Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
BMJ Open. 2021 Mar 19;11(3):e046464. doi: 10.1136/bmjopen-2020-046464.
Children 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.
Cross-sectional study.
Two public-sector tertiary-care hospitals in northern India, during November 2018 and March 2019.
We 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.
Proportion 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.
We 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.
This 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.
儿童在使用医疗保健系统时属于弱势群体，存在健康状况不佳的风险因素，包括可预防疫苗的疾病。本研究旨在量化印度住院儿童错过疫苗接种的情况，并确定照顾者和医疗保健提供者认为的疫苗接种障碍。
横断面研究。
印度北部的两家公立三级保健医院，于 2018 年 11 月至 2019 年 3 月期间开展。
我们通过医院出院情况追踪了 263 名年龄在 1-59 个月的住院儿童，以评估其疫苗接种状况，并记录住院期间进行的补种疫苗情况。我们采访了照顾者和医疗保健提供者，以评估他们对疫苗接种的看法。
考虑到年龄因素，认为有多少住院儿童未完全接种疫苗；有多少符合接种条件但未完全接种疫苗的儿童错过了接种疫苗的机会；按抗原划分的疫苗覆盖率。
我们发现，263 名住院儿童中有 65.4%（172/263）在就诊时年龄未完全接种疫苗。在未完全接种疫苗的儿童中，61.0%年龄小于 4 个月，55.6%表示之前因患病曾到医疗机构就诊。与区域疫苗接种覆盖率数据相比，住院儿童中未完全接种疫苗的比例更高。在接受追踪直至出院的未完全接种疫苗的儿童中，有 98.1%（158/161）在出院时仍未完全接种疫苗，被视为“错过了接种疫苗的机会”。不被认为是国家和国际指南中规定的禁忌症的疫苗接种禁忌症是医疗保健提供者在住院期间不接种疫苗的最常见原因。在未完全接种疫苗的儿童的照顾者中，90.1%表示如果医疗保健提供者建议，他们愿意在孩子生病时让其接种疫苗。
本试点研究证实，住院的患病儿童错过了大量疫苗接种机会。通过照顾者、医疗保健提供者和医疗保健系统共同采取协调行动来解决这些问题，可以提高整体疫苗接种覆盖率。
