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Vaccine preventable diseases are major threats to the health and well-being of children under five years of age. They contribute a great deal to childhood illnesses and disabilities, and are accountable for a high percentage of childhood mortality worldwide. In Nigeria, the government has made a lot of effort to provide immunizations against these childhood diseases. It is however sad to note that many children still do not complete their routine immunization. The purpose of this paper is to determine factors which influence mothers’ compliance with childhood immunization.

This was a descriptive study carried out among 600 mothers of under-five children randomly selected from nine postnatal clinics in Ekiti State between January and August 2016. A self-structured validated questionnaire containing items to explore demographic characteristics of respondents, compliance with child immunization (Cronbach’s α=0.92) and determinants of compliance (Cronbach’s α=0.83) was the instrument for data collection. Multiple regression analysis was used to identify determinants of mothers’ compliance with childhood immunization.

The level of compliance of mothers with childhood immunization was high (80 percent). The two factors which contributed significantly to mothers’ compliance were the mothers’ knowledge of childhood immunization (β weight= 0.243) and mothers’ educational status (β weight=0.169). Mothers with tertiary education had the highest level of compliance (76.8 percent).

Having good knowledge of childhood immunization and a high educational status positively influence a mothers’ compliance with child immunization.

Throughout history, pandemics have played a significant role in reshaping human civilizations through mortalities, morbidities, economic losses and other catastrophic consequences. The present COVID-19 pandemic has brought the world to its knees resulting in overstretched healthcare systems, increased health inequalities and disruptions to people’s right to health including life-saving routine immunization programs across the world.

This is a commentary paper.

Immunization remains one of the most successful, safe, cost-effective and proven fundamental disease prevention measures in the history of public health. However, the COVID-19 pandemic has effectively thrown the world's immunization practices out of gear, depriving approximately 80 million infants, in rich and poor countries alike, at risk of triggering a resurgence of vaccine-preventable diseases such as diphtheria, measles and polio. It is estimated that each COVID-19 death averted by suspending immunization sessions in Africa could lead to 29-347 future deaths due to other diseases including measles, yellow fever, polio, meningitis, pneumonia and diarrhoea.

The value of implementing robust immunization policies cannot be underestimated. Risks associated with postponing immunization services and the fact that COVID-19 is now an integral part of human civilization have resulted in several countries making special efforts to continue their immunization services. However, critical precautionary measures are warranted to prevent COVID-19 among healthcare service providers, facilitators, caregivers and children during the immunization sessions.

The Expanded Program on Immunization (EPI) has still been found to offer services that do not comply with standards. The purpose of this paper is to ascertain competency in terms of the knowledge and skills of the EPI staff.

The research design was a mixed-methods approach. The quantitative method employed a questionnaire survey on the perceived competency of 382 EPI staffs from six regions in Thailand. This was paired alongside of the qualitative method, where four staffs were in-depth interviewed, and the performance of the EPI staffs was observed.

The overall perceived competency in the work of immunization was at a high level. A comparative analysis between the quantitative and qualitative data showed findings in three categories. First, the perception of competency was high, and performance conformed to standards in the preparation of the setting and equipment for providing the service; second, the perception of competency was high, but in the performance of their work the participants did not comply completely with standards for scheduling the immunization appointments or for vaccine storage; and third, the perception of competency was either moderate or low, and the performance of work was inadequate for vaccine estimations, registering reports, and dealing with adverse events following immunization.

The findings showed a gap between perception of knowledge-and-skill competency and actual practice in EPI service. Effective cooperation among involved organizations in order to improve the standard of performance in expanding the quality of EPI service provision in Thailand is suggested.

The purpose of this paper is to achieve effective governance of online rumors through the proposed rumor propagation model and immunization strategy.

The paper leverages the agent-based modeling (ABM) method to model individuals from two aspects, behavior and attitude. Based on the analysis and research of online data, we propose a rumor propagation model, namely the Untouched view transmit removed-Susceptible hesitate agree disagree (Unite-Shad), and devise an immunization strategy, namely the Gravity Immunization Strategy (GIS). A graph-based framework, namely Pregel, is used to carry out the rumor propagation simulation experiments. Through the experiments, the rationality of the Unite-Shad and the effectiveness of the GIS are verified.

The study discovers that the inconsistency between human behaviors and attitudes in rumor propagation can be explained by the Unite-shad model. Besides, the GIS, which shows better performance in small-world networks than in scale-free networks, can effectively suppress rumor propagation in the early stage.

This paper provides an effective immunization strategy for rumor governance. Specifically, the Unite-Shad model reveals the mechanism of rumor propagation, and the GIS provides an effective governance method for selecting immune nodes.

The inconsistency of human behaviors and attitudes in real scenes is modeled in the Unite-Shad model. Combined with the model, the definition of diffusion domain is proposed and a novel immunization strategy, namely GIS, is designed, which is significant for the social governance of rumor propagation.

The COVID-19 pandemic has forced countries to consider how to reach vulnerable communities with extended outreach services to improve vaccination uptake. The authors created an optimization model to align with decision-makers' objective to maximize immunization coverage within constrained budgets and deploy resources considering empirical data and endogenous demand.

A mixed integer program (MIP) determines the location of outreach sites and the resource deployment across health centers and outreach sites. The authors validated the model and evaluated the approach in consultation with UNICEF using a case study from The Gambia.

Results in The Gambia showed that by opening new outreach sites and optimizing resource allocation and scheduling, the Ministry of Health could increase immunization coverage from 91.0 to 97.1% under the same budget. Case study solutions informed managerial insights to drive gains in vaccine coverage even without the application of sophisticated tools.

The research extended resource constrained LMIC vaccine distribution modeling literature in two ways: first, endogenous calculation of demand as a function of distance to health facility location enabled the effective design of the vaccine network around convenience to the community and second, the model's resource bundle concept more accurately and flexibly represented complex requirements and costs for specific resources, which facilitated buy-in from stakeholders responsible for managing health budgets. The paper also demonstrated how to leverage empirical research and spatial analysis of publicly available demographic and geographic data to effectively represent important contextual factors.

Each individual needs to be vaccinated to control the spread of the COVID-19 pandemic in the shortest possible time. However, the vaccine distribution with an already strained supply chain in low- and middle-income countries (LMICs) will not be effective enough to vaccinate all the population in stipulated time. The purpose of this paper is to show that there is a need to revolutionize the vaccine supply chain (VSC) by overcoming the challenges of sustainable vaccine distribution.

An integrated lean, agile and green (LAG) framework is proposed to overcome the challenges of the sustainable vaccine supply chain (SVSC). A hybrid best worst method (BWM)–Measurement of Alternatives and Ranking According to COmpromise Solution (MARCOS) methodology is designed to analyze the challenges and solutions.

The analysis shows that vaccine wastage is the most critical challenge for SVSC, and the coordination among stakeholders is the most significant solution followed by effective management support.

The result of the analysis can help the health care organizations (HCOs) to manage the VSC. The effective vaccination in stipulated time will help control the further spread of the virus, which will result in the normalcy of business and availability of livelihood for millions of people.

To the best of the author's knowledge, this is the first study to explore sustainability in VSC by considering the environmental and social impact of vaccination. The LAG-based framework is also a new approach in VSC to find the solution for existing challenges.

Evaluating primary care for children has not before been undertaken on a national level, and only infrequently on an international level, an adult-focused perspective is the norm. The Models of Child Health Appraised (MOCHA) project explored the evaluation of quality of primary care for children in a nationally comparable way, which recognises the influence of all components of child well-being and well-becoming. Using adult-focused metrics fails to account for children’s physical and psycho-social development at different ages, differences in health and non-health determinants, patterns of disease and risk factors and the stages of the life course. To do this, we attempted to identify comparable measures of child health in the European Union and European Economic Area countries, we aimed to perform a structural equation modelling technique to identify causal effects of certain policies or procedures in children’s primary care and we aimed to identify and interrogate large datasets for key tracer conditions. We found that the creation of comparative data for children and child health services remains a low priority in Europe, and the largely unmet need for indicators covering all the healthcare dimensions hampers development of evidence-based policy. In terms of the MOCHA project objective of appraising models of child primary health care, the results of this specific work show that the means of appraisal of system and service quality are not yet agreed or mature, as well as having inadequate data to fuel them.

A qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could influence vaccination-related behaviors and their utilization. This study aims to document the perceptions of caretakers, community members and healthcare service providers related to childhood vaccination practices in slums under the national immunization program (NIP) of India.

This was a qualitative community-based cross-sectional study. Focus group discussions with caretakers, community members and healthcare service providers were used to build a holistic, detailed description and analysis of the factors associated with childhood vaccination practices within its real-world context.

Lack of awareness, fear of adverse events following immunization, inappropriate timing of vaccination sessions, loss of daily earnings, migration, lack of good behavior of health staffs, shortage of logistics and vaccines, limited resources and infrastructures and high expectations of beneficiaries were some of the vital barriers impacting vaccination practices in slums.

Though this study provides significant good information on the indicators that can be considered to improve the vaccination practices in any slum settings, it has is also a limitations too due to its setting. Therefore, one needs to be cautious while generalizing these results to other settings like rural. In addition, Though we believe that these strategies could be useful in any setting, it is also important to tailor these observations them as per the need of the society and the population. Also, this is a self-reported qualitative study and therefore the perspectives reported in this study need to be taken with caution. Further, low vaccination, poor awareness, compromised healthcare services, high expectations could be considered as a stigma/fear among the responders and therefore there is always a chance of underreporting. Thus, it would be important in future to conduct a study involving a broader group of people in society and to establish factors associated with the vaccination coverage. that can help in improvement of vaccination.

Initiatives such as regular interactions at different levels, effective communication including reminders, behavior interventions, the continued supply of vaccines and logistics, additional resources for the vaccination program, incentives and recognition, extended sessions and people-friendly healthcare delivery system could be helpful to strengthen the routine vaccination practices in slums.