| Background:Rotavirus is the leading cause of severe diarrhea in children under five years of age.It is highly infectious and spreads rapidly.Rotavirus causes diarrhea,gastroenteritis,and other diseases,which are widely susceptible to children,seriously affect children’s health and cause a heavy disease burden and economic burden on individuals,health systems,and society.Vaccination is currently the most effective means of preventing rotavirus infection and reducing morbidity and mortality from rotavirus-related diseases.Increasing the coverage rate of the rotavirus vaccine plays a vital role in protecting the health of children under five.Therefore,understanding the current situation of rotavirus vaccination in Chinese children and exploring the factors affecting rotavirus vaccination have important guiding significance for improving the rotavirus vaccination rate.Objective:The purpose of this study was to understand the current situation of rotavirus vaccination in children under five years of age,focusing on the individual factors of children’s guardians and the characteristic factors of the rotavirus vaccine itself and considering the influence of social and environmental factors,to comprehensively analyze the factors that may affect rotavirus vaccination,and to put forward policy suggestions to improve the current situation of rotavirus vaccination.Methods:This study takes Jinan,Zhengzhou,and Lanzhou as sample cities.Regarding individual factors of children’s guardians,Jinan Children’s Hospital,Henan Children’s Hospital,and Gansu Children’s Hospital were selected as the questionnaire survey site.A structured questionnaire was used to conduct a face-to-face survey among 636 guardians of children under five.Chi-square test,rank sum test,t-test,Oneway Anova,simple linear regression,multiple linear regression,binary logistic regression,and other statistical methods were used for empirical analysis.In terms of vaccine factors,this study designed a discrete choice experiment questionnaire and conducted an online survey on the guardians of 415 children under the age of 5 in Jinan,Zhengzhou,and Lanzhou through the WJX platform.The mixed logit model was used for analysis.In addition,3 policymakers,12 pediatricians,20 immunization service providers,and 17 children’s guardians were interviewed in this study to obtain data on social and environmental factors and supplement individual factors and vaccine factors.The thematic analysis was used to analyze the interview data.Results:In terms of the status of rotavirus vaccination,593 guardians were included in the final analysis in the three cities.The proportion of children actually vaccinated with rotavirus vaccine was 31.2%(185/593),among which the proportion of children vaccinated with rotavirus vaccine in Zhengzhou was 42.9%(87/203),accounting for the highest proportion,followed by children in Jinan,accounting for 32.1%(62/193).The proportion of children vaccinated in Lanzhou was the lowest.Only 18.3%(36/197)of children were vaccinated against rotavirus.The factors influencing rotavirus vaccination include the factors of children’s guardians individual,the rotavirus vaccine itself,and social environment.(1)In terms of the individual factors of guardians,the cognitive level of guardians and vaccine hesitancy significantly affected the vaccination rate of children.The higher the cognitive scores of the guardians,the more likely they were to vaccinate their children against rotavirus(OR=1.323,95%CI:1.224,1.430).The lower the guardians’ vaccine hesitancy score,the more likely they were to vaccinate their children against rotavirus(OR=0.982,95%CI:0.967,0.997).(2)In terms of the vaccine itself,359 guardians were included in the final analysis in the three cities.Guardians are likelier to choose the rotavirus vaccine regimen with a high vaccine protection rate,long protection period,low incidence of general adverse reactions,low out-of-pocket costs,and 2-hour vaccination time.The incidence of general adverse reactions is the most critical factor affecting vaccination,and the vaccination time is the least important.If the incidence of general adverse reactions to vaccines decreased from 1/10 to 1/50,the probability of guardians choosing the vaccine increased by 74.5%.The predicted highest probability vaccination scheme was 91.8%.(3)In terms of social and environmental factors,vaccine law and policy factors,vaccine publicity factors,and service capacity factors of vaccination institutions will affect the vaccination situation of children rotavirus vaccine.Conclusion and suggestion:In the three cities investigated in this study,the rotavirus vaccination rate of children under 5 years old is low,the awareness level of children’s guardians needs to be improved,and vaccine hesitation is still the main factor affecting the vaccination rate of children.In addition,the discrete choice experiment found that guardians were more preferred to choose the vaccine with low incidence of adverse reactions,high vaccine protection rate,long vaccine protection period,low outof-pocket costs and 2 hours of vaccination time.At present,there are no authoritative policy documents such as technical guidelines for vaccination against rotavirus vaccine,and there are no welfare measures such as incentives and fee waivers to promote rotavirus vaccination;Inadequate publicity for rotavirus vaccine;The service capacity of vaccination institutions needs to be continuously improved.Therefore,to improve the rotavirus vaccine coverage rate,this study suggests improving rotavirus vaccination policy,strengthening the construction of immunization planning team,building a comprehensive and interconnected information system,and improving immunization service capacity.Improving the quality of vaccine products to enhance the safety and effectiveness of vaccines further;More efforts to reduce the cost of vaccines;Strengthening disease and vaccine publicity;Improving the awareness level of policymakers,children’s guardians,and pediatricians;Reducing the vaccine hesitation of children’s guardians as much as possible. |
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