Nnaji Chukwudi A, Wiysonge Charles S, Adamu Abdu A, Lesosky Maia, Mahomed Hassan, Ndwandwe Duduzile
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa.
Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa.
Vaccines (Basel). 2022 May 16;10(5):785. doi: 10.3390/vaccines10050785.
Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0-23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0-23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers' low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13-11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25-0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07-0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06-0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.
尽管南非在确保儿童普遍获得常规免疫服务方面付出了巨大努力，但免疫覆盖率仍存在重大差距。本研究评估了开普敦初级卫生保健（PHC）机构中0至23个月儿童的疫苗接种错失机会（MOV）程度及相关因素。我们使用多水平二项逻辑回归模型来探索与MOV相关的个体和背景因素，其中0至23个月的儿童为第1层，嵌套在初级卫生保健机构（第2层）内。共纳入了674名儿童及其照顾者。MOV患病率为14.1%，各次区域范围为9.1%至18.9%。特定剂量的MOV患病率在麻疹疫苗第二剂中最高（9.5%），在轮状病毒疫苗第一剂中最低（0.6%）。儿童经历MOV的可能性与照顾者的低教育水平（优势比（OR）=3.53，95%可信区间（CrI）：1.13 - 11.03）、近期收到免疫信息（OR = 0.46，95%CrI：0.25 - 0.87）、父母双方共同参与免疫决策（OR = 0.21，95%CrI：0.07 - 0.62）以及卫生机构工作人员数量（OR = 0.18，95%CrI：0.06 - 0.61）显著相关。开普敦儿童中MOV的负担受个体和背景因素影响，这为质量改进以及改善常规免疫服务提供的更广泛策略提供了重要机会。
