Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study

Abstract

Background Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. Methods A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18–54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. Results A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28–4.58; MCV2, OR = 1.42–3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). Conclusions Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China. Graphical abstract

Qualitative Insights on Barriers to Receiving a Second Dose of Measles-Containing Vaccine (MCV2), Oromia Region of Ethiopia

“…It is possible that the lack of information and awareness of the vaccine caused or compounded the reported misconceptions and rumors in the community. This is supported by studies conducted globally in low-, middle-, and high-income countries that have attributed limited awareness and consequent misconceptions both at individual and community levels to low MCV2 coverage [13][14][15]. The lack of caregiver awareness of MCV2 identified may be compounded by the reported limitations of MCV2 knowledge and skills to capacitate caregivers among trusted sources of information (HCWs and community leaders).…”

“…As the above lack of the perceived importance of MCV2 seems to originate from across the immunization ecosystem, steps to build a perception of the importance of the MCV2 vaccine need to occur at all levels. HCWs and community leaders might receive enhanced training and engagement on MCV2 and its purpose, an intervention that has been observed in existing research to correlate with increased immunization uptake [8,13,15]. Additionally, providing healthcare workers and community leaders training on communication/counseling skills and targeted literacy-level-appropriate messages about MCV2 may in turn increase community awareness of MCV2.…”

Knowledge and practices of vaccination for children with rheumatic diseases: A single-center study in China

“…Meanwhile, vaccinators should collaborate with rheumatologists to develop individual vaccination strategies for patients with PRDs based on their specific treatment. 21 , 40 , 41 …”

Health system barriers to timely routine measles vaccinations in rural southwest China: a qualitative study on the perspectives of township vaccination professionals and village doctors

“…Data were collected in 2015, and the delayed submission of this study can be attributed to the extensive time required for publishing quantitative survey series 58 and collating qualitative data in this study. Despite the fact that this study was conducted several years ago, findings not only have future implications for vaccination policymakers to eliminate vaccination-related health system barriers to timely routine vaccinations in rural China and other developing countries with similar barriers, but also offer profound lessons learnt to improve the timeliness of vaccinations in post-COVID-19 era.…”