Missed opportunities for immunization during visits for curative care: a randomized cross-over trial in Sudan

Abstract

Infants who come to health facilities for curative care in developing countries are usually not vaccinated at the same time. To assess what could be done a randomized cross-over study was carried out in twelve urban health centres in Sudan where two approaches were investigated: (1) the place for vaccination was moved very close to the consulting room, and (2) the doctor seeing the infant wrote a prescription recommending vaccination for the child. On average, 55% of the infants needing immunization were vaccinated when either of these approaches was followed. No difference was found between the two interventions in terms of the proportion of eligible children who were immunized (mean difference, 2%; 95% Cl, -4% to +7%). The more sick an infant appeared to be to the mother, the more likely she was to refuse vaccination. Older infants and infants not previously vaccinated were also less likely to be immunized. The number of missed opportunities can thus be reduced using these simple approaches. However, to immunize infants who are sick, unvaccinated, or have limited access to health facilities will require more social mobilization, health education, and outreach activities.

PIP: Infants who come to health facilities for curative care in developing countries are usually not vaccinated at the same time. To assess what could be done, a randomized cross-over study was carried out in 12 urban health centers in Sudan where 2 approaches were investigated: where the site for vaccination was moved very close to the consulting room and when the doctor seeing the infant wrote a prescription recommending vaccination for the child. On the average, 55% of the infants who required immunization were vaccinated when either of these approaches was followed. No difference was found between the 2 intervention approaches in terms of the proportion of eligible children who were immunized (mean difference, 2%; 95% confidence interval, -4%-+7%). The sicker the infant appeared to the mother, the more likely she was to refuse vaccination. Older infants and those not previously vaccinated were also less likely to be immunized. The number of missed opportunities can thus be reduced using these simple approaches. However, to immunize infants who are sick, unvaccinated, or have limited access to health facilities will require more social mobilization, health education, and outreach activities.