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Missed opportunities for immunizations at curative and preventive health care visits.

Abstract：

:In Ghana, a population-based immunization coverage survey revealed missed opportunities at preventive and curative care visits among children 12-18 months old attending the local hospital in the eastern region of Ghana. Parent-held immunization cards do not have a place to record curative care visits. If pediatric patient's immunization schedules were not complete, health workers tracked down outpatient department (OPD) tickets and recorded the dates of previous visits to the OPD. 60.5% of 294 children were completely immunized. 21.4% had missed an opportunity during at least 1 visit to a clinic compared to 32% in a review of 10 studies from developing countries. Had health workers taken the opportunity to immunize children without a complete immunization schedule, the immunization coverage level would have been 66.7%. 56.9% of the 116 incompletely immunized children had received curative care at the local hospital. The researchers could obtain OPD numbers on only 39 of 66 children. They recovered hospital records for 32 children. The dates for all OPD visits were recorded on these records. The mothers of the remaining 27 tended to lose the flimsy OPD ticket. 30 of the 32 children had missed an opportunity for immunization, particularly for measles (24). 20 children needed only 1 more visit to complete the schedule. Had these opportunities not been missed at OPDs, immunization coverage could have increased to 70.7%. If all children who received curative care at the hospital had completed the schedule, immunization coverage would have increased even further to 83%. 75% of missed opportunities were for measles vaccination. Logistical problems at the hospital, shortage of community health nurses, and assumption of false contraindications by some hospital workers were responsible for missed opportunities. OPD nurses often referred children with incomplete immunization to the primary health care department, 20 m away. In conclusion, a comprehensive, integrated, home-based health record with all records of non-inpatient preventive and curative health events, including dates of immunization, is needed.

journal_name

Trans R Soc Trop Med Hyg

journal_title

Transactions of the Royal Society of Tropical Medicine and Hygiene

authors

Brugha R

doi

10.1016/0035-9203(95)90451-4

subject

Has Abstract

pub_date

1995-11-01 00:00:00

pages

698

issue

eissn

0035-9203

issn

1878-3503

journal_volume

pub_type

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Missed opportunities for immunizations at curative and preventive health care visits.