Thực trạng tiêm chủng đầy đủ, đúng lịch cho trẻ dưới 1 tuổi và một số yếu tố ảnh hưởng tại phường Tân Lợi, thành phố Buôn Ma Thuột, năm 2020

A cross-sectional descriptive study combining quantitative and qualitative methods is conducted with the objectives: 1/ Describe timely immunization completion for children under one year old and 2/ Analayze some factors affecting timely immunization completion for children under one year old in Tan Loi ward, Buon Ma Thuot city in 2020. The results indicated that timely immunization completion reached 95%, the rate of timely immunization completion was only 43.1%, the highest rate of vaccination against tuberculosis was 96.3%; The lowest rate was the 5-in-1 vaccination schedule for four-month-old children with 43.1%. The study found associations between occupation, educational level and ehenic (OR = 1.5-5, p<0,05). Two negative factors affecting the full and on schedule vaccination rate in the study area are the lack of attention and coordination of local authorities to participate in the immunization program, leading to some mothers, delaying or refusing to vaccinate their children Keywords: Immunization, Children under one year old, full, timely.

Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China

Background: Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. Methods: A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. Results: Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13–3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16–3.40). Conclusions: Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.

Clinical and epidemiological characteristics of measles in adults residents of the Altai territory

The aim of the study is to determine the clinical and epidemiological features of measles in the Altai territory. Materials and methods: a retrospective analysis of 92 medical histories of inpatient patients with a confirmed diagnosis of «Measles» at the age of 17 to 54 years, who were treated in the Infectious Departments of City Hospitals № 5 and №11 in Barnaul in 2015–2018, was made. Results: the epidemic situation of measles in the Altai territory is characterized by an increase of morbidity rate in 2015, as well as isolated cases in 2017–2018. The peculiarity of the outbreak of the disease was in-hospital infection of patients upon admission to medical hospitals and late diagnosis of measles, as well as the importation of infection from adjacent territories (regions of Russia and the Republic of Kazakhstan), which is confirmed by genotyping of the virus in patients. The development of the disease in 23,9% of those,who were vaccinated, was routinely observed in the age group older than 30 years. In the clinical picture of measles at the present stage, along with the classical manifestations, in 15.2% of patients in the first days of the disease gastroenteritis was marked, in 40,2% of patients the signs of hepatitis (cytolysis syndrome) were observed. Conclusion: the prevalence among the patientspersons, older than 30 years, may indicate the extinction of post-vaccination immunity. Timely immunization against measles in adulthood (after 30 years), will increase the effectiveness of measures to implement the program of elimination of measles in the Altai territory. The development of gastroenteritis up to the 5 days of the disease (on average 2,5±0.9 days), hepatitis in the period of height of the disease (in 15,2% and 40,2% of patients, respectively), determined the erroneous diagnosis of «Enterovirus infection», pseudotuberculosis, etc. and deserved the attention of practitioners.

THE ROLE OF THE PATRONAGE NURSE IN THE PREVENTION AND EARLY DETECTION OF DISEASES IN CHILDREN UP TO 12 MONTHS OF AGE

The potential of the health visitors’ home visit in prevention and early detection of diseases in children up to 12 months of age was evaluated by analysis of the correlation among the time of the neonatal death and causes of infant mortality in the Republic of North Macedonia for the period 2013-2017. It was found that the infectious diseases were the most attributable for neonatal deaths in infants older than 1 month suggesting the need for higher involvement of the health visitors in addressing this issue. The role of the health visitor is in terms of education, care, promotion of hygiene and improvement of living conditions, as well as in stimulating the exclusive breastfeeding of up to 6 months of age of the infant, and demystifying the parents' doubts regarding timely immunization. Through a cross-sectional on-line survey into the current situation in the Rep. N. Macedonia, it was found that a significant percentage of the respondents were dissatisfied with the counselling approach and the competence of the health visitor; some of them were not even visited by the service. Due to this dissatisfaction, the trust in the medical personnel is reduced, particularly regarding the immunization concerns. The survey data demonstrates the need for improvement of the health visiting service in terms of advancement in counselling skills, rigorous work monitoring, and higher level of health visitors training regarding the recognition of the symptoms of infectious diseases, the methods for successful breastfeeding, and their capability to raise awareness for timely immunization.

MODERN EPIDEMIOLOGICAL AND ECONOMIC CHARACTERISTICS OF WHOOPING COUGH IN MOSCOW

The goal of the study was the identification of epidemiological features of whooping cough and assessment of economic losses due to this disease in Moscow.Materials and methods. The retrospective descriptive epidemiological research is conducted. The statistical data on incidence of whooping cough in the Russian Federation and in Moscow from 2009 to June, 2018, the reports on registration of whooping cough cases as well as the results of laboratory testing on whooping cough in Moscow in 2017 have been studied. The general losses from whooping cough in Moscow in 2017 have been calculated.Results. The whooping cough incidence in Moscow considerably influences a situation on this infection in the country in general as more than 20% of all cases of whooping cough in Russia are registered in the capital, where the incidence exceed by 1.5–2.5 times the average country level. The incidence of whooping cough among children of 7–14 years and the share of this group of population in the structure of the whooping cough cases have increased in Moscow, and outbreaks of pertussis at schools are observed. In Moscow the general losses due to whooping cough in children of 7–14 years in 2017 were estimated as 19.72 million rubles. High performance of vaccinal prevention of whooping cough is confirmed: in Moscow in 2017 the coefficient of epidemiological efficiency of vaccination among children of 6-12 months was 97.7%, among children at the age of 1 year – 82.6%, 2 years -79.9%, 3 years – 74.9%. Weighted average of direct loss from a case of whooping cough was estimated as 31182.2 rubles. The general losses due to whooping cough in Moscow in 2017 were 67.88 million rubles.Conclusion. It is necessary to take additional measures for vaccinal prevention of whooping cough at children of school age and to support the high level of coverage by timely immunization of children of the first year of life. For assessment of economic feasibility of vaccinal prevention of whooping cough it is necessary to consider the size of economic losses due to this disease.

Assessment of timely immunization in an urbanized agglomeration of East Delhi, India

Background: The under-5 mortality rate in India has shown a decline in the last few decades. However, there is still a lot of work to be done for our country to achieve sustainable developmental goals. One of the factors contributing to child survival is immunization coverage, but high coverage does not mean timely vaccination. ‘On time’ immunization is an important yet little researched factor shielding a child from susceptibility to vaccine preventable diseases. This study aims at assessing the extent of timely immunization and predictors of intentional delay in vaccination of children.Methods: A cross-sectional study was conducted in East Delhi among caregivers having a child in the age group of 13-24 months. Sample size was calculated at 95% confidence limit and 3.5% absolute precision. The final sample size obtained was 350.Results: The percentage of fully and timely vaccinated children is 67.1%, whereas children fully vaccinated but with a delay of 4 weeks from the recommended age of administration is 19.7%. Partial vaccination was found in 11.2% of children and 2% of children were found to be not vaccinated. The most common reason for delay in immunization was pain at the time of administration leading baby cries and fear of needles (26.1%), followed by bad experience with previous vaccination (11.6%). Fear of side effects (14.5%) and being denied vaccination without card (11.6%) were other reasons.Conclusions: The immunization program should include timely completion of vaccination as a quality indicator. Delayed immunization can lead to epidemics in the community and threaten the goal of elimination of vaccine preventable diseases. Improving timeliness can be successfully achieved if the reasons for delay are taken into account.

Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

Routine childhood immunizations against infectious diseases are an integral part of our public health infrastructure. They provide direct protection to the immunized individual and indirect protection to children and adults unable to be immunized via the effect of community immunity. All 50 states, the District of Columbia, and Puerto Rico have regulations requiring proof of immunization for child care and school attendance as a public health strategy to protect children in these settings and to secondarily serve as a mechanism to promote timely immunization of children by their caregivers. Although all states and the District of Columbia have mechanisms to exempt school attendees from specific immunization requirements for medical reasons, the majority also have a heterogeneous collection of regulations and laws that allow nonmedical exemptions from childhood immunizations otherwise required for child care and school attendance. The American Academy of Pediatrics (AAP) supports regulations and laws requiring certification of immunization to attend child care and school as a sound means of providing a safe environment for attendees and employees of these settings. The AAP also supports medically indicated exemptions to specific immunizations as determined for each individual child. The AAP views nonmedical exemptions to school-required immunizations as inappropriate for individual, public health, and ethical reasons and advocates for their elimination.

Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule

OBJECTIVES To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children &lt;2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests. METHODS An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012. RESULTS The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children &lt;2 years requested to spread out vaccines; 21% reported ≥10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective. CONCLUSIONS Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.

Determinant of timely hepatitis B zero dose immunization in East Lombok, West Nusa Tenggara

Hepatitis B remains as one of health problem in the world. The results of several studies related to factors in predicting of timely hepatitis B immunization were still inconsistent. Aim of this study is to identify determinant of timely hepatitis B zero dose immunization in East Lombok. We used cross sectional design study derived from immunization coverage survey at six districts/cities in 2013. A Total of 227 children aged 12 to 23 months who already got immunization of hepatitis B zero dose and well documented were included as samples in this study. Timely immunization was defined based on the distance between time of birth and time of received hepatitis B immunization (zero dose) that is within 24 hours after birth. Data was analyzed using Chi-square and Logistic regression in multivariate level. The result of this study showed only 60.4% of children were get timely hepatitis B zero dose immunization. Mother’s behavior agains immunization program is the only factor that can predict the timely hepatitis B zero dose immunization (P-value 0.007 CI 95% 1.94-3.62). Meanwhile, other factors i.e. sex, socio-economic status, parent’s education, knowledge and attitude of mother and place of immunization service have not able to predict the outcome, statistically. The stakeholder should improve the optimal exsisting services, which will be impact to maternal behavior in immunization programe.Keywords : Immunization, Hepatitis Zero dose, Timely