Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Delays in childhood immunization may have adverse health implications. In the United States, childhood immunization among children who are below 3 years of age continues to be below Healthy People 2020 targets for some vaccines such as DTaP, PCV, HIB, Hep A, Rotavirus, and Hep B birth dose. The purpose of this study was to examine the association between maternal characteristics and childhood immunization series completion rates among children 2 years of age. The social learning theory and self-efficacy theory provided the theoretical foundation for the study. Data from the Florida Department of Health Immunization Surveys were used. ANOVA and multinomial statistical tests were used to analyze the data. According to the study results, maternal factors such as age, marital status, and educational level were significant predictors of childhood immunization completion rates. The findings from the study could lead to positive social change initiatives through education and inclusion of mothers' concerns during interventions to increase immunization rates in children. Increase in immunization completion rates can reduce communicable disease in the population. Insights from this study could assist health care providers, parents, and care givers in their responsibilities relative to childhood immunization practices.

Autism is a childhood developmental disorder characterized by impaired social interaction, difficulty with verbal and nonverbal communication and limited activities. The root cause of autism is unknown. However it has been postulated that administration of the measles, mumps, and rubella (MMR) vaccine may be causally related to the development of autism. MMR vaccination is a requirement for entry into schools, so any increase in adverse events associated with the vaccine carries widespread public health importance. The primary objective of this study was to conduct a meta-analysis of the association between the MMR vaccination and the development of autism. The meta-analysis was limited to studies with an experimental design, unvaccinated control group, and odds ratio or relative risk as the effect measure. Both the fixed effects and random effects models were applied. A total of 29 studies were identified for possible inclusion in the meta-analysis. After applying the inclusion/exclusion criteria seven studies were included in the meta-analysis. The pooled treatment effect was weighted based on the width of the 95% confidence interval for each of the individual studies. The pooled effect measure for the seven studies was 1.052 (95% CI: 0.973, 1.138) (P=0.202). An association between the MMR vaccine and the development of autism was not found in this analysis. Public health initiatives should continue to support mandatory vaccination with MMR for entry into school and steps should be taken to eliminate any barriers to vaccination. Further epidemiological studies are needed to assess the root cause of autism

Economic barriers remain an obstacle to ensuring that children in the United States are protected against vaccine-preventable diseases. Disparities persist despite programs in place to alleviate them, such as the Vaccines for Children program, which provides free vaccines for eligible children. Using data from the 2010 National Immunization Survey, this study addresses whether insurance status has an impact on immunization uptake by investigating associations between vaccine receipt and insurance type, VFC eligibility, and insurance continuity. Logistic regression was performed using possible important factors suggested in the literature. Among children in the national sample, results showed strong associations between up-to-date immunization status and insurance type, VFC eligibility, and insurance continuity, suggesting that additional steps must be taken to alleviate disparities in vaccine receipt. Regression analysis showed child’s age group, insurance continuity, and number of vaccine providers to be the strongest predictors of up-to-date status among children in the national sample.

Yes / Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision-making process. This research aimed to explore the factors that influence healthcare workers' experience and perceptions about delivering childhood immunization in Fiji. A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi-structured open-ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews. There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule. Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.

Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Parents and/or caregivers all over the world are expected to comply with existing childhood immunisation programmes in order to prevent outbreaks of preventable childhood diseases. The most important justification for this study was the 2010 measles outbreak in the Western Cape province of South Africa. This outbreak correlated with the study conclusions of Corrigall, Coetzee and Cameron (2008:41) as they found the immunisation coverage in the Western Cape to be insufficient to prevent outbreaks of preventable childhood diseases. From the literature, it seemed that attitudes and factors that influence parent and/or caregiver compliance with the routine childhood immunisation schedule in the Witzenberg sub-district of the Western Cape persist. In doing this study, the researcher’s purpose was to discover what those factors were. The aim was to determine, understand and describe the attitudes and factors influencing parent and/or caregiver compliance with the routine childhood immunisation schedule, and the nature thereof. The set objectives were to gain knowledge of and insight into the factors influencing participants’ adherence with routine childhood immunisation; and participants’ feelings, attitudes, and experiences surrounding immunisation within the context of their health care environment. A quantitative research approach, with a smaller qualitative component, was selected for this study which had an exploratory descriptive design. The population targeted for data collection included parents and/or caregivers of children aged 0 to 60 months in the Witzenberg sub-district (N=8374), as well as in community health centres (CHCs) that provided immunisation and/or other primary health care services in the mentioned subdistrict (N=16). The non-probability convenience sampling of parents and/or caregivers consisted of 376 participants (n=376), while 8 CHCs (n=8) were selected through systematic sampling. The measuring instrument used as the data collection technique for this study was a selfadministered questionnaire. A pilot study was conducted to pre-test the questionnaire, and its reliability and validity were further ensured by submitting it for review to research experts in methodology and nursing. A combination of quantitative and qualitative methods was used to analyse the study data. MS Excel was used to capture the quantitative data after which it was analysed using descriptive statistics by means of STATISTICA version 9-software. Tesch’s approach to qualitative data analysis was used as a guideline with the purpose of identifying and categorising the essential qualitative data and grouping it together in one descriptive framework. The main findings were that parents and/or caregivers involved in this study were positive about immunisation and their experiences within the health service environment. They also felt that health workers were playing an important role in their decision-making process. However, their knowledge regarding the purpose of and contra-indications for immunisation were insufficient, and most parents reported that their children experienced side effects after immunisation. Key recommendations on conclusion of the study include clear, accurate and specific information to parents about the purpose of immunisation and its contra-indications and side effects. Vaccinators and managers should be informed about the persistent problem with mild vaccination side effects and refresher courses should be provided with regard to infection control, administration techniques and the reporting of adverse effects. / AFRIKAANSE OPSOMMING: Daar word van ouers en/of versorgers oor die wêreld verwag om aan bestaande kinderimmunisasieprogramme te voldoen ter voorkoming van vaksien-voorkombare siektes. Die belangrikste regverdiging vir die studie was die masel-uitbreking in die Wes-Kaapprovinsie van Suid-Afrika in 2010. Die uitbraak het die studiebevindinge ondersteun van Corrigall, Coetzee en Cameron (2008:41), wat bevind het dat immunisasiedekking in die Wes-Kaap onvoldoende was om ʼn uitbreking van voorkombare kindersiektes te verhoed. Volgens die literatuur het dit voorgekom asof die gesindhede en faktore wat ouers en/of versorgers se houding jeens die roetine- kinder-immunisasieskedule in die Witzenberg sub-distrik van die Wes-Kaap beïnvloed, voortduur. Die navorser het met hierdie studie ten doel gehad om die faktore te ontdek, ten einde die gesindhede en faktore wat ‘n invloed uitoefen te bepaal, te verstaan en te omskryf. Die doelwitte was om kennis in te win oor en insig te verkry in die faktore wat ouers en/of versorgers se aanhanklikheid met routine kinder immunisering beinbloed; en in ouers en/of versorgers se gevoelens, houdings en ondervindings ten opsigte van immunisasie in hulle gesondheidsorg-omgewing. ‘n Kwantitatiewe navorsingsbenadering met ‘n kleiner kwalitatiewe komponent is geselekteer vir die studie wat ‘n ondersoekend-beskrywende navorsingsontwerp gehad het. Die populasie wat geteiken is vir data-insameling was ouers en/of versorgers van kinders van 0 tot 60 maande in die Witzenberg sub-distrik (N=8374), asook gemeenskapsgesondheidsentrums wat immunisasie en/of ander primêre gesondheidsorgdienste in die genoemde sub-distrik aanbied (N=16). Die nie-waarskynlike gerieflikheidsteekproef van ouers en/of versorgers het uit 376 deelnemers (n=376) bestaan, terwyl 8 (n=8) gemeenskapsgesondheidsentrums deur middel van sistematiese steekproefbepaling geselekteer is. Die meetinstrument vir data-insameling in die studie was self-geadministreerde vraelyste. ‘n Loodsstudie is uitgevoer as vooraf-toetsing van die vraelys en die geldigheid en betroubaarheid daarvan is verder verseker deur die vraelys aan navorsingskenners in navorsingsmetodologie en verpleging te onderwerp. ‘n Kombinasie van kwantitatiewe en kwalitatiewe metodes is gebruik vir die analisering van die studie-data. Die kwantitatiewe data is op MS Excel ingevoer waarna beskrywende statistieke deur middel van Statistica weergawe 9-sagteware gebruik is om dit te analiseer. Tesch se benadering tot kwalitatiewe data-analise is as riglyn gebruik met die doel om belangrike data te identifiseer, te kategoriseer en in ‘n beskrywende raamwerk te groepeer. In die studie is daar hoofsaaklik bevind dat ouers en/of versorgers positief is oor immunisasie en hul ondervinding binne die gesondheidsorgomgewing, en dat gesondheidswerkers ʼn belangrike rol in hul besluitnemingsproses speel. Hul kennis aangaande die doel van en kontra-indikasies vir immunisasie was egter onvoldoende en die meeste ouers en/of versorgers het gerapporteer dat hul kinders ná immunisasie probleme met newe-effekte ondervind het. Die hoofaanbevelings wat uit die studie voortgespruit het, was dat duidelike, akkurate en spesifieke inligting aan ouers en/of versorgers verskaf moet word aangaande die doel van immunisasie en die kontra-indikasies daarvoor. Immuniseerders en bestuurders moet ook ingelig word oor die voortdurende voorkoms van newe-effekte sodat opknappingskursusse oor infeksiebeheer, korrekte toedieningstegnieke en die rapportering van newe-effekte aangebied kan word.

Barnvaccination har varit en av de mest betydelsefulla åtgärderna för att främja folkhälsan och förebygga sjukdomsrelaterade dödsfall hos barn. Barnvaccinationstäckningen har emellertid minskat globalt med anledning av en ökad tveksamhet kring vaccinationer. Studiens syfte var att undersöka hur specialistsjuksköterskor främjar vårdnadshavares följsamhet till det allmänna barnvaccinationsprogrammet. Studien var empirisk med kvalitativ studiedesign. Semistrukturerade intervjuer genomfördes med elva specialistsjuksköterskor inom barnhälsovården och analyserades med kvalitativ innehållsanalys, i enlighet med   Lundman och Hällgren Granheim (2017).   I resultatet framkom lokala riktlinjer och nationella riktlinjer för att främja följsamhet till barnvaccinationsprogrammet. Att ge vårdnadshavare generell information om barnvaccinationer var den viktigaste åtgärden för att främja vaccinationstäckningen. Vid tveksamheter till barnvaccination var det avgörande för specialistsjuksköterskan att ha ett personcentrerat förhållningssätt mot vårdnadshavare. Att ge kunskap samt använda ett tvärprofessionellt samarbete var också betydelsefullt. Vidare forskning kan fokusera på vårdnadshavares perspektiv på barnvaccination för att få ytterligare vägledning i hur barnvaccinationstäckningen kan främjas. Det kan också vara betydelsefullt med ytterligare forskning kring hur specialistsjuksköterskor kan bemöta vårdnadshavare som avstår vaccination för sitt barn. / Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent death among children, caused by diseases. The global coverage of childhood immunization has however decreased globally due to an increased hesitancy towards immunizations. The aim of this study was to examine how specialist nurses promote legal guardians’ adherence to the national childhood immunization program. This study was empirical with a qualitative study design. Semi-structured interviews with eleven specialist nurses in pediatric primary care were conducted. The interviews were analyzed using a qualitative content analysis.    The results showed both local guidelines and national guidelines to promote adherence to the childhood immunizations program. The main nursing intervention to promote childhood immunization coverage was to give legal guardians general information about the program. If hesitation, it was essential to have a person-centered approach towards the legal guardian. Educating guardians and using a multidisciplinary approach was also beneficial. Further research suggests focusing on the guardians’ perspective regarding childhood immunization as it may generate further guidance in how to promote immunization coverage. It may also be beneficial to conduct further research on how specialist nurses can respond to guardians who decline immunization for their child.

Introduction: Complete childhood Immunization remains the most effective way for prevention of Vaccine Preventable Diseases. The 2016 Uganda Demography Health Survey (UDHS) reported that only 55% of children aged 12-23 months had been fully vaccinated. The relationship between maternal education and childhood immunization among Ugandan children remains unclear with most of the studies done being limited in scope. Objective: To investigate the association between maternal education and childhood immunization in Uganda. Methods: This study was based on analysis of data from the UDHS. The study included 2815 children aged 12 – 23 months. Permission and data to conduct the analyses was sought from the DHS Program website. Bivariate and multivariate logistic regression models were used to assess association between the maternal education and full immunization. Adjusted odds ratios (OR) with their 95% confidence intervals (CI) were reported. A p value <0.05 was considered statistically significant. Results: Association between maternal education and childhood immunization was statistically significant (Primary Education - OR = 0.50 95%CI: 0.32 - 0.77, P value = 0.002 and Secondary Education – OR = 0.62 95%CI: 0.39 – 0.97, P value = 0.038). ANC visits, possession of a Child Health Card also had a strong effect on Childhood Immunization. Conclusion: Lower maternal education is associated with reduced completion of childhood immunization. To promote childhood immunization Parents with education lower than Secondary School should be targeted and the usefulness of ANC visits should be emphasized.

The purpose of this study was to determine the progress of the immunization program for Contagious Diseases in the City Schools of Dallas, Texas, over a period of ten years, dating from September 1928, to September 1938. An endeavor was made to determine how the Health Works Program of the Dallas Public Schools developed, and the protection it gave the public children.