Main Article Content
Abstract
RÉSUMÉ
Introduction. Dans un contexte où les taux de couverture vaccinale sont faibles, les hospitalisations sont une occasion pour s’assurer de la vaccination des enfants. L’étude avait pour but de préciser les déterminants et raisons de non vaccination complète des enfants hospitalisés dans deux hôpitaux à Yaoundé. Méthodologie. Notre étude transversale a porté sur les enfants admis dans deux hôpitaux de référence de Yaoundé. Les connaissances des mères sur la vaccination ont été analysées, de même que le motif d’hospitalisation. La recherche des contacts antérieurs des enfants avec les formations sanitaires (FOSA) permettait d’explorer d’éventuelles occasions manquées de vaccination. Les facteurs associés et les raisons de la vaccination incomplète étaient également décrits. Résultats. Nous avons colligé les informations sur 205 sujets parmi lesquels 75,1% âgés de moins de 3 ans. Les principaux motifs d’hospitalisation étaient le paludisme (49,3%) et la pneumonie (14,1%). La plupart des parents connaissaient la vaccination (86,3%) ainsi que son rôle (92,1%) avec pour principale source d’information le personnel de santé (68,4%). La complétude vaccinale globale était de 40%, soit 65,9% et 50,3% pour les vaccins de routine (PEV) et hors PEV respectivement. Cette complétude n’était pas retrouvée chez 60% des patients bien que 90% aient fréquenté une FOSA. Les occasions manquées de vaccination s’élevaient à 65,7% et 61,8% pour le PEV et les vaccins hors PEV respectivement. Les raisons de non vaccination étaient dominées par l’ignorance (65,9%) et les ruptures en stock de vaccin (21,1%). Cependant, le niveau d’étude secondaire (p=0,020), la présence d’une pneumonie (p=0,020) et le fait d’être premier enfant influençaient négativement la vaccination (p=0,008). Conclusion. La complétude vaccinale était insuffisante malgré de bonnes connaissances des parents sur l’importance de la vaccination. Il est important d’agir sur les occasions manquées, surtout chez les ainés et les enfants des mères d’un faible niveau d’étude.
ABSTRACT
Introduction. Several preventable diseases are still responsible for high morbidity and mortality in children due to inadequate vaccination. In a context where vaccination coverage rates are low, hospitalization is an opportunity to ensure immunization of children. The aim of the study was to describe the missed opportunities of vaccination as well as the associated factors and reasons for incomplete vaccination in children. Methodology. This was a cross-sectional study focused on children admitted in two reference hospitals in Yaoundé. Mothers' knowledge of immunization was analyzed, as was the reason for hospitalization. The inquiry for previous contacts of the children with the health facilities made it possible to explore possible missed opportunities of vaccination. The associated factors and reasons for incomplete vaccination were also described. Results. We collected information on 205 children, of which 75.1% were younger than 3 years of age. The main reasons for hospitalization were malaria (49.3%) and pneumonia (14.1%). Most parents were aware of immunization (86.3%) and their role (92.1%) with health workers as the main source of information (68.4%). The overall vaccine coverage was 40%, ie 65.9% and 50.3% for routine (EPI) and non-EPI vaccines, respectively. This coverage was not found in 60% of the patients although 90% attended a health facility. The missed opportunities for immunization were 65.7% and 61.8% for EPI and non-EPI vaccines respectively. The reasons for non-vaccination were dominated by ignorance (65.9%) and shortages in vaccine stock (21.1%). However, secondary education (p = 0.020), presence of pneumonia (p = 0.020) and being the first child negatively influenced vaccination (p = 0.008). Conclusion. Vaccine coverage was inadequate despite good knowledge from parents of the value of vaccination. It is important to act on missed opportunities, especially among seniors and children of low-educated mothers.
Article Details
References
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- OMS. La vaccination dans le monde: vision et stratégie 2006-2015 [Internet]. [cité 24 déc 2016]. Disponible sur: http://www.who.int/immunization/givs/fr/
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- Bobossi-Serengbé G, Fioboy R, Ndoyo J, Nakouné E. Les occasions manquées de vaccination chez les enfants de 0 à 11 mois à Bangui. J Pédiatrie Puériculture. déc 2014;27(6):289‑93.
- Waters HR, Dougherty L, Tegang S-P, Tran N, Wiysonge CS, Long K, et al. Coverage and costs of childhood immunizations in Cameroon. Bull World Health Organ. sept 2004;82(9):668‑75.
- Ministère de la Santé Publique du Cameroun. Plan d’action du programme pays-Cameroun. 2012.
- Njua CVM, Nguefack F, Chelo D, Tejiokem M, Kago I, Kobela M. Rappels vaccinaux hors programme élargi de vaccination dans deux écoles de l’éducation de base de Yaoundé, Cameroun. Pan Afr Med J [Internet]. 2011 [cité 5 août 2015];10(0). Disponible sur: http://www.ajol.info/index.php/pamj/article/view/72230
- Wu C-J, Ko H-C, Lee H-C, Tsai W-C, Li M-G, Pao Y-Z, et al. Decline of Tetanus Antitoxin Level with Age in Taiwan. J Formos Med Assoc. 1 mai 2009;108(5):395‑401.
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- Gustafsson L, Hessel L, Storsaeter J, Olin P. Long-term Follow-up of Swedish Children Vaccinated With Acellular Pertussis Vaccines at 3, 5, and 12 Months of Age Indicates the Need for a Booster Dose at 5 to 7 Years of Age. Pediatrics. 1 sept 2006;118(3):978‑84.
- Posfay-Barbe KM, Kobela M, Sottas C, Grillet S, Taguebue J, Ekoe T, et al. Frequent failure of adolescent booster responses to tetanus toxoid despite infant immunization: waning of infancy-induced immune memory? Vaccine. 17 juin 2010;28(27):4356‑61.
- Trollfors B, Knutsson N, Taranger J, Mark A, Bergfors E, Sundh V, et al. Diphtheria, tetanus and pertussis antibodies in 10-year-old children before and after a booster dose of three toxoids: implications for the timing of a booster dose. Eur J Pediatr. janv 2006;165(1):14‑8.
- Soura AB, Mberu B, Elungata P, Lankoande B, Millogo R, Beguy D, et al. Understanding Inequities in Child Vaccination Rates among the Urban Poor: Evidence from Nairobi and Ouagadougou Health and Demographic Surveillance Systems. J Urban Health Bull N Y Acad Med. févr 2015;92(1):39‑54.
- Kum-Nji P, James D, Herrod HG. Immunization Status of Hospitalized Preschool Children: Risk Factors Associated With Inadequate Immunization. Pediatrics. 1 sept 1995;96(3):434‑8.
- Faye A, Seck I, Dia AT. Facteurs d’abandon de la vaccination en milieu rural sénégalais. Médecine Afr Noire. 2010;57(3):137‑41.
- Pahud B, Clark S, Herigon JC, Sherman A, Lynch DA, Hoffman A, et al. A Pilot Program to Improve Vaccination Status for Hospitalized Children. Hosp Pediatr. 1 janv 2015;5(1):35‑41.
- Ba Pouth SFB, Kazambu D, Delissaint D, Kobela M. Couverture vaccinale et facteurs associés à la non complétude vaccinale des enfants de 12 à 23 mois du district de santé de Djoungolo-Cameroun en 2012. Pan Afr Med J [Internet]. 4 févr 2014 [cité 1 sept 2015];17. Disponible sur: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247736/
- Ministère de la santé publique. Plan d’action annuel 2014 du programme élargi de vaccination du Cameroun. 2014.
- Nguefack Dongmo F, Tassadong C, Dongmo R, Tatah S, Fodoung Wamba Danny S, Chiabi A, et al. Factors Influencing Routine Vaccination of Children of Mothers Live-Stock Retailers in the Markets of Yaoundé. World J Vaccines. 12 mai 2016;06(02):23.
- Russo G, Miglietta A, Pezzotti P, Biguioh RM, Mayaka GB, Sobze MS, et al. Vaccine coverage and determinants of incomplete vaccination in children aged 12–23 months in Dschang, West Region, Cameroon: a cross-sectional survey during a polio outbreak. BMC Public Health. 10 juill 2015;15(1):630.
- Bielicki JA, Achermann R, Berger C. In touch but not up-to-date: Ambulatory visits and vaccination status in a cohort of young Swiss children. Vaccine. 4 nov 2013;31(46):5375‑80.
- Mutua MK, Kimani-Murage E, Ngomi N, Ravn H, Mwaniki P, Echoka E. Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya. Trop Med Health. 2016;44:13.
- Bobossi-Serengbé G, Fioboy R, Ndoyo J, Nakouné E. Les occasions manquées de vaccination chez les enfants de 0 à 11mois à Bangui. J Pédiatrie Puériculture. 2014;27(6):289‑93.
- Kahn JG, Mokdad AH, Deming MS, Roungou JB, Boby AM, Excler JL, et al. Avoiding missed opportunities for immunization in the Central African Republic: potential impact on vaccination coverage. Bull World Health Organ. 1995;73(1):47‑55.
- Schlumberger M, Bamoko A, Yaméogo TM, Rouvet F, Ouedraogo R, Traoré B, et al. Impact positif sur le Programme élargi de vaccinations de l’envoi de SMS de rappel à partir d’un registre informatisé, Bobo-Dioulasso (Burkina Faso). Bull Société Pathol Exot. 1 déc 2015;108(5):349‑54.
- Vannice KS, Salmon DA, Shui I, Omer SB, Kissner J, Edwards KM, et al. Attitudes and Beliefs of Parents Concerned About Vaccines: Impact of Timing of Immunization Information. Pediatrics. 1 mai 2011;127(Supplement 1):S120‑6.
- Whyte MD, Whyte IV J, Cormier E, Eccles DW. Factors influencing parental decision making when parents choose to deviate from the standard pediatric immunization schedule. J Community Health Nurs. 2011;28(4):204‑14.
- Awadh AI, Hassali MA, Al-lela OQ, Bux SH, Elkalmi RM, Hadi H. Immunization knowledge and practice among Malaysian parents: a questionnaire development and pilot-testing. BMC Public Health. 27 oct 2014;14(1):1107.
- Yip WC, Orbeta A. The relative importance of price and quality in consumer choice of provider: the case of Egypt. Int Health Syst Group Work Pap. 1999;80.
- Fotoula B. Childhood vaccination uptake and factors affecting this in athens, greece. Health Sci J [Internet]. 2010 [cité 2 janv 2017]; Disponible sur: http://www.hsj.gr/abstract/childhood-vaccination-uptake-and-factors-affecting-this-in-athens-greece-3581.html
- Harmsen IA, Doorman GG, Mollema L, Ruiter RA, Kok G, de Melker HE. Parental information-seeking behaviour in childhood vaccinations. BMC Public Health. 2013;13:1219.
- Qutaiba B Al-lela O, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 25 janv 2014;14:20.
- Topuzoğlu A, Ay P, Hidiroglu S, Gurbuz Y. The barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers. Eur J Public Health. 1 août 2007;17(4):348‑52.
- Etana B, Deressa W. Factors associated with complete immunization coverage in children aged 12-23 months in Ambo Woreda, Central Ethiopia. BMC Public Health. 2012;12:566.
- Guthmann J-P, Chauvin P, Le Strat Y, Soler M, Fonteneau L, Lévy-Bruhl D. Moindre couverture vaccinale par le vaccin anti-pneumococcique conjugue dans les menages aux revenus faibles: une etude en Île-de-France. Arch Pédiatrie. 2014;21(6):584‑92.
- Bouhamam N, Laporte R, Boutin A, Uters M, Bremond V, Noel G, et al. Précarité, couverture sociale et couverture vaccinale: enquête chez les enfants consultant aux urgences pédiatriques. Arch Pédiatrie. 2012;19(3):242‑7.
- OMS. Plan d’action mondial pour les vaccins 2011-2020 [Internet]. 2013 [cité 2 janv 2017]. Disponible sur: http://who.int/immunization/global_vaccine_action_plan/DoV_GVAP_2012_2020/fr/
References
WHO. Immunization coverage [Internet]. 2016 [cité 12 janv 2017]. Disponible sur: http://www.who.int/mediacentre/factsheets/fs378/en/
OMS. La vaccination dans le monde: vision et stratégie 2006-2015 [Internet]. [cité 24 déc 2016]. Disponible sur: http://www.who.int/immunization/givs/fr/
Guiso N. Impact de la vaccination sur l’épidémiologie des maladies infectieuses: exemple de la coqueluche. MS Rev. 2007;
Minal (K. Patel), Gacic-Dobo M, Peter M S, Dabbagh A, Mulders MN, Okwo-Bele J-M, et al. Progress towards regional measles elimination – worldwide, 2000–2015. Wkly Epidemiol Rec Relevé Épidémiologique Hebd. 2016;91(45):525–536.
Organisation Mondiale de la Santé. Mesurer l’impact de la vaccination par les vaccins conjugués anti-streptococcus pneumoniae et anti-Haemophilus influenzae type b. Measuring impact of streptococcus pneumoniae and haemophilus influenzae type b conjugate vaccination [Internet]. 2013 [cité 24 déc 2016]; Disponible sur: http://www.who.int/iris/handle/10665/82076
Santoni F. Le programme élargi de vaccination: 25 ans demain. Médecine Trop. 2001;61(2):177‑86.
Bobossi-Serengbé G, Fioboy R, Ndoyo J, Nakouné E. Les occasions manquées de vaccination chez les enfants de 0 à 11 mois à Bangui. J Pédiatrie Puériculture. déc 2014;27(6):289‑93.
Waters HR, Dougherty L, Tegang S-P, Tran N, Wiysonge CS, Long K, et al. Coverage and costs of childhood immunizations in Cameroon. Bull World Health Organ. sept 2004;82(9):668‑75.
Ministère de la Santé Publique du Cameroun. Plan d’action du programme pays-Cameroun. 2012.
Njua CVM, Nguefack F, Chelo D, Tejiokem M, Kago I, Kobela M. Rappels vaccinaux hors programme élargi de vaccination dans deux écoles de l’éducation de base de Yaoundé, Cameroun. Pan Afr Med J [Internet]. 2011 [cité 5 août 2015];10(0). Disponible sur: http://www.ajol.info/index.php/pamj/article/view/72230
Wu C-J, Ko H-C, Lee H-C, Tsai W-C, Li M-G, Pao Y-Z, et al. Decline of Tetanus Antitoxin Level with Age in Taiwan. J Formos Med Assoc. 1 mai 2009;108(5):395‑401.
Gidding HF, Backhouse JL, Gilbert GL, Burgess MA. Immunity to diphtheria and tetanus in Australia: a national serosurvey. Med J Aust [Internet]. 2005 [cité 24 déc 2016];183(6). Disponible sur: https://www.mja.com.au/journal/2005/183/6/immunity-diphtheria-and-tetanus-australia-national-serosurvey
Gustafsson L, Hessel L, Storsaeter J, Olin P. Long-term Follow-up of Swedish Children Vaccinated With Acellular Pertussis Vaccines at 3, 5, and 12 Months of Age Indicates the Need for a Booster Dose at 5 to 7 Years of Age. Pediatrics. 1 sept 2006;118(3):978‑84.
Posfay-Barbe KM, Kobela M, Sottas C, Grillet S, Taguebue J, Ekoe T, et al. Frequent failure of adolescent booster responses to tetanus toxoid despite infant immunization: waning of infancy-induced immune memory? Vaccine. 17 juin 2010;28(27):4356‑61.
Trollfors B, Knutsson N, Taranger J, Mark A, Bergfors E, Sundh V, et al. Diphtheria, tetanus and pertussis antibodies in 10-year-old children before and after a booster dose of three toxoids: implications for the timing of a booster dose. Eur J Pediatr. janv 2006;165(1):14‑8.
Soura AB, Mberu B, Elungata P, Lankoande B, Millogo R, Beguy D, et al. Understanding Inequities in Child Vaccination Rates among the Urban Poor: Evidence from Nairobi and Ouagadougou Health and Demographic Surveillance Systems. J Urban Health Bull N Y Acad Med. févr 2015;92(1):39‑54.
Kum-Nji P, James D, Herrod HG. Immunization Status of Hospitalized Preschool Children: Risk Factors Associated With Inadequate Immunization. Pediatrics. 1 sept 1995;96(3):434‑8.
Faye A, Seck I, Dia AT. Facteurs d’abandon de la vaccination en milieu rural sénégalais. Médecine Afr Noire. 2010;57(3):137‑41.
Pahud B, Clark S, Herigon JC, Sherman A, Lynch DA, Hoffman A, et al. A Pilot Program to Improve Vaccination Status for Hospitalized Children. Hosp Pediatr. 1 janv 2015;5(1):35‑41.
Ba Pouth SFB, Kazambu D, Delissaint D, Kobela M. Couverture vaccinale et facteurs associés à la non complétude vaccinale des enfants de 12 à 23 mois du district de santé de Djoungolo-Cameroun en 2012. Pan Afr Med J [Internet]. 4 févr 2014 [cité 1 sept 2015];17. Disponible sur: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247736/
Ministère de la santé publique. Plan d’action annuel 2014 du programme élargi de vaccination du Cameroun. 2014.
Nguefack Dongmo F, Tassadong C, Dongmo R, Tatah S, Fodoung Wamba Danny S, Chiabi A, et al. Factors Influencing Routine Vaccination of Children of Mothers Live-Stock Retailers in the Markets of Yaoundé. World J Vaccines. 12 mai 2016;06(02):23.
Russo G, Miglietta A, Pezzotti P, Biguioh RM, Mayaka GB, Sobze MS, et al. Vaccine coverage and determinants of incomplete vaccination in children aged 12–23 months in Dschang, West Region, Cameroon: a cross-sectional survey during a polio outbreak. BMC Public Health. 10 juill 2015;15(1):630.
Bielicki JA, Achermann R, Berger C. In touch but not up-to-date: Ambulatory visits and vaccination status in a cohort of young Swiss children. Vaccine. 4 nov 2013;31(46):5375‑80.
Mutua MK, Kimani-Murage E, Ngomi N, Ravn H, Mwaniki P, Echoka E. Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya. Trop Med Health. 2016;44:13.
Bobossi-Serengbé G, Fioboy R, Ndoyo J, Nakouné E. Les occasions manquées de vaccination chez les enfants de 0 à 11mois à Bangui. J Pédiatrie Puériculture. 2014;27(6):289‑93.
Kahn JG, Mokdad AH, Deming MS, Roungou JB, Boby AM, Excler JL, et al. Avoiding missed opportunities for immunization in the Central African Republic: potential impact on vaccination coverage. Bull World Health Organ. 1995;73(1):47‑55.
Schlumberger M, Bamoko A, Yaméogo TM, Rouvet F, Ouedraogo R, Traoré B, et al. Impact positif sur le Programme élargi de vaccinations de l’envoi de SMS de rappel à partir d’un registre informatisé, Bobo-Dioulasso (Burkina Faso). Bull Société Pathol Exot. 1 déc 2015;108(5):349‑54.
Vannice KS, Salmon DA, Shui I, Omer SB, Kissner J, Edwards KM, et al. Attitudes and Beliefs of Parents Concerned About Vaccines: Impact of Timing of Immunization Information. Pediatrics. 1 mai 2011;127(Supplement 1):S120‑6.
Whyte MD, Whyte IV J, Cormier E, Eccles DW. Factors influencing parental decision making when parents choose to deviate from the standard pediatric immunization schedule. J Community Health Nurs. 2011;28(4):204‑14.
Awadh AI, Hassali MA, Al-lela OQ, Bux SH, Elkalmi RM, Hadi H. Immunization knowledge and practice among Malaysian parents: a questionnaire development and pilot-testing. BMC Public Health. 27 oct 2014;14(1):1107.
Yip WC, Orbeta A. The relative importance of price and quality in consumer choice of provider: the case of Egypt. Int Health Syst Group Work Pap. 1999;80.
Fotoula B. Childhood vaccination uptake and factors affecting this in athens, greece. Health Sci J [Internet]. 2010 [cité 2 janv 2017]; Disponible sur: http://www.hsj.gr/abstract/childhood-vaccination-uptake-and-factors-affecting-this-in-athens-greece-3581.html
Harmsen IA, Doorman GG, Mollema L, Ruiter RA, Kok G, de Melker HE. Parental information-seeking behaviour in childhood vaccinations. BMC Public Health. 2013;13:1219.
Qutaiba B Al-lela O, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 25 janv 2014;14:20.
Topuzoğlu A, Ay P, Hidiroglu S, Gurbuz Y. The barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers. Eur J Public Health. 1 août 2007;17(4):348‑52.
Etana B, Deressa W. Factors associated with complete immunization coverage in children aged 12-23 months in Ambo Woreda, Central Ethiopia. BMC Public Health. 2012;12:566.
Guthmann J-P, Chauvin P, Le Strat Y, Soler M, Fonteneau L, Lévy-Bruhl D. Moindre couverture vaccinale par le vaccin anti-pneumococcique conjugue dans les menages aux revenus faibles: une etude en Île-de-France. Arch Pédiatrie. 2014;21(6):584‑92.
Bouhamam N, Laporte R, Boutin A, Uters M, Bremond V, Noel G, et al. Précarité, couverture sociale et couverture vaccinale: enquête chez les enfants consultant aux urgences pédiatriques. Arch Pédiatrie. 2012;19(3):242‑7.
OMS. Plan d’action mondial pour les vaccins 2011-2020 [Internet]. 2013 [cité 2 janv 2017]. Disponible sur: http://who.int/immunization/global_vaccine_action_plan/DoV_GVAP_2012_2020/fr/