Jejaw Melak, Tafere Tesfahun Zemene, Tiruneh Misganaw Guadie, Hagos Asebe, Teshale Getachew, Tilahun Mikias Mered, Negash Wubshet D, Demissie Kaleb Assegid
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Optometry, School of Medicine and Health Science, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.
BMC Public Health. 2025 Jan 7;25(1):62. doi: 10.1186/s12889-024-21273-3.
Despite vaccination being the most cost-effective means to prevent disease and its adverse consequences, missing opportunities for vaccination remains a critical public health challenge. Many SSA countries still couldn't reach the target endorsed by the Global Vaccine Action Plan. Identifying contributing factors helps policymakers and planners to design potential interventions to avert missing opportunities for vaccination. Thus, this study aimed to assess the prevalence and factors associated with missed opportunities for vaccination.
This study used nationally representative demographic and health survey data collected from 2016 to 2023 among 44,149 children aged 12 to 23 months in SSA countries. Stata version 14 statistical package was used. Bi-variable and multivariable logistic regression analyses were done to ascertain factors associated with a missed opportunity for vaccination at a p-value less than 0.05 with adjusted odds ratios (AORs) with a 95% confidence interval.
The overall prevalence of missed opportunity for vaccination (MOV) was 75.46% (95% CI: 75.04, 75.87%). The highest prevalence of MOV occurred in Gambia (93.85%), whereas the lowest was reported in Mauritania (41.59%). Children age: 12 to 15 months (AOR = 1.3, 95%CI:1.22, 1.36) and 16 to 18 months (AOR = 1.1, 95%CI: 1.04, 1.16), maternal age 35 to 49 (AOR = 1.1, 95%CI: 1.02, 1.17), married mother (AOR = 0.85, 95%CI: 0.80, 0.90), education: didn't attend formal education (AOR = 1.13, 95%CI: 1.10, 1.22) and completed primary education (AOR = 1.1, 95%CI: 1.02, 1.16), ANC: never attend (AOR = 0.76, 95%CI:0.71, 0.82) and having four and above ANC visit (AOR = 0.9, 95%CI:0.85, 0.96), health insurance users (AOR = 1.4, 95%CI: 1.25, 1.49), male headed household (AOR = 1.35, 95%CI: 1.27, 1.43), religion: Muslim (AOR = 1.5, 95%CI:1.38, 1.57), Animist (AOR = 1.5, 95%CI:1.31, 1.64), and Catholic followers (AOR = 1.2, 95%CI:1.13, 1.31) and Protestant (AOR = 0.88, 95%CI:0.82, 0.95), home delivery (AOR = 0.79, 95%CI:0.75, 0.84), rural dwellers (AOR = 1.1, 95%CI: 1.04, 1.17), ever had media exposure (AOR = 0.91, 95%CI:0.86, 0.97), big problem to reach health facility (AOR = 1.1, 95%CI: 1.02, 1.14), high community wealth status (AOR = 0.91, 95%CI: 0.83, 0.99), low community level educational status (AOR = 1.2, 95%CI: 1.14, 1.38) and human development index: middle (AOR = 1.4, 95%CI: 1.21, 1.59) were factors associated with MOV.
The overall pooled prevalence of missed opportunities for vaccination in Sub-Saharan remains high. Children's age, maternal age, marital status, education, antenatal care visit, health insurance utilization, sex of household head, religion, place of delivery, residence, media exposure, distance to reach health facility, community wealth status, community educational status, and human development index of the countries were significantly associated with MOV. Policymakers have to encourage technology to promote multimedia exposure to increase community awareness about vaccination, encourage engagement of male partner, and religious leaders in child health. Additionally, potential stakeholders should give great emphasis for accessibility of education and health service for rural and remote areas, and poor segments of population through fostering community health workers and outreach programs, and financial support to increase vaccine coverage by averting missed opportunities for vaccinations. Qualitative research is recommended to explore the facilitators and barriers of missed opportunities for vaccinations among children.
尽管接种疫苗是预防疾病及其不良后果最具成本效益的手段，但错过疫苗接种机会仍是一项严峻的公共卫生挑战。许多撒哈拉以南非洲国家仍未实现《全球疫苗行动计划》认可的目标。确定促成因素有助于政策制定者和规划者设计潜在干预措施，以避免错过疫苗接种机会。因此，本研究旨在评估疫苗接种错过机会的患病率及相关因素。
本研究使用了2016年至2023年期间在撒哈拉以南非洲国家收集的具有全国代表性的人口与健康调查数据，涉及44149名12至23个月大的儿童。使用了Stata 14统计软件包。进行了双变量和多变量逻辑回归分析，以确定与疫苗接种错过机会相关的因素，p值小于0.05，调整后的优势比（AOR）及95%置信区间。
疫苗接种错过机会（MOV）的总体患病率为75.46%（95%CI：75.04，75.87%）。MOV患病率最高的是冈比亚（93.85%），而最低的是毛里塔尼亚（41.59%）。儿童年龄：12至15个月（AOR = 1.3，95%CI：1.22，1.36）和16至18个月（AOR = 1.1，95%CI：1.04，1.16），母亲年龄35至49岁（AOR = 1.1，95%CI：1.02，1.17），已婚母亲（AOR = 0.85，95%CI：0.80，0.90），教育程度：未接受正规教育（AOR = 1.13，95%CI：1.10，1.22）和完成小学教育（AOR = 1.1，95%CI：1.02，1.16），产前检查：从未进行（AOR = 0.76，95%CI：0.71，0.82）和进行四次及以上产前检查（AOR = 0.9，95%CI：0.85，0.96），医疗保险使用者（AOR = 1.4，95%CI：1.25，1.49），男性户主家庭（AOR = 1.35，95%CI：1.27，1.43），宗教：穆斯林（AOR = 1.5，95%CI：1.38，1.57），万物有灵论者（AOR = 1.5，95%CI：1.31，1.64），天主教信徒（AOR = 1.2，95%CI：1.13，1.31）和新教（AOR = 0.88，95%CI：0.82，0.95），在家分娩（AOR = 0.79，95%CI：0.75，0.84），农村居民（AOR = 1.1，95%CI：1.04，1.17），曾接触媒体（AOR = 0.91，95%CI：0.86，0.97），前往医疗机构存在大问题（AOR = 1.1，95%CI：1.02，1.14），社区财富状况高（AOR = 0.91，95%CI：0.83，0.99），社区教育水平低（AOR = 1.2，95%CI：1.14，1.38）以及人类发展指数：中等（AOR = 1.4，95%CI：1.21，1.59）是与MOV相关的因素。
撒哈拉以南地区疫苗接种错过机会的总体合并患病率仍然很高。儿童年龄、母亲年龄、婚姻状况、教育程度、产前检查次数、医疗保险使用情况、户主性别、宗教、分娩地点、居住地址、媒体接触情况、前往医疗机构的距离、社区财富状况、社区教育状况以及国家的人类发展指数与MOV显著相关。政策制定者必须鼓励利用技术促进多媒体曝光，以提高社区对疫苗接种的认识，鼓励男性伴侣和宗教领袖参与儿童健康事务。此外，潜在利益相关者应高度重视通过培养社区卫生工作者和推广项目，以及提供财政支持，以增加农村和偏远地区及贫困人口的教育和卫生服务可及性，从而通过避免错过疫苗接种机会来提高疫苗接种覆盖率。建议进行定性研究，以探索儿童疫苗接种错过机会的促进因素和障碍。
