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Project Information Document-Integrated Safeguards Data Sheet - RMI Multisectoral Early Childhood Development Project - P166800
Marshall Islands
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Marshall Islands
This paper evaluates and compares two randomized interventions in Tonga, one targeting the home environment of children up to age 5 and one targeting the school environment for first and second grade students. The first intervention supports communities to set up and run playgroups that aim to improve caregiver-child interaction at home and ultimately improve children's readiness for school. Among children of mothers without high school education, being in a treatment community positively affects the school readiness literacy domains and overall score by 0.19 and 0.2 standard deviation, respectively, for girls and the literacy domains for boys by 0.17 standard deviation. The second intervention provides teachers with training, materials, and coaching to improve reading instruction practices and students’ reading ability. It increased average early grade reading scores by approximately 0.18 standard deviation per year of exposure. Two cohorts of children were potentially exposed to both interventions, providing an opportunity to compare, for the same population of children, the effects of an early childhood intervention with a school-based intervention using a common measure of learning achievement. The school readiness intervention is found to have positive effects on early grade reading scores only among children in the reading intervention’s control group; effect sizes of approximately 0.29 standard deviation were found at the end of second grade for children exposed to one year of the school readiness intervention and at the end of first grade for girls exposed to two years of the intervention. (Tonga)
The development objective of the Climate Resilient Transport Project for Samoa is to improve the climate resilience of Samoa’s road network and improve Government’s ability to respond to an Eligible Crisis.Some of the negative impacts are include : (i) high environmental risk; (ii) may create impacts that require more sophisticated planning and preparation of mitigation measures; (iii) have technical complexities and requirements that would go beyond the capacity normally available in-country; (iv) would trigger additional safeguards policies or change the project’s safeguards category; and (v) are not aligned with public interests or do not benefit common goods or public services; Some of the mitigation measures are include : (i) soil excavation and other earth-moving works to widen existing roads, protect and stabilize vulnerable slopes, improve existing or construct new drainage and replace at least two existing river crossings in Upolu and Savaii; (ii) extreme weather events such as cyclones, strong winds, storm surges, king tides, and heavy rainfall, associated with climate change are now being experienced with increasing regularity and intensity; (iii) utility services have traditionally occupied the road reserve as a convenient corridor, with a number of services already located underground and alongside the existing roads; (iv) reduced air quality as a result of dust released from site works, vehicle fumes and smoke from burning wastes; (v) contractor offices in laydown areas and workers camps also attract men and women from surrounding communities looking for employment, as well as local vendors and sellers (including children) of fresh produce, cook food etc.; (vi) occupational health and safety is a concern for employers and especially workers who will be directly exposed during construction to hazards such as noise, fumes and vibration from moving equipment and vehicles, heavy lifting and others. (Samoa)
BACKGROUND: Aboriginal and Torres Strait Islander peoples experience a greater burden of cervical cancer than other Australians. Vaccination can prevent diseases caused by human papillomavirus (HPV), but uptake remains inequitable. We aimed to understand barriers and enablers influencing the participation of Queensland Aboriginalmed and Torres Strait Islander adolescents in the school-based HPV vaccination program. METHODS: Using an Indigenist research approach and guided by a socio-ecological model for health promotion, Aboriginal and Torres Strait Islander voices were centred in this project. In 2020-2021 we conducted Yarns (a culturally appropriate qualitative method) with 65 Aboriginal and Torres Strait Islander adolescents and 20 parents from 10 diverse Queensland schools. Yarns addressed understandings of HPV and HPV vaccination, information and resources, vaccine consent, experience of vaccination, and suggestions for improvement. Thematic analysis using a codebook approach was conducted. RESULTS: The first major theme related to factors leading up to the vaccination clinic. Despite varying levels of knowledge and understanding of HPV and HPV vaccination, most adolescents and parents supported the idea of vaccinations to prevent diseases and benefit their health. Adolescents and parents reported difficulties completing and returning the consent form and wanted more accessible information and improved communication about the vaccine, delivered in culturally appropriate ways. The second major theme related to factors on the day of the vaccination clinic. Adolescents reported a need for privacy during vaccination, ways to manage heightened emotions triggered by the vaccination clinic, and the presence of trusted support people. Findings were contextualised within the COVID-19 pandemic and vaccination rollout, with the pandemic causing disruptions to the school program and the HPV vaccine perceived as more trustworthy than the then-new COVID-19 vaccines. CONCLUSIONS: We provide several recommendations to support Aboriginal and Torres Strait Islander adolescents to be vaccinated against HPV, such as flexible consent processes with assistance from Aboriginal and Torres Strait Islander support staff; availability of culturally safe educational materials for adolescents, parents and school staff; the presence of Aboriginal and Torres Strait Islander support staff at clinics, and adherence to optimal clinic set up and scheduling to improve adolescents' experience of vaccination. These recommendations can guide programmatic changes and interventions to increase HPV vaccination rates among Aboriginal and Torres Strait Islander adolescents, thereby advancing equity in cervical cancer outcomes.
Tamara Butler, Kate Anderson, Ami Morseu-Diop et al.
We analysed Australian Immunisation Register (AIR) data as at 3 April 2022 for children, adolescents and adults for the calendar year 2021, with data on trends from previous years also presented. Children: ‘Fully vaccinated’ coverage in Australian children in 2021 was 0.6–0.8 of a percentage point lower than in 2020 at the 12-month (94.2%) and 60-month (94.0%) age assessment milestones, but stable at the 24-month milestone (92.1%). Due to the lag time involved in assessment at milestone ages, ‘fully vaccinated’ coverage figures for 2020 and 2021 predominantly reflect vaccinations due in 2019 and 2020, respectively, and hence show a small impact on childhood coverage in the first year of the coronavirus disease 2019 (COVID-19) pandemic. ‘Fully vaccinated’ coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children was 0.7–1.5 percentage points lower in 2021 than 2020 at the 12-month (91.6%), 24-month (90.1%) and 60-month (96.3%) milestones, although 2.3 percentage points higher than children overall at 60 months. Influenza vaccination coverage in children aged 6–59 months was approximately 20 percentage points lower in 2021 than 2020, both for children overall (26.5%) and for Indigenous children (22.5%). ‘On time’ vaccination (within 30 days of the recommended age) was up to two percentage points lower in 2021 than 2020 for vaccines due at 4 and 6 months of age, suggesting possible pandemic impacts, but was similar or higher for vaccines due at 12 months of age. While on-time vaccination in Indigenous children has improved progressively since 2012, it remained 6–13 percentage points lower than in children overall in 2021. ‘Fully vaccinated’ coverage at the earlier milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months was 1.5–2.8 percentage points lower for children living in the least advantaged residential area quintile than the most advantaged, a similar disparity as in 2020. Coverage at the earlier milestones was 2.3–10.0 percentage points lower for Indigenous children living in remote areas than in major cities and regional areas, with disparity at 21 months of age 2.1–2.2 percentage points higher in 2021 than in 2020, and 1.2–2.1 percentage points higher at 51 months. Adolescents: In 2021, a total of 80.3% of girls and 77.2% of boys (and 73.3% and 66.2% of Indigenous girls and boys) had completed the human papillomavirus (HPV) vaccination schedule by 15 years of age, 0.2–0.4 of a percentage point lower than 2020 (1.7–1.8 percentage points for Indigenous), reflecting vaccinations due in school programs prior to the pandemic with possible pandemic impact on catch-up vaccination. However, the proportion of adolescents completing the two-dose HPV vaccination schedule within a calendar year was 15.3 percentage points lower in 2021 than 2020 and 26.9 percentage points lower than in 2019, likely due to pandemic-related disruption to school-based programs. Additionally, 87.3% of adolescents (83.8% for Indigenous) had received the recommended booster dose of diphtheria-tetanus-acellular pertussis (dTpa) vaccine by 15 years, and 76.1% (66.7% for Indigenous) the recommended meningococcal ACWY vaccine dose by 17 years of age. Adults: Zoster vaccine coverage in 2021 remained relatively low, at just over 30%, in adults aged 70 years, but increased to 47% in those aged 71–79 years, reflecting ongoing catch-up vaccination. Coverage of 13vPCV was low in 2021, reaching 17.2% in adults aged 70 years and 20.1% in those aged 71–79 years. Influenza vaccination coverage in adults in 2021 was progressively higher with increasing age, reaching 62.1% in the 65–74 years age group (64.6% in Indigenous) and 68.5% in the 75+ years age group (67.7% in Indigenous). Influenza vaccine coverage for other National Immunisation Program (NIP)-eligible Indigenous adult age groups was only 22.0% for those aged 20–49 years, and 43.5% for those aged 50–64 years. By the end of 2021, a total of 91.6% of people in Australia aged 16+ years had received a second dose of a COVID-19 vaccine (71.8% for Indigenous), with over 99% of those aged 70+ years having received a second dose. Conclusions: Vaccination coverage in children and adolescents remained relatively high in 2021, although with some evidence of COVID-19 pandemic impacts, particularly on receipt of two doses of HPV vaccine within the same calendar year. It will be important to ensure catch-up vaccination in children and adolescents occurs. A strengthened focus on adult vaccination is needed, as coverage remained suboptimal in 2021. The impact of mandatory reporting of all NIP vaccinations from mid-2021, on completeness of AIR data, has not yet been formally evaluated.
Brynley Hull, Alexandra Hendry, Aditi Dey et al.
This 9th annual immunisation coverage report shows data for 2015 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus (HPV) Vaccination Program Register. This report includes coverage data for ‘fully immunised’ and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, ‘fully immunised’ coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, coverage reached its highest ever level of 93% during 2015. As in previous years, coverage for ‘fully immunised’ at 12 and 24 months of age among Indigenous children was 3.4% and 3.3% lower than for non-Indigenous children overall, respectively. In 2015, 77.8% of Australian females aged 15 years had 3 documented doses of HPV vaccine (jurisdictional range 68.0–85.6%), and 86.2% had at least one dose, compared to 73.4% and 82.7%, respectively, in 2014. The differential of on-time vaccination between Indigenous and non-Indigenous children in 2015 diminished progressively from 18.4% for vaccines due at 12 months to 15.7% for those due at 24 months of age. In 2015, the proportion of children whose parents had registered an objection to vaccination was 1.2% at the national level, with large regional variations. This was a marked decrease from 1.8% in 2014 and the lowest rate of registered vaccination objection nationally since 2007 when it was 1.1%. Medical contraindication exemptions for Australia were more than double in 2015 compared with the previous year (635 to 1,401).
Brynley Hull, Alexandra Hendry, Aditi Dey et al.
Australian Immunisation Register data have been analysed for children aged < 5 years, focusing on changes in coverage at key milestone ages (12, 24 and 60 months) between 2017 and 2018, while also documenting longer term trends. Fully vaccinated coverage increased at the 12- and 60-months milestones to 93.9% and 94.0%, respectively, but, in the context of additional antigens required, decreased to 90.1% at 24 months. Following the move to a two-dose rotavirus vaccine schedule across Australia from mid-2017, rotavirus vaccine coverage increased from 86.8% to 90.9%. In 2018, most jurisdictions funded influenza vaccine for non-Indigenous children aged 6 months to < 5 years; the National Immunisation Program has funded influenza vaccine for Aboriginal and Torres Strait Islander children and medically at-risk children since 2015 and 2010, respectively. Recorded influenza vaccine coverage in Aboriginal and Torres Strait Islander children doubled from 14.9% to 31.4%, and increased fivefold in non-Indigenous children from 5.0% to 25.9% in 2018. The timeliness of fully vaccinated coverage was also examined at earlier milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by area of residence. For all children, coverage among those living in the least advantaged residential area quintile was 3–4% lower than that for those in the most advantaged quintile at the 9-, 15- and 21-month milestones. Importantly, although Aboriginal and Torres Strait Islander children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (91.8% versus 93.1% for non-Indigenous), coverage increased to 98.5% at 60 months; coverage was also high in non-Indigenous children at 96.2%, above the 95% target critical to measles control. These data demonstrate continuing improvements in immunisation coverage and suggest potential new coverage targets for earlier protection in the first two years of life.
Brynley Hull, Alexandra Hendry, Aditi Dey et al.
Australian Immunisation Register data have been analysed for children aged < 5 years, focusing on changes in vaccination coverage at standard age milestones (12, 24 and 60 months) between 2018 and 2019. ‘Fully vaccinated’ coverage in 2019 increased by 0.1–0.4% at the three age milestones to 94.3% at 12 months, 90.2% at 24 months (in the context of additional antigens required at 24 months) and 94.2% at 60 months. Rotavirus vaccine coverage (2 doses) increased from 90.9% in 2018 to 91.9% in 2019. ‘Fully vaccinated’ coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children increased by 0.5–1.1% in 2019, reaching 92.9% at 12 months, 88.9% at 24 months and 96.9% at the 60 months (2.7 percentage points higher than in children overall). Recorded influenza vaccination coverage in children aged 6 months to < 5 years increased by 11.4 percentage points to 42.7% in Indigenous children in 2019, and by 15.6 percentage points to 41.8% in children overall. Longstanding issues with timeliness of vaccination in Indigenous children persisted, although the disparity between Indigenous and non-Indigenous children in on-time coverage (within 30 days of due date), for vaccines due at 4 months of age, decreased from 10.4–10.7 to 9.6–9.8 percentage points between 2018 and 2019. The timeliness of ‘fully vaccinated’ coverage was also examined at earlier age milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by Indigenous status, socioeconomic status and remoteness of area of residence. Coverage in children living in the least-advantaged residential area quintile was 2.6–2.7% lower than that for those living in the most-advantaged quintile at the 9-, 15- and 21-month milestones, although these disparities were 0.5–1.5 percentage points lower than in 2018. Coverage at the earlier milestones in Indigenous children in remote areas was 1.5–6.7% percentage points lower than that for Indigenous children in major cities and regional areas, although there were some improvements since 2018. Importantly, although Indigenous children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (92.7% versus 93.3% overall), coverage increased to 98.8% at 60 months; coverage was also high overall at 96.4%, above the 95% target critical to measles control. In conclusion, this report demonstrates continuing improvements across a range of immunisation indicators in Australia in 2019. However, some issues with timeliness persist, particularly in Indigenous and socioeconomically disadvantaged children. New coverage targets for earlier protection in the first 2 years of life may be indicated, along with a review of current ‘fully vaccinated’ assessment algorithms, particularly at the 60-month age milestone.
Brynley Hull, Alexandra Hendry, Aditi Dey et al.
We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program (NIP) funded vaccines, as at 4 February 2024 for children, adolescents and adults, focusing on the calendar year 2023 and trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. ChildrenFully vaccinated coverage in Australian children in 2023 was lower than in 2022 at the 12-month (92.8%, down from 93.3%), 24-month (90.8%, down from 91.0%) and 60-month (93.3%, down from 93.4%) age assessment milestones. This follows the 1.1–1.5 percentage point decrease at these three milestones between the 2020 and 2022 reports, which came after eight years of generally increasing coverage. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was also slightly lower in 2023 than in 2022 at the 12-month (89.7%, down from 90.0%), 24-month (87.8%, down from 87.9%) and 60-month (95.0%, down from 95.1%) milestones, following a 1.9–3.3 percentage point decrease between the 2020 and 2022 reports. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2023 predominantly reflect vaccinations due in 2022, when COVID-19 pandemic-related restrictions had largely been removed. Factors contributing to this ongoing decline in coverage in children include a combination of acceptance and access issues. AdolescentsAmong adolescents turning 15 years in 2023, 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 1.1 and 1.3 percentage points lower than in 2022, respectively (2.1–3.1 percentage points lower for Indigenous adolescents). Coverage of an adolescent dose of meningococcal ACWY vaccine in adolescents turning 17 years in 2023 was 72.8% overall and 62.3% in Indigenous adolescents, 3.1 and 3.3 percentage points lower than in 2022, respectively. These decreases reflect impacts of the pandemic on school-based programs in 2020–2021. To provide an early insight into any immediate impacts on coverage of moving to the NIP single-dose HPV vaccine schedule in 2023 (offered in Year 7 in all jurisdictions), we calculated coverage of at least one dose of HPV vaccine by 31 December in adolescents turning 13 years, with South Australia excluded due to change of delivery from Year 8 in 2022, and found it to be around 3 percentage points lower in 2023 than 2022, and 6 percentage points lower in Indigenous girls, with patterns of diphtheria-tetanus-pertussis vaccination (also single-dose at this age) and HPV vaccination coverage broadly similar. This decrease in vaccinations due in school programs after pandemic restrictions had been removed could be due to impacts of the single-dose HPV transition (i.e. if fewer opportunities for vaccination are provided due to fewer school visits) or may be due to other factors that have changed or disrupted previous school immunisation program operations or reduced parental confidence in vaccination. It is important to promote catch-up vaccination and to monitor renewed efforts to ensure equitable coverage is achieved, particularly given HPV vaccine coverage by 15 years of age in 2023 was 4–8 percentage points lower in adolescents residing in socio-economically disadvantaged and remote areas. AdultsZoster vaccination coverage in adults turning 71 years was 41.0% overall in 2023, down from 41.3% in 2022, and 36.1% in Indigenous adults, down from 36.5%. However, the availability of the new (non-live) protein-based herpes zoster vaccine (Shingrix) from 1 November 2023 has resulted in increased uptake for the larger eligible cohort. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) in adults turning 71 years was 37.6% in 2023, up from 33.8% in 2022, and 43.0% in Indigenous adults, up from 37.7%. Coverage of 13vPCV was lower among Indigenous adults turning 50–59 years (17.5%) and 60–69 years (23.4%) in 2023, despite this vaccine being funded under the NIP. Influenza vaccination coverage decreased across all adult age groups in 2023, both overall and in Indigenous adults, with decreases ranging from 5–11 percentage points. ConclusionsThere have continued to be modest but concerning declines in vaccination coverage in children and adolescents relative to pre-pandemic peaks, with decreases greater in Indigenous children and adolescents. Evidence suggests that the factors contributing to these ongoing declines are complex and variable but include both vaccine acceptance and access issues. The picture for adult coverage is more mixed, with coverage increasing for 13vPCV, stable for zoster and decreasing for influenza vaccination, though consistently suboptimal across all vaccines. Ongoing monitoring of vaccination coverage, and further exploration of the reasons underpinning these decreases and suboptimal coverage, are needed to inform approaches to address barriers effectively and to increase vaccine uptake and equity of coverage.
Brynley Hull, Alexandra Hendry, Kristine Macartney et al.
We analysed Australian Immunisation Register (AIR) data for children, adolescents and adults as at 2 February 2025, concentrating primarily on National Immunisation Program (NIP)–funded vaccines. Our focus was on the calendar year 2024 and trends from previous years. This report provides comprehensive analyses and interpretation of vaccination coverage data to inform immunisation policy and programs in Australia. Along with the results outlined below, the report also includes a range of other data for vaccines given across the lifespan, including data on timeliness and vaccination provider settings. Population overall Children Fully vaccinated coverage decreased between 2023 and 2024 at all three standard age milestones: 12 months (from 92.8% to 91.6%); 24 months (from 90.8% to 89.4%); and 60 months (from 93.3% to 92.7%). This follows the 1.2–2.0 percentage point decrease in vaccination coverage uptake at these three milestones between the 2020 and 2023 reports. A combination of acceptance and access factors have contributed to this ongoing decline. Adolescents Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 to 81.1% in girls and 77.9% boys; these values were 3.1 and 3.9 percentage points lower, respectively, than in 2023 and 5.5 and 7.0 percentage points lower than in 2020. In girls and boys turning 15 years of age in 2024, respectively 83.4% and 80.9% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Overall, 68.5% of girls and 64.4% of boys turning 16 years of age in 2024 had received an adolescent dose of meningococcal ACWY vaccine by 31 December 2024. Adults Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 45.9% for adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 38.6% for adults turning 71 years of age in 2024, which was 1.0 percentage point higher than in 2023; and 41.5% for adults aged ≥ 70 years, which was 6.9 percentage points higher than in 2023. Influenza vaccination coverage decreased in 2024 across all adult age groups. Aboriginal and Torres Strait Islander peoples Children Fully vaccinated coverage for Aboriginal and Torres Strait Islander children decreased between 2023 and 2024 at all three age milestones: 12 months (from 89.7% to 89.2%), 24 months (from 87.8% to 86.7%) and 60 months (from 95.0% to 94.4%), following a 2.0–3.4 percentage point decrease between the 2020 and 2023 reports. However, coverage of meningococcal B vaccine, which was introduced onto the NIP for all Aboriginal and Torres Strait Islander children in July 2020, was higher in 2024 than 2023: namely, 83.0% versus 81.0% for the first dose; 80.9% versus 80.0% for the second dose; and 75.0% versus 71.7% for the third dose. Adolescents Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 in Aboriginal and Torres Strait Islander adolescents to 76.7% for girls and 69.2% for boys; these values were 4.2 and 5.8 percentage points lower, respectively, than in 2023 and 11.1 and 13.8 percentage points lower than in 2020. In Aboriginal and Torres Strait Islander girls and boys turning 15 years of age in 2024, respectively 79.3% and 73.0% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Coverage of an adolescent dose of meningococcal ACWY vaccine received by 31 December 2024 in Aboriginal and Torres Strait Islander adolescents turning 16 years of age in 2024 was 52.7% for girls and 47.1% for boys. Adults Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 42.2% for Aboriginal and Torres Strait Islander adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 48.7% for Aboriginal and Torres Strait Islander adults turning 71 years of age in 2024, which was 5.7 percentage points higher than in 2023, and 47.8% for those aged ≥ 70 years, which was 8.1 percentage points higher than in 2023. However, it was only 23.2% for those aged 50–69 years. Influenza vaccination coverage decreased in 2024 across all Aboriginal and Torres Strait Islander adult age groups. Conclusions There have been concerning and persistent downward trends in childhood and adolescent vaccination coverage in Australia since 2020, with further declines in 2024. The picture for adult coverage is more mixed, but consistently suboptimal across all vaccines. National surveys of parents of young children and adults have identified a range of access and acceptance barriers that may be contributing to observed declines in coverage. More research is needed to delineate contributory factors, particularly among adolescents and Aboriginal and Torres Strait Islander peoples. This can then be used to inform evidence-based and culturally appropriate strategies to increase vaccine uptake and coverage equity. The National Immunisation Strategy for Australia 2025–2030 provides a comprehensive framework to guide such measures and improve coverage – and hence the protection provided by vaccine programs – against disease.
Brynley Hull, Alexandra Hendry, Kristine Macartney et al.