Missed Opportunities for Vaccination in the Dominican Republic: Results of an Operational Investigation

Abstract

Background. Despite the success of the Dominican Republic's National Immunization Program, homogenous vaccine coverage has not been achieved. In October 2012, the country implemented a study on missed opportunities for vaccination (MOVs) in children aged <5 years. Methods. A cross-sectional study of 102 healthcare facilities was implemented in 30 high-risk municipalities. Overall, 1500 parents and guardians of children aged <5 years were interviewed. A MOV is defined as when a person who is eligible for vaccination and with no contraindications visits a health facility and does not receive a required vaccine. We evaluated the causes of MOVs and identified risk factors associated with MOVs in the Dominican Republic. Results. Of the 514 children with available and reliable vaccination histories, 293 (57.0%) were undervaccinated after contact with a health provider. Undervaccinated children had 836 opportunities to receive a needed vaccine. Of these, 358 (42.8%) qualified as MOVs, with at least one MOV observed in 225 children (43.7%). Factors associated with MOVs included urban geographic area (OR = 1.80; p = 0.02), age 1–4 years (OR = 3.63; p ≤ 0.0001), and the purpose of the health visit being a sick visit (OR = 1.65; p = 0.02). Conclusions. MOVs were associated primarily with health workers failing to request and review patients' immunization cards.

Missed opportunities and barriers for vaccination: a descriptive analysis of private and public health facilities in four African countries

“…Immunization histories of the sick children and their illness severity are unknown, so it is not possible to ascertain the proportion of children eligible for vaccination who were not screened. A recent study in Dominican Republic [ 24 ] found that 53% of children visiting health facilities for illness and eligible for vaccination had MOV, compared to 40% of children visiting for vaccination. A review of 57 studies of MOV [ 6 ] found a pooled MOV prevalence among children of 32.2%; the most common reasons for MOV related to health care provider practices, of which not reviewing immunization cards or vaccination history were the most common.…”

Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities

“…This suggests the occurrence of MOV, as children had contact with health services to receive some, but not all vaccines they were eligible for [17]. As seen from these reports, previous studies assessing MOV or factors related to MOV have been limited in scope and have used varying methodologies, leading to limitations in comparability and varying interpretations [15,16,[18][19][20][21][22][23].…”

Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization’s revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage

“…Reducing MOV requires contextual evidence regarding the prevalence of MOV and its contributing factors. Several studies have investigated MOV elsewhere [10] , [11] , [12] , [13] , [14] , [15] , [16] , but to our knowledge there have been none to date in Burkina Faso.…”