Academic journal article International Journal of Child and Adolescent Health

Measles-Rubella Immunization Coverage and Associated Factors in the Southern Province of Zambia

Academic journal article International Journal of Child and Adolescent Health

Measles-Rubella Immunization Coverage and Associated Factors in the Southern Province of Zambia

Article excerpt

Introduction

Measles remains one of the top vaccine-preventable killers of children worldwide while rubella continues to be the main cause of congenital birth defects referred to as congenital rubella syndrome (CRS). The World Health Organization (1) estimates that more than 100,000 babies are bom with CRS each year and the majority are in Africa and SouthEast Asia. Rubella poses an ongoing threat for millions of mothers and their children in developing countries because when a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing on the defects (CRS) to the unborn child (2). Recent studies on measles in subSaharan Africa also indicate that between 0.5 and 10% of children who get measles die from it (3) and that in the absence of vaccination, almost 100% of the population become infected with measles (4).

Despite the fact that not all children get vaccinated during routine and major campaigns, it is clear that vaccines reduce morbidity and mortality (5). Determinants of immunization coverage vary from one community to the other and researchers have identified factors relating to the likelihood of parents to have their children immunized. While in developing countries inadequate access to immunization and background characteristics such as low education, literacy and socio-economic status explain why children are not immunized, in developed countries parents make a conscious decision not to use readily available vaccines (6). Low immunization coverages continue to characterize the immunization efforts in many countries especially in sub-Saharan countries. Household size, education and occupation have an impact on immunization coverage (7). Skepticism for vaccination has been observed to be high among maternal parents with less education (8) and Brenner et al. (9) in another study observed that maternal employment status was significantly associated with being up-to-date with vaccination status. Another study indicates that paternal parent involvement in maternal child health programs positively influence vaccination status rates (10). Other factors observed to be associated with immunization seeking behavior include age and wealth (11). Factors such as low income and multiple children in a home have also been identified as being strongly associated with under vaccination (12). It is further noted that most immunization coverages indicate low estimate coverages for older children and this has been attributed to poor documentation of vaccination of older children compared to younger children (7). Consistent results suggest that education and information about vaccination influence vaccine acceptance in the population (13, 14).

In many wealthy and middle-income countries, improvements in living standards, nutrition, and quality of health care have reduced the measles mortality rate to such low levels that many citizens no longer perceive measles or rubella as a serious problem. When individuals no longer see cases of a previously common disease they begin to believe the vaccine no longer provides benefits. Thus, successful vaccination programs can begin to suffer from public misperceptions that any risks associated with the vaccine might outweigh the invisible benefits. It is such misperceptions that may lead to resurgence of measles in developing countries. WHO observed that the resurgence of measles in Africa during 2009 and 2010 occurred largely due to underlying weaknesses in health systems, including difficulties in reaching and sustaining high vaccination coverage (15).

Although rubella vaccine has been available since 1969, it is still underused in some regions of the world, for instance, in Africa only a few countries routinely immunize against rubella. Based on the United Nations country classification, rubella vaccine is used in 92% of industrialized countries and 36% of those with economies-in-transition, and only 28% of developing countries (16). For the countries that have introduced rubella vaccine, few report any data on the impact of vaccination. …

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