在一些设施中，报告的覆盖率低于50%。由于卫生工作者和照顾者缺乏意识和知识、卫生工作者的态度和优先级、等待时间长、临床医生和护士对符合条件儿童的协调和转诊不佳以及总体上缺乏将疫苗接种视为卫生监测助理职责的团队方法，导致错过为儿童提供最新疫苗接种的机会。其他值得注意的问题包括在庄园农场劳作的照顾者时间有限、冷链设备运行不佳导致疫苗供应不足、交通有限以及未认识到MOV对免疫接种覆盖率低下的影响。
简单、低成本、务实且由社区驱动的干预措施可能会减少MOVs并提高疫苗接种覆盖率。
