UNASSIGNED: Infectious diseases present a substantial worldwide health challenge, yet vaccines have played a crucial role in significantly decreasing illness rates. Despite their effectiveness, global vaccination coverage stands at 85%, leaving a considerable number of infants without routine immunization. Our study seeks to examine the occurrence of delayed primary vaccination and the factors influencing it in Riyadh, Saudi Arabia addressing a critical void in current research.
UNASSIGNED: A cross-sectional investigation was carried out in the primary care facilities of the first health cluster in Riyadh, Saudi Arabia. Information was gathered utilizing a well-structured questionnaire, modified from a prior study. The study encompassed children aged two years and younger, accompanied by their parents who brought their vaccination cards for the visit. Non-probability convenience sampling was employed for data collection. Subsequently, the data underwent thorough cleaning in Excel (Microsoft Excel) and was subjected to analysis using IBM SPSS 29 (IBM SPSS Statistics 29).
UNASSIGNED: The study involved 402 participants, primarily over 12 months old, with a balanced gender distribution. Noteworthy findings indicate a 20.9% prevalence of childhood vaccine delays, with reasons such as high-grade fever (33.3%) and travel (26.2%). Significant associations were found in children aged 6-12 months (25.8%, P = 0.039), families with over four children (31%, P = 0.010), perceptions of vaccine harm (50.0%, P = 0.013), and acknowledgment of neglect (96.4%, P = 0.001).
UNASSIGNED: The research illuminates the complex factors influencing childhood vaccine delays in Saudi Arabia. Stressing the significance of personalized interventions, it underscores the necessity to tackle challenges specific to age, parental perspectives, and access issues for improved vaccination outcomes.

The second dose of measles-containing vaccines (MCV2) has significant programmatic relevance in the current immunisation landscape because it serves as both an opportunity to reduce measles immunity gaps and strengthen second year of life vaccination platforms. However, MCV2 coverage remains suboptimal across countries in the World Health Organization (WHO) African Region and this puts a significant number of children at risk of morbidity and mortality from measles despite the availability of an effective vaccine. There is an urgent need to strengthen the implementation of MCV2 but this requires a thorough and systematic understanding of contextual factors that influence it. The literature that describes the determinants of implementation of MCV2 in a manner that adequately accounts for the complexity of the implementation context is scarce. Therefore, the purpose of this rapid review was to explore the implementation determinants of MCV2 in the WHO African Region using systems thinking. Literature search in two databases (PubMed and Google Scholar) were conducted. After screening, a total of 17 eligible articles were included in the study. Thematic analysis of extracted data was performed to identify the implementation determinants, after which they were mapped using the Consolidated Framework for Implementation Research (CFIR). A causal loop diagram (CLD) was used to illustrate the linkages between identified determinants. We found 44 implementation determinants across the five CFIR domains, i.e., innovation, outer setting, inner setting, individual, and implementation process. The majority of identified determinants are within the individual domain followed by the inner setting domain. The CLD showed that multiple contingent connections and feedback relationships exist between the identified implementation determinants within and across CFIR domains. The linkages between the implementation determinants revealed three balancing and reinforcing loops each. The findings suggest that implementation determinants of second-dose measles vaccination in the WHO African Region are complex, with multiple interconnections and interdependencies, and this insight should guide subsequent policies. There is an urgent need for further implementation research with embedded CLD in specific settings to inform the design of tailored systemic strategies to improve the implementation effectiveness of MCV2.

Despite overall improvements observed at the national level, there is a significant disparity in childhood vaccination coverage rates between urban and rural regions, particularly within tribal and remote areas in Pakistan. Our study aimed to explore the views of community/tribal leaders concerning barriers and their local solutions for improving vaccine uptake, with a specific focus on remote settings. An exploratory qualitative research study was conducted from July to September 2019 in Shikarpur, Sindh, Pakistan. We interviewed 11 community leaders, after developing a semi-structured interview guide based on the health belief model. Following validation, the collected data was transcribed and subsequently translated into the English language. A stepwise process of manual familiarization, coding, theme generation, and theme review using an inductive approach was followed. While most of the rural community leaders expressed a willingness to support vaccinations, numerous unexplored barriers were identified. These barriers included an unsustainable communication system heavily dependent on polio mobile teams, discourteous behavior of healthcare personnel, cultural restrictions that limited women\'s involvement, economic hardships, limited transportation options, insufficient collaboration with the education sector, poor knowledge among community leaders, and security concerns. Additionally, they proposed some innovative solutions of information dissemination methods through the Ottaque system, ethics-based training, subsidized transportation services or voucher system, and addressing security concerns in collaboration with community leaders. Our findings suggest policymakers take both community leaders and members for an inclusive policy-making process to redraft the special policy for these remote and rural areas.

An increasing vaccine hesitancy among parents, which has resulted in insufficient rates of immunization, provides reason to reconsider childhood vaccination practices. Studies suggest that parents\' decision-making process concerning whether to vaccinate their child is highly influenced by cognitive biases. These biases can be utilized to increase vaccination uptake via changes in the choice context. This article considers childhood vaccination programmes, which involve children being vaccinated in school or daycare unless their parents actively \'opt out\'. We suggest that such programmes reconcile parents\' decisional authority and vaccination duties. First, opt-out childhood vaccination based in schools or daycare centres are not disrespectful of parental authority. Second, the programme aligns the default setting with a moral obligation to vaccinate one\'s child that most parents have.

BACKGROUND: Cameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model.
METHODS: This cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis.
RESULTS: Over 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention.
CONCLUSIONS: The use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.

This systematic review and meta-analysis aimed to examine the association between maternal education and completion of childhood vaccination among aged 12-23 months children in Ethiopia. Systematic review and meta-analysis. PubMed-Medline, EMBASE, SCOPUS, Global Health, and Google Scholar were searched for articles published from January 2010 to January 2020. The data extraction was reported based on the PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed the I2 test and a funnel plot to assess heterogeneity and check for publication bias. We assessed 841 studies for eligibility, of which 43 studies were included in the qualitative synthesis, and 28 studies were fully accessed for meta-analysis. The overall pooled effect of this systematic review and meta-analysis demonstrated a positive association between maternal education and completion of childhood vaccination. Having a primary level of maternal education was correlated with a 1.87 times higher likelihood (95% CI 1.76-1.98) of completing childhood vaccination compared to having no education. Furthermore, attending secondary education and above was associated with a 3.47 times higher likelihood (95% CI 3.18-3.78) of completing childhood vaccination compared to having no education. This systematic review and meta-analysis study revealed that as the level of maternal education increases, the completion of childhood vaccination accelerates. Therefore, investment in maternal education should be prioritized as an intervention. Empowering mothers through education can contribute to the reduction and prevention of vaccine-preventable diseases and associated risks.

BACKGROUND: Confidence in childhood vaccination is high in Norway and the Norwegian Childhood Immunization Programme (NCIP) achieves high overall coverage rates. However, lower coverage has been observed for some immigrant groups, including Polish immigrants who represent the largest immigrant group in Norway. Anti-vaccine sentiments and increased refusal of mandatory childhood vaccination has been on the rise in Poland, but it is unknown whether such attitudes also apply to Polish immigrants in Norway, as they experience a different vaccination policy and perhaps also different attitudes to vaccines. This qualitative study aims to explore attitudes towards childhood vaccination in Norway among Polish immigrants.
METHODS: We interviewed 15 Polish parents living in Norway in 2022. We recruited the participants by purposive sampling and analyzed the interviews by reflexive thematic analysis.
RESULTS: Three themes were identified: views of childhood vaccination, vaccine hesitancy, and differences in childhood vaccination between Poland and Norway. Overall, the participants favored childhood vaccination and viewed most of the vaccines included in the NCIP as safe and reliable. Human papilloma virus, meningococcal and pneumococcal vaccines were declined by some of the parents. Comparisons of childhood vaccination in Poland and Norway was evident in many of the interviews, especially among parents whose children had received vaccines in both countries. The participants were well acquainted with the NCIP, favored voluntary childhood vaccination, and the majority expressed a high level of trust in Norwegian health authorities.
CONCLUSIONS: Polish immigrants to Norway generally expressed positive views about childhood vaccination. Non-vaccination was related to lack of knowledge and/or unfamiliarity with certain vaccines and not with anti-vaccine sentiments or conspiracy theories. The study highlights how parents\' knowledge, in combination with norms and trends from both birth country and country of residence, influence parents\' decision making about vaccination.

UNASSIGNED: The United States Food and Drug Administration authorized COVID-19 vaccines for children ages 5-11 years in October 2021 during the Omicron predominant period. Parental vaccine hesitancy was prevalent during this time, resulting in low childhood COVID-19 vaccine uptake. Most studies exploring factors influencing parental vaccine hesitancy have focused on racial and ethnic minorities and lower socioeconomic populations; however, there is little knowledge of the drive drivers of vaccine hesitancy among White parents with higher education and socioeconomic statuses.
UNASSIGNED: We conducted semi-structured interviews with a sample of 15 White mothers of children ages 5-11 years in Atlanta, GA, between October-December 2021. Thematic analysis was performed using NVivo 12.
UNASSIGNED: Mothers were college-educated, homeowners, and fully vaccinated against COVID-19. Key findings included decreased pediatrician\'s recommendations for COVID-19 vaccines, reliance on information from specialized doctors and scientists, distrust in public health authorities, high risk-perception of COVID-19 vaccines, and low risk-perception of COVID-19 disease. Factors related to vaccine acceptance were altruism and practicality.
UNASSIGNED: This study adds to the sparse literature on reasons for vaccine hesitancy among White mothers of children ages 5-11 years with higher educational and socioeconomic status. Improving vaccine uptake among this group is critical for protecting the health of their children and other vulnerable populations. Tailored vaccine messaging and intervention are warranted to address their unique attitudes, beliefs, and behaviors. An enhanced understanding of the factors influencing subpopulations of parents can help vaccine policymakers and healthcare providers improve efforts to reduce vaccine hesitancy, particularly for new vaccines.

BACKGROUND: The aim of this review was to investigate the impact of short message service (SMS)-based interventions on childhood and adolescent vaccine coverage and timeliness.
METHODS: A pre-defined search strategy was used to identify all relevant publications up until July 2022 from electronic databases. Reports of randomised trials written in English and involving children and adolescents less than 18 years old were included. The review was conducted in accordance with PRISMA guidelines.
RESULTS: Thirty randomised trials were identified. Most trials were conducted in high-income countries. There was marked heterogeneity between studies. SMS-based interventions were associated with small to moderate improvements in vaccine coverage and timeliness compared to no SMS reminder. Reminders with embedded education or which were combined with monetary incentives performed better than simple reminders in some settings.
CONCLUSIONS: Some SMS-based interventions appear effective for improving child vaccine coverage and timeliness in some settings. Future studies should focus on identifying which features of SMS-based strategies, including the message content and timing, are determinants of effectiveness.

Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants\' immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.