Families who access the health system for non-vaccine services are more likely to have fully immunized children. Non-vaccine related healthcare encounters serve as opportunities to vaccinate children. – VoICE
Key Concept

Key Evidence: Communities with higher rates of health services utilization, particularly institutional childbirth, were more likely to have higher immunization coverage rates.

From the VoICE editors: This data, from a study in the Democratic Republic of Congo, had an adjusted odds ratio of 2.36.

Acharya P., Kismul H., Mapatano, M.A., et al. 2018. Individual- and Community-level Determinants of Child Immunization in the Democratic Republic of Congo: A Multilevel Analysis. PLOS One. 13(8).
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Key Evidence: Missed opportunities for vaccination i.e. percentage of children who failed to attain full immunization coverage (FIC) among those receiving one or more other health interventions were assessed through a study of 14 geographically diverse countries. In children with a vaccination rate below 70%, FIC was observed to be lowest in children born to mothers who failed to attend antenatal care across countries. The largest difference in FIC (54%) was observed in Côte d’Ivoire comparing children born to mothers who attended four or more ANC visits compared to no ANC visits. The presence of skilled birth attendant (SBA) was linked to higher rates of FIC with a 36% lower FIC in children born without a SBA in Nigeria. Post-natal care (PNC) acted as a factor contributing to 31% increase in FIC in the children who received PNC in Ethiopia. Vitamin A supplementation and sleeping under an insecticide treated bed net (ITN) were also positively linked to increase in FIC in the Democratic Republic of Congo and Haiti respectively.

Restrepo-Mendez, M.C., Barros, A.J., Wong, K.L.M., et al. 2016. Missed opportunities in full immunization coverage: findings from low- and lower-middle-income countries. Global Health Action. 9(1).
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Key Evidence: Mothers in Nigeria were between 2-4 times more likely to have fully immunized children if they attended 1-3 antenatal care (ANC) visits, between 2.5-8 times more likely if they attended 4-7 ANC visits, and between nearly 3-14 times more likely if they attended at least 8 ANC visits compared to those who had no ANC.

From the VoICE Editors: Similar findings have been seen in many LMICs, including Senegal, Bangladesh, Indonesia, India, Zimbabwe, and Southwest Ethiopia. 

Anichukwu OI and Asamoah BO 2019. The impact of maternal health care utilisation on routine immunisation. BMJ Open. 9(6).
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