VoICE Immunization Evidence: Synergies Between Health System Programs
Synergies between health system programs
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.
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.
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.
The integration of maternal and child health interventions into immunization campaigns can lead to improved rates of immunizations and related healthcare interventions.
Key Evidence: In an effort to reach children with vitamin A deficiency in the African countries of Angola, Chad, Cote d’Ivoire, and Togo, vitamin A supplementation was administered during Polio vaccine campaigns. This led to a minimum coverage of 80% for vitamin A and 84% for polio vaccine in all of the immunization campaigns. During the second year of vitamin A integration into the polio vaccination campaign, coverage exceeded 90% for both vitamin A and polio vaccination in all four countries.
Children born to mothers who received health care services during pregnancy and/or delivery have higher vaccination rates than children whose mothers received less or no care.
Key Evidence: Kenyan children born outside of a health facility with the aid of a traditional birth attendant were around 80% more likely to be non-vaccinated or under-vaccinated than children born in a government health facility.
Key Evidence: Children in Pakistan born to women who had 3 or 4 antenatal care visits were 40-60% more likely to receive all required vaccines on time than children whose mothers made only 1 or 2 ANC visits.
Key Evidence: The likelihood of a child 12-23 months of age in Myanmar having completed their vaccinations was more than 3 times greater if his or her mother had received tetanus vaccination during pregnancy, and almost 2 times greater if she made at least 4 antenatal care visits than mothers who hadn’t, after other factors, such as parents’ educational level, household income, residence (rural vs. urban) and mother’s age, were controlled for.
Key Evidence: Mothers in a study in Ghana who used recommended maternal health care services — defined as at least 4 antenatal care visits, having a skilled attendant at birth, and delivery in a health facility — was a predictor of timely vaccination of their infants. Compared to children whose mothers received one or two of these services, infants born to mothers who received all three interventions were ≈30% more likely to be fully vaccinated by 12-23 months of age, while children whose mothers received none of these services were only about half as likely to be fully vaccinated. Investing in maternal health, which creates familiarity with the health system and increases mothers’ knowledge about disease prevention, can improve the health of both the mother and her children beyond infancy.
Key Evidence: Ethiopian mothers receiving any of three maternal health services — antenatal care, delivery services or tetanus vaccination — significantly increased the likelihood of their children being fully immunized by 12-23 months of age. Therefore, national immunization initiatives should concentrate on improving access of pregnant women to these key maternal health services.
Key Evidence: An analysis of rotavirus vaccine introduction in two Latin American countries (Honduras and Peru) suggests that the introduction of the vaccine might have had a favorable impact on coverage and timing of other similarly scheduled vaccinations.
Prenatal care-seeking can be combined with maternal immunization to compound the health benefits to mother and child while leveraging the cost-savings of integrating programs.
Key Evidence: Increased uptake of immunization for vaccine-preventable diseases, particularly in low- and middle-income countries, could save the lives of thousands of mothers and children each year. The disease burden of tetanus, influenza, and pertussis has been minimized in many countries through maternal immunization, but wider applications of this strategy are now needed.
Where routine immunization programs are well-established, introduction of new vaccines rarely causes major disruptions and may offer collateral benefits.
Key Evidence: In Rwanda, HPV vaccine introduction through a new school-based delivery program provided the opportunity to offer additional health services to all school-children (girls and boys), including health promotion sessions, de-worming and opportunities for voluntary, free circumcision.