Valdecantos, Ronan Lemwel (2024) Organisational and Structural Domains Affecting Childhood Immunisation and Human Papillomavirus Vaccine Coverage in Europe: to Improve the Primary Healthcare Delivery System. [Tesi di dottorato]

Anteprima

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Abstract

Rebuilding the organisational and structural aspects of immunization initiatives will significantly contribute to the strengthening of primary health care systems. Successful childhood and adult immunization programs and achieving targeted vaccine coverage, including the Human papillomavirus vaccine, will support resilient and sustainable primary healthcare systems and global health security. Despite wide immunization campaigns, organisational and structural concerns cause care problems in European Health Systems. In the first study, we reviewed organisational and structural data that may affect childhood vaccination coverage. We searched a wide range of databases from 1 January 2007 to 6 July 2021 for quantitative or qualitative studies on childhood vaccine coverage interventions. Organisational and structural factors that cause vaccine worries among pediatric parents and data on vaccination willingness were assessed. Ottawa, JBI's critical appraisal instrument, and Amstar quality assessment were used to assess bias. 205 studies in 21 papers satisfied the inclusion criteria. Most studies were done in the UK (6), EU (3), and Italy (3). Parental engagement and personalization, mandatory vaccination policies, program redesign, supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tools and Supplemental Immunisation Activity (SIA), and information models have been shown to increase vaccination coverage in primary healthcare settings. In the second study, we assessed the organizational and structural factors affecting HPV vaccine coverage. From January 1, 1995, to May 15, 2023, we explored many databases for HPV immunisation research approaches. Outcome evaluations explored organizational and structural factors that create HPV vaccine concerns in women and men, and vaccination willingness factors. Ottawa, JBI's critical appraisal, and Amstar monitored prejudice. We included 302 studies from 10 papers. Italy, Belgium, England, Switzerland, France, the UK, and Spain featured studies. 15 and 27 European nations had combined-diverse research. Multiple primary healthcare strategies have raised HPV vaccination rates. These include vaccine procurement and cost-effectiveness, school-based immunization programs, electronic health databases, health professional training, health education and communication, and monitoring and surveillance. Lastly, The study investigated how the Deprivation Index, number of General Practitioners, and number of General Paediatricians affected mandatory and non-mandatory paediatric vaccine coverage throughout Campania Region local health authorities and health districts for birth cohorts between 2001 and 2015. A population-based ecological time series analysis of Campania, southern Italy's most populous region. Public health records provided the Deprivation Index and number of primary care providers and pediatricians by local health district, while the regional immunisation database provided vaccination coverage data. Univariate descriptive statistics specified research features, while mixed-effect linear regression models correlated factors of interest with vaccination coverage. Despite fluctuations in MMR vaccination rates, immunization coverage as a whole has increased. Vaccination coverage for DTaP, poliomyelitis, and hepatitis B exhibited a drop as the Deprivation Index increased, suggesting a decline in socioeconomic circumstances. Localities with a greater number of general pediatricians had a greater coverage of Haemophilus influenzae type B among children aged 6 (Coefficient 9.78, 95% CI 1.00 | 18.56). Efforts must be concentrated in public health to eradicate immunization disparities. Expanding vaccination campaigns, enhancing catch-up programs, and providing primary care with additional resources to assist pediatricians and general practitioners in increasing patient awareness and adherence should be among these public health measures.

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