Are children on track with their routine immunization schedule in a fragile and protracted conflict state of South Sudan? A community-based cross-sectional study

Abstract

Objectives The objective of this study was to assess if children aged 0–23 months in a conflict-affected state of South Sudan were on track with their immunization schedule and to identify predisposing factors that affected this study population from being on track with their routine immunization schedule. Design Community-based cross-sectional study using a semi-structured questionnaire. The binary outcome of interest was defined as being on or off track with routine vaccination schedule. Multivariable logistic regression was used to analyze for the association between the predisposing factors surveyed and being off track with one’s routine immunization schedule. Setting Rural communities in four counties (Rumbek Center, Rumbek North, Rumbek East and Wulu) of the Western Lakes state in South Sudan during January 10, 2020 to June 10, 2020. Participants We surveyed 428 children aged 0–23 months and their mothers/caregivers who lived in either of the four counties in the Western Lakes State. Participants were selected using random ballot sampling. Results More than three-quarters of the children surveyed (75.5%) were off track with their vaccination schedule. Children with an immunization card had 71% reduced odds of being off track with their immunization (AOR = 0.29; 95% CI 0.10–0.83, p-value = 0.021) compared to children without immunization cards. Children who reside near health facilities and do not require transportation to facilities had 87% reduced odds of being off track with their immunization compared to those who lived far and required transport to facilities. Giving an adequate immunization notice before conducting immunization outreach visits to communities was also associated with reduced odds (AOR = 0.27; 95% CI 0.09–0.78. p-value = 0.016) of children being off track with their immunization. Conclusion This study revealed that most children were off track with their vaccination schedule in South Sudan, which is not only influenced by maternal characteristics but mainly by community- and state-level immunization service delivery mechanisms. Policies and interventions to improve child immunization uptake should prioritize these contextual characteristics.

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

“…The HP state government also used drum beating for reaching the caregivers during the periodic routine immunization intensification campaign known as Mission Indradhanush. Consistent with the drum beating initiative, Idris et al reported that in the fragile and conflict settings prior notification to the community before conducting the outreach immunization helped in the on-time vaccination of children [10]. Abdur, et al suggested the use of public announcements using loudspeakers to make uneducated caregivers aware of the timely vaccination of children in the hard-to-reach areas [11].…”

Why are missed opportunities for immunisation and immunisation defaulting among children indistinguishable?

“…Defaulters, on the other hand, have recently been defined as a child who is off track with their immunization schedule (18) or a delayed immunized child [ 19 ], who has not received his eligible vaccine dose for 28 days or more of delay according to its country's recommended schedule. Nonetheless, these researchers included children aged 0–23 months in their study [ 18 , 19 ].…”

Leveraging the CORE Group Partners Project Polio Infrastructure to Integrate COVID-19 Vaccination and Routine Immunization in South Sudan

“… 12 A 2020 community-based cross-sectional study in rural communities in 4 counties of South Sudan’s Western Lakes State found that 75.5% of children were not following the prescribed immunization schedule. 13 The RI schedule in South Sudan covers children aged younger than 1 year but has expanded to children up to age 23 months to account for significant population movement. Additionally, RI for women of childbearing age provides vaccines for tetanus and diphtheria.…”