Cluster sampling methodology to evaluate immunization coverage

BACKGROUND Immunization is a key component of primary health care and an indisputable human right.Vaccines are critical to the prevention and control of infectious disease outbreaks.The coronavirus disease 2019(COVID-19)pandemic and associated disruptions over the past two years have strained the health systems,with many children missing out on essential childhood vaccines.AIM To evaluate the immunization coverage among 12-23-month-old children in the rural areas of Community Health Centre(CHC)Dighal and to determine the factors influencing the existing immunization coverage.METHODS A coverage evaluation survey was conducted according to the 30-cluster sampling technique,which is the standard methodology for such surveys devised by World Health Organization.A total of 300 children aged 12-23 months were included,whose immunization details were noted from their immunization cards.RESULTS Full immunization rate was noted in 86.7%of the children,with partial and non-immunized children accounting for 9%and 4.3%respectively.The full immunization dropout rate was 4.2%.The common reasons for partial or non-immunization were family problem including illness of mother,vaccine not being available and child being ill.Place of birth(P=0.014)and availability of immunization card(P<0.001)were significant predictors of the immunization status.Since the study was conducted in 2020/2021,health services were disrupted due to the COVID-19 lockdown.CONCLUSION Due to the coverage being higher than the national average,it was concluded that the immunization coverage was optimal and not affected by the COVID-19 pandemic.

Rethinking Strategies to Address Inequity in Immunization Services towards Achieving Universal Immunization Coverage (UIC) in Karachi, Pakistan

Karachi, the largest city in Pakistan, having high population growth and a complex health care environment, has highest density of unimmunized (zero dose) and under-immunized children. The main reasons of low immunization coverage in Karachi were lack of governance and accountability in a duplicative and fragmented health management structure, weak and inequitable immunization services, and lack of demand and trust among people for immunization services. The Expanded Programme on Immunization (EPI), Ministry of Health (MOH) in Sindh Province spearheaded a structured and collaborative process to develop strategies for addressing inequity in immunization services towards achieving Universal Immunization Coverage (UIC) in Karachi. The process included a situation analysis with gathering quantitative and qualitative information on the root causes of zero-dose and inequity of the immunization services. The strategies and interventions were developed with multi-layer input and feedback of the stakeholders and partners, and focusing primarily to address gaps in three program areas: governance, leadership and accountability;immunization service delivery;and building demand and trust among the people. The interventions were further prioritized for high-risk areas;identified based on maximum number zero-dose children, presence of large slum areas, measles outbreak and on-going circulation of wild poliovirus. Finally, costing for the Roadmap activities was done through consultation with partners and aligning domestic and external (donor) resources. In this paper, we have highlighted the unique process the Sindh Government undertook in collaboration with the stakeholders and partners to develop strategies and interventions for addressing inequity in urban immunization services in Karachi towards achieving Universal Immunization Coverage (UIC). Similar processes can be adapted, as a potential model, for developing strategies to achieve universal health coverage in the cities of Pakistan and in other countries.

Survey of coverage,strategy and cost of hepatitis B vaccination in rural and urban areas of China

AIM In order to understand the coverage, immunization strategy and cost of hepatitis B (HB) vaccination of China in recent years. METHODS A two stage household random sampling method was used in the survey. RESULTS The survey carried out at 112 Disease Surveillance Points (DSPs) of 25 provinces, autonomous regions and municipalities of China in 1996, showed that the coverage rates of HB vaccination among neonates were 96 9% in the urban DSPs and 50 8% in the rural DSPs in 1993-1994, while in students aged 7-9 years, they were 85 8% and 31 5% in 1994, respectively. Up to 1994, 97 5% of the urban DSPs and 73 9% of the rural DSPs on a neonate vaccination against HB program were included in EPI. About 93% of the urban DSPs and 44% of the rural DSPs did HBsAg and HBeAg screening for all or part of pregnant women. The neonates received the regimen of high dose HB vaccine in combination with hepatitis B immune globin (HBIG) if their mothers were HBsAg and/or HBeAg positive in pregnancy, otherwise they received the low dose vaccine (10μg×3). Part of DSPs had a lower neonate coverage due to unreasonable allocation of the vaccines (used for adults not at risk) or higher cost or insufficient supply of the vaccines. It is necessary to evaluate the quality of serological lab test to HBVMs in the maternal prescreening. CONCLUSION Remarkable achievements have been made according to the national planning and policy of HB immunization in China.

Forecasting Measles Immunization Coverage Using ARIMA Model

This study aimed to find a model to forecast monthly measles immunization coverage using Autoregressive Integrated Moving Average (ARIMA). The monthly registered data for measles immunization coverage from January 2014 to December 2018 were used for the development of the model. The best model with the smallest Normalized Bayesian Information Criterion (BIC) of 8.673 is ARIMA (0, 1, 0). ARIMA (0, 1, 0) was used to forecast the monthly measles immunization coverage for the next 36 months from January 2018 to December 2020. The results obtained prove that this model can be used for forecasting future immunization coverage and will help decision-makers to establish strategies, priorities, and proper use of immunization resources.

CLOUD RADIATIVE AND MICROPHYSICAL EFFECTS ON THE RELATION BETWEEN SPATIAL MEAN RAIN RATE, RAIN INTENSITY AND FRACTIONAL RAINFALL COVERAGE

Cloud radiative and microphysical effects on the relation between spatial mean rain rate, rain intensity and fractional rainfall coverage are investigated in this study by conducting and analyzing a series of two-dimensional cloud resolving model sensitivity experiments of pre-summer torrential rainfall in June 2008. The analysis of time-mean data shows that the exclusion of radiative effects of liquid clouds reduces domain mean rain rate by decreasing convective rain rate mainly through the reduced convective-rainfall area associated with the strengthened hydrometeor gain in the presence of radiative effects of ice clouds, whereas it increases domain mean rain rate by enhancing convective rain rate mainly via the intensified convective rain intensity associated with the enhanced net condensation in the absence of radiative effects of ice clouds. The removal of radiative effects of ice clouds decreases domain mean rain rate by reducing stratiform rain rate through the suppressed stratiform rain intensity related to the suppressed net condensation in the presence of radiative effects of liquid clouds, whereas it increases domain mean rain rate by strengthening convective rain rate mainly via the enhanced convective rain intensity in response to the enhanced net condensation in the absence of radiative effects of liquid clouds. The elimination of microphysical effects of ice clouds suppresses domain mean rain rate by reducing stratiform rain rate through the reduced stratiform-rainfall area associated with severely reduced hydrometeor loss.

Avoiding the Will O’ the Wisp: Challenges in Measuring High Levels of Immunization Coverage with Precision

There have been tremendous improvements in immunization coverage since the Expanded Programme on Immunization was launched. We highlight inherent challenges in measuring immunization coverage with precision as coverage levels increase due to the sensitivity of coverage to the accuracy of target population estimates. In fact, when comparing across groups at high levels of coverage, error in target population estimates can obscure differences in immunization coverage.

A Comparison of National Immunization Programme Target Population Estimates with Data from an Independent Source and Differences in Computed Coverage Levels for the Third Dose of DTP Containing Vaccine

Background: Comparison of target populations for immunization used by national immunization programmes with independent sources can be useful for identifying irregular patterns. Similarly, understanding differences in computed coverage levels that result from changes in target population estimates can be important. Methods: Using data reported annually by national immunization programmes to WHO and UNICEF, we compared the national number of births and surviving infants with estimates reported by the United Nations Population Division (UNPD). We also re-computed and compared coverage levels for the third dose of DTP containing vaccine (DTP3) using the nationally reported number of children vaccinated with DTP3 (the numerator) and the nationally reported number of children in the target population (the denominator) and compared this value with DTP3 coverage computed using the nationally reported number of children vaccinated and the UNPD estimate of the national number of surviving infants as an independent denominator. Results: We observed differences in the number of births and surviving infants reported by national immunization programmes compared with those estimated by the UNPD. Year-to-year changes in the number of births and surviving infants reported by national immunization programmes often exceeded those estimated by the UNPD. The re-computed administrative coverage levels for DTP3 using a nationally reported target population tended to be higher on average than those re-computed using the UNPD target population estimates. Conclusion: Target population estimates are a challenge for immunization programmes, and comparison to independent sources can be useful. There is increasing need to trace and better understand the processes and conditions affecting the enumeration and recording of the number of children in the target population for immunization services and the number of children vaccinated while recognizing that the challenge to do so is greater in some locations than others.

High Immunization Coverage but Delayed Immunization Reflects Gaps in Health Management Information System (HMIS) in District Kangra, Himachal Pradesh, India—An Immunization Evaluation

Background: Complete and timely childhood immunization is one of the most cost-effective interventions in improving child survival in developing countries. Computerized HMIS has been recently introduced to collect aggregated data on service beneficiaries in Himachal Pradesh. HMIS provides coverage estimates for immunization while information on timeliness is currently not available. Hence we conducted a study to validate coverage and assess the timeliness of immunization in Kangra District of Himachal Pradesh. We surveyed mothers (224) of children aged 12 - 23 months (as on January 2008) and selected 32 clusters in the district between January and March 2008. Design/Methods: We conducted a cross sectional survey and selected 32 clusters by probability proportional to size method whereas seven eligible children per cluster were randomly selected. We interviewed mothers using a structured interview schedule, examined immunization card & looked for Bacillus Calmette Guierre (BCG) Scar. Vaccination after 30 days from national schedule was considered “delayed”. We computed proportions of children completely immunized, immunization delayed, frequency of reasons for delay and 95% Confidence Interval (CI) for significance of associated factors. We conducted a case control analysis of factors associated with timely immunization by taking timely immunized children as cases and delayed immunized ones as controls. Results/Outcome: Reported coverage was universal (100%). Validated full immunization coverage was 94.2% by card/record & 99% by history. Only 29.5% (CI = 20.6% - 37.4%) of children were fully immunized as per schedule (delay less than 30 days). Median delay was 21 days for BCG, 28 days for Diptheria Pertussis Tetanus (DPT 3) and 25 days for measles. Among those with delayed vaccinations, reasons were forgetfulness (36%), lack of correct knowledge (27%) & mother gone to parents’ home (27%) & insufficient children in a camp to open full dose BCG vial (22%). Our case control analysis of timely vaccinated versus delayed vaccination revealed that “precall” (reminder) was significantly [OR = 0.1, CI = 0.2 - 0.5] protective against delayed vaccination. Logistic Regression of delay > 30 days revealed that having returned unimmunized from immunization camp earlier due to insufficient children to open vaccine vial (because of high wastage factor) was significantly associated with delayed immunization (p = 0.0000), while knowledge of date of immunization camp was significantly protective from delayed immunization (p = 0.0026). 68% of the children were having at least one immunization delayed over 30 days from recommended schedule, while the proportion of children whose immunization was delayed by over 90 days was 9.4%. Conclusions: Validated field coverage estimates are lower than reported which can be due to inclusion of children of migrants in numerator & not in the denominator. High proportion of children (>70%) were delayed, suggesting implications for WHO’s strategy of measles control & national Tuberculosis (TB) control programmes, as 4.5% of them had suffered from measles. To avoid delays we recommend (i) use of mono dose vials for BCG;(ii) precall notice to mothers;(iii) modification of HMIS software to track immunization status and timeliness of individual beneficiaries rather than aggregate numbers.

Improving Routine Immunization Coverage Through Optimally Designed Predictive Models

Routine immunization(RI)of children is the most effective and timely public health intervention for decreasing child mortality rates around the globe.Pakistan being a low-and-middle-income-country(LMIC)has one of the highest child mortality rates in the world occurring mainly due to vaccine-preventable diseases(VPDs).For improving RI coverage,a critical need is to establish potential RI defaulters at an early stage,so that appropriate interventions can be targeted towards such populationwho are identified to be at risk of missing on their scheduled vaccine uptakes.In this paper,a machine learning(ML)based predictivemodel has been proposed to predict defaulting and non-defaulting children on upcoming immunization visits and examine the effect of its underlying contributing factors.The predictivemodel uses data obtained from Paigham-e-Sehat study having immunization records of 3,113 children.The design of predictive model is based on obtaining optimal results across accuracy,specificity,and sensitivity,to ensure model outcomes remain practically relevant to the problem addressed.Further optimization of predictive model is obtained through selection of significant features and removing data bias.Nine machine learning algorithms were applied for prediction of defaulting children for the next immunization visit.The results showed that the random forest model achieves the optimal accuracy of 81.9%with 83.6%sensitivity and 80.3%specificity.The main determinants of vaccination coverage were found to be vaccine coverage at birth,parental education,and socioeconomic conditions of the defaulting group.This information can assist relevant policy makers to take proactive and effective measures for developing evidence based targeted and timely interventions for defaulting children.

Thinking Out-of-Box in Addressing Communication and Service Delivery Challenges: Use of a Traditional Communication Method for Improving Immunization Coverage in Remote Rural Hard-to-Reach Areas of India

Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.

Approach to Improving TT&C Coverage Rate of LEO and MEO Spacecrafts in China

With the rapid increase of number and types of Low Earth Orbit (LEO) and Medium Earth Orbit (MEO) spacecrafts in China, the insufficiency of TT&C resources is exposed.How to improve LEO and MEO TT&C coverage rate has become the key problem of TT&C system,which should be resolved urgently. Firstly,the basic concepts of TT&C coverage are discussed and the relation between TT&C coverage of ground station and geography latitude of ground station as well as spacecraft altitude are analyzed. Secondly,the United States NASA TT&C network is taken as an instance to describe the developing process of TT&C network. Finally,in combination with TT&C activities of LEO and MEO spacecrafts in China,the method to heighten TT&C coverage rate is put forward,such as rational establishing station,space resources application,international TT&C cooperation etc.

掺杂对TiC_(2)纳米片析氢反应的第一性原理研究

过渡金属二碳族化物单层作为一种廉价而丰富的材料,在制氢催化剂方面的应用越来越受到人们的关注.在这项工作中,基于第一性原理计算研究了掺杂二碳化钛单层的析氢还原.我们发现掺杂元素和浓度对单分子膜的催化能力有强烈的影响.结果表明,在高氢覆盖率内,O和V掺杂能有效的降低氢吸附的吉布斯自由能.低密度掺杂可以提高催化能力.我们进一步研究表明,由于V原子在二碳化钛(TiC_(2))单层中具有最低的负形成能,因此比其他过渡金属原子更容易取代Ti原子.期望掺钒TiC_(2)单分子膜能以更高的效率应用于水电解.

鼻内镜手术联合糠酸莫米松鼻喷雾剂治疗慢性鼻窦炎伴鼻息肉疗效及对患者鼻黏膜CD4^(+)及CD8^(+)T细胞分布的影响

目的:探讨鼻内镜手术(FESS)联合糠酸莫米松鼻喷雾剂治疗慢性鼻窦炎伴鼻息肉(CRSwNP)的疗效及对鼻黏膜CD4^(+)及CD8^(+)T细胞分布的影响。方法:选择96例CRSwNP患者,按随机数字表法分为对照组(FESS)和观察组(FESS联合糠酸莫米松鼻喷雾剂)各48例。比较两组临床疗效,治疗前后鼻腔通气功能、鼻黏膜CD4^(+)及CD8^(+)T细胞分布、鼻黏液纤毛清除功能及复发率。结果:对照组无效10例,总有效率79.17%,观察组无效2例,总有效率95.83%,两组比较差异有统计学意义(均P<0.05)。观察组治疗后血清肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平下降,低于对照组,鼻黏膜功能均优于对照组,CD4^(+),CD4^(+)/CD8^(+)较对照组升高,CD8^(+)较对照组下降(均P<0.05)。且观察组患者术后1年内的复发率为4.17%,明显低于对照组的22.92%(χ^(2)=7.207,P<0.05)。结论:鼻内镜手术联合糠酸莫米松鼻喷剂治疗慢性鼻窦炎伴鼻息肉效果较好,且复发率低,能够降低患者的炎性反应,促进黏膜免疫功能修复,提高黏液纤毛清除功能。

Forecasting increasing rate of power consumption based on immune genetic algorithm combined with neural network

Considering the factors affecting the increasing rate of power consumption, the BP neural network structure and the neural network forecasting model of the increasing rate of power consumption were established. Immune genetic algorithm was applied to optimizing the weight from input layer to hidden layer, from hidden layer to output layer, and the threshold value of neuron nodes in hidden and output layers. Finally, training the related data of the increasing rate of power consumption from 1980 to 2000 in China, a nonlinear network model between the increasing rate of power consumption and influencing factors was obtained. The model was adopted to forecasting the increasing rate of power consumption from 2001 to 2005, and the average absolute error ratio of forecasting results is 13.521 8%. Compared with the ordinary neural network optimized by genetic algorithm, the results show that this method has better forecasting accuracy and stability for forecasting the increasing rate of power consumption.

Objective response rate assessment in oncology: Current situation and future expectations

The tumor objective response rate(ORR)is an important parameter to demonstrate the efficacy of a treatment in oncology.The ORR is valuable for clinical decision making in routine practice and a significant end-point for reporting the results of clinical trials.World Health Organization and Response Evaluation Criteria in Solid Tumors(RECIST)are anatomic response criteria developed mainly for cytotoxic chemotherapy.These criteria are based on the visual assessment of tumor size in morphological images provided by computed tomography(CT)or magnetic resonance imaging.Anatomic response criteria may not be optimal for biologic agents,some disease sites,and some regional therapies.Consequently,modifications of RECIST,Choi criteria and Morphologic response criteria were developed based on the concept of the evaluation of viable tumors.Despite its limitations,RECIST v1.1 is validated in prospective studies,is widely accepted by regulatory agencies and has recently shown good performance for targeted cancer agents.Finally,some alternatives of RECIST were developed as immune-specific response criteria for checkpoint inhibitors.Immune RECIST criteria are based essentially on defining true progressive disease after a confirmatory imaging.Some graphical methods may be useful to show longitudinal change in the tumor burden over time.Tumor tissue is a tridimensional heterogenous mass,and tumor shrinkage is not always symmetrical;thus,metabolic response assessments using positron emission tomography(PET)or PET/CT may reflect the viability of cancer cells or functional changes evolving after anticancer treatments.The metabolic response can show the benefit of a treatment earlier than anatomic shrinkage,possibly preventing delays in drug approval.Computer-assisted automated volumetric assessments,quantitative multimodality imaging in radiology,new tracers in nuclear medicine and finally artificial intelligence have great potential in future evaluations.

Impact of Survival Rate and Safety Analysis of Concurrent Chemoradiotherapy in Patients with Recurrent Cervical Cancer

Objective:To investigate the effect of concurrent chemoradiotherapy on the survival rate and safety of patients with recurrent cervical cancer.Methods:A total of 107 patients with recurrent cervical cancer who were treated in our hospital from March 2016 to January 2019 were retrospectively analyzed and randomly divided into the control group(n=53)and the observation group(n=54)and treated conventionally.On this basis,the control group was treated with radiotherapy,and the observation group was treated with concurrent radiotherapy and chemotherapy.The clinical efficacy,cellular immune index,survival rate and rate of adverse reactions were compared between the two groups.Results:Compared with the total effective rate of 79.25%in the control group,the observation group was 94.44%,and the difference was statistically significant(P<0.05).After treatment,the levels of NK,CD3+,and CD4+in the two groups were higher than before the treatment,and the observation group was higher than the control group.The difference was statistically significant(P<0.05).Compared with the adverse reaction rate of 18.87%in the control group,the observation group was 11.11%,but the difference was not statistically significant(P>0.05).Conclusion:Concurrent chemoradiotherapy for patients with recurrent cervical cancer has a significant effect,which not only can effectively improve the cellular immune index and the survival rate of patients,but also have high safety.

Artificial Induction of Twinning by an Active Immunization of Beef Cows Against Inhibin Partially Purified from Porcine Seminal Plasma

Two hundred and seventy multiparous Chinese Yellow cattle (beef) were selected at 1 to 3 months postpartum and divided into three groups (90 cows for each). Animals were given both a primary and booster immunizations with a total dose of 3 mg (Group Th) or 1.5 mg (Group Tl) of seminal preparation containing inhibin activity, emulsified with Freund's complete adjuvant and incomplete adjuvant (for booster) , at 3 or 4-week intervals. Other cows were treated with the same volume of seminal preparation without inhibin activity as procedures mentioned above to serve as a control (Group C). Artificial inseminations were given twice at 8 - 12 h intervals when the cow was in heat. Jugular venous blood samples were collected from each cow and used to assay the presence of antibody against seminal preparation by double-diffusion in agar precipitation test and to detect the titer of inhibin antibody by an ELISA method. Data from 247 cows showed that 83.9% (73/87) of cows were in estrus and ovulated 89 ova altogether, of which 19 cows ovulated twin ova and 15 cows produced twins in Group Th (n = 87). However, only 61.1% (44/72) of cows in Group TI (n = 72) and 62.5% (55/88) of cows in Group C were in estrus and ovulated 46 and 52 ova altogether respectively. The ovulation rate (1.27 ± 0.03), calving rate (126.3%) and twinning rate (26.3%) in Group Th were greater than those in Groups Tl or C (P<0.01). Furthermore, the ovulation rate was associated with antibody titer in sera of immunized animals (r = 0.7507, P<0.01). These results indicate that active immunization of postpartum cows against inhibin purified from porcine seminal plasma may increase the ovulation rate and induce twinning, suggesting the potential to develop a method to improve fertility in cows.

Feasibility Study of Enforcing Immunization Certificate Check Before Primary School or Kindergarten Enrollment in Guizhou Province, China

Objective To study the feasibility of enforcing immunization certificate check before children enroll in primary schools or kindergartens in Guizhou Province. Methods Quantitative and qualitative studies were conducted. The multi-stage and cluster sampling approach was adopted for the quantitative part of the study. A questionnaire was designed and 996 children and their keepers were interviewed. Principals, doctors or teachers of the primary schools, directors and child care nurses of kindergarten, and staff of immunization agencies were invited to take part in 12 focus group discussions; meanwhile, face-to-face individual in-depth interviews with 16 officials of the Health, Education and Governmental Departments at various levels were conducted. Results The total number of subjects was 996. 16.7% of the children in the study completed all the procedures of the National Immunization Programme. 34.3% of them had immunization certificates while the remainder 44.7% registered in immunization agencies. Factors, including the migrant children, doubt about vaccine efficiency, mother’s occupation and educational background, knowledge of the National Immunization Programme on targeted vaccines, played an important role in obtaining or not immunization certificates. 95% of the keepers interviewed thought the immunization certificates were useful; 94.8% of them considered the check was critical while only 3.6% of them thought it unnecessary. The first reason from those who found it unnecessary was that they feared that repeated immunization might affect their children’s health. The second reason was the cost of immunization, which some of them could not afford to pay. However, the Health Department expressed a favorable attitude to the checking scheme. Though the Education Department agreed that the scheme was essential, they worried that it would affect the enrollment rate.Conclusion In spite of the difficulty in administering immunization certificate check, the effort would be rewarding for raising the immunization coverage rate among the children in Guizhou Province.

Vaccination Coverage and Its Determinants in Children Aged 11 - 23 Months in an Urban District of Nigeria

Background/Objectives: Performance of the vaccination programme in Nigeria is lower than the regional average as well the 95% target necessary for sustained control of vaccine preventable diseases. This study is aimed at assessing the vaccination coverage and its associated factors in children aged 11 - 23 months in Enugu Metropolis. Methods: A cross sectional study in which caregivers and their children pair, aged 11 - 23 months attending children’s outpatient clinics in Enugu metropolis was undertaken. Respondents were selected consecutively while data were collected using pretested interviewer administered semi-structured questionnaire. Data were analyzed using SPSS version 20.0 while level of significance was set at p < 0.05. Logistic regression analysis was used to identify independent predictors of full vaccination. Results: Of 351 subjects studied, 84.9% (298) were fully immunized according to the national programme on immunization schedule using both vaccination cards and history. The OPV0, OPV3, pentavalent-1, pentavalent-3 and measles coverage at the time of survey were 100.0%, 97.2%, 98.0%, 98.6%, 96.9% and 95.4%, respectively. On logistic regression: maternal occupation (government employees), children born in government hospitals and knowledge of when to start and complete vaccinations in a child were the likely predictors for completion of full vaccination in the children. Conclusion: The vaccination coverage among the study group was adjudged to be relatively high. Delivery of a child in a government hospital and the knowledge of the age when routine vaccinations should begin and end in a child were the independent predictors of the high vaccination coverage rate observed. Awareness and health education efforts in government tertiary hospitals should be extended to private and other hospitals to improve and sustain national vaccination coverage in Nigeria.

Proportionate Target Population Estimates Used by National Immunization Programmes in Sub-Saharan Africa and Comparison with Values from an External Source

Background: In order to effectively plan the delivery of immunization services, manage stock and supply levels and target interventions, national immunization programmes (NIP) must have an estimate of the target population they serve. To overcome challenges with target population estimation, some NIPs apply “rule-of-thumb” conversion factors to total population estimates. We compare these proportionate target population values with those from an external source. Methods: Using data reported by national immunization programmes in sub-Saharan Africa, we computed the proportionate target population as the number of births, surviving infants and children under 5 years of age, respectively, as a proportion of the total population size. We compared these values with those estimates computed from United Nations Population Division (UNPD) data. We then recomputed NIP target population sizes using the proportionate target population values from the UNPD applied to the total population size reported by NIP. Results: Data were available from 47 sub-Saharan Africa countries. Births as a proportion of the total population were greater within reports from NIP (median, 0.0400;IQR: 0.350 - 0.0437) compared to values from UNPD estimates (median, 0.0364;IQR: 0.0332 - 0.0406). Similar patterns were observed for surviving infants (median: NIP, 0.0360;UNPD, 0.0337) and children under 5 years of age (median: NIP, 0.1735;UNPD, 0.1594). The percent difference in proportionate target population ratios between reports from NIPs and the UNPD was >10% in 23 countries for births, in 18 countries for surviving infants, in 15 countries for children under 5 years of age. After re-computing target populations using UNPD proportionate target population values applied to NIP reported total population, recomputed administrative coverage levels for the third dose of DTP containing vaccine were higher in 32 of the 47 countries compared to reported administrative coverage levels. Conclusion: Because childhood immunization-related target populations are among the more difficult ones to accurately estimate and project, immunization programmes in sub-Saharan Africa are encouraged to include a critical assessment of the target population values, in conjunction with their national statistics system, as part of the on-going programme monitoring process.