Dadanova Gulzada, Horth Roberta, Kubatova Aisuluu, Ishenapysova Gulbara, Otorbaeva Dinagul, Nabirova Dilyara
Central Asia Advanced Field Epidemiology Training Program, Almaty, Kazakhstan.
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
BMJ Public Health. 2025 Sep 8;3(2):e002652. doi: 10.1136/bmjph-2025-002652. eCollection 2025.
High vaccination coverage is critical for preventing disease transmission. In Bishkek (population: 1.15 million), childhood vaccination coverage was <90% in 2022. Understanding missed opportunities for vaccination (MOV) at healthcare visits was needed to increase coverage.
Using the World Health Organization MOV assessment guide, we selected 33 primary care clinics in Bishkek. We conducted sequential exit interviews with caregivers of children aged <30 months who received healthcare for any reason. Caregiver's attitude towards vaccines was measured by asking if it was good, neutral or negative. We extracted vaccine records from the facility's medical records. MOV was calculated as the proportion of children who were not up to date on all their vaccines by the end of the visit, among those eligible for at least one vaccine at the start of the visit. We used multivariable Poisson regression to assess characteristics associated with MOV.
Of 650 participating children, 448 (69%) were eligible for vaccination. Among whom, 86% had a MOV after their visit and 6% had never been vaccinated. MOV prevalence was 81% for children aged 0-11 months (n=240) and 92% for those aged 12-30 months (n=208), ranging from 79% to 93% across the four districts. Providers did not check the immunisation status of 53% of children. Among 133 children whose primary visit purpose was vaccination, 53% were still not up to date on all their vaccines by the end of the visit. MOV risk was higher among children whose vaccination status was not checked by the provider compared with those who were checked (adjusted prevalence ratio (aPR) 1.13, 95% CI 1.05 to 1.22) and children whose caregivers had negative (aPR 1.10, 95% CI 1.03 to 1.18) or neutral attitudes (aPR 1.11, 95% CI 1.03 to 1.19) vs positive attitudes.
Nearly nine in 10 children missed a vaccination opportunity during their healthcare visit. Strategies for checking immunisation status at each visit and addressing caregiver and healthcare barriers may help increase immunisation coverage.
高疫苗接种覆盖率对于预防疾病传播至关重要。在比什凯克（人口：115万），2022年儿童疫苗接种覆盖率低于90%。为了提高覆盖率，需要了解在医疗就诊时错过的疫苗接种机会（MOV）。
我们依据世界卫生组织的MOV评估指南，在比什凯克选取了33家初级保健诊所。我们对因任何原因接受医疗服务的30个月以下儿童的看护人进行了连续的离场访谈。通过询问看护人对疫苗的态度是积极、中立还是消极来衡量其态度。我们从医疗机构的病历中提取疫苗接种记录。MOV的计算方法是，在就诊开始时符合至少一种疫苗接种条件的儿童中，到就诊结束时未完成所有疫苗接种的儿童所占的比例。我们使用多变量泊松回归来评估与MOV相关的特征。
在650名参与研究的儿童中，448名（69%）符合疫苗接种条件。其中，86%的儿童在就诊后存在MOV，6%的儿童从未接种过疫苗。0至11个月大的儿童（n = 240）的MOV患病率为81%，12至30个月大的儿童（n = 208）的MOV患病率为92%，四个区的患病率在79%至93%之间。医护人员未检查53%儿童的免疫接种状况。在133名主要就诊目的是接种疫苗的儿童中，53%的儿童在就诊结束时仍未完成所有疫苗接种。与接种状况被检查的儿童相比，接种状况未被医护人员检查的儿童的MOV风险更高（调整患病率比（aPR）为1.13，95%置信区间为1.05至1.22），看护人态度消极（aPR为1.10，95%置信区间为1.03至1.18）或中立（aPR为1.11，95%置信区间为1.03至1.19）的儿童与态度积极的儿童相比，MOV风险也更高。
近十分之九的儿童在医疗就诊期间错过了疫苗接种机会。每次就诊时检查免疫接种状况以及解决看护人和医疗保健方面障碍的策略可能有助于提高免疫接种覆盖率。
