Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Yaounde, Cameroon.
Department of Public Health, Faculty of Medecine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
JMIR Public Health Surveill. 2022 Mar 1;8(3):e32213. doi: 10.2196/32213.
Countries' Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries.
We aim to assess whether involving community volunteers (CVs) to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children's vaccination timeliness, completeness, and coverage.
This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness.
Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette-Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group.
Findings support that involving CVs to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children's vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts.
Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548.
国家扩大免疫规划（EPI）有助于降低死亡率和发病率，但大多数低收入国家仍难以获得这些疫苗。
我们旨在评估让社区志愿者（CV）来跟踪儿童的疫苗接种状况和人口流动情况，并利用记录的数据来规划补种免疫接种活动，是否能提高儿童的疫苗接种及时性、完整性和覆盖率。
这是一项基于现场的随机对照试验，喀麦隆西部富姆邦区的社区被分配到干预组或对照组。在干预组中，每个社区培训一名 CV ，每月家访一次，持续一年，以评估和记录 EPI 目标儿童、他们的人口流动和免疫接种状况的详细信息。扫描记录的页面通过 WhatsApp 发送到卫生中心免疫接种小组，并用于组织每月的社区补种免疫接种活动。在对照组中，常规开展 EPI 疫苗接种活动。在干预开始后的 6 个月和 12 个月，在两个研究组中进行调查，以评估和比较免疫接种的及时性、覆盖率和完整性。
总体而言，在基线和终线时，每个集群调查了 30 栋建筑。在干预组的基线和终线调查中，分别有 630 户（99.5%）和 718 户（98.4%）同意参与，而对照组分别有 507 户和 651 户，分别有 505 户（99.6%）和 636 户（97.7%）同意参与。在 12 个月的干预后，与对照组相比，干预组 0-11 个月龄（调整后的优势比[OR] 1.1，95%CI 0.7-1.8）和 0-59 个月龄（OR 1.1，95%CI 0.9-1.4）儿童的卡介苗（BCG）疫苗首剂接种及时性没有增加，而 0-23 个月龄儿童的第一年内 BCG 疫苗接种的覆盖率显著增加（OR 1.5，95%CI 1.1-2.2）。与对照组相比，12-59 个月龄和 12-23 个月龄组的白喉-百日咳-破伤风和乙型肝炎+流感嗜血杆菌 b 型（DPT-Hi+Hb）疫苗 3 剂（OR 2.0，95%CI 1.5-2.7）和 DPT-Hi+Hb 疫苗 1 剂（OR 1.8，95%CI 1.4-2.4）的覆盖率显著增加。特定（DPT-Hi+Hb 疫苗 1 剂至 DPT-Hi+Hb 疫苗 3 剂：OR 1.9，95%CI 1.4-2.6）和一般（BCG 至麻疹：OR 1.5，95%CI 1.1-2.1）疫苗完整性也显著增加。
研究结果支持让 CV 来跟踪儿童的疫苗接种状况和人口流动情况，并利用记录的数据来规划补种免疫接种活动，这可以提高儿童的疫苗接种及时性、完整性和覆盖率。这种策略应该被采用，以改善 EPI 目标人群的疫苗接种机会，并在其他情况下验证一致性。
泛非临床试验注册处 PACTR201808527428720；https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548。
