Uptake and determinants of routine immunization among vulnerable children and adolescents in sub-Saharan Africa: A scoping review

IF 4.5 3区医学 Q2 IMMUNOLOGY Vaccine Pub Date : 2025-03-20 DOI:10.1016/j.vaccine.2025.127021

Christine Karanja Chege , Serah Karanja , William Ogallo , Fred Were , Michael Boele van Hensbroek , Ambrose Agweyu

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Abstract

Background

Despite notable improvements in coverage of immunization services in sub-Saharan Africa (SSA) over recent decades, there are marked inequities across populations. We undertook a scoping review to study the uptake and determinants of routine immunization (RI). This is the health system component that regularly delivers vaccination services to eligible populations as set out in national immunization schedules among vulnerable children and adolescents in sub-Saharan Africa.

Methods

We adopted the population-concept-context format to address the 2 research questions. The population was vulnerable children and adolescents from birth to 18 years from 2010 to 2020. The context was sub-Saharan Africa. An electronic search was conducted in PubMed, SCOPUS and African Journals Online, following which the selected studies were entered into a data extraction tool. Estimates of immunization uptake as well as quantitative and qualitative synthesis of demand and supply determinants of immunization were carried out.

Results

Out of the 6040 studies screened, 68 articles were finally selected.

Nineteen of these focused on older children and adolescents (9–18 years).

RI uptake ranged from 1/201 (0.01 %; 95 % CI:0.01–0.03) to 205/216 (95 %; 95 % CI:0.92–0.97). Demand-related factors that were positively correlated with RI uptake were non-Muslim religion (aOR:1.56,95 % CI:1.11–2.17), high caregiver vaccination knowledge (aOR:3.30,95 % CI:0.26–3.56), high household socio-economic status (aOR:1.25,95 % CI:1.04–1.49) and short distance from health facility (aOR:1.63,95 % CI:1.10–2.39). Attendance of less than 4 antenatal visits (aOR:0.47,95 %CI:0.32–0.67) and Somali ethnicity (aOR:0.41,95 %CI:0.19–0.91) were negatively associated with RI uptake. Only 3 quantitative studies examined supply determinants of immunization uptake. Conducive health facility attributes were positively correlated with RI uptake (aOR:2.21,95 % CI:1.22–3.98) while the cost of obtaining vaccination (aOR:1.01,95 % CI:0.63–1.60) and health worker shortage (aOR:0.33,95 % CI:0.02–0.13) were negatively correlated.

Conclusion

RI uptake among vulnerable sub-populations of children and adolescents varies widely. There is a paucity of studies on supply-side determinants of routine immunization uptake and also among adolescents.

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撒哈拉以南非洲弱势儿童和青少年常规免疫接种的接受率和决定因素：范围审查。

背景：尽管近几十年来撒哈拉以南非洲（SSA）的免疫服务覆盖率显著提高，但人群之间存在明显的不平等。我们进行了一项范围审查，以研究常规免疫（RI）的摄取和决定因素。这是卫生系统的组成部分，根据撒哈拉以南非洲国家脆弱儿童和青少年免疫计划的规定，定期向符合条件的人群提供疫苗接种服务。方法：采用人口-概念-语境的形式来回答两个研究问题。2010年至2020年的人口为出生至18岁的弱势儿童和青少年。背景是撒哈拉以南非洲。在PubMed、SCOPUS和非洲在线期刊中进行了电子检索，随后将选定的研究输入到数据提取工具中。对免疫摄取进行了估计，并对免疫需求和供应决定因素进行了定量和定性综合。结果：在6040项研究中，最终选择了68篇。其中19项重点是年龄较大的儿童和青少年（9-18岁）。RI摄取范围为1/201 (0.01%；95% CI:0.01-0.03)至205/216 (95%；95% ci:0.92-0.97)。需求相关因素与RI吸收呈正相关的是非穆斯林宗教（aOR:1.56, 95% CI:1.11-2.17）、高护理人员疫苗接种知识（aOR:3.30, 95% CI:0.26-3.56）、高家庭社会经济地位（aOR:1.25, 95% CI:1.04-1.49）和距离卫生设施较近（aOR:1.63, 95% CI:1.10-2.39）。产前出诊少于4次（aOR:0.47, 95% CI:0.32-0.67）和索马里族裔（aOR:0.41, 95% CI:0.19-0.91）与RI摄取呈负相关。只有3项定量研究检查了免疫摄取的供应决定因素。有利的卫生设施属性与疫苗接种吸收率呈正相关（aOR:2.21, 95% CI:1.22-3.98），而获得疫苗接种的成本（aOR:1.01, 95% CI:0.63-1.60）和卫生工作者短缺（aOR:0.33, 95% CI:0.02-0.13）呈负相关。结论：儿童和青少年易感亚人群的RI摄取差异很大。关于常规免疫接种的供应方决定因素的研究很少，在青少年中也是如此。

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

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