Background: Under-five morbidity and mortality is preventable due to incomplete and delayed immunization. Mobile health education has the potential to enhance caregiver awareness, attendance at appointments, and timely vaccine uptake. The aim of this study was to assess the effect of a structured mobile health education intervention on immunization coverage among under-five children. Methods: A quasi-experimental community-based study was carried out with 360 caregiver-child pairs in two similar community areas in rural primary health centres. The intervention group was provided with weekly mobile health education messages and vaccine reminders for six months, and the comparison group was provided with routine services. Caregiver knowledge and child immunization status (by card or health record) were documented during baseline and endline assessments. Results: Baseline immunization coverage was comparable between the intervention and comparison groups, with 62.8% vs 61.1% of children being fully immunized, respectively (p = 0.741). The intervention group had a higher rate of coverage at 6 months (86.1% vs. 68.3%, p < 0.001). Mean caregiver knowledge score improved from 12.4 ± 3.1 to 18.7 ± 2.6 in the intervention group and from 12.1 ± 3.4 to 13.6 ± 3.2 in the comparison group (p < 0.001). The intervention group saw a significant increase in timely vaccine uptake from 54.4% to 79.4%. At endline, mobile health exposure continued to be independently associated with full immunization (AOR 3.42, 95% CI 2.02-5.79). Conclusion: Mobile health education had a significant effect on the knowledge, full immunization coverage, and timeliness of under-five children. Combining localised mobile reminders with the delivery of routine immunisation services can reinforce public health services.
A key focus of the health-related sustainable development goal (SDG) 3 is universal health coverage (UHC), including access to safe, effective, quality, and affordable essential medicines and \nvaccines. However, the challenges to achieving UHC are substantial, especially with increased demands on the health sector and with most budgets being static or shrinking. \nImmunization programmes have been successful in reaching children \nworldwide. For example, 86% of the world’s infants had received three doses of diphtheria-tetanus-pertussis (DTP3) \nvaccine in 2018. The experiences from such programmes can contribute to UHC, and as these programmes strive to adapt to new global strategic frameworks, such as Gavi, the Vaccine Alliance’s \nstrategy Gavi and the World Health Organization’s (WHO) Immunization Agenda 2030, these efforts can inform \nthe progressive realization of UHC. Immunization programmes that can sustain regular levels of contact between health providers and beneficiaries at the community level have enabled new vaccines to be added to routine immunization schedules and other interventions to be delivered to children and their families. In addition, experiences from both polio campaigns and the child health days strategy show that incorporating additional interventions into campaigns can \nincrease coverage of these interventions as well as of vaccinations.
Mickey Chopra, Zulfiqar Ahmed Bhutta, Diana Chang Blanc et al.
IntroductionSince the late 2000s, several major measles epidemics have occurred in Europe, including France. In 2017, the French Health Ministry extended from three to 11 the number of mandatory childhood vaccines required for preschool and primary school admission; these included the vaccine against measles, mumps and rubella (MMR).AimOur aim was to assess if this measure helped to improve MMR vaccine timeliness (VT) or reduce socioeconomic inequalities in MMR vaccine coverage.MethodsA nationwide study of three birth cohorts (2015, 2017, 2019) followed up 2.1 million children for 48 months to assess the course of the timeliness of MMR vaccine dispensation, before and after it became mandatory in France (January 2018). Data came from the French national health insurance fund drug reimbursement database.ResultsDespite improvements from 2015 to 2019, pharmacies dispensed MMR vaccines late for 33% of children in the 2019 cohort (mean cumulative delay compared with recommended dates: 7.1 months). Vaccines for children from low-income families were dispensed later (mean delay of at least +1 month) than those from higher-income families. The 2019 cohort did not reach the 95% WHO target of two MMR doses at 24 months of age, nor at 48 months.DiscussionWith measles intensifying worldwide, these vaccination delays and inequalities may contribute to the resurgence of epidemics. In addition to vaccination mandates, an ambitious public health policy is needed to reduce inequalities in access to vaccination and to improve parents' vaccine acceptance through educational strategies.
Dimitri Scronias, Lisa Fressard, Laure Fonteneau et al.
The health system is the primary vehicle for the delivery of nutrition-specific interventions that aim to reduce maternal and child malnutrition. The integration of nutrition interventions into existing health interventions is promising, but to ensure that no one is left behind requires that access to essential health services is equitably distributed. This study aims to assess trends and socioeconomic inequalities in coverage of reproductive, maternal, newborn and child health (RMNCH) and assess its association with child nutritional outcomes in Ethiopia. Using the Ethiopian Demographic and Health Survey (2005, 2011, 2016, and 2019), we estimated the coverage of RMNCH interventions in Ethiopia using the co-coverage index, which is a count of the number of interventions accessed. We assessed the trend and inequalities in co-coverage and evaluated its association with child nutritional outcomes like stunting, wasting, and minimum dietary diversity (MDD). The national co-coverage index has shown a significant increase over the 2005-2019 period. However, all of the RMNCH interventions constituting the co-coverage index showed a pro-rich and pro-urban distribution (p < 0.05). The highest inequality, based on the slope index of inequality (SII), was observed for skilled assistance during delivery (SII: 80.4%), followed by access to an improved source of drinking water (SII: 62.6%), and antenatal care visits (SII: 55.5%). The low coverage in RMNCH and the observed inequality were associated with stunting, wasting, and MDD. Reducing socioeconomic inequality in RMNCH is key to achieve the health, nutrition and equity-related goals of the Sustainable Development Goals.
Child–parent screening for familial hypercholesterolemia (FH) is a population method for identifying children and their parents who are at high risk of premature ischaemic heart disease due to inherited high cholesterol.1 The method links screening with childhood immunisation allowing universal coverage of the population, and identifies FH securely based on cholesterol measurement supported by FH mutation testing.2 The early identification of FH allows the introduction of preventive treatment before the onset of ischaemic heart disease, and ensures screening happens at the stage in life when a cholesterol measurement is most discriminatory for FH (1–2 years of age). The method has been shown to be feasible and acceptable in a national demonstration project;3 over 3 years, 10,095 children (median age 13 months) were screened at 92 UK general practices during routine immunisations – 84% of parents accepted the offer of screening and 94% said they would have a second child screened by the method if it were offered.34 Child–parent screening identified one new FH positive individual for every 125 children screened. The method leads naturally to cascade testing in which relatives are tested – half of all first degree relatives being affected.5 Integrated child–parent cascade screening is highly effective and cost-effective.6,7 It is not known whether access to screening varies across ethnic groups. We used data from the Child–parent Screening Study to investigate this. The ethnic mix of 10,095 children who attended for screening between 2012 and 2015 was compared with the ethnic mix recorded in the Office for National Statistics (ONS) census data for the same age group at a similar point in time, based on a survey of 3,496,750 children.8 For both surveys ethnicity was self-defined using specified categories (white, mixed, Asian, black and other). Figure 1(a) (10,095 children screened) and (b) (3,496,750 children in census) shows similar ethnic group proportions indicating that child–parent screening is not preferentially taken up by any one particular ethnic group. Proportion of children by ethnic group screened for familial hypercholesterolemia in the Child–parent Screening Study (a) compared with age and time-matched census data for England and Wales (b). Numbers in pie-chart are percentages of total population (to two significant figures). The Health and Social Care Act 2012 includes specific duties for providers and commissioners of NHS screening programmes with regard to reducing health inequalities between the people of England.9 Under the act, screening programmes should pay particular attention to reaching people in diverse ethnic groups; a requirement that has also been highlighted in other countries.10 The data from the Child–parent Screening Study indicate that this requirement is met in screening for FH in children at the time of immunisation. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: the child-parent screening study was funded by Medical Research Council (UK).
BACKGROUND: In developing countries like Ethiopia, about 3 million children's deaths are attributed to vaccine-preventable diseases. Studies especially that try to explain the urban to rural vaccination coverage discrepancy are limited in the study area. This study aimed to assess full vaccination coverage and associated factors among children aged 12-23 months in rural and urban kebeles of Pawi district. METHODS: A community-based comparative cross-sectional study among urban and rural kebeles was conducted. A multistage sampling method was used to select 456 rural and 229 urban. Data were collected from mothers/caregivers using interviewer-administered questionnaires and vaccination cards. Full vaccination coverage was estimated for both urban and rural kebeles. Multivariable logistic regression analysis was used to identify factors associated with full vaccination. Adjusted Odds Ratio with a 95% confidence interval was reported. RESULTS: Full vaccination coverage was 67% (95% CI 63% -71%) and 60% (95% CI: 54% -66%) among rural and urban residents, respectively. Educational status of the father (AOR=2.69; 95% CI, 1.61-4.48), using postnatal care (PNC) (AOR=2.60; 95% CI, 1.58-4.29), discussion on side effect and contraindications of vaccines (AOR=1.82 95% CI, 1.16-2.88), and Institutional delivery (AOR=4.39, 95% CI 2.17-8.87) were factors significantly associated with full vaccination among rural children, whereas using Knowledge on immunization schedules (AOR=1.92 95% CI, 1.03-3.60), PNC (AOR=3.19; 95% CI, 1.57-6.47), discussion on side effects and contraindications of vaccines (AOR=2.75; 95% CI, 1.4-5.3) were notably associated with full vaccination among urban children. CONCLUSION: The study reveals vaccination coverage was higher in rural compared to urban kebeles but it is still far below the WHO recommended target. Therefore interventions shall be made to improve the coverage especially by using the identified factors like improving PNC service and promoting institutional delivery and health education.
BACKGROUND: The current prevalence and factors associated with non-vaccination in children born between 2017 and 2018, considering vaccination status up to 24 months of age in the State of Ceará, should be assessed to justify the need to identify the population eligible for timely vaccination with valid doses to ensure optimal protection against vaccine-preventable diseases. This study aimed to estimate the prevalence and analyze the sociodemographic factors associated with non-vaccination among children born between 2017 and 2018 residing in Fortaleza and Sobral, Ceará State, Northeast Brazil. METHODS: A population-based household survey of the 2017-2018 birth cohort was conducted using cluster sampling in Fortaleza and Sobral. The prevalence of non-vaccination, including no-dose and incomplete-dose categories, was estimated using prevalence ratios from Poisson regression with robust variance and survey design adjustment. RESULTS: Of the children, 54.55% were not fully vaccinated, and 9.91% did not receive a single valid dose of any vaccine (Fortaleza: 10.46%; Sobral: 2.71%). Missing doses were mainly for meningitis (29.14%), rotavirus diarrhea (25.46%), and pneumonia and meningitis (24.44%). Non-vaccination was associated with maternal ethnicity, specifically White (Caucasian) (aPR, 2.07; 95% CI, 1.08-3.94; p = 0.028), and with the use of private vaccination services (aPR, 1.72; 95% CI, 1.46-2.04; p < 0.001). CONCLUSIONS: Non-vaccination was highly prevalent among children born between 2017 and 2018 in Ceará. The findings highlight the need to strengthen and reorient vaccination efforts across sectors and to implement catch-up strategies for children who missed valid doses.
Adjoane Maurício Silva Maciel, Carla Magda Allan Santos Domingues, Anderson Fuentes Ferreira et al.
Immunization is widely acknowledged as one of the most impactful and cost-effective public health interventions for reducing morbidity and mortality in children under five. It plays a critical role in preventing infectious diseases such as measles, pertussis, tetanus, and poliomyelitis, and is credited with saving between 4 to 5 million lives globally each year [1,2]. Despite its success, inequities in vaccine coverage persist across and within countries [3]. According to WHO/UNICEF estimates, global coverage with the third dose of the diphtheria-tetanus-pertussis (DTP3) vaccine stood at 85% in 2024, with nearly 14.3 million children classified as “zero-dose” having received no vaccines through routine services [2]. High-income countries consistently achieve over 90% coverage, while lower-middle-income and conflict-affected regions lag significantly behind [4]. While regional immunization initiatives and partnerships like Gavi, the Vaccine Alliance, have expanded access to vaccines in sub-Saharan Africa discrepancies persist wholly and geographically clustered [4,5]. For instance, a spatial analysis in Ethiopia using 2019 DHS data found persistent “zero-dose” hotspots, particularly in rural and border regions [6]. Likewise, studies from countries such as Nigeria and the Democratic Republic of Congo continue to show that children living in remote, impoverished, or conflict-affected areas are far less likely to receive complete vaccination schedules [7,8]. Though the average polio vaccination coverage in sub-Saharan Africa is approximately 85%, this still falls short of global targets, and local-level analysis often reveals much lower rates in hard-to-reach populations [9]. Across the globe, determinants of immunization status are influenced by the socio-economic, political, and healthcare contexts in which families live. In high-income countries, vaccine uptake is increasingly shaped by vaccine hesitancy, misinformation, and parental perceptions of risk and trust in healthcare systems [10,11]. Meanwhile, in low- and middle-income countries outside Africa, structural and access-related factors predominate [12]. Studies from Asia and Latin America identify low maternal education, long travel distances to health facilities, household poverty, inadequate health worker outreach, and weak health infrastructure as the most consistent barriers to childhood immunization [12–14]. In West Africa, childhood immunization is influenced by both structural barriers and social determinants such as maternal education, household income, and geographic location [15]. While the region faces challenges similar to other low- and middle-income countries, disparities in vaccine coverage often reflect uneven access to healthcare, especially between urban and rural areas [16] . In Ghana, although significant progress has been made through initiatives like the Expanded Programme on Immunization, there remain substantial gaps. Subnational disparities in coverage persist, and certain populations particularly in remote or underserved communities continue to face barriers to full immunization [17]. There have been studies that explored the determinants of childhood immunization globally and regionally but there remains a need for more context-specific syntheses. A recent systematic review examined factors influencing immunization coverage among children across Africa. The review highlighted common challenges such as maternal education, healthcare access, and socio-economic status [18] . However, the findings were aggregated across diverse settings, offering limited insight into the specific national contexts in which these challenges manifest including Ghana. In Ghana, existing research on childhood immunization is often fragmented, geographically restricted, or focused on population subgroups. As a result, there is no comprehensive synthesis that captures the full landscape of immunization coverage and its key determinants at the national level. This gap limits the ability to understand which children are most at risk of being under- or unimmunized, and why. This scoping review, therefore, aims to map the available evidence on the rate and determinants of immunization status among children under five in Ghana. Consolidating and analyzing existing studies, the review will provide a clearer picture of emerging trends, contextual drivers, and evidence gaps. The findings will inform future systematic reviews, guide policymakers and public health practitioners, and support the design of more targeted, equitable interventions. Ultimately, this work will contribute to Ghana’s progress toward universal health coverage and the reduction of child mortality which is in line with Sustainable Development Goal 3.2.
Grace Atitsogbey, Mustapha Amoadu, Godswill Sedinam Lanyo et al.
Introduction: Immunisation is a cost-effective public health intervention worldwide responsible for the reduction of infant and child morbidity and mortality. Full immunisation is a state of obtaining all vaccination according to the Immunisation schedule of Nepal. Methods: The secondary data of Nepal was downloaded from the DHS Program. A total of 1709 children aged 16-23 months were analysed for descriptive statistics. All the analyses were weighted by its sampling weight. The full immunisation status indicates those who completed 1 dose of BCG, 3 doses of Polio, 3 doses of DPT and 1 dose of Measles. The independent variables are further subdivided into enabling, predisposing and external environmental factors. Results: Over half of children (52.6%) were from Terai, nearly a quarter (23.0%) from province 2. More males (53.5%) and the majority of (86.1%) children with birth order one to three were immunised. Mother aged < 20 years (62%), working father (96.1%), working mother (59.7%), educated father (87.3%) and educated mother (70.7%) had children with complete immunisation. Non-smoker mother (94.6%) had fully immunised children. Nearly three quarters (73.5%) from a middle and rich family, those with PNC within 3 days (35.9%), delivered at a health facility (64.2%), and had PNC check from the skilled provider (12.1%) had completely immunised their children. Conclusions: Significant differences based on external environment, enabling factors and predisposing factors for full immunisation status was observed. Specific interventions based on these factors are recommended.
Vaccination of children continues to pose problems, and the vaccination coverage rate is very low in DR Congo. Cultural, social and economic constraints at various levels are thought to be the main causes. Faced with this health emergency, the Congolese government has implemented strategies to increase the level of immunization coverage among children, and to help reduce child morbidity and mortality linked to vaccine-preventable diseases. A household survey was carried out in 2019 in the provinces of Ituri and Haut-Katanga to estimate the level of coverage at grassroots level. A representative cluster sample was used to exhaustively cover 63 health zones (36 in Ituri and 27 in Haut-Katanga). Over 6,300 mothers/caregivers of children aged 10-23 months were interviewed, at a rate of 100 mothers/caregivers per health zone. The results of this survey show that overall, nearly 49% of children aged 10-23 months are fully vaccinated in Ituri, compared with 53.12% in Haut-Katanga. There are still large numbers of zerodose children (those who have never been vaccinated since birth). For all vaccines, results varied: 53.12% of children in Ituri and 46.88% in Haut-Katanga received the bacillus Calmette and Guerin (BCG) vaccine. BCG vaccine was administered at birth to 39.76% of children in Ituri, versus 60.24% in Haut-Katanga. The discrepancies suggest a missed opportunity and therefore unmet needs for several reasons, principally vaccine stock-outs. For other antigens, there is a downward trend in both provinces between input and output doses. This suggests a lack of effective monitoring. Only 49.6% of children in Ituri and 50.33% of children in Haut-Katanga received the entry dose of polio vaccine (OPV0).
Joseph Oyaya Mundala, Joël Fumwakwau Kiniati, Leurby Ikina Bokele et al.
