Albania is facing decreasing childhood immunisation coverage and delay in timeliness of vaccination despite a growing economy and universal health insurance. Our aim is to estimate childhood immunisation timeliness and vaccine confidence associated with health information source, maternal, socioeconomic, and geographic characteristics in Albania. We used the 2017–2018 Albania Demographic and Health Survey to analyse childhood immunisation timeliness and vaccine confidence among 2113 and 1795 mothers of under-5-year-old children respectively using simple and multivariable logistic regression. Among mothers of under-5-year-old children in Albania, 78.1% [95% CI: 74.3, 81.5] never postponed or rejected childhood vaccines. Immunisation delay was reported by 21.3% [18.0, 25.1] of mothers, but a majority (67.0%) were caused by the infant’s sickness at the time of vaccination, while a minority (6.1%) due to mothers’ concerns about vaccine safety and side effects. Vaccine confidence was high among the mothers at 92.9% [91.0, 94.4] with similar geographical patterns to immunisation timeliness. Among 1.3% of mothers who ever refused vaccination of their children, the main concerns were about vaccine safety (47.8%) and side effects (23.1%). With respect to childhood immunisation timeliness, after controlling for other background characteristics, mothers whose main health information source was the Internet/social media had 34% (adjusted odds-ratio AOR = 0.66 [0.47, 0.94], p = 0.020) lower odds in comparison to other sources, working mothers had 35% (AOR = 0.65 [0.47, 0.91], p = 0.013) lower odds in comparison to non-working mothers, mothers with no education had 86% (AOR = 0.14 [0.03, 0.67], p = 0.014) lower odds compared to those who completed higher education, and mothers living in AL02-Qender and AL03-Jug regions had 62% (AOR = 0.38 [0.23, 0.63], p < 0.0001) and 64% (AOR = 0.36 [0.24, 0.53], p < 0.0001) lower odds respectively in comparison to those residing in AL01-Veri region (p < 0.0001). With respect to vaccine confidence, mothers whose main health information source was the Internet/social media had 56% (AOR = 0.44 [0.27, 0.73], p = 0.002) lower odds in comparison to other sources, single mothers had 92% (AOR = 0.08 [0.01, 0.65], p = 0.019) lower odds compared to those married/living with a partner, mothers of specific ethnicites (like Roma) had 61% (AOR = 0.39 [0.15, 0.97], p = 0.042) lower odds in comparison to mothers of Albanian ethnicity, and mothers living in AL03-Jug region had 67% (AOR = 0.33 [0.19, 0.59], p ≤ 0.0001) lower odds compared to mothers residing in AL01-Veri region. Reinforcement of scientific evidence-based online communication about childhood immunisation in combination with tracking and analysis of vaccine hesitancy sentiment and anti-vaccination movements on the Internet/social media would be beneficial in improving immunisation timeliness and vaccine confidence in Albania. Since parents tend to search online for information that would confirm their original beliefs, traditional ways of promoting vaccination by healthcare professionals who enjoy confidence as trusted sources of health information should be sustained and strengthened to target the inequities in childhood immunisation timelines and vaccine confidence in Albania.

中文翻译：

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阿尔巴尼亚按健康信息来源、孕产妇、社会经济和地理特征划分的儿童免疫及时性和疫苗信心


尽管阿尔巴尼亚经济不断增长并拥有全民健康保险，但其儿童免疫覆盖率仍面临下降和疫苗接种及时性延迟的问题。我们的目的是估计与阿尔巴尼亚健康信息来源、孕产妇、社会经济和地理特征相关的儿童免疫及时性和疫苗信心。我们利用 2017-2018 年阿尔巴尼亚人口和健康调查，利用简单和多变量逻辑回归，分别分析了 2113 名和 1795 名 5 岁以下儿童母亲的儿童免疫及时性和疫苗信心。在阿尔巴尼亚 5 岁以下儿童的母亲中，78.1% [95% CI: 74.3, 81.5] 从未推迟或拒绝接种儿童疫苗。 21.3% [18.0, 25.1] 的母亲报告了免疫延迟，但大多数（67.0%）是由于婴儿在接种疫苗时生病造成的，少数（6.1%）是由于母亲对疫苗安全性的担忧和副作用。母亲们对疫苗的信心很高，高达 92.9% [91.0, 94.4]，其地理模式与免疫及时性相似。在曾经拒绝给孩子接种疫苗的母亲中，有1.3%的人主要担心疫苗安全性（47.8%）和副作用（23.1%）。关于儿童免疫及时性，在控制其他背景特征后，主要健康信息来源是互联网/社交媒体的母亲在儿童期免疫接种的几率较低（调整后比值比 AOR = 0.66 [0.47, 0.94]，p = 0.020），为 34%。与其他来源相比，职业母亲的几率比非工作母亲低 35% (AOR = 0.65 [0.47, 0.91], p = 0.013)，未受过教育的母亲的几率为 86% (AOR = 0.14 [0.03, 0.67] ，p = 0。014) 与完成高等教育的母亲相比，这一比例较低，居住在 AL02-Qender 和 AL03-Jug 地区的母亲的这一比例为 62% (AOR = 0.38 [0.23, 0.63], p < 0.0001) 和 64% (AOR = 0.36 [ 0.24, 0.53], p < 0.0001) 与居住在 AL01-Veri 区域的人 (p < 0.0001) 相比，赔率分别较低。就疫苗信心而言，与其他来源相比，主要健康信息来源是互联网/社交媒体的母亲有 56% (AOR = 0.44 [0.27, 0.73], p = 0.002) 的几率较低，单身母亲有 92% (AOR = 0.44 [0.27, 0.73], p = 0.002) = 0.08 [0.01, 0.65], p = 0.019) 与已婚/与伴侣同居的人相比，特定种族（如罗姆人）的母亲的几率较低 61% (AOR = 0.39 [0.15, 0.97], p = 0.042)与阿尔巴尼亚裔母亲相比，居住在 AL03-Jug 地区的母亲的患病率比居住在 AL01-Veri 地区的母亲低 67% (AOR = 0.33 [0.19, 0.59], p ≤ 0.0001)。加强基于科学证据的儿童免疫在线交流，结合跟踪和分析互联网/社交媒体上的疫苗犹豫情绪和反疫苗运动，将有利于提高阿尔巴尼亚的免疫及时性和疫苗信心。由于父母倾向于在网上搜索可以证实其原始信念的信息，因此应维持和加强由享有可信健康信息来源信心的医疗保健专业人员促进疫苗接种的传统方式，以解决阿尔巴尼亚儿童免疫时间表和疫苗信心方面的不平等问题。