Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa.
Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
PLoS One. 2019 Jul 10;14(7):e0218572. doi: 10.1371/journal.pone.0218572. eCollection 2019.
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.
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.
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.
The study identified important local factors that are responsible for MOV which can be addressed in the QI programme.
本研究旨在确定在尼日利亚卡诺州纳萨拉瓦地区的初级保健（PHC）机构中，0-23 月龄儿童错过接种机会（MOV）的相关因素。
本研究为质量改进计划的实施前阶段的横断面研究。采用单阶段聚类抽样技术。在卡诺州纳萨拉瓦地方政府区的十个随机选择的 PHC 机构中，对 0-23 月龄儿童的照顾者进行数据收集。使用半结构式访谈问卷。采用频率和百分比来总结数据。使用包含固定效应和随机效应分量的多水平逻辑回归模型来分别获得关联和变异的度量值。
共有 675 名儿童的照顾者做出了回应。在这些儿童中，MOV（至少一种抗原）的发生率为 36.15%。MOV（针对个别抗原）发生率最高的是灭活脊髓灰质炎疫苗，其次是麻疹疫苗。随机效应模型对空模型产生的组内相关系数为 9.60%。固定效应模型显示，与因医疗咨询而前往卫生机构的儿童相比，陪同照顾者前往卫生机构的儿童更有可能错过接种疫苗（OR=2.86，95%CI：1.28-5.80）。未能在卫生机构就诊当天接种疫苗（OR=2.32，95%CI：1.12-4.12）和在有 3 名或更多疫苗接种者的诊所就诊（OR=12.91，95%CI：4.82-27.14）会增加 MOV 的可能性。
本研究确定了导致 MOV 的重要当地因素，这些因素可以在质量改进计划中得到解决。
