Missed opportunities for vaccination among healthcare-seeking children: a cross-sectional study in Bishkek, Kyrgyzstan, 2023.

Background: High vaccination coverage is critical for preventing disease transmission. In Bishkek (population: 1.15 million), childhood vaccination coverage was <90% in 2022. Understanding missed opportunities for vaccination (MOV) at healthcare visits was needed to increase coverage.

Methods: Using the World Health Organization MOV assessment guide, we selected 33 primary care clinics in Bishkek. We conducted sequential exit interviews with caregivers of children aged <30 months who received healthcare for any reason. Caregiver's attitude towards vaccines was measured by asking if it was good, neutral or negative. We extracted vaccine records from the facility's medical records. MOV was calculated as the proportion of children who were not up to date on all their vaccines by the end of the visit, among those eligible for at least one vaccine at the start of the visit. We used multivariable Poisson regression to assess characteristics associated with MOV.

Results: Of 650 participating children, 448 (69%) were eligible for vaccination. Among whom, 86% had a MOV after their visit and 6% had never been vaccinated. MOV prevalence was 81% for children aged 0-11 months (n=240) and 92% for those aged 12-30 months (n=208), ranging from 79% to 93% across the four districts. Providers did not check the immunisation status of 53% of children. Among 133 children whose primary visit purpose was vaccination, 53% were still not up to date on all their vaccines by the end of the visit. MOV risk was higher among children whose vaccination status was not checked by the provider compared with those who were checked (adjusted prevalence ratio (aPR) 1.13, 95% CI 1.05 to 1.22) and children whose caregivers had negative (aPR 1.10, 95% CI 1.03 to 1.18) or neutral attitudes (aPR 1.11, 95% CI 1.03 to 1.19) vs positive attitudes.

Conclusion: Nearly nine in 10 children missed a vaccination opportunity during their healthcare visit. Strategies for checking immunisation status at each visit and addressing caregiver and healthcare barriers may help increase immunisation coverage.