Missed Opportunities for Vaccine Equity
Condition: Under-vaccinated
Study type: Interventional

Summary: 
      Despite the overwhelming impact of vaccines on child health and the tremendous progress in
      vaccine coverage globally, challenges of vaccine inequities persist. Missed opportunities for
      vaccination (MOV) is defined as any contact with health services by an individual who is
      eligible for vaccination which does not result in the recommended vaccines being given. This
      is common in several countries, and it presents a window of opportunity to provide vaccine
      services to those vulnerable children accessing healthcare facilities.

      The overall purpose of this project is to reduce missed opportunities for vaccinations by
      targeting hospitalized children who are vulnerable to poor health outcomes, but who are also
      within easy access of the healthcare system. The research team proposes implementing the
      Missed Opportunities for Vaccination Equity (MOVE), an intervention to improve timeliness and
      coverage of vaccination, and increase demand for vaccination services, through a combination
      of sensitization of children's caregivers and health workers, manual vaccination data capture
      in the ward, and re-purposed vaccination resources. The strategy engages key stakeholders in
      the design of the intervention through a co-creation workshop; their involvement in the
      design and execution of the intervention will improve sustainability in the long-term. This
      intervention builds on existing healthcare systems, and, when scaled up, can target
      inequities in vaccination coverage in the general population, without placing additional
      strain on the healthcare system in terms of workforce or financial resources.
    

Detailed description: 
      This pilot project is structured as a pre-post analysis of an implementation strategy to
      address missed opportunities for vaccination (MOV) among hospitalized children in India and
      Nigeria. India and Nigeria have similar rates of missed opportunities for vaccinations, and
      similar discrepancies with monitoring vaccination records when a child is in the hospital.
      The research team intends to collect the same pre-data in both India and Nigeria, implement
      the same intervention in both countries, and collect the same post-data in both study sites.

      The pre-intervention, intervention, and post-intervention, are all described below.

      Pre-Intervention period: The first three months of the project constitute the
      pre-intervention period, and they will consist of a situational analysis which will assess
      the burden of MOV as well as the barriers and facilitators for reducing MOV. Eligible
      participants will be enrolled after providing informed consent. Procedures would include
      verifying vaccination cards and medical records at admission and at discharge, conducting
      in-depth interviews with parents or caregivers during the hospital course, and administering
      structured questionnaires to hospital healthcare personnel crucial to hospitalized child care
      and provision of vaccinations.

      Intervention: This will begin with a co-creation workshop where the results of the
      pre-intervention period will be discussed, and the MOV intervention will be implemented. In
      summary, the intervention will include four components which are: (1) Disseminate
      (vaccination awareness among healthcare providers and child caregivers); (2) Document
      (vaccination status); (3) Deploy (vaccines); and (4) Discharge (provide advice/referrals for
      catch-up and routine vaccinations).

      Using a human-centered design approach, the research team will design an intervention,
      endorsed by local healthcare providers and stakeholders, which will be implemented primarily
      by the existing hospital healthcare staff. Research staff will play a role in data collection
      for monitoring purposes, but will not play a role in implementing the intervention.

      Post-Intervention period: Ongoing data collection after the MOV intervention is initiated and
      continued, will constitute the 'post-intervention' period. During this period, data
      collectors will collect the same data that is being collected in the pre-intervention. The
      research team intends to compare the results of our pre and post intervention data, to
      determine if this intervention has reduced the amount of children who are missed for
      vaccinations.
    

Intervention name(s): Minimizing Missed Opportunities for Vaccination (MOV)
Intervention type(s): Other
Intervention description(s): This bundle of interventions has four components that include: (1) Disseminate (vaccination awareness among healthcare providers and child caregivers); (2) Document (vaccination status); (3) Deploy (vaccines); and (4) Discharge (provide advice/referrals for catch-up and routine vaccinations).
Intervention model: Single Group Assignment
Intervention model description: This is a 'pre-post' study design, where the intervention is designed and implemented by the regular non-research clinical staff. This intervention has four components that are described in the 'intervention' section.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: vaccination; under-vaccination; missed opportunities for vaccination