REDUCING THE PERCENTAGE OF NON-VACCINATION OR INCOMPLETE VACCINATION OF DTP3 AND MEASLES-CONTAINING VACCINE (1 AND 2) AMONG CHILDREN UNDER SIX YEARS OF AGE IN THE SHAMAKHI REGION TO LESS THAN 5%

Hasanova S., Bayramova D., Najafov A., Safarli H., Chobanli R., Emek M.

7. Uluslararası 25. Ulusal Halk Sağlığı Kongresi, Antalya, Türkiye, 14 - 17 Aralık 2023, ss.571-575, (Tam Metin Bildiri)

Yayın Türü: Bildiri / Tam Metin Bildiri
Basıldığı Şehir: Antalya
Basıldığı Ülke: Türkiye
Sayfa Sayıları: ss.571-575
Akdeniz Üniversitesi Adresli: Evet

Özet

REDUCING THE PERCENTAGE OF NON-VACCINATION OR INCOMPLETE VACCINATION

OF DTP3 AND MEASLES-CONTAINING VACCINE (1 AND 2) AMONG CHILDREN UNDER

SIX YEARS OF AGE IN THE SHAMAKHI REGION TO LESS THAN 5%

Shabnam Hasanova1, Dunya Bayramova2, Abbasali Najafov3, Halima Safarli4, Rashad Chobanli5, Mestan Emek6

1Baku Main Medical Center

2Caspian Event Organisers

3The Administration of Regional Medical Divisions

4WHO Azerbaijan Country Office

5State Agency on Mandatory Health Insurence Azerbaijan

6Akdeniz University Faculty of Medicine Department of Public Health

Vaccines have been one of the greatest advances in global health and development for two centuries, safely

preventing the scourge of diseases such as polio, measles, and smallpox while helping children grow up healthy

and happy.

Thanks to immunization efforts around the world, children can walk, play, dance, and learn. Vaccinated children

perform better in school, leading to greater economic benefits. Today, vaccines are estimated to be one of the

most cost-effective means of improving global well-being. They act as a protective shield, keeping families and

communities safe. Despite these long-term benefits, low immunization rates persist. With the impact of the

pandemic, global vaccine coverage in 2021, which includes 3 doses of diphtheria-tetanus-pertussis vaccine

plus the first dose of measles, has fallen to an estimated 81%, the lowest level since 2008. Globally, 25.0 million

children were unvaccinated or incompletely vaccinated in 2021, 5.9 million more than in 2019(1).

Shamakhi region is located in the southeastern foothills of the Greater Caucasus at an altitude of 800 meters

above sea level, 118 km west of Baku. The Shamakhi region covers an area of 166.1 square kilometers with a

population density of 65 people per square kilometer. Each person in the region has access to 1.1 hectares of

agricultural land(2).

As of January 1, 2022, the total population of the region was 108,100 people, with 41,226 residing in the

city of Shamakhi. Among the population, 54,400 are men, and 53,700 are women. Approximately 47.0

percent of the region’s population lives in the city, while 53.0 percent resides in rural areas. There are 33 Rural

Administrative Districts in Shamakhi. The percentage of children aged 0-4 years is 8.0%. Shamakhi provides

a substantial healthcare infrastructure with 44 healthcare facilities. In terms of healthcare workers per 10000

inhabitants, Shamakhi is below the Azerbaijani average. While the number of physicians per 10000 people is

32.4 in the country as a whole, it is 11.1 in Shamakhi. While the number of nurses per 10000 people is 58.1, it

is 28.5 in Shamakhi. (3).

In Azerbaijan, the Hygiene and Epidemiological Centers, under the management of the Ministry of Health,

are responsible for the supply, cold chain, and records of the vaccines, while vaccine implementation occurs

at Primary Healthcare Centers managed by the Azerbaijani Management Union of Medical Territorial Units

(TABIB). As of 2022, the vaccination coverage of Azerbaijan and Shamakhi is shown in Table 1 below(4).

Table 1. The routine immunization coverage for the year 2022.

Azerbaijan Shamakhi

DTP1 89.9% 91.7%

DTP2 86.9% 91.5%

DTP3 83.1% 91.1%

MMR1 92.6% 86.3%

MMR2 90.7% 91.9%

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Although the values presented here are high, the denominator used for the inclusion calculation is not fully

known, so the extent to which the results reflect the real situation in society is open to debate.

Based on data provided by GAVI, 10,019 children in Azerbaijan were not vaccinated in 2021. Vaccination

percentages of the Republic of Azerbaijan differ by region. Among these indicators, there are regions with a

vaccination coverage of 70.0%(5).

WHO and UNICEF immunization coverage estimates for Azerbaijan in 2021 are shown below. The population

targeted by vaccines in the graph below has decreased by 32 percent between 2016 and 2021. The main

reason for this was the suspension of the service in 2020 and 2021 due to the COVID-19 pandemic(6). In

summary, it is observed that problems related to vaccination coverage increased during the pandemic period.

Figure 1 Azerbaijan: WHO and Unicef Estimates of Immunization Coverage 2021 Revision

For whatever reason failure to vaccinate children can lead to the re-spreading of diseases that have not been

seen in recent times and, in severe cases, can lead to their death or disability.

As a result of the literature review, four main groups of cases of non-vaccination or delay in vaccination of

children were identified:

• Hesitation (fear of repercussions, misinformation, insecurity, religious views, low level of education of

parents, etc.)

• Healthcare workers-related issues (lack of continuing education modules, presence of unjustified

contraindications, waiting time after vaccination, etc.)

• Accessibility challenges (people with low welfare living in hard-to-reach villages, vaccination of the

population only in institutions where they are registered, lack of vaccination visits in rural areas)

• Registration, follow-up, monitoring and coordination (deficiencies in the system, lack of follow-up of

unvaccinated children)

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Figure 2 below shows the causal network for the presence of children not vaccinated or delayed vaccination

until age 6.

Figure 2. Causal Network for The Presence Of Children Not Vaccinated or Delayed Vaccination Until Age 6.

Action plan

After analyzing the detailed assessment results, unvaccinated children are assigned and involved in vaccination.

Aim: Reduce the percentage of non-vaccination or incomplete vaccination of DTP3 and measles-containing

vaccine (1 and 2) among children under six years of age in the Shamakhi region to less than 5% during the

next one year (01.01.24-31.12.24).

Objectives:

• Evaluation of the current situation regarding vaccination coverage in children under six years of age

• Investigating and evaluating the reasons for vaccine refusal or delay and taking appropriate action

• To make recommendations for the improvement of the vaccine registration system

• Preparation of updated continuous educational programs on vaccination to increase the knowledge of

healthcare workers on vaccination (especially pediatricians)

• Increasing coordination between HEC(Hygiene Epidemiology Center) and TABIB

• Increasing accessibility

In the first phase, information on non-vaccination will be collected and analyzed from the TABIB, HECs, and

nursery and kindergartens to assess the current situation. At this stage, a sample representative of Shamakhi

will be selected and a vaccine coverage survey will be conducted. A coordination group will be established

between HEC and TABIB to analyze the available data and monthly vaccination assessment meetings will be

held. Analysis and monitoring of immunization practices will be developed as specified in the “Immunization

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Program for the Prevention of Communicable Diseases between 2023-2027” dated 20 June 2023(7).

Immunization practices and records in institutions will be closely monitored through institutional visits. In

particular, real and false contraindications in immunization practices will be reviewed.

In cooperation with the immunization training team previously formed in Shamakhi, training will be started

for health workers who have not received training. For those who have already received training, updated

training will be provided. During the monitoring, suggestions for improving the existing Health Information

system on immunization will be shared with TABIB and the Ministry of Health. To increase accessibility, the

frequency of mobile services to remote villages and the number of vaccination visits will be increased.

The program model of the intervention is presented in Figure 3.

Figure 3. Program model of intervention plan Reducing the percentage of non-vaccination or incomplete

vaccination children in Shamakhi