Investigator(s)
| WHO Technical Officer |
Ela Singh Rathaur WHO Nepal Ela Singh Rathaur 
|
| Principal Investigator |
Sameer Mani Dixit Center for Molecular Dynamics Nepal (CMDN) Sameer Mani Dixit
|
| Co-Investigator(s) |
Balwinder Singh Chawla World Health Organization, Nepal Balwinder Singh Chawla
|
| Co-Investigator(s) |
Rahul Pradhan World Health Organization, Nepal Rahul Pradhan
|
Title(s) and abstract
| Scientific title | Assess Immunization coverage and knowledge of mother/care givers towards vaccination in 13 districts (Gavi DLI based) of Nepal |
| Public title | Assess Immunization coverage and knowledge of mother/care givers towards vaccination in 13 districts of Nepal |
| Background | Nepal's National Immunization Programme (NIP) has made significant progress, but challenges persist in achieving targeted and consistent coverage, particularly in geographically and economically disadvantaged areas. DLI are performance-based measures that are commonly used in results-based finance to distribute funds based on the attainment of specific outcomes. When used to vaccination programs, DLI can help improve program efficiency, efficacy, and impact. GAVI uses Disbursement Linked Indicators (DLIs) to incentivize success in vaccination programs. The Gavi Joint Appraisal suggested a performance-based distribution system for the HSS Grant to the National vaccination Program for 2016-2020 in 2016 with the goal of improving vaccination coverage, equality, and vaccine supply chain management. The indicators chosen for assessment were related to the aims of the National Health Sector Strategy (2015-2020). National Immunization Program has been performing verification of DLIs to receive allocated DLI (disbursement linked indicator) tranche for year two and subsequent years of the NHSS. |
| Objectives | Surveys will be conducted to assess immunization coverage among 12-35 months for all vaccines included in the national immunization schedule to be completed by the age of 15 months in the 13 low performing districts, which have been included in the DLI. The specific survey objectives are: 1.2.1Primary Objectives ● To estimate coverage among 12-23 months children at the time of survey for all antigens given in the first year of life ● To estimate coverage in 24-35 months children at the time of survey for all antigens given in the second year of life 1.2.2 Secondary Objectives ● To assess knowledge of mother/care givers towards routine vaccination ● To assess reasons for children who have not received single dose or missed one or more doses of vaccines in routine immunization ● To assess proportion of home-based vaccination card retention and assess the reasons for an absent home-based vaccination record among the mother/caretakers of children aged 12- 35 months who did not have a home-based record available at the time of survey |
| Study Methods | This is cross-sectional research that will be conducted in the 13 low-performing districts covered in the DLI. Mothers/caregivers of eligible children will be the respondents. The total number of houses that will be visited for the effective sample size is 12,430. A two-stage probability proportional to size sampling technique will be used. Data will be collected using a standard questionnaire developed with recommendations from the WHO Vaccination Coverage Survey Manual, Post Campaign Coverage Survey of Measles Rubella supplementary Immunization activities 2021 in Nepal, and Behavioral and Social Drivers of Vaccination-Tool and Practical Guidance," and the tool will be pretested. Data will be collected in an electronic version of CAPI with GPS coordinates, and this tablet will be used. The CAPI data will be synced with the central server in Kathmandu. Preliminary data analysis will be conducted using the SPSS/R tool. Data will be evaluated using descriptive statistics and bivariate/multivariate analysis to determine coverage and other relevant variables. The mothers' and caregivers' knowledge will be examined using the Behavioral and Social Drivers of Vaccination framework. Ethical approval will be obtained from the Nepal Health Research Council, and WHO-SEARO Ethics Review Committee and the research will be conducted in compliance with ethical and human rights standards. An internal systematic monitoring plan will be implemented by continual communication between field teams and frequent review sessions, with the FWD, WHO, CMDN central team, and other important partners all overseeing it together. The study's findings will help policymakers and stakeholders develop effective strategies to achieve optimum immunization coverage in Nepal. |
| Expected outcomes and use of results | This survey will assess the proportion of children in 12-23 months reached and 24-35 months reached by routine immunization. Similarly, the survey will assess card retention rate and identify factors related to vaccination uptake in these districts. Survey findings will provide evidence of status regarding disbursement linked indicator on equity in immunization, “reduced equity gap in 13 low performing districts” and to identify barriers in seeking immunization services in these districts, including determinants. The finding will guide formulating strategies and intervention to address the barriers and reach the unreached with equity. |
| Keywords | GAVI, DLI, Immunization, Coverage, Equity |
Research Details
| Student research | No |
| Start Date | 01-Jun-2024 |
| End Date | 30-Sep-2024 |
| Key Implementing Institution | World Health Organization |
| Multi-country research | No |
| Nationwide research | No |
| Nepal, Nepal, Nepal, Nepal, Nepal | |
| Research Domain(s) | Maternal, Reproductive and Child Health |
| Research field(s) | Immunization/Vaccine Preventable Disease, |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Under Review |