Towards a Strategy for Reducing Missed Opportunities for Vaccination in Malawi: Implications of a Qualitative Health Facility Assessment

Abstract

Background Missed opportunities for vaccination (MOVs), estimated to be about 32-47% of child healthcare clinic visits in various settings globally, contribute to unfulfilled childhood vaccination coverage targets in the African region. Objective We assessed the extent of MOVs, identify local drivers and test interventions to reduce MOVs in Malawi. Methods We conducted in-depth and key informant interviews with administrators of district hospitals and officers in charge of community health facilities. Focus group discussions were held with health workers and caregivers of children under 24 months of age who received services from study health facilities in Malawi. Coverage rates were collected from the health facility records Results Vaccination is appreciated in the communities, but coverage is generally below targets. In some facilities, reported coverage was less than 50%. Opportunities to provide up-to-date vaccination for children were missed due to lack of awareness and knowledge of health workers and caregivers, attitude and priority of health workers, long waiting time, poor coordination and referral of eligible children by clinicians and nurses and overall lack of a team approach to vaccination perceived as a responsibility of health surveillance assistants. Other notable issues included limited time of caregivers labouring on estate farms, unavailability of vaccines resulting from poorly functioning of cold chain equipment and limited transport and failure to appreciate the impact of MOV on poor immunization coverage. Conclusion Simple, low-cost, pragmatic and community-driven interventions that may reduce MOVs and improve vaccine coverage

Assessment of missed opportunities for vaccination in Kenyan health facilities, 2016

“…A missed opportunity for vaccination (MOV) includes any contact with health services by a child (or adult) who is eligible for vaccination (unvaccinated, partially vaccinated, or not upto-date, and free of contraindications to vaccination), which does not result in the individual receiving all the vaccine doses for which he or she is eligible [1,2]. Studies have shown that MOV can occur for a variety of reasons including health workers not checking vaccination status, limited integration of vaccination services with other health services, a shortage of staff administering vaccines, poor vaccination card retention, and stock-outs of vaccines or related supplies [1,[3][4][5][6][7][8][9]. MOV may be hindering countries from increasing their vaccination coverage; successful efforts to address MOV have the potential to help countries reach their immunization targets, improve timeliness, and promote integration between health programs.…”

Health workers’ perceptions and challenges in implementing meningococcal serogroup a conjugate vaccine in the routine childhood immunization schedule in Burkina Faso

“…In an analysis of 46 countries, including Burkina Faso, one study revealed that missed opportunities to vaccinate children with MCV were more frequent than for diphtheria-pertussis-tetanus (DPT) vaccine or oral polio vaccine; this may in part be due to the fact that MCV is a lyophilized vaccine and must be discarded within a 6-to 8-h window once reconstituted or at the end of the immunization session, whichever comes first, whereas DPT and polio vaccines can be used as long as the Vaccine Vial Monitor is valid or the vaccine is not expired [30]. These findings point to the need to emphasize the WHO recommendation [31] to open a multi-dose vial for even one eligible child in order to decrease missed opportunities for vaccination [31]; health worker training should be done for new hires along with in-service training of existing staff to reinforce appropriate practices [32].…”

Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis (Preprint)

“…While there is currently limited evidence on the structural and contextual factors responsible for missed opportunities for vaccination in different contexts, research efforts in this area have increased in recent years. As a result, there has been an increasing body of evidence on the prevalence of missed opportunities for vaccination and associated factors over the last decade, including in African and other low-and middle-income countries contexts [46][47][48][49][50][51]. To date, however, there remain enormous gaps in what is known.…”