Peer-reviewed article
Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces
Yaguan Zhou, Duanhui Li, Yuan Cao, Fenhua Lai, Yu Wang et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compared immunization coverage for non-national program vaccines (like Hib, varicella, and pneumococcal vaccines) among children aged 1-6 years across four family types in China: local urban, migrant, non-left-behind rural, and left-behind rural families. Children in local urban families had the highest vaccination coverage, while left-behind rural children had the lowest, receiving vaccines at only 14% the rate of local urban children. The research identified that caregiver knowledge, satisfaction with vaccination schedules, and characteristics like caregiver age and sex were strongly associated with non-national program vaccination rates.
Key points
- Immunization coverage for all non-NIP vaccines was highest among local urban children and lowest among left-behind rural children (14% of local urban rates)
- Migrant children had 65% the vaccination coverage of local urban children; non-left-behind rural children had 29%
- Caregiver knowledge about vaccines was a key factor, with good knowledge associated with vaccination for some groups but inversely for others
- Caregiver satisfaction with vaccination schedules emerged as a core factor connecting coverage, knowledge, and satisfaction
- Child age over 2 years was consistently associated with higher non-NIP vaccination across all family types
Limitations
This cross-sectional study cannot establish causation, only associations. The findings are specific to two provinces and may not represent all of China; the study also relies on caregiver recall and self-report of vaccination status.
Abstract
BACKGROUND: Migrant and left-behind families are vulnerable in health services utilization, but little is known about their disparities in immunization of non-National Immunization Program (NIP) vaccines. This study aims to evaluate the immunization coverage, knowledge, satisfaction, and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China. METHODS: A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China. A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire, and their families were grouped into four types: local urban, migrant, non-left-behind, and left-behind. Non-NIP vaccines included Hemophilus influenza b (Hib) vaccine, varicella vaccine, rotavirus vaccine, enterovirus 71 vaccine (EV71) and 13-valent pneumonia vaccine (PCV13). Log-binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the difference on immunization coverage of children, and knowledge and satisfaction of caregivers among families. The network models were conducted to explore the interplay of immunization coverage, knowledge, and satisfaction. Logistic regression models with odds ratios (ORs) and 95% CIs were used to estimate the associated factors of non-NIP vaccination. RESULTS: The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest, followed by migrant, non-left-behind and left-behind families. Compared with local urban children, the PRs (95% CIs) for getting all vaccinated were 0.65 (0.52-0.81), 0.29 (0.22-0.37) and 0.14 (0.09-0.21) among migrant children, non-left-behind children and left-behind children, respectively. The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule. Non-NIP vaccination was associated with characteristics of both children and caregivers, including age of children (> 2 years-OR: 1.69, 95% CI: 1.07-2.68 for local urban children; 2.67, 1.39-5.13 for migrant children; 3.09, 1.23-7.76 for non-left-behind children); and below caregivers' characteristics: family role (parents: 0.37, 0.14-0.99 for non-left-behind children), age (≤ 35 years: 7.27, 1.39-37.94 for non-left-behind children), sex (female: 0.49, 0.30-0.81 for local urban children; 0.31, 0.15-0.62 for non-left-behind children), physical health (more than average: 1.58, 1.07-2.35 for local urban children) and non-NIP vaccines knowledge (good: 0.45, 0.30-0.68 for local urban children; 7.54, 2.64-21.50 for left-behind children). CONCLUSIONS: There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts. Non-NIP vaccination promotion strategies, including education on caregivers, and optimization of the immunization information system, should be delivered particularly among left-behind and migrant families.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Descriptive analysis of immunization coverage, caregiver knowledge, and satisfaction with non-NIP vaccines across family types; identification of associated factors to inform future promotion strategies
- Population
- 1,648 caregivers of children aged 1-6 years in urban Zhejiang and rural Henan provinces, stratified into local urban, migrant, non-left-behind, and left-behind family types
Key finding
Local urban children had highest non-NIP vaccine coverage; left-behind children had 14% (95% CI: 0.09-0.21) of local urban coverage