Critical success factors for routine immunization performance: A case study of Zambia 2000 to 2018

Micek, Katie; Hester, Kyra A; Chanda, Chama; Darwar, Roopa; Dounebaine, Bonheur; Ellis, Anna; Keskinocak, Pınar; Leslie, Abimbola; Manyando, Mwangala; Nazzal, Dima; Ogutu, Emily Awino; Sakas, Zoe; Castillo-Zunino, Francisco; Kilembe, William; Bednarczyk, Robert A.; Freeman, Matthew C.; Banda, Lucy M.; Bueno, Natália S.; Dudgeon, Matthew R.; Escoffery, Cam; Isett, Kimberley R.; Jaishwal, Chandni; James, Hanleigh; Juma, Sheba; Kabengele, Chishiba; Kwendakwape, Chanda; MacKay, Rebecca A.; Montagnes, B. Pablo; Mwaanga, Annie M.; Omer, Saad B.; Orenstein, Walter A.; Phiri, Hilda; Pilingana, Lister; Rueda, Miguel R.; Rosenblum, Simone; Tsao, Vivian; Yu, Zhuoting

doi:10.1016/j.jvacx.2022.100166

Cited by 22 publications

(45 citation statements)

References 24 publications

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“…This study was part of the vaccine exemplars study, which assessed how and why some countries achieved high growth and sustained coverage of early childhood vaccination [23]. Using a case study positive deviant approach, we identified three such countries based on available country-level data on early childhood vaccination (Nepal, Senegal, and Zambia) [24,25,26]. Additional details of the selection of these countries can be found elsewhere [27].…”

Section: Methodsmentioning

confidence: 99%

Association of childhood vaccination with family planning, healthcare access, and women education: analysis of Nepal, Senegal and Zambia

Castillo-Zunino¹,

Hester²,

Keskinocak

et al. 2022

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Background Childhood vaccination, family planning, healthcare access, and women's empowerment are goals targeted by the Sustainable Development Goals (SDG). Barriers to healthcare access impede vaccination, and tackling goals holistically could create larger gains than siloed efforts. We studied Nepal, Senegal, and Zambia to test the association between childhood vaccinations and other SDG indicators to identify clustered deprivations. We quantified how children with few - or no - vaccines and their mothers were vulnerable in other SDG areas. Methods We analyzed Demographic and Health Surveys (DHS) from Nepal, Senegal, and Zambia. Through ordinal logistic regressions, controlling for household/mother's characteristics, we identified strong predictors of the number of vaccine doses one-year-old children received. Through bootstrapping and optimal propensity scores matching, we compared children with no or few childhood doses (0-2 doses in early 2000s, or 0-4 in late 2010s) to children who received eight doses (DTP1-3, MVC1, Pol1-3, and BCG vaccines). Findings Mothers of children who received eight doses were 14-30% more likely than mothers of children with few or no doses to have accessed a health facility in the last year (95% CIs were 16-44% in Nepal 2001, -5% to 33% Nepal 2016, 3-26% Senegal 2005, 1-31% Senegal 2019, 9-38% Zambia 2001-02, 7-36% Zambia 2018), knew on average 0.7-1.5 more contraceptive methods (0.9-2.0 Nepal 2005, 0.1-1.5 Nepal 2016, 0.6-1.7 Senegal 2005, 0.2-1.7 Senegal 2019, 0.1-1.4 Zambia 2001-02, 0.5-1.4 Zambia 2018), and had 10-22% higher literacy rates (12-32% Nepal 2001, -7% to 36% Nepal 2016, 10-26% Senegal 2005, -3 to 22% Senegal 2019, -4% to 28% Zambia 2001-02, 5-36% Zambia 2018). Interpretation Children with few or no vaccine doses and their mothers were behind in access to family planning, healthcare, and education compared to fully vaccinated children and their mothers. Such differences can further impede immunizations; therefore, integrated education and health services are needed to improve vaccination outcomes.

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Section: Methodsmentioning

confidence: 99%

Association of childhood vaccination with family planning, healthcare access, and women education: analysis of Nepal, Senegal and Zambia

Castillo-Zunino¹,

Hester²,

Keskinocak

et al. 2022

Preprint

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“…Past work has sought to synthesize and/or assess particular characteristics of successful immunization programs; nonetheless, few studies have expressly focused on both zero-dose children and incorporating mixed-methodologies with a positive outlier lens. For example, qualitative research in Senegal, Zambia, and Nepal points to factors including strong community engagement, integrated delivery, adaptive service provision, and robust data systems as central to improving and/or maintaining high levels of DTP1 and/or DTP3 [ 35 , 50 , 51 , 52 ]. However, the degree to which these approaches are fully transferable to communities with high zero-dose burdens remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Assessing Potential Exemplars in Reducing Zero-Dose Children: A Novel Approach for Identifying Positive Outliers in Decreasing National Levels and Geographic Inequalities in Unvaccinated Children

et al. 2023

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Background: Understanding past successes in reaching unvaccinated or “zero-dose” children can help inform strategies for improving childhood immunization in other settings. Drawing from positive outlier methods, we developed a novel approach for identifying potential exemplars in reducing zero-dose children. Methods: Focusing on 2000–2019, we assessed changes in the percentage of under-one children with no doses of the diphtheria–tetanus–pertussis vaccine (no-DTP) across two geographic dimensions in 56 low- or lower-middle-income countries: (1) national levels; (2) subnational gaps, as defined as the difference between the 5th and 95th percentiles of no-DTP prevalence across second administrative units. Countries with the largest reductions for both metrics were considered positive outliers or potential ‘exemplars’, demonstrating exception progress in reducing national no-DTP prevalence and subnational inequalities. Last, so-called “neighborhood analyses” were conducted for the Gavi Learning Hub countries (Nigeria, Mali, Uganda, and Bangladesh), comparing them with countries that had similar no-DTP measures in 2000 but different trajectories through 2019. Results: From 2000 to 2019, the Democratic Republic of the Congo, Ethiopia, and India had the largest absolute decreases for the two no-DTP dimensions—national prevalence and subnational gaps—while Bangladesh and Burundi registered the largest relative reductions for each no-DTP metric. Neighborhood analyses highlighted possible opportunities for cross-country learning among Gavi Learning Hub countries and potential exemplars in reducing zero-dose children. Conclusions: Identifying where exceptional progress has occurred is the first step toward better understanding how such gains could be achieved elsewhere. Further examination of how countries have successfully reduced levels of zero-dose children—especially across variable contexts and different drivers of inequality—could support faster, sustainable advances toward greater vaccination equity worldwide.

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“…Other qualitative analyses have found insufficient funds and resources and staffing issues as barriers to immunization [35,36]. Secondly, coordination and engagement of different levels of the country (e.g., ministry, districts/subnational, and local community) and stakeholders was crucial to public education to increase community demand and rollout of the programs [4][5][6]37]. Related to this, communication and feedback loops and incentives provided motivation for reaching immunization goals;…”

Section: Discussionmentioning

confidence: 99%

“…Countries have reported progress in vaccine delivery over the years; however, immunization coverage has varied widely among and within countries [2]. Several countries within Africa and SouthEast Asia regions have outperformed their peers with significant increases in routine immunization coverage since 2000 -including Nepal, Senegal, and Zambia [3][4][5][6]. Understanding the factors that contributed to the success of these countries can add to the existing literature and be adopted by other countries to improve their immunization program performance.…”

Section: Introductionmentioning

confidence: 99%

Drivers of Early Childhood Vaccination Success in Nepal, Senegal, and Zambia: A Multiple Case Study Analysis Using the Consolidated Framework of Implementation Research

Escoffery

Ogutu

Sakas

et al. 2023

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Introduction The fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed on how the related processes and implementation strategies - including the facilitators and barriers- contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success. Methods We conducted 277 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) to identify immunization program key facilitators and barriers. Results We found that the common facilitators to program implementation across the countries were the CFIR inner setting constructs of 1) networks and communications, 2) goals and feedback, 3) relative priority, and 4) readiness for implementation; and outer setting constructs of 4) cosmopolitanism and 5) external policies and mandates. The common barriers were incentives and rewards, available resources, access to knowledge and information, and patients needs and resources. Critical to the success of these national immunization programs were prioritization and codification of health as a human right, clear chain of command and shared ownership of immunization, communication of program goals and feedback, offering of incentives at multiple levels, training of staff central to vaccination education, the provision of resources to support the program, key partnerships and guidance on implementation and adoption of vaccination policies. Conclusion Adequate organizational commitment, resources, communication, training, and partnerships were the most critical facilitators for these countries to improve childhood vaccination.

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Critical success factors for routine immunization performance: A case study of Zambia 2000 to 2018

Cited by 22 publications

References 24 publications

Association of childhood vaccination with family planning, healthcare access, and women education: analysis of Nepal, Senegal and Zambia

Association of childhood vaccination with family planning, healthcare access, and women education: analysis of Nepal, Senegal and Zambia

Assessing Potential Exemplars in Reducing Zero-Dose Children: A Novel Approach for Identifying Positive Outliers in Decreasing National Levels and Geographic Inequalities in Unvaccinated Children

Drivers of Early Childhood Vaccination Success in Nepal, Senegal, and Zambia: A Multiple Case Study Analysis Using the Consolidated Framework of Implementation Research

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