Ngo-Bebe Dosithée, Mechael Patricia, Kwilu Fulbert Nappa, Bukele Théophane Kekemb, Langwana Félicité, Lobukulu Genèse Lolimo, Kalonji Marcelo Ilunga, Kalalizi Bahindwa, Tschirhart Kevin, Luhata Christophe Lungayo, Gachen Carine
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
health.enabled, 3147 Tennyson St NW, Washington, DC, 20015, USA.
BMC Public Health. 2025 Jan 24;25(1):311. doi: 10.1186/s12889-025-21578-x.
The National Expanded Program on Immunization in the Democratic Republic of the Congo implemented a program in 9 Provinces to generate georeferenced immunization microplans to strengthen the planning and implementation of vaccination services. The intervention aimed to improve identification and immunization of zero-dose children and overall immunization coverage.
This study applies a mixed-methods design including survey tools, in-depth interviews and direct observation to document the uptake, use, and acceptance of the immunization microplans developed with geospatial data in two intervention provinces and one control province from February to June 2023. A total of 113 health facilities in 98 Health Areas in 15 Health Zones in the three provinces were included in the study sample. Select providers received training on gender-intentional approaches for the collection and use of geospatial data which was evaluated through a targeted qualitative study. A secondary analysis of immunization coverage survey data (2020-2022) was conducted to assess the associated effects on immunization coverage, especially changes in rates of zero dose children, defined as those aged 12-23 months who have not received a single dose of Pentavalent vaccine.
This research study shows that georeferenced microplans are well received, utilized, and led to changes in routine immunization service planning and delivery. In addition, the gender intervention is perceived to have led to changes in the approaches taken to overcome sociocultural gender norms and engage communities to reach as many children as possible, leveraging the ability of women to engage more effectively to support vaccination services. The quantitative analyses showed that georeferenced microplans may have contributed to a dramatic and sustained trend of high immunization coverage in the intervention site of Haut-Lomami, which saw dramatic improvement in coverage for 3 antigens and little change in Pentavalent drop-out rate over three years of implementation.
The overall study identified positive contributions of the georeferenced data in the planning and delivery of routine immunization services. It is recommended to conduct further analyses in Kasai in 2024 and 2025 to evaluate the longer-term effects of the gender intervention on immunization coverage and equity outcomes.
The study was registered and given BMC Central International Standard. Randomised Controlled Trial Number ISRCTN65876428 on March 11, 2021.
刚果民主共和国的国家扩大免疫规划于2023年2月至6月在9个省份实施了一项计划，以生成地理参考免疫微观计划，加强疫苗接种服务的规划和实施。该干预措施旨在改善零剂次儿童的识别和免疫接种情况以及总体免疫覆盖率。
本研究采用混合方法设计，包括调查工具、深入访谈和直接观察，以记录2023年2月至6月在两个干预省份和一个对照省份使用地理空间数据制定的免疫微观计划的采用、使用和接受情况。三个省份15个卫生区98个卫生区域的113个卫生设施被纳入研究样本。选定的提供者接受了关于收集和使用地理空间数据的性别针对性方法的培训，并通过有针对性的定性研究进行评估。对免疫覆盖率调查数据（2020 - 2022年）进行了二次分析，以评估其对免疫覆盖率的相关影响，特别是零剂次儿童（定义为12 - 23个月龄且未接种过一剂五价疫苗的儿童）比例的变化。
本研究表明，地理参考微观计划受到好评、得到利用，并导致了常规免疫服务规划和提供方式的改变。此外，性别干预被认为导致了在克服社会文化性别规范以及促使社区尽可能多地覆盖儿童方面所采取方法的改变，利用了女性更有效地参与支持疫苗接种服务的能力。定量分析表明，地理参考微观计划可能促成了上洛马米干预地区免疫覆盖率持续大幅上升的趋势，在三年实施期间，该地区三种抗原的覆盖率有显著提高，五价疫苗的退出率变化不大。
总体研究确定了地理参考数据在常规免疫服务规划和提供方面的积极贡献。建议在2024年和2025年对开赛省进行进一步分析，以评估性别干预对免疫覆盖率和公平结果的长期影响。
该研究已注册并获得BMC Central国际标准。随机对照试验编号ISRCTN65876428，于2021年3月11日注册。
