TY - JOUR
T1 - Development of a cumulative metric of vaccination adherence behavior and its application among a cohort of 12-month-olds in western Kenya
AU - Benzaken, Casey L.
AU - Miller, Joshua D.
AU - Onono, Maricianah
AU - Young, Sera L.
N1 - Funding Information:
This work was supported by the National Institute of Mental Health (K01 MH098902 and R21 MH108444). The views and conclusions contained herein are those of the authors and should not be interpreted as those of the National Institute of Mental Health or the National Institutes of Health.We thank the Kenya Medical Research Institute (KEMRI) for providing space within the FACES clinics for the work to be conducted, logistic support to conduct this research, and oversight in Kenya. We would also like to warmly thank Abigail Smith for statistical advice, study nurses and study trackers, the mothers and their infants who participated in this study, as well as students in Dr. Young's course, ?Methods in Global Health & Anthropology: Turning Numbers into a Story?, who provided feedback on early versions on this project.
Funding Information:
This work was supported by the National Institute of Mental Health ( K01 MH098902 and R21 MH108444 ). The views and conclusions contained herein are those of the authors and should not be interpreted as those of the National Institute of Mental Health or the National Institutes of Health .
PY - 2020/4/16
Y1 - 2020/4/16
N2 - Objectives: The timely receipt of the recommended vaccination regimen, i.e. vaccination maintenance, is an underexplored, but important, indicator of public health. There is currently no standardized method for quantifying cumulative vaccination maintenance, however, and no simple way to explore predictors of adherence to vaccination schedules. We therefore sought to (1) develop a Vaccination Maintenance Score (VMS) and (2) apply this score to determine the predictors of vaccination behavior among infants in western Kenya (n = 245). Methods: Women in western Kenya were enrolled during pregnancy and surveyed repeatedly through one year postpartum. Data were collected on a range of sociodemographic and health indicators and vaccinations. For each infant, we analyzed receipt of 11 vaccines recommended by the Kenyan Ministry of Health. We operationalized VMS as the total number of vaccines received on schedule. Vaccines that were not received or received off schedule were scored 0. VMS was modeled using multivariable tobit regression models. Results: We found that 85.7% of infants were fully immunized, but only 42.4% had optimal VMS, i.e. scored 11. The median (IQR) VMS was 10 (3). In multivariable regression, each one-point increase in maternal quality of life score (range: 0–32) was associated with a 0.22-point increase in VMS; each additional child in the household was associated with a 0.34-point increase in VMS; and initiating breastfeeding at birth was associated a 2.01-point increase in VMS. Conclusions: Coverage of the recommended vaccinations (85.7%) was nearly twice as high as cumulative timely receipt (42.4%). The VMS satisfies a need for a location-specific but easily adaptable metric of vaccination adherence behavior. It can be used to complement traditional methods of vaccination coverage and timeliness to better understand underlying behaviors that influence vaccination events, and thereby inform interventions to improve vaccination rates and decrease the burden of vaccine-preventable disease. Clinical Trial Registration: NCT02974972 and NCT02979418.
AB - Objectives: The timely receipt of the recommended vaccination regimen, i.e. vaccination maintenance, is an underexplored, but important, indicator of public health. There is currently no standardized method for quantifying cumulative vaccination maintenance, however, and no simple way to explore predictors of adherence to vaccination schedules. We therefore sought to (1) develop a Vaccination Maintenance Score (VMS) and (2) apply this score to determine the predictors of vaccination behavior among infants in western Kenya (n = 245). Methods: Women in western Kenya were enrolled during pregnancy and surveyed repeatedly through one year postpartum. Data were collected on a range of sociodemographic and health indicators and vaccinations. For each infant, we analyzed receipt of 11 vaccines recommended by the Kenyan Ministry of Health. We operationalized VMS as the total number of vaccines received on schedule. Vaccines that were not received or received off schedule were scored 0. VMS was modeled using multivariable tobit regression models. Results: We found that 85.7% of infants were fully immunized, but only 42.4% had optimal VMS, i.e. scored 11. The median (IQR) VMS was 10 (3). In multivariable regression, each one-point increase in maternal quality of life score (range: 0–32) was associated with a 0.22-point increase in VMS; each additional child in the household was associated with a 0.34-point increase in VMS; and initiating breastfeeding at birth was associated a 2.01-point increase in VMS. Conclusions: Coverage of the recommended vaccinations (85.7%) was nearly twice as high as cumulative timely receipt (42.4%). The VMS satisfies a need for a location-specific but easily adaptable metric of vaccination adherence behavior. It can be used to complement traditional methods of vaccination coverage and timeliness to better understand underlying behaviors that influence vaccination events, and thereby inform interventions to improve vaccination rates and decrease the burden of vaccine-preventable disease. Clinical Trial Registration: NCT02974972 and NCT02979418.
KW - Kenya
KW - Vaccination adherence
KW - Vaccination coverage
KW - Vaccination maintenance
KW - Vaccination timeliness
KW - sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=85081921082&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081921082&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2020.03.011
DO - 10.1016/j.vaccine.2020.03.011
M3 - Article
C2 - 32184035
AN - SCOPUS:85081921082
VL - 38
SP - 3429
EP - 3435
JO - Vaccine
JF - Vaccine
SN - 0264-410X
IS - 18
ER -