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Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study

BACKGROUND: Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system ba...

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Autores principales: Tang, Xian-Yan, Cheng, Man, Geater, Alan, Deng, Qiu-Yun, Zhong, Ge, Lin, Yue-Dong, Chen, Ning, Lan, Tao, Jiang, Long-Yan, Zhu, Man-Tong, Li, Qiao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296749/
https://www.ncbi.nlm.nih.gov/pubmed/34294157
http://dx.doi.org/10.1186/s40249-021-00885-6
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author Tang, Xian-Yan
Cheng, Man
Geater, Alan
Deng, Qiu-Yun
Zhong, Ge
Lin, Yue-Dong
Chen, Ning
Lan, Tao
Jiang, Long-Yan
Zhu, Man-Tong
Li, Qiao
author_facet Tang, Xian-Yan
Cheng, Man
Geater, Alan
Deng, Qiu-Yun
Zhong, Ge
Lin, Yue-Dong
Chen, Ning
Lan, Tao
Jiang, Long-Yan
Zhu, Man-Tong
Li, Qiao
author_sort Tang, Xian-Yan
collection PubMed
description BACKGROUND: Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. METHODS: A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18–54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. RESULTS: A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28–4.58; MCV2, OR = 1.42–3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). CONCLUSIONS: Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40249-021-00885-6.
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spelling pubmed-82967492021-07-22 Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study Tang, Xian-Yan Cheng, Man Geater, Alan Deng, Qiu-Yun Zhong, Ge Lin, Yue-Dong Chen, Ning Lan, Tao Jiang, Long-Yan Zhu, Man-Tong Li, Qiao Infect Dis Poverty Research Article BACKGROUND: Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. METHODS: A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18–54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. RESULTS: A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28–4.58; MCV2, OR = 1.42–3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). CONCLUSIONS: Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40249-021-00885-6. BioMed Central 2021-07-22 /pmc/articles/PMC8296749/ /pubmed/34294157 http://dx.doi.org/10.1186/s40249-021-00885-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Tang, Xian-Yan
Cheng, Man
Geater, Alan
Deng, Qiu-Yun
Zhong, Ge
Lin, Yue-Dong
Chen, Ning
Lan, Tao
Jiang, Long-Yan
Zhu, Man-Tong
Li, Qiao
Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study
title Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study
title_full Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study
title_fullStr Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study
title_full_unstemmed Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study
title_short Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study
title_sort multi-level determinants of failure to receive timely and complete measles vaccinations in southwest china: a mixed methods study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296749/
https://www.ncbi.nlm.nih.gov/pubmed/34294157
http://dx.doi.org/10.1186/s40249-021-00885-6
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