Akwataghibe Ngozi N, Ogunsola Elijah A, Broerse Jacqueline E W, Popoola Oluwafemi A, Agbo Adanna I, Dieleman Marjolein A
Global Health Department, Royal Tropical Institute, Amsterdam, Netherlands.
Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Front Public Health. 2019 Dec 20;7:392. doi: 10.3389/fpubh.2019.00392. eCollection 2019.
In 2005, Nigeria adopted the Reach Every Ward strategy to improve vaccination coverage for children, 0-23 months. By 2015, Ogun state had full coverage in 12 of its 20 local government areas but eight had pockets of unimmunized children, with the highest burden (37%) in Remo-North. This study aimed to identify factors in Remo-North influencing the use of immunization services, in order to inform intervention approaches to tackle barriers to immunization utilization. We carried out a cross-sectional study using mixed methods including a survey of caregivers of 215 children, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community men and women ( = 98). Two wards (Ilara and Ipara) were purposively chosen for the study. Data was analyzed using the SAGE Working Group Vaccine Hesitancy model. Only 56 children (32.6%) of the 172 children over 9 months of age had immunization cards available for inspection. Of these, 23 (59.6%) were fully immunized, noticeably higher in Ipara than Ilara. However, when immunization status was assessed by card and recall, 84.9% of the children were assessed as fully immunized. Caregivers in the more rural Ilara had less knowledge of vaccine schedules. The importance of all doses was recognized more by Ipara respondents (95.5%) than in Ilara (75.3%) ( < 0.05). Community links to immunization and household decision-making patterns influenced immunization use in both wards. Migrants and those living in hard-to-reach areas were disadvantaged in both wards. Health service factors like absence of delivery services, shortage of health workers, unavailability of vaccines at scheduled times, and indirect costs of immunization contributed to low utilization. Immunization utilization was influenced by interlinked community and health services issues. Intervention approaches should ensure that communities' priorities are addressed, actors at both levels involved and strategies are adjusted to suit contexts.
2005年，尼日利亚采用了“覆盖每个行政区”战略，以提高0至23个月儿童的疫苗接种覆盖率。到2015年，奥贡州20个地方政府辖区中有12个实现了全面覆盖，但仍有8个辖区存在未接种疫苗儿童的零散分布情况，其中雷莫北区的负担最重（37%）。本研究旨在确定雷莫北区影响免疫服务使用的因素，以便为解决免疫接种利用障碍的干预方法提供依据。我们采用混合方法进行了一项横断面研究，包括对215名儿童的看护人进行调查、对参与免疫服务提供的利益相关者进行25次半结构化访谈，以及与社区男性和女性进行16次焦点小组讨论（n = 98）。本研究特意选择了两个行政区（伊拉拉和伊帕拉）。数据采用SAGE工作组疫苗犹豫模型进行分析。在172名9个月以上的儿童中，只有56名儿童（32.6%）有免疫接种卡可供检查。其中，23名儿童（59.6%）完成了全程免疫接种，伊帕拉的这一比例明显高于伊拉拉。然而，当通过接种卡和回忆来评估免疫接种状况时，84.9%的儿童被评估为完成了全程免疫接种。伊拉拉较偏远地区的看护人对疫苗接种时间表的了解较少。伊帕拉的受访者（95.5%）比伊拉拉的受访者（75.3%）更认可所有剂次疫苗接种的重要性（P < 0.05）。社区与免疫接种的联系以及家庭决策模式在两个行政区都影响着免疫接种的使用情况。在两个行政区，移民和居住在难以到达地区的人都处于不利地位。诸如缺乏接生服务、卫生工作者短缺、在预定时间没有疫苗供应以及免疫接种的间接费用等卫生服务因素导致了低接种率。免疫接种的利用率受到社区和卫生服务相关问题相互关联的影响。干预方法应确保解决社区的优先事项，让两个层面的行为主体都参与进来，并根据具体情况调整策略。
