Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand

Debela, Mulisa Senbeta; Garrett, A. P. Nick; Charania, Nadia A.

doi:10.1080/21645515.2022.2131336

Cited by 7 publications

(7 citation statements)

References 59 publications

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“…Mother and father's education, father's occupation, monthly family income, and previous loss of children were discovered to be associated with good vaccination practice. Our findings are congruent with that of Debela, Garrett and Charania [23] who studied the determinants of vaccine hesitancy among resettled refugee…”

Section: Plos Onesupporting

confidence: 92%

Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox’s Bazar, Bangladesh

et al. 2023

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Introduction Immunization campaigns and Expanded Program on Immunization (EPI) were launched by Government of Bangladesh (GoB) in collaboration with WHO and other Non-governmental Organizations (NGOs) to tackle the increased risk of vaccine preventable disease outbreak in the Rohingya refugee camps. Immunization coverage was found to be lower than expected. However, a few studies explored the factors behind low vaccine uptake among Refugee children. Therefore, this study was aimed. Methods A cross sectional study was carried out among Rohingya parents living in registered camps and makeshift settlements located in Teknaf and Ukhiya upazilla of Cox’s Bazar, Bangladesh. A total of 224 Rohingya parents were conveniently selected (122 parents from each type of camps). Data was collected using a pretested interviewer-administered semi-structured questionnaire with the help of bilingual volunteers who understand Rohingya dialect. All statistical analyses were carried out in IBM SPSS Version 26 (New York, USA). Results Total 63.1% of Rohingya parents had good practice regarding childhood immunization (completed EPI vaccination) as per schedule. Of all, 74.6% had good knowledge and 94.7% had positive attitude towards EPI vaccination. Good practice regarding vaccination was significantly more common among parents living in registered camps (77%) than those living in makeshift settlements (49.2%, p<0.001). Multivariable logistic regression analysis revealed that living in registered camps (Adjusted Odds Ratio [aOR]: 2.99; 95% Confidence Interval [CI]: 1.41–6.32) and good knowledge level (aOR: 2.88; 95%CI: 1.32–15.82) were independent determinants of good practice. A separate analysis in both type of camps revealed that in registered camps, good knowledge level (aOR: 3.62; 95%CI: 1.45–9.04) and having >2 children (aOR: 3.71; 95%CI: 1.34–10.27), and in makeshift settlements, father’s employment (aOR: 2.33; 95%CI: 1.34–6.72), father’s education (aOR: 3.00; 95%CI: 1.34–6.72) and presence of any electronic device (e.g., radio, television, mobile phone) (aOR: 4.01; 95%CI: 0.96–16.84) were significant determinants of good childhood immunization practice. Conclusion Health education and promotion strategies should be implemented to increase knowledge and awareness about EPI immunization benefits among Rohingya parents to ensure greater coverage.

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Section: Plos Onesupporting

confidence: 92%

Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox’s Bazar, Bangladesh

et al. 2023

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“…[55][56][57][58][59] Other explanations may be limited language ability or health literacy and lower confidence in vaccine information from the media. 59 We found a high degree of variation by region of origin (the range of differences in rates was 29.5 percentage points for second generation immigrant and refugee adolescents and 53.6…”

Section: Jama Network Open | Public Healthsupporting

confidence: 89%

“…Educational attainment is higher in protected persons than in resettled refugees and may explain differences within refugee groups in our study. Although evidence on parental education and vaccination acceptance is not universal, studies from North America, New Zealand, and Europe have reported a positive association . Other explanations may be limited language ability or health literacy and lower confidence in vaccine information from the media …”

Section: Discussionmentioning

confidence: 99%

“…Although evidence on parental education and vaccination acceptance is not universal, [52][53][54] studies from North America, New Zealand, and Europe have reported a positive association. [55][56][57][58][59] Other explanations may be limited language ability or health literacy and lower confidence in vaccine information from the media. 59 We found a high degree of variation by region of origin (the range of differences in rates was 29.5 percentage points for second generation immigrant and refugee adolescents and 53.6…”

Section: Jama Network Open | Public Healthmentioning

confidence: 99%

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COVID-19 Vaccine Uptake in Immigrant, Refugee, and Nonimmigrant Children and Adolescents in Ontario, Canada

Brandenberger

Duchen

et al. 2023

JAMA Netw Open

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ImportanceCOVID-19 vaccinations are recommended for minors. Surveys indicate lower vaccine acceptance by some immigrant and refugee groups.ObjectiveTo identify characteristics in immigrant, refugee, and nonimmigrant minors associated with vaccination.Design, Setting, and ParticipantsThis retrospective cohort study used linked, population-based demographic and health care data from Ontario, Canada, including all children aged 4 to 17 years registered for universal health insurance on January 1, 2021, across 2 distinct campaigns: for adolescents (ages 12-17 years), starting May 23, 2021, and for children (ages 5-11 years), starting November 25, 2021, through April 24, 2022. Data were analyzed from May 9 to August 2, 2022.ExposuresImmigrant or refugee status and immigration characteristics (recency, category, region of origin, and generation).Main Outcomes and MeasuresOutcomes of interest were crude rates of COVID-19 vaccination (defined as ≥1 vaccination for children and ≥2 vaccinations for adolescents) and adjusted odds ratios (aORs) with 95% CIs for vaccination, adjusted for clinical, sociodemographic, and health system factors.ResultsThe total cohort included 2.2 million children and adolescents, with 1 098 749 children (mean [SD] age, 7.06 [2.00] years; 563 388 [51.3%] males) and 1 142 429 adolescents (mean [SD] age, 14.00 [1.99] years; 586 617 [51.3%] males). Among children, 53 090 (4.8%) were first-generation and 256 886 (23.4%) were second-generation immigrants or refugees; among adolescents, 104 975 (9.2%) were first-generation and 221 981 (19.4%) were second-generation immigrants or refugees, most being economic or family-class immigrants. Immigrants, particularly refugees, were more likely to live in neighborhoods with highest material deprivation (first-generation immigrants: 18.6% of children and 20.2% of adolescents; first-generation refugees: 46.4% of children and 46.3% of adolescents; nonimmigrants: 18.5% of children and 17.2% of adolescents) and COVID-19 risk (first-generation immigrants; 20.0% of children and 20.5% of adolescents; first-generation refugees: 9.4% of children and 12.6% of adolescents; nonimmigrants: 6.9% of children and 6.8% of adolescents). Vaccination rates (53.1% in children and 79.2% in adolescents) were negatively associated with material deprivation. In both age groups, odds for vaccination were higher in immigrants (children: aOR, 1.30; 95% CI, 1.27-1.33; adolescents: aOR, 1.10; 95% CI, 1.08-1.12) but lower in refugees (children: aOR, 0.34; 95% CI, 0.33-0.36; adolescents: aOR, 0.88; 95% CI, 0.84-0.91) compared with nonimmigrants. In immigrant- and refugee-only models stratified by generation, region of origin was associated with uptake, compared with the overall rate, with the lowest odds observed in immigrants and refugees from Eastern Europe (children: aOR, 0.40; 95% CI, 0.35-0.46; adolescents: aOR, 0.41; 95% CI, 0.38-0.43) and Central Africa (children: aOR, 0.24; 95% CI, 0.16-0.35; adolescents: aOR, 0.51,CI: 0.45-0.59) and the highest odds observed in immigrants and refugees from Southeast Asia (children: aOR, 2.68; 95% CI, 2.47-2.92; adolescents aOR, 4.42; 95% CI, 4.10-4.77). Adjusted odds of vaccination among immigrants and refugees from regions with lowest vaccine coverage were similar across generations.Conclusions and RelevanceIn this cohort study using a population-based sample in Canada, nonrefugee immigrants had higher vaccine coverage than nonimmigrants. Substantial heterogeneity by region of origin and lower vaccination coverage in refugees persisted across generations. These findings suggest that vaccine campaigns need precision public health approaches targeting specific barriers in identified, undervaccinated subgroups.

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“…The refugee population is a vulnerable group, especially when it comes to adjusting to a new setting and with all certainties regarding their settlement (Kiselev et al, 2020 ). Also, parents with low health literacy about vaccination benefit are reported to delay their children to receive all of their vaccines (Debela, 2022 ). Therefore, we tried to address these needs by providing information about the benefits of vaccines, in form of visual information and simple text, as developed by experts at UNICEF and the World Health Organization (Khader et al, 2022 ).…”

Section: Discussion and Final Remarksmentioning

confidence: 99%

Children Immunization App (CIMA): A Non-randomized Controlled Trial Among Syrian Refugees in Zaatari Camp, Jordan

et al. 2023

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Approximately 20 million children are not vaccinated, especially among refugees. There is a growing access to smartphones, among refugees, which can help in improving their vaccination. We assessed the impact of an app for the vaccination follow-up visit among refugees in Jordan. We developed an app and tested it through a non-randomized trial at the Zaatari refugees camp in Jordan. The study was conducted during March – December 2019 at three vaccination clinics inside the camp. The study included two study groups (intervention and control groups) for refugees living at the camp. The intervention group included parents who own an Android smartphone and have one newborn that require between one and four first vaccination doses and they accepted to participate in the study, during their regular visit to the vaccination clinics. The control group was for the usual care. We compared both study groups for returning back to one follow-up visit, using Kaplan-Meier survival analysis. We recruited 936 babies (n = 471; 50.3% in the intervention group, both study groups were similar at baseline). The majority of mothers were literate (94.2%) with a median age of 24. The majority of the babies had a vaccination card (n = 878, 94%). One quarter (26%) of mother-babies pairs of the intervention group came back within one week (versus 22% for control group); When it comes to lost-follow-up, 22% and 28% did not have a history of returning back (intervention and control groups respectively, p = 0.06) (Relative risk reduction: 19%). The Kaplan-Meier Survival Analysis showed a statistically significant progressive reduction in the duration of coming back late for the follow-up vaccine visit. We tested a vaccination app for the first time, in a refugee population setting. The app can be used as a reminder for parents to come back on time for their children’s vaccine follow-up visits.

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Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand

Cited by 7 publications

References 59 publications

Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox’s Bazar, Bangladesh

Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox’s Bazar, Bangladesh

COVID-19 Vaccine Uptake in Immigrant, Refugee, and Nonimmigrant Children and Adolescents in Ontario, Canada

Children Immunization App (CIMA): A Non-randomized Controlled Trial Among Syrian Refugees in Zaatari Camp, Jordan

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